Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery.

BACKGROUND: Enhanced recovery protocols may reduce postoperative complications and length of hospital stay. However, the implementation of these protocols requires time and financial investment. This study evaluated the cost-effectiveness of enhanced recovery implementation. METHODS: The first 50 consecutive patients treated during implementation of an enhanced recovery programme were compared with 50 consecutive patients treated in the year before its introduction. The enhanced recovery protocol principally implemented preoperative counselling, reduced preoperative fasting, preoperative carbohydrate loading, avoidance of premedication, optimized fluid balance, standardized postoperative analgesia, use of a no-drain policy, as well as early nutrition and mobilization. Length of stay, readmissions and complications within 30 days were compared. A cost-minimization analysis was performed. RESULTS: Hospital stay was significantly shorter in the enhanced recovery group: median 7 (interquartile range 5-12) versus 10 (7-18) days (P = 0·003); two patients were readmitted in each group. The rate of severe complications was lower in the enhanced recovery group (12 versus 20 per cent), but there was no difference in overall morbidity. The mean saving per patient in the enhanced recovery group was euro1651. CONCLUSION: Enhanced recovery is cost-effective, with savings evident even in the initial implementation period.

Adaptive Protocol Stacks for Mobile Devices

Tulevaisuudessa siirrettävät laitteet, kuten matkapuhelimet ja kämmenmikrot, pystyvät muodostamaan verkkoyhteyden käyttäen erilaisia yhteysmenetelmiä eri tilanteissa. Yhteysmenetelmillä on toisistaan poikkeavat viestintäominaisuudet mm. latenssin, kaistanleveyden, virhemäärän yms. suhteen. Langattomille yhteysmenetelmille on myös ominaista tietoliikenneyhteyden ominaisuuksien voimakas muuttuminen ympäristön suhteen. Parhaan suorituskyvyn ja käytettävyyden saavuttamiseksi, on siirrettävän laitteen pystyttävä mukautumaan käytettyyn viestintämenetelmään ja viestintäympäristössä tapahtuviin muutoksiin. Olennainen osa tietoliikenteessä ovat protokollapinot, jotka mahdollistavat tietoliikenneyhteyden järjestelmien välillä tarjoten verkkopalveluita päätelaitteen käyttäjäsovelluksille. Jotta protokollapinot pystyisivät mukautumaan tietyn viestintäympäristön ominaisuuksiin, on protokollapinon käyttäytymistä pystyttävä muuttamaan ajonaikaisesti. Perinteisesti protokollapinot ovat kuitenkin rakennettu muuttumattomiksi niin, että mukautuminen tässä laajuudessa on erittäin vaikeaa toteuttaa, ellei jopa mahdotonta. Tämä diplomityö käsittelee mukautuvien protokollapinojen rakentamista käyttäen komponenttipohjaista ohjelmistokehystä joka mahdollistaa protokollapinojen ajonaikaisen muuttamisen. Toteuttamalla esimerkkijärjestelmän, ja mittaamalla sen suorituskykyä vaihtelevassa tietoliikenneympäristössä, osoitamme, että mukautuvat protokollapinot ovat mahdollisia rakentaa ja ne tarjoavat merkittäviä etuja erityisesti tulevaisuuden siirrettävissä laitteissa.

Mobile Protocol Stack Simulator

Nykypäivän maailma tukeutuu verkkoihin. Tietokoneverkot ja langattomat puhelimet ovat jo varsin tavallisia suurelle joukolle ihmisiä. Uusi verkkotyyppi on ilmestynyt edelleen helpottamaan ihmisten verkottunutta elämää. Ad hoc –verkot mahdollistavat joustavan verkonmuodostuksen langattomien päätelaitteiden välille ilman olemassa olevaa infrastruktuuria. Diplomityö esittelee uuden simulaatiotyökalun langattomien ad hoc –verkkojen simulointiin protokollatasolla. Se esittelee myös kyseisten verkkojen taustalla olevat periaatteet ja teoriat. Lähemmin tutkitaan OSI-mallin linkkikerroksen kaistanjakoprotokollia ad hoc –verkoissa sekä vastaavan toteutusta simulaattorissa. Lisäksi esitellään joukko simulaatioajoja esimerkiksi simulaattorin toiminnasta ja mahdollisista käyttökohteista.

Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy.

BACKGROUND: Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy. METHODS: ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model. RESULTS: The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were euro922 per patient. Mean total costs were euro56 083 per patient in the ERAS group and euro63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were euro9139 and euro13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151). CONCLUSION: ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.

Cost Optimisation of Mobile Advertising Client Data Transfer

Data traffic caused by mobile advertising client software when it is communicating with the network server can be a pain point for many application developers who are considering advertising-funded application distribution, since the cost of the data transfer might scare their users away from using the applications. For the thesis project, a simulation environment was built to mimic the real client-server solution for measuring the data transfer over varying types of connections with different usage scenarios. For optimising data transfer, a few general-purpose compressors and XML-specific compressors were tried for compressing the XML data, and a few protocol optimisations were implemented. For optimising the cost, cache usage was improved and pre-loading was enhanced to use free connections to load the data. The data traffic structure and the various optimisations were analysed, and it was found that the cache usage and pre-loading should be enhanced and that the protocol should be changed, with report aggregation and compression using WBXML or gzip.

An adaptive cluster based routing scheme for mobile wireless sensor networks

Clustering schemes improve energy efficiency of wireless sensor networks. The inclusion of mobility as a new criterion for the cluster creation and maintenance adds new challenges for these clustering schemes. Cluster formation and cluster head selection is done on a stochastic basis for most of the algorithms. In this paper we introduce a cluster formation and routing algorithm based on a mobility factor. The proposed algorithm is compared with LEACH-M protocol based on metrics viz. number of cluster head transitions, average residual energy, number of alive nodes and number of messages lost

A location aided cooperative caching protocol for mobile ad hoc networks

Cooperative caching is an attractive solution for reducing bandwidth demands and network latency in mobile ad hoc networks. Deploying caches in mobile nodes can reduce the overall traffic considerably. Cache hits eliminate the need to contact the data source frequently, which avoids additional network overhead. In this paper we propose a data discovery and cache management policy for cooperative caching, which reduces the caching overhead and delay by reducing the number of control messages flooded in to the network. A cache discovery process based on location of neighboring nodes is developed for this. The cache replacement policy we propose aims at increasing the cache hit ratio. The simulation results gives a promising result based on the metrics of studies

RMAC-M: Extending the R-MAC Protocol for an Energy Efficient, Delay Tolerant Underwater Acoustic Sensor Network application with a mobile data mule node

One of the major applications of underwater acoustic sensor networks (UWASN) is ocean environment monitoring. Employing data mules is an energy efficient way of data collection from the underwater sensor nodes in such a network. A data mule node such as an autonomous underwater vehicle (AUV) periodically visits the stationary nodes to download data. By conserving the power required for data transmission over long distances to a remote data sink, this approach extends the network life time. In this paper we propose a new MAC protocol to support a single mobile data mule node to collect the data sensed by the sensor nodes in periodic runs through the network. In this approach, the nodes need to perform only short distance, single hop transmission to the data mule. The protocol design discussed in this paper is motivated to support such an application. The proposed protocol is a hybrid protocol, which employs a combination of schedule based access among the stationary nodes along with handshake based access to support mobile data mules. The new protocol, RMAC-M is developed as an extension to the energy efficient MAC protocol R-MAC by extending the slot time of R-MAC to include a contention part for a hand shake based data transfer. The mobile node makes use of a beacon to signal its presence to all the nearby nodes, which can then hand-shake with the mobile node for data transfer. Simulation results show that the new protocol provides efficient support for a mobile data mule node while preserving the advantages of R-MAC such as energy efficiency and fairness.

An enhanced relay-enabled medium access control protocol for wireless ad hoc networks

In this paper we propose an enhanced relay-enabled distributed coordination function (rDCF) for wireless ad hoc networks. The idea of rDCF is to use high data rate nodes to work as relays for the low data rate nodes. The relay helps to increase the throughput and lower overall blocking time of nodes due to faster dual-hop transmission. rDCF achieves higher throughput over IEEE 802.11 distributed coordination function (DCF). The protocol is further enhanced for higher throughput and reduced energy. These enhancements result from the use of a dynamic preamble (i.e. using short preamble for the relay transmission) and also by reducing unnecessary overhearing (by other nodes not involved in transmission). We have modeled the energy consumption of rDCF, showing that rDCF provides an energy efficiency of 21.7% at 50 nodes over 802.11 DCF. Compared with the existing rDCF, the enhanced rDCF (ErDCF) scheme proposed in this paper yields a throughput improvement of 16.54% (at the packet length of 1000 bytes) and an energy saving of 53% at 50 nodes.

Enhanced three-factor security protocol for consumer USB mass storage devices

The Universal Serial Bus (USB) is an extremely popular interface standard for computer peripheral connections and is widely used in consumer Mass Storage Devices (MSDs). While current consumer USB MSDs provide relatively high transmission speed and are convenient to carry, the use of USB MSDs has been prohibited in many commercial and everyday environments primarily due to security concerns. Security protocols have been previously proposed and a recent approach for the USB MSDs is to utilize multi-factor authentication. This paper proposes significant enhancements to the three-factor control protocol that now makes it secure under many types of attacks including the password guessing attack, the denial-of-service attack, and the replay attack. The proposed solution is presented with a rigorous security analysis and practical computational cost analysis to demonstrate the usefulness of this new security protocol for consumer USB MSDs.

Gadolinium diethylenetriaminepentaacetate enhancement kinetics in the menisci of asymptomatic subjects: a first step towards a dedicated dGEMRIC (delayed gadolinium-enhanced MRI of cartilage)-like protocol for biochemical imaging of the menisci

It was our aim to investigate the gadolinium diethylenetriaminepentaacetate (Gd-DTPA(2-) ) enhancement kinetics in the menisci of the knee joint over a prolonged period of time. Six asymptomatic volunteers (four men and two women; mean age, 25 ± 2.4 years) were enrolled. Sagittal, T(1) -weighted, spin-echo MR sequences of the right knee joint were obtained at 3 T. Imaging was performed before (baseline), 1 h after and in half-hour intervals up to 9 h after the intravenous administration of 0.2 mmol/kg of Gd-DTPA(2-) . To measure the rates of contrast enhancement relative to the baseline, regions of interest that covered the anterior and posterior horns of the medial and lateral meniscus were defined on each of two adjacent sections, and enhancement curves were constructed. An enhancement peak between 2.5 and 4.5 h after Gd-DTPA(2-) administration was observed, and analysis of variance also revealed no significant difference (p=0.94), in terms of enhancement, within this time interval. Pair-wise, post hoc testing also revealed no significant differences between 2.5 and 3, 3 and 3.5, 3.5 and 4, and 4 and 4.5 h post Gd-DTPA(2-) application. Our preliminary data therefore suggest that the time window suitable for a dGEMRIC (delayed gadolinium-enhanced MRI of cartilage)-like T(1) mapping of the menisci is relatively short, and lies between 2.5 and 4.5 h after Gd-DTPA(2-) injection.

A Link Quality and Geographical-aware Routing Protocol for Video Transmission in Mobile IoT

Wireless mobile sensor networks are enlarging the Internet of Things (IoT) portfolio with a huge number of multimedia services for smart cities. Safety and environmental monitoring multimedia applications will be part of the Smart IoT systems, which aim to reduce emergency response time, while also predicting hazardous events. In these mobile and dynamic (possible disaster) scenarios, opportunistic routing allows routing decisions in a completely distributed manner, by using a hop- by-hop route decision based on protocol-specific characteristics, and a predefined end-to-end path is not a reliable solution. This enables the transmission of video flows of a monitored area/object with Quality of Experience (QoE) support to users, headquarters or IoT platforms. However, existing approaches rely on a single metric to make the candidate selection rule, including link quality or geographic information, which causes a high packet loss rate, and reduces the video perception from the human standpoint. This article proposes a cross-layer Link quality and Geographical-aware Opportunistic routing protocol (LinGO), which is designed for video dissemination in mobile multimedia IoT environments. LinGO improves routing decisions using multiple metrics, including link quality, geographic loca- tion, and energy. The simulation results show the benefits of LinGO compared with well-known routing solutions for video transmission with QoE support in mobile scenarios.

Enhanced Caching Strategies At the Edge of LTE Mobile Networks

With a boom in the usage of mobile devices for traffic-heavy applications, mobile networks struggle to deliver good performance while saving resources to support more users and save on costs. In this paper, we propose enhanced strategies for the preemptive migration of content stored in Information-Centric Networking caches at the edge of LTE mobile networks. With such strategies, the concept of content following the users interested in it becomes a reality and content within caches is more optimized towards the requests of nearby users. Results show that the strategies are feasible, efficient and, when compared to default caching strategies, ensure that content is delivered faster to end users while using bandwidth and storage resources more efficiently at the core of the network.

Improving availability of mobile networks using a cluster routing protocol with redundant cluster head

We show a cluster based routing protocol in order to improve the convergence of the clusters and of the network it is proposed to use a backup cluster head. The use of a event discrete simulator is used for the implementation and the simulation of a hierarchical routing protocol called the Backup Cluster Head Protocol (BCHP). Finally it is shown that the BCHP protocol improves the convergence and availability of the network through a comparative analysis with the Ad Hoc On Demand Distance Vector (AODV)[1] routing protocol and Cluster Based Routing Protocol (CBRP)[2]