CASPR: Judiciously Using the Cloud for Wide-Area Packet Recovery

We revisit a classic networking problem -- how to recover from lost packets in the best-effort Internet. We propose CASPR, a system that judiciously leverages the cloud to recover from lost or delayed packets. CASPR supplements and protects best-effort connections by sending a small number of coded packets along the highly reliable but expensive cloud paths. When receivers detect packet loss, they recover packets with the help of the nearby data center, not the sender, thus providing quick and reliable packet recovery for latency-sensitive applications. Using a prototype implementation and its deployment on the public cloud and the PlanetLab testbed, we quantify the benefits of CASPR in providing fast, cost effective packet recovery. Using controlled experiments, we also explore how these benefits translate into improvements up and down the network stack

CASPR: judiciously using the cloud for wide-area packet recovery

We revisit a classic networking problem -- how to recover from lost packets in the best-effort Internet. We propose CASPR, a system that judiciously leverages the cloud to recover from lost or delayed packets. CASPR supplements and protects best-effort connections by sending a small number of coded packets along the highly reliable but expensive cloud paths. When receivers detect packet loss, they recover packets with the help of the nearby data center, not the sender, thus providing quick and reliable packet recovery for latency-sensitive applications. Using a prototype implementation and its deployment on the public cloud and the PlanetLab testbed, we quantify the benefits of CASPR in providing fast, cost effective packet recovery. Using controlled experiments, we also explore how these benefits translate into improvements up and down the network stack.First author draf

Etiology, functional status and short term outcome of patients with pituitary lesions. An experience from a developing country

OBJECTIVE: To describe the etiology, functional status and short term outcome of patients with pituitary lesions (PL). METHODS: Brain or pituitary MRI reports of 3753 patients were analyzed for PL over the period of 2000 to 2007, done at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. MRIs with reported PL and all those ordered by Endocrinologists with or without pituitary abnormalities, were included in the analysis. This made a total of 338 (9%) MRI reports. PL were defined as pituitary tumors, cysts, haemorrhage, hypoplasia; and empty sella. Patients with these PL, were analyzed for symptoms, hormonal profile and short term outcome in the hospital retrospectively. RESULTS: In the analysis of 338 MRI reports, 23% had normal pituitary gland on MRI examination. Hypogonadotrophic hypogonadism was the commonest (38.5%) endocrine abnormality seen with normal pituitary MRI, followed by hypopituitarism (5.1%). Most common PL identified were macroadenoma (38.7%), empty sella (16.5%) and microadenoma (12.7%). Patients with macroadenoma had 58% of non-functional tumours while 19.1% had hypopituitrism, 17.6% had acromegaly and 17.5% had prolactinoma. Majority of these lesions were causing headache and visual symptoms (42.7%) and were treated with surgery (75.5%). Patients with microadenoma included 39.5% prolactinomas, 18.6% cushing disease, 14% acromegaly, 4.7% hypogonadotrophic hypogonadism and 2.3% hypopituitrism. Majority of these lesions were treated with drugs and 37.3% were treated with surgery. In empty sella patients, 32% patients had endocrine abnormalities among which 21.4% had hypopituitrism, 2% had hypogonadotrophic hypogonadism, and only 6% patients had normal endocrine workup. A significant number of patients (62.5%) never had endocrine hormonal checkup. CONCLUSION: Although PL are less common entities (9% in 3,753 reports) but they are associated with significant endocrinal abnormalities and need prompt treatment. Empty sella, which is not considered as a distinct abnormality, is also associated with significant endocrine deficiencies

Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan

Objectives: We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan. Design, settings and participants: Multistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models. Main outcome measures: Prevalence of prediabetes and type 2 diabetes. Results: Of 18 856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51–60 years (26.03%, p<0.001), no formal education (17.66%, p<0.001), class III obese (35.09%, p<0.001), family history (31.29%, p<0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT. Conclusions: The prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Judicious QoS using cloud overlays

We revisit the long-standing problem of providing network QoS to applications, and propose the concept of judicious QoS -- combining the cheaper, best effort IP service with the cloud, which offers a highly reliable infrastructure and the ability to add in-network services, albeit at higher cost. Our proposed J-QoS framework offers a range of reliability services with different cost vs. delay trade-offs, including: i) a forwarding service that forwards packets over the cloud overlay, ii) a caching service, which stores packets inside the cloud and allows them to be pulled in case of packet loss or disruption on the Internet, and iii) a novel coding service that provides the least expensive packet recovery option by combining packets of multiple application streams and sending a small number of coded packets across the more expensive cloud paths. We demonstrate the feasibility of these services using measurements from RIPE Atlas and a live deployment on PlanetLab. We also consider case studies on how J-QoS works with services up and down the network stack, including Skype video conferencing, TCP-based web transfers, and cellular access networks.First author draf

Traditional Usage of Wild Fauna among the Local Inhabitants of Ladakh, Trans-Himalayan Region

Zootherapy is accepted all around the globe not only in ancient cultures but different animal derived medicines are also part of the practice in the modern health care systems. The present study assessed the traditional ethnozoological usage of wild animals by local inhabitants in Ladakh region, India, and the reference data for scientific approaches for protection of faunal diversity in trans-Himalayas. The ethnozoological documentation of the animals in Ladakh was carried out through semistructured and close-ended questionnaire surveys and interviews. Multivariate ecological community analysis was used to elucidate the relationship between ethnozoological usage and animal species. Our results showed three animal usage clusters with 32% similarity. Moreover, the similarity in animal usage between digging tools, trophy, handle of tools, decoration, and matting, showed less than 32% of similarity. The highest priority of local people was for food followed by decoration and medicinal usage. The most frequently used animal parts were meat followed by fur and horn. Medicinal uses of 48% of the reported species, i.e., Alectoris chukar (chukar), Cuon alpinus (Asiatic wild dog), Lepus oiostolus (hares), Marmota himalayana (marmots), Ovis aries vignei (Ladakh urial), Pantholops hodgsonii (Tibetan antelope), Procapra picticaudata (Tibetan gazelle), Pseudois nayaur (blue sheep), Tetraogallus himalayensis (Himalayan snow), Tetraogallus tibetanus (Tibetan snow cock), and Lutra lutra (common otter) were reported for the first time from this region. Our study provides innovative information regarding the ethnozoological knowledge in the Ladakh region and reference data for policymakers, researchers, land managers, common public, and the other stakeholders to develop logical and scientific approaches for sustainable use of faunal diversity in hotspot regions like trans-Himalayas and other similar biodiversity-rich sites

A case report of Insulinoma Pancreas in an 80 old lady with long standing history: managed by 3 D Laparoscopic resection

Introduction: Insulinomas are a rare group of neuroendocrine tumors. Ninety percent are benign and most are solitary. They can have varied presentations and long-standing history of symptoms. Mostly people are affected in fourth to sixth decades of life. Insulinomas can have association with multiple endocrine neoplasia type 1 (MEN) however typically they are sporadic. Most are solitary and benign. Most common presentation is symptomatic hypoglycemia. After investigations, surgery is the treatment of choice and can offer cure. Laparoscopic surgery can offer all the benefits of minimally invasive surgery and equal oncological outcomes in high volume and dedicated centers. 3D laparoscopy further improves outcomes. Case Presentation: This case presentation is about an 80-year-old female who presented with long standing symptoms. After biochemical and radiological investigation, she was treated with 3-D laparoscopic distal pancreatectomy. Histopathology was consistent with insulinoma and she had resolution of symptoms. Conclusion: Insulinoma is a rare tumor and proper management is multidisciplinary. Proper management leads to rapid cure and resolution of the symptoms

Generic Methods for Micrometer- And Nanometer-Scale Surface Derivatization Based on Photochemical Coupling of Primary Amines to Monolayers of Aryl Azides on Gold and Aluminum Oxide Surfaces

A series of aryl azide terminated thiols and phosphonic acids has been synthesized, and used to prepare self-assembled monolayers on (respectively) gold and aluminum oxide surfaces. The rates of photoactivation were determined using contact angle measurement and X-ray photoelectron spectroscopy (XPS). The behavior of a diazirine functionalized aryl thiol was also studied. The rates of activation were found to be similar for all five adsorbates. However, the extent of photochemical coupling of a primary amine was significantly greater for the aryl azides than for the diazirine. A range of primary amines was successfully coupled to all of the azides with high yield. Little difference in reactivity was observed following perfluorination of the aromatic ring. Micrometer-scale patterns were fabricated by carrying out exposures of the aryl azide terminated SAMs through a mask submerged under a film of primary amine. Contrasting amines could be introduced to unreacted regions in a subsequent maskless step. A scanning near-field optical microscope was used to fabricate nanopatterns. Exposure of the azides to irradiation at 325 nm in air enabled selective deactivation of azides. The surrounding surface was functionalized with a primary amine in a maskless process; when a protein-resistant oligo­(ethylene glycol) functionalized amine was used it was possible to produce protein nanopatterns, by adsorbing protein to features defined using near-field exposure