Assessing patient's belief on HIV testing before elective surgery: room for improvements in Switzerland !

Background: ln Switzerland no HIV test is performed without the patient's consent based on a Voluntary Counseling and Testing policy (VCT). We hypothesized that a substantial proportion of patients going through an elective surgery falsely believed that an HIV test was performed on a routine basis and that the lack of transmission of result was interpreted as being HIV negative. Method: All patients with elective orthopedic surgery during 2007 were contacted by phone in 2008. A structured questionnaire assessed their belief about routine preoperative blood analysis (diabetes, coagulation function, HIV test and cholesterol level) as well as result awareness and interpretation. Variables included age and gender. Analysis were conducted using the software JMP 6.0.3. Results: 1123 patients were included. 130 (12 %) were excluded (Le. unreachable, unable to communicate on the phone, not operated). 993 completed the survey (89 %). Median age was 51 (16-79). 50 % were female. 376 (38 %) patients thought they had an HIV test performed before surgery but none of them had one. 298 (79 %) interpreted the absence of result as a negative HIV test. A predictive factor to believe an HIV test had been done was an age below 50 years old (45 % vs 33 % for 16-49 years old and 50-79 years old respectively, p < 0.001). No difference was observed between genders. Conclusion: ln Switzerland, nearly 40 % of the patients falsely thought an HIV test had been performed on a routine basis before surgery and were erroneously reassured about their HIV status. These results should either improve the information given to the patient regarding preoperative exams, or motivate public health policy to consider HIV opt-out screening instead of VCT strategy.

Conditioning of stochastic 3-D fracture networks to hydrological and geophysical data

The geometry and connectivity of fractures exert a strong influence on the flow and transport properties of fracture networks. We present a novel approach to stochastically generate three-dimensional discrete networks of connected fractures that are conditioned to hydrological and geophysical data. A hierarchical rejection sampling algorithm is used to draw realizations from the posterior probability density function at different conditioning levels. The method is applied to a well-studied granitic formation using data acquired within two boreholes located 6 m apart. The prior models include 27 fractures with their geometry (position and orientation) bounded by information derived from single-hole ground-penetrating radar (GPR) data acquired during saline tracer tests and optical televiewer logs. Eleven cross-hole hydraulic connections between fractures in neighboring boreholes and the order in which the tracer arrives at different fractures are used for conditioning. Furthermore, the networks are conditioned to the observed relative hydraulic importance of the different hydraulic connections by numerically simulating the flow response. Among the conditioning data considered, constraints on the relative flow contributions were the most effective in determining the variability among the network realizations. Nevertheless, we find that the posterior model space is strongly determined by the imposed prior bounds. Strong prior bounds were derived from GPR measurements and helped to make the approach computationally feasible. We analyze a set of 230 posterior realizations that reproduce all data given their uncertainties assuming the same uniform transmissivity in all fractures. The posterior models provide valuable statistics on length scales and density of connected fractures, as well as their connectivity. In an additional analysis, effective transmissivity estimates of the posterior realizations indicate a strong influence of the DFN structure, in that it induces large variations of equivalent transmissivities between realizations. The transmissivity estimates agree well with previous estimates at the site based on pumping, flowmeter and temperature data.

Social network measures for "nosduocentered" networks, their predictive power on performance

Our purpose in this article is to define a network structure which is based on two egos instead of the egocentered (one ego) or the complete network (n egos). We describe the characteristics and properties for this kind of network which we call “nosduocentered network”, comparing it with complete and egocentered networks. The key point for this kind of network is that relations exist between the two main egos and all alters, but relations among others are not observed. After that, we use new social network measures adapted to the nosduocentered network, some of which are based on measures for complete networks such as degree, betweenness, closeness centrality or density, while some others are tailormade for nosduocentered networks. We specify three regression models to predict research performance of PhD students based on these social network measures for different networks such as advice, collaboration, emotional support and trust. Data used are from Slovenian PhD students and their s

A quality-based cost distribution charging scheme for QoS multicast networks

This paper presents a new charging scheme for cost distribution along a point-to-multipoint connection when destination nodes are responsible for the cost. The scheme focus on QoS considerations and a complete range of choices is presented. These choices go from a safe scheme for the network operator to a fair scheme to the customer. The in-between cases are also covered. Specific and general problems, like the incidence of users disconnecting dynamically is also discussed. The aim of this scheme is to encourage the users to disperse the resource demand instead of having a large number of direct connections to the source of the data, which would result in a higher than necessary bandwidth use from the source. This would benefit the overall performance of the network. The implementation of this task must balance between the necessity to offer a competitive service and the risk of not recovering such service cost for the network operator. Throughout this paper reference to multicast charging is made without making any reference to any specific category of service. The proposed scheme is also evaluated with the criteria set proposed in the European ATM charging project CANCAN

Evaluating the probability and the impact of a failure in GMPLS based networks

In this paper, we define a new scheme to develop and evaluate protection strategies for building reliable GMPLS networks. This is based on what we have called the network protection degree (NPD). The NPD consists of an a priori evaluation, the failure sensibility degree (FSD), which provides the failure probability, and an a posteriori evaluation, the failure impact degree (FID), which determines the impact on the network in case of failure, in terms of packet loss and recovery time. Having mathematical formulated these components, experimental results demonstrate the benefits of the utilization of the NPD, when used to enhance some current QoS routing algorithms in order to offer a certain degree of protection

Enhancing fault management performance of two-step QoS routing algorithms in GMPLS networks

In this paper a novel methodology aimed at minimizing the probability of network failure and the failure impact (in terms of QoS degradation) while optimizing the resource consumption is introduced. A detailed study of MPLS recovery techniques and their GMPLS extensions are also presented. In this scenario, some features for reducing the failure impact and offering minimum failure probabilities at the same time are also analyzed. Novel two-step routing algorithms using this methodology are proposed. Results show that these methods offer high protection levels with optimal resource consumption

An improved method for discovering link criticality in transport networks

Quantitatively assessing the importance or criticality of each link in a network is of practical value to operators, as that can help them to increase the network's resilience, provide more efficient services, or improve some other aspect of the service. Betweenness is a graph-theoretical measure of centrality that can be applied to communication networks to evaluate link importance. However, as we illustrate in this paper, the basic definition of betweenness centrality produces inaccurate estimations as it does not take into account some aspects relevant to networking, such as the heterogeneity in link capacity or the difference between node-pairs in their contribution to the total traffic. A new algorithm for discovering link centrality in transport networks is proposed in this paper. It requires only static or semi-static network and topology attributes, and yet produces estimations of good accuracy, as verified through extensive simulations. Its potential value is demonstrated by an example application. In the example, the simple shortest-path routing algorithm is improved in such a way that it outperforms other more advanced algorithms in terms of blocking ratio

Full label space reduction in MPLS networks: asymmetric merged tunneling

Traffic Engineering objective is to optimize network resource utilization. Although several works have been published about minimizing network resource utilization in MPLS networks, few of them have been focused in LSR label space reduction. This letter studies Asymmetric Merged Tunneling (AMT) as a new method for reducing the label space in MPLS network. The proposed method may be regarded as a combination of label merging (proposed in the MPLS architecture) and asymmetric tunneling (proposed recently in our previous works). Finally, simulation results are performed by comparing AMT with both ancestors. They show a great improvement in the label space reduction factor

Label Space Reduction in MPLS Networks: How Much Can A Single Stacked Label Do?

Most network operators have considered reducing LSR label spaces (number of labels used) as a way of simplifying management of underlaying virtual private networks (VPNs) and therefore reducing operational expenditure (OPEX). The IETF outlined the label merging feature in MPLS-allowing the configuration of multipoint-to-point connections (MP2P)-as a means of reducing label space in LSRs. We found two main drawbacks in this label space reduction a)it should be separately applied to a set of LSPs with the same egress LSR-which decreases the options for better reductions, and b)LSRs close to the edge of the network experience a greater label space reduction than those close to the core. The later implies that MP2P connections reduce the number of labels asymmetrically

Partial disjoint path for multi-layer protection in GMPLS networks

In this paper, different recovery methods applied at different network layers and time scales are used in order to enhance the network reliability. Each layer deploys its own fault management methods. However, current recovery methods are applied to only a specific layer. New protection schemes, based on the proposed partial disjoint path algorithm, are defined in order to avoid protection duplications in a multi-layer scenario. The new protection schemes also encompass shared segment backup computation and shared risk link group identification. A complete set of experiments proves the efficiency of the proposed methods in relation with previous ones, in terms of resources used to protect the network, the failure recovery time and the request rejection ratio

Enhanced multi-layer protection in multi-service GMPLS networks

This paper focuses on QoS routing with protection in an MPLS network over an optical layer. In this multi-layer scenario each layer deploys its own fault management methods. A partially protected optical layer is proposed and the rest of the network is protected at the MPLS layer. New protection schemes that avoid protection duplications are proposed. Moreover, this paper also introduces a new traffic classification based on the level of reliability. The failure impact is evaluated in terms of recovery time depending on the traffic class. The proposed schemes also include a novel variation of minimum interference routing and shared segment backup computation. A complete set of experiments proves that the proposed schemes are more efficient as compared to the previous ones, in terms of resources used to protect the network, failure impact and the request rejection ratio

Adding new components to the knowledge plane GMPLS over WDM networks

A recent study defines a new network plane: the knowledge plane. The incorporation of the knowledge plane over the network allows having more accurate information of the current and future network states. In this paper, the introduction and management of the network reliability information in the knowledge plane is proposed in order to improve the quality of service with protection routing algorithms in GMPLS over WDM networks. Different experiments prove the efficiency and scalability of the proposed scheme in terms of the percentage of resources used to protect the network

Estimation of the probability of congestion using Monte Carlo method in OPS networks

In networks with small buffers, such as optical packet switching based networks, the convolution approach is presented as one of the most accurate method used for the connection admission control. Admission control and resource management have been addressed in other works oriented to bursty traffic and ATM. This paper focuses on heterogeneous traffic in OPS based networks. Using heterogeneous traffic and bufferless networks the enhanced convolution approach is a good solution. However, both methods (CA and ECA) present a high computational cost for high number of connections. Two new mechanisms (UMCA and ISCA) based on Monte Carlo method are proposed to overcome this drawback. Simulation results show that our proposals achieve lower computational cost compared to enhanced convolution approach with an small stochastic error in the probability estimation