Apport de la Qualité de l’Expérience dans l’optimisation de services multimédia : application à la diffusion de la vidéo et à la VoIP

The emerging and fast growth of multimedia services have created new challenges for network service providers in order to guarantee the best user's Quality of Experience (QoE) in diverse networks with distinctive access technologies. Usually, various methods and techniques are used to predict the user satisfaction level by studying the combined impact of numerous factors. In this thesis, we consider two important multimedia services to evaluate the user perception, which are: video streaming service, and VoIP. This study investigates user's QoE that follows three directions: (1) methodologies for subjective QoE assessment of video services, (2) regulating user's QoE using video a rate adaptive algorithm, and (3) QoE-based power efficient resource allocation methods for Long Term Evaluation-Advanced (LTE-A) for VoIP. Initially, we describe two subjective methods to collect the dataset for assessing the user's QoE. The subjectively collected dataset is used to investigate the influence of different parameters (e.g. QoS, video types, user profile, etc.) on user satisfaction while using the video services. Later, we propose a client-based HTTP rate adaptive video streaming algorithm over TCP protocol to regulate the user's QoE. The proposed method considers three Quality of Service (QoS) parameters that govern the user perception, which are: Bandwidth, Buffer, and dropped Frame rate (BBF). The BBF method dynamically selects the suitable video quality according to network conditions and user's device properties. Lastly, we propose a QoE driven downlink scheduling method, i.e. QoE Power Escient Method (QEPEM) for LTE-A. It esciently allocates the radio resources, and optimizes the use of User Equipment (UE) power utilizing the Discontinuous Reception (DRX) method in LTE-AL'émergence et la croissance rapide des services multimédia dans les réseaux IP ont créé de nouveaux défis pour les fournisseurs de services réseau, qui, au-delà de la Qualité de Service (QoS) issue des paramètres techniques de leur réseau, doivent aussi garantir la meilleure qualité de perception utilisateur (Quality of Experience, QoE) dans des réseaux variés avec différentes technologies d'accès. Habituellement, différentes méthodes et techniques sont utilisées pour prédire le niveau de satisfaction de l'utilisateur, en analysant l'effet combiné de multiples facteurs. Dans cette thèse, nous nous intéressons à la commande du réseau en intégrant à la fois des aspects qualitatifs (perception du niveau de satisfaction de l'usager) et quantitatifs (mesure de paramètres réseau) dans l'objectif de développer des mécanismes capables, à la fois, de s'adapter à la variabilité des mesures collectées et d'améliorer la qualité de perception. Pour ce faire, nous avons étudié le cas de deux services multimédia populaires, qui sont : le streaming vidéo, et la voix sur IP (VoIP). Nous investiguons la QoE utilisateur de ces services selon trois aspects : (1) les méthodologies d'évaluation subjective de la QoE, dans le cadre d'un service vidéo, (2) les techniques d'adaptation de flux vidéo pour garantir un certain niveau de QoE, et (3) les méthodes d'allocation de ressource, tenant compte de la QoE tout en économisant l'énergie, dans le cadre d'un service de VoIP (LTE-A). Nous présentons d'abord deux méthodes pour récolter des jeux de données relatifs à la QoE. Nous utilisons ensuite ces jeux de données (issus des campagnes d'évaluation subjective que nous avons menées) pour comprendre l'influence de différents paramètres (réseau, terminal, profil utilisateur) sur la perception d'un utilisateur d'un service vidéo. Nous proposons ensuite un algorithme de streaming vidéo adaptatif, implémenté dans un client HTTP, et dont le but est d'assurer un certain niveau de QoE et le comparons à l'état de l'art. Notre algorithme tient compte de trois paramètres de QoS (bande passante, taille de mémoires tampons de réception et taux de pertes de paquets) et sélectionne dynamiquement la qualité vidéo appropriée en fonction des conditions du réseau et des propriétés du terminal de l'utilisateur. Enfin, nous proposons QEPEM (QoE Power Efficient Method), un algorithme d'ordonnancement basé sur la QoE, dans le cadre d'un réseau sans fil LTE, en nous intéressant à une allocation dynamique des ressources radio en tenant compte de la consommation énergétiqu

RADIOLOGICAL AND PATHOLOGICAL CORRELATION OF LUNG NODULES IN A BACKGROUND OF METASTATIC DISEASE

Background: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (<1 cm) lung nodules. The determination of the underlying malignant or benign nature of a lung nodule poses a great diagnostic challenge and depends on a number of factors, including the radiographic appearance of nodule, the presence of non-pulmonary metastases, characteristics of growth and histological criteria. Methods: The medical records of 89 patients admitted to our specialist cancer centre between 2008 and 2013 were reviewed. Patients of all age groups and tumour category were included in the study. Clinical data of these patients were collected and the following parameters were analysed: Radiographic diagnosis, location, size, laterality and number of nodules and histological impression. The radiological findings were then correlated with histopathological findings. The nodules were sub-classified into groups on the basis of size (A = 0–0.5 cm; B = 0.5–0.9 cm; C = 1.0–1.5 cm and D = >1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P < 0.05.Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%).Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastase

Synovial Lipomatosis; A Clinicopathological Study of a Rare Entity

Objective: This study was conducted to analyse the clinicopathological and radiological features associated with Synovial lipomatosis.Patients and Methods: Cases diagnosed as Synovial lipomatosis from 2008 to 2018 were retrieved and clinical information and histology were reviewed.Results: Thirteen cases of Synovial lipomatosis were diagnosed between 2008 and 2018. Most common site was knee joint and mean age of presentation was 28.6. About 62% of subjects were males and mostly presented with joint pain and swelling. Two of the subjects had significant history of trauma and disease was bilateral in one of the cases. Microscopically, villous proliferation of synovium with infiltration of mature adipocytes was noted. Focal synovial hyperplasia and inflammatory infiltrate were other findings in some of the cases.Conclusion: Synovial lipomatosis should be considered in the differential diagnosis of joint pain and swelling and should be distinguished from Pigmented villonodular synovitis, Synovial haemangioma and intra-articular synovial lipoma (IASL) using radiological and histological features

Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: A quasi-experimental study

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p\u3c0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas

Soft Tissue Tumours with Epithelioid Morphoogy

 To study the morphologicalfindings of soft tissue sarcomas with epithelioidmorphology and their distribution with respect tothe age, gender and location

A study to evaluate the acceptability, feasibility and impact of packaged interventions (“Diarrhea Pack”) for prevention and treatment of childhood diarrhea in rural Pakistan

Background: Diarrhea remains one of the leading public health issues in developing countries and is a major contributor in morbidity and mortality in children under five years of age. Interventions such as ORS, Zinc, water purification and improved hygiene and sanitation can significantly reduce the diarrhea burden but their coverage remains low and has not been tested as packaged intervention before. This study attempts to evaluate the package of evidence based interventions in a “Diarrhea Pack” through first level health care providers at domiciliary level in community based settings. This study sought to evaluate the acceptability, feasibility and impact of diarrhea Pack on diarrhea burden. Methods: A cluster randomized design was used to evaluate the objectives of the project a union council was considered as a cluster for analysis, a total of eight clusters, four in intervention and four in control were included in the study. We conducted a baseline survey in all clusters followed by the delivery of diarrhea Pack in intervention clusters through community health workers at domiciliary level and through sales promoters to health care providers and pharmacies. Four quarterly surveillance rounds were conducted to evaluate the impact of diarrhea pack in all clusters by an independent team of Field workers. Results: Both the intervention and control clusters were similar at the baseline but as the study progress we found a significant increase in uptake of ORS and Zinc along with the reduction in antibiotic use, diarrhea burden and hospitalization in intervention clusters when compared with the control clusters. We found that the Diarrhea Pack was well accepted with all of its components in the community. Conclusion: The intervention was well accepted and had a productive impact on the uptake of ORS and zinc and reduction in the use of antibiotics. It is feasible to deliver interventions such as diarrhea pack through community health workers in community settings. The intervention has the potential to be scaled up at national level

Primary Adenosquamous Carcinoma of Prostate: A Rare Aggressive Tumor

Adenosquamous carcinoma is an aggressive tumor of prostate with only 30 cases reported so far in literature. We present a case of this rare entity that was seen in our department. A 70 years old male presented with urinary outflow obstruction and slightly raised PSA levels [5mg/ml (normal; 0-4 mg/ml)]. Transuretheral resection of prostate was done and specimen was sent to our department. Histologically, it composed of both malignant squamous and glandular components. Squamous component showed large tumor cells with abundant cytoplasm and nuclei with prominent nucleoli. Glandular component showed tumor cells arranged in acinar pattern, predominantly in cribriform architecture. As the current guidlines, Gleason grading is not required for adenosquamous carcinoma of prostate. The case was reported as the adenosquamous carcinoma of prostate. This rare tumor has an extremely poor prognosis with most of the patients dying within 1 year of diagnosis