A stochastic control approach for scheduling multimedia transmissions over a polled multiaccess fading channel

We develop scheduling strategies for carrying multimedia traffic over a polled multiple access wireless network with fading. We consider a slotted system with three classes of traffic (voice, streaming media and file transfers). A Markov model is used for the fading and also for modeling voice packet arrivals and streaming arrivals. The performance objectives are a loss probability for voice, mean network delay for streaming media, and time average throughput for file transfers. A central scheduler (e.g., the access point in a single cell IEEE 802.11 wireless local area network (WLAN)) is assumed to be able to keep track of all the available state information and make the scheduling decision in each slot (e.g., as would be the case for PCF mode operation of the IEEE 802.11 WLAN). The problem is modeled as a constrained Markov decision problem. By using constraint relaxations (a linear relaxation and Whittle type relaxations) an index based policy is obtained. For the file transfers the decision problem turns out to be one with partial state information. Numerical comparisons are provided with the performance obtained from some simple policies

The association between hemoglobin concentration and neurologic outcome after cardiac arrest.

PURPOSE: The purpose of the study is to determine the association between hemoglobin concentration (Hgb) and neurologic outcome in postarrest patients. METHODS: We conducted a retrospective cohort study using the Penn Alliance for Therapeutic Hypothermia (PATH) cardiac arrest registry. Inclusion criteria were resuscitated cardiac arrest (inhospital or out of hospital) and an Hgb value recorded within 24 hours of return of spontaneous circulation. The primary outcome was favorable neurologic status at hospital discharge. Survival to hospital discharge was a secondary outcome. RESULTS: There were 598 eligible patients from 21 hospitals. Patients with favorable neurologic outcome had significantly higher median Hgb in the first 2 hours (12.7 vs 10.5 g/dL; P \u3c .001) and 6 hours (12.6 vs 10.6 g/dL; P \u3c .001) postarrest. Controlling for age, pulseless rhythm, etiology, location of arrest, receipt of targeted temperature management, hematologic or metastatic malignancy, or preexisting renal insufficiency, there was a significant relationship between Hgb and neurologic outcome within the first 6 hours after arrest (odds ratio, 1.23; 95% confidence interval, 1.09-1.38) and survival to hospital discharge (odds ratio, 1.20; 95% confidence interval, 1.08-1.34). CONCLUSION: Higher Hgb after cardiac arrest is associated with favorable neurologic outcome, particularly within the first 6 hours. It is unclear if this effect is due to impaired oxygen delivery or if Hgb is a marker for more severe illness

New Insights from a Fixed Point Analysis of Single Cell IEEE 802.11 WLANs

We study a fixed point formalisation of the well known analysis of Bianchi. We provide a significant simplification and generalisation of the analysis. In this more general framework, the fixed point solution and performance measures resulting from it are studied. Uniqueness of the fixed point is established. Simple and general throughput formulas are provided. It is shown that the throughput of any flow will be bounded by the one with the smallest transmission rate. The aggregate throughput is bounded by the reciprocal of the harmonic mean of the transmission rates. In an asymptotic regime with a large number of nodes, explicit formulas for the collision probability, the aggregate attempt rate and the aggregate throughput are provided. The results from the analysis are compared with ns2

Hepatoprotective effect of combined extracts of Andrographis paniculata, Boerhaviadiffusa, Eclipta alba and Picrorhiza kurroa on carbon tetrachloride andparacetamol-induced hepatotoxicity in rats

Extracts obtained from Andrographis paniculata, Boerhavia diffusa, Eclipta alba and Picrorhiza kurroa were mixed in an equal ratio and the combined extract was evaluated for the hepatoprotective activity against carbon tetrachloride and paracetamol induced hepatotoxicity in rats. The hepatotoxicants increased the levels of transaminases, total bilirubin, triglycerides and decreased the level of albumin in the serum of rat. Liver homogenate of the rats showed an increase in the lipid peroxidation level and reduction in the levels of glutathione. The rats administered with the combined extract reversed the biochemical parameters reflecting the liver function. The combined extract showed significant (P < 0.05) dose dependent hepatoprotective activity against the toxicants as it was evident from the values of biochemical parameters when compared to silymarin administered animals. The results showed that the recovery exhibited by the combined extract at 400 mg/kg dose level was highest among other doses tested and was well comparable to silymarin treated rats

Evaluation of the response rate of chemo-radiation and brachytherapy in patients with locally advanced carcinoma cervix in a tertiary care center

Background: Incidence and mortality estimates are used to measure the burden of cancer in a population and survival estimates are ideal for evaluating the outcome of cancer control activities. Survival studies evaluate the quality and quantity of life of a group of patients after diagnosing the disease. The patient survival after the diagnosis of cervical cancer is indirectly influenced by socio-economic factors. The present study was carried out with an aim to evaluate the success rate of chemo-radiation followed by brachytherapy to the patients of locally advanced carcinoma (Ca.) cervix in a tertiary care center.Methods: All cases were staged according to the International Federation of Gynaecologists and Oncologists (FIGO) staging system. To illustrate the observed survival of cancer patients Kaplan-Meier curve was plotted. All the patients, except one, completed chemo-radiation and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reactions, disease-free survival, and overall survival.Results: There were 22 patients of Carcinoma cervix reported in the radiation oncology department in the year 2018 and 2019. The overall treatment time ranged from 30 days to 178 days, with a median of 63 days. All the patients had a complete response after the treatment. The median follow-up time for all the patients was 15 months. Three patients had a metastatic recurrence and one patient developed distant metastases as well as local recurrence. Overall survival rate was 100% while the disease-free survival rate was 81.82%.Conclusions: The response to chemo-radiation in the treatment of locally advanced Carcinoma cervix is comparable to historic data and is well tolerated

Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department

We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level. Design: Prospective cohort study. Setting: Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr. Patients: Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED. Interventions: A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate testing was introduced. Measurements and main results: Primary endpoints include the following: percent of patients having a lactate level drawn, percent of lactate samples resulting before room placement, and time intervals from triage to lactate blood draw and to lactate result. Secondary endpoints were percentage of patients admitted to the hospital, percentage admitted to the ICU, and in-hospital mortality. Six thousand nine hundred six patients were included: 226 historic controls (HCs) and 6,680 intervention group patients. The mean serum lactate level was 1.77 ± 1.18 mmol/L. The percentage of patients having a lactate resulted increased from 27.4% in the HC period to 79.6%. The percentage of these lactate results available while the patient was still in the waiting room increased from 0.4% during the HC period to 33.7% during Phase 5 (p \u3c 0.0001). In the intervention period, time from triage to lactate result decreased (78.1-63.4 min; p \u3c 0.0001) and time to treatment room decreased (59.3-39.6 min; p \u3c 0.0001). Conclusions: Implementation of a computerized lactate order using readily available data obtained during ED triage, combined with point-of-care lactate testing, improves time to lactate blood draw and lactate result in patients at risk for severe sepsis. Initial lactate levels correlated with admission to the hospital, admission to the ICU, and in-hospital mortality

The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients.

The quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of poor outcomes: a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective observational study, we explored the performance of triage qSOFA (tqSOFA), maximum qSOFA, and first initial serum lactate (\u3e 3 mmol/L) at predicting in-hospital mortality and compared these results to those for the initial SIRS criteria obtained in triage. A total of 2859 sepsis cases were included and the in-hospital mortality rate was 14.4%. The sensitivity of tqSOFA ≥ 2 and maximum qSOFA ≥ 2 to predict in-hospital mortality were 33% and 69%, respectively. For comparison, the triage SIRS criteria and the initial lactate \u3e 3 mmol/L had sensitivities of 82% and 65%, respectively. These results demonstrate that in a large ED sepsis database the earliest measurement of end organ impairment, tqSOFA, performed poorly at identifying patients at increased risk of mortality and maximum qSOFA did not significantly outperform initial serum lactate levels

Age-Related Differences in Biomarkers of Acute Inflammation During Hospitalization for Sepsis

To evaluate age-related differences in inflammation biomarkers during the first 72 hours of hospitalization for sepsis

Power Constrained and Delay Optimal Policies for Scheduling Transmission over a Fading Channel

We consider an optimal power and rate scheduling problem for a single user transmitting to a base station on a fading wireless link with the objective of minimizing the mean delay subject to an average power constraint. The base station acts as a controller which, depending upon the transmitter buffer lengths and the signal power to interference ratio (SIR) on the uplink pilot channel, allocates transmission rate and power to the user. We provide structural results for an average cost optimal stationary policy under a long run average transmitter power constraint. We obtain a closed form expression relating the optimal policy when the SIR is the best, to the optimal policy for any other SIR value. We also obtain lower and upper bounds for the optimal policy