Reversing The Meaning of Node Connectivity for Content Placement in Networks of Caches

It is a widely accepted heuristic in content caching to place the most popular content at the nodes that are the best connected. The other common heuristic is somewhat contradictory, as it places the most popular content at the edge, at the caching nodes nearest the users. We contend that neither policy is best suited for caching content in a network and propose a simple alternative that places the most popular content at the least connected node. Namely, we populate content first at the nodes that have the lowest graph centrality over the network topology. Here, we provide an analytical study of this policy over some simple topologies that are tractable, namely regular grids and trees. Our mathematical results demonstrate that placing popular content at the least connected nodes outperforms the aforementioned alternatives in typical conditions

Response surface approach to minimize the residual stresses in full penetration pulsed TIG weldments of Ti-5Al-2.5Sn alloy

Pulsation of current in Tungsten Inert Gas (TIG) welding is employed to obtain good quality weldments. Peak current, background current, and welding speed in TIG welding are important parameters and their effects on the induced residual stresses are studied using Box–Behnken design methodology. The location of maximum residual stress was found to be close to the weld centerline. Longitudinal and transverse residual stresses at this location were found to be dependent on the pulsed TIG welding input parameters. However, using design of experiment approach, welding speed was found to have the most dominant influence on the stress values. In order to minimize the residual stresses, a reduction in heat input also led to reduction of weld pool penetration. The results of multiresponse optimization showed that in order to achieve a full penetration weldment, a minimum value of 235 MPa for longitudinal and 84 MPa for transverse residual stress will be attained. A weldment with these features can be obtained by using a high value of peak current and a high value of welding speed

A comparative study of pulsed laser and pulsed TIG welding of Ti-5Al-2.5Sn titanium alloy sheet

Pulsed Nd:YAG laser beam welding (P-LBW) and pulsed tungsten inert gas (P-TIG) welding were used to prepare full penetration bead-on-plate weldments of 1.6 mm thick Ti-5Al-2.5Sn alpha titanium alloy sheet. The influence of welding phenomenon on the microstructure, micro-hardness, tensile properties, surface and sub-surface residual stress distribution and deformation and distortion of both the weldments were studied. Higher cooling rate in P-LBW resulted in complete α’ martensitic transformation in fusion zone whereas in P-TIG weldment α’ and acicular α was formed within equiaxed β matrix due to lower cooling rate. Hardness in fusion zone of P-LBW was higher than that of the fusion zone of P-TIG weldment due to faster cooling rate in P-LBW. The welded zone in both the weldments showed higher hardness and strength than that of the parent metal since a ductile fracture occurred in the un-welded section during tensile testing. Residual stresses in both P-LBW and P-TIG weldments showed similar trend but the distribution was much narrower in P-LBW due to less width of heat affected zone. P-LBW resulted in more nonuniformity in through thickness stress profile because of greater top to bottom width ratio. Less residual stresses, deformation and distortion and superior mechanical properties in P-LBW made the process more feasible than P-TIG for the welding of Ti-5Al-2.5Sn alloy sheet

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches.

Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program

Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning.

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection

Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management.

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery

Successful management of aggressive fibromatosis of the neck using wide surgical excision: a case report

<p>Abstract</p> <p>Introduction</p> <p>Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity.</p> <p>Case presentation</p> <p>We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis.</p> <p>Conclusion</p> <p>Due to the rarity of the condition no guidelines are available on the indications and extent of each modality. Due to its aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, we suggest that aggressive surgery is a viable management option and may be successfully used as a single modality treatment.</p

Assessing emergency medical care in low income countries: A pilot study from Pakistan

Background: Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country - Pakistan. Methods: We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts - Faisalabad and Peshawar - in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results: The majority of respondents 43/44(98%), in community survey were not satisfied with the emergency care provided. Most participants 36/44(82%) mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83) for 19/29(66%) respondents. Most health care providers 43/44(98%) were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74%) had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion: Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network

A comparative analysis of toluidine blue with frozen section in oral squamous cell carcinoma

Background:Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins. Methods: After obtaining clearance from the in-house ethical review committee, a prospective study was conducted at Aga Khan University Hospital, Karachi, from August 15, 2009 to March 14, 2010. A sample of 56 consenting Patients with biopsy-proven OSCC were included in the study, giving us 280 tumor margins. Margins were analyzed using toluidine blue staining and frozen section histopathology. A receiver operator curve (ROC) was then applied to compare assessment of margin status by toluidine blue and frozen section. Results: Of the 280 examined margins 11 stained positive with toluidine blue, three were positive on frozen section biopsy, and three were positive on final histopathology. Toluidine blue staining had sensitivity and specificity of 100% and 97%, respectively. The diagnostic accuracy of toluidine blue was found to be 97.1% with a positive predictive value (PPV) of 27.2% and a negative predictive value (NPV) of 100%. Conclusions: Toluidine blue can be used as an effective screening modality for the assessment of intraoperative margins in resource limited environments and reducing the number of frozen section biopsies performed. Further by providing real-time clinical information within minutes it can reduce indirect costs such as operating room time. It may also be used as an ad hoc for frozen section biopsies where frozen section facilities are available