Development, implementation, and evaluation of a structured reporting web tool for abdominal aortic aneurysms

BACKGROUND The majority of radiological reports are lacking a standard structure. Even within a specialized area of radiology, each report has its individual structure with regards to details and order, often containing too much of non-relevant information the referring physician is not interested in. For gathering relevant clinical key parameters in an efficient way or to support long-term therapy monitoring, structured reporting might be advantageous. OBJECTIVE Despite of new technologies in medical information systems, medical reporting is still not dynamic. To improve the quality of communication in radiology reports, a new structured reporting system was developed for abdominal aortic aneurysms (AAA), intended to enhance professional communication by providing the pertinent clinical information in a predefined standard. METHODS Actual state analysis was performed within the departments of radiology and vascular surgery by developing a Technology Acceptance Model. The SWOT (strengths, weaknesses, opportunities, and threats) analysis focused on optimization of the radiology reporting of patients with AAA. Definition of clinical parameters was achieved by interviewing experienced clinicians in radiology and vascular surgery. For evaluation, a focus group (4 radiologists) looked at the reports of 16 patients. The usability and reliability of the method was validated in a real-world test environment in the field of radiology. RESULTS A Web-based application for radiological "structured reporting" (SR) was successfully standardized for AAA. Its organization comprises three main categories: characteristics of pathology and adjacent anatomy, measurements, and additional findings. Using different graphical widgets (eg, drop-down menus) in each category facilitate predefined data entries. Measurement parameters shown in a diagram can be defined for clinical monitoring and be adducted for quick adjudications. Figures for optional use to guide and standardize the reporting are embedded. Analysis of variance shows decreased average time required with SR to obtain a radiological report compared to free-text reporting (P=.0001). Questionnaire responses confirm a high acceptance rate by the user. CONCLUSIONS The new SR system may support efficient radiological reporting for initial diagnosis and follow-up for AAA. Perceived advantages of our SR platform are ease of use, which may lead to more accurate decision support. The new system is open to communicate not only with clinical partners but also with Radiology Information and Hospital Information Systems.

Testbed Evaluation of Sensor Node Overlay Multicast

The Sensor Node Overlay Multicast (SNOMC) protocol supports reliable, time-efficient and energy-efficient dissemination of data from one sender node to multiple receivers as it is needed for configuration, code update, and management operations in wireless sensor networks. SNOMC supports end-to-end reliability using negative acknowledgements. The mechanism is simple and easy to implement and can significantly reduce the number of transmissions. SNOMC supports three different caching strategies namely caching on each intermediate node, caching on branching nodes, or caching on the sender node only. SNOMC was evaluated in our in-house real-world testbed and compared to a number of common data dissemination protocols. It outperforms the selected protocols in terms of transmission time, number of transmitted packets, and energy-consumption.

Real-World Evaluation of Sensor Context-aware Adaptive Duty-cycled Opportunistic Routing

Energy is of primary concern in wireless sensor networks (WSNs). Low power transmission makes the wireless links unreliable, which leads to frequent topology changes. Resulting packet retransmissions aggravate the energy consumption. Beaconless routing approaches, such as opportunistic routing (OR) choose packet forwarders after data transmissions, and are promising to support dynamic features of WSNs. This paper proposes SCAD - Sensor Context-aware Adaptive Duty-cycled beaconless OR for WSNs. SCAD is a cross-layer routing solution and it brings the concept of beaconless OR into WSNs. SCAD selects packet forwarders based on multiple types of network contexts. To achieve a balance between performance and energy efficiency, SCAD adapts duty-cycles of sensors based on real-time traffic loads and energy drain rates. We implemented SCAD in TinyOS running on top of Tmote Sky sensor motes. Real-world evaluations show that SCAD outperforms other protocols in terms of both throughput and network lifetime.

Evaluation of respiratory function by barometric whole-body plethysmography in healthy dogs.

The objective of the present study was to assess the validity of barometric whole-body plethysmography (BWBP), to establish reference values, and to standardise a bronchoprovocative test to investigate airway responsiveness using BWBP in healthy dogs. BWBP measurements were obtained from six healthy beagle dogs using different protocols: (1) during three consecutive periods (3.5min each) in two morning and two evening sessions; (2) before and after administration of two protocols of sedation; (3) before and after nebulisation of saline and increasing concentrations of carbachol and histamine both in conscious dogs and in dogs under both protocols of sedation. Enhanced pause (PENH) was used as index of bronchoconstriction. Basal BWBP measurements were also obtained in 22 healthy dogs of different breeds, age and weight. No significant influence of either time spent in the chamber or daytime was found for most respiratory variables but a significant dog effect was detected for most variables. A significant body weight effect was found on tidal volume and peak flow values (P<0.05). Response to carbachol was not reproducible and always associated with side effects. Nebulisation of histamine induced a significant increase in respiratory rate, peak expiratory flow, peak expiratory flow/peak inspiratory flow ratio and PENH (P<0.05). The response was reproduced in each dog at different concentrations of histamine. Sedation with acepromazine+buprenorphine had little influence on basal measurements and did not change the results of histamine challenge. It was concluded that BWBP is a safe, non invasive and reliable technique of investigation of lung function in dogs which provides new opportunities to characterise respiratory status, to evaluate airway hyperresponsiveness and to assess therapeutic interventions.

Evaluation of HA-fibrin-based hydrogel for restoration of degenerated intervertebral disc

Introduction: Intervertebral disc degeneration is associated with loss of nucleus pulposus (NP) tissue and reduced disc height[1]. A number of therapies, including synthetic and natural biomaterials, have been developed to restore full disc function and to minimize the pain and disability caused by this disease. Fibrin-based biomaterials are used as a replacement for NP or as a cell carrier for tissue engineering approaches[2]. While the behavior of such gels is well-characterized from a material point of view, little is known about their contribution to intervertebral disc (IVD) restoration under dynamic loads. The aim of the present study is the evaluation of a hyaluronic acid fibrin-based hydrogel (ProCore) used to repair an in vitro model of disc degeneration under dynamic loading. Methods: In vitro model of disc degeneration was induced in intact coccygeal bovine IVD by papain digestion of the NP as previously described[3]. In order to characterize fibrin hydrogels, four experimental groups were considered: 1) intact IVD (control), 2) IVD injected with PBS, 3) injection of hydrogels in degenerative IVD and 4) injection of hydrogels in combination with human bone marrow-derived mesenchymal stem cells (MSC) in degenerative IVD. All of the groups were subjected to dynamic loading protocols consisting of 0.2MPa static compression superimposed with ±2° torsion at 0.2Hz for 8h per day and maintained for 7 days. Additionally, one group consisted of degenerative IVD injected with hydrogel and subjected to static compression. Disc heights were monitored after the duration of the loading and compared to the initial disc height. The macrostructure of the formed tissue and the cellular distribution was evaluated by histological means. Results: After one week of loading, the degenerative IVD filled with hydrogel in combination with MSC (dynamic load), hydrogels (dynamic load) and hydrogels (static load) showed a reduction in height by 30%, 15% and 20%, respectively, as compared to their initial disc height. Histological sections showed that the HA-fibrin gel fully occupied the nucleotomized region of the disc and that fibrin was effective in filling the discontinuities of the cavity region. Furthermore, the cells were homogenously distributed along the fibrin hydrogels after 7 days of loading. Discussion: In this study, we showed that fibrin hydrogels showed a good integration within the papain-induced model of disc degeneration and can withstand the applied loads. Fibrin hydrogels can contribute to disc restoration by possibly maintaining adequate stiffness of the tissue and thus preventing disorganization of the surrounding IVD. References: 1. Jarman, J.P., Arpinar, V.E., Baruah, D., Klein, A.P., Maiman, D.J., and Tugan Muftuler, L. (2014). Intervertebral disc height loss demonstrates the threshold of major pathological changes during degeneration. Eur Spine J . 2. Colombini, A., Ceriani, C., Banfi, G., Brayda-Bruno, M., and Moretti, M. (2014). Fibrin in intervertebral disc tissue engineering. Tissue Eng Part B Rev . 3. Chan, S.C., Bürki, A., Bonél, H.M., Benneker, L.M., and Gantenbein-Ritter, B. (2013). Papain-induced in vitro disc degeneration model for the study of injectable nucleus pulposus therapy. Spine J 13, 273-283. Acknowledgement We thank the Swiss National Science Foundation SNF #310030_153411 for funding.

Evaluation of the success of medical management for presumptive cervical intervertebral disk herniation in dogs.

OBJECTIVE To determine the success of medical management of presumptive cervical disk herniation in dogs and variables associated with treatment outcome. DESIGN Retrospective case series. ANIMALS Dogs (n=88) with presumptive cervical disk herniation. METHODS Dogs with presumptive cervical and thoracolumbar disk herniation were identified from medical records at 2 clinics and clients were mailed a questionnaire related to the success of therapy, clinical recurrence of signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records. RESULTS Ninety-seven percent of dogs (84/87) with complete information were described as ambulatory at initial evaluation. Successful treatment was reported for 48.9% of dogs with 33% having recurrence of clinical signs and 18.1% having therapeutic failure. Bivariable logistic regression showed that non-steroidal anti-inflammatory drug (NSAID) administration was associated with success (P=.035; odds ratio [OR]=2.52). Duration of cage rest and glucocorticoid administration were not significantly associated with success or QOL. Dogs with less-severe neurologic dysfunction were more likely to have a successful outcome (OR=2.56), but this association was not significant (P=.051). CONCLUSIONS Medical management can lead to an acceptable outcome in many dogs with presumptive cervical disk herniation. Based on these data, NSAIDs should be considered as part of the therapeutic regimen. Cage rest duration and glucocorticoid administration do not appear to benefit these dogs, but this should be interpreted cautiously because of the retrospective data collection and use of client self-administered questionnaire follow-up. CLINICAL RELEVANCE These results provide insight into the success of medical management for presumptive cervical disk herniation in dogs and may allow for refinement of treatment protocols.

Evaluation of the success of medical management for presumptive thoracolumbar intervertebral disk herniation in dogs.

OBJECTIVE To determine the success of medical management of presumptive thoracolumbar disk herniation in dogs and the variables associated with treatment outcome. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n=223) with presumptive thoracolumbar disk herniation. METHODS Medical records from 2 clinics were used to identify affected dogs, and owners were mailed a questionnaire about success of therapy, recurrence of clinical signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records. RESULTS Eighty-three percent of dogs (185/223) were ambulatory at initial evaluation. Successful treatment was reported for 54.7% of dogs, with 30.9% having recurrence of clinical signs and 14.4% classified as therapeutic failures. From bivariable logistic regression, glucocorticoid administration was negatively associated with success (P=.008; odds ratio [OR]=.48) and QOL scores (P=.004; OR=.48). The duration of cage rest was not significantly associated with success or QOL. Nonambulatory dogs were more likely to have lower QOL scores (P=.01; OR=2.34). CONCLUSIONS Medical management can lead to an acceptable outcome in many dogs with presumptive thoracolumbar disk herniation. Cage rest duration does not seem to affect outcome and glucocorticoids may negatively impact success and QOL. The conclusions in this report should be interpreted cautiously because of the retrospective data collection and the use of client self-administered questionnaire follow-up. CLINICAL RELEVANCE These results provide an insight into the success of medical management for presumptive thoracolumbar disk herniation in dogs and may allow for refinement of treatment protocols.

A Framework for Realistic and Systematic Multicast Performance Evaluation

Previous multicast research often makes commonly accepted but unverifed assumptions on network topologies and group member distribution in simulation studies. In this paper, we propose a framework to systematically evaluate multicast performance for different protocols. We identify a series of metrics, and carry out extensive simulation studies on these metrics with different topological models and group member distributions for three case studies. Our simulation results indicate that realistic topology and group membership models are crucial to accurate multicast performance evaluation. These results can provide guidance for multicast researchers to perform realistic simulations, and facilitate the design and development of multicast protocols.

Application of NMR techniques for the evaluation of fruit internal quality and physical properties of food

Los alimentos son sistemas complejos, formados por diversas estructuras a diferentes escalas: macroscópica y microscópica. Muchas propiedades de los alimentos, que son importantes para su procesamiento, calidad y tratamiento postcosecha, están relacionados con su microestructura. La presente tesis doctoral propone una metodología completa para la determinación de la estructura de alimentos desde un punto de vista multi-escala, basándose en métodos de Resonancia Magnética Nuclear (NMR). Las técnicas de NMR son no invasivas y no destructivas y permiten el estudio tanto de macro- como de microestructura. Se han utilizado distintos procedimientos de NMR dependiendo del nivel que se desea estudiar. Para el nivel macroestructural, la Imagen de Resonancia Magnética (MRI) ha resultado ser muy útil para la caracterización de alimentos. Para el estudio microestructural, la MRI requiere altos tiempos de adquisición, lo que hace muy difícil la transferencia de esta técnica a aplicaciones en industria. Por tanto, la optimización de procedimientos de NMR basados en secuencias relaxometría 2D T1/T2 ha resultado ser una estrategia primordial en esta tesis. Estos protocolos de NMR se han implementado satisfactoriamente por primera vez en alto campo magnético. Se ha caracterizado la microestructura de productos alimentarios enteros por primera vez utilizando este tipo de protocolos. Como muestras, se han utilizado dos tipos de productos: modelos de alimentos y alimentos reales (manzanas). Además, como primer paso para su posterior implementación en la industria agroalimentaria, se ha mejorado una línea transportadora, especialmente diseñada para trabajar bajo condiciones de NMR en trabajos anteriores del grupo LPF-TAGRALIA. Se han estudiado y seleccionado las secuencias más rápidas y óptimas para la detección de dos tipos de desórdenes internos en manzanas: vitrescencia y roturas internas. La corrección de las imágenes en movimiento se realiza en tiempo real. Asimismo, se han utilizado protocolos de visión artificial para la clasificación automática de manzanas potencialmente afectadas por vitrescencia. El presente documento está dividido en diferentes capítulos: el Capítulo 2 explica los antecedentes de la presente tesis y el marco del proyecto en el que se ha desarrollado. El Capítulo 3 recoge el estado del arte. El Capítulo 4 establece los objetivos de esta tesis doctoral. Los resultados se dividen en cinco sub-secciones (dentro del Capítulo 5) que corresponden con los trabajos publicados bien en revistas revisadas por pares, bien en congresos internacionales o bien como capítulos de libros revisados por pares. La Sección 5.1. es un estudio del desarrollo de la vitrescencia en manzanas mediante MRI y lo relaciona con la posición de la fruta dentro de la copa del árbol. La Sección 5.2 presenta un trabajo sobre macro- y microestructura en modelos de alimentos. La Sección 5.3 es un artículo en revisión en una revista revisada por pares, en el que se hace un estudio microestrcutural no destructivo mediante relaxometría 2D T1/T2. la Sección 5.4, hace una comparación entre manzanas afectadas por vitrescencia mediante dos técnicas: tomografía de rayos X e MRI, en manzana. Por último, en la Sección 5.5 se muestra un trabajo en el que se hace un estudio de secuencias de MRI en línea para la evaluación de calidad interna en manzanas. Los siguientes capítulos ofrecen una discusión y conclusiones (Capítulo 6 y 7 respectivamente) de todos los capítulos de esta tesis doctoral. Finalmente, se han añadido tres apéndices: el primero con una introducción de los principios básicos de resonancia magnética nuclear (NMR) y en los otros dos, se presentan sendos estudios sobre el efecto de las fibras en la rehidratación de cereales de desayuno extrusionados, mediante diversas técnicas. Ambos trabajos se presentaron en un congreso internacional. Los resultados más relevantes de la presente tesis doctoral, se pueden dividir en tres grandes bloques: resultados sobre macroestructura, resultados sobre microestructura y resultados sobre MRI en línea. Resultados sobre macroestructura: - La imagen de resonancia magnética (MRI) se aplicó satisfactoriamente para la caracterización de macroestructura. En particular, la reconstrucción 3D de imágenes de resonancia magnética permitió identificar y caracterizar dos tipos distintos de vitrescencia en manzanas: central y radial, que se caracterizan por el porcentaje de daño y la conectividad (número de Euler). - La MRI proveía un mejor contraste para manzanas afectadas por vitrescencia que las imágenes de tomografía de rayos X (X-Ray CT), como se pudo verificar en muestras idénticas de manzana. Además, el tiempo de adquisición de la tomografía de rayos X fue alrededor de 12 veces mayor (25 minutos) que la adquisición de las imágenes de resonancia magnética (2 minutos 2 segundos). Resultados sobre microestructura: - Para el estudio de microestructura (nivel subcelular) se utilizaron con éxito secuencias de relaxometría 2D T1/T2. Estas secuencias se usaron por primera vez en alto campo y sobre piezas de alimento completo, convirtiéndose en una forma no destructiva de llevar a cabo estudios de microestructura. - El uso de MRI junto con relaxometría 2D T1/T2 permite realizar estudios multiescala en alimentos de forma no destructiva. Resultados sobre MRI en línea: - El uso de imagen de resonancia magnética en línea fue factible para la identificación de dos tipos de desórdenes internos en manzanas: vitrescencia y podredumbre interna. Las secuencias de imagen tipo FLASH resultaron adecuadas para la identificación en línea de vitrescencia en manzanas. Se realizó sin selección de corte, debido a que la vitrescencia puede desarrollarse en cualquier punto del volumen de la manzana. Se consiguió reducir el tiempo de adquisición, de modo que se llegaron a adquirir 1.3 frutos por segundos (758 ms por fruto). Las secuencias de imagen tipo UFLARE fueron adecuadas para la detección en línea de la podredumbre interna en manzanas. En este caso, se utilizó selección de corte, ya que se trata de un desorden que se suele localizar en la parte central del volumen de la manzana. Se consiguió reducir el tiempo de adquisicón hasta 0.67 frutos por segundo (1475 ms por fruto). En ambos casos (FLASH y UFLARE) fueron necesarios algoritmos para la corrección del movimiento de las imágenes en tiempo real. ABSTRACT Food is a complex system formed by several structures at different scales: macroscopic and microscopic. Many properties of foods that are relevant to process engineering or quality and postharvest treatments are related to their microstructure. This Ph.D Thesis proposes a complete methodology for food structure determination, in a multiscale way, based on the Nuclear Magnetic Resonance (NMR) phenomenon since NMR techniques are non-invasive and non-destructive, and allow both, macro- and micro-structure study. Different NMR procedures are used depending on the structure level under study. For the macrostructure level, Magnetic Resonance Imaging (MRI) revealed its usefulness for food characterization. For microstructure insight, MRI required high acquisition times, which is a hindrance for transference to industry applications. Therefore, optimization of NMR procedures based on T1/T2 relaxometry sequences was a key strategy in this Thesis. These NMR relaxometry protocols, are successfully implemented in high magnetic field. Microstructure of entire food products have been characterized for the first time using these protocols. Two different types of food products have been studied: food models and actual food (apples). Furthermore, as a first step for the food industry implementation, a grading line system, specially designed for working under NMR conditions in previous works of the LPF-TAGRALIA group, is improved. The study and selection of the most suitable rapid sequence to detect two different types of disorders in apples (watercore and internal breakdown) is performed and the real time image motion correction is applied. In addition, artificial vision protocols for the automatic classification of apples potentially affected by watercore are applied. This document is divided into seven different chapters: Chapter 2 explains the thesis background and the framework of the project in which it has been worked. Chapter 3 comprises the state of the art. Chapter 4 establishes de objectives of this Ph.D thesis. The results are divided into five different sections (in Chapter 5) that correspond to published peered reviewed works. Section 5.1 assesses the watercore development in apples with MRI and studies the effect of fruit location in the canopy. Section 5.2 is an MRI and 2D relaxometry study for macro- and microstructure assessment in food models. Section 5.3 is a non-destructive microstructural study using 2D T1/T2 relaxometry on watercore affected apples. Section 5.4 makes a comparison of X-ray CT and MRI on watercore disorder of different apple cultivars. Section 5.5, that is a study of online MRI sequences for the evaluation of apple internal quality. The subsequent chapters offer a general discussion and conclusions (Chapter 6 and Chapter 7 respectively) of all the works performed in the frame of this Ph.D thesis (two peer reviewed journals, one book chapter and one international congress).Finally, three appendices are included in which an introduction to NMR principles is offered and two published proceedings regarding the effect of fiber on the rehydration of extruded breakfast cereal are displayed. The most relevant results can be summarized into three sections: results on macrostructure, results on microstructure and results on on-line MRI. Results on macrostructure: - MRI was successfully used for macrostructure characterization. Indeed, 3D reconstruction of MRI in apples allows to identify two different types of watercore (radial and block), which are characterized by the percentage of damage and the connectivity (Euler number). - MRI provides better contrast for watercore than X-Ray CT as verified on identical samples. Furthermore, X-Ray CT images acquisition time was around 12 times higher (25 minutes) than MRI acquisition time (2 minutes 2 seconds). Results on microstructure: - 2D T1/T2 relaxometry were successfully applied for microstructure (subcellular level) characterization. 2D T1/T2 relaxometry sequences have been applied for the first time on high field for entire food pieces, being a non-destructive way to achieve microstructure study. - The use of MRI together with 2D T1/T2 relaxometry sequences allows a non-destructive multiscale study of food. Results on on-line MRI: - The use of on-line MRI was successful for the identification of two different internal disorders in apples: watercore and internal breakdown. FLASH imaging was a suitable technique for the on-line detection of watercore disorder in apples, with no slice selection, since watercore is a physiological disorder that may be developed anywhere in the apple volume. 1.3 fruits were imaged per second (768 ms per fruit). UFLARE imaging is a suitable sequence for the on-line detection of internal breakdown disorder in apples. Slice selection was used, as internal breakdown is usually located in the central slice of the apple volume. 0.67 fruits were imaged per second (1475 ms per fruit). In both cases (FLASH and UFLARE) motion correction was performed in real time, during the acquisition of the images.

Performance evaluation of database replication systems.

One of the most demanding needs in cloud computing is that of having scalable and highly available databases. One of the ways to attend these needs is to leverage the scalable replication techniques developed in the last decade. These techniques allow increasing both the availability and scalability of databases. Many replication protocols have been proposed during the last decade. The main research challenge was how to scale under the eager replication model, the one that provides consistency across replicas. In this paper, we examine three eager database replication systems available today: Middle-R, C-JDBC and MySQL Cluster using TPC-W benchmark. We analyze their architecture, replication protocols and compare the performance both in the absence of failures and when there are failures.

Evaluating treatment protocols to prevent antibiotic resistance

The spread of bacteria resistant to antimicrobial agents calls for population-wide treatment strategies to delay or reverse the trend toward antibiotic resistance. Here we propose new criteria for the evaluation of the population-wide effects of treatment protocols for directly transmitted bacterial infections and discuss different usage patterns for single and multiple antibiotic therapy. A mathematical model suggests that the long-term benefit of single drug treatment from introduction of the antibiotic until a high frequency of resistance precludes its use is almost independent of the pattern of antibiotic use. When more than one antibiotic is employed, sequential use of different antibiotics in the population (“cycling”) is always inferior to treatment strategies where, at any given time, equal fractions of the population receive different antibiotics. However, treatment of all patients with a combination of antibiotics is in most cases the optimal treatment strategy.

Ontological evaluation of enterprise systems interoperability using ebXML

Enterprise systems interoperability (ESI) is an important topic for business currently. This situation is evidenced, at least in part, by the number and extent of potential candidate protocols for such process interoperation, viz., ebXML, BPML, BPEL, and WSCI. Wide-ranging support for each of these candidate standards already exists. However, despite broad acceptance, a sound theoretical evaluation of these approaches has not yet been provided. We use the Bunge-Wand-Weber (BWW) models, in particular, the representation model, to provide the basis for such a theoretical evaluation. We, and other researchers, have shown the usefulness of the representation model for analyzing, evaluating, and engineering techniques in the areas of traditional and structured systems analysis, object-oriented modeling, and process modeling. In this work, we address the question, what are the potential semantic weaknesses of using ebXML alone for process interoperation between enterprise systems? We find that users will lack important implementation information because of representational deficiencies; due to ontological redundancy, the complexity of the specification is unnecessarily increased; and, users of the specification will have to bring in extra-model knowledge to understand constructs in the specification due to instances of ontological excess.

An evaluation of TCP over wired-to-wireless networks

To exploit the popularity of TCP as still the dominant sender and protocol of choice for transporting data reliably across the heterogeneous Internet, this thesis explores end-to-end performance issues and behaviours of TCP senders when transferring data to wireless end-users. The theme throughout is on end-users located specifically within 802.11 WLANs at the edges of the Internet, a largely untapped area of work. To exploit the interests of researchers wanting to study the performance of TCP accurately over heterogeneous conditions, this thesis proposes a flexible wired-to-wireless experimental testbed that better reflects conditions in the real-world. To exploit the transparent functionalities between TCP in the wired domain and the IEEE 802.11 WLAN protocols, this thesis proposes a more accurate methodology for gauging the transmission and error characteristics of real-world 802.11 WLANs. It also aims to correlate any findings with the functionality of fixed TCP senders. To exploit the popularity of Linux as a popular operating system for many of the Internet’s data servers, this thesis studies and evaluates various sender-side TCP congestion control implementations within the recent Linux v2.6. A selection of the implementations are put under systematic testing using real-world wired-to-wireless conditions in order to screen and present a viable candidate/s for further development and usage in the modern-day heterogeneous Internet. Overall, this thesis comprises a set of systematic evaluations of TCP senders over 802.11 WLANs, incorporating measurements in the form of simulations, emulations, and through the use of a real-world-like experimental testbed. The goal of the work is to ensure that all aspects concerned are comprehensively investigated in order to establish rules that can help to decide under which circumstances the deployment of TCP is optimal i.e. a set of paradigms for advancing the state-of-the-art in data transport across the Internet.

Evaluation of dry eye

Dry eye is a common yet complex condition. Intrinsic and extrinsic factors can cause dysfunction of the lids, lacrimal glands, meibomian glands, ocular surface cells, or neural network. These problems would ultimately be expressed at the tear film-ocular surface interface. The manifestations of these problems are experienced as symptoms such as grittiness, discomfort, burning sensation, hyperemia, and secondary epiphora in some cases. Accurate investigation of dry eye is crucial to correct management of the condition. Techniques can be classed according to their investigation of tear production, tear stability, and surface damage (including histological tests). The application, validity, reliability, compatibility, protocols, and indications for these are important. The use of a diagnostic algorithm may lead to more accurate diagnosis and management. The lack of correlation between signs and symptoms seems to favor tear film osmolarity, an objective biomarker, as the best current clue to correct diagnosis.

Evaluation of hemifield sector analysis protocol in multifocal visual evoked potential (MFVEP) objective perimetry for the diagnosis and early detection of glaucomatous field defects

Visual field assessment is a core component of glaucoma diagnosis and monitoring, and the Standard Automated Perimetry (SAP) test is considered up until this moment, the gold standard of visual field assessment. Although SAP is a subjective assessment and has many pitfalls, it is being constantly used in the diagnosis of visual field loss in glaucoma. Multifocal visual evoked potential (mfVEP) is a newly introduced method used for visual field assessment objectively. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study, we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. OBJECTIVES: The purpose of this study is to examine the effectiveness of a new analysis method in the Multi-Focal Visual Evoked Potential (mfVEP) when it is used for the objective assessment of the visual field in glaucoma patients, compared to the gold standard technique. METHODS: 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the 3 groups in the mean signal to noise ratio SNR (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). sensitivity and specificity of the HAS protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. DISCUSSION: The results showed that the new analysis protocol was able to confirm already existing field defects detected by standard HFA, was able to differentiate between the 3 study groups with a clear distinction between normal and patients with suspected glaucoma; however the distinction between normal and glaucoma patients was especially clear and significant. CONCLUSION: The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss.