Confucius Queue Management: Be Fair But Not Too Fast

When many users and unique applications share a congested edge link (e.g., a home network), everyone wants their own application to continue to perform well despite contention over network resources. Traditionally, network engineers have focused on fairness as the key objective to ensure that competing applications are equitably and led by the switch, and hence have deployed fair queueing mechanisms. However, for many network workloads today, strict fairness is directly at odds with equitable application performance. Real-time streaming applications, such as videoconferencing, suffer the most when network performance is volatile (with delay spikes or sudden and dramatic drops in throughput). Unfortunately, "fair" queueing mechanisms lead to extremely volatile network behavior in the presence of bursty and multi-flow applications such as Web traffic. When a sudden burst of new data arrives, fair queueing algorithms rapidly shift resources away from incumbent flows, leading to severe stalls in real-time applications. In this paper, we present Confucius, the first practical queue management scheme to effectively balance fairness against volatility, providing performance outcomes that benefit all applications sharing the contended link. Confucius outperforms realistic queueing schemes by protecting the real-time streaming flows from stalls in competing with more than 95% of websites. Importantly, Confucius does not assume the collaboration of end-hosts, nor does it require manual parameter tuning to achieve good performance

Identifying Distinct Risk Profiles to Predict Adverse Events among Community-Dwelling Older Adults

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p \u3c 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Middleboxes as a Cloud Service

Today's networks do much more than merely deliver packets. Through the deployment of middleboxes, enterprise networks today provide improved security -- e.g., filtering malicious content -- and performance capabilities -- e.g., caching frequently accessed content. Although middleboxes are deployed widely in enterprises, they bring with them many challenges: they are complicated to manage, expensive, prone to failures, and challenge privacy expectations.In this thesis, we aim to bring the benefits of cloud computing to networking.We argue that middlebox services can be outsourced to cloud providers in asimilar fashion to how mail, compute, and storage are today outsourced. We beginby presenting APLOMB, a system that allows enterprises to outsource middleboxprocessing to a third party cloud or ISP. For enterprise networks, APLOMB canreduce costs, ease management, and provide resources for scalability andfailover. For service providers, APLOMB offers new customers and businessopportunities, but also presents new challenges. Middleboxes have tighterperformance demands than existing cloud services, and hence supporting APLOMBrequires redesigning software at the cloud. We re-consider classical cloudchallenges including fault-tolerance and privacy, showing how to implementmiddlebox software solutions with throughput and latency 2-4 orders of magnitudemore efficient than general-purpose cloud approaches. %Some of the technologies discussed in this thesis are presently being adopted by industrial systems used by cloud providers and ISPs

Silo: Predictable message completion time in the cloud.

Abstract Many cloud applications need predictable completion of application tasks. To achieve this, they require predictable completion time for network messages. We identify three key requirements for such predictability: guaranteed network bandwidth, guaranteed per-packet delay and guaranteed burst allowance. We present Silo, a network architecture for public cloud datacenters that offers these guarantees. Silo leverages the fact that guaranteed bandwidth and delay are tightly coupled: controlling tenant bandwidth yields deterministic bounds on network queuing delay. Silo builds upon network calculus to determine how tenants with competing requirements can coexist, using a novel packet pacing mechanism to ensure the requirements are met. We have implemented a Silo prototype comprising a VM placement manager and a Windows Hyper-V network driver. Silo does not require any changes to applications, VMs or network switches. We use testbed experiments and large scale simulations to show that Silo can ensure predictable message latency for competing applications in cloud datacenters