Flexible cross layer optimization for fixed and mobile broadband telecommunication networks and beyond

In der heutigen Zeit, in der das Internet im Allgemeinen und Telekommunikationsnetze im Speziellen kritische Infrastrukturen erreicht haben, entstehen hohe Anforderungen und neue Herausforderungen an den Datentransport in Hinsicht auf Effizienz und Flexibilität. Heutige Telekommunikationsnetze sind jedoch rigide und statisch konzipiert, was nur ein geringes Maß an Flexibilität und Anpassungsfähigkeit der Netze ermöglicht und darüber hinaus nur im begrenzten Maße die Wichtigkeit von Datenflüssen im wiederspiegelt. Diverse Lösungsansätze zum kompletten Neuentwurf als auch zum evolutionären Konzept des Internet wurden ausgearbeitet und spezifiziert, um diese neuartigen Anforderungen und Herausforderungen adäquat zu adressieren. Einer dieser Ansätze ist das Cross Layer Optimierungs-Paradigma, welches eine bisher nicht mögliche direkte Kommunikation zwischen verteilten Funktionalitäten unterschiedlichen Typs ermöglicht, um ein höheres Maß an Dienstgüte zu erlangen. Ein wesentlicher Indikator, welcher die Relevanz dieses Ansatzes unterstreicht, zeichnet sich durch die Programmierbarkeit von Netzwerkfunktionalitäten aus, welche sich aus der Evolution von heutigen hin zu zukünftigen Netzen erkennen lässt. Dieses Konzept wird als ein vielversprechender Lösungsansatz für Kontrollmechanismen von Diensten in zukünftigen Kernnetzwerken erachtet. Dennoch existiert zur Zeit der Entstehung dieser Doktorarbeit kein Ansatz zur Cross Layer Optimierung in Festnetz-und Mobilfunknetze, welcher der geforderten Effizienz und Flexibilität gerecht wird. Die übergeordnete Zielsetzung dieser Arbeit adressiert die Konzeptionierung, Entwicklung und Evaluierung eines Cross Layer Optimierungsansatzes für Telekommunikationsnetze. Einen wesentlichen Schwerpunkt dieser Arbeit stellt die Definition einer theoretischen Konzeptionierung und deren praktischer Realisierung eines Systems zur Cross Layer Optimierung für Telekommunikationsnetze dar. Die durch diese Doktorarbeit analysierten wissenschaftlichen Fragestellungen betreffen u.a. die Anwendbarkeit von Cross Layer Optimierungsansätzen auf Telekommunikationsnetzwerke; die Betrachtung neuartiger Anforderungen; existierende Konzepte, Ansätze und Lösungen; die Abdeckung neuer Funktionalitäten durch bereits existierende Lösungen; und letztendlich den erkennbaren Mehrwert des neu vorgeschlagenen Konzepts gegenüber den bestehenden Lösungen. Die wissenschaftlichen Beiträge dieser Doktorarbeit lassen sich grob durch vier Säulen skizzieren: Erstens werden der Stand der Wissenschaft und Technik analysiert und bewertet, Anforderungen erhoben und eine Lückenanalyse vorgenommen. Zweitens werden Herausforderungen, Möglichkeiten, Limitierungen und Konzeptionierungsaspekte eines Modells zur Cross Layer Optimierung analysiert und evaluiert. Drittens wird ein konzeptionelles Modell - Generic Adaptive Resource Control (GARC) - spezifiziert, als Prototyp realisiert und ausgiebig validiert. Viertens werden theoretische und praktische Beiträge dieser Doktorarbeit vertiefend analysiert und bewertet.As the telecommunication world moves towards a data-only network environment, signaling, voice and other data are similarly transported as Internet Protocol packets. New requirements, challenges and opportunities are bound to this transition and influence telecommunication architectures accordingly. In this time in which the Internet in general, and telecommunication networks in particular, have entered critical infrastructures and systems, it is of high importance to guarantee efficient and flexible data transport. A certain level of Quality-of-Service (QoS) for critical services is crucial even during overload situations in the access and core network, as these two are the bottlenecks in the network. However, the current telecommunication architecture is rigid and static, which offers very limited flexibility and adaptability. Several concepts on clean slate as well as evolutionary approaches have been proposed and defined in order to cope with these new challenges and requirements. One of these approaches is the Cross Layer Optimization paradigm. This concept omits the strict separation and isolation of the Application-, Control- and Network-Layers as it enables interaction and fosters Cross Layer Optimization among them. One indicator underlying this trend is the programmability of network functions, which emerges clearly during the telecommunication network evolution towards the Future Internet. The concept is regarded as one solution for service control in future mobile core networks. However, no standardized approach for Cross Layer signaling nor optimizations in between the individual layers have been standardized at the time this thesis was written. The main objective of this thesis is the design, implementation and evaluation of a Cross Layer Optimization concept on telecommunication networks. A major emphasis is given to the definition of a theoretical model and its practical realization through the implementation of a Cross Layer network resource optimization system for telecommunication systems. The key questions answered through this thesis are: in which way can the Cross Layer Optimization paradigm be applied on telecommunication networks; which new requirements arise; which of the required functionalities cannot be covered through existing solutions, what other conceptual approaches already exist and finally whether such a new concept is viable. The work presented in this thesis and its contributions can be summarized in four parts: First, a review of related work, a requirement analysis and a gap analysis were performed. Second, challenges, limitations, opportunities and design aspects for specifying an optimization model between application and network layer were formulated. Third, a conceptual model - Generic Adaptive Resource Control (GARC) - was specified and its prototypical implementation was realized. Fourth, the theoretical and practical thesis contributions was validated and evaluated

Postoperative Anaemia Might Be a Risk Factor for Postoperative Delirium and Prolonged Hospital Stay: A Secondary Analysis of a Prospective Cohort Study

Background: Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis is to investigate the association of postoperative anaemia in accordance with the sex specific World Health Organization definition of anaemia to postoperative delirium and its impact on the duration of hospital stay. Methods: A secondary analysis of the prospective multicentric observational CESARO-study was conducted. 800 adult patients undergoing elective surgery were enrolled from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally invasive surgery in Germany. Patients were classified as anaemic according to the World Health Organization parameters, setting the haemoglobin level cut off below 12g/dl for females and below 13g/dl for males. Focus of the investigation were patients with acute anaemia. Patients with present preoperative anaemia or missing haemoglobin measurement were excluded from the sample set. Delirium screening was established postoperatively for at least 24 hours and up to three days, applying the validated Nursing Delirium Screening Scale. Results: The initial sample set contained 800 patients of which 183 were suitable for analysis in the study. Ninety out of 183 (49.2%) suffered from postoperative anaemia. Ten out of 93 (10.9%) patients without postoperative anaemia developed a postoperative delirium. In the group with postoperative anaemia, 28 (38.4%) out of 90 patients suffered from postoperative delirium (odds ratio 3.949, 95% confidence interval, (1.358-11.480)) after adjustment for NYHA-stadium, severity of surgery, cutting/suture time, duration of anaesthesia, transfusion of packed red cells and sedation status with Richmond Agitation Scale after surgery. Additionally, patients who suffered from postoperative anaemia showed a significantly longer duration of hospitalisation (7.75 vs. 12.42 days, odds ratio = 1.186, 95% confidence interval, 1.083-1.299, after adjustments). Conclusion: The study results reveal that postoperative anaemia is not only a frequent postsurgical complication with an incidence probability of almost 50%, but could also be associated with a postoperative delirium and a prolonged hospitalisation

Adverse events of endoscopic full-thickness resection:results from the German and Dutch nationwide colorectal FTRD registry

Background and Aims: Endoscopic full-thickness resection (eFTR) is emerging as a minimally invasive alternative to surgery for complex colorectal lesions. Previous studies have demonstrated favorable safety results; however, large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our aim was to provide further insight in AEs after eFTR.Methods: Data from all registered eFTR procedures in the German and Dutch colorectal full-thickness resection device registries between July 2015 and March 2021 were collected. Safety outcomes included immediate and late AEs.Results: Of 1892 procedures, the overall AE rate was 11.3% (213/1892). No AE-related mortality occurred. Perforations occurred in 2.5% (47/1892) of all AEs, 57.4% (27/47) of immediate AEs, and 42.6% (20/47) of delayed AEs. Successful endoscopic closure was achieved in 29.8% of cases (13 immediate and 1 delayed), and antibiotic treatment was sufficient in 4.3% (2 delayed). The appendicitis rate for appendiceal lesions was 9.9% (13/131), and 46.2% (6/13) could be treated conservatively. The severe AE rate requiring surgery was 2.2% (42/1892), including delayed perforations in .9% (17/1892) and immediate perforations in .7% (13/1892). Delayed perforations occurred between days 1 and 10 (median, 2) after eFTR, and 58.8% (10/17) were located on the left side. Other severe AEs were appendicitis (.4%, 7/1892), luminal stenosis (.1%, 2/1892), delayed bleeding (.1%, 1/1892), pain after eFTR close to the dentate line (.1%, 1/1892), and grasper entrapment in the clip (.1%, 1/1892).Conclusions: Colorectal eFTR is a safe procedure with a low risk for severe AEs in everyday practice and without AE-related mortality. These results further support the position of eFTR as an established minimally invasive technique for complex colorectal lesions.</p

Industry associations, health innovation systems and politics of development: the cases of India and South Africa

Over the last 20 years, developing countries have witnessed the increased role of non-governmental actors such as health industry associations and umbrella organizations in the diffusion and governance of health innovation. Utilizing extensive interviews with actors in the Indian and South African health industries, this paper argues that, in a context of emerging pluralism – i.e., a dynamic context of bargaining between competing (public and private) interests and values – these associations constitute public actors that play dual roles in the politics of innovation and development. Specifically, not only do they engage downstream by diffusing knowledge to their respective health innovation systems in order to achieve common objectives, they also engage upstream with their governments to co-develop policies and regulations. This dual role of health industry associations and umbrella organizations makes them less neutral politically but more effective institutionally, and their innovative and political role should be seriously taken into account in the healthcare sector

In-depth profiling of COVID-19 risk factors and preventive measures in healthcare workers

PURPOSE To determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals. METHODS In a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a~quaternary care, multicenter hospital~in Munich, Germany. RESULTS 7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5-3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2-6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8-3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0-7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0-17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7-1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3-35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks. CONCLUSION Awareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy

Belle II Technical Design Report

The Belle detector at the KEKB electron-positron collider has collected almost 1 billion Y(4S) events in its decade of operation. Super-KEKB, an upgrade of KEKB is under construction, to increase the luminosity by two orders of magnitude during a three-year shutdown, with an ultimate goal of 8E35 /cm^2 /s luminosity. To exploit the increased luminosity, an upgrade of the Belle detector has been proposed. A new international collaboration Belle-II, is being formed. The Technical Design Report presents physics motivation, basic methods of the accelerator upgrade, as well as key improvements of the detector.Comment: Edited by: Z. Dole\v{z}al and S. Un

Epigenetic upregulation of FKBP5 by aging and stress contributes to NF-kappa B-driven inflammation and cardiovascular risk

Aging and psychosocial stress are associated with increased inflammation and disease risk, but the underlying molecular mechanisms are unclear. Because both aging and stress are also associated with lasting epigenetic changes, a plausible hypothesis is that stress along the lifespan could confer disease risk through epigenetic effects on molecules involved in inflammatory processes. Here, by combining large-scale analyses in human cohorts with experiments in cells, we report that FKBP5, a protein implicated in stress physiology, contributes to these relations. Across independent human cohorts (total n > 3,000), aging synergized with stress-related phenotypes, measured with childhood trauma and major depression questionnaires, to epigenetically up-regulate FKBP5 expression. These age/stress-related epigenetic effects were recapitulated in a cellular model of replicative senescence, whereby we exposed replicating human fibroblasts to stress (glucocorticoid) hormones. Unbiased genome-wide analyses in human blood linked higher FKBP5 mRNA with a proinflammatory profile and altered NF-kappa B-related gene networks. Accordingly, experiments in immune cells showed that higher FKBP5 promotes inflammation by strengthening the interactions of NF-kappa B regulatory kinases, whereas opposing FKBP5 either by genetic deletion (CRISPR/Cas9-mediated) or selective pharmacological inhibition prevented the effects on NF-kappa B. Further, the age/stress-related epigenetic signature enhanced FKBP5 response to NF-kappa B through a positive feedback loop and was present in individuals with a history of acute myocardial infarction, a disease state linked to peripheral inflammation. These findings suggest that aging/stress-driven FKBP5-NF-kappa B signaling mediates inflammation, potentially contributing to cardiovascular risk, and may thus point to novel biomarker and treatment possibilities.Peer reviewe

Natriuretic Peptides and Assessment of Cardiovascular Disease Risk in Asymptomatic Persons

Current tools for cardiovascular disease (CVD) risk assessment in asymptomatic individuals are imperfect. Preventive measures aimed only at individuals deemed high risk by current algorithms neglect large numbers of low-risk and intermediate-risk individuals who are destined to develop CVD and who would benefit from early and aggressive treatment. Natriuretic peptides have the potential both to identify individuals at risk for future cardiovascular events and to help detect subclinical CVD. Choosing the appropriate subpopulation to target for natriuretic peptide testing will help maximize the performance and the cost effectiveness. The combined use of multiple risk markers, including biomarkers, genetic testing, and imaging or other noninvasive measures of risk, offers promise for further refining risk assessment algorithms. Recent studies have highlighted the utility of natriuretic peptides for preoperative risk stratification; however, cost effectiveness and outcomes studies are needed to affirm this and other uses of natriuretic peptides for cardiovascular risk assessment in asymptomatic individuals