Fastpass: A Centralized “Zero-Queue” Datacenter Network

An ideal datacenter network should provide several properties, including low median and tail latency, high utilization (throughput), fair allocation of network resources between users or applications, deadline-aware scheduling, and congestion (loss) avoidance. Current datacenter networks inherit the principles that went into the design of the Internet, where packet transmission and path selection decisions are distributed among the endpoints and routers. Instead, we propose that each sender should delegate control—to a centralized arbiter—of when each packet should be transmitted and what path it should follow. This paper describes Fastpass, a datacenter network architecture built using this principle. Fastpass incorporates two fast algorithms: the first determines the time at which each packet should be transmitted, while the second determines the path to use for that packet. In addition, Fastpass uses an efficient protocol between the endpoints and the arbiter and an arbiter replication strategy for fault-tolerant failover. We deployed and evaluated Fastpass in a portion of Facebook’s datacenter network. Our results show that Fastpass achieves high throughput comparable to current networks at a 240 reduction is queue lengths (4.35 Mbytes reducing to 18 Kbytes), achieves much fairer and consistent flow throughputs than the baseline TCP (5200 reduction in the standard deviation of per-flow throughput with five concurrent connections), scalability from 1 to 8 cores in the arbiter implementation with the ability to schedule 2.21 Terabits/s of traffic in software on eight cores, and a 2.5 reduction in the number of TCP retransmissions in a latency-sensitive service at Facebook.National Science Foundation (U.S.) (grant IIS-1065219)Irwin Mark Jacobs and Joan Klein Jacobs Presidential FellowshipHertz Foundation (Fellowship

The Case for RackOut: Scalable Data Serving Using Rack-Scale Systems

To provide low latency and high throughput guarantees, most large key-value stores keep the data in the memory of many servers. Despite the natural parallelism across lookups, the load imbalance, introduced by heavy skew in the popularity distribution of keys, limits performance. To avoid violating tail latency service-level objectives, systems tend to keep server utilization low and organize the data in micro-shards, which provides units of migration and replication for the purpose of load balancing. These techniques reduce the skew, but incur additional monitoring, data replication and consistency maintenance overheads. In this work, we introduce RackOut, a memory pooling technique that leverages the one-sided remote read primitive of emerging rack-scale systems to mitigate load imbalance while respecting service-level objectives. In RackOut, the data is aggregated at rack-scale granularity, with all of the participating servers in the rack jointly servicing all of the rack’s micro-shards. We develop a queuing model to evaluate the impact of RackOut at the datacenter scale. In addition, we implement a RackOut proof-of-concept key-value store, evaluate it on two experimental platforms based on RDMA and Scale-Out NUMA, and use these results to validate the model. Our results show that RackOut can increase throughput up to 6× for RDMA and 8.6× for Scale-Out NUMA compared to a scale-out deployment, while respecting tight tail latency service-level objectives

Anticholinergic drug burden tools/scales and adverse outcomes in different clinical settings: a systematic review of reviews

Background: Cumulative anticholinergic exposure (anticholinergic burden) has been linked to a number of adverse outcomes. To conduct research in this area, an agreed approach to describing anticholinergic burden is needed. Objective: This review set out to identify anticholinergic burden scales, to describe their rationale, the settings in which they have been used and the outcomes associated with them. Methods: A search was performed using the Healthcare Databases Advanced Search of MEDLINE, EMBASE, Cochrane, CINAHL and PsycINFO from inception to October 2016 to identify systematic reviews describing anticholinergic burden scales or tools. Abstracts and titles were reviewed to determine eligibility for review with eligible articles read in full. The final selection of reviews was critically appraised using the ROBIS tool and pre-defined data were extracted; the primary data of interest were the anticholinergic burden scales or tools used. Results: Five reviews were identified for analysis containing a total of 62 original articles. Eighteen anticholinergic burden scales or tools were identified with variation in their derivation, content and how they quantified the anticholinergic activity of medications. The Drug Burden Index was the most commonly used scale or tool in community and database studies, while the Anticholinergic Risk Scale was used more frequently in care homes and hospital settings. The association between anticholinergic burden and clinical outcomes varied by index and study. Falls and hospitalisation were consistently found to be associated with anticholinergic burden. Mortality, delirium, physical function and cognition were not consistently associated. Conclusions: Anticholinergic burden scales vary in their rationale, use and association with outcomes. This review showed that the concept of anticholinergic burden has been variably defined and inconsistently described using a number of indices with different content and scoring. The association between adverse outcomes and anticholinergic burden varies between scores and has not been conclusively established

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice