QMLE: a methodology for statistical inference of service demands from queueing data

Estimating the demands placed by services on physical resources is an essential step for the definition of performance models. For example, scalability analysis relies on these parameters to predict queueing delays under increasing loads. In this paper, we investigate maximum likelihood (ML) estimators for demands at load-independent and load-dependent resources in systems with parallelism constraints. We define a likelihood function based on state measurements and derive necessary conditions for its maximization. We then obtain novel estimators that accurately and inexpensively obtain service demands using only aggregate state data. With our approach, and also thanks to approximation methods for computing marginal and joint distributions for the load-dependent case, confidence intervals can be rigorously derived, explicitly taking into account both topology and concurrency levels of the services. Our estimators and their confidence intervals are validated against simulations and real system measurements for two multi-tier applications, showing high accuracy also in the presence of load-dependent resources

Successful maternal and fetal outcome in patients with Takayasu arteritis: two case reports of Type I and Type IV in stage 2

Takayasu's arteritis, is a rare, chronic, idiopathic, inflammatory disease of the large arteries, primarily involves the aorta, its main branches as well as the coronary and pulmonary arteries. It is mostly seen among women with child bearing age group (80%). During pregnancy, the increased intravascular volume impair circulation and exacerbate aortic regurgitation, hypertension, and congestive heart failure. Hypertension is one of the serious complication that can develop, leading to intrauterine growth restriction, maternal heart failure, and fetal haemorrhage and during postpartum period

Pelvic schwannoma mimicking as an adnexal mass

Schwannoma (neurilemmomas), a peripheral nerve sheath tumour generally occurs on the head and neck region, their pelvic occurrence is much rare. Retroperitoneal schwannomas are the rarest of all retroperitoneal tumours. We report a 45 year woman with a schwannoma in the retro peritoneum that was preoperatively diagnosed as an adnexal mass

Epithelioid leiomyosarcoma: a rare uterine cancer

A uterine epithelioid leiomyosarcoma is a rare malignant tumour that arises from the smooth muscle lining the walls of the uterus. The exact cause of leiomyosarcoma, including uterine leiomyosarcoma accounting for 5 to 10% is unknown. Leiomyosarcoma is the most common subtype of uterine sarcoma, accounts for 1-2% of uterine malignancies. Malignancy should be suspected in menopausal women with tumour growth who are not on hormonal replacement therapy. A 64-year-old female had attained menopause 16 year back and developed postmenopausal bleeding since 2 months, with palpable mass, of 16 weeks size. Ultrasonography showed whorled mass lesions, endometrium and myometrium could not be seen separately. Uterus with both ovaries removed. Intra-operative findings showed 16 weeks uterine mass with size 15×10.5×10cm and weight 1kg with intramural fibroid. Necrotic and haemorrhagic areas with degenerative changes seen on cut section suggestive of malignancy. Histopathology and immunohistochemistry reported epithelioid leiomyosarcoma

Carbon turnover in the water-soluble protein of the adult human lens.

PurposeHuman eye lenses contain cells that persist from embryonic development. These unique, highly specialized fiber cells located at the core (nucleus) of the lens undergo pseudo-apoptosis to become devoid of cell nuclei and most organelles. Ostensibly lacking in protein transcriptional capabilities, it is currently believed that these nuclear fiber cells owe their extreme longevity to the perseverance of highly stable and densely packed crystallin proteins. Maintaining the structural and functional integrity of lenticular proteins is necessary to sustain cellular transparency and proper vision, yet the means by which the lens actually copes with a lifetime of oxidative stress, seemingly without any capacity for protein turnover and repair, is not completely understood. Although many years of research have been predicated upon the assumption that there is no protein turnover or renewal in nuclear fiber cells, we investigated whether or not different protein fractions possess protein of different ages by using the (14)C bomb pulse.MethodsAdult human lenses were concentrically dissected by gently removing the cell layers in water or shaving to the nucleus with a curved micrometer-controlled blade. The cells were lysed, and the proteins were separated into water-soluble and water-insoluble fractions. The small molecules were removed using 3 kDa spin filters. The (14)C/C was measured in paired protein fractions by accelerator mass spectrometry, and an average age for the material within the sample was assigned using the (14)C bomb pulse.ResultsThe water-insoluble fractions possessed (14)C/C ratios consistent with the age of the cells. In all cases, the water-soluble fractions contained carbon that was younger than the paired water-insoluble fraction.ConclusionsAs the first direct evidence of carbon turnover in protein from adult human nuclear fiber cells, this discovery supports the emerging view of the lens nucleus as a dynamic system capable of maintaining homeostasis in part due to intricate protein transport mechanisms and possibly protein repair. This finding implies that the lens plays an active role in the aversion of age-related nuclear (ARN) cataract

Parents' perceived obstacles to pediatric clinical trial participation: Findings from the clinical trials transformation initiative.

Enrollment of children into pediatric clinical trials remains challenging. More effective strategies to improve recruitment of children into trials are needed. This study used in-depth qualitative interviews with parents who were approached to enroll their children in a clinical trial in order to gain an understanding of the barriers to pediatric clinical trial participation. Twenty-four parents whose children had been offered the opportunity to participate in a clinical trial were interviewed: 19 whose children had participated in at least 1 clinical trial and 5 who had declined participation in any trial. Each study aspect, from the initial explanation of the study to the end of the study, can affect the willingness of parents to consent to the proposed study and future studies. Establishing trust, appropriate timing, a transparent discussion of risks and benefits oriented to the layperson, and providing motivation for children to participate were key factors that impacted parents' decisions. In order for clinical trial accrual to be successful, parents' priorities and considerations must be a central focus, beginning with initial trial design. The recommendations from the parents who participated in this study can be used to support budget allocations that ensure adequate training of study staff and improved staffing on nights and weekends. Studies of parent responses in outpatient settings and additional inpatient settings will provide valuable information on the consent process from the child's and parent's perspectives. Further studies are needed to explore whether implementation of such strategies will result in improved recruitment for pediatric clinical trials

Perceived barriers to pediatrician and family practitioner participation in pediatric clinical trials: Findings from the Clinical Trials Transformation Initiative.

Despite legislation to stimulate pediatric drug development through clinical trials, enrolling children in trials continues to be challenging. Non-investigator (those who have never served as a clinical trial investigator) providers are essential to recruitment of pediatric patients, but little is known regarding the specific barriers that limit pediatric providers from participating in and referring their patients to clinical trials. We conducted an online survey of pediatric providers from a wide variety of practice types across the United States to evaluate their attitudes and awareness of pediatric clinical trials. Using a 4-point Likert scale, providers described their perception of potential barriers to their practice serving as a site for pediatric clinical trials. Of the 136 providers surveyed, 52/136 (38%) had previously referred a pediatric patient to a trial, and only 17/136 (12%) had ever been an investigator for a pediatric trial. Lack of awareness of existing pediatric trials was a major barrier to patient referral by providers, in addition to consideration of trial risks, distance to the site, and time needed to discuss trial participation with parents. Overall, providers perceived greater challenges related to parental concerns and parent or child logistical barriers than study implementation and ethics or regulatory barriers as barriers to their practice serving as a trial site. Providers who had previously been an investigator for a pediatric trial were less likely to be concerned with potential barriers than non-investigators. Understanding the barriers that limit pediatric providers from collaboration or inhibit their participation is key to designing effective interventions to optimize pediatric trial participation

Patient-specific finite element analysis of human corneal lenticules: An experimental and numerical study.

The number of elective refractive surgeries is constantly increasing due to the drastic increase in myopia prevalence. Since corneal biomechanics are critical to human vision, accurate modeling is essential to improve surgical planning and optimize the results of laser vision correction. In this study, we present a numerical model of the anterior cornea of young patients who are candidates for laser vision correction. Model parameters were determined from uniaxial tests performed on lenticules of patients undergoing refractive surgery by means of lenticule extraction, using patient-specific models of the lenticules. The models also took into account the known orientation of collagen fibers in the tissue, which have an isotropic distribution in the corneal plane, while they are aligned along the corneal curvature and have a low dispersion outside the corneal plane. The model was able to reproduce the experimental data well with only three parameters. These parameters, determined using a realistic fiber distribution, yielded lower values than those reported in the literature. Accurate characterization and modeling of the cornea of young patients is essential to study better refractive surgery for the population undergoing these treatments, to develop in silico models that take corneal biomechanics into account when planning refractive surgery, and to provide a basis for improving visual outcomes in the rapidly growing population undergoing these treatments

Studies in Dolichos lablab (ROXB.) and (L.) the Indian field and garden bean-IV

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