SEP: A Stable Election Protocol for clustered heterogeneous wireless sensor networks

We study the impact of heterogeneity of nodes, in terms of their energy, in wireless sensor networks that are hierarchically clustered. In these networks some of the nodes become cluster heads, aggregate the data of their cluster members and transmit it to the sink. We assume that a percentage of the population of sensor nodes is equipped with additional energy resources-this is a source of heterogeneity which may result from the initial setting or as the operation of the network evolves. We also assume that the sensors are randomly (uniformly) distributed and are not mobile, the coordinates of the sink and the dimensions of the sensor field are known. We show that the behavior of such sensor networks becomes very unstable once the first node dies, especially in the presence of node heterogeneity. Classical clustering protocols assume that all the nodes are equipped with the same amount of energy and as a result, they can not take full advantage of the presence of node heterogeneity. We propose SEP, a heterogeneous-aware protocol to prolong the time interval before the death of the first node (we refer to as stability period), which is crucial for many applications where the feedback from the sensor network must be reliable. SEP is based on weighted election probabilities of each node to become cluster head according to the remaining energy in each node. We show by simulation that SEP always prolongs the stability period compared to (and that the average throughput is greater than) the one obtained using current clustering protocols. We conclude by studying the sensitivity of our SEP protocol to heterogeneity parameters capturing energy imbalance in the network. We found that SEP yields longer stability region for higher values of extra energy brought by more powerful nodes.

DIP: Density Inference Protocol for wireless sensor networks and its application to density-unbiased statistics

Wireless sensor networks have recently emerged as enablers of important applications such as environmental, chemical and nuclear sensing systems. Such applications have sophisticated spatial-temporal semantics that set them aside from traditional wireless networks. For example, the computation of temperature averaged over the sensor field must take into account local densities. This is crucial since otherwise the estimated average temperature can be biased by over-sampling areas where a lot more sensors exist. Thus, we envision that a fundamental service that a wireless sensor network should provide is that of estimating local densities. In this paper, we propose a lightweight probabilistic density inference protocol, we call DIP, which allows each sensor node to implicitly estimate its neighborhood size without the explicit exchange of node identifiers as in existing density discovery schemes. The theoretical basis of DIP is a probabilistic analysis which gives the relationship between the number of sensor nodes contending in the neighborhood of a node and the level of contention measured by that node. Extensive simulations confirm the premise of DIP: it can provide statistically reliable and accurate estimates of local density at a very low energy cost and constant running time. We demonstrate how applications could be built on top of our DIP-based service by computing density-unbiased statistics from estimated local densities.

dPAM: A Distributed Prefetching Protocol for Scalable Asynchronous Multicast in P2P Systems

We leverage the buffering capabilities of end-systems to achieve scalable, asynchronous delivery of streams in a peer-to-peer environment. Unlike existing cache-and-relay schemes, we propose a distributed prefetching protocol where peers prefetch and store portions of the streaming media ahead of their playout time, thus not only turning themselves to possible sources for other peers but their prefetched data can allow them to overcome the departure of their source-peer. This stands in sharp contrast to existing cache-and-relay schemes where the departure of the source-peer forces its peer children to go the original server, thus disrupting their service and increasing server and network load. Through mathematical analysis and simulations, we show the effectiveness of maintaining such asynchronous multicasts from several source-peers to other children peers, and the efficacy of prefetching in the face of peer departures. We confirm the scalability of our dPAM protocol as it is shown to significantly reduce server load.

TCP Boston: A Fragmentation-tolerant TCP Protocol for ATM Networks

The popularity of TCP/IP coupled with the premise of high speed communication using Asynchronous Transfer Mode (ATM) technology have prompted the network research community to propose a number of techniques to adapt TCP/IP to ATM network environments. ATM offers Available Bit Rate (ABR) and Unspecified Bit Rate (UBR) services for best-effort traffic, such as conventional file transfer. However, recent studies have shown that TCP/IP, when implemented using ABR or UBR, leads to serious performance degradations, especially when the utilization of network resources (such as switch buffers) is high. Proposed techniques-switch-level enhancements, for example-that attempt to patch up TCP/IP over ATMs have had limited success in alleviating this problem. The major reason for TCP/IP's poor performance over ATMs has been consistently attributed to packet fragmentation, which is the result of ATM's 53-byte cell-oriented switching architecture. In this paper, we present a new transport protocol, TCP Boston, that turns ATM's 53-byte cell-oriented switching architecture into an advantage for TCP/IP. At the core of TCP Boston is the Adaptive Information Dispersal Algorithm (AIDA), an efficient encoding technique that allows for dynamic redundancy control. AIDA makes TCP/IP's performance less sensitive to cell losses, thus ensuring a graceful degradation of TCP/IP's performance when faced with congested resources. In this paper, we introduce AIDA and overview the main features of TCP Boston. We present detailed simulation results that show the superiority of our protocol when compared to other adaptations of TCP/IP over ATMs. In particular, we show that TCP Boston improves TCP/IP's performance over ATMs for both network-centric metrics (e.g., effective throughput) and application-centric metrics (e.g., response time).

Validating Arbitrarily Large Network Protocol Compositions with Finite Computation

Formal tools like finite-state model checkers have proven useful in verifying the correctness of systems of bounded size and for hardening single system components against arbitrary inputs. However, conventional applications of these techniques are not well suited to characterizing emergent behaviors of large compositions of processes. In this paper, we present a methodology by which arbitrarily large compositions of components can, if sufficient conditions are proven concerning properties of small compositions, be modeled and completely verified by performing formal verifications upon only a finite set of compositions. The sufficient conditions take the form of reductions, which are claims that particular sequences of components will be causally indistinguishable from other shorter sequences of components. We show how this methodology can be applied to a variety of network protocol applications, including two features of the HTTP protocol, a simple active networking applet, and a proposed web cache consistency algorithm. We also doing discuss its applicability to framing protocol design goals and to representing systems which employ non-model-checking verification methodologies. Finally, we briefly discuss how we hope to broaden this methodology to more general topological compositions of network applications.

An Energy-conscious Transport Protocol for Multi-hop Wireless Networks

We present a transport protocol whose goal is to reduce power consumption without compromising delivery requirements of applications. To meet its goal of energy efficiency, our transport protocol (1) contains mechanisms to balance end-to-end vs. local retransmissions; (2) minimizes acknowledgment traffic using receiver regulated rate-based flow control combined with selected acknowledgements and in-network caching of packets; and (3) aggressively seeks to avoid any congestion-based packet loss. Within a recently developed ultra low-power multi-hop wireless network system, extensive simulations and experimental results demonstrate that our transport protocol meets its goal of preserving the energy efficiency of the underlying network.

JTP: An Energy-conscious Transport Protocol for Wireless Ad Hoc Networks

Within a recently developed low-power ad hoc network system, we present a transport protocol (JTP) whose goal is to reduce power consumption without trading off delivery requirements of applications. JTP has the following features: it is lightweight whereby end-nodes control in-network actions by encoding delivery requirements in packet headers; JTP enables applications to specify a range of reliability requirements, thus allocating the right energy budget to packets; JTP minimizes feedback control traffic from the destination by varying its frequency based on delivery requirements and stability of the network; JTP minimizes energy consumption by implementing in-network caching and increasing the chances that data retransmission requests from destinations "hit" these caches, thus avoiding costly source retransmissions; and JTP fairly allocates bandwidth among flows by backing off the sending rate of a source to account for in-network retransmissions on its behalf. Analysis and extensive simulations demonstrate the energy gains of JTP over one-size-fits-all transport protocols.

Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

Background: The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims: This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre. A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion: The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

Patient-centred screening for primary immunodeficiency: a multi-stage diagnostic protocol designed for non-immunologists.

Efficient early identification of primary immunodeficiency disease (PID) is important for prognosis, but is not an easy task for non-immunologists. The Clinical Working Party of the European Society for Immunodeficiencies (ESID) has composed a multi-stage diagnostic protocol that is based on expert opinion, in order to increase the awareness of PID among doctors working in different fields. The protocol starts from the clinical presentation of the patient; immunological skills are not needed for its use. The multi-stage design allows cost-effective screening for PID within the large pool of potential cases in all hospitals in the early phases, while more expensive tests are reserved for definitive classification in collaboration with an immunologist at a later stage. Although many PIDs present in childhood, others may present at any age. The protocols presented here are therefore aimed at both adult physicians and paediatricians. While designed for use throughout Europe, there will be national differences which may make modification of this generic algorithm necessary.

Randomised, prospective and cross-over comparison of Buseriline by intranasal spray versus D-triptoreline by intramuscular injection in long protocol, in in vitro fertilisation

info:eu-repo/semantics/nonPublished

Vascular structures for volumetric cooling and mechanical strength

When solid material is removed in order to create flow channels in a load carrying structure, the strength of the structure decreases. On the other hand, a structure with channels is lighter and easier to transport as part of a vehicle. Here, we show that this trade off can be used for benefit, to design a vascular mechanical structure. When the total amount of solid is fixed and the sizes, shapes, and positions of the channels can vary, it is possible to morph the flow architecture such that it endows the mechanical structure with maximum strength. The result is a multifunctional structure that offers not only mechanical strength but also new capabilities necessary for volumetric functionalities such as self-healing and self-cooling. We illustrate the generation of such designs for strength and fluid flow for several classes of vasculatures: parallel channels, trees with one, two, and three bifurcation levels. The flow regime in every channel is laminar and fully developed. In each case, we found that it is possible to select not only the channel dimensions but also their positions such that the entire structure offers more strength and less flow resistance when the total volume (or weight) and the total channel volume are fixed. We show that the minimized peak stress is smaller when the channel volume (φ) is smaller and the vasculature is more complex, i.e., with more levels of bifurcation. Diminishing returns are reached in both directions, decreasing φ and increasing complexity. For example, when φ=0.02 the minimized peak stress of a design with one bifurcation level is only 0.2% greater than the peak stress in the optimized vascular design with two levels of bifurcation. © 2010 American Institute of Physics.

Study protocol: home-based telehealth stroke care: a randomized trial for veterans.

BACKGROUND: Stroke is one of the most disabling and costly impairments of adulthood in the United States. Stroke patients clearly benefit from intensive inpatient care, but due to the high cost, there is considerable interest in implementing interventions to reduce hospital lengths of stay. Early discharge rehabilitation programs require coordinated, well-organized home-based rehabilitation, yet lack of sufficient information about the home setting impedes successful rehabilitation. This trial examines a multifaceted telerehabilitation (TR) intervention that uses telehealth technology to simultaneously evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative treatment, prescribe exercises tailored for stroke patients and provide periodic goal oriented reassessment, feedback and encouragement. METHODS: We describe an ongoing Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily the effect of TR on physical function and secondarily the effect on disability, falls-related self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b) Usual Care. The TR intervention uses a combination of three videotaped visits and five telephone calls, an in-home messaging device, and additional telephonic contact as needed over a 3-month study period, to provide a progressive rehabilitative intervention with a treatment goal of safe functional mobility of the individual within an accessible home environment. Dependent variables will be measured at baseline, 3-, and 6-months and analyzed with a linear mixed-effects model across all time points. DISCUSSION: For patients recovering from stroke, the use of TR to provide home assessments and follow-up training in prescribed equipment has the potential to effectively supplement existing home health services, assist transition to home and increase efficiency. This may be particularly relevant when patients live in remote locations, as is the case for many veterans. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00384748.

Study protocol: the Adherence and Intensification of Medications (AIM) study--a cluster randomized controlled effectiveness study.

BACKGROUND: Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. METHODS: In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP) measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL), medication adherence determined from pharmacy refill data, and medication intensification rates. DISCUSSION: Integration of the three intervention elements--proactive identification, adherence counseling and medication intensification--is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. TRIAL REGISTRATION: The ClinicalTrials.gov registration number is NCT00495794.

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Making sense of health information technology implementation: A qualitative study protocol.

BACKGROUND: Implementing new practices, such as health information technology (HIT), is often difficult due to the disruption of the highly coordinated, interdependent processes (e.g., information exchange, communication, relationships) of providing care in hospitals. Thus, HIT implementation may occur slowly as staff members observe and make sense of unexpected disruptions in care. As a critical organizational function, sensemaking, defined as the social process of searching for answers and meaning which drive action, leads to unified understanding, learning, and effective problem solving -- strategies that studies have linked to successful change. Project teamwork is a change strategy increasingly used by hospitals that facilitates sensemaking by providing a formal mechanism for team members to share ideas, construct the meaning of events, and take next actions. METHODS: In this longitudinal case study, we aim to examine project teams' sensemaking and action as the team prepares to implement new information technology in a tiertiary care hospital. Based on management and healthcare literature on HIT implementation and project teamwork, we chose sensemaking as an alternative to traditional models for understanding organizational change and teamwork. Our methods choices are derived from this conceptual framework. Data on project team interactions will be prospectively collected through direct observation and organizational document review. Through qualitative methods, we will identify sensemaking patterns and explore variation in sensemaking across teams. Participant demographics will be used to explore variation in sensemaking patterns. DISCUSSION: Outcomes of this research will be new knowledge about sensemaking patterns of project teams, such as: the antecedents and consequences of the ongoing, evolutionary, social process of implementing HIT; the internal and external factors that influence the project team, including team composition, team member interaction, and interaction between the project team and the larger organization; the ways in which internal and external factors influence project team processes; and the ways in which project team processes facilitate team task accomplishment. These findings will lead to new methods of implementing HIT in hospitals.