How well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine or hip? A cost-effectiveness analysis

Dual energy X-ray absorptiometry (DXA) is widely accepted as the reference method for diagnosis and monitoring of osteoporosis and for assessment of fracture risk, especially at hip. However, axial-DXA is not suitable for mass screening, because it is usually confined to specialized centers. We propose a two-step diagnostic approach to postmenopausal osteoporosis: the first step, using an inexpensive, widely available screening technique, aims at risk stratification in postmenopausal women; the second step, DXA of spine and hip is applied only to potentially osteoporotic women preselected on the basis of the screening measurement. In a group of 110 healthy postmenopausal woman, the capability of various peripheral bone measurement techniques to predict osteoporosis at spine and/or hip (T-score < -2.5SD using DXA) was tested using receiver operating characteristic (ROC) curves: radiographic absorptiometry of phalanges (RA), ultrasonometry at calcaneus (QUS. CALC), tibia (SOS.TIB), and phalanges (SOS.PHAL). Thirty-three women had osteoporosis at spine and/or hip with DXA. Areas under the ROC curves were 0.84 for RA, 0.83 for QUS.CALC, 0.77 for SOS.PHAL (p < 0.04 vs RA) and 0.74 for SOS.TIB (p < 0.02 vs RA and p = 0.05 vs QUS.CALC). For levels of sensitivity of 90%, the respective specificities were 67% (RA), 64% (QUS.CALC), 48% (SOS.PHAL), and 39% (SOS.TIB). In a cost-effective two-step, the price of the first step should not exceed 54% (RA), 51% (QUS.CALC), 42% (SOS.PHAL), and 25% (SOS.TIB). In conclusion, RA, QUS.CALC, SOS.PHAL, and SOS.TIB may be useful to preselect postmenopausal women in whom axial DXA is indicated to confirm/exclude osteoporosis at spine or hip.

Real-World Energy Measurements of a Wireless Mesh Network

Over the past several years the topics of energy consumption and energy harvesting have gained significant importance as a means for improved operation of wireless sensor and mesh networks. Energy-awareness of operation is especially relevant for application scenarios from the domain of environmental monitoring in hard to access areas. In this work we reflect upon our experiences with a real-world deployment of a wireless mesh network. In particular, a comprehensive study on energy measurements collected over several weeks during the summer and the winter period in a network deployment in the Swiss Alps is presented. Energy performance is monitored and analysed for three system components, namely, mesh node, battery and solar panel module. Our findings cover a number of aspects of energy consumption, including the amount of load consumed by a mesh node, the amount of load harvested by a solar panel module, and the dependencies between these two. With our work we aim to shed some light on energy-aware network operation and to help both users and developers in the planning and deployment of a new wireless (mesh) network for environmental research.

Energy Efficiency Issues in Information-Centric Networking

In this paper we address energy efficiency issues of Information Centric Networking (ICN) architectures. In the proposed framework, we investigate the impact of ICN architectures on energy consumption of networking hardware devices and compare them with the energy consumption of other content dissemination methods. In particular, we investigate the consequences of caching in ICN from the energy efficiency perspective, taking into account the energy consumption of different hardware components in the ICN architectures. Based on the results of the analysis, we address the practical issues regarding the possible deployment and evolution of ICN from an energy-efficiency perspective. Finally, we summarize our findings and discuss the outlook/future perspectives on the energy efficiency of Information-Centric Networks.

Enhancing IEEE 802.11 Energy Efficiency for Continuous Media Applications

This paper proposes the Optimized Power save Algorithm for continuous Media Applications (OPAMA) to improve end-user device energy efficiency. OPAMA enhances the standard legacy Power Save Mode (PSM) of IEEE 802.11 by taking into consideration application specific requirements combined with data aggregation techniques. By establishing a balanced cost/benefit tradeoff between performance and energy consumption, OPAMA is able to improve energy efficiency, while keeping the end-user experience at a desired level. OPAMA was assessed in the OMNeT++ simulator using real traces of variable bitrate video streaming applications. The results showed the capability to enhance energy efficiency, achieving savings up to 44% when compared with the IEEE 802.11 legacy PSM.

A Routing Protocol Based on Energy and Link Quality for Internet of Things Applications

The Internet of Things (IoT) is attracting considerable attention from the universities, industries, citizens and governments for applications, such as healthcare, environmental monitoring and smart buildings. IoT enables network connectivity between smart devices at all times, everywhere, and about everything. In this context, Wireless Sensor Networks (WSNs) play an important role in increasing the ubiquity of networks with smart devices that are low-cost and easy to deploy. However, sensor nodes are restricted in terms of energy, processing and memory. Additionally, low-power radios are very sensitive to noise, interference and multipath distortions. In this context, this article proposes a routing protocol based on Routing by Energy and Link quality (REL) for IoT applications. To increase reliability and energy-efficiency, REL selects routes on the basis of a proposed end-to-end link quality estimator mechanism, residual energy and hop count. Furthermore, REL proposes an event-driven mechanism to provide load balancing and avoid the premature energy depletion of nodes/networks. Performance evaluations were carried out using simulation and testbed experiments to show the impact and benefits of REL in small and large-scale networks. The results show that REL increases the network lifetime and services availability, as well as the quality of service of IoT applications. It also provides an even distribution of scarce network resources and reduces the packet loss rate, compared with the performance of well-known protocols.

MRI-guided and CT-guided cervical nerve root infiltration therapy: a cost comparison

PURPOSE To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. MATERIALS AND METHODS Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. RESULTS The mean intervention time was 24.9 min. (range: 12 - 36 min.) for MRI-guided infiltration and 19.7 min. (range: 5 - 54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. CONCLUSION Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance.