Enhancing quality of service in software-defined networks

Resource management is of paramount importance in network scenarios and it is a long-standing and still open issue. Unfortunately, while technology and innovation continue to evolve, our network infrastructure system has been maintained almost in the same shape for decades and this phenomenon is known as “Internet ossification”. Software-Defined Networking (SDN) is an emerging paradigm in computer networking that allows a logically centralized software program to control the behavior of an entire network. This is done by decoupling the network control logic from the underlying physical routers and switches that forward traffic to the selected destination. One mechanism that allows the control plane to communicate with the data plane is OpenFlow. The network operators could write high-level control programs that specify the behavior of an entire network. Moreover, the centralized control makes it possible to define more specific and complex tasks that could involve many network functionalities, e.g., security, resource management and control, into a single framework. Nowadays, the explosive growth of real time applications that require stringent Quality of Service (QoS) guarantees, brings the network programmers to design network protocols that deliver certain performance guarantees. This thesis exploits the use of SDN in conjunction with OpenFlow to manage differentiating network services with an high QoS. Initially, we define a QoS Management and Orchestration architecture that allows us to manage the network in a modular way. Then, we provide a seamless integration between the architecture and the standard SDN paradigm following the separation between the control and data planes. This work is a first step towards the deployment of our proposal in the University of California, Los Angeles (UCLA) campus network with differentiating services and stringent QoS requirements. We also plan to exploit our solution to manage the handoff between different network technologies, e.g., Wi-Fi and WiMAX. Indeed, the model can be run with different parameters, depending on the communication protocol and can provide optimal results to be implemented on the campus network.

Trauma-induced coagulopathy in severely injured patients: knowledge lost in translation?

Many guidelines exist on how to treat patients with multiple injuries correctly in an accident and emergency setting. The aim of the present work was to find out how well patients are treated focusing on trauma induced coagulopathy (TIC), and what anaesthetists involved in trauma care think about their own experiences with TIC.

Posttraumatic stress disorder and soluble cellular adhesion molecules at rest and in response to a trauma-specific interview in patients after myocardial infarction

Posttraumatic stress disorder (PTSD) and circulating cellular adhesion molecules (CAMs) predict cardiovascular risk. We hypothesized a positive relationship between PTSD caused by myocardial infarction (MI) and soluble CAMs. We enrolled 22 post-MI patients with interviewer-rated PTSD and 22 post-MI patients with no PTSD. At 32±6months after index MI, all patients were re-scheduled to undergo the Clinician-Administered PTSD Scale (CAPS) interview and had blood collected to assess soluble CAMs at rest and after the CAPS interview. Relative to patients with no PTSD, those with PTSD had significantly higher levels of soluble vascular cellular adhesion molecule (sVCAM)-1 and intercellular adhesion molecule (sICAM)-1 at rest and, controlling for resting CAM levels, significantly higher sVCAM-1 and sICAM-1 after the interview. Greater severity of PTSD predicted significantly higher resting levels of sVCAM-1 and soluble P-selectin in patients with PTSD. At follow-up, patients with persistent PTSD (n=15) and those who had remitted (n=7) did not significantly differ in CAM levels at rest and after the interview; however, both these groups had significantly higher sVCAM-1 and sICAM-1 at rest and also after the interview compared to patients with no PTSD. Elevated levels of circulating CAMs might help explain the psychophysiologic link of PTSD with cardiovascular risk.

Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction

Hypercoagulability of the blood might partially explain the increased cardiovascular disease risk in posttraumatic stress disorder (PTSD) and is also triggered by anticipatory stress. We hypothesized exaggerated procoagulant reactivity in patients with PTSD in response to a trauma-specific interview that would be moderated by momentary stress levels. We examined 23 patients with interviewer-diagnosed PTSD caused by myocardial infarction (MI) and 21 post-MI patients without PTSD. A second diagnostic (i.e., trauma-specific) interview to assess posttraumatic stress severity was performed after a median follow-up of 26 months (range 12-36). Before that interview patients rated levels of momentary stress (Likert scale 0-10) and had blood collected before and after the interview. The interaction between PTSD diagnostic status at study entry and level of momentary stress before the follow-up interview predicted reactivity of fibrinogen (P=0.036) and d-dimer (P=0.002) to the PTSD interview. Among patients with high momentary stress levels, PTSD patients had greater fibrinogen (P=0.023) and d-dimer (P=0.035) reactivity than non-PTSD patients. Among patients with low momentary stress levels, PTSD patients had less d-dimer reactivity than non-PTSD patients (P=0.024); fibrinogen reactivity did not significantly differ between groups. Momentary stress levels, but not severity of posttraumatic stress, correlated with d-dimer reactivity in PTSD patients (r=0.46, P=0.029). We conclude that momentary stress levels moderated the relationship between PTSD and procoagulant reactivity to a trauma-specific interview. Procoagulant reactivity in post-MI patients with PTSD confronted with their traumatically experienced MI was observed if patients perceived high levels of momentary stress before the interview.

Optimising care in a Swiss University Emergency Department by implementing a multicentre trauma register (TARN): report on evaluation, costs and benefits of trauma registries

Diagnostic and therapeutic approaches to trauma patients are, depending on experience, equipment and different therapeutic doctrines, subject to wide variations. The ability to compare trauma centres using a standardised trauma register helps to reveal unresolved systemic issues and simplifies the quality management in an Emergency Department (ED).

Proximal row carpectomy in emergency

Proximal row carpectomy (PRC) is a well-accepted procedure for the treatment of early post-traumatic degenerative disease of the wrist. Much less frequently, PRC has been advocated as an emergency procedure for irreparable fracture-dislocation of the wrist. Our objective was to compare the results of PRC in patients having undergone this procedure in the two contexts. We conducted a retrospective analysis of the clinical and radiographic results of six patients treated by emergency PRC as compared to six patients who underwent elective PRC. The mean follow-up was 36 months. Both the patient's satisfaction and the grasp of the wrist joint were significantly better in patients who underwent PRC emergency as compared to those having undergone elective PRC. Quick DASH score, radiographic results, and return to work were also more favourable in these patients, but the difference between the two groups was not significant. This study confirms that PRC is a valuable salvage technique indicated in early posttraumatic wrist collapse. Moreover, when performed in emergency, the procedure shows even better subjective and objective results, allowing a majority of patients to return to their previous job.

Coping personality type and environmental enrichment affect aggression at weaning in pigs

This study investigated the effects of different environmental treatments and personality types on aggression at mixing of newly weaned domestic piglets. From birth to weaning, 16 litters were housed with their dams in either barren (B) or larger, substrate-enriched (E) environments. At 15 days old, piglets were classified as 'high' (HR) or low resistant' (LR) in a manual restraint test (backtest), which is thought to identify proactive (HR) and reactive (LR) stress coping strategies that may reflect different personality types. At 30 days old, 128 piglets were weaned, relocated and mixed into 32 pens comprising two HR and two LR unfamiliar pigs, balanced for sex and weaning weight. Eight B and eight E groups changed environmental condition whereas the others remained in the same type of environment. Number and duration of fights. fight outcomes and unilateral fighting were scored for 5 h post-mixing and skin lesions were counted before and 5 h, 1 day and 2 days after mixing. On the day following weaning, fighting and also exploratory and oral manipulative behaviours were measured for 6 h. Generalized Linear Mixed Model analyses suggested interactions between pre-weaning environment, post-weaning environment and personality type. Overall, pre-weaning E pigs had longer fights at weaning and mixing (P=0.01) and fought for longer on the next day (P=0.02) than pre-weaning B pigs, and inflicted more skin lesions (P=0.02). Post-weaning enrichment did not affect fighting at mixing but reduced the time spent fighting the next day (P=0.03). Personality had subtle and environment-dependent effects on fighting, and influenced the "structure" rather than the amount of aggressive behaviour. HR pigs, for instance, bullied (i.e. chased surrendering pigs) more often (P=0.009) and their fighting behaviour was less affected by their relative body weight than that of LR pigs. Post-weaning E pigs showed relatively higher levels of exploratory behaviour (P=0.02) and less oral manipulative behaviour (P=0.04) than post-weaning B pigs. In particular, switching from a good quality environment (E) to a worse quality one (B) at weaning decreased exploratory behaviour on the next day, especially for LR pigs, who also tended to fight with and orally manipulate their pen mates more in that condition, and seemed to be more affected by a deterioration of the environment. Overall, pre-weaning enrichment increased aggression after weaning whereas post-weaning enrichment reduced it, and personality type related to some aspects of fighting behaviour. (C) 2011 Elsevier B.V. All rights reserved.

Resuscitative emergency thoracotomy in a Swiss trauma centre

Resuscitative emergency thoracotomy (ET) is performed as a salvage manoeuvre for selected patients with trauma. However, reports from European trauma centres are scarce.

The Cultural Construction Of Posttraumatic Stress Disorder: Sociopolitical Responses To Psychological Trauma In American And Vie

In my thesis, I incorporate both psychological research and personal narratives in order to explain why, in the aftermath of the Vietnam War, the United States officially recognized Post-Traumatic Stress Disorder while the Vietnamese government did not. The absence of Vietnamese studies on the impact of PTSD on veterans, in comparison to the abundance of research collected on American soldiers, is reflective not of a disparity in the actual prevalence of the disorder, but of the influence of political policy on the scope of Vietnamese psychology. Personal narratives from Vietnamese civilians and soldiers thus reveal accounts of trauma otherwise hidden due to the absence of Vietnamese psychological research. Although these two nations conspicuously differed in their respective responses to the prevalence of psychological trauma in war veterans, these responses demonstrated that both the recognition and rejection of PTSD was a result of sociopolitical factors: political ideologies, rather than scientific reasons, dictated whether the postwar trajectory of psychological research focused on fully exploring the impact of PTSD on veteran populations. The association of military defeat with psychological trauma thus fixed attention on certain groups of veterans, including former American and South Vietnamese soldiers, while ignoring the impact of trauma on veterans of the Viet Cong and North Vietnamese Army. The correlation of a soldier¿s ideological background with psychological trauma, rather than exposure to actual traumatic experiences, demonstrates that cultural and sociopolitical factors are far more influential in the construction of PTSD than objective indicators of the disorder¿s prevalence. Culturally-constructed responses to disorders such as PTSD therefore account for the subjective treatment of mental illness. The American and Vietnamese responses to veterans suffering from PTSD both demonstrated that the evidence of mental health problems in an individual does not guarantee an immediate or appropriate diagnosis and treatment regimen. External authorities whose primary aims are not necessarily concerned with the objective treatment of all victims of mental illness subjectively dictate mental health care policy, and therefore risk ignoring or marginalizing the needs of individuals in need of proper treatment.

Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: A meta-analysis

This meta-analysis synthesizes the available data on the strength of association between anger and posttraumatic stress disorder (PTSD) and between hostility and PTSD, covering 39 studies with trauma-exposed adults. Effect sizes did not differ for anger and hostility, which could therefore be combined; effect sizes for anger expression variables were analyzed separately. The analyses revealed large effects. The weighted mean effect size (r) was .48 for anger–hostility, .29 for anger out, .53 for anger in, and -.44 for anger control. Moderator analyses were conducted for anger–hostility, showing that effect sizes were substantially larger with increasing time since the event and that effect sizes were larger in samples with military war experience than in samples that had experienced other types of traumatic events.