Downlink and Uplink Decoupling: a Disruptive Architectural Design for 5G Networks

Cell association in cellular networks has traditionally been based on the downlink received signal power only, despite the fact that up and downlink transmission powers and interference levels differed significantly. This approach was adequate in homogeneous networks with macro base stations all having similar transmission power levels. However, with the growth of heterogeneous networks where there is a big disparity in the transmit power of the different base station types, this approach is highly inefficient. In this paper, we study the notion of Downlink and Uplink Decoupling (DUDe) where the downlink cell association is based on the downlink received power while the uplink is based on the pathloss. We present the motivation and assess the gains of this 5G design approach with simulations that are based on Vodafone's LTE field trial network in a dense urban area, employing a high resolution ray-tracing pathloss prediction and realistic traffic maps based on live network measurements.Comment: 6 pages, 7 figures, conference paper, submitted to IEEE GLOBECOM 201

Interference-Aware Decoupled Cell Association in Device-to-Device based 5G Networks

Cell association in cellular networks is an important aspect that impacts network capacity and eventually quality of experience. The scope of this work is to investigate the different and generalized cell association (CAS) strategies for Device-to-Device (D2D) communications in a cellular network infrastructure. To realize this, we optimize D2D-based cell association by using the notion of uplink and downlink decoupling that was proven to offer significant performance gains. We propose an integer linear programming (ILP) optimization framework to achieve efficient D2D cell association that minimizes the interference caused by D2D devices onto cellular communications in the uplink as well as improve the D2D resource utilization efficiency. Simulation results based on Vodafone's LTE field trial network in a dense urban scenario highlight the performance gains and render this proposal a candidate design approach for future 5G networks.Comment: 5 pages, 5 figures. Accepted in IEEE VTC spring 201

Bio-Inspired Resource Allocation for Relay-Aided Device-to-Device Communications

The Device-to-Device (D2D) communication principle is a key enabler of direct localized communication between mobile nodes and is expected to propel a plethora of novel multimedia services. However, even though it offers a wide set of capabilities mainly due to the proximity and resource reuse gains, interference must be carefully controlled to maximize the achievable rate for coexisting cellular and D2D users. The scope of this work is to provide an interference-aware real-time resource allocation (RA) framework for relay-aided D2D communications that underlay cellular networks. The main objective is to maximize the overall network throughput by guaranteeing a minimum rate threshold for cellular and D2D links. To this direction, genetic algorithms (GAs) are proven to be powerful and versatile methodologies that account for not only enhanced performance but also reduced computational complexity in emerging wireless networks. Numerical investigations highlight the performance gains compared to baseline RA methods and especially in highly dense scenarios which will be the case in future 5G networks.Comment: 6 pages, 6 figure

Downlink and Uplink Cell Association with Traditional Macrocells and Millimeter Wave Small Cells

Millimeter wave (mmWave) links will offer high capacity but are poor at penetrating into or diffracting around solid objects. Thus, we consider a hybrid cellular network with traditional sub 6 GHz macrocells coexisting with denser mmWave small cells, where a mobile user can connect to either opportunistically. We develop a general analytical model to characterize and derive the uplink and downlink cell association in view of the SINR and rate coverage probabilities in such a mixed deployment. We offer extensive validation of these analytical results (which rely on several simplifying assumptions) with simulation results. Using the analytical results, different decoupled uplink and downlink cell association strategies are investigated and their superiority is shown compared to the traditional coupled approach. Finally, small cell biasing in mmWave is studied, and we show that unprecedented biasing values are desirable due to the wide bandwidth.Comment: 30 pages, 9 figures. Submitted to IEEE Transactions on Wireless Communication

Load & Backhaul Aware Decoupled Downlink/Uplink Access in 5G Systems

Until the 4th Generation (4G) cellular 3GPP systems, a user equipment's (UE) cell association has been based on the downlink received power from the strongest base station. Recent work has shown that - with an increasing degree of heterogeneity in emerging 5G systems - such an approach is dramatically suboptimal, advocating for an independent association of the downlink and uplink where the downlink is served by the macro cell and the uplink by the nearest small cell. In this paper, we advance prior art by explicitly considering the cell-load as well as the available backhaul capacity during the association process. We introduce a novel association algorithm and prove its superiority w.r.t. prior art by means of simulations that are based on Vodafone's small cell trial network and employing a high resolution pathloss prediction and realistic user distributions. We also study the effect that different power control settings have on the performance of our algorithm.Comment: 6 pages, 6 figures. Submitted to the IEEE International Conference on Communications (ICC 2015

Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in diabetic and non-diabetic patients

PurposeThe aim of the study was to estimate the role of ankle-brachial pressure index (ABI) in predicting severity of coronary artery disease (CAD) in patients with or without diabetes mellitus.MethodsThis study included 120 patients with CAD proved by coronary angiography and ABI was measured for all of them. They were divided into 4 groups; Group (A): Non-diabetic patients without peripheral arterial disease (PAD) (ABI < or =0.9) , Group (B):diabetic patients without PAD (ABI < or =0.9), Group (C):Non-diabetic patients with PAD (ABI>0.9) and Group (D):diabetic patients with PAD (ABI>0.9).ResultsHypertension was more prevalent in group (D) (p value>0.05). Group (C) had the highest mean age and the highest percentage of smokers, after normalization of the effects of the risk factors mean Gensini score, mean number of affected coronary vessels, mean number of coronary artery lesions and the percentage of coronary artery chronic total occlusions (CTO) were significantly higher in groups (C & D) (p>0.001) (Table 1).ConclusionABI had a significant relationship with the degree of CAD severity. Therefore ABI seems to be a reliable independent prognostic marker of CAD severity in patients with or without diabetes mellitus

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care