Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia

Because of an elevated serum phosphate level, patients who suffer from chronic kidney failure frequently tend to have cardiovascular calcification and are therefore exposed to a higher probability of a fatal event. Phosphate binders are able to reduce these negative effects. Currently, there are primarily two groups of phosphate binders (calcium-containing and calcium-free phosphate binders) which are considered to be almost equally effective in terms of binding of free phosphate. There are, however, a few disadvantages of the two groups. While the calcium-containing binders are associated with an increased risk of hypercalcaemia, which is dose dependent, calcium-free binders have been criticized as being too expensive. As the expenditure for patients suffering from chronic kidney failure increases from year to year, as a result of increasing prevalence, there is a growing need for an alternative to existing phosphate binders. The study presented here therefore summarizes available information for the novel combination preparation OsvaRen® (calcium acetate/magnesium carbonate) as an alternative therapy to the calcium-free phosphate binder Renagel® (sevelamer-hydrochloride) and to calcium-containing preparations. The results of this systematic review showed that OsvaRen® is at least equally effective in the regulation of serum phosphate level as Renagel®. In particular, OsvaRen® shows no clinically relevant difference in terms of the control of the serum calcium levels compared to Renagel® and thereby does not increase the risk of a hypercalcaemia, in contrast to pure calcium-based phosphate binders. On the other hand, Renagel® therapy is much more frequently associated with gastrointestinal side-effects, a tendency to result in higher tablet burden for patients and high medication costs. The CALMAG study showed that OsvaRen® was at least as effective and safe in terms of controlling serum phosphate and serum calcium levels as Renagel® while, at the same time, resulting in about 80% lower costs. In addition, OsvaRen® offers a lower risk of hypercalcaemia and associated subsequent costs and is thereby also superior to pure calcium-containing phosphate binders. Because of the effectiveness and tolerability of calcium acetate/magnesium carbonate, OsvaRen® offers a clinically suitable and, at the same time, cost-effective therapeutic option in the therapy of hyperphosphataemia.Fresenius Medical Care Deutschland Gmb

Visceral Adipose Tissue Inflammatory Factors (TNF-Alpha, SOCS3) in Gestational Diabetes (GDM): Epigenetics as a Clue in GDM Pathophysiology

Gestational diabetes (GDM) is among the most challenging diseases in westernized countries, affecting mother and child, immediately and in later life. Obesity is a major risk factor for GDM. However, the impact visceral obesity and related epigenetics play for GDM etiopathogenesis have hardly been considered so far. Our recent findings within the prospective 'EaCH' cohort study of women with GDM or normal glucose tolerance (NGT), showed the role, critical factors of insulin resistance (i.e., adiponectin, insulin receptor) may have for GDM pathophysiology with epigenetically modified expression in subcutaneous (SAT) and visceral (VAT) adipose tissues. Here we investigated the expression and promoter methylation of key inflammatory candidates, tumor necrosis factor-alpha (TNF-α) and suppressor of cytokine signaling 3 (SOCS3) in maternal adipose tissues collected during caesarian section (GDM, n = 19; NGT, n = 22). The mRNA expression of TNF-α and SOCS3 was significantly increased in VAT, but not in SAT, of GDM patients vs. NGT, accompanied by specific alterations of respective promoter methylation patterns. In conclusion, we propose a critical role of VAT and visceral obesity for the pathogenesis of GDM, with epigenetic alterations of the expression of inflammatory factors as a potential factor

Travel light:State shedding for efficient operator migration

Operator migration is a crucial concept to adapt event processing systems to dynamic changes. When the placement of a stateful operator changes, the operator state must be migrated to the new host. However, operator state size and time constraints can make it impossible to migrate the operator without severe Quality of Service (QoS) degradation. As a relief, we propose to perform state shedding in such a situation. The core idea of state shedding is to partition the operator state, assign a utility to each partial state, and use the utility and size of each partial state to identify the most useful partial states that can be migrated in a given time frame. Thus, state shedding can maintain a substantially higher QoS with a lower impact on query results than state-of-the-art solutions targeting consistent state at the old and new host. In this paper, we define this novel approach and in a simulation environment evaluate state shedding in migration scenarios with pattern-matching queries

Fuzzy logic-based approximate event notification in sparse MANETs

Mobile Ad-Hoc Networks (MANETs) are an important communication infrastructure to support emergency and rescue operations. To address the frequent disconnections and network partitions that might occur, we have developed a distributed event notification service (DENS) for sparse MANETs. In most event notification solutions, subscriptions are formed with crisp values or crisp value ranges. However, in emergency and rescue operations subscribers may not always have time to give crisp values or crisp value ranges. Moreover, subscriber's interests in queries have gradual nature and subjective measure that calls for computing by words. Therefore, we design and implement a simple fuzzy concept based subscription language allowing more expressive subscriptions and more sophisticated event-filtering. It is built on two new ideas: using features as multi-attribute indexes of the subscription and predicate patterns for processing subscriptions with arbitrary Boolean operators. However, requiring more computational efforts, fuzzy logic introduces performance penalties in the whole network. The proposed services have been evaluated for run-time, space and scalability efficiency. The proposed design framework is extensible to the user- and application-semantics and configurable to the dynamics in data that publish/subscribe paradigm imposes at runtime

Juno:An adaptive delivery-centric middleware

This paper proposes a new delivery-centric abstraction. A delivery-centric abstraction allows applications to generate content requests agnostic to location or protocol, with the additional ability to stipulate high-level requirements regarding such things as performance, security, resource consumption and monetary cost. A delivery-centric system therefore constantly adapts to fulfil these requirements, given the constraints of the environment. This abstraction has been realised through a delivery-centric middleware called Juno, which uses a reconfigurable software architecture to (i) discover multiple sources of an item of content, (ii) model each source's ability to provide the content, then (iii) adapt to interact with the source(s) that can best fulfil the application's requirements. Juno therefore utilises existing providers in a backwards compatible way, supporting immediate deployment. This paper evaluates Juno using Emulab to validate its ability to adapt to its environment

ILORIN: Identifier-locator resolution for infrastructure-less networks

This word is at: 2012 Third International Conference on the Network of the Future (NOF) took place 21-23 November in Tunis, Tunisia. web event http://www.ati.es/spip.php?article2118In order to overcome the limitations of the current Internet addressing, it is generally accepted that the Future Internet needs a separation between identifiers and network locators. Such identifier-locator split is also needed in infrastructureless networks, such as Mobile ad hoc Networks (MANETs) and Delay Tolerant Networks, since they are an integral part of the Future Internet. Despite the amount of work in infrastructurebased networks, only a few proposals have considered how to apply this identifier-locator split in infrastructure-less networks. The contribution of this paper is an identifier-locator resolution system that can work in sparse MANETs, which are prone to network partitions. Our approach is an identifier-locator association discovery system, which uses periodic beacons to exchange the resolution information, avoiding the establishment of shared state between nodes. Our system exploits the broadcast nature of the wireless medium, opportunistic encounters, and information replication to disseminate identifier-locator associations across the network. The results of our extensive experiments demonstrate that our solution outperforms the related work, achieving a higher identifier-locator association discovery rate. Index Terms—Identifier-Locator split, Resolution system, Mobile Ad Hoc Network, Delay Tolerant Network.This work has been funded by the VERDIKT Programme of the Norwegian Research Council throughthe DT-Stream project (project number 183312/S10) and the Regional Government of Madrid through the MEDIANET project (MEDIANET S2009/TIC-1468)Publicad

Towards reliable video transmission over sparse MANETs in emergencies

Video delivery in a mobile ad-hoc network that can be deployed by members of an emergency service in an incident zone is an appealing tool for emergency and rescue services, but has not been studied yet. In order to design and test a suitable solution, we have generated realistic evaluation scenarios by modeling fireman action plans and GPS traces from real situations. We propose an overlay network solution with routing and reliability mechanisms. The Emergency Overlay Routing (EOR) protocol is a reactive protocol integrated into a store-carry-forward architecture. It selects ferry nodes to transport video data from a camera in the Incident Area to the Incident Chief’s node, looking for the minimum delay, but reliable, candidate. We also propose a simple credit based mechanism (RTCP+) to improve the communication reliability. The evaluation of the whole system shows a great improvement against previous results and promising expectations

Towards reliable video transmission over sparse MANETs in emergencies

Video delivery in a mobile ad-hoc network that can be deployed by members of an emergency service in an incident zone is an appealing tool for emergency and rescue services, but has not been studied yet. In order to design and test a suitable solution, we have generated realistic evaluation scenarios by modeling fireman action plans and GPS traces from real situations. We propose an overlay network solution with routing and reliability mechanisms. The Emergency Overlay Routing (EOR) protocol is a reactive protocol integrated into a store-carry-forward architecture. It selects ferry nodes to transport video data from a camera in the Incident Area to the Incident Chief’s node, looking for the minimum delay, but reliable, candidate. We also propose a simple credit based mechanism (RTCP+) to improve the communication reliability. The evaluation of the whole system shows a great improvement against previous results and promising expectations

An Overlay Routing Protocol for Video over sparse MANETs in Emergencies

Video delivery over a mobile ad-hoc network that can be deployed by members of an emergency service in an incident zone is an appealing tool for emergency and rescue services, but has not be studied yet. In order to design and test a suitable solution, we have generated realistic evaluation scenarios by modeling fireman action plans and GPS traces from real situations. The Emergency Overlay Routing (EOR) protocol is a reactive protocol integrated into a store-carry-forward architecture. It selects ferry nodes to transport video data from a camera in the Incident Area to the Incident Chief’s node, looking for the minimum delay, but reliable, candidate. The evaluation of EOR shows its superiority to the well-known DTN routing protocol, PROPHET, under this conditions