Auto-Configuration Protocols in Mobile Ad Hoc Networks

PubMed Central

Villalba, Luis Javier García; Matesanz, Julián García; Orozco, Ana Lucila Sandoval; Díaz, José Duván Márquez

2011-01-01

The TCP/IP protocol allows the different nodes in a network to communicate by associating a different IP address to each node. In wired or wireless networks with infrastructure, we have a server or node acting as such which correctly assigns IP addresses, but in mobile ad hoc networks there is no such centralized entity capable of carrying out this function. Therefore, a protocol is needed to perform the network configuration automatically and in a dynamic way, which will use all nodes in the network (or part thereof) as if they were servers that manage IP addresses. This article reviews the major proposed auto-configuration protocols for mobile ad hoc networks, with particular emphasis on one of the most recent: D2HCP. This work also includes a comparison of auto-configuration protocols for mobile ad hoc networks by specifying the most relevant metrics, such as a guarantee of uniqueness, overhead, latency, dependency on the routing protocol and uniformity. PMID:22163814

Sputnik: ad hoc distributed computation.

PubMed

Völkel, Gunnar; Lausser, Ludwig; Schmid, Florian; Kraus, Johann M; Kestler, Hans A

2015-04-15

In bioinformatic applications, computationally demanding algorithms are often parallelized to speed up computation. Nevertheless, setting up computational environments for distributed computation is often tedious. Aim of this project were the lightweight ad hoc set up and fault-tolerant computation requiring only a Java runtime, no administrator rights, while utilizing all CPU cores most effectively. The Sputnik framework provides ad hoc distributed computation on the Java Virtual Machine which uses all supplied CPU cores fully. It provides a graphical user interface for deployment setup and a web user interface displaying the current status of current computation jobs. Neither a permanent setup nor administrator privileges are required. We demonstrate the utility of our approach on feature selection of microarray data. The Sputnik framework is available on Github http://github.com/sysbio-bioinf/sputnik under the Eclipse Public License. hkestler@fli-leibniz.de or hans.kestler@uni-ulm.de Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Trust recovery model of Ad Hoc network based on identity authentication scheme

NASA Astrophysics Data System (ADS)

Liu, Jie; Huan, Shuiyuan

2017-05-01

Mobile Ad Hoc network trust model is widely used to solve mobile Ad Hoc network security issues. Aiming at the problem of reducing the network availability caused by the processing of malicious nodes and selfish nodes in mobile Ad Hoc network routing based on trust model, an authentication mechanism based on identity authentication mobile Ad Hoc network is proposed, which uses identity authentication to identify malicious nodes, And trust the recovery of selfish nodes in order to achieve the purpose of reducing network congestion and improving network quality. The simulation results show that the implementation of the mechanism can effectively improve the network availability and security.

MWAHCA: A Multimedia Wireless Ad Hoc Cluster Architecture

PubMed Central

Diaz, Juan R.; Jimenez, Jose M.; Sendra, Sandra

2014-01-01

Wireless Ad hoc networks provide a flexible and adaptable infrastructure to transport data over a great variety of environments. Recently, real-time audio and video data transmission has been increased due to the appearance of many multimedia applications. One of the major challenges is to ensure the quality of multimedia streams when they have passed through a wireless ad hoc network. It requires adapting the network architecture to the multimedia QoS requirements. In this paper we propose a new architecture to organize and manage cluster-based ad hoc networks in order to provide multimedia streams. Proposed architecture adapts the network wireless topology in order to improve the quality of audio and video transmissions. In order to achieve this goal, the architecture uses some information such as each node's capacity and the QoS parameters (bandwidth, delay, jitter, and packet loss). The architecture splits the network into clusters which are specialized in specific multimedia traffic. The real system performance study provided at the end of the paper will demonstrate the feasibility of the proposal. PMID:24737996

MWAHCA: a multimedia wireless ad hoc cluster architecture.

PubMed

Diaz, Juan R; Lloret, Jaime; Jimenez, Jose M; Sendra, Sandra

2014-01-01

Wireless Ad hoc networks provide a flexible and adaptable infrastructure to transport data over a great variety of environments. Recently, real-time audio and video data transmission has been increased due to the appearance of many multimedia applications. One of the major challenges is to ensure the quality of multimedia streams when they have passed through a wireless ad hoc network. It requires adapting the network architecture to the multimedia QoS requirements. In this paper we propose a new architecture to organize and manage cluster-based ad hoc networks in order to provide multimedia streams. Proposed architecture adapts the network wireless topology in order to improve the quality of audio and video transmissions. In order to achieve this goal, the architecture uses some information such as each node's capacity and the QoS parameters (bandwidth, delay, jitter, and packet loss). The architecture splits the network into clusters which are specialized in specific multimedia traffic. The real system performance study provided at the end of the paper will demonstrate the feasibility of the proposal.

Hybrid Packet-Pheromone-Based Probabilistic Routing for Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Kashkouli Nejad, Keyvan; Shawish, Ahmed; Jiang, Xiaohong; Horiguchi, Susumu

Ad-Hoc networks are collections of mobile nodes communicating using wireless media without any fixed infrastructure. Minimal configuration and quick deployment make Ad-Hoc networks suitable for emergency situations like natural disasters or military conflicts. The current Ad-Hoc networks can only support either high mobility or high transmission rate at a time because they employ static approaches in their routing schemes. However, due to the continuous expansion of the Ad-Hoc network size, node-mobility and transmission rate, the development of new adaptive and dynamic routing schemes has become crucial. In this paper we propose a new routing scheme to support high transmission rates and high node-mobility simultaneously in a big Ad-Hoc network, by combining a new proposed packet-pheromone-based approach with the Hint Based Probabilistic Protocol (HBPP) for congestion avoidance with dynamic path selection in packet forwarding process. Because of using the available feedback information, the proposed algorithm does not introduce any additional overhead. The extensive simulation-based analysis conducted in this paper indicates that the proposed algorithm offers small packet-latency and achieves a significantly higher delivery probability in comparison with the available Hint-Based Probabilistic Protocol (HBPP).

Quantum load balancing in ad hoc networks

NASA Astrophysics Data System (ADS)

Hasanpour, M.; Shariat, S.; Barnaghi, P.; Hoseinitabatabaei, S. A.; Vahid, S.; Tafazolli, R.

2017-06-01

This paper presents a novel approach in targeting load balancing in ad hoc networks utilizing the properties of quantum game theory. This approach benefits from the instantaneous and information-less capability of entangled particles to synchronize the load balancing strategies in ad hoc networks. The quantum load balancing (QLB) algorithm proposed by this work is implemented on top of OLSR as the baseline routing protocol; its performance is analyzed against the baseline OLSR, and considerable gain is reported regarding some of the main QoS metrics such as delay and jitter. Furthermore, it is shown that QLB algorithm supports a solid stability gain in terms of throughput which stands a proof of concept for the load balancing properties of the proposed theory.

Supporting Dynamic Ad hoc Collaboration Capabilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agarwal, Deborah A.; Berket, Karlo

2003-07-14

Modern HENP experiments such as CMS and Atlas involve as many as 2000 collaborators around the world. Collaborations this large will be unable to meet often enough to support working closely together. Many of the tools currently available for collaboration focus on heavy-weight applications such as videoconferencing tools. While these are important, there is a more basic need for tools that support connecting physicists to work together on an ad hoc or continuous basis. Tools that support the day-to-day connectivity and underlying needs of a group of collaborators are important for providing light-weight, non-intrusive, and flexible ways to work collaboratively.more » Some example tools include messaging, file-sharing, and shared plot viewers. An important component of the environment is a scalable underlying communication framework. In this paper we will describe our current progress on building a dynamic and ad hoc collaboration environment and our vision for its evolution into a HENP collaboration environment.« less

A Decentralized VPN Service over Generalized Mobile Ad-Hoc Networks

NASA Astrophysics Data System (ADS)

Fujita, Sho; Shima, Keiichi; Uo, Yojiro; Esaki, Hiroshi

We present a decentralized VPN service that can be built over generalized mobile ad-hoc networks (Generalized MANETs), in which topologies can be represented as a time-varying directed multigraph. We address wireless ad-hoc networks and overlay ad-hoc networks as instances of Generalized MANETs. We first propose an architecture to operate on various kinds of networks through a single set of operations. Then, we design and implement a decentralized VPN service on the proposed architecture. Through the development and operation of a prototype system we implemented, we found that the proposed architecture makes the VPN service applicable to each instance of Generalized MANETs, and that the VPN service makes it possible for unmodified applications to operate on the networks.

Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI.

PubMed

Bonzel, Tassilo; Schächinger, Volker; Dörge, Hilmar

2016-05-01

We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p < 0.057), but mortality was higher in 1.PCI patients with

Intelligent Sensing and Classification in DSR-Based Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Dempsey, Tae; Sahin, Gokhan; Morton, Yu T. (Jade

Wireless ad hoc networks have fundamentally altered today's battlefield, with applications ranging from unmanned air vehicles to randomly deployed sensor networks. Security and vulnerabilities in wireless ad hoc networks have been considered at different layers, and many attack strategies have been proposed, including denial of service (DoS) through the intelligent jamming of the most critical packet types of flows in a network. This paper investigates the effectiveness of intelligent jamming in wireless ad hoc networks using the Dynamic Source Routing (DSR) and TCP protocols and introduces an intelligent classifier to facilitate the jamming of such networks. Assuming encrypted packet headers and contents, our classifier is based solely on the observable characteristics of size, inter-arrival timing, and direction and classifies packets with up to 99.4% accuracy in our experiments.

Initial Report of the Deans Cyber Warfare Ad Hoc Committee

DTIC Science & Technology

2011-12-22

in a cyber warfare environment. Among the more notable recent developments have been the establishment of a new Cyber Warfare Command (USCYBERCOM) at...information-warfare-centric organization. Clearly, future Naval Academy graduates will be expected to know more about cyber warfare than those we have...graduated in the past. The Academic Dean and Provost tasked an ad hoc committeethe Cyber Warfare ad hoc Committeeto examine how USNA can best ensure that

Global Coverage from Ad-Hoc Constellations in Rideshare Orbits

NASA Technical Reports Server (NTRS)

Ellis, Armin; Mercury, Michael; Brown, Shannon

2012-01-01

A promising area of small satellite development is in providing higher temporal resolution than larger satellites. Traditional constellations have required specific orbits and dedicated launch vehicles. In this paper we discuss an alternative architecture in which the individual elements of the constellation are launched as rideshare opportunities. We compare the coverage of such an ad-hoc constellation with more traditional constellations. Coverage analysis is based on actual historical data from rideshare opportunities. Our analysis includes ground coverage and temporal revisits for Polar, Tropics, Temperate, and Global regions, comparing ad-hoc and Walker constellation.

The effects of malicious nodes on performance of mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Li, Fanzhi; Shi, Xiyu; Jassim, Sabah; Adams, Christopher

2006-05-01

Wireless ad hoc networking offers convenient infrastructureless communication over the shared wireless channel. However, the nature of ad hoc networks makes them vulnerable to security attacks. Unlike their wired counterpart, infrastructureless ad hoc networks do not have a clear line of defense, their topology is dynamically changing, and every mobile node can receive messages from its neighbors and can be contacted by all other nodes in its neighborhood. This poses a great danger to network security if some nodes behave in a malicious manner. The immediate concern about the security in this type of networks is how to protect the network and the individual mobile nodes against malicious act of rogue nodes from within the network. This paper is concerned with security aspects of wireless ad hoc networks. We shall present results of simulation experiments on ad hoc network's performance in the presence of malicious nodes. We shall investigate two types of attacks and the consequences will be simulated and quantified in terms of loss of packets and other factors. The results show that network performance, in terms of successful packet delivery ratios, significantly deteriorates when malicious nodes act according to the defined misbehaving characteristics.

Packets Distributing Evolutionary Algorithm Based on PSO for Ad Hoc Network

NASA Astrophysics Data System (ADS)

Xu, Xiao-Feng

2018-03-01

Wireless communication network has such features as limited bandwidth, changeful channel and dynamic topology, etc. Ad hoc network has lots of difficulties in accessing control, bandwidth distribution, resource assign and congestion control. Therefore, a wireless packets distributing Evolutionary algorithm based on PSO (DPSO)for Ad Hoc Network is proposed. Firstly, parameters impact on performance of network are analyzed and researched to obtain network performance effective function. Secondly, the improved PSO Evolutionary Algorithm is used to solve the optimization problem from local to global in the process of network packets distributing. The simulation results show that the algorithm can ensure fairness and timeliness of network transmission, as well as improve ad hoc network resource integrated utilization efficiency.

Ad Hoc Information Extraction for Clinical Data Warehouses.

PubMed

Dietrich, Georg; Krebs, Jonathan; Fette, Georg; Ertl, Maximilian; Kaspar, Mathias; Störk, Stefan; Puppe, Frank

2018-05-01

Clinical Data Warehouses (CDW) reuse Electronic health records (EHR) to make their data retrievable for research purposes or patient recruitment for clinical trials. However, much information are hidden in unstructured data like discharge letters. They can be preprocessed and converted to structured data via information extraction (IE), which is unfortunately a laborious task and therefore usually not available for most of the text data in CDW. The goal of our work is to provide an ad hoc IE service that allows users to query text data ad hoc in a manner similar to querying structured data in a CDW. While search engines just return text snippets, our systems also returns frequencies (e.g. how many patients exist with "heart failure" including textual synonyms or how many patients have an LVEF < 45) based on the content of discharge letters or textual reports for special investigations like heart echo. Three subtasks are addressed: (1) To recognize and to exclude negations and their scopes, (2) to extract concepts, i.e. Boolean values and (3) to extract numerical values. We implemented an extended version of the NegEx-algorithm for German texts that detects negations and determines their scope. Furthermore, our document oriented CDW PaDaWaN was extended with query functions, e.g. context sensitive queries and regex queries, and an extraction mode for computing the frequencies for Boolean and numerical values. Evaluations in chest X-ray reports and in discharge letters showed high F1-scores for the three subtasks: Detection of negated concepts in chest X-ray reports with an F1-score of 0.99 and in discharge letters with 0.97; of Boolean values in chest X-ray reports about 0.99, and of numerical values in chest X-ray reports and discharge letters also around 0.99 with the exception of the concept age. The advantages of an ad hoc IE over a standard IE are the low development effort (just entering the concept with its variants), the promptness of the results and the

A Group Based Key Sharing and Management Algorithm for Vehicular Ad Hoc Networks

PubMed Central

Moharram, Mohammed Morsi; Azam, Farzana

2014-01-01

Vehicular ad hoc networks (VANETs) are one special type of ad hoc networks that involves vehicles on roads. Typically like ad hoc networks, broadcast approach is used for data dissemination. Blind broadcast to each and every node results in exchange of useless and irrelevant messages and hence creates an overhead. Unicasting is not preferred in ad-hoc networks due to the dynamic topology and the resource requirements as compared to broadcasting. Simple broadcasting techniques create several problems on privacy, disturbance, and resource utilization. In this paper, we propose media mixing algorithm to decide what information should be provided to each user and how to provide such information. Results obtained through simulation show that fewer number of keys are needed to share compared to simple broadcasting. Privacy is also enhanced through this approach. PMID:24587749

Decentralized session initiation protocol solution in ad hoc networks

NASA Astrophysics Data System (ADS)

Han, Lu; Jin, Zhigang; Shu, Yantai; Dong, Linfang

2006-10-01

With the fast development of ad hoc networks, SIP has attracted more and more attention in multimedia service. This paper proposes a new architecture to provide SIP service for ad hoc users, although there is no centralized SIP server deployed. In this solution, we provide the SIP service by the introduction of two nodes: Designated SIP Server (DS) and its Backup Server (BDS). The nodes of ad hoc network designate DS and BDS when they join the session nodes set and when some pre-defined events occur. A new sip message type called REGISTRAR is presented so nodes can send others REGISTRAR message to declare they want to be DS. According to the IP information taken in the message, an algorithm works like the election of DR and BDR in OSPF protocol is used to vote DS and BDS SIP servers. Naturally, the DS will be replaced by BDS when the DS is down for predicable or unpredictable reasons. To facilitate this, the DS should register to the BDS and transfer a backup of the SIP users' database. Considering the possibility DS or BDS may abruptly go down, a special policy is given. When there is no DS and BDS, a new election procedure is triggered just like the startup phase. The paper also describes how SIP works normally in the decentralized model as well as the evaluation of its performance. All sessions based on SIP in ad hoc such as DS voting have been tested in the real experiments within a 500m*500m square area where about 30 random nodes are placed.

Information Sharing Modalities for Mobile Ad-Hoc Networks

NASA Astrophysics Data System (ADS)

de Spindler, Alexandre; Grossniklaus, Michael; Lins, Christoph; Norrie, Moira C.

Current mobile phone technologies have fostered the emergence of a new generation of mobile applications. Such applications allow users to interact and share information opportunistically when their mobile devices are in physical proximity or close to fixed installations. It has been shown how mobile applications such as collaborative filtering and location-based services can take advantage of ad-hoc connectivity to use physical proximity as a filter mechanism inherent to the application logic. We discuss the different modes of information sharing that arise in such settings based on the models of persistence and synchronisation. We present a platform that supports the development of applications that can exploit these modes of ad-hoc information sharing and, by means of an example, show how such an application can be realised based on the supported event model.

Interference Drop Scheme: Enhancing QoS Provision in Multi-Hop Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Luo, Chang-Yi; Komuro, Nobuyoshi; Takahashi, Kiyoshi; Kasai, Hiroyuki; Ueda, Hiromi; Tsuboi, Toshinori

Ad hoc networking uses wireless technologies to construct networks with no physical infrastructure and so are expected to provide instant networking in areas such as disaster recovery sites and inter-vehicle communication. Unlike conventional wired networks services, services in ad hoc networks are easily disrupted by the frequent changes in traffic and topology. Therefore, solutions to assure the Quality of Services (QoS) in ad hoc networks are different from the conventional ones used in wired networks. In this paper, we propose a new queue management scheme, Interference Drop Scheme (IDS) for ad hoc networks. In the conventional queue management approaches such as FIFO (First-in First-out) and RED (Random Early Detection), a queue is usually managed by a queue length limit. FIFO discards packets according to the queue limit, and RED discards packets in an early and random fashion. IDS, on the other hand, manages the queue according to wireless interference time, which increases as the number of contentions in the MAC layer increases. When there are many MAC contentions, IDS discards TCP data packets. By observing the interference time and discarding TCP data packets, our simulation results show that IDS improves TCP performance and reduces QoS violations in UDP in ad hoc networks with chain, grid, and random topologies. Our simulation results also demonstrate that wireless interference time is a better metric than queue length limit for queue management in multi-hop ad hoc networks.

Anomaly Detection Techniques for Ad Hoc Networks

ERIC Educational Resources Information Center

Cai, Chaoli

2009-01-01

Anomaly detection is an important and indispensable aspect of any computer security mechanism. Ad hoc and mobile networks consist of a number of peer mobile nodes that are capable of communicating with each other absent a fixed infrastructure. Arbitrary node movements and lack of centralized control make them vulnerable to a wide variety of…

Timing of intervention in high-risk non-ST-elevation acute coronary syndromes in PCI versus non-PCI centres : Sub-group analysis of the ELISA-3 trial.

PubMed

Badings, E A; Remkes, W S; Dambrink, J-H E; The, S H K; Van Wijngaarden, J; Tjeerdsma, G; Rasoul, S; Timmer, J R; van der Wielen, M L J; Lok, D J A; van 't Hof, A W J

2016-03-01

To compare the effect of timing of intervention in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in percutaneous coronary intervention (PCI) versus non-PCI centres. A post-hoc sub-analysis was performed of the ELISA III trial, a randomised multicentre trial investigating outcome of early (< 12 h) versus late (> 48 h) angiography and revascularisation in 542 patients with high-risk NSTE-ACS. 90 patients were randomised in non-PCI centres and tended to benefit more from an early invasive strategy than patients included in the PCI centre (relative risk 0.23 vs. 0.85 [p for interaction = 0.089] for incidence of the combined primary endpoint of death, reinfarction and recurrent ischaemia after 30 days of follow-up). This was largely driven by reduction in recurrent ischaemia. In non-PCI centres, patients randomised to the late group had a 4 and 7 day longer period until PCI or coronary artery bypass grafting, respectively. This difference was less pronounced in the PCI centre. This post-hoc analysis from the ELISA-3 trial suggests that NSTE-ACS patients initially hospitalised in non-PCI centres show the largest benefit from early angiography and revascularisation, associated with a shorter waiting time to revascularisation. Improved patient logistics and transfer between non-PCI and PCI centres might therefore result in better clinical outcome.

MAC Protocol for Ad Hoc Networks Using a Genetic Algorithm

PubMed Central

Elizarraras, Omar; Panduro, Marco; Méndez, Aldo L.

2014-01-01

The problem of obtaining the transmission rate in an ad hoc network consists in adjusting the power of each node to ensure the signal to interference ratio (SIR) and the energy required to transmit from one node to another is obtained at the same time. Therefore, an optimal transmission rate for each node in a medium access control (MAC) protocol based on CSMA-CDMA (carrier sense multiple access-code division multiple access) for ad hoc networks can be obtained using evolutionary optimization. This work proposes a genetic algorithm for the transmission rate election considering a perfect power control, and our proposition achieves improvement of 10% compared with the scheme that handles the handshaking phase to adjust the transmission rate. Furthermore, this paper proposes a genetic algorithm that solves the problem of power combining, interference, data rate, and energy ensuring the signal to interference ratio in an ad hoc network. The result of the proposed genetic algorithm has a better performance (15%) compared to the CSMA-CDMA protocol without optimizing. Therefore, we show by simulation the effectiveness of the proposed protocol in terms of the throughput. PMID:25140339

75 FR 43565 - NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice: (10-084)] NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting AGENCY: National Aeronautics and Space Administration. ACTION... amended, the National Aeronautics and Space Administration announces a two-part meeting of the Ad-Hoc Task...

75 FR 33838 - NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice (10-065)] NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting AGENCY: National Aeronautics and Space Administration. ACTION... amended, the National Aeronautics and Space Administration announces a meeting of the Ad-Hoc Task Force on...

75 FR 15742 - NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-30

... NATIONAL AERONAUTICS AND SPACE ADMINISTRATION [Notice: (10-035)] NASA Advisory Council; Ad-Hoc Task Force on Planetary Defense; Meeting AGENCY: National Aeronautics and Space Administration. ACTION... amended, the National Aeronautics and Space Administration announces a meeting of the Ad-Hoc Task Force on...

Providing Location Security in Vehicular Ad Hoc Networks

ERIC Educational Resources Information Center

Yan, Gongjun

2010-01-01

Location is fundamental information in Vehicular Ad-hoc Networks (VANETs). Almost all VANET applications rely on location information. Therefore it is of importance to ensure location information integrity, meaning that location information is original (from the generator), correct (not bogus or fabricated) and unmodified (value not changed). We…

What Is the Problem of Ad Hoc Hypotheses?

ERIC Educational Resources Information Center

Bamford, Greg

1999-01-01

Philosophers' attempts to convincingly explicate the received view of an ad hoc hypothesis--that it accounts for only the observations it was designed to account for--have been unsuccessful. Familiar and firmer criteria for evaluating the hypotheses or modified theories so classified are characteristically available. Contains 41 references.…

29 CFR 1912.11 - Terms of ad hoc committee members.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 7 2011-07-01 2011-07-01 false Terms of ad hoc committee members. 1912.11 Section 1912.11 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADVISORY COMMITTEES ON STANDARDS Organizational Matters § 1912.11 Terms of ad...

29 CFR 1912.11 - Terms of ad hoc committee members.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Terms of ad hoc committee members. 1912.11 Section 1912.11 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADVISORY COMMITTEES ON STANDARDS Organizational Matters § 1912.11 Terms of ad...

Data Mining of Extremely Large Ad Hoc Data Sets to Produce Inverted Indices

DTIC Science & Technology

2016-06-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited DATA MINING OF...COVERED Master’s Thesis 4. TITLE AND SUBTITLE DATA MINING OF EXTREMELY LARGE AD HOC DATA SETS TO PRODUCE INVERTED INDICES 5. FUNDING NUMBERS 6...INTENTIONALLY LEFT BLANK iii Approved for public release; distribution is unlimited DATA MINING OF EXTREMELY LARGE AD HOC DATA SETS TO PRODUCE

Typicality Mediates Performance during Category Verification in Both Ad-Hoc and Well-Defined Categories

ERIC Educational Resources Information Center

Sandberg, Chaleece; Sebastian, Rajani; Kiran, Swathi

2012-01-01

Background: The typicality effect is present in neurologically intact populations for natural, ad-hoc, and well-defined categories. Although sparse, there is evidence of typicality effects in persons with chronic stroke aphasia for natural and ad-hoc categories. However, it is unknown exactly what influences the typicality effect in this…

On Trust Evaluation in Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Nguyen, Dang Quan; Lamont, Louise; Mason, Peter C.

Trust has been considered as a social relationship between two individuals in human society. But, as computer science and networking have succeeded in using computers to automate many tasks, the concept of trust can be generalized to cover the reliability and relationships of non-human interaction, such as, for example, information gathering and data routing. This paper investigates the evaluation of trust in the context of ad hoc networks. Nodes evaluate each other’s behaviour based on observables. A node then decides whether to trust another node to have certain innate abilities. We show how accurate such an evaluation could be. We also provide the minimum number of observations required to obtain an accurate evaluation, a result that indicates that observation-based trust in ad hoc networks will remain a challenging problem. The impact of making networking decisions using trust evaluation on the network connectivity is also examined. In this manner, quantitative decisions can be made concerning trust-based routing with the knowledge of the potential impact on connectivity.

Impact of network structure on the capacity of wireless multihop ad hoc communication

NASA Astrophysics Data System (ADS)

Krause, Wolfram; Glauche, Ingmar; Sollacher, Rudolf; Greiner, Martin

2004-07-01

As a representative of a complex technological system, the so-called wireless multihop ad hoc communication networks are discussed. They represent an infrastructure-less generalization of todays wireless cellular phone networks. Lacking a central control authority, the ad hoc nodes have to coordinate themselves such that the overall network performs in an optimal way. A performance indicator is the end-to-end throughput capacity. Various models, generating differing ad hoc network structure via differing transmission power assignments, are constructed and characterized. They serve as input for a generic data traffic simulation as well as some semi-analytic estimations. The latter reveal that due to the most-critical-node effect the end-to-end throughput capacity sensitively depends on the underlying network structure, resulting in differing scaling laws with respect to network size.

Ad Hoc Categories and False Memories: Memory Illusions for Categories Created On-The-Spot

ERIC Educational Resources Information Center

Soro, Jerônimo C.; Ferreira, Mário B.; Semin, Gün R.; Mata, André; Carneiro, Paula

2017-01-01

Three experiments were designed to test whether experimentally created ad hoc associative networks evoke false memories. We used the DRM (Deese, Roediger, McDermott) paradigm with lists of ad hoc categories composed of exemplars aggregated toward specific goals (e.g., going for a picnic) that do not share any consistent set of features. Experiment…

Distributed generation of shared RSA keys in mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Liu, Yi-Liang; Huang, Qin; Shen, Ying

2005-12-01

Mobile Ad Hoc Networks is a totally new concept in which mobile nodes are able to communicate together over wireless links in an independent manner, independent of fixed physical infrastructure and centralized administrative infrastructure. However, the nature of Ad Hoc Networks makes them very vulnerable to security threats. Generation and distribution of shared keys for CA (Certification Authority) is challenging for security solution based on distributed PKI(Public-Key Infrastructure)/CA. The solutions that have been proposed in the literature and some related issues are discussed in this paper. The solution of a distributed generation of shared threshold RSA keys for CA is proposed in the present paper. During the process of creating an RSA private key share, every CA node only has its own private security. Distributed arithmetic is used to create the CA's private share locally, and that the requirement of centralized management institution is eliminated. Based on fully considering the Mobile Ad Hoc network's characteristic of self-organization, it avoids the security hidden trouble that comes by holding an all private security share of CA, with which the security and robustness of system is enhanced.

Energy Efficient and QoS sensitive Routing Protocol for Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Saeed Tanoli, Tariq; Khalid Khan, Muhammad

2013-12-01

Efficient routing is an important part of wireless ad hoc networks. Since in ad hoc networks we have limited resources, there are many limitations like bandwidth, battery consumption, and processing cycle etc. Reliability is also necessary since there is no allowance for invalid or incomplete information (and expired data is useless). There are various protocols that perform routing by considering one parameter but ignoring other parameters. In this paper we present a protocol that finds route on the basis of bandwidth, energy and mobility of the nodes participating in the communication.

Passive and Active Analysis in DSR-Based Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Dempsey, Tae; Sahin, Gokhan; Morton, Y. T. (Jade)

Security and vulnerabilities in wireless ad hoc networks have been considered at different layers, and many attack strategies have been proposed, including denial of service (DoS) through the intelligent jamming of the most critical packet types of flows in a network. This paper investigates the effectiveness of intelligent jamming in wireless ad hoc networks using the Dynamic Source Routing (DSR) and TCP protocols and introduces an intelligent classifier to facilitate the jamming of such networks. Assuming encrypted packet headers and contents, our classifier is based solely on the observable characteristics of size, inter-arrival timing, and direction and classifies packets with up to 99.4% accuracy in our experiments. Furthermore, we investigate active analysis, which is the combination of a classifier and intelligent jammer to invoke specific responses from a victim network.

Reputation-Based Internet Protocol Security: A Multilayer Security Framework for Mobile Ad Hoc Networks

DTIC Science & Technology

2010-09-01

secure ad-hoc networks of mobile sensors deployed in a hostile environment . These sensors are normally small 86 and resource...Communications Magazine, 51, 2008. 45. Kumar, S.A. “Classification and Review of Security Schemes in Mobile Comput- ing”. Wireless Sensor Network , 2010... Networks ”. Wireless /Mobile Network Security , 2008. 85. Xiao, Y. “Accountability for Wireless LANs, Ad Hoc Networks , and Wireless

Intelligent routing protocol for ad hoc wireless network

NASA Astrophysics Data System (ADS)

Peng, Chaorong; Chen, Chang Wen

2006-05-01

A novel routing scheme for mobile ad hoc networks (MANETs), which combines hybrid and multi-inter-routing path properties with a distributed topology discovery route mechanism using control agents is proposed in this paper. In recent years, a variety of hybrid routing protocols for Mobile Ad hoc wireless networks (MANETs) have been developed. Which is proactively maintains routing information for a local neighborhood, while reactively acquiring routes to destinations beyond the global. The hybrid protocol reduces routing discovery latency and the end-to-end delay by providing high connectivity without requiring much of the scarce network capacity. On the other side the hybrid routing protocols in MANETs likes Zone Routing Protocol still need route "re-discover" time when a route between zones link break. Sine the topology update information needs to be broadcast routing request on local zone. Due to this delay, the routing protocol may not be applicable for real-time data and multimedia communication. We utilize the advantages of a clustering organization and multi-routing path in routing protocol to achieve several goals at the same time. Firstly, IRP efficiently saves network bandwidth and reduces route reconstruction time when a routing path fails. The IRP protocol does not require global periodic routing advertisements, local control agents will automatically monitor and repair broke links. Secondly, it efficiently reduces congestion and traffic "bottlenecks" for ClusterHeads in clustering network. Thirdly, it reduces significant overheads associated with maintaining clusters. Fourthly, it improves clusters stability due to dynamic topology changing frequently. In this paper, we present the Intelligent Routing Protocol. First, we discuss the problem of routing in ad hoc networks and the motivation of IRP. We describe the hierarchical architecture of IRP. We describe the routing process and illustrate it with an example. Further, we describe the control manage

UMDR: Multi-Path Routing Protocol for Underwater Ad Hoc Networks with Directional Antenna

NASA Astrophysics Data System (ADS)

Yang, Jianmin; Liu, Songzuo; Liu, Qipei; Qiao, Gang

2018-01-01

This paper presents a new routing scheme for underwater ad hoc networks based on directional antennas. Ad hoc networks with directional antennas have become a hot research topic because of space reuse may increase networks capacity. At present, researchers have applied traditional self-organizing routing protocols (such as DSR, AODV) [1] [2] on this type of networks, and the routing scheme is based on the shortest path metric. However, such routing schemes often suffer from long transmission delays and frequent link fragmentation along the intermediate nodes of the selected route. This is caused by a unique feature of directional transmission, often called as “deafness”. In this paper, we take a different approach to explore the advantages of space reuse through multipath routing. This paper introduces the validity of the conventional routing scheme in underwater ad hoc networks with directional antennas, and presents a special design of multipath routing algorithm for directional transmission. The experimental results show a significant performance improvement in throughput and latency.

Two Phase Admission Control for QoS Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Chen, Chien-Sheng; Su, Yi-Wen; Liu, Wen-Hsiung; Chi, Ching-Lung

In this paper a novel and effective two phase admission control (TPAC) for QoS mobile ad hoc networks is proposed that satisfies the real-time traffic requirements in mobile ad hoc networks. With a limited amount of extra overhead, TPAC can avoid network congestions by a simple and precise admission control which blocks most of the overloading flow-requests in the route discovery process. When compared with previous QoS routing schemes such as QoS-aware routing protocol and CACP protocols, it is shown from system simulations that the proposed scheme can increase the system throughput and reduce both the dropping rate and the end-to-end delay. Therefore, TPAC is surely an effective QoS-guarantee protocol to provide for real-time traffic.

Strategies for generating multiple instances of common and ad hoc categories.

PubMed

Vallée-Tourangeau, F; Anthony, S H; Austin, N G

1998-09-01

In a free-emission procedure participants were asked to generate instances of a given category and to report, retrospectively, the strategies that they were aware of using in retrieving instances. In two studies reported here, participants generated instances for common categories (e.g. fruit) and for ad hoc categories (e.g., things people keep in their pockets) for 90 seconds and for each category described how they had proceeded in doing so. Analysis of the protocols identified three broad classes of strategy: (1) experiential, where memories of specific or generic personal experiences involving interactions with the category instances acted as cues; (2) semantic, where a consideration of abstract conceptual characteristics of a category were employed to retrieve category exemplars; (3) unmediated, where instances were effortlessly retrieved without mediating cognitions of which subjects were aware. Experiential strategies outnumbered semantic strategies (on average 4 to 1) not only for ad hoc categories but also for common categories. This pattern was noticeably reversed for ad hoc categories that subjects were unlikely to have experienced personally (e.g. things sold on the black market in Russia). Whereas more traditional accounts of semantic memory have favoured decontextualised abstract representations of category knowledge, to the extent that mode of access informs us of knowledge structures, our data suggest that category knowledge is significantly grounded in terms of everyday contexts where category instances are encountered.

Cross-Layer Service Discovery Mechanism for OLSRv2 Mobile Ad Hoc Networks.

PubMed

Vara, M Isabel; Campo, Celeste

2015-07-20

Service discovery plays an important role in mobile ad hoc networks (MANETs). The lack of central infrastructure, limited resources and high mobility make service discovery a challenging issue for this kind of network. This article proposes a new service discovery mechanism for discovering and advertising services integrated into the Optimized Link State Routing Protocol Version 2 (OLSRv2). In previous studies, we demonstrated the validity of a similar service discovery mechanism integrated into the previous version of OLSR (OLSRv1). In order to advertise services, we have added a new type-length-value structure (TLV) to the OLSRv2 protocol, called service discovery message (SDM), according to the Generalized MANET Packet/Message Format defined in Request For Comments (RFC) 5444. Each node in the ad hoc network only advertises its own services. The advertisement frequency is a user-configurable parameter, so that it can be modified depending on the user requirements. Each node maintains two service tables, one to store information about its own services and another one to store information about the services it discovers in the network. We present simulation results, that compare our service discovery integrated into OLSRv2 with the one defined for OLSRv1 and with the integration of service discovery in Ad hoc On-demand Distance Vector (AODV) protocol, in terms of service discovery ratio, service latency and network overhead.

Cross-Layer Service Discovery Mechanism for OLSRv2 Mobile Ad Hoc Networks

PubMed Central

Vara, M. Isabel; Campo, Celeste

2015-01-01

Service discovery plays an important role in mobile ad hoc networks (MANETs). The lack of central infrastructure, limited resources and high mobility make service discovery a challenging issue for this kind of network. This article proposes a new service discovery mechanism for discovering and advertising services integrated into the Optimized Link State Routing Protocol Version 2 (OLSRv2). In previous studies, we demonstrated the validity of a similar service discovery mechanism integrated into the previous version of OLSR (OLSRv1). In order to advertise services, we have added a new type-length-value structure (TLV) to the OLSRv2 protocol, called service discovery message (SDM), according to the Generalized MANET Packet/Message Format defined in Request For Comments (RFC) 5444. Each node in the ad hoc network only advertises its own services. The advertisement frequency is a user-configurable parameter, so that it can be modified depending on the user requirements. Each node maintains two service tables, one to store information about its own services and another one to store information about the services it discovers in the network. We present simulation results, that compare our service discovery integrated into OLSRv2 with the one defined for OLSRv1 and with the integration of service discovery in Ad hoc On-demand Distance Vector (AODV) protocol, in terms of service discovery ratio, service latency and network overhead. PMID:26205272

Validity of using ad hoc methods to analyze secondary traits in case-control association studies.

PubMed

Yung, Godwin; Lin, Xihong

2016-12-01

Case-control association studies often collect from their subjects information on secondary phenotypes. Reusing the data and studying the association between genes and secondary phenotypes provide an attractive and cost-effective approach that can lead to discovery of new genetic associations. A number of approaches have been proposed, including simple and computationally efficient ad hoc methods that ignore ascertainment or stratify on case-control status. Justification for these approaches relies on the assumption of no covariates and the correct specification of the primary disease model as a logistic model. Both might not be true in practice, for example, in the presence of population stratification or the primary disease model following a probit model. In this paper, we investigate the validity of ad hoc methods in the presence of covariates and possible disease model misspecification. We show that in taking an ad hoc approach, it may be desirable to include covariates that affect the primary disease in the secondary phenotype model, even though these covariates are not necessarily associated with the secondary phenotype. We also show that when the disease is rare, ad hoc methods can lead to severely biased estimation and inference if the true disease model follows a probit model instead of a logistic model. Our results are justified theoretically and via simulations. Applied to real data analysis of genetic associations with cigarette smoking, ad hoc methods collectively identified as highly significant (P<10-5) single nucleotide polymorphisms from over 10 genes, genes that were identified in previous studies of smoking cessation. © 2016 WILEY PERIODICALS, INC.

An Ad-Hoc Adaptive Pilot Model for Pitch Axis Gross Acquisition Tasks

NASA Technical Reports Server (NTRS)

Hanson, Curtis E.

2012-01-01

An ad-hoc algorithm is presented for real-time adaptation of the well-known crossover pilot model and applied to pitch axis gross acquisition tasks in a generic fighter aircraft. Off-line tuning of the crossover model to human pilot data gathered in a fixed-based high fidelity simulation is first accomplished for a series of changes in aircraft dynamics to provide expected values for model parameters. It is shown that in most cases, for this application, the traditional crossover model can be reduced to a gain and a time delay. The ad-hoc adaptive pilot gain algorithm is shown to have desirable convergence properties for most types of changes in aircraft dynamics.

Energy Efficient Probabilistic Broadcasting for Mobile Ad-Hoc Network

NASA Astrophysics Data System (ADS)

Kumar, Sumit; Mehfuz, Shabana

2017-06-01

In mobile ad-hoc network (MANETs) flooding method is used for broadcasting route request (RREQ) packet from one node to another node for route discovery. This is the simplest method of broadcasting of RREQ packets but it often results in broadcast storm problem, originating collisions and congestion of packets in the network. A probabilistic broadcasting is one of the widely used broadcasting scheme for route discovery in MANETs and provides solution for broadcasting storm problem. But it does not consider limited energy of the battery of the nodes. In this paper, a new energy efficient probabilistic broadcasting (EEPB) is proposed in which probability of broadcasting RREQs is calculated with respect to remaining energy of nodes. The analysis of simulation results clearly indicate that an EEPB route discovery scheme in ad-hoc on demand distance vector (AODV) can increase the network lifetime with a decrease in the average power consumption and RREQ packet overhead. It also decreases the number of dropped packets in the network, in comparison to other EEPB schemes like energy constraint gossip (ECG), energy aware gossip (EAG), energy based gossip (EBG) and network lifetime through energy efficient broadcast gossip (NEBG).

Information Fusion in Ad hoc Wireless Sensor Networks for Aircraft Health Monitoring

NASA Astrophysics Data System (ADS)

Fragoulis, Nikos; Tsagaris, Vassilis; Anastassopoulos, Vassilis

In this paper the use of an ad hoc wireless sensor network for implementing a structural health monitoring system is discussed. The network is consisted of sensors deployed throughout the aircraft. These sensors being in the form of a microelectronic chip and consisted of sensing, data processing and communicating components could be easily embedded in any mechanical aircraft component. The established sensor network, due to its ad hoc nature is easily scalable, allowing adding or removing any number of sensors. The position of the sensor nodes need not necessarily to be engineered or predetermined, giving this way the ability to be deployed in inaccessible points. Information collected from various sensors of different modalities throughout the aircraft is then fused in order to provide a more comprehensive image of the aircraft structural health. Sensor level fusion along with decision quality information is used, in order to enhance detection performance.

A fault-tolerant small world topology control model in ad hoc networks for search and rescue

NASA Astrophysics Data System (ADS)

Tan, Mian; Fang, Ling; Wu, Yue; Zhang, Bo; Chang, Bowen; Holme, Petter; Zhao, Jing

2018-02-01

Due to their self-organized, multi-hop and distributed characteristics, ad hoc networks are useful in search and rescue. Topology control models need to be designed for energy-efficient, robust and fast communication in ad hoc networks. This paper proposes a topology control model which specializes for search and rescue-Compensation Small World-Repeated Game (CSWRG)-which integrates mobility models, constructing small world networks and a game-theoretic approach to the allocation of resources. Simulation results show that our mobility models can enhance the communication performance of the constructed small-world networks. Our strategy, based on repeated game, can suppress selfish behavior and compensate agents that encounter selfish or faulty neighbors. This model could be useful for the design of ad hoc communication networks.

Multicasting in Wireless Communications (Ad-Hoc Networks): Comparison against a Tree-Based Approach

NASA Astrophysics Data System (ADS)

Rizos, G. E.; Vasiliadis, D. C.

2007-12-01

We examine on-demand multicasting in ad hoc networks. The Core Assisted Mesh Protocol (CAMP) is a well-known protocol for multicast routing in ad-hoc networks, generalizing the notion of core-based trees employed for internet multicasting into multicast meshes that have much richer connectivity than trees. On the other hand, wireless tree-based multicast routing protocols use much simpler structures for determining route paths, using only parent-child relationships. In this work, we compare the performance of the CAMP protocol against the performance of wireless tree-based multicast routing protocols, in terms of two important factors, namely packet delay and ratio of dropped packets.

Space-Time Processing for Tactical Mobile Ad Hoc Networks

DTIC Science & Technology

2007-08-01

rates in mobile ad hoc networks. In addition, he has considered the design of a cross-layer multi-user resource allocation framework using a... framework for many-to-one communication. In this context, multiple nodes cooperate to transmit their packets simultaneously to a single node using multi...spatially multiplexed signals transmitted from multiple nodes. Our goal is to form a framework that activates different sets of communication links

Space-Time Processing for Tactical Mobile Ad Hoc Networks

DTIC Science & Technology

2008-08-01

vision for multiple concurrent communication settings, i.e., a many-to-many framework where multi-packet transmissions (MPTs) and multi-packet...modelling framework of capacity-delay tradeoffs We have introduced the first unified modeling framework for the computation of fundamental limits o We...dalities in wireless n twor i-packet modelling framework to account for the use of m lti-packet reception (MPR) f ad hoc networks with MPT under

Taxonomic and ad hoc categorization within the two cerebral hemispheres.

PubMed

Shen, Yeshayahu; Aharoni, Bat-El; Mashal, Nira

2015-01-01

A typicality effect refers to categorization which is performed more quickly or more accurately for typical than for atypical members of a given category. Previous studies reported a typicality effect for category members presented in the left visual field/right hemisphere (RH), suggesting that the RH applies a similarity-based categorization strategy. However, findings regarding the typicality effect within the left hemisphere (LH) are less conclusive. The current study tested the pattern of typicality effects within each hemisphere for both taxonomic and ad hoc categories, using words presented to the left or right visual fields. Experiment 1 tested typical and atypical members of taxonomic categories as well as non-members, and Experiment 2 tested typical and atypical members of ad hoc categories as well as non-members. The results revealed a typicality effect in both hemispheres and in both types of categories. Furthermore, the RH categorized atypical stimuli more accurately than did the LH. Our findings suggest that both hemispheres rely on a similarity-based categorization strategy, but the coarse semantic coding of the RH seems to facilitate the categorization of atypical members.

Dynamic autonomous routing technology for IP-based satellite ad hoc networks

NASA Astrophysics Data System (ADS)

Wang, Xiaofei; Deng, Jing; Kostas, Theresa; Rajappan, Gowri

2014-06-01

IP-based routing for military LEO/MEO satellite ad hoc networks is very challenging due to network and traffic heterogeneity, network topology and traffic dynamics. In this paper, we describe a traffic priority-aware routing scheme for such networks, namely Dynamic Autonomous Routing Technology (DART) for satellite ad hoc networks. DART has a cross-layer design, and conducts routing and resource reservation concurrently for optimal performance in the fluid but predictable satellite ad hoc networks. DART ensures end-to-end data delivery with QoS assurances by only choosing routing paths that have sufficient resources, supporting different packet priority levels. In order to do so, DART incorporates several resource management and innovative routing mechanisms, which dynamically adapt to best fit the prevailing conditions. In particular, DART integrates a resource reservation mechanism to reserve network bandwidth resources; a proactive routing mechanism to set up non-overlapping spanning trees to segregate high priority traffic flows from lower priority flows so that the high priority flows do not face contention from low priority flows; a reactive routing mechanism to arbitrate resources between various traffic priorities when needed; a predictive routing mechanism to set up routes for scheduled missions and for anticipated topology changes for QoS assurance. We present simulation results showing the performance of DART. We have conducted these simulations using the Iridium constellation and trajectories as well as realistic military communications scenarios. The simulation results demonstrate DART's ability to discriminate between high-priority and low-priority traffic flows and ensure disparate QoS requirements of these traffic flows.

Ad Hoc Supervision of General Practice Registrars as a "Community of Practice": Analysis, Interpretation and Re-Presentation

ERIC Educational Resources Information Center

Clement, T.; Brown, J.; Morrison, J.; Nestel, D.

2016-01-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also…

Ad hoc instrumentation methods in ecological studies produce highly biased temperature measurements

USGS Publications Warehouse

Terando, Adam J.; Youngsteadt, Elsa; Meineke, Emily K.; Prado, Sara G.

2017-01-01

In light of global climate change, ecological studies increasingly address effects of temperature on organisms and ecosystems. To measure air temperature at biologically relevant scales in the field, ecologists often use small, portable temperature sensors. Sensors must be shielded from solar radiation to provide accurate temperature measurements, but our review of 18 years of ecological literature indicates that shielding practices vary across studies (when reported at all), and that ecologists often invent and construct ad hoc radiation shields without testing their efficacy. We performed two field experiments to examine the accuracy of temperature observations from three commonly used portable data loggers (HOBO Pro, HOBO Pendant, and iButton hygrochron) housed in manufactured Gill shields or ad hoc, custom‐fabricated shields constructed from everyday materials such as plastic cups. We installed this sensor array (five replicates of 11 sensor‐shield combinations) at weather stations located in open and forested sites. HOBO Pro sensors with Gill shields were the most accurate devices, with a mean absolute error of 0.2°C relative to weather stations at each site. Error in ad hoc shield treatments ranged from 0.8 to 3.0°C, with the largest errors at the open site. We then deployed one replicate of each sensor‐shield combination at five sites that varied in the amount of urban impervious surface cover, which presents a further shielding challenge. Bias in sensors paired with ad hoc shields increased by up to 0.7°C for every 10% increase in impervious surface. Our results indicate that, due to variable shielding practices, the ecological literature likely includes highly biased temperature data that cannot be compared directly across studies. If left unaddressed, these errors will hinder efforts to predict biological responses to climate change. We call for greater standardization in how temperature data are recorded in the field, handled in analyses, and

Modeling and optimization of Quality of Service routing in Mobile Ad hoc Networks

NASA Astrophysics Data System (ADS)

Rafsanjani, Marjan Kuchaki; Fatemidokht, Hamideh; Balas, Valentina Emilia

2016-01-01

Mobile ad hoc networks (MANETs) are a group of mobile nodes that are connected without using a fixed infrastructure. In these networks, nodes communicate with each other by forming a single-hop or multi-hop network. To design effective mobile ad hoc networks, it is important to evaluate the performance of multi-hop paths. In this paper, we present a mathematical model for a routing protocol under energy consumption and packet delivery ratio of multi-hop paths. In this model, we use geometric random graphs rather than random graphs. Our proposed model finds effective paths that minimize the energy consumption and maximizes the packet delivery ratio of the network. Validation of the mathematical model is performed through simulation.

Ad-Hoc Networks and the Mobile Application Security System (MASS)

DTIC Science & Technology

2006-01-01

solution to this problem that addresses critical aspects of security in ad-hoc mobile application networks. This approach involves preventing unauthorized...modification of a mobile application , both by other applications and by hosts, and ensuring that mobile code is authentic and authorized. These...capabilities constitute the Mobile Application Security System (MASS). The MASS applies effective, robust security to mobile application -based systems

Conflict Management in "Ad Hoc" Problem-Solving Groups: A Preliminary Investigation.

ERIC Educational Resources Information Center

Wallace, Les; Baxter, Leslie

Full study of small group communication must include consideration of task and socio-emotional dimensions, especially in relation to group problem solving. Thirty small groups were tested for their reactions in various "ad hoc" conflict resolution situations. Instructions to the groups were (1) no problem-solving instructions (control),…

T2AR: trust-aware ad-hoc routing protocol for MANET.

PubMed

Dhananjayan, Gayathri; Subbiah, Janakiraman

2016-01-01

Secure data transfer against the malicious attacks is an important issue in an infrastructure-less independent network called mobile ad-hoc network (MANET). Trust assurance between MANET nodes is the key parameter in the high-security provision under dynamic topology variations and open wireless constraints. But, the malicious behavior of nodes reduces the trust level of the nodes that leads to an insecure data delivery. The increase in malicious attacks causes the excessive energy consumption that leads to a reduction of network lifetime. The lack of positional information update of the nodes in ad-hoc on-demand vector (AODV) protocol during the connection establishment offers less trust level between the nodes. Hence, the trust rate computation using energy and mobility models and its update are the essential tasks for secure data delivery. This paper proposes a trust-aware ad-hoc routing (T2AR) protocol to improve the trust level between the nodes in MANET. The proposed method modifies the traditional AODV routing protocol with the constraints of trust rate, energy, mobility based malicious behavior prediction. The packet sequence ID matching from the log reports of neighbor nodes determine the trust rate that avoids the malicious report generation. Besides, the direct and indirect trust observation schemes utilization increases the trust level. Besides, the received signal strength indicator utilization determines the trusted node is within the communication range or not. The comparative analysis between the proposed T2AR with the existing methods such as TRUNCMAN, RBT, GR, FBR and DICOTIDS regarding the average end-to-end delay, throughput, false positives, packet delivery ratio shows the effectiveness of T2AR in the secure MANET environment design.

Performance Analysis of Hierarchical Group Key Management Integrated with Adaptive Intrusion Detection in Mobile ad hoc Networks

DTIC Science & Technology

2016-04-05

applications in wireless networks such as military battlefields, emergency response, mobile commerce , online gaming, and collaborative work are based on the...www.elsevier.com/locate/peva Performance analysis of hierarchical group key management integrated with adaptive intrusion detection in mobile ad hoc...Accepted 19 September 2010 Available online 26 September 2010 Keywords: Mobile ad hoc networks Intrusion detection Group communication systems Group

CABG Versus PCI

PubMed Central

Habib, Robert H.; Dimitrova, Kamellia R.; Badour, Sanaa A.; Yammine, Maroun B.; El-Hage-Sleiman, Abdul-Karim M.; Hoffman, Darryl M.; Geller, Charles M.; Schwann, Thomas A.; Tranbaugh, Robert F.

2017-01-01

BACKGROUND Treatment of multivessel coronary artery disease with traditional single-arterial coronary artery bypass graft (SA-CABG) has been associated with superior intermediate-term survival and reintervention compared with percutaneous coronary intervention (PCI) using either bare-metal stents (BMS) or drug-eluting stents (DES). OBJECTIVES This study sought to investigate longer-term outcomes including the potential added advantage of multiarterial coronary artery bypass graft (MA-CABG). METHODS We studied 8,402 single-institution, primary revascularization, multivessel coronary artery disease patients: 2,207 BMS-PCI (age 66.6 ± 11.9 years); 2,381 DES-PCI (age 65.9 ± 11.7 years); 2,289 SA-CABG (age 69.3 ± 9.0 years); and 1,525 MA-CABG (age 58.3 ± 8.7 years). Patients with myocardial infarction within 24 h, shock, or left main stents were excluded. Kaplan-Meier analysis and Cox regression were used to separately compare 9-year all-cause mortality and unplanned reintervention for BMS-PCI and DES-PCI to respective propensity-matched SA-CABG and MA-CABG cohorts. RESULTS BMS-PCI was associated with worse survival than SA-CABG, especially from 0 to 7 years (p = 0.015) and to a greater extent than MA-CABG was (9-year follow-up: 76.3% vs. 86.9%; p < 0.001). The surgery-to-BMS-PCI hazard ratios (HR) were as follows: versus SA-CABG, HR: 0.87; and versus MA-CABG, HR: 0.38. DES-PCI showed similar survival to SA-CABG except for a modest 0 to 3 years surgery advantage (HR: 1.06; p = 0.615). Compared with MA-CABG, DES-PCI exhibited worse survival at 5 (86.3% vs. 95.6%) and 9 (82.8% vs. 89.8%) years (HR: 0.45; p <0.001). Reintervention was substantially worse with PCI for all comparisons (all p <0.001). CONCLUSIONS Multiarterial surgical revascularization, compared with either BMS-PCI or DES-PCI, resulted in substantially enhanced death and reintervention-free survival. Accordingly, MA-CABG represents the optimal therapy for multivessel coronary artery disease and should be

Protocols for Detection and Removal of Wormholes for Secure Routing and Neighborhood Creation in Wireless Ad Hoc Networks

ERIC Educational Resources Information Center

Hayajneh, Thaier Saleh

2009-01-01

Wireless ad hoc networks are suitable and sometimes the only solution for several applications. Many applications, particularly those in military and critical civilian domains (such as battlefield surveillance and emergency rescue) require that ad hoc networks be secure and stable. In fact, security is one of the main barriers to the extensive use…

Cutting Corners: Provider Perceptions of Interpretation Services and Factors Related to Use of an Ad Hoc Interpreter.

PubMed

Mayo, Rachel; Parker, Veronica G; Sherrill, Windsor W; Coltman, Kinneil; Hudson, Matthew F; Nichols, Christina M; Yates, Adam M; Pribonic, Anne Paige

2016-06-01

This study assessed health providers' perceptions of factors related to professional interpretation services and the association between these factors and the potential use of ad hoc interpreters. Data were collected from a convenience sample of 150 health services providers at a large, regional health system in South Carolina. Providers rated "ability to communicate effectively during a clinical encounter" as paramount regarding the use of interpretation services. The most important factors related to the likely use of ad hoc interpreters (cutting corners) included locating a qualified interpreter, having to wait for a qualified interpreter, and technical difficulties regarding phone and video technology. Health care organizations may benefit from increasing staff awareness about patient safety and legal and regulatory risks involved with the use of ad hoc interpreters. © The Author(s) 2016.

Capacity-Delay Trade-Off in Collaborative Hybrid Ad-Hoc Networks with Coverage Sensing.

PubMed

Chen, Lingyu; Luo, Wenbin; Liu, Chen; Hong, Xuemin; Shi, Jianghong

2017-01-26

The integration of ad hoc device-to-device (D2D) communications and open-access small cells can result in a networking paradigm called hybrid the ad hoc network, which is particularly promising in delivering delay-tolerant data. The capacity-delay performance of hybrid ad hoc networks has been studied extensively under a popular framework called scaling law analysis. These studies, however, do not take into account aspects of interference accumulation and queueing delay and, therefore, may lead to over-optimistic results. Moreover, focusing on the average measures, existing works fail to give finer-grained insights into the distribution of delays. This paper proposes an alternative analytical framework based on queueing theoretic models and physical interference models. We apply this framework to study the capacity-delay performance of a collaborative cellular D2D network with coverage sensing and two-hop relay. The new framework allows us to fully characterize the delay distribution in the transform domain and pinpoint the impacts of coverage sensing, user and base station densities, transmit power, user mobility and packet size on the capacity-delay trade-off. We show that under the condition of queueing equilibrium, the maximum throughput capacity per device saturates to an upper bound of 0.7239 λ b / λ u bits/s/Hz, where λ b and λ u are the densities of base stations and mobile users, respectively.

Capacity-Delay Trade-Off in Collaborative Hybrid Ad-Hoc Networks with Coverage Sensing

PubMed Central

Chen, Lingyu; Luo, Wenbin; Liu, Chen; Hong, Xuemin; Shi, Jianghong

2017-01-01

The integration of ad hoc device-to-device (D2D) communications and open-access small cells can result in a networking paradigm called hybrid the ad hoc network, which is particularly promising in delivering delay-tolerant data. The capacity-delay performance of hybrid ad hoc networks has been studied extensively under a popular framework called scaling law analysis. These studies, however, do not take into account aspects of interference accumulation and queueing delay and, therefore, may lead to over-optimistic results. Moreover, focusing on the average measures, existing works fail to give finer-grained insights into the distribution of delays. This paper proposes an alternative analytical framework based on queueing theoretic models and physical interference models. We apply this framework to study the capacity-delay performance of a collaborative cellular D2D network with coverage sensing and two-hop relay. The new framework allows us to fully characterize the delay distribution in the transform domain and pinpoint the impacts of coverage sensing, user and base station densities, transmit power, user mobility and packet size on the capacity-delay trade-off. We show that under the condition of queueing equilibrium, the maximum throughput capacity per device saturates to an upper bound of 0.7239 λb/λu bits/s/Hz, where λb and λu are the densities of base stations and mobile users, respectively. PMID:28134769

Work, Family, and Community: Summary Proceedings of an Ad Hoc Committee.

ERIC Educational Resources Information Center

Hayes, Cheryl D., Ed.

These proceedings contain summaries of five working group discussions and a discussion of suggestions for future research from an ad hoc meeting on Work, Family, and Community (Fedruary 21-22, 1980) in Washington, D.C. The meeting had these objectives: (1) to identify salient policy and research issues associated with changing patterns of labor…

A Survey on Trust Management for Mobile Ad Hoc Networks

DTIC Science & Technology

2011-11-01

expects, trust is dangerous implying the possible betrayal of trust. In his comments on Lagerspetz’s book titled Trust: The Tacit Demand, Lahno [24...AODV Zouridaki et al. (2005 ) [79] (2006) [80] Secure routing Direct observation [79][80] Reputation by secondhand information [80] Packet dropping...areas of signal processing, wireless communications, sensor and mobile ad hoc networks. He is co-editor of the book Wireless Sensor Networks: Signal

An Optimal CDS Construction Algorithm with Activity Scheduling in Ad Hoc Networks

PubMed Central

Penumalli, Chakradhar; Palanichamy, Yogesh

2015-01-01

A new energy efficient optimal Connected Dominating Set (CDS) algorithm with activity scheduling for mobile ad hoc networks (MANETs) is proposed. This algorithm achieves energy efficiency by minimizing the Broadcast Storm Problem [BSP] and at the same time considering the node's remaining energy. The Connected Dominating Set is widely used as a virtual backbone or spine in mobile ad hoc networks [MANETs] or Wireless Sensor Networks [WSN]. The CDS of a graph representing a network has a significant impact on an efficient design of routing protocol in wireless networks. Here the CDS is a distributed algorithm with activity scheduling based on unit disk graph [UDG]. The node's mobility and residual energy (RE) are considered as parameters in the construction of stable optimal energy efficient CDS. The performance is evaluated at various node densities, various transmission ranges, and mobility rates. The theoretical analysis and simulation results of this algorithm are also presented which yield better results. PMID:26221627

On knowledge transfer management as a learning process for ad hoc teams

NASA Astrophysics Data System (ADS)

Iliescu, D.

2017-08-01

Knowledge management represents an emerging domain becoming more and more important. Concepts like knowledge codification and personalisation, knowledge life-cycle, social and technological dimensions, knowledge transfer and learning management are integral parts. Focus goes here in the process of knowledge transfer for the case of ad hoc teams. The social dimension of knowledge transfer plays an important role. No single individual actors involved in the process, but a collective one, representing the organisation. It is critically important for knowledge to be managed from the life-cycle point of view. A complex communication network needs to be in place to supports the process of knowledge transfer. Two particular concepts, the bridge tie and transactive memory, would eventually enhance the communication. The paper focuses on an informational communication platform supporting the collaborative work on knowledge transfer. The platform facilitates the creation of a topic language to be used in knowledge modelling, storage and reuse, by the ad hoc teams.

Scalable Architecture for Multihop Wireless ad Hoc Networks

NASA Technical Reports Server (NTRS)

Arabshahi, Payman; Gray, Andrew; Okino, Clayton; Yan, Tsun-Yee

2004-01-01

A scalable architecture for wireless digital data and voice communications via ad hoc networks has been proposed. Although the details of the architecture and of its implementation in hardware and software have yet to be developed, the broad outlines of the architecture are fairly clear: This architecture departs from current commercial wireless communication architectures, which are characterized by low effective bandwidth per user and are not well suited to low-cost, rapid scaling in large metropolitan areas. This architecture is inspired by a vision more akin to that of more than two dozen noncommercial community wireless networking organizations established by volunteers in North America and several European countries.

A Survey on Trust Management for Mobile Ad Hoc Networks

DTIC Science & Technology

2010-07-01

betrayal of trust. In his comments on Lagerspetz’s book titled Trust: The Tacit Demand, Lahno [24] describes the author’s view on trust as a moral...extension of AODV Zouridaki et al. (2005 ) [79] (2006) [80] Secure routing Direct observation [79][80] Reputation by secondhand information [80...the broad areas of signal processing, wireless communications, sensor and mobile ad hoc networks. He is co-editor of the book Wireless Sensor Networks

Power-Aware Intrusion Detection in Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Şen, Sevil; Clark, John A.; Tapiador, Juan E.

Mobile ad hoc networks (MANETs) are a highly promising new form of networking. However they are more vulnerable to attacks than wired networks. In addition, conventional intrusion detection systems (IDS) are ineffective and inefficient for highly dynamic and resource-constrained environments. Achieving an effective operational MANET requires tradeoffs to be made between functional and non-functional criteria. In this paper we show how Genetic Programming (GP) together with a Multi-Objective Evolutionary Algorithm (MOEA) can be used to synthesise intrusion detection programs that make optimal tradeoffs between security criteria and the power they consume.

Design of free patterns of nanocrystals with ad hoc features via templated dewetting

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aouassa, M.; Berbezier, I.; Favre, L.

Design of monodisperse ultra-small nanocrystals (NCs) into large scale patterns with ad hoc features is demonstrated. The process makes use of solid state dewetting of a thin film templated through alloy liquid metal ion source focused ion beam (LMIS-FIB) nanopatterning. The solid state dewetting initiated at the edges of the patterns controllably creates the ordering of NCs with ad hoc placement and periodicity. The NC size is tuned by varying the nominal thickness of the film while their position results from the association of film retraction from the edges of the lay out and Rayleigh-like instability. The use of ultra-highmore » resolution LMIS-FIB enables to produce monocrystalline NCs with size, periodicity, and placement tunable as well. It provides routes for the free design of nanostructures for generic applications in nanoelectronics.« less

The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.

PubMed

Roberts, Nicole K; Williams, Reed G; Schwind, Cathy J; Sutyak, John A; McDowell, Christopher; Griffen, David; Wall, Jarrod; Sanfey, Hilary; Chestnut, Audra; Meier, Andreas H; Wohltmann, Christopher; Clark, Ted R; Wetter, Nathan

2014-02-01

Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams. Copyright © 2014 Elsevier Inc. All rights reserved.

Ad hoc categories and false memories: Memory illusions for categories created on-the-spot.

PubMed

Soro, Jerônimo C; Ferreira, Mário B; Semin, Gün R; Mata, André; Carneiro, Paula

2017-11-01

Three experiments were designed to test whether experimentally created ad hoc associative networks evoke false memories. We used the DRM (Deese, Roediger, McDermott) paradigm with lists of ad hoc categories composed of exemplars aggregated toward specific goals (e.g., going for a picnic) that do not share any consistent set of features. Experiment 1 revealed considerable levels of false recognitions of critical words from ad hoc categories. False recognitions occurred even when the lists were presented without an organizing theme (i.e., the category's label). Experiments 1 and 2 tested whether (a) the ease of identifying the categories' themes, and (b) the lists' backward associative strength could be driving the effect. List identifiability did not correlate with false recognition, and the effect remained even when backward associative strength was controlled for. Experiment 3 manipulated the distractor items in the recognition task to address the hypothesis that the salience of unrelated items could be facilitating the occurrence of the phenomenon. The effect remained when controlling for this source of facilitation. These results have implications for assumptions made by theories of false memories, namely the preexistence of associations in the activation-monitoring framework and the central role of gist extraction in fuzzy-trace theory, while providing evidence of the occurrence of false memories for more dynamic and context-dependent knowledge structures. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Ad Hoc Selection of Voice over Internet Streams

NASA Technical Reports Server (NTRS)

Macha, Mitchell G. (Inventor); Bullock, John T. (Inventor)

2014-01-01

A method and apparatus for a communication system technique involving ad hoc selection of at least two audio streams is provided. Each of the at least two audio streams is a packetized version of an audio source. A data connection exists between a server and a client where a transport protocol actively propagates the at least two audio streams from the server to the client. Furthermore, software instructions executable on the client indicate a presence of the at least two audio streams, allow selection of at least one of the at least two audio streams, and direct the selected at least one of the at least two audio streams for audio playback.

Ad Hoc Selection of Voice over Internet Streams

NASA Technical Reports Server (NTRS)

Macha, Mitchell G. (Inventor); Bullock, John T. (Inventor)

2008-01-01

A method and apparatus for a communication system technique involving ad hoc selection of at least two audio streams is provided. Each of the at least two audio streams is a packetized version of an audio source. A data connection exists between a server and a client where a transport protocol actively propagates the at least two audio streams from the server to the client. Furthermore, software instructions executable on the client indicate a presence of the at least two audio streams, allow selection of at least one of the at least two audio streams, and direct the selected at least one of the at least two audio streams for audio playback.

Worm epidemics in wireless ad hoc networks

NASA Astrophysics Data System (ADS)

Nekovee, Maziar

2007-06-01

A dramatic increase in the number of computing devices with wireless communication capability has resulted in the emergence of a new class of computer worms which specifically target such devices. The most striking feature of these worms is that they do not require Internet connectivity for their propagation but can spread directly from device to device using a short-range radio communication technology, such as WiFi or Bluetooth. In this paper, we develop a new model for epidemic spreading of these worms and investigate their spreading in wireless ad hoc networks via extensive Monte Carlo simulations. Our studies show that the threshold behaviour and dynamics of worm epidemics in these networks are greatly affected by a combination of spatial and temporal correlations which characterize these networks, and are significantly different from the previously studied epidemics in the Internet.

Dynamic fair node spectrum allocation for ad hoc networks using random matrices

NASA Astrophysics Data System (ADS)

Rahmes, Mark; Lemieux, George; Chester, Dave; Sonnenberg, Jerry

2015-05-01

Dynamic Spectrum Access (DSA) is widely seen as a solution to the problem of limited spectrum, because of its ability to adapt the operating frequency of a radio. Mobile Ad Hoc Networks (MANETs) can extend high-capacity mobile communications over large areas where fixed and tethered-mobile systems are not available. In one use case with high potential impact, cognitive radio employs spectrum sensing to facilitate the identification of allocated frequencies not currently accessed by their primary users. Primary users own the rights to radiate at a specific frequency and geographic location, while secondary users opportunistically attempt to radiate at a specific frequency when the primary user is not using it. We populate a spatial radio environment map (REM) database with known information that can be leveraged in an ad hoc network to facilitate fair path use of the DSA-discovered links. Utilization of high-resolution geospatial data layers in RF propagation analysis is directly applicable. Random matrix theory (RMT) is useful in simulating network layer usage in nodes by a Wishart adjacency matrix. We use the Dijkstra algorithm for discovering ad hoc network node connection patterns. We present a method for analysts to dynamically allocate node-node path and link resources using fair division. User allocation of limited resources as a function of time must be dynamic and based on system fairness policies. The context of fair means that first available request for an asset is not envied as long as it is not yet allocated or tasked in order to prevent cycling of the system. This solution may also save money by offering a Pareto efficient repeatable process. We use a water fill queue algorithm to include Shapley value marginal contributions for allocation.

Cross-layer model design in wireless ad hoc networks for the Internet of Things.

PubMed

Yang, Xin; Wang, Ling; Xie, Jian; Zhang, Zhaolin

2018-01-01

Wireless ad hoc networks can experience extreme fluctuations in transmission traffic in the Internet of Things, which is widely used today. Currently, the most crucial issues requiring attention for wireless ad hoc networks are making the best use of low traffic periods, reducing congestion during high traffic periods, and improving transmission performance. To solve these problems, the present paper proposes a novel cross-layer transmission model based on decentralized coded caching in the physical layer and a content division multiplexing scheme in the media access control layer. Simulation results demonstrate that the proposed model effectively addresses these issues by substantially increasing the throughput and successful transmission rate compared to existing protocols without a negative influence on delay, particularly for large scale networks under conditions of highly contrasting high and low traffic periods.

Cross-layer model design in wireless ad hoc networks for the Internet of Things

PubMed Central

Wang, Ling; Xie, Jian; Zhang, Zhaolin

2018-01-01

Wireless ad hoc networks can experience extreme fluctuations in transmission traffic in the Internet of Things, which is widely used today. Currently, the most crucial issues requiring attention for wireless ad hoc networks are making the best use of low traffic periods, reducing congestion during high traffic periods, and improving transmission performance. To solve these problems, the present paper proposes a novel cross-layer transmission model based on decentralized coded caching in the physical layer and a content division multiplexing scheme in the media access control layer. Simulation results demonstrate that the proposed model effectively addresses these issues by substantially increasing the throughput and successful transmission rate compared to existing protocols without a negative influence on delay, particularly for large scale networks under conditions of highly contrasting high and low traffic periods. PMID:29734355

A game-theoretic approach to optimize ad hoc networks inspired by small-world network topology

NASA Astrophysics Data System (ADS)

Tan, Mian; Yang, Tinghong; Chen, Xing; Yang, Gang; Zhu, Guoqing; Holme, Petter; Zhao, Jing

2018-03-01

Nodes in ad hoc networks are connected in a self-organized manner. Limited communication radius makes information transmit in multi-hop mode, and each forwarding needs to consume the energy of nodes. Insufficient communication radius or exhaustion of energy may cause the absence of some relay nodes and links, further breaking network connectivity. On the other hand, nodes in the network may refuse to cooperate due to objective faulty or personal selfish, hindering regular communication in the network. This paper proposes a model called Repeated Game in Small World Networks (RGSWN). In this model, we first construct ad hoc networks with small-world feature by forming "communication shortcuts" between multiple-radio nodes. Small characteristic path length reduces average forwarding times in networks; meanwhile high clustering coefficient enhances network robustness. Such networks still maintain relative low global power consumption, which is beneficial to extend the network survival time. Then we use MTTFT strategy (Mend-Tolerance Tit-for-Tat) for repeated game as a rule for the interactions between neighbors in the small-world networks. Compared with other five strategies of repeated game, this strategy not only punishes the nodes' selfishness more reasonably, but also has the best tolerance to the network failure. This work is insightful for designing an efficient and robust ad hoc network.

Forming an ad-hoc nearby storage, based on IKAROS and social networking services

NASA Astrophysics Data System (ADS)

Filippidis, Christos; Cotronis, Yiannis; Markou, Christos

2014-06-01

We present an ad-hoc "nearby" storage, based on IKAROS and social networking services, such as Facebook. By design, IKAROS is capable to increase or decrease the number of nodes of the I/O system instance on the fly, without bringing everything down or losing data. IKAROS is capable to decide the file partition distribution schema, by taking on account requests from the user or an application, as well as a domain or a Virtual Organization policy. In this way, it is possible to form multiple instances of smaller capacity higher bandwidth storage utilities capable to respond in an ad-hoc manner. This approach, focusing on flexibility, can scale both up and down and so can provide more cost effective infrastructures for both large scale and smaller size systems. A set of experiments is performed comparing IKAROS with PVFS2 by using multiple clients requests under HPC IOR benchmark and MPICH2.

A Multi-User Game-Theoretical Multipath Routing Protocol to Send Video-Warning Messages over Mobile Ad Hoc Networks

PubMed Central

Mezher, Ahmad Mohamad; Igartua, Mónica Aguilar; de la Cruz Llopis, Luis J.; Segarra, Esteve Pallarès; Tripp-Barba, Carolina; Urquiza-Aguiar, Luis; Forné, Jordi; Gargallo, Emilio Sanvicente

2015-01-01

The prevention of accidents is one of the most important goals of ad hoc networks in smart cities. When an accident happens, dynamic sensors (e.g., citizens with smart phones or tablets, smart vehicles and buses, etc.) could shoot a video clip of the accident and send it through the ad hoc network. With a video message, the level of seriousness of the accident could be much better evaluated by the authorities (e.g., health care units, police and ambulance drivers) rather than with just a simple text message. Besides, other citizens would be rapidly aware of the incident. In this way, smart dynamic sensors could participate in reporting a situation in the city using the ad hoc network so it would be possible to have a quick reaction warning citizens and emergency units. The deployment of an efficient routing protocol to manage video-warning messages in mobile Ad hoc Networks (MANETs) has important benefits by allowing a fast warning of the incident, which potentially can save lives. To contribute with this goal, we propose a multipath routing protocol to provide video-warning messages in MANETs using a novel game-theoretical approach. As a base for our work, we start from our previous work, where a 2-players game-theoretical routing protocol was proposed to provide video-streaming services over MANETs. In this article, we further generalize the analysis made for a general number of N players in the MANET. Simulations have been carried out to show the benefits of our proposal, taking into account the mobility of the nodes and the presence of interfering traffic.Finally, we also have tested our approach in a vehicular ad hoc network as an incipient start point to develop a novel proposal specifically designed for VANETs. PMID:25897496

A Multi-User Game-Theoretical Multipath Routing Protocol to Send Video-Warning Messages over Mobile Ad Hoc Networks.

PubMed

Mezher, Ahmad Mohamad; Igartua, Mónica Aguilar; de la Cruz Llopis, Luis J; Pallarès Segarra, Esteve; Tripp-Barba, Carolina; Urquiza-Aguiar, Luis; Forné, Jordi; Sanvicente Gargallo, Emilio

2015-04-17

The prevention of accidents is one of the most important goals of ad hoc networks in smart cities. When an accident happens, dynamic sensors (e.g., citizens with smart phones or tablets, smart vehicles and buses, etc.) could shoot a video clip of the accident and send it through the ad hoc network. With a video message, the level of seriousness of the accident could be much better evaluated by the authorities (e.g., health care units, police and ambulance drivers) rather than with just a simple text message. Besides, other citizens would be rapidly aware of the incident. In this way, smart dynamic sensors could participate in reporting a situation in the city using the ad hoc network so it would be possible to have a quick reaction warning citizens and emergency units. The deployment of an efficient routing protocol to manage video-warning messages in mobile Ad hoc Networks (MANETs) has important benefits by allowing a fast warning of the incident, which potentially can save lives. To contribute with this goal, we propose a multipath routing protocol to provide video-warning messages in MANETs using a novel game-theoretical approach. As a base for our work, we start from our previous work, where a 2-players game-theoretical routing protocol was proposed to provide video-streaming services over MANETs. In this article, we further generalize the analysis made for a general number of N players in the MANET. Simulations have been carried out to show the benefits of our proposal, taking into account the mobility of the nodes and the presence of interfering traffic. Finally, we also have tested our approach in a vehicular ad hoc network as an incipient start point to develop a novel proposal specifically designed for VANETs.

Specialist availability in emergencies: contributions of response times and the use of ad hoc coverage in New York State.

PubMed

Rabin, Elaine; Patrick, Lisa

2016-04-01

Nationwide, hospitals struggle to maintain specialist on-call coverage for emergencies. We seek to further understand the issue by examining reliability of scheduled coverage and the role of ad hoc coverage when none is scheduled. An anonymous electronic survey of all emergency department (ED) directors of a large state. Overall and for 10 specialties, respondents were asked to estimate on-call coverage extent and "reliability" (frequency of emergency response in a clinically useful time frame: 2 hours), and use and effect of ad hoc emergency coverage to fill gaps. Descriptive statistics were performed using Fisher exact and Wilcoxon sign rank tests for significance. Contact information was obtained for 125 of 167 ED directors. Sixty responded (48%), representing 36% of EDs. Forty-six percent reported full on-call coverage scheduled for all specialties. Forty-six percent reported consistent reliability. Coverage and reliability were strongly related (P<.01; 33% reported both), and larger ED volume correlated with both (P<.01). Ninety percent of hospitals that had gaps in either employed ad hoc coverage, significantly improving coverage for 8 of 10 specialties. For all but 1 specialty, more than 20% of hospitals reported that specialists are "Never", "Rarely" or "Sometimes" reliable (more than 50% for cardiovascular surgery, hand surgery and ophthalmology). Significant holes in scheduled on-call specialist coverage are compounded by frequent unreliability of on-call specialists, but partially ameliorated by ad hoc specialist coverage. Regionalization may help because a 2-tiered system may exist: larger hospitals have more complete, reliable coverage. Better understanding of specialists' willingness to treat emergencies ad hoc without taking formal call will suggest additional remedies. Copyright © 2015 Elsevier Inc. All rights reserved.

HOW GAS-DYNAMIC FLARE MODELS POWERED BY PETSCHEK RECONNECTION DIFFER FROM THOSE WITH AD HOC ENERGY SOURCES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Longcope, D. W.; Klimchuk, J. A.

Aspects of solar flare dynamics, such as chromospheric evaporation and flare light curves, have long been studied using one-dimensional models of plasma dynamics inside a static flare loop, subjected to some energy input. While extremely successful at explaining the observed characteristics of flares, all such models so far have specified energy input ad hoc, rather than deriving it self-consistently. There is broad consensus that flares are powered by magnetic energy released through reconnection. Recent work has generalized Petschek’s basic reconnection scenario, topological change followed by field line retraction and shock heating, to permit its inclusion in a one-dimensional flare loop model. Heremore » we compare the gas dynamics driven by retraction and shocking to those from more conventional static loop models energized by ad hoc source terms. We find significant differences during the first minute, when retraction leads to larger kinetic energies and produces higher densities at the loop top, while ad hoc heating tends to rarify the loop top. The loop-top density concentration is related to the slow magnetosonic shock, characteristic of Petschek’s model, but persists beyond the retraction phase occurring in the outflow jet. This offers an explanation for observed loop-top sources of X-ray and EUV emission, with advantages over that provided by ad hoc heating scenarios. The cooling phases of the two models are, however, notably similar to one another, suggesting that observations at that stage will yield little information on the nature of energy input.« less

Smart border: ad-hoc wireless sensor networks for border surveillance

NASA Astrophysics Data System (ADS)

He, Jun; Fallahi, Mahmoud; Norwood, Robert A.; Peyghambarian, Nasser

2011-06-01

Wireless sensor networks have been proposed as promising candidates to provide automated monitoring, target tracking, and intrusion detection for border surveillance. In this paper, we demonstrate an ad-hoc wireless sensor network system for border surveillance. The network consists of heterogeneously autonomous sensor nodes that distributively cooperate with each other to enable a smart border in remote areas. This paper also presents energy-aware and sleeping algorithms designed to maximize the operating lifetime of the deployed sensor network. Lessons learned in building the network and important findings from field experiments are shared in the paper.

Spontaneous ad hoc mobile cloud computing network.

PubMed

Lacuesta, Raquel; Lloret, Jaime; Sendra, Sandra; Peñalver, Lourdes

2014-01-01

Cloud computing helps users and companies to share computing resources instead of having local servers or personal devices to handle the applications. Smart devices are becoming one of the main information processing devices. Their computing features are reaching levels that let them create a mobile cloud computing network. But sometimes they are not able to create it and collaborate actively in the cloud because it is difficult for them to build easily a spontaneous network and configure its parameters. For this reason, in this paper, we are going to present the design and deployment of a spontaneous ad hoc mobile cloud computing network. In order to perform it, we have developed a trusted algorithm that is able to manage the activity of the nodes when they join and leave the network. The paper shows the network procedures and classes that have been designed. Our simulation results using Castalia show that our proposal presents a good efficiency and network performance even by using high number of nodes.

On service differentiation in mobile Ad Hoc networks.

PubMed

Zhang, Shun-liang; Ye, Cheng-qing

2004-09-01

A network model is proposed to support service differentiation for mobile Ad Hoc networks by combining a fully distributed admission control approach and the DIFS based differentiation mechanism of IEEE802.11. It can provide different kinds of QoS (Quality of Service) for various applications. Admission controllers determine a committed bandwidth based on the reserved bandwidth of flows and the source utilization of networks. Packets are marked when entering into networks by markers according to the committed rate. By the mark in the packet header, intermediate nodes handle the received packets in different manners to provide applications with the QoS corresponding to the pre-negotiated profile. Extensive simulation experiments showed that the proposed mechanism can provide QoS guarantee to assured service traffic and increase the channel utilization of networks.

An artificial immune system approach with secondary response for misbehavior detection in mobile ad hoc networks.

PubMed

Sarafijanović, Slavisa; Le Boudec, Jean-Yves

2005-09-01

In mobile ad hoc networks, nodes act both as terminals and information relays, and they participate in a common routing protocol, such as dynamic source routing (DSR). The network is vulnerable to routing misbehavior, due to faulty or malicious nodes. Misbehavior detection systems aim at removing this vulnerability. In this paper, we investigate the use of an artificial immune system (AIS) to detect node misbehavior in a mobile ad hoc network using DSR. The system is inspired by the natural immune system (IS) of vertebrates. Our goal is to build a system that, like its natural counterpart, automatically learns, and detects new misbehavior. We describe our solution for the classification task of the AIS; it employs negative selection and clonal selection, the algorithms for learning and adaptation used by the natural IS. We define how we map the natural IS concepts such as self, antigen, and antibody to a mobile ad hoc network and give the resulting algorithm for classifying nodes as misbehaving. We implemented the system in the network simulator Glomosim; we present detection results and discuss how the system parameters affect the performance of primary and secondary response. Further steps will extend the design by using an analogy to the innate system, danger signal, and memory cells.

The Use of English as Ad Hoc Institutional Standard in the Belgian Asylum Interview

ERIC Educational Resources Information Center

Maryns, Katrijn

2017-01-01

In institutional settings of globalization, labelled languages are generally preferred over multilingual repertoires and mobile language resources. Drawing on linguistic-ethnographic analysis of the way English is treated as an invariable "ad hoc" idiom in the Belgian asylum interview, this article demonstrates how institutional measures…

Assessing Clinical Microbiology Practice Guidelines: American Society for Microbiology Ad Hoc Committee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment.

PubMed

Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney

2017-11-01

As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.

Assessing Clinical Microbiology Practice Guidelines: American Society for Microbiology Ad Hoc Committee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment

PubMed Central

Kirn, Thomas J.; Westblade, Lars F.; Humphries, Romney

2017-01-01

ABSTRACT As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. PMID:28835476

Greedy data transportation scheme with hard packet deadlines for wireless ad hoc networks.

PubMed

Lee, HyungJune

2014-01-01

We present a greedy data transportation scheme with hard packet deadlines in ad hoc sensor networks of stationary nodes and multiple mobile nodes with scheduled trajectory path and arrival time. In the proposed routing strategy, each stationary ad hoc node en route decides whether to relay a shortest-path stationary node toward destination or a passing-by mobile node that will carry closer to destination. We aim to utilize mobile nodes to minimize the total routing cost as far as the selected route can satisfy the end-to-end packet deadline. We evaluate our proposed routing algorithm in terms of routing cost, packet delivery ratio, packet delivery time, and usability of mobile nodes based on network level simulations. Simulation results show that our proposed algorithm fully exploits the remaining time till packet deadline to turn into networking benefits of reducing the overall routing cost and improving packet delivery performance. Also, we demonstrate that the routing scheme guarantees packet delivery with hard deadlines, contributing to QoS improvement in various network services.

Greedy Data Transportation Scheme with Hard Packet Deadlines for Wireless Ad Hoc Networks

PubMed Central

Lee, HyungJune

2014-01-01

We present a greedy data transportation scheme with hard packet deadlines in ad hoc sensor networks of stationary nodes and multiple mobile nodes with scheduled trajectory path and arrival time. In the proposed routing strategy, each stationary ad hoc node en route decides whether to relay a shortest-path stationary node toward destination or a passing-by mobile node that will carry closer to destination. We aim to utilize mobile nodes to minimize the total routing cost as far as the selected route can satisfy the end-to-end packet deadline. We evaluate our proposed routing algorithm in terms of routing cost, packet delivery ratio, packet delivery time, and usability of mobile nodes based on network level simulations. Simulation results show that our proposed algorithm fully exploits the remaining time till packet deadline to turn into networking benefits of reducing the overall routing cost and improving packet delivery performance. Also, we demonstrate that the routing scheme guarantees packet delivery with hard deadlines, contributing to QoS improvement in various network services. PMID:25258736

The 5th Meeting of the Ad Hoc Panel on Terminal Configured Vehicles

NASA Technical Reports Server (NTRS)

1977-01-01

A report of the fifth meeting of the NASA Research and Technology Advisory Council, Ad Hoc panel on Terminal Configured Vehicles is presented. Some of the following topics were discussed; (1) microwave landing systems; (2) whole word computer system status; (3) flight path angle control: (4) VTOL approaches and landing technology; and (5) simulation study in wind shear.

Adaptive Reliable Routing Protocol Using Combined Link Stability Estimation for Mobile Ad hoc Networks

NASA Astrophysics Data System (ADS)

Vadivel, R.; Bhaskaran, V. Murali

2010-10-01

The main reason for packet loss in ad hoc networks is the link failure or node failure. In order to increase the path stability, it is essential to distinguish and moderate the failures. By knowing individual link stability along a path, path stability can be identified. In this paper, we develop an adaptive reliable routing protocol using combined link stability estimation for mobile ad hoc networks. The main objective of this protocol is to determine a Quality of Service (QoS) path along with prolonging the network life time and to reduce the packet loss. We calculate a combined metric for a path based on the parameters Link Expiration Time, Node Remaining Energy and Node Velocity and received signal strength to predict the link stability or lifetime. Then, a bypass route is established to retransmit the lost data, when a link failure occurs. By simulation results, we show that the proposed reliable routing protocol achieves high delivery ratio with reduced delay and packet drop.

A multihop key agreement scheme for wireless ad hoc networks based on channel characteristics.

PubMed

Hao, Zhuo; Zhong, Sheng; Yu, Nenghai

2013-01-01

A number of key agreement schemes based on wireless channel characteristics have been proposed recently. However, previous key agreement schemes require that two nodes which need to agree on a key are within the communication range of each other. Hence, they are not suitable for multihop wireless networks, in which nodes do not always have direct connections with each other. In this paper, we first propose a basic multihop key agreement scheme for wireless ad hoc networks. The proposed basic scheme is resistant to external eavesdroppers. Nevertheless, this basic scheme is not secure when there exist internal eavesdroppers or Man-in-the-Middle (MITM) adversaries. In order to cope with these adversaries, we propose an improved multihop key agreement scheme. We show that the improved scheme is secure against internal eavesdroppers and MITM adversaries in a single path. Both performance analysis and simulation results demonstrate that the improved scheme is efficient. Consequently, the improved key agreement scheme is suitable for multihop wireless ad hoc networks.

A Multihop Key Agreement Scheme for Wireless Ad Hoc Networks Based on Channel Characteristics

PubMed Central

Yu, Nenghai

2013-01-01

A number of key agreement schemes based on wireless channel characteristics have been proposed recently. However, previous key agreement schemes require that two nodes which need to agree on a key are within the communication range of each other. Hence, they are not suitable for multihop wireless networks, in which nodes do not always have direct connections with each other. In this paper, we first propose a basic multihop key agreement scheme for wireless ad hoc networks. The proposed basic scheme is resistant to external eavesdroppers. Nevertheless, this basic scheme is not secure when there exist internal eavesdroppers or Man-in-the-Middle (MITM) adversaries. In order to cope with these adversaries, we propose an improved multihop key agreement scheme. We show that the improved scheme is secure against internal eavesdroppers and MITM adversaries in a single path. Both performance analysis and simulation results demonstrate that the improved scheme is efficient. Consequently, the improved key agreement scheme is suitable for multihop wireless ad hoc networks. PMID:23766725

Stochastic does not equal ad hoc. [theories of lunar origin

NASA Technical Reports Server (NTRS)

Hartmann, W. K.

1984-01-01

Some classes of influential events in solar system history are class-predictable but not event-predictable. Theories of lunar origin should not ignore class-predictable stochastic events. Impacts and close encounters with large objects during planet formation are class-predictable. These stochastic events, such as large impacts that triggered ejection of Earth-mantle material into a circum-Earth cloud, should not be rejected as ad hoc. A way to deal with such events scientifically is to investigate their consequences; if it can be shown that they might produce the Moon, they become viable concepts in theories of lunar origin.

Integrated Social and Quality of Service Trust Management of Mobile Groups in Ad Hoc Networks

DTIC Science & Technology

2013-01-01

high resiliency to malicious attacks and misbehaving nodes. Keywords—trust management; mobile ad hoc networks; QoS trust; social trust; trust...paper we address an importance issue of trust management protocol design for MANETs: trust bias minimization despite misbehaving nodes performing

Topology for efficient information dissemination in ad-hoc networking

NASA Technical Reports Server (NTRS)

Jennings, E.; Okino, C. M.

2002-01-01

In this paper, we explore the information dissemination problem in ad-hoc wirless networks. First, we analyze the probability of successful broadcast, assuming: the nodes are uniformly distributed, the available area has a lower bould relative to the total number of nodes, and there is zero knowledge of the overall topology of the network. By showing that the probability of such events is small, we are motivated to extract good graph topologies to minimize the overall transmissions. Three algorithms are used to generate topologies of the network with guaranteed connectivity. These are the minimum radius graph, the relative neighborhood graph and the minimum spanning tree. Our simulation shows that the relative neighborhood graph has certain good graph properties, which makes it suitable for efficient information dissemination.

Spontaneous Ad Hoc Mobile Cloud Computing Network

PubMed Central

Lacuesta, Raquel; Sendra, Sandra; Peñalver, Lourdes

2014-01-01

Cloud computing helps users and companies to share computing resources instead of having local servers or personal devices to handle the applications. Smart devices are becoming one of the main information processing devices. Their computing features are reaching levels that let them create a mobile cloud computing network. But sometimes they are not able to create it and collaborate actively in the cloud because it is difficult for them to build easily a spontaneous network and configure its parameters. For this reason, in this paper, we are going to present the design and deployment of a spontaneous ad hoc mobile cloud computing network. In order to perform it, we have developed a trusted algorithm that is able to manage the activity of the nodes when they join and leave the network. The paper shows the network procedures and classes that have been designed. Our simulation results using Castalia show that our proposal presents a good efficiency and network performance even by using high number of nodes. PMID:25202715

Analytical Models of Cross-Layer Protocol Optimization in Real-Time Wireless Sensor Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Hortos, William S.

The real-time interactions among the nodes of a wireless sensor network (WSN) to cooperatively process data from multiple sensors are modeled. Quality-of-service (QoS) metrics are associated with the quality of fused information: throughput, delay, packet error rate, etc. Multivariate point process (MVPP) models of discrete random events in WSNs establish stochastic characteristics of optimal cross-layer protocols. Discrete-event, cross-layer interactions in mobile ad hoc network (MANET) protocols have been modeled using a set of concatenated design parameters and associated resource levels by the MVPPs. Characterization of the "best" cross-layer designs for a MANET is formulated by applying the general theory of martingale representations to controlled MVPPs. Performance is described in terms of concatenated protocol parameters and controlled through conditional rates of the MVPPs. Modeling limitations to determination of closed-form solutions versus explicit iterative solutions for ad hoc WSN controls are examined.

A secure 3-way routing protocols for intermittently connected mobile ad hoc networks.

PubMed

Sekaran, Ramesh; Parasuraman, Ganesh Kumar

2014-01-01

The mobile ad hoc network may be partially connected or it may be disconnected in nature and these forms of networks are termed intermittently connected mobile ad hoc network (ICMANET). The routing in such disconnected network is commonly an arduous task. Many routing protocols have been proposed for routing in ICMANET since decades. The routing techniques in existence for ICMANET are, namely, flooding, epidemic, probabilistic, copy case, spray and wait, and so forth. These techniques achieve an effective routing with minimum latency, higher delivery ratio, lesser overhead, and so forth. Though these techniques generate effective results, in this paper, we propose novel routing algorithms grounded on agent and cryptographic techniques, namely, location dissemination service (LoDiS) routing with agent AES, A-LoDiS with agent AES routing, and B-LoDiS with agent AES routing, ensuring optimal results with respect to various network routing parameters. The algorithm along with efficient routing ensures higher degree of security. The security level is cited testing with respect to possibility of malicious nodes into the network. This paper also aids, with the comparative results of proposed algorithms, for secure routing in ICMANET.

A Secure 3-Way Routing Protocols for Intermittently Connected Mobile Ad Hoc Networks

PubMed Central

Parasuraman, Ganesh Kumar

2014-01-01

The mobile ad hoc network may be partially connected or it may be disconnected in nature and these forms of networks are termed intermittently connected mobile ad hoc network (ICMANET). The routing in such disconnected network is commonly an arduous task. Many routing protocols have been proposed for routing in ICMANET since decades. The routing techniques in existence for ICMANET are, namely, flooding, epidemic, probabilistic, copy case, spray and wait, and so forth. These techniques achieve an effective routing with minimum latency, higher delivery ratio, lesser overhead, and so forth. Though these techniques generate effective results, in this paper, we propose novel routing algorithms grounded on agent and cryptographic techniques, namely, location dissemination service (LoDiS) routing with agent AES, A-LoDiS with agent AES routing, and B-LoDiS with agent AES routing, ensuring optimal results with respect to various network routing parameters. The algorithm along with efficient routing ensures higher degree of security. The security level is cited testing with respect to possibility of malicious nodes into the network. This paper also aids, with the comparative results of proposed algorithms, for secure routing in ICMANET. PMID:25136697

An extended smart utilization medium access control (ESU-MAC) protocol for ad hoc wireless systems

NASA Astrophysics Data System (ADS)

Vashishtha, Jyoti; Sinha, Aakash

2006-05-01

The demand for spontaneous setup of a wireless communication system has increased in recent years for areas like battlefield, disaster relief operations etc., where a pre-deployment of network infrastructure is difficult or unavailable. A mobile ad-hoc network (MANET) is a promising solution, but poses a lot of challenges for all the design layers, specifically medium access control (MAC) layer. Recent existing works have used the concepts of multi-channel and power control in designing MAC layer protocols. SU-MAC developed by the same authors, efficiently uses the 'available' data and control bandwidth to send control information and results in increased throughput via decreasing contention on the control channel. However, SU-MAC protocol was limited for static ad-hoc network and also faced the busy-receiver node problem. We present the Extended SU-MAC (ESU-MAC) protocol which works mobile nodes. Also, we significantly improve the scheme of control information exchange in ESU-MAC to overcome the busy-receiver node problem and thus, further avoid the blockage of control channel for longer periods of time. A power control scheme is used as before to reduce interference and to effectively re-use the available bandwidth. Simulation results show that ESU-MAC protocol is promising for mobile, ad-hoc network in terms of reduced contention at the control channel and improved throughput because of channel re-use. Results show a considerable increase in throughput compared to SU-MAC which could be attributed to increased accessibility of control channel and improved utilization of data channels due to superior control information exchange scheme.

Defense Acquisition and the Case of the Joint Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a Mechanism for Adaptive Change

DTIC Science & Technology

2013-04-01

Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a Mechanism for Adaptive Change Kathryn Aten and John T. Dillard Naval...Defense Acquisition and the Case of the Joint Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a Mechanism for Adaptive Change...describes the preliminary analysis and findings of our study exploring what drives successful organizational adaptation in the context of technology

An Energy Efficient Power Control Protocol for Ad Hoc Networks Using Directional Antennas

NASA Astrophysics Data System (ADS)

Quiroz-Perez, Carlos; Gulliver, T. Aaron

A wireless ad hoc network is a collection of mobile nodes that can communicate with each other. Typically, nodes employ omnidirectional antennas. The use of directional antennas can increase spatial reuse, reduce the number of hops to a destination, reduce interference, and increase the transmission range in a specific direction. This is because omnidirectional antennas radiate equally in all directions, limiting the transmission range.

Report of the Ad Hoc Committee on Religious and Cultural Celebrations in the Library.

ERIC Educational Resources Information Center

Rathemacher, Andree; Grubman, Sheila Black; Lahiri, Amar; Gilton, Donna; Sharif, Mohammed

The charge of the University of Rhode Island's Ad Hoc Committee on Religious and Cultural Celebrations in the Library was to: investigate all opportunities for the library to educate the campus community about religious and cultural holidays; consider all the major religions of the world and the possibility of having displays for the symbols of…

Defense Acquisition and the Case of the Joint Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a Mechanism for Adaptive Change

DTIC Science & Technology

2013-10-01

pmlkploba=obmloq=pbofbp= Defense Acquisition and the Case of the Joint Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a...of the Joint Capabilities Technology Demonstration Office: Ad Hoc Problem Solving as a Mechanism for Adaptive Change 5a. CONTRACT NUMBER 5b. GRANT...findings of our study exploring what drives successful organizational adaptation in the context of technology transition and acquisition within the

Data management issues in mobile ad hoc networks

PubMed Central

HARA, Takahiro

2017-01-01

Research on mobile ad hoc networks (MANETs) has become a hot research topic since the middle 1990’s. Over the first decade, most research focused on networking techniques, ignoring data management issues. We, however, realized early the importance of data management in MANETs, and have been conducting studies in this area for 15 years. In this review, we summarize some key technical issues related to data management in MANETs, and the studies we have done in addressing these issues, which include placement of data replicas, update management, and query processing with security management. The techniques proposed in our studies have been designed with deep considerations of MANET features including network partitioning, node participation/disappearance, limited network bandwidth, and energy efficiency. Our studies published in early 2000’s have developed a new research field as data management in MANETs. Also, our recent studies are expected to be significant guidelines of new research directions. We conclude the review by discussing some future directions for research. PMID:28496052

Data management issues in mobile ad hoc networks.

PubMed

Hara, Takahiro

2017-01-01

Research on mobile ad hoc networks (MANETs) has become a hot research topic since the middle 1990's. Over the first decade, most research focused on networking techniques, ignoring data management issues. We, however, realized early the importance of data management in MANETs, and have been conducting studies in this area for 15 years. In this review, we summarize some key technical issues related to data management in MANETs, and the studies we have done in addressing these issues, which include placement of data replicas, update management, and query processing with security management. The techniques proposed in our studies have been designed with deep considerations of MANET features including network partitioning, node participation/disappearance, limited network bandwidth, and energy efficiency. Our studies published in early 2000's have developed a new research field as data management in MANETs. Also, our recent studies are expected to be significant guidelines of new research directions. We conclude the review by discussing some future directions for research.

Integrated data lookup and replication scheme in mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Chen, Kai; Nahrstedt, Klara

2001-11-01

Accessing remote data is a challenging task in mobile ad hoc networks. Two problems have to be solved: (1) how to learn about available data in the network; and (2) how to access desired data even when the original copy of the data is unreachable. In this paper, we develop an integrated data lookup and replication scheme to solve these problems. In our scheme, a group of mobile nodes collectively host a set of data to improve data accessibility for all members of the group. They exchange data availability information by broadcasting advertising (ad) messages to the group using an adaptive sending rate policy. The ad messages are used by other nodes to derive a local data lookup table, and to reduce data redundancy within a connected group. Our data replication scheme predicts group partitioning based on each node's current location and movement patterns, and replicates data to other partitions before partitioning occurs. Our simulations show that data availability information can quickly propagate throughout the network, and that the successful data access ratio of each node is significantly improved.

ARSENAL: A Cross Layer Architecture for Secure Resilient Tactical Mobile AdHoc Networks

DTIC Science & Technology

2016-01-21

stations separated by 0.5 to 1 km can be coherently measured to a single mobile subscriber using LTE signaling. These are the first measurements of...undertake three parallel but inter-coupled tasks geared towards a) performing measurements via real deployments and enhancing our understanding of layer...dependencies and vulnerabilities in mobile ad hoc networks; these measurements will be on existing testbeds at The views, opinions and/or findings

ARSENAL: A Cross Layer Architecture for SecureResilient Tactical Mobile AdHoc Networks

DTIC Science & Technology

2016-01-21

stations separated by 0.5 to 1 km can be coherently measured to a single mobile subscriber using LTE signaling. These are the first measurements of...undertake three parallel but inter-coupled tasks geared towards a) performing measurements via real deployments and enhancing our understanding of layer...dependencies and vulnerabilities in mobile ad hoc networks; these measurements will be on existing testbeds at The views, opinions and/or findings

Panel Discussion : Report of the APS Ad-Hoc Committee on LGBT Issues

NASA Astrophysics Data System (ADS)

Atherton, Tim; Barthelemy, Ramon; Garmon, Savannah; Reeves, Kyle; APS Ad-Hoc Committee on LGBT Issues Team

Following the presentation of the findings and recommendations of the APS Ad-Hoc Committee on LGBT Issues (C-LGBT) by Committee Chair Michael Falk, a panel discussion will be held featuring several members of the committee. The discussion will focus on how APS can best ensure the recommendations of the committee are carried out in a timely fashion and other ideas on future APS efforts toward LGBT inclusion in physics. Discussion topics will also include the research and other input that shaped the committee's findings and recommendations.

Intelligent QoS routing algorithm based on improved AODV protocol for Ad Hoc networks

NASA Astrophysics Data System (ADS)

Huibin, Liu; Jun, Zhang

2016-04-01

Mobile Ad Hoc Networks were playing an increasingly important part in disaster reliefs, military battlefields and scientific explorations. However, networks routing difficulties are more and more outstanding due to inherent structures. This paper proposed an improved cuckoo searching-based Ad hoc On-Demand Distance Vector Routing protocol (CSAODV). It elaborately designs the calculation methods of optimal routing algorithm used by protocol and transmission mechanism of communication-package. In calculation of optimal routing algorithm by CS Algorithm, by increasing QoS constraint, the found optimal routing algorithm can conform to the requirements of specified bandwidth and time delay, and a certain balance can be obtained among computation spending, bandwidth and time delay. Take advantage of NS2 simulation software to take performance test on protocol in three circumstances and validate the feasibility and validity of CSAODV protocol. In results, CSAODV routing protocol is more adapt to the change of network topological structure than AODV protocol, which improves package delivery fraction of protocol effectively, reduce the transmission time delay of network, reduce the extra burden to network brought by controlling information, and improve the routing efficiency of network.

Intelligent self-organization methods for wireless ad hoc sensor networks based on limited resources

NASA Astrophysics Data System (ADS)

Hortos, William S.

2006-05-01

A wireless ad hoc sensor network (WSN) is a configuration for area surveillance that affords rapid, flexible deployment in arbitrary threat environments. There is no infrastructure support and sensor nodes communicate with each other only when they are in transmission range. To a greater degree than the terminals found in mobile ad hoc networks (MANETs) for communications, sensor nodes are resource-constrained, with limited computational processing, bandwidth, memory, and power, and are typically unattended once in operation. Consequently, the level of information exchange among nodes, to support any complex adaptive algorithms to establish network connectivity and optimize throughput, not only deplete those limited resources and creates high overhead in narrowband communications, but also increase network vulnerability to eavesdropping by malicious nodes. Cooperation among nodes, critical to the mission of sensor networks, can thus be disrupted by the inappropriate choice of the method for self-organization. Recent published contributions to the self-configuration of ad hoc sensor networks, e.g., self-organizing mapping and swarm intelligence techniques, have been based on the adaptive control of the cross-layer interactions found in MANET protocols to achieve one or more performance objectives: connectivity, intrusion resistance, power control, throughput, and delay. However, few studies have examined the performance of these algorithms when implemented with the limited resources of WSNs. In this paper, self-organization algorithms for the initiation, operation and maintenance of a network topology from a collection of wireless sensor nodes are proposed that improve the performance metrics significant to WSNs. The intelligent algorithm approach emphasizes low computational complexity, energy efficiency and robust adaptation to change, allowing distributed implementation with the actual limited resources of the cooperative nodes of the network. Extensions of the

Ad hoc supervision of general practice registrars as a 'community of practice': analysis, interpretation and re-presentation.

PubMed

Clement, T; Brown, J; Morrison, J; Nestel, D

2016-05-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also provide an opportunity for learning and teaching. Wenger's (Communities of practice: learning, meaning, and identity. Cambridge University Press, New York, 1998) social theory of learning ('communities of practice') guided a secondary analysis of audio-recordings of ad hoc encounters. Data from one encounter is re-presented as an extended sequence to maintain congruence with the theoretical perspective and enhance vicariousness. An interpretive commentary communicates key features of Wenger's theory and highlights the researchers' interpretations. We argue that one encounter can reveal universal understandings of clinical supervision and that the process of naturalistic generalisation allows readers to transfer others' experiences to their own contexts. The paper raises significant analytic, interpretive, and representational issues. We highlight that report writing is an important, but infrequently discussed, part of research design. We discuss the challenges of supporting the learning and teaching that arises from adopting a socio-cultural lens and argue that such a perspective importantly captures the complex range of issues that work-based practitioners have to grapple with. This offers a challenge to how we research and seek to influence work-based learning and teaching in health care settings.

Mapping Ad Hoc Communications Network of a Large Number Fixed-Wing UAV Swarm

DTIC Science & Technology

2017-03-01

partitioned sub-swarms. The work covered in this thesis is to build a model of the NPS swarm’s communication network in ns-3 simulation software and use...partitioned sub- swarms. The work covered in this thesis is to build a model of the NPS swarm’s communication network in ns-3 simulation software and...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS MAPPING AD HOC COMMUNICATIONS NETWORK OF A LARGE NUMBER FIXED-WING UAV SWARM by Alexis

Energy conservation in ad hoc multimedia networks using traffic-shaping mechanisms

NASA Astrophysics Data System (ADS)

Chandra, Surendar

2003-12-01

In this work, we explore network traffic shaping mechanisms that deliver packets at pre-determined intervals; allowing the network interface to transition to a lower power consuming sleep state. We focus our efforts on commodity devices, IEEE 802.11b ad hoc mode and popular streaming formats. We argue that factors such as the lack of scheduling clock phase synchronization among the participants and scheduling delays introduced by back ground tasks affect the potential energy savings. Increasing the periodic transmission delays to transmit data infrequently can offset some of these effects at the expense of flooding the wireless channel for longer periods of time; potentially increasing the time to acquire the channel for non-multimedia traffic. Buffering mechanisms built into media browsers can mitigate the effects of these added delays from being mis-interpreted as network congestion. We show that practical implementations of such traffic shaping mechanisms can offer significant energy savings.

PCI-based WILDFIRE reconfigurable computing engines

NASA Astrophysics Data System (ADS)

Fross, Bradley K.; Donaldson, Robert L.; Palmer, Douglas J.

1996-10-01

WILDFORCE is the first PCI-based custom reconfigurable computer that is based on the Splash 2 technology transferred from the National Security Agency and the Institute for Defense Analyses, Supercomputing Research Center (SRC). The WILDFORCE architecture has many of the features of the WILDFIRE computer, such as field- programmable gate array (FPGA) based processing elements, linear array and crossbar interconnection, and high- performance memory and I/O subsystems. New features introduced in the PCI-based WILDFIRE systems include memory/processor options that can be added to any processing element. These options include static and dynamic memory, digital signal processors (DSPs), FPGAs, and microprocessors. In addition to memory/processor options, many different application specific connectors can be used to extend the I/O capabilities of the system, including systolic I/O, camera input and video display output. This paper also discusses how this new PCI-based reconfigurable computing engine is used for rapid-prototyping, real-time video processing and other DSP applications.

Adaptive Flow Control for Enabling Quality of Service in Tactical Ad Hoc Wireless Networks

DTIC Science & Technology

2010-12-01

environment in wireless networks , we use sensors in the network routers to detect and respond to congestion. We use backpressure techniques... wireless mesh network . In the current approach, we used OLSR as the routing scheme. However, B.A.T.M.A.N. offers the significant advantage of being based...Control and QoS Routing in Multi-Channel Wireless Mesh Networks ,” 68-77. ACM International Symposium on Mobile Ad Hoc Networking &

Scalable Authenticated Tree Based Group Key Exchange for Ad-Hoc Groups

NASA Astrophysics Data System (ADS)

Desmedt, Yvo; Lange, Tanja; Burmester, Mike

Task-specific groups are often formed in an ad-hoc manner within large corporate structures, such as companies. Take the following typical scenario: A director decides to set up a task force group for some specific project. An order is passed down the hierarchy where it finally reaches a manager who selects some employees to form the group. The members should communicate in a secure way and for efficiency, a symmetric encryption system is chosen. To establish a joint secret key for the group, a group key exchange (GKE) protocol is used. We show how to use an existing Public Key Infrastructure (PKI) to achieve authenticated GKE by modifying the protocol and particularly by including signatures.

Ad hoc committee on global climate issues: Annual report

USGS Publications Warehouse

Gerhard, L.C.; Hanson, B.M.B.

2000-01-01

The AAPG Ad Hoc Committee on Global Climate Issues has studied the supposition of human-induced climate change since the committee's inception in January 1998. This paper details the progress and findings of the committee through June 1999. At that time there had been essentially no geologic input into the global climate change debate. The following statements reflect the current state of climate knowledge from the geologic perspective as interpreted by the majority of the committee membership. The committee recognizes that new data could change its conclusions. The earth's climate is constantly changing owing to natural variability in earth processes. Natural climate variability over recent geological time is greater than reasonable estimates of potential human-induced greenhouse gas changes. Because no tool is available to test the supposition of human-induced climate change and the range of natural variability is so great, there is no discernible human influence on global climate at this time.

Enhancement of Beaconless Location-Based Routing with Signal Strength Assistance for Ad-Hoc Networks

NASA Astrophysics Data System (ADS)

Chen, Guowei; Itoh, Kenichi; Sato, Takuro

Routing in Ad-hoc networks is unreliable due to the mobility of the nodes. Location-based routing protocols, unlike other protocols which rely on flooding, excel in network scalability. Furthermore, new location-based routing protocols, like, e. g. BLR [1], IGF [2], & CBF [3] have been proposed, with the feature of not requiring beacons in MAC-layer, which improve more in terms of scalability. Such beaconless routing protocols can work efficiently in dense network areas. However, these protocols' algorithms have no ability to avoid from routing into sparse areas. In this article, historical signal strength has been added as a factor into the BLR algorithm, which avoids routing into sparse area, and consequently improves the global routing efficiency.

Robotic disaster recovery efforts with ad-hoc deployable cloud computing

NASA Astrophysics Data System (ADS)

Straub, Jeremy; Marsh, Ronald; Mohammad, Atif F.

2013-06-01

Autonomous operations of search and rescue (SaR) robots is an ill posed problem, which is complexified by the dynamic disaster recovery environment. In a typical SaR response scenario, responder robots will require different levels of processing capabilities during various parts of the response effort and will need to utilize multiple algorithms. Placing these capabilities onboard the robot is a mediocre solution that precludes algorithm specific performance optimization and results in mediocre performance. Architecture for an ad-hoc, deployable cloud environment suitable for use in a disaster response scenario is presented. Under this model, each service provider is optimized for the task and maintains a database of situation-relevant information. This service-oriented architecture (SOA 3.0) compliant framework also serves as an example of the efficient use of SOA 3.0 in an actual cloud application.

Trust Management in Mobile Ad Hoc Networks for Bias Minimization and Application Performance Maximization

DTIC Science & Technology

2014-02-26

set of anomaly detection rules 62 I.-R. Chen et al. / Ad Hoc Networks 19 (2014) 59–74 Author’s personal copy including the interval rule (for...deficiencies in anomaly detection (e.g., imperfection of rules) by a false negative probability (PHfn) of misidentifying an unhealthy node as a...multimedia servers, Multimedia Syst. 8 (2) (2000) 83–91. [53] R. Mitchell, I.R. Chen, Adaptive intrusion detection for unmanned aircraft systems based on

Clinician Ratings of Interpreter Mediated Visits in Underserved Primary Care Settings with Ad hoc, In-person Professional, and Video Conferencing Modes

PubMed Central

Nápoles, Anna M.; Santoyo-Olsson, Jasmine; Karliner, Leah S.; O’Brien, Helen; Gregorich, Steven E.; Pérez-Stable, Eliseo J.

2013-01-01

Language interpretation ameliorates health disparities among underserved limited English-proficient patients, yet few studies have compared clinician satisfaction with these services. Self-administered clinician post-visit surveys compared the quality of interpretation and communication, visit satisfaction, degree of patient engagement, and cultural competence of visits using untrained people acting as interpreters (ad hoc), in-person professional, or video conferencing professional interpretation for 283 visits. Adjusting for clinician and patient characteristics, the quality of interpretation of in-person and video conferencing modes were rated similarly (OR=1.79; 95% CI 0.74, 4.33). The quality of in-person (OR=5.55; 95% CI 1.50, 20.51) and video conferencing (OR=3.10; 95% CI 1.16, 8.31) were rated higher than ad hoc interpretation. Self-assessed cultural competence was better for in-person versus video conferencing interpretation (OR=2.32; 95% CI 1.11, 4.86). Video conferencing interpretation increases access without compromising quality, but cultural nuances may be better addressed by in-person interpreters. Professional interpretation is superior to ad hoc (OR=4.15; 95% CI 1.43, 12.09). PMID:20173271

An adaptive density-based routing protocol for flying Ad Hoc networks

NASA Astrophysics Data System (ADS)

Zheng, Xueli; Qi, Qian; Wang, Qingwen; Li, Yongqiang

2017-10-01

An Adaptive Density-based Routing Protocol (ADRP) for Flying Ad Hoc Networks (FANETs) is proposed in this paper. The main objective is to calculate forwarding probability adaptively in order to increase the efficiency of forwarding in FANETs. ADRP dynamically fine-tunes the rebroadcasting probability of a node for routing request packets according to the number of neighbour nodes. Indeed, it is more interesting to privilege the retransmission by nodes with little neighbour nodes. We describe the protocol, implement it and evaluate its performance using NS-2 network simulator. Simulation results reveal that ADRP achieves better performance in terms of the packet delivery fraction, average end-to-end delay, normalized routing load, normalized MAC load and throughput, which is respectively compared with AODV.

A Family of ACO Routing Protocols for Mobile Ad Hoc Networks

PubMed Central

Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-hoon

2017-01-01

In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads. PMID:28531159

A Family of ACO Routing Protocols for Mobile Ad Hoc Networks.

PubMed

Rupérez Cañas, Delfín; Sandoval Orozco, Ana Lucila; García Villalba, Luis Javier; Kim, Tai-Hoon

2017-05-22

In this work, an ACO routing protocol for mobile ad hoc networks based on AntHocNet is specified. As its predecessor, this new protocol, called AntOR, is hybrid in the sense that it contains elements from both reactive and proactive routing. Specifically, it combines a reactive route setup process with a proactive route maintenance and improvement process. Key aspects of the AntOR protocol are the disjoint-link and disjoint-node routes, separation between the regular pheromone and the virtual pheromone in the diffusion process and the exploration of routes, taking into consideration the number of hops in the best routes. In this work, a family of ACO routing protocols based on AntOR is also specified. These protocols are based on protocol successive refinements. In this work, we also present a parallelized version of AntOR that we call PAntOR. Using programming multiprocessor architectures based on the shared memory protocol, PAntOR allows running tasks in parallel using threads. This parallelization is applicable in the route setup phase, route local repair process and link failure notification. In addition, a variant of PAntOR that consists of having more than one interface, which we call PAntOR-MI (PAntOR-Multiple Interface), is specified. This approach parallelizes the sending of broadcast messages by interface through threads.

Cross-layer protocols optimized for real-time multimedia services in energy-constrained mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Hortos, William S.

2003-07-01

Mobile ad hoc networking (MANET) supports self-organizing, mobile infrastructures and enables an autonomous network of mobile nodes that can operate without a wired backbone. Ad hoc networks are characterized by multihop, wireless connectivity via packet radios and by the need for efficient dynamic protocols. All routers are mobile and can establish connectivity with other nodes only when they are within transmission range. Importantly, ad hoc wireless nodes are resource-constrained, having limited processing, memory, and battery capacity. Delivery of high quality-ofservice (QoS), real-time multimedia services from Internet-based applications over a MANET is a challenge not yet achieved by proposed Internet Engineering Task Force (IETF) ad hoc network protocols in terms of standard performance metrics such as end-to-end throughput, packet error rate, and delay. In the distributed operations of route discovery and maintenance, strong interaction occurs across MANET protocol layers, in particular, the physical, media access control (MAC), network, and application layers. The QoS requirements are specified for the service classes by the application layer. The cross-layer design must also satisfy the battery-limited energy constraints, by minimizing the distributed power consumption at the nodes and of selected routes. Interactions across the layers are modeled in terms of the set of concatenated design parameters including associated energy costs. Functional dependencies of the QoS metrics are described in terms of the concatenated control parameters. New cross-layer designs are sought that optimize layer interdependencies to achieve the "best" QoS available in an energy-constrained, time-varying network. The protocol design, based on a reactive MANET protocol, adapts the provisioned QoS to dynamic network conditions and residual energy capacities. The cross-layer optimization is based on stochastic dynamic programming conditions derived from time-dependent models of

Linking Satellites Via Earth "Hot Spots" and the Internet to Form Ad Hoc Constellations

NASA Technical Reports Server (NTRS)

Mandl, Dan; Frye, Stu; Grosvenor, Sandra; Ingram, Mary Ann; Langley, John; Miranda, Felix; Lee, Richard Q.; Romanofsky, Robert; Zaman, Afoz; Popovic, Zoya

2004-01-01

As more assets are placed in orbit, opportunities emerge to combine various sets of satellites in temporary constellations to perform collaborative image collections. Often, new operations concepts for a satellite or set of satellites emerge after launch. To the degree with which new space assets can be inexpensively and rapidly integrated into temporary or "ad hoc" constellations, will determine whether these new ideas will be implemented or not. On the Earth Observing 1 (EO-1) satellite, a New Millennium Program mission, a number of experiments were conducted and are being conducted to demonstrate various aspects of an architecture that, when taken as a whole, will enable progressive mission autonomy. In particular, the target architecture will use adaptive ground antenna arrays to form, as close as possible, the equivalent of wireless access points for low earth orbiting satellites. Coupled with various ground and flight software and the Internet. the architecture enables progressive mission autonomy. Thus, new collaborative sensing techniques can be implemented post-launch. This paper will outline the overall operations concept and highlight details of both the research effort being conducted in ad hoc constellations, mission autonomy and

Energy-Aware Multipath Routing Scheme Based on Particle Swarm Optimization in Mobile Ad Hoc Networks

PubMed Central

Robinson, Y. Harold; Rajaram, M.

2015-01-01

Mobile ad hoc network (MANET) is a collection of autonomous mobile nodes forming an ad hoc network without fixed infrastructure. Dynamic topology property of MANET may degrade the performance of the network. However, multipath selection is a great challenging task to improve the network lifetime. We proposed an energy-aware multipath routing scheme based on particle swarm optimization (EMPSO) that uses continuous time recurrent neural network (CTRNN) to solve optimization problems. CTRNN finds the optimal loop-free paths to solve link disjoint paths in a MANET. The CTRNN is used as an optimum path selection technique that produces a set of optimal paths between source and destination. In CTRNN, particle swarm optimization (PSO) method is primly used for training the RNN. The proposed scheme uses the reliability measures such as transmission cost, energy factor, and the optimal traffic ratio between source and destination to increase routing performance. In this scheme, optimal loop-free paths can be found using PSO to seek better link quality nodes in route discovery phase. PSO optimizes a problem by iteratively trying to get a better solution with regard to a measure of quality. The proposed scheme discovers multiple loop-free paths by using PSO technique. PMID:26819966

Quality of service routing in wireless ad hoc networks

NASA Astrophysics Data System (ADS)

Sane, Sachin J.; Patcha, Animesh; Mishra, Amitabh

2003-08-01

An efficient routing protocol is essential to guarantee application level quality of service running on wireless ad hoc networks. In this paper we propose a novel routing algorithm that computes a path between a source and a destination by considering several important constraints such as path-life, availability of sufficient energy as well as buffer space in each of the nodes on the path between the source and destination. The algorithm chooses the best path from among the multiples paths that it computes between two endpoints. We consider the use of control packets that run at a priority higher than the data packets in determining the multiple paths. The paper also examines the impact of different schedulers such as weighted fair queuing, and weighted random early detection among others in preserving the QoS level guarantees. Our extensive simulation results indicate that the algorithm improves the overall lifetime of a network, reduces the number of dropped packets, and decreases the end-to-end delay for real-time voice application.

Noise-Assisted Concurrent Multipath Traffic Distribution in Ad Hoc Networks

PubMed Central

Murata, Masayuki

2013-01-01

The concept of biologically inspired networking has been introduced to tackle unpredictable and unstable situations in computer networks, especially in wireless ad hoc networks where network conditions are continuously changing, resulting in the need of robustness and adaptability of control methods. Unfortunately, existing methods often rely heavily on the detailed knowledge of each network component and the preconfigured, that is, fine-tuned, parameters. In this paper, we utilize a new concept, called attractor perturbation (AP), which enables controlling the network performance using only end-to-end information. Based on AP, we propose a concurrent multipath traffic distribution method, which aims at lowering the average end-to-end delay by only adjusting the transmission rate on each path. We demonstrate through simulations that, by utilizing the attractor perturbation relationship, the proposed method achieves a lower average end-to-end delay compared to other methods which do not take fluctuations into account. PMID:24319375

A memetic optimization algorithm for multi-constrained multicast routing in ad hoc networks

PubMed Central

Hammad, Karim; El Bakly, Ahmed M.

2018-01-01

A mobile ad hoc network is a conventional self-configuring network where the routing optimization problem—subject to various Quality-of-Service (QoS) constraints—represents a major challenge. Unlike previously proposed solutions, in this paper, we propose a memetic algorithm (MA) employing an adaptive mutation parameter, to solve the multicast routing problem with higher search ability and computational efficiency. The proposed algorithm utilizes an updated scheme, based on statistical analysis, to estimate the best values for all MA parameters and enhance MA performance. The numerical results show that the proposed MA improved the delay and jitter of the network, while reducing computational complexity as compared to existing algorithms. PMID:29509760

A memetic optimization algorithm for multi-constrained multicast routing in ad hoc networks.

PubMed

Ramadan, Rahab M; Gasser, Safa M; El-Mahallawy, Mohamed S; Hammad, Karim; El Bakly, Ahmed M

2018-01-01

A mobile ad hoc network is a conventional self-configuring network where the routing optimization problem-subject to various Quality-of-Service (QoS) constraints-represents a major challenge. Unlike previously proposed solutions, in this paper, we propose a memetic algorithm (MA) employing an adaptive mutation parameter, to solve the multicast routing problem with higher search ability and computational efficiency. The proposed algorithm utilizes an updated scheme, based on statistical analysis, to estimate the best values for all MA parameters and enhance MA performance. The numerical results show that the proposed MA improved the delay and jitter of the network, while reducing computational complexity as compared to existing algorithms.

BCDP: Budget Constrained and Delay-Bounded Placement for Hybrid Roadside Units in Vehicular Ad Hoc Networks

PubMed Central

Li, Peng; Huang, Chuanhe; Liu, Qin

2014-01-01

In vehicular ad hoc networks, roadside units (RSUs) placement has been proposed to improve the the overall network performance in many ITS applications. This paper addresses the budget constrained and delay-bounded placement problem (BCDP) for roadside units in vehicular ad hoc networks. There are two types of RSUs: cable connected RSU (c-RSU) and wireless RSU (w-RSU). c-RSUs are interconnected through wired lines, and they form the backbone of VANETs, while w-RSUs connect to other RSUs through wireless communication and serve as an economical extension of the coverage of c-RSUs. The delay-bounded coverage range and deployment cost of these two cases are totally different. We are given a budget constraint and a delay bound, the problem is how to find the optimal candidate sites with the maximal delay-bounded coverage to place RSUs such that a message from any c-RSU in the region can be disseminated to the more vehicles within the given budget constraint and delay bound. We first prove that the BCDP problem is NP-hard. Then we propose several algorithms to solve the BCDP problem. Simulation results show the heuristic algorithms can significantly improve the coverage range and reduce the total deployment cost, compared with other heuristic methods. PMID:25436656

Context dependent off loading for cloudlet in mobile ad-hoc network

NASA Astrophysics Data System (ADS)

Bhatt, N.; Nadesh, R. K.; ArivuSelvan, K.

2017-11-01

Cloud Computing in Mobile Ad-hoc network is emerging part of research consideration as the demand and competency of mobile devices increased in last few years. To follow out operation within the remote cloud builds the postponement and influences the administration standard. To keep away from this trouble cloudlet is presented. Cloudlet gives identical support of the devices as cloud at low inactivity however at high transfer speed. Be that as it may, choice of a cloudlet for offloading calculation with flat energy is a noteworthy test if multiple cloud let is accessible adjacent. Here I proposed energy and bandwidth (Traffic overload for communication with cloud) aware cloudlet selection strategy based on the context dependency of the device location. It works on the basis of mobile device location and bandwidth availability of cloudlet. The cloudlet offloading and selection process using given solution is simulated in Cloud ~ Simulator.

An enhanced performance through agent-based secure approach for mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Bisen, Dhananjay; Sharma, Sanjeev

2018-01-01

This paper proposes an agent-based secure enhanced performance approach (AB-SEP) for mobile ad hoc network. In this approach, agent nodes are selected through optimal node reliability as a factor. This factor is calculated on the basis of node performance features such as degree difference, normalised distance value, energy level, mobility and optimal hello interval of node. After selection of agent nodes, a procedure of malicious behaviour detection is performed using fuzzy-based secure architecture (FBSA). To evaluate the performance of the proposed approach, comparative analysis is done with conventional schemes using performance parameters such as packet delivery ratio, throughput, total packet forwarding, network overhead, end-to-end delay and percentage of malicious detection.

Energy Aware Cluster-Based Routing in Flying Ad-Hoc Networks.

PubMed

Aadil, Farhan; Raza, Ali; Khan, Muhammad Fahad; Maqsood, Muazzam; Mehmood, Irfan; Rho, Seungmin

2018-05-03

Flying ad-hoc networks (FANETs) are a very vibrant research area nowadays. They have many military and civil applications. Limited battery energy and the high mobility of micro unmanned aerial vehicles (UAVs) represent their two main problems, i.e., short flight time and inefficient routing. In this paper, we try to address both of these problems by means of efficient clustering. First, we adjust the transmission power of the UAVs by anticipating their operational requirements. Optimal transmission range will have minimum packet loss ratio (PLR) and better link quality, which ultimately save the energy consumed during communication. Second, we use a variant of the K-Means Density clustering algorithm for selection of cluster heads. Optimal cluster heads enhance the cluster lifetime and reduce the routing overhead. The proposed model outperforms the state of the art artificial intelligence techniques such as Ant Colony Optimization-based clustering algorithm and Grey Wolf Optimization-based clustering algorithm. The performance of the proposed algorithm is evaluated in term of number of clusters, cluster building time, cluster lifetime and energy consumption.

A high performance, ad-hoc, fuzzy query processing system for relational databases

NASA Technical Reports Server (NTRS)

Mansfield, William H., Jr.; Fleischman, Robert M.

1992-01-01

Database queries involving imprecise or fuzzy predicates are currently an evolving area of academic and industrial research. Such queries place severe stress on the indexing and I/O subsystems of conventional database environments since they involve the search of large numbers of records. The Datacycle architecture and research prototype is a database environment that uses filtering technology to perform an efficient, exhaustive search of an entire database. It has recently been modified to include fuzzy predicates in its query processing. The approach obviates the need for complex index structures, provides unlimited query throughput, permits the use of ad-hoc fuzzy membership functions, and provides a deterministic response time largely independent of query complexity and load. This paper describes the Datacycle prototype implementation of fuzzy queries and some recent performance results.

Federal Government Printing and Publishing: Policy Issues. Report of the Ad Hoc Advisory Committee on Revision of Title 44.

ERIC Educational Resources Information Center

Joint Committee on Printing, Washington, DC.

Designed to present a better understanding of the government's system of printing and distributing information and to highlight problems, alternatives, and important policy questions, this report synthesizes 13 weeks of the Ad Hoc Advisory Committee hearings on six topics: (1) Administration of policy--who should establish and administer policy in…

Ad-Hoc Queries over Document Collections - A Case Study

NASA Astrophysics Data System (ADS)

Löser, Alexander; Lutter, Steffen; Düssel, Patrick; Markl, Volker

We discuss the novel problem of supporting analytical business intelligence queries over web-based textual content, e.g., BI-style reports based on 100.000's of documents from an ad-hoc web search result. Neither conventional search engines nor conventional Business Intelligence and ETL tools address this problem, which lies at the intersection of their capabilities. "Google Squared" or our system GOOLAP.info, are examples of these kinds of systems. They execute information extraction methods over one or several document collections at query time and integrate extracted records into a common view or tabular structure. Frequent extraction and object resolution failures cause incomplete records which could not be joined into a record answering the query. Our focus is the identification of join-reordering heuristics maximizing the size of complete records answering a structured query. With respect to given costs for document extraction we propose two novel join-operations: The multi-way CJ-operator joins records from multiple relationships extracted from a single document. The two-way join-operator DJ ensures data density by removing incomplete records from results. In a preliminary case study we observe that our join-reordering heuristics positively impact result size, record density and lower execution costs.

Ad Hoc modeling, expert problem solving, and R&T program evaluation

NASA Technical Reports Server (NTRS)

Silverman, B. G.; Liebowitz, J.; Moustakis, V. S.

1983-01-01

A simplified cost and time (SCAT) analysis program utilizing personal-computer technology is presented and demonstrated in the case of the NASA-Goddard end-to-end data system. The difficulties encountered in implementing complex program-selection and evaluation models in the research and technology field are outlined. The prototype SCAT system described here is designed to allow user-friendly ad hoc modeling in real time and at low cost. A worksheet constructed on the computer screen displays the critical parameters and shows how each is affected when one is altered experimentally. In the NASA case, satellite data-output and control requirements, ground-facility data-handling capabilities, and project priorities are intricately interrelated. Scenario studies of the effects of spacecraft phaseout or new spacecraft on throughput and delay parameters are shown. The use of a network of personal computers for higher-level coordination of decision-making processes is suggested, as a complement or alternative to complex large-scale modeling.

Assessment of interbreeding and introgression of farm genes into a small Scottish Atlantic salmon Salmo salar stock: ad hoc samples - ad hoc results?

PubMed

Verspoor, E; Knox, D; Marshall, S

2016-12-01

An eclectic set of tissues and existing data, including purposely collected samples, spanning 1997-2006, was used in an ad hoc assessment of hybridization and introgression of farmed wild Atlantic salmon Salmo salar in the small Loch na Thull (LnT) catchment in north-west Scotland. The catchment is in an area of marine farm production and contains freshwater smolt rearing cages. The LnT S. salar stock was found to be genetically distinctive from stocks in neighbouring rivers and, despite regular reports of feral farm S. salar, there was no evidence of physical or genetic mixing. This cannot be completely ruled out, however, and low level mixing with other local wild stocks has been suggested. The LnT population appeared underpinned by relatively smaller effective number of breeders (N eb ) and showed relatively low levels of genetic diversity, consistent with a small effective population size. Small sample sizes, an incomplete farm baseline and the use of non-diagnostic molecular markers, constrain the power of the analysis but the findings strongly support the LnT catchment having a genetically distinct wild S. salar population little affected by interbreeding with feral farm escapes. © 2016 The Fisheries Society of the British Isles.

An epidemic model for biological data fusion in ad hoc sensor networks

NASA Astrophysics Data System (ADS)

Chang, K. C.; Kotari, Vikas

2009-05-01

Bio terrorism can be a very refined and a catastrophic approach of attacking a nation. This requires the development of a complete architecture dedicatedly designed for this purpose which includes but is not limited to Sensing/Detection, Tracking and Fusion, Communication, and others. In this paper we focus on one such architecture and evaluate its performance. Various sensors for this specific purpose have been studied. The accent has been on use of Distributed systems such as ad-hoc networks and on application of epidemic data fusion algorithms to better manage the bio threat data. The emphasis has been on understanding the performance characteristics of these algorithms under diversified real time scenarios which are implemented through extensive JAVA based simulations. Through comparative studies on communication and fusion the performance of channel filter algorithm for the purpose of biological sensor data fusion are validated.

Introduction to Blueweb: A Decentralized Scatternet Formation Algorithm for Bluetooth Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Yu, Chih-Min; Huang, Chia-Chi

In this letter, a decentralized scatternet formation algorithm called Bluelayer is proposed. First, Bluelayer uses a designated root to construct a tree-shaped subnet and propagates an integer variable k1 called counter limit as well as a constant k in its downstream direction to determine new roots. Then each new root asks its upstream master to start a return connection procedure to convert the tree-shaped subnet into a web-shaped subnet for its immediate upstream root. At the same time, each new root repeats the same procedure as the root to build its own subnet until the whole scatternet is formed. Simulation results show that Bluelayer achieves good network scalability and generates an efficient scatternet configuration for various sizes of Bluetooth ad hoc network.

Predicting impact of multi-paths on phase change in map-based vehicular ad hoc networks

NASA Astrophysics Data System (ADS)

Rahmes, Mark; Lemieux, George; Sonnenberg, Jerome; Chester, David B.

2014-05-01

Dynamic Spectrum Access, which through its ability to adapt the operating frequency of a radio, is widely believed to be a solution to the limited spectrum problem. Mobile Ad Hoc Networks (MANETs) can extend high capacity mobile communications over large areas where fixed and tethered-mobile systems are not available. In one use case with high potential impact cognitive radio employs spectrum sensing to facilitate identification of allocated frequencies not currently accessed by their primary users. Primary users own the rights to radiate at a specific frequency and geographic location, secondary users opportunistically attempt to radiate at a specific frequency when the primary user is not using it. We quantify optimal signal detection in map based cognitive radio networks with multiple rapidly varying phase changes and multiple orthogonal signals. Doppler shift occurs due to reflection, scattering, and rapid vehicle movement. Path propagation as well as vehicle movement produces either constructive or destructive interference with the incident wave. Our signal detection algorithms can assist the Doppler spread compensation algorithm by deciding how many phase changes in signals are present in a selected band of interest. Additionally we can populate a spatial radio environment map (REM) database with known information that can be leveraged in an ad hoc network to facilitate Dynamic Spectrum Access. We show how topography can help predict the impact of multi-paths on phase change, as well as about the prediction from dense traffic areas. Utilization of high resolution geospatial data layers in RF propagation analysis is directly applicable.

Cooperative Education and the Academy. and Response to the Preliminary Report of the Ad Hoc Committee on Cooperative Education and the Curriculum.

ERIC Educational Resources Information Center

Heinemann, Harry N.; And Others

1988-01-01

Two articles describe the final report submitted by the Ad Hoc Committee on Cooperative Education and the Curriculum to the Cooperative Education Association and the reaction to that report by the person who established the committee. (JOW)

History-based route selection for reactive ad hoc routing protocols

NASA Astrophysics Data System (ADS)

Medidi, Sirisha; Cappetto, Peter

2007-04-01

Ad hoc networks rely on cooperation in order to operate, but in a resource constrained environment not all nodes behave altruistically. Selfish nodes preserve their own resources and do not forward packets not in their own self interest. These nodes degrade the performance of the network, but judicious route selection can help maintain performance despite this behavior. Many route selection algorithms place importance on shortness of the route rather than its reliability. We introduce a light-weight route selection algorithm that uses past behavior to judge the quality of a route rather than solely on the length of the route. It draws information from the underlying routing layer at no extra cost and selects routes with a simple algorithm. This technique maintains this data in a small table, which does not place a high cost on memory. History-based route selection's minimalism suits the needs the portable wireless devices and is easy to implement. We implemented our algorithm and tested it in the ns2 environment. Our simulation results show that history-based route selection achieves higher packet delivery and improved stability than its length-based counterpart.

Random Time Identity Based Firewall In Mobile Ad hoc Networks

NASA Astrophysics Data System (ADS)

Suman, Patel, R. B.; Singh, Parvinder

2010-11-01

A mobile ad hoc network (MANET) is a self-organizing network of mobile routers and associated hosts connected by wireless links. MANETs are highly flexible and adaptable but at the same time are highly prone to security risks due to the open medium, dynamically changing network topology, cooperative algorithms, and lack of centralized control. Firewall is an effective means of protecting a local network from network-based security threats and forms a key component in MANET security architecture. This paper presents a review of firewall implementation techniques in MANETs and their relative merits and demerits. A new approach is proposed to select MANET nodes at random for firewall implementation. This approach randomly select a new node as firewall after fixed time and based on critical value of certain parameters like power backup. This approach effectively balances power and resource utilization of entire MANET because responsibility of implementing firewall is equally shared among all the nodes. At the same time it ensures improved security for MANETs from outside attacks as intruder will not be able to find out the entry point in MANET due to the random selection of nodes for firewall implementation.

A+-Helix of Protein C Inhibitor (PCI) Is a Cell-penetrating Peptide That Mediates Cell Membrane Permeation of PCI*

PubMed Central

Yang, Hanjiang; Wahlmüller, Felix Christof; Sarg, Bettina; Furtmüller, Margareta; Geiger, Margarethe

2015-01-01

Protein C inhibitor (PCI) is a serpin with broad protease reactivity. It binds glycosaminoglycans and certain phospholipids that can modulate its inhibitory activity. PCI can penetrate through cellular membranes via binding to phosphatidylethanolamine. The exact mechanism of PCI internalization and the intracellular role of the serpin are not well understood. Here we showed that testisin, a glycosylphosphatidylinositol-anchored serine protease, cleaved human PCI and mouse PCI (mPCI) at their reactive sites as well as at sites close to their N terminus. This cleavage was observed not only with testisin in solution but also with cell membrane-anchored testisin on U937 cells. The cleavage close to the N terminus released peptides rich in basic amino acids. Synthetic peptides corresponding to the released peptides of human PCI (His1–Arg11) and mPCI (Arg1–Ala18) functioned as cell-penetrating peptides. Because intact mPCI but not testisin-cleaved mPCI was internalized by Jurkat T cells, a truncated mPCI mimicking testisin-cleaved mPCI was created. The truncated mPCI lacking 18 amino acids at the N terminus was not taken up by Jurkat T cells. Therefore our model suggests that testisin or other proteases could regulate the internalization of PCI by removing its N terminus. This may represent one of the mechanisms regulating the intracellular functions of PCI. PMID:25488662

Virtual machine-based simulation platform for mobile ad-hoc network-based cyber infrastructure

DOE PAGES

Yoginath, Srikanth B.; Perumalla, Kayla S.; Henz, Brian J.

2015-09-29

In modeling and simulating complex systems such as mobile ad-hoc networks (MANETs) in de-fense communications, it is a major challenge to reconcile multiple important considerations: the rapidity of unavoidable changes to the software (network layers and applications), the difficulty of modeling the critical, implementation-dependent behavioral effects, the need to sustain larger scale scenarios, and the desire for faster simulations. Here we present our approach in success-fully reconciling them using a virtual time-synchronized virtual machine(VM)-based parallel ex-ecution framework that accurately lifts both the devices as well as the network communications to a virtual time plane while retaining full fidelity. At themore » core of our framework is a scheduling engine that operates at the level of a hypervisor scheduler, offering a unique ability to execute multi-core guest nodes over multi-core host nodes in an accurate, virtual time-synchronized manner. In contrast to other related approaches that suffer from either speed or accuracy issues, our framework provides MANET node-wise scalability, high fidelity of software behaviors, and time-ordering accuracy. The design and development of this framework is presented, and an ac-tual implementation based on the widely used Xen hypervisor system is described. Benchmarks with synthetic and actual applications are used to identify the benefits of our approach. The time inaccuracy of traditional emulation methods is demonstrated, in comparison with the accurate execution of our framework verified by theoretically correct results expected from analytical models of the same scenarios. In the largest high fidelity tests, we are able to perform virtual time-synchronized simulation of 64-node VM-based full-stack, actual software behaviors of MANETs containing a mix of static and mobile (unmanned airborne vehicle) nodes, hosted on a 32-core host, with full fidelity of unmodified ad-hoc routing protocols, unmodified

Virtual machine-based simulation platform for mobile ad-hoc network-based cyber infrastructure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yoginath, Srikanth B.; Perumalla, Kayla S.; Henz, Brian J.

In modeling and simulating complex systems such as mobile ad-hoc networks (MANETs) in de-fense communications, it is a major challenge to reconcile multiple important considerations: the rapidity of unavoidable changes to the software (network layers and applications), the difficulty of modeling the critical, implementation-dependent behavioral effects, the need to sustain larger scale scenarios, and the desire for faster simulations. Here we present our approach in success-fully reconciling them using a virtual time-synchronized virtual machine(VM)-based parallel ex-ecution framework that accurately lifts both the devices as well as the network communications to a virtual time plane while retaining full fidelity. At themore » core of our framework is a scheduling engine that operates at the level of a hypervisor scheduler, offering a unique ability to execute multi-core guest nodes over multi-core host nodes in an accurate, virtual time-synchronized manner. In contrast to other related approaches that suffer from either speed or accuracy issues, our framework provides MANET node-wise scalability, high fidelity of software behaviors, and time-ordering accuracy. The design and development of this framework is presented, and an ac-tual implementation based on the widely used Xen hypervisor system is described. Benchmarks with synthetic and actual applications are used to identify the benefits of our approach. The time inaccuracy of traditional emulation methods is demonstrated, in comparison with the accurate execution of our framework verified by theoretically correct results expected from analytical models of the same scenarios. In the largest high fidelity tests, we are able to perform virtual time-synchronized simulation of 64-node VM-based full-stack, actual software behaviors of MANETs containing a mix of static and mobile (unmanned airborne vehicle) nodes, hosted on a 32-core host, with full fidelity of unmodified ad-hoc routing protocols, unmodified

Modern foreign language teachers - don't leave those kids alone! Linguistic-cultural "give and take" in an ad-hoc tutoring scheme

NASA Astrophysics Data System (ADS)

Leroy, Norah

2017-08-01

This paper addresses the theme of social inclusion through language learning. The focus is on an ad-hoc tutoring scheme set up between newly arrived British migrant pupils and French monolingual pupils in a small secondary school in the south-west of France. Though the original objective of this tutoring scheme was to improve the English skills of the younger pupils, feedback reports indicated that it also had a positive impact on the relationship between the British migrant pupils and their French peers. Teachers believed that those involved participated more fully in class, and appeared more self-assured and generally happy thanks to the interpersonal relationships this scheme helped to forge. This study demonstrates the necessity of analysing the socio-cultural context migrants may find themselves in, in order to identify potential challenges. The ad-hoc tutoring scheme described here is an example of how language learning can support the integration and inclusion of "new generation" migrants into everyday school life.

A Feasible Approach for an Early Manned Lunar Landing. Part II: Detailed Report of Ad Hoc Task Group

NASA Technical Reports Server (NTRS)

Fleming, William A.

1961-01-01

This report, in two parts, presents a program development plan for attempting a first manned lunar landing in 1967. The two parts consist of a Summary Report and a Detailed Report representing the coordinated output of the Ad Hoc Task Group assigned to the study. The study was started in response to the request for such a study by the Associate Administrator in his memorandum of May 2, 1961 establishing the Ad Hoc Task Group. The purpose of the study was to take a first cut at the tasks associated with the design, development and construction of the equipment and facilities as well as the development of the crews, and to show the time phasing 6f these tasks. Included are the space sciences, life science and advanced technology tasks whose data and results are needed for designing and developing the systems required in carrying out the mission. The plan presented in the two reports does not presume to be a firm plan. Its basic purpose is, by choosing one feasible method, to size up the scope, schedule and cost of the job, discover the main problems, pacing items and major decisions and provide a threshold from which a firm and detailed project development plan can be jointly formulated by the various elements of NASA.

Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry.

PubMed

Härle, Tobias; Zeymer, Uwe; Hochadel, Matthias; Zahn, Ralf; Kerber, Sebastian; Zrenner, Bernhard; Schächinger, Volker; Lauer, Bernward; Runde, Thorsten; Elsässer, Albrecht

2017-02-01

There is growing evidence for beneficial prognostic and economic effects of FFR-guided treatment of stable coronary artery disease. We sought to evaluate the real-world use of FFR measurements in patients undergoing elective coronary angiography. We analyzed the data of the prospective ALKK coronary angiography and PCI registry including data of 38 hospitals from January 2010 to December 2013. A total of 100,977 patients undergoing coronary angiography were included. In 3240 patients (3.2 %) intracoronary pressure measurement was performed. There was a wide range of use of FFR measurement in the different analyzed ALKK hospitals from 0.1 to 8.8 % in elective patients with suspected or known coronary artery disease (median 2.7 %, quartiles 0.9 and 5.3 %), with a successive increase of use over time during the study period. Overall, it was performed in 3.2 % of coronary angiographies. Use in patients with three-vessel disease (2.5 %) and recommendation for bypass surgery (1.6 %) was less frequent. In procedures without PCI, dose area product was higher in the FFR group (2641 cGy × cm 2 vs. 2368 cGy × cm 2 , p < 0.001), while it was lower in procedures with ad hoc PCI (4676 cGy × cm 2 vs. 5143 cGy × cm 2 , p < 0.001). The performing center turned out to be the strongest predictor. The use of FFR measurement was very heterogeneous between different hospitals and in general relatively low, in particular in patients with multivessel disease or recommendation for bypass surgery, but there was a positive trend during the study period. Technically, FFR measurement was not associated with an increased periprocedural complication rate.

On mobile wireless ad hoc IP video transports

NASA Astrophysics Data System (ADS)

Kazantzidis, Matheos

2006-05-01

Multimedia transports in wireless, ad-hoc, multi-hop or mobile networks must be capable of obtaining information about the network and adaptively tune sending and encoding parameters to the network response. Obtaining meaningful metrics to guide a stable congestion control mechanism in the transport (i.e. passive, simple, end-to-end and network technology independent) is a complex problem. Equally difficult is obtaining a reliable QoS metrics that agrees with user perception in a client/server or distributed environment. Existing metrics, objective or subjective, are commonly used after or before to test or report on a transmission and require access to both original and transmitted frames. In this paper, we propose that an efficient and successful video delivery and the optimization of overall network QoS requires innovation in a) a direct measurement of available and bottleneck capacity for its congestion control and b) a meaningful subjective QoS metric that is dynamically reported to video sender. Once these are in place, a binomial -stable, fair and TCP friendly- algorithm can be used to determine the sending rate and other packet video parameters. An adaptive mpeg codec can then continually test and fit its parameters and temporal-spatial data-error control balance using the perceived QoS dynamic feedback. We suggest a new measurement based on a packet dispersion technique that is independent of underlying network mechanisms. We then present a binomial control based on direct measurements. We implement a QoS metric that is known to agree with user perception (MPQM) in a client/server, distributed environment by using predetermined table lookups and characterization of video content.

Hierarchical auto-configuration addressing in mobile ad hoc networks (HAAM)

NASA Astrophysics Data System (ADS)

Ram Srikumar, P.; Sumathy, S.

2017-11-01

Addressing plays a vital role in networking to identify devices uniquely. A device must be assigned with a unique address in order to participate in the data communication in any network. Different protocols defining different types of addressing are proposed in literature. Address auto-configuration is a key requirement for self organizing networks. Existing auto-configuration based addressing protocols require broadcasting probes to all the nodes in the network before assigning a proper address to a new node. This needs further broadcasts to reflect the status of the acquired address in the network. Such methods incur high communication overheads due to repetitive flooding. To address this overhead, a new partially stateful address allocation scheme, namely Hierarchical Auto-configuration Addressing (HAAM) scheme is extended and proposed. Hierarchical addressing basically reduces latency and overhead caused during address configuration. Partially stateful addressing algorithm assigns addresses without the need for flooding and global state awareness, which in turn reduces the communication overhead and space complexity respectively. Nodes are assigned addresses hierarchically to maintain the graph of the network as a spanning tree which helps in effectively avoiding the broadcast storm problem. Proposed algorithm for HAAM handles network splits and merges efficiently in large scale mobile ad hoc networks incurring low communication overheads.

Performance Improvement in Geographic Routing for Vehicular Ad Hoc Networks

PubMed Central

Kaiwartya, Omprakash; Kumar, Sushil; Lobiyal, D. K.; Abdullah, Abdul Hanan; Hassan, Ahmed Nazar

2014-01-01

Geographic routing is one of the most investigated themes by researchers for reliable and efficient dissemination of information in Vehicular Ad Hoc Networks (VANETs). Recently, different Geographic Distance Routing (GEDIR) protocols have been suggested in the literature. These protocols focus on reducing the forwarding region towards destination to select the Next Hop Vehicles (NHV). Most of these protocols suffer from the problem of elevated one-hop link disconnection, high end-to-end delay and low throughput even at normal vehicle speed in high vehicle density environment. This paper proposes a Geographic Distance Routing protocol based on Segment vehicle, Link quality and Degree of connectivity (SLD-GEDIR). The protocol selects a reliable NHV using the criteria segment vehicles, one-hop link quality and degree of connectivity. The proposed protocol has been simulated in NS-2 and its performance has been compared with the state-of-the-art protocols: P-GEDIR, J-GEDIR and V-GEDIR. The empirical results clearly reveal that SLD-GEDIR has lower link disconnection and end-to-end delay, and higher throughput as compared to the state-of-the-art protocols. It should be noted that the performance of the proposed protocol is preserved irrespective of vehicle density and speed. PMID:25429415

Performance improvement in geographic routing for Vehicular Ad Hoc Networks.

PubMed

Kaiwartya, Omprakash; Kumar, Sushil; Lobiyal, D K; Abdullah, Abdul Hanan; Hassan, Ahmed Nazar

2014-11-25

Geographic routing is one of the most investigated themes by researchers for reliable and efficient dissemination of information in Vehicular Ad Hoc Networks (VANETs). Recently, different Geographic Distance Routing (GEDIR) protocols have been suggested in the literature. These protocols focus on reducing the forwarding region towards destination to select the Next Hop Vehicles (NHV). Most of these protocols suffer from the problem of elevated one-hop link disconnection, high end-to-end delay and low throughput even at normal vehicle speed in high vehicle density environment. This paper proposes a Geographic Distance Routing protocol based on Segment vehicle, Link quality and Degree of connectivity (SLD-GEDIR). The protocol selects a reliable NHV using the criteria segment vehicles, one-hop link quality and degree of connectivity. The proposed protocol has been simulated in NS-2 and its performance has been compared with the state-of-the-art protocols: P-GEDIR, J-GEDIR and V-GEDIR. The empirical results clearly reveal that SLD-GEDIR has lower link disconnection and end-to-end delay, and higher throughput as compared to the state-of-the-art protocols. It should be noted that the performance of the proposed protocol is preserved irrespective of vehicle density and speed.

Preserving Nevada's Environmental Heritage: A Report of the Ad Hoc Committee on Environmental Quality. Final Report to the Governor's Natural Resources Council.

ERIC Educational Resources Information Center

Nevada State Dept. of Conservation and Natural Resources, Carson City.

The Environmental Quality Ad Hoc Committee has prepared this report for the Governor's Natural Resources Council (Nevada). It is a compilation of available factual data focusing attention on needed statutory and administrative changes to preserve Nevada's environmental heritage and from which recommendations for future budgetary and legislative…

A novel unbalanced multiple description coder for robust video transmission over ad hoc wireless networks

NASA Astrophysics Data System (ADS)

Huang, Feng; Sun, Lifeng; Zhong, Yuzhuo

2006-01-01

Robust transmission of live video over ad hoc wireless networks presents new challenges: high bandwidth requirements are coupled with delay constraints; even a single packet loss causes error propagation until a complete video frame is coded in the intra-mode; ad hoc wireless networks suffer from bursty packet losses that drastically degrade the viewing experience. Accordingly, we propose a novel UMD coder capable of quickly recovering from losses and ensuring continuous playout. It uses 'peg' frames to prevent error propagation in the High-Resolution (HR) description and improve the robustness of key frames. The Low-Resolution (LR) coder works independent of the HR one, but they can also help each other recover from losses. Like many UMD coders, our UMD coder is drift-free, disruption-tolerant and able to make good use of the asymmetric available bandwidths of multiple paths. The simulation results under different conditions show that the proposed UMD coder has the highest decoded quality and lowest probability of pause when compared with concurrent UMDC techniques. The coder also has a comparable decoded quality, lower startup delay and lower probability of pause than a state-of-the-art FEC-based scheme. To provide robustness for video multicast applications, we propose non-end-to-end UMDC-based video distribution over a multi-tree multicast network. The multiplicity of parents decorrelates losses and the non-end-to-end feature increases the throughput of UMDC video data. We deploy an application-level service of LR description reconstruction in some intermediate nodes of the LR multicast tree. The principle behind this is to reconstruct the disrupted LR frames by the correctly received HR frames. As a result, the viewing experience at the downstream nodes benefits from the protection reconstruction at the upstream nodes.

Future of the PCI Readmission Metric.

PubMed

Wasfy, Jason H; Yeh, Robert W

2016-03-01

Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular Data Registry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk. © 2016 American Heart Association, Inc.

Modern Foreign Language Teachers--Don't Leave Those Kids Alone! Linguistic-Cultural "Give and Take" in an Ad-Hoc Tutoring Scheme

ERIC Educational Resources Information Center

Leroy, Norah

2017-01-01

This paper addresses the theme of social inclusion through language learning. The focus is on an ad-hoc tutoring scheme set up between newly arrived British migrant pupils and French monolingual pupils in a small secondary school in the south-west of France. Though the original objective of this tutoring scheme was to improve the English skills of…

Impact of Beamforming on the Path Connectivity in Cognitive Radio Ad Hoc Networks

PubMed Central

Dung, Le The; Hieu, Tran Dinh; Choi, Seong-Gon; Kim, Byung-Seo; An, Beongku

2017-01-01

This paper investigates the impact of using directional antennas and beamforming schemes on the connectivity of cognitive radio ad hoc networks (CRAHNs). Specifically, considering that secondary users use two kinds of directional antennas, i.e., uniform linear array (ULA) and uniform circular array (UCA) antennas, and two different beamforming schemes, i.e., randomized beamforming and center-directed to communicate with each other, we study the connectivity of all combination pairs of directional antennas and beamforming schemes and compare their performances to those of omnidirectional antennas. The results obtained in this paper show that, compared with omnidirectional transmission, beamforming transmission only benefits the connectivity when the density of secondary user is moderate. Moreover, the combination of UCA and randomized beamforming scheme gives the highest path connectivity in all evaluating scenarios. Finally, the number of antenna elements and degree of path loss greatly affect path connectivity in CRAHNs. PMID:28346377

Use of synthesized data to support complex ad-hoc queries in an enterprise information warehouse: a diabetes use case.

PubMed

Rogers, Patrick; Erdal, Selnur; Santangelo, Jennifer; Liu, Jianhua; Schuster, Dara; Kamal, Jyoti

2008-11-06

The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility incorporating operational, clinical, and biological data sets from multiple enterprise system. It is common for users of the IW to request complex ad-hoc queries that often require significant intervention by data analyst. In response to this challenge, we have designed a workflow that leverages synthesized data elements to support such queries in an more timely, efficient manner.

CABG Versus PCI: Greater Benefit in Long-Term Outcomes With Multiple Arterial Bypass Grafting.

PubMed

Habib, Robert H; Dimitrova, Kamellia R; Badour, Sanaa A; Yammine, Maroun B; El-Hage-Sleiman, Abdul-Karim M; Hoffman, Darryl M; Geller, Charles M; Schwann, Thomas A; Tranbaugh, Robert F

2015-09-29

Treatment of multivessel coronary artery disease with traditional single-arterial coronary artery bypass graft (SA-CABG) has been associated with superior intermediate-term survival and reintervention compared with percutaneous coronary intervention (PCI) using either bare-metal stents (BMS) or drug-eluting stents (DES). This study sought to investigate longer-term outcomes including the potential added advantage of multiarterial coronary artery bypass graft (MA-CABG). We studied 8,402 single-institution, primary revascularization, multivessel coronary artery disease patients: 2,207 BMS-PCI (age 66.6 ± 11.9 years); 2,381 DES-PCI (age 65.9 ± 11.7 years); 2,289 SA-CABG (age 69.3 ± 9.0 years); and 1,525 MA-CABG (age 58.3 ± 8.7 years). Patients with myocardial infarction within 24 h, shock, or left main stents were excluded. Kaplan-Meier analysis and Cox regression were used to separately compare 9-year all-cause mortality and unplanned reintervention for BMS-PCI and DES-PCI to respective propensity-matched SA-CABG and MA-CABG cohorts. BMS-PCI was associated with worse survival than SA-CABG, especially from 0 to 7 years (p = 0.015) and to a greater extent than MA-CABG was (9-year follow-up: 76.3% vs. 86.9%; p < 0.001). The surgery-to-BMS-PCI hazard ratios (HR) were as follows: versus SA-CABG, HR: 0.87; and versus MA-CABG, HR: 0.38. DES-PCI showed similar survival to SA-CABG except for a modest 0 to 3 years surgery advantage (HR: 1.06; p = 0.615). Compared with MA-CABG, DES-PCI exhibited worse survival at 5 (86.3% vs. 95.6%) and 9 (82.8% vs. 89.8%) years (HR: 0.45; p <0.001). Reintervention was substantially worse with PCI for all comparisons (all p <0.001). Multiarterial surgical revascularization, compared with either BMS-PCI or DES-PCI, resulted in substantially enhanced death and reintervention-free survival. Accordingly, MA-CABG represents the optimal therapy for multivessel coronary artery disease and should be enthusiastically adopted by

Securing mobile ad hoc networks using danger theory-based artificial immune algorithm.

PubMed

Abdelhaq, Maha; Alsaqour, Raed; Abdelhaq, Shawkat

2015-01-01

A mobile ad hoc network (MANET) is a set of mobile, decentralized, and self-organizing nodes that are used in special cases, such as in the military. MANET properties render the environment of this network vulnerable to different types of attacks, including black hole, wormhole and flooding-based attacks. Flooding-based attacks are one of the most dangerous attacks that aim to consume all network resources and thus paralyze the functionality of the whole network. Therefore, the objective of this paper is to investigate the capability of a danger theory-based artificial immune algorithm called the mobile dendritic cell algorithm (MDCA) to detect flooding-based attacks in MANETs. The MDCA applies the dendritic cell algorithm (DCA) to secure the MANET with additional improvements. The MDCA is tested and validated using Qualnet v7.1 simulation tool. This work also introduces a new simulation module for a flooding attack called the resource consumption attack (RCA) using Qualnet v7.1. The results highlight the high efficiency of the MDCA in detecting RCAs in MANETs.

Securing Mobile Ad Hoc Networks Using Danger Theory-Based Artificial Immune Algorithm

PubMed Central

2015-01-01

A mobile ad hoc network (MANET) is a set of mobile, decentralized, and self-organizing nodes that are used in special cases, such as in the military. MANET properties render the environment of this network vulnerable to different types of attacks, including black hole, wormhole and flooding-based attacks. Flooding-based attacks are one of the most dangerous attacks that aim to consume all network resources and thus paralyze the functionality of the whole network. Therefore, the objective of this paper is to investigate the capability of a danger theory-based artificial immune algorithm called the mobile dendritic cell algorithm (MDCA) to detect flooding-based attacks in MANETs. The MDCA applies the dendritic cell algorithm (DCA) to secure the MANET with additional improvements. The MDCA is tested and validated using Qualnet v7.1 simulation tool. This work also introduces a new simulation module for a flooding attack called the resource consumption attack (RCA) using Qualnet v7.1. The results highlight the high efficiency of the MDCA in detecting RCAs in MANETs. PMID:25946001

Distributive routing and congestion control in wireless multihop ad hoc communication networks

NASA Astrophysics Data System (ADS)

Glauche, Ingmar; Krause, Wolfram; Sollacher, Rudolf; Greiner, Martin

2004-10-01

Due to their inherent complexity, engineered wireless multihop ad hoc communication networks represent a technological challenge. Having no mastering infrastructure the nodes have to selforganize themselves in such a way that for example network connectivity, good data traffic performance and robustness are guaranteed. In this contribution the focus is on routing and congestion control. First, random data traffic along shortest path routes is studied by simulations as well as theoretical modeling. Measures of congestion like end-to-end time delay and relaxation times are given. A scaling law of the average time delay with respect to network size is revealed and found to depend on the underlying network topology. In the second step, a distributive routing and congestion control is proposed. Each node locally propagates its routing cost estimates and information about its congestion state to its neighbors, which then update their respective cost estimates. This allows for a flexible adaptation of end-to-end routes to the overall congestion state of the network. Compared to shortest-path routing, the critical network load is significantly increased.

Medium Access Control Protocols for Cognitive Radio Ad Hoc Networks: A Survey

PubMed Central

Islam, A. K. M. Muzahidul; Baharun, Sabariah; Mansoor, Nafees

2017-01-01

New wireless network paradigms will demand higher spectrum use and availability to cope with emerging data-hungry devices. Traditional static spectrum allocation policies cause spectrum scarcity, and new paradigms such as Cognitive Radio (CR) and new protocols and techniques need to be developed in order to have efficient spectrum usage. Medium Access Control (MAC) protocols are accountable for recognizing free spectrum, scheduling available resources and coordinating the coexistence of heterogeneous systems and users. This paper provides an ample review of the state-of-the-art MAC protocols, which mainly focuses on Cognitive Radio Ad Hoc Networks (CRAHN). First, a description of the cognitive radio fundamental functions is presented. Next, MAC protocols are divided into three groups, which are based on their channel access mechanism, namely time-slotted protocol, random access protocol and hybrid protocol. In each group, a detailed and comprehensive explanation of the latest MAC protocols is presented, as well as the pros and cons of each protocol. A discussion on future challenges for CRAHN MAC protocols is included with a comparison of the protocols from a functional perspective. PMID:28926952

3VSR: Three Valued Secure Routing for Vehicular Ad Hoc Networks using Sensing Logic in Adversarial Environment

PubMed Central

Wang, Liangmin

2018-01-01

Today IoT integrate thousands of inter networks and sensing devices e.g., vehicular networks, which are considered to be challenging due to its high speed and network dynamics. The goal of future vehicular networks is to improve road safety, promote commercial or infotainment products and to reduce the traffic accidents. All these applications are based on the information exchange among nodes, so not only reliable data delivery but also the authenticity and credibility of the data itself are prerequisite. To cope with the aforementioned problem, trust management come up as promising candidate to conduct node’s transaction and interaction management, which requires distributed mobile nodes cooperation for achieving design goals. In this paper, we propose a trust-based routing protocol i.e., 3VSR (Three Valued Secure Routing), which extends the widely used AODV (Ad hoc On-demand Distance Vector) routing protocol and employs the idea of Sensing Logic-based trust model to enhance the security solution of VANET (Vehicular Ad-Hoc Network). The existing routing protocol are mostly based on key or signature-based schemes, which off course increases computation overhead. In our proposed 3VSR, trust among entities is updated frequently by means of opinion derived from sensing logic due to vehicles random topologies. In 3VSR the theoretical capabilities are based on Dirichlet distribution by considering prior and posterior uncertainty of the said event. Also by using trust recommendation message exchange, nodes are able to reduce computation and routing overhead. The simulated results shows that the proposed scheme is secure and practical. PMID:29538314

3VSR: Three Valued Secure Routing for Vehicular Ad Hoc Networks using Sensing Logic in Adversarial Environment.

PubMed

Sohail, Muhammad; Wang, Liangmin

2018-03-14

Today IoT integrate thousands of inter networks and sensing devices e.g., vehicular networks, which are considered to be challenging due to its high speed and network dynamics. The goal of future vehicular networks is to improve road safety, promote commercial or infotainment products and to reduce the traffic accidents. All these applications are based on the information exchange among nodes, so not only reliable data delivery but also the authenticity and credibility of the data itself are prerequisite. To cope with the aforementioned problem, trust management come up as promising candidate to conduct node's transaction and interaction management, which requires distributed mobile nodes cooperation for achieving design goals. In this paper, we propose a trust-based routing protocol i.e., 3VSR (Three Valued Secure Routing), which extends the widely used AODV (Ad hoc On-demand Distance Vector) routing protocol and employs the idea of Sensing Logic-based trust model to enhance the security solution of VANET (Vehicular Ad-Hoc Network). The existing routing protocol are mostly based on key or signature-based schemes, which off course increases computation overhead. In our proposed 3VSR, trust among entities is updated frequently by means of opinion derived from sensing logic due to vehicles random topologies. In 3VSR the theoretical capabilities are based on Dirichlet distribution by considering prior and posterior uncertainty of the said event. Also by using trust recommendation message exchange, nodes are able to reduce computation and routing overhead. The simulated results shows that the proposed scheme is secure and practical.

Hop Optimization and Relay Node Selection in Multi-hop Wireless Ad-Hoc Networks

NASA Astrophysics Data System (ADS)

Li, Xiaohua(Edward)

In this paper we propose an efficient approach to determine the optimal hops for multi-hop ad hoc wireless networks. Based on the assumption that nodes use successive interference cancellation (SIC) and maximal ratio combining (MRC) to deal with mutual interference and to utilize all the received signal energy, we show that the signal-to-interference-plus-noise ratio (SINR) of a node is determined only by the nodes before it, not the nodes after it, along a packet forwarding path. Based on this observation, we propose an iterative procedure to select the relay nodes and to calculate the path SINR as well as capacity of an arbitrary multi-hop packet forwarding path. The complexity of the algorithm is extremely low, and scaling well with network size. The algorithm is applicable in arbitrarily large networks. Its performance is demonstrated as desirable by simulations. The algorithm can be helpful in analyzing the performance of multi-hop wireless networks.

Real-Time Support on IEEE 802.11 Wireless Ad-Hoc Networks: Reality vs. Theory

NASA Astrophysics Data System (ADS)

Kang, Mikyung; Kang, Dong-In; Suh, Jinwoo

The usable throughput of an IEEE 802.11 system for an application is much less than the raw bandwidth. Although 802.11b has a theoretical maximum of 11Mbps, more than half of the bandwidth is consumed by overhead leaving at most 5Mbps of usable bandwidth. Considering this characteristic, this paper proposes and analyzes a real-time distributed scheduling scheme based on the existing IEEE 802.11 wireless ad-hoc networks, using USC/ISI's Power Aware Sensing Tracking and Analysis (PASTA) hardware platform. We compared the distributed real-time scheduling scheme with the real-time polling scheme to meet deadline, and compared a measured real bandwidth with a theoretical result. The theoretical and experimental results show that the distributed scheduling scheme can guarantee real-time traffic and enhances the performance up to 74% compared with polling scheme.

A User Authentication Scheme Based on Elliptic Curves Cryptography for Wireless Ad Hoc Networks

PubMed Central

Chen, Huifang; Ge, Linlin; Xie, Lei

2015-01-01

The feature of non-infrastructure support in a wireless ad hoc network (WANET) makes it suffer from various attacks. Moreover, user authentication is the first safety barrier in a network. A mutual trust is achieved by a protocol which enables communicating parties to authenticate each other at the same time and to exchange session keys. For the resource-constrained WANET, an efficient and lightweight user authentication scheme is necessary. In this paper, we propose a user authentication scheme based on the self-certified public key system and elliptic curves cryptography for a WANET. Using the proposed scheme, an efficient two-way user authentication and secure session key agreement can be achieved. Security analysis shows that our proposed scheme is resilient to common known attacks. In addition, the performance analysis shows that our proposed scheme performs similar or better compared with some existing user authentication schemes. PMID:26184224

A User Authentication Scheme Based on Elliptic Curves Cryptography for Wireless Ad Hoc Networks.

PubMed

Chen, Huifang; Ge, Linlin; Xie, Lei

2015-07-14

The feature of non-infrastructure support in a wireless ad hoc network (WANET) makes it suffer from various attacks. Moreover, user authentication is the first safety barrier in a network. A mutual trust is achieved by a protocol which enables communicating parties to authenticate each other at the same time and to exchange session keys. For the resource-constrained WANET, an efficient and lightweight user authentication scheme is necessary. In this paper, we propose a user authentication scheme based on the self-certified public key system and elliptic curves cryptography for a WANET. Using the proposed scheme, an efficient two-way user authentication and secure session key agreement can be achieved. Security analysis shows that our proposed scheme is resilient to common known attacks. In addition, the performance analysis shows that our proposed scheme performs similar or better compared with some existing user authentication schemes.

Pseudo-random dynamic address configuration (PRDAC) algorithm for mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Wu, Shaochuan; Tan, Xuezhi

2007-11-01

By analyzing all kinds of address configuration algorithms, this paper provides a new pseudo-random dynamic address configuration (PRDAC) algorithm for mobile ad hoc networks. Based on PRDAC, the first node that initials this network randomly chooses a nonlinear shift register that can generates an m-sequence. When another node joins this network, the initial node will act as an IP address configuration sever to compute an IP address according to this nonlinear shift register, and then allocates this address and tell the generator polynomial of this shift register to this new node. By this means, when other node joins this network, any node that has obtained an IP address can act as a server to allocate address to this new node. PRDAC can also efficiently avoid IP conflicts and deal with network partition and merge as same as prophet address (PA) allocation and dynamic configuration and distribution protocol (DCDP). Furthermore, PRDAC has less algorithm complexity, less computational complexity and more sufficient assumption than PA. In addition, PRDAC radically avoids address conflicts and maximizes the utilization rate of IP addresses. Analysis and simulation results show that PRDAC has rapid convergence, low overhead and immune from topological structures.

On using multiple routing metrics with destination sequenced distance vector protocol for MultiHop wireless ad hoc networks

NASA Astrophysics Data System (ADS)

Mehic, M.; Fazio, P.; Voznak, M.; Partila, P.; Komosny, D.; Tovarek, J.; Chmelikova, Z.

2016-05-01

A mobile ad hoc network is a collection of mobile nodes which communicate without a fixed backbone or centralized infrastructure. Due to the frequent mobility of nodes, routes connecting two distant nodes may change. Therefore, it is not possible to establish a priori fixed paths for message delivery through the network. Because of its importance, routing is the most studied problem in mobile ad hoc networks. In addition, if the Quality of Service (QoS) is demanded, one must guarantee the QoS not only over a single hop but over an entire wireless multi-hop path which may not be a trivial task. In turns, this requires the propagation of QoS information within the network. The key to the support of QoS reporting is QoS routing, which provides path QoS information at each source. To support QoS for real-time traffic one needs to know not only minimum delay on the path to the destination but also the bandwidth available on it. Therefore, throughput, end-to-end delay, and routing overhead are traditional performance metrics used to evaluate the performance of routing protocol. To obtain additional information about the link, most of quality-link metrics are based on calculation of the lost probabilities of links by broadcasting probe packets. In this paper, we address the problem of including multiple routing metrics in existing routing packets that are broadcasted through the network. We evaluate the efficiency of such approach with modified version of DSDV routing protocols in ns-3 simulator.

Transradial PCI and Same Day Discharge.

PubMed

Elfandi, Ali; Safirstein, Jordan G

2018-02-24

The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD). This literature review was performed to evaluate the studies that were published over the last 17 years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: "same day," "same day discharge," "outpatient," and "ambulatory radial PCI." Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals. The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.

Optimal route discovery for soft QOS provisioning in mobile ad hoc multimedia networks

NASA Astrophysics Data System (ADS)

Huang, Lei; Pan, Feng

2007-09-01

In this paper, we propose an optimal routing discovery algorithm for ad hoc multimedia networks whose resource keeps changing, First, we use stochastic models to measure the network resource availability, based on the information about the location and moving pattern of the nodes, as well as the link conditions between neighboring nodes. Then, for a certain multimedia packet flow to be transmitted from a source to a destination, we formulate the optimal soft-QoS provisioning problem as to find the best route that maximize the probability of satisfying its desired QoS requirements in terms of the maximum delay constraints. Based on the stochastic network resource model, we developed three approaches to solve the formulated problem: A centralized approach serving as the theoretical reference, a distributed approach that is more suitable to practical real-time deployment, and a distributed dynamic approach that utilizes the updated time information to optimize the routing for each individual packet. Examples of numerical results demonstrated that using the route discovered by our distributed algorithm in a changing network environment, multimedia applications could achieve better QoS statistically.

Associations Between Complex PCI and Prasugrel or Clopidogrel Use in Patients With Acute Coronary Syndrome Who Undergo PCI: From the PROMETHEUS Study.

PubMed

Chandrasekhar, Jaya; Baber, Usman; Sartori, Samantha; Aquino, Melissa; Kini, Annapoorna S; Rao, Sunil; Weintraub, William; Henry, Timothy D; Farhan, Serdar; Vogel, Birgit; Sorrentino, Sabato; Ge, Zhen; Kapadia, Samir; Muhlestein, Joseph B; Weiss, Sandra; Strauss, Craig; Toma, Catalin; DeFranco, Anthony; Effron, Mark B; Keller, Stuart; Baker, Brian A; Pocock, Stuart; Dangas, George; Mehran, Roxana

2018-03-01

Potent P2Y 12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction. Copyright © 2018. Published by Elsevier Inc.

Energy-efficient algorithm for broadcasting in ad hoc wireless sensor networks.

PubMed

Xiong, Naixue; Huang, Xingbo; Cheng, Hongju; Wan, Zheng

2013-04-12

Broadcasting is a common and basic operation used to support various network protocols in wireless networks. To achieve energy-efficient broadcasting is especially important for ad hoc wireless sensor networks because sensors are generally powered by batteries with limited lifetimes. Energy consumption for broadcast operations can be reduced by minimizing the number of relay nodes based on the observation that data transmission processes consume more energy than data reception processes in the sensor nodes, and how to improve the network lifetime is always an interesting issue in sensor network research. The minimum-energy broadcast problem is then equivalent to the problem of finding the minimum Connected Dominating Set (CDS) for a connected graph that is proved NP-complete. In this paper, we introduce an Efficient Minimum CDS algorithm (EMCDS) with help of a proposed ordered sequence list. EMCDS does not concern itself with node energy and broadcast operations might fail if relay nodes are out of energy. Next we have proposed a Minimum Energy-consumption Broadcast Scheme (MEBS) with a modified version of EMCDS, and aimed at providing an efficient scheduling scheme with maximized network lifetime. The simulation results show that the proposed EMCDS algorithm can find smaller CDS compared with related works, and the MEBS can help to increase the network lifetime by efficiently balancing energy among nodes in the networks.

A DNA-Inspired Encryption Methodology for Secure, Mobile Ad Hoc Networks

NASA Technical Reports Server (NTRS)

Shaw, Harry

2012-01-01

Users are pushing for greater physical mobility with their network and Internet access. Mobile ad hoc networks (MANET) can provide an efficient mobile network architecture, but security is a key concern. A figure summarizes differences in the state of network security for MANET and fixed networks. MANETs require the ability to distinguish trusted peers, and tolerate the ingress/egress of nodes on an unscheduled basis. Because the networks by their very nature are mobile and self-organizing, use of a Public Key Infra structure (PKI), X.509 certificates, RSA, and nonce ex changes becomes problematic if the ideal of MANET is to be achieved. Molecular biology models such as DNA evolution can provide a basis for a proprietary security architecture that achieves high degrees of diffusion and confusion, and resistance to cryptanalysis. A proprietary encryption mechanism was developed that uses the principles of DNA replication and steganography (hidden word cryptography) for confidentiality and authentication. The foundation of the approach includes organization of coded words and messages using base pairs organized into genes, an expandable genome consisting of DNA-based chromosome keys, and a DNA-based message encoding, replication, and evolution and fitness. In evolutionary computing, a fitness algorithm determines whether candidate solutions, in this case encrypted messages, are sufficiently encrypted to be transmitted. The technology provides a mechanism for confidential electronic traffic over a MANET without a PKI for authenticating users.

Ad hoc versus standardized admixtures for continuous infusion drugs in neonatal intensive care: cognitive task analysis of safety at the bedside.

PubMed

Brannon, Timothy S

2006-01-01

Continuous infusion intravenous (IV) drugs in neonatal intensive care are usually prepared based on patient weight so that the dose is readable as a simple multiple of the infusion pump rate. New safety guidelines propose that hospitals switch to using standardized admixtures of these drugs to prevent calculation errors during ad hoc preparation. Extended hierarchical task analysis suggests that switching to standardized admixtures may lead to more errors in programming the pump at the bedside.

Verifying Safety Messages Using Relative-Time and Zone Priority in Vehicular Ad Hoc Networks.

PubMed

Banani, Sam; Gordon, Steven; Thiemjarus, Surapa; Kittipiyakul, Somsak

2018-04-13

In high-density road networks, with each vehicle broadcasting multiple messages per second, the arrival rate of safety messages can easily exceed the rate at which digital signatures can be verified. Since not all messages can be verified, algorithms for selecting which messages to verify are required to ensure that each vehicle receives appropriate awareness about neighbouring vehicles. This paper presents a novel scheme to select important safety messages for verification in vehicular ad hoc networks (VANETs). The proposed scheme uses location and direction of the sender, as well as proximity and relative-time between vehicles, to reduce the number of irrelevant messages verified (i.e., messages from vehicles that are unlikely to cause an accident). Compared with other existing schemes, the analysis results show that the proposed scheme can verify messages from nearby vehicles with lower inter-message delay and reduced packet loss and thus provides high level of awareness of the nearby vehicles.

An Energy-Efficient and Robust Multipath Routing Protocol for Cognitive Radio Ad Hoc Networks.

PubMed

Singh, Kishor; Moh, Sangman

2017-09-04

Routing in cognitive radio ad hoc networks (CRAHNs) is a daunting task owing to dynamic topology, intermittent connectivity, spectrum heterogeneity, and energy constraints. Other prominent aspects such as channel stability, path reliability, and route discovery frequency should also be exploited. Several routing protocols have been proposed for CRAHNs in the literature. By stressing on one of the aspects more than any other, however, they do not satisfy all requirements of throughput, energy efficiency, and robustness. In this paper, we propose an energy-efficient and robust multipath routing (ERMR) protocol for CRAHNs by considering all prominent aspects including residual energy and channel stability in design. Even when the current routing path fails, the alternative routing path is immediately utilized. In establishing primary and alternative routing paths, both residual energy and channel stability are exploited simultaneously. Our simulation study shows that the proposed ERMR outperforms the conventional protocol in terms of network throughput, packet delivery ratio, energy consumption, and end-to-end delay.

Verifying Safety Messages Using Relative-Time and Zone Priority in Vehicular Ad Hoc Networks

PubMed Central

Banani, Sam; Thiemjarus, Surapa; Kittipiyakul, Somsak

2018-01-01

In high-density road networks, with each vehicle broadcasting multiple messages per second, the arrival rate of safety messages can easily exceed the rate at which digital signatures can be verified. Since not all messages can be verified, algorithms for selecting which messages to verify are required to ensure that each vehicle receives appropriate awareness about neighbouring vehicles. This paper presents a novel scheme to select important safety messages for verification in vehicular ad hoc networks (VANETs). The proposed scheme uses location and direction of the sender, as well as proximity and relative-time between vehicles, to reduce the number of irrelevant messages verified (i.e., messages from vehicles that are unlikely to cause an accident). Compared with other existing schemes, the analysis results show that the proposed scheme can verify messages from nearby vehicles with lower inter-message delay and reduced packet loss and thus provides high level of awareness of the nearby vehicles. PMID:29652840

An Energy-Efficient and Robust Multipath Routing Protocol for Cognitive Radio Ad Hoc Networks

PubMed Central

Singh, Kishor

2017-01-01

Routing in cognitive radio ad hoc networks (CRAHNs) is a daunting task owing to dynamic topology, intermittent connectivity, spectrum heterogeneity, and energy constraints. Other prominent aspects such as channel stability, path reliability, and route discovery frequency should also be exploited. Several routing protocols have been proposed for CRAHNs in the literature. By stressing on one of the aspects more than any other, however, they do not satisfy all requirements of throughput, energy efficiency, and robustness. In this paper, we propose an energy-efficient and robust multipath routing (ERMR) protocol for CRAHNs by considering all prominent aspects including residual energy and channel stability in design. Even when the current routing path fails, the alternative routing path is immediately utilized. In establishing primary and alternative routing paths, both residual energy and channel stability are exploited simultaneously. Our simulation study shows that the proposed ERMR outperforms the conventional protocol in terms of network throughput, packet delivery ratio, energy consumption, and end-to-end delay. PMID:28869551

Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG.

PubMed

Mavroudis, Chrysostomos A; Kotecha, Tushar; Chehab, Omar; Hudson, Jonathan; Rakhit, Roby D

2017-02-01

Secondary percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery is increasingly common. Graft vessel PCI has higher rates of adverse events compared with native coronary vessel PCI. To investigate the clinical outcomes of patients with prior CABG who underwent secondary PCI of either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. 220 patients (84% male) who underwent PCI in our institution to either GV (n=89), NV (n=103) or both GV and NV (NG group) (n=28) were studied. The study population underwent 378 procedures (GV group; n=126, NV group; n=164 and NG group; n=88). Median follow up was for 36months [range 2-75months]. Target vessel revascularisation (TVR) occurred in 12.5% of the GV group and 3.6% in the NV group [p=0.0004], and was predominantly due to in-stent restenosis. Patients who had PCI due to TVR were more likely to suffer from diabetes and peripheral vascular disease. History of chronic renal failure was associated with higher risk (HR 2.21, p=0.005) whereas preserved left ventricular ejection fraction (LVEF) with lower risk (HR 0.17, p=0.0007) of death. The median survival (interval between CABG and end of follow-up period) was lower in the GV compared with the NV group (315 vs 372months p=0.005). This registry demonstrates inferior long term outcome for patients undergoing secondary PCI of GV versus NV. Where possible, a strategy of NV rather than GV target PCI should be considered in patients with prior CABG. Secondary PCI in patients with prior CABG surgery is increasingly common. Graft vessel PCI has inferior outcomes with high rates of restenosis and occlusion compared with native coronary vessel PCI. We studied the clinical outcomes of 220 patients with prior CABG who underwent secondary PCI to either a graft vessel (GV), a native coronary vessel (NV) or both graft and native (NG) vessels. Target vessel revascularisation was 5 times higher in the GV

Antiplatelet therapy in PCI

PubMed Central

Fanaroff, Alexander; Rao, Sunil

2018-01-01

Platelets play a key role in mediating stent thrombosis, the major cause of ischemic events in the immediate period following percutaneous coronary intervention (PCI). For this reason, antiplatelet therapy, started at the time of PCI and continued for at least 30 days afterwards, is the cornerstone of antithrombotic therapy after PCI. However, the use of antiplatelet agents increase bleeding risk, with more potent antiplatelet agents further increasing bleeding risk. For this reason, balancing prevention of ischemic events with risk of bleeding is fundamental to the effective use of antiplatelet agents. In the past 5 years, potent and fast-acting P2Y12 inhibitors have been introduced, and have augmented the antiplatelet armamentarium available to interventional cardiologists. In this review, we review the preclinical and clinical data surrounding these new agents, and discuss the significant questions and controversies that still exist regarding the optimal antiplatelet strategy. PMID:28582206

Ad Hoc versus Standardized Admixtures for Continuous Infusion Drugs in Neonatal Intensive Care: Cognitive Task Analysis of Safety at the Bedside

PubMed Central

Brannon, Timothy S.

2006-01-01

Continuous infusion intravenous (IV) drugs in neonatal intensive care are usually prepared based on patient weight so that the dose is readable as a simple multiple of the infusion pump rate. New safety guidelines propose that hospitals switch to using standardized admixtures of these drugs to prevent calculation errors during ad hoc preparation. Extended hierarchical task analysis suggests that switching to standardized admixtures may lead to more errors in programming the pump at the bedside. PMID:17238482

Ad Hoc Networking for Unmanned Ground Vehicles: Design and Evaluation at Command, Control, Communications, Intelligence, Surveillance and Reconnaissance On-the-Move

DTIC Science & Technology

2006-11-01

software components used in the ad hoc nodes for the C4ISR OTM experiment were OLSRD, an open-source proactive MANET routing software, and OpenVPN , an...developed by Mike Baker (openwrt.org). 6OpenVPN is a trademark of OpenVPN Solutions LLC. 6 Secure communications in the MANET are achieved with...encryption provided by Wired Equivalent Privacy (WEP) and OpenVPN . The WEP protocol, which is part of the IEEE 802.11 wireless networking standard

Ad Hoc working group on diurnal and semi-diurnal Earth Orientation variation.

NASA Astrophysics Data System (ADS)

Gipson, J. M.

2017-12-01

Diurnal and semi-diurnal Earth orientation ("HF-EOP") variation were detected in the early 1990s in SLR and VLBI data. Beginning in 1996 a model of HF-EOP variation based on ocean-tides derived from Topex data was included in the IERS standards. This model has not been updated since then with the exception of including libration for effects for polar motion (2003 IERS conventions) and UT1 (2010 IERS conventions). The accuracy of Space Geodesy has increased remarkably over the last 20 years and the 1996 IERS HF-EOP model is no longer adequate. At the conclusion of the 2017 GGOS/IERS Unified Analysis Workshop an ad hoc working group was formed including representatives of the IDS, IGS, ILRS, and IVS. The goal of the working group is to test several models of HF-EOP in the different space geodesy techniques and to make a recommendation to the IERS for the adoption of a new HF-EOP model. In this presentation I will give a summary of work on HF-EOP done to date by various scientists which demonstrate the inadequacy of the current IERS HF-EOP model. I will then describe the goals and the progress of the working group to date, with a preview of further work.

An ultra-wide bandwidth-based range/GPS tight integration approach for relative positioning in vehicular ad hoc networks

NASA Astrophysics Data System (ADS)

Shen, Feng; Wayn Cheong, Joon; Dempster, Andrew G.

2015-04-01

Relative position awareness is a vital premise for the implementation of emerging intelligent transportation systems, such as collision warning. However, commercial global navigation satellite systems (GNSS) receivers do not satisfy the requirements of these applications. Fortunately, cooperative positioning (CP) techniques, through sharing the GNSS measurements between vehicles, can improve the performance of relative positioning in a vehicular ad hoc network (VANET). In this paper, while assuming there are no obstacles between vehicles, a new enhanced tightly coupled CP technique is presented by adding ultra-wide bandwidth (UWB)-based inter-vehicular range measurements. In the proposed CP method, each vehicle fuses the GPS measurements and the inter-vehicular range measurements. Based on analytical and experimental results, in the full GPS coverage environment, the new tight integration CP method outperforms the INS-aided tight CP method, tight CP method, and DGPS by 11%, 15%, and 24%, respectively; in the GPS outage scenario, the performance improvement achieves 60%, 65%, and 73%, respectively.

Predictors of Interventional Success of Antegrade PCI for CTO.

PubMed

Luo, Chun; Huang, Meiping; Li, Jinglei; Liang, Changhong; Zhang, Qun; Liu, Hui; Liu, Zaiyi; Qu, Yanji; Jiang, Jun; Zhuang, Jian

2015-07-01

This study aimed to identify significant lesion features of chronic total occlusions (CTOs) that predict failure of antegrade (A) percutaneous coronary intervention (PCI) using pre-procedure coronary computed tomography angiography (CTA) combined with conventional coronary angiography (CCA). The current predictors of successful A-PCI in the setting of CTOs are uncertain. Such knowledge might prompt early performance of a retrograde (R)-PCI approach if predictors of A-PCI failure are present. Consecutive patients confirmed to have at least 1 CTO of native coronary arteries underwent coronary CTA- and CCA-guided PCI in which computed tomography and fluoroscopic images were placed side by side before or during PCI. The study included 103 patients with 108 CTOs; 80 lesions were successfully treated with A-PCI and 28 lesions failed this approach, for an A-PCI success rate of 74%. A total of 15 of 28 failed cases underwent attempted R-PCI. Only 1 case also failed R-PCI; thus, the total PCI success rate was 87%. By multivariable analysis, the factors significantly predictive of failed A-PCI included negative remodeling (odds ratio [OR]: 137.82) and lesion length >31.89 mm on coronary CTA (OR: 7.04), and ostial or bifurcation lesions on CCA (OR: 8.02). R-PCI was successful in 14 of 15 patients (93.3%), in whom good appearance of the occluded distal segment and well-developed collateral vessels were present. Morphologic predictors of failed A-PCI on the basis of pre-procedure coronary CTA and CCA imaging may be identified, which may assist in determining which patients with CTO lesions would benefit from an early R-PCI strategy. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Non-ad-hoc decision rule for the Dempster-Shafer method of evidential reasoning

NASA Astrophysics Data System (ADS)

Cheaito, Ali; Lecours, Michael; Bosse, Eloi

1998-03-01

This paper is concerned with the fusion of identity information through the use of statistical analysis rooted in Dempster-Shafer theory of evidence to provide automatic identification aboard a platform. An identity information process for a baseline Multi-Source Data Fusion (MSDF) system is defined. The MSDF system is applied to information sources which include a number of radars, IFF systems, an ESM system, and a remote track source. We use a comprehensive Platform Data Base (PDB) containing all the possible identity values that the potential target may take, and we use the fuzzy logic strategies which enable the fusion of subjective attribute information from sensor and the PDB to make the derivation of target identity more quickly, more precisely, and with statistically quantifiable measures of confidence. The conventional Dempster-Shafer lacks a formal basis upon which decision can be made in the face of ambiguity. We define a non-ad hoc decision rule based on the expected utility interval for pruning the `unessential' propositions which would otherwise overload the real-time data fusion systems. An example has been selected to demonstrate the implementation of our modified Dempster-Shafer method of evidential reasoning.

Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis

PubMed Central

Pandit, Anil; Aryal, Madan Raj; Aryal Pandit, Aashrayata; Hakim, Fayaz Ahmad; Giri, Smith; Mainali, Naba Raj; Sharma, Prashant; Lee, Howard R; Fortuin, F David; Mookadam, Farouk

2014-01-01

Aim The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations. Methods PubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I2 statistics. Results In three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I2=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I2=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I2=0%) compared with culprit-only revascularisation. Conclusions In patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials. PMID:25332779

An Efficient and QoS Supported Multichannel MAC Protocol for Vehicular Ad Hoc Networks

PubMed Central

Tan, Guozhen; Yu, Chao

2017-01-01

Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety (transport efficiency and infotainment) applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. Different types of applications require different levels Quality-of-Service (QoS) support. Recently, transport efficiency and infotainment applications (e.g., electronic map download and Internet access) have received more and more attention, and this kind of applications is expected to become a big market driver in a near future. In this paper, we propose an Efficient and QoS supported Multichannel Medium Access Control (EQM-MAC) protocol for VANETs in a highway environment. The EQM-MAC protocol utilizes the service channel resources for non-safety message transmissions during the whole synchronization interval, and it dynamically adjusts minimum contention window size for different non-safety services according to the traffic conditions. Theoretical model analysis and extensive simulation results show that the EQM-MAC protocol can support QoS services, while ensuring the high saturation throughput and low transmission delay for non-safety applications. PMID:28991217

Adaptive Control Parameters for Dispersal of Multi-Agent Mobile Ad Hoc Network (MANET) Swarms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurt Derr; Milos Manic

A mobile ad hoc network is a collection of independent nodes that communicate wirelessly with one another. This paper investigates nodes that are swarm robots with communications and sensing capabilities. Each robot in the swarm may operate in a distributed and decentralized manner to achieve some goal. This paper presents a novel approach to dynamically adapting control parameters to achieve mesh configuration stability. The presented approach to robot interaction is based on spring force laws (attraction and repulsion laws) to create near-optimal mesh like configurations. In prior work, we presented the extended virtual spring mesh (EVSM) algorithm for the dispersionmore » of robot swarms. This paper extends the EVSM framework by providing the first known study on the effects of adaptive versus static control parameters on robot swarm stability. The EVSM algorithm provides the following novelties: 1) improved performance with adaptive control parameters and 2) accelerated convergence with high formation effectiveness. Simulation results show that 120 robots reach convergence using adaptive control parameters more than twice as fast as with static control parameters in a multiple obstacle environment.« less

Data Delivery Method Based on Neighbor Nodes' Information in a Mobile Ad Hoc Network

PubMed Central

Hayashi, Takuma; Taenaka, Yuzo; Okuda, Takeshi; Yamaguchi, Suguru

2014-01-01

This paper proposes a data delivery method based on neighbor nodes' information to achieve reliable communication in a mobile ad hoc network (MANET). In a MANET, it is difficult to deliver data reliably due to instabilities in network topology and wireless network condition which result from node movement. To overcome such unstable communication, opportunistic routing and network coding schemes have lately attracted considerable attention. Although an existing method that employs such schemes, MAC-independent opportunistic routing and encoding (MORE), Chachulski et al. (2007), improves the efficiency of data delivery in an unstable wireless mesh network, it does not address node movement. To efficiently deliver data in a MANET, the method proposed in this paper thus first employs the same opportunistic routing and network coding used in MORE and also uses the location information and transmission probabilities of neighbor nodes to adapt to changeable network topology and wireless network condition. The simulation experiments showed that the proposed method can achieve efficient data delivery with low network load when the movement speed is relatively slow. PMID:24672371

Data delivery method based on neighbor nodes' information in a mobile ad hoc network.

PubMed

Kashihara, Shigeru; Hayashi, Takuma; Taenaka, Yuzo; Okuda, Takeshi; Yamaguchi, Suguru

2014-01-01

This paper proposes a data delivery method based on neighbor nodes' information to achieve reliable communication in a mobile ad hoc network (MANET). In a MANET, it is difficult to deliver data reliably due to instabilities in network topology and wireless network condition which result from node movement. To overcome such unstable communication, opportunistic routing and network coding schemes have lately attracted considerable attention. Although an existing method that employs such schemes, MAC-independent opportunistic routing and encoding (MORE), Chachulski et al. (2007), improves the efficiency of data delivery in an unstable wireless mesh network, it does not address node movement. To efficiently deliver data in a MANET, the method proposed in this paper thus first employs the same opportunistic routing and network coding used in MORE and also uses the location information and transmission probabilities of neighbor nodes to adapt to changeable network topology and wireless network condition. The simulation experiments showed that the proposed method can achieve efficient data delivery with low network load when the movement speed is relatively slow.

PCPA: A Practical Certificateless Conditional Privacy Preserving Authentication Scheme for Vehicular Ad Hoc Networks

PubMed Central

2018-01-01

Vehicle ad hoc networks (VANETs) is a promising network scenario for greatly improving traffic efficiency and safety, in which smart vehicles can communicate with other vehicles or roadside units. For the availability of VANETs, it is very important to deal with the security and privacy problems for VANETs. In this paper, based on certificateless cryptography and elliptic curve cryptography, we present a certificateless signature with message recovery (CLS-MR), which we believe are of independent interest. Then, a practical certificateless conditional privacy preserving authentication (PCPA) scheme is proposed by incorporating the proposed CLS-MR scheme. Furthermore, the security analysis shows that PCPA satisfies all security and privacy requirements. The evaluation results indicate that PCPA achieves low computation and communication costs because there is no need to use the bilinear pairing and map-to-point hash operations. Moreover, extensive simulations show that PCPA is feasible and achieves prominent performances in terms of message delay and message loss ratio, and thus is more suitable for the deployment and adoption of VANETs. PMID:29762511

Post Hoc Analyses of ApoE Genotype-Defined Subgroups in Clinical Trials.

PubMed

Kennedy, Richard E; Cutter, Gary R; Wang, Guoqiao; Schneider, Lon S

2016-01-01

Many post hoc analyses of clinical trials in Alzheimer's disease (AD) and mild cognitive impairment (MCI) are in small Phase 2 trials. Subject heterogeneity may lead to statistically significant post hoc results that cannot be replicated in larger follow-up studies. We investigated the extent of this problem using simulation studies mimicking current trial methods with post hoc analyses based on ApoE4 carrier status. We used a meta-database of 24 studies, including 3,574 subjects with mild AD and 1,171 subjects with MCI/prodromal AD, to simulate clinical trial scenarios. Post hoc analyses examined if rates of progression on the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) differed between ApoE4 carriers and non-carriers. Across studies, ApoE4 carriers were younger and had lower baseline scores, greater rates of progression, and greater variability on the ADAS-cog. Up to 18% of post hoc analyses for 18-month trials in AD showed greater rates of progression for ApoE4 non-carriers that were statistically significant but unlikely to be confirmed in follow-up studies. The frequency of erroneous conclusions dropped below 3% with trials of 100 subjects per arm. In MCI, rates of statistically significant differences with greater progression in ApoE4 non-carriers remained below 3% unless sample sizes were below 25 subjects per arm. Statistically significant differences for ApoE4 in post hoc analyses often reflect heterogeneity among small samples rather than true differential effect among ApoE4 subtypes. Such analyses must be viewed cautiously. ApoE genotype should be incorporated into the design stage to minimize erroneous conclusions.

Predictors of subjective health status 10 years post-PCI.

PubMed

van den Berge, Jan C; Dulfer, Karolijn; Utens, Elisabeth M W J; Hartman, Eline M J; Daemen, Joost; van Geuns, Robert J; van Domburg, Ron T

2016-06-01

Subjective health status is an increasingly important parameter to assess the effect of percutaneous coronary intervention (PCI) in clinical practice. Aim of this study was to determine medical and psychosocial predictors of poor subjective health status over a 10 years' post-PCI period. We included a series of consecutive PCI patients (n = 573) as part of the RESEARCH registry, a Dutch single-center retrospective cohort study. These patients completed the 36-item Short-Form Health Survey (SF-36) at baseline and 10 years post-PCI. We found 6 predictors of poor subjective health status 10 years post-PCI: SF-36 at baseline, age, previous PCI, obesity, acute myocardial infarction as indication for PCI, and diabetes mellitus (arranged from most to least numbers of sub domains). SF-36 scores at baseline, age, and previous PCI were significant predictors of subjective health status 10 years post-PCI. Specifically, the SF-36 score at baseline was an important predictor. Thus assessment of subjective health status at baseline is useful as an indicator to predict long-term subjective health status. Subjective health status becomes better by optimal medical treatment, cardiac rehabilitation and psychosocial support. This is the first study determining predictors of subjective health status 10 years post-PCI.

A communication theoretical analysis of FRET-based mobile ad hoc molecular nanonetworks.

PubMed

Kuscu, Murat; Akan, Ozgur B

2014-09-01

Nanonetworks refer to a group of nanosized machines with very basic operational capabilities communicating to each other in order to accomplish more complex tasks such as in-body drug delivery, or chemical defense. Realizing reliable and high-rate communication between these nanomachines is a fundamental problem for the practicality of these nanonetworks. Recently, we have proposed a molecular communication method based on Förster Resonance Energy Transfer (FRET) which is a nonradiative excited state energy transfer phenomenon observed among fluorescent molecules, i.e., fluorophores. We have modeled the FRET-based communication channel considering the fluorophores as single-molecular immobile nanomachines, and shown its reliability at high rates, and practicality at the current stage of nanotechnology. In this study, for the first time in the literature, we investigate the network of mobile nanomachines communicating through FRET. We introduce two novel mobile molecular nanonetworks: FRET-based mobile molecular sensor/actor nanonetwork (FRET-MSAN) which is a distributed system of mobile fluorophores acting as sensor or actor node; and FRET-based mobile ad hoc molecular nanonetwork (FRET-MAMNET) which consists of fluorophore-based nanotransmitter, nanoreceivers and nanorelays. We model the single message propagation based on birth-death processes with continuous time Markov chains. We evaluate the performance of FRET-MSAN and FRET-MAMNET in terms of successful transmission probability and mean extinction time of the messages, system throughput, channel capacity and achievable communication rates.

Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial).

PubMed

Rodriguez-Araujo, Gerardo; Cilingiroglu, Mehmet; Mego, David; Hakeem, Abdul; Lendel, Vasili; Cawich, Ian; Paixao, Andre; Marmagkiolis, Konstantinos; Flaherty, Patrick; Rollefson, William

2018-06-02

Transradial percutaneous coronary intervention (TR-PCI) has been increasingly popular over the last decade in the US. Previous studies have shown that same-day (SD) discharge after elective PCI is as safe as overnight (ON) observation. Our study was performed to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI. This is a single center registry of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge -SD-; Overnight Stay -ON-). Demographic data, procedural characteristics and adverse outcomes were recorded. Outcomes included 30 day-MACE and procedure- related complications, as well as total operative costs in patients from both groups. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups. The entire cohort included 852 patients (429 in SD group and 423 in ON group) and the propensity score matched groups of 245 patients in the SD group and 245 patients in the ON group. The two groups had no significant baseline clinical differences, and had similar clinical outcomes. Specifically, no significant difference was noted in procedural complications (3.7% vs 2.5%, p = 0.43), re-hospitalization (4.1% vs 4.1%, p = 0.92), re-intervention (2.5% vs 2.1%, p = 0.77), myocardial infarction (0% vs 0.08%, p = 0.15), stroke (0% vs 0%, p = 1.0) and all-cause mortality (0% vs 0%, p = 1.0). SD Group patients had a significant lower procedure-related cost compared to overnight stay patients ($3,346.45 vs $4,681.99, p < 0.0001) and lower 30-day post procedure-associated cumulative costs/total operating costs ($4,493.22 vs $7,112.21, p < 0.0001). In elective patients undergoing low risk TR-PCI, same-day discharge seems to be a safe and feasible clinical practice, with significant potential savings to the US healthcare system. Copyright © 2018 Elsevier Inc. All rights

Optimal JPWL Forward Error Correction Rate Allocation for Robust JPEG 2000 Images and Video Streaming over Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Agueh, Max; Diouris, Jean-François; Diop, Magaye; Devaux, François-Olivier; De Vleeschouwer, Christophe; Macq, Benoit

2008-12-01

Based on the analysis of real mobile ad hoc network (MANET) traces, we derive in this paper an optimal wireless JPEG 2000 compliant forward error correction (FEC) rate allocation scheme for a robust streaming of images and videos over MANET. The packet-based proposed scheme has a low complexity and is compliant to JPWL, the 11th part of the JPEG 2000 standard. The effectiveness of the proposed method is evaluated using a wireless Motion JPEG 2000 client/server application; and the ability of the optimal scheme to guarantee quality of service (QoS) to wireless clients is demonstrated.

An overview of PCI in the very elderly

PubMed Central

Shanmugam, Vimalraj Bogana; Harper, Richard; Meredith, Ian; Malaiapan, Yuvaraj; Psaltis, Peter J

2015-01-01

Cardiovascular disease, and in particular ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly (> 80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indicates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI settings: elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients. PMID:25870621

The inherent catastrophic traps in retrograde CTO PCI.

PubMed

Wu, Eugene B; Tsuchikane, Etsuo

2018-05-01

When we learn to drive, our driving instructor tells us how to check the side mirror and turn your head to check the blind spot before changing lanes. He tells us how to stop at stop signs, how to drive in slippery conditions, the safe stopping distances, and these all make our driving safe. Similarly, when we learn PCI, our mentors teach us to seat the guiding catheter co-axially, to wire the vessel safely, to deliver balloon and stents over the wire, to watch the pressure of the guiding, in order that we perform PCI safely and evade complications. In retrograde CTO PCI, there is no such published teaching. Also many individual mentors have not had the wide experience to see all the possible complications of retrograde CTO PCI and, therefore, may not be able to warn their apprentice. As the number of retrograde procedures increase worldwide, there is a corresponding increase in catastrophic complications, many of which, we as experts, can see are easily avoidable. To breach this gap in knowledge, this article describes 12 commonly met inherent traps in retrograde CTO PCI. They are inherent because by arranging our equipment in the manner to perform retrograde CTO PCI, these complications are either induced directly or happen easily. We hope this work will enhance safety of retrograde CTO PCI and avoid many catastrophic complications for our readers and operators. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Antithrombotic therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention: should we change our practice after the PIONEER AF-PCI and RE-DUAL PCI trials?

PubMed

Duerschmied, D; Brachmann, J; Darius, H; Frey, N; Katus, H A; Rottbauer, W; Schäfer, A; Thiele, H; Bode, C; Zeymer, Uwe

2018-04-20

The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA 2 DS 2 -VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known. In the rather small randomized WOEST trial, the combination of a vitamin K antagonist (VKA) and clopidogrel decreased bleeding compared to the conventional triple therapy with VKA, clopidogrel and aspirin. In the PIONEER AF-PCI trial, two rivaroxaban-based treatment regimens significantly reduced bleeding complications compared to conventional triple therapy without increasing embolic or ischemic complications following PCI. Dual therapy with rivaroxaban and clopidogrel appeared to provide an optimal risk-benefit ratio. In the RE-DUAL PCI trial, dual therapy with dabigatran also reduced bleeding complications compared to conventional triple therapy. With respect to the composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization dabigatran-based dual therapy was non-inferior to VKA-based triple therapy. The upcoming trials AUGUSTUS with apixaban and ENTRUST-PCI with edoxaban will further examine the use of NOACs in this setting. While recent guidelines recommend NOAC-based dual therapy in only a subset of patients (those who are at increased risk of bleeding), the available data now suggest that this should be the preferred choice for the majority of patients. Adding aspirin to this primary choice for up to 4 weeks in patients at especially high ischemic risk would likely prevent atherothrombotic events, but this needs further

An Ad-hoc Satellite Network to Measure Filamentary Current Structures in the Auroral Zone

NASA Astrophysics Data System (ADS)

Nabong, C.; Fritz, T. A.; Semeter, J. L.

2014-12-01

An ad-hoc cubesat-based satellite network project known as ANDESITE is under development at Boston University. It aims to develop a dense constellation of easy-to-use, rapidly-deployable low-cost wireless sensor nodes in space. The objectives of the project are threefold: 1) Demonstrate viability of satellite based sensor networks by deploying an 8-node miniature sensor network to study the filamentation of the field aligned currents in the auroral zones of the Earth's magnetosphere. 2) Test the scalability of proposed protocols, including localization techniques, tracking, data aggregation, and routing, for a 3 dimensional wireless sensor network using a "flock" of nodes. 3) Construct a 6U Cube-sat running the Android OS as an integrated constellation manager, data mule and sensor node deplorer. This small network of sensor nodes will resolve current densities at different spatial resolutions in the near-Earth magnetosphere using measurements from magnetometers with 1-nT sensitivities and 0.2 nT/√Hz self-noise. Mapping of these currents will provide new constraints for models of auroral particle acceleration, wave-particle interactions, ionospheric destabilization, and other kinetic processes operating in the low-beta plasma of the near Earth magnetosphere.

Report of the APS Ad-Hoc Committee on LGBT Issues - Presentation of Findings and Recommendations

NASA Astrophysics Data System (ADS)

Falk, Michael

In 2014 the Executive Officer of the American Physical Society (APS), Kate Kirby, created an Ad-Hoc Committee on LGBT Issues (C-LGBT) charged with reporting on the obstacles to inclusion of LGBT physicists, a term which for the purpose of this report refers to persons who self-identify as lesbian, gay, bisexual, transgender, queer, questioning, intersex, or asexual, as well as other sexual and gender minorities. The full charge was as follows: ``The committee will advise the APS on the current status of LGBT issues in physics, provide recommendations for greater inclusion, and engage physicists in laying the foundation for a more inclusive physics community. ?More specifically, the committee will investigate LGBT representation in physics, assess the educational and professional climate in physics, recommend changes in policies and practices that impact LGBT physicists, and address other issues that affect inclusion.'' We will present the findings and recommendations of the C-LGBT final report, and a panel discussion will be held following the presentation to discuss the future of APS efforts toward LGBT inclusion in physics.

Report of the APS Ad-Hoc Committee on LGBT Issues - Presentation of Findings and Recommendations

NASA Astrophysics Data System (ADS)

Long, Elena

2016-03-01

In 2014 the Executive Officer of the American Physical Society (APS), Kate Kirby, created an Ad-Hoc Committee on LGBT Issues (C-LGBT) charged with reporting on the obstacles to inclusion of LGBT physicists, a term which for the purpose of this report refers to persons who self-identify as lesbian, gay, bisexual, transgender, queer, questioning, intersex, or asexual, as well as other sexual and gender minorities. The full charge was as follows: ``The committee will advise the APS on the current status of LGBT issues in physics, provide recommendations for greater inclusion, and engage physicists in laying the foundation for a more inclusive physics community? More specifically, the committee will investigate LGBT representation in physics, assess the educational and professional climate in physics, recommend changes in policies and practices that impact LGBT physicists, and address other issues that affect inclusion.'' We will present the findings and recommendations of the C-LGBT final report, and a panel discussion will be held following the presentation to discuss the future of APS efforts toward LGBT inclusion in physics.

The impact of place of enrollment and delay to reperfusion on 90-day post-infarction mortality in the ASSENT-4 PCI trial: assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention.

PubMed

Ross, Allan M; Huber, Kurt; Zeymer, Uwe; Armstrong, Paul W; Granger, Christopher B; Goldstein, Patrick; Bogaerts, Kris; Van de Werf, Frans

2009-10-01

We have performed a retrospective analysis of the data stratified by time to treatment and by enrollment site: percutaneous coronary intervention hospitals (PCIH), nonpercutaneous coronary intervention hospitals (NoPCIH), or in a pre-hospital setting (PreH). The ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention) trial intended to test the hypothesis that in ST-segment elevation myocardial infarction (STEMI) patients an upfront fibrinolytic bolus before PCI ("facilitated PCI") compared with primary PCI would benefit STEMI patients facing a long pre-PCI delay. Seven hundred forty-nine patients (45%) presented directly to PCIH, 578 (34%) presented to NoPCIH, and 334 (20%) were randomized and initially treated in the PreH setting. Patients in the PreH-facilitated group had the shortest delays (pain-to-fibrinolytic treatment 125 min) and the lowest 90-day mortality (3.1%). Among patients randomized to primary PCI, the shortest time from pain to first balloon was similarly in the PreH group (223 min). They had the lowest mortality of the primary PCI patient groups (4.1%). The highest mortality (8.4%) was in patients presenting to a PCIH and assigned to the facilitated strategy. Their pain-to-lysis time was 174 min and pain-to-PCI time 266 min (or 92 min after lysis). Few patients fit the target population, long delays to PCI for whom facilitated PCI was designed. Patients treated early after pain onset in the PreH setting do well after a facilitated approach. Despite limitations of post hoc subgroup analysis, these observations suggest caution in extrapolating the results of the ASSENT-4 trial to the "real world" where many patients might have potentially short pain-to-fibrinolysis time but are facing a long transport time to primary PCI.

Energy Efficient Link Aware Routing with Power Control in Wireless Ad Hoc Networks.

PubMed

Katiravan, Jeevaa; Sylvia, D; Rao, D Srinivasa

2015-01-01

In wireless ad hoc networks, the traditional routing protocols make the route selection based on minimum distance between the nodes and the minimum number of hop counts. Most of the routing decisions do not consider the condition of the network such as link quality and residual energy of the nodes. Also, when a link failure occurs, a route discovery mechanism is initiated which incurs high routing overhead. If the broadcast nature and the spatial diversity of the wireless communication are utilized efficiently it becomes possible to achieve improvement in the performance of the wireless networks. In contrast to the traditional routing scheme which makes use of a predetermined route for packet transmission, such an opportunistic routing scheme defines a predefined forwarding candidate list formed by using single network metrics. In this paper, a protocol is proposed which uses multiple metrics such as residual energy and link quality for route selection and also includes a monitoring mechanism which initiates a route discovery for a poor link, thereby reducing the overhead involved and improving the throughput of the network while maintaining network connectivity. Power control is also implemented not only to save energy but also to improve the network performance. Using simulations, we show the performance improvement attained in the network in terms of packet delivery ratio, routing overhead, and residual energy of the network.

Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety.

PubMed

Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

2016-01-15

The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels.

Energy Efficient Link Aware Routing with Power Control in Wireless Ad Hoc Networks

PubMed Central

Katiravan, Jeevaa; Sylvia, D.; Rao, D. Srinivasa

2015-01-01

In wireless ad hoc networks, the traditional routing protocols make the route selection based on minimum distance between the nodes and the minimum number of hop counts. Most of the routing decisions do not consider the condition of the network such as link quality and residual energy of the nodes. Also, when a link failure occurs, a route discovery mechanism is initiated which incurs high routing overhead. If the broadcast nature and the spatial diversity of the wireless communication are utilized efficiently it becomes possible to achieve improvement in the performance of the wireless networks. In contrast to the traditional routing scheme which makes use of a predetermined route for packet transmission, such an opportunistic routing scheme defines a predefined forwarding candidate list formed by using single network metrics. In this paper, a protocol is proposed which uses multiple metrics such as residual energy and link quality for route selection and also includes a monitoring mechanism which initiates a route discovery for a poor link, thereby reducing the overhead involved and improving the throughput of the network while maintaining network connectivity. Power control is also implemented not only to save energy but also to improve the network performance. Using simulations, we show the performance improvement attained in the network in terms of packet delivery ratio, routing overhead, and residual energy of the network. PMID:26167529

Dynamic Agent Classification and Tracking Using an Ad Hoc Mobile Acoustic Sensor Network

NASA Astrophysics Data System (ADS)

Friedlander, David; Griffin, Christopher; Jacobson, Noah; Phoha, Shashi; Brooks, Richard R.

2003-12-01

Autonomous networks of sensor platforms can be designed to interact in dynamic and noisy environments to determine the occurrence of specified transient events that define the dynamic process of interest. For example, a sensor network may be used for battlefield surveillance with the purpose of detecting, identifying, and tracking enemy activity. When the number of nodes is large, human oversight and control of low-level operations is not feasible. Coordination and self-organization of multiple autonomous nodes is necessary to maintain connectivity and sensor coverage and to combine information for better understanding the dynamics of the environment. Resource conservation requires adaptive clustering in the vicinity of the event. This paper presents methods for dynamic distributed signal processing using an ad hoc mobile network of microsensors to detect, identify, and track targets in noisy environments. They seamlessly integrate data from fixed and mobile platforms and dynamically organize platforms into clusters to process local data along the trajectory of the targets. Local analysis of sensor data is used to determine a set of target attribute values and classify the target. Sensor data from a field test in the Marine base at Twentynine Palms, Calif, was analyzed using the techniques described in this paper. The results were compared to "ground truth" data obtained from GPS receivers on the vehicles.

An adaptive neural swarm approach for intrusion defense in ad hoc networks

NASA Astrophysics Data System (ADS)

Cannady, James

2011-06-01

Wireless sensor networks (WSN) and mobile ad hoc networks (MANET) are being increasingly deployed in critical applications due to the flexibility and extensibility of the technology. While these networks possess numerous advantages over traditional wireless systems in dynamic environments they are still vulnerable to many of the same types of host-based and distributed attacks common to those systems. Unfortunately, the limited power and bandwidth available in WSNs and MANETs, combined with the dynamic connectivity that is a defining characteristic of the technology, makes it extremely difficult to utilize traditional intrusion detection techniques. This paper describes an approach to accurately and efficiently detect potentially damaging activity in WSNs and MANETs. It enables the network as a whole to recognize attacks, anomalies, and potential vulnerabilities in a distributive manner that reflects the autonomic processes of biological systems. Each component of the network recognizes activity in its local environment and then contributes to the overall situational awareness of the entire system. The approach utilizes agent-based swarm intelligence to adaptively identify potential data sources on each node and on adjacent nodes throughout the network. The swarm agents then self-organize into modular neural networks that utilize a reinforcement learning algorithm to identify relevant behavior patterns in the data without supervision. Once the modular neural networks have established interconnectivity both locally and with neighboring nodes the analysis of events within the network can be conducted collectively in real-time. The approach has been shown to be extremely effective in identifying distributed network attacks.

Enhancing the Selection of Backoff Interval Using Fuzzy Logic over Wireless Ad Hoc Networks

PubMed Central

Ranganathan, Radha; Kannan, Kathiravan

2015-01-01

IEEE 802.11 is the de facto standard for medium access over wireless ad hoc network. The collision avoidance mechanism (i.e., random binary exponential backoff—BEB) of IEEE 802.11 DCF (distributed coordination function) is inefficient and unfair especially under heavy load. In the literature, many algorithms have been proposed to tune the contention window (CW) size. However, these algorithms make every node select its backoff interval between [0, CW] in a random and uniform manner. This randomness is incorporated to avoid collisions among the nodes. But this random backoff interval can change the optimal order and frequency of channel access among competing nodes which results in unfairness and increased delay. In this paper, we propose an algorithm that schedules the medium access in a fair and effective manner. This algorithm enhances IEEE 802.11 DCF with additional level of contention resolution that prioritizes the contending nodes according to its queue length and waiting time. Each node computes its unique backoff interval using fuzzy logic based on the input parameters collected from contending nodes through overhearing. We evaluate our algorithm against IEEE 802.11, GDCF (gentle distributed coordination function) protocols using ns-2.35 simulator and show that our algorithm achieves good performance. PMID:25879066

SVANET: A smart vehicular ad hoc network for efficient data transmission with wireless sensors.

PubMed

Sahoo, Prasan Kumar; Chiang, Ming-Jer; Wu, Shih-Lin

2014-11-25

Wireless sensors can sense any event, such as accidents, as well as icy roads, and can forward the rescue/warning messages through intermediate vehicles for any necessary help. In this paper, we propose a smart vehicular ad hoc network (SVANET) architecture that uses wireless sensors to detect events and vehicles to transmit the safety and non-safety messages efficiently by using different service channels and one control channel with different priorities. We have developed a data transmission protocol for the vehicles in the highway, in which data can be forwarded with the help of vehicles if they are connected with each other or data can be forwarded with the help of nearby wireless sensors. Our data transmission protocol is designed to increase the driving safety, to prevent accidents and to utilize channels efficiently by adjusting the control and service channel time intervals dynamically. Besides, our protocol can transmit information to vehicles in advance, so that drivers can decide an alternate route in case of traffic congestion. For various data sharing, we design a method that can select a few leader nodes among vehicles running along a highway to broadcast data efficiently. Simulation results show that our protocol can outperform the existing standard in terms of the end to end packet delivery ratio and latency.

Frame Transmission Efficiency-Based Cross-Layer Congestion Notification Scheme in Wireless Ad Hoc Networks.

PubMed

He, Huaguang; Li, Taoshen; Feng, Luting; Ye, Jin

2017-07-15

Different from the traditional wired network, the fundamental cause of transmission congestion in wireless ad hoc networks is medium contention. How to utilize the congestion state from the MAC (Media Access Control) layer to adjust the transmission rate is core work for transport protocol design. However, recent works have shown that the existing cross-layer congestion detection solutions are too complex to be deployed or not able to characterize the congestion accurately. We first propose a new congestion metric called frame transmission efficiency (i.e., the ratio of successful transmission delay to the frame service delay), which describes the medium contention in a fast and accurate manner. We further present the design and implementation of RECN (ECN and the ratio of successful transmission delay to the frame service delay in the MAC layer, namely, the frame transmission efficiency), a general supporting scheme that adjusts the transport sending rate through a standard ECN (Explicit Congestion Notification) signaling method. Our method can be deployed on commodity switches with small firmware updates, while making no modification on end hosts. We integrate RECN transparently (i.e., without modification) with TCP on NS2 simulation. The experimental results show that RECN remarkably improves network goodput across multiple concurrent TCP flows.

Direct trust-based security scheme for RREQ flooding attack in mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Kumar, Sunil; Dutta, Kamlesh

2017-06-01

The routing algorithms in MANETs exhibit distributed and cooperative behaviour which makes them easy target for denial of service (DoS) attacks. RREQ flooding attack is a flooding-type DoS attack in context to Ad hoc On Demand Distance Vector (AODV) routing protocol, where the attacker broadcasts massive amount of bogus Route Request (RREQ) packets to set up the route with the non-existent or existent destination in the network. This paper presents direct trust-based security scheme to detect and mitigate the impact of RREQ flooding attack on the network, in which, every node evaluates the trust degree value of its neighbours through analysing the frequency of RREQ packets originated by them over a short period of time. Taking the node's trust degree value as the input, the proposed scheme is smoothly extended for suppressing the surplus RREQ and bogus RREQ flooding packets at one-hop neighbours during the route discovery process. This scheme distinguishes itself from existing techniques by not directly blocking the service of a normal node due to increased amount of RREQ packets in some unusual conditions. The results obtained throughout the simulation experiments clearly show the feasibility and effectiveness of the proposed defensive scheme.

Secure and Fair Cluster Head Selection Protocol for Enhancing Security in Mobile Ad Hoc Networks

PubMed Central

Paramasivan, B.; Kaliappan, M.

2014-01-01

Mobile ad hoc networks (MANETs) are wireless networks consisting of number of autonomous mobile devices temporarily interconnected into a network by wireless media. MANETs become one of the most prevalent areas of research in the recent years. Resource limitations, energy efficiency, scalability, and security are the great challenging issues in MANETs. Due to its deployment nature, MANETs are more vulnerable to malicious attack. The secure routing protocols perform very basic security related functions which are not sufficient to protect the network. In this paper, a secure and fair cluster head selection protocol (SFCP) is proposed which integrates security factors into the clustering approach for achieving attacker identification and classification. Byzantine agreement based cooperative technique is used for attacker identification and classification to make the network more attack resistant. SFCP used to solve this issue by making the nodes that are totally surrounded by malicious neighbors adjust dynamically their belief and disbelief thresholds. The proposed protocol selects the secure and energy efficient cluster head which acts as a local detector without imposing overhead to the clustering performance. SFCP is simulated in network simulator 2 and compared with two protocols including AODV and CBRP. PMID:25143986

Sketching Awareness: A Participatory Study to Elicit Designs for Supporting Ad Hoc Emergency Medical Teamwork

PubMed Central

Kusunoki, Diana; Sarcevic, Aleksandra; Zhang, Zhan; Yala, Maria

2014-01-01

Prior CSCW research on awareness in clinical settings has mostly focused on higher-level team coordination spanning across longer-term trajectories at the department and inter-department levels. In this paper, we offer a perspective on what awareness means within the context of an ad hoc, time- and safety-critical medical setting by looking at teams treating severely ill patients with urgent needs. We report findings from four participatory design workshops conducted with emergency medicine clinicians at two regional emergency departments. Workshops were developed to elicit design ideas for information displays that support awareness in emergency medical situations. Through analysis of discussions and clinicians’ sketches of information displays, we identified five features of teamwork that can be used as a foundation for supporting awareness from the perspective of clinicians. Based on these findings, we contribute rich descriptions of four facets of awareness that teams manage during emergency medical situations: team member awareness, elapsed time awareness, teamwork-oriented and patient-driven task awareness, and overall progress awareness. We then discuss these four awareness types in relation to awareness facets found in the CSCW literature. PMID:25870498

VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System.

PubMed

Bhoi, S K; Khilar, P M

2016-03-01

Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

Secure and fair cluster head selection protocol for enhancing security in mobile ad hoc networks.

PubMed

Paramasivan, B; Kaliappan, M

2014-01-01

Mobile ad hoc networks (MANETs) are wireless networks consisting of number of autonomous mobile devices temporarily interconnected into a network by wireless media. MANETs become one of the most prevalent areas of research in the recent years. Resource limitations, energy efficiency, scalability, and security are the great challenging issues in MANETs. Due to its deployment nature, MANETs are more vulnerable to malicious attack. The secure routing protocols perform very basic security related functions which are not sufficient to protect the network. In this paper, a secure and fair cluster head selection protocol (SFCP) is proposed which integrates security factors into the clustering approach for achieving attacker identification and classification. Byzantine agreement based cooperative technique is used for attacker identification and classification to make the network more attack resistant. SFCP used to solve this issue by making the nodes that are totally surrounded by malicious neighbors adjust dynamically their belief and disbelief thresholds. The proposed protocol selects the secure and energy efficient cluster head which acts as a local detector without imposing overhead to the clustering performance. SFCP is simulated in network simulator 2 and compared with two protocols including AODV and CBRP.

Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety

PubMed Central

Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

2016-01-01

The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels. PMID:26784204

Ad Hoc Influenza Vaccination During Years of Significant Antigenic Drift in a Tropical City With 2 Seasonal Peaks

PubMed Central

Wong, Martin C.S.; Nelson, E. Anthony S.; Leung, Czarina; Lee, Nelson; Chan, Martin C.W.; Choi, Kin Wing; Rainer, Timothy H.; Cheng, Frankie W.T.; Wong, Samuel Y.S.; Lai, Christopher K.C.; Lam, Bosco; Cheung, Tak Hong; Leung, Ting Fan; Chan, Paul K.S.

2016-01-01

Abstract We evaluated the acceptability of an additional ad hoc influenza vaccination among the health care professionals following seasons with significant antigenic drift. Self-administered, anonymous surveys were performed by hard copy questionnaires in public hospitals, and by an on-line platform available to all healthcare professionals, from April 1st to May 31st, 2015. A total of 1290 healthcare professionals completed the questionnaires, including doctors, nurses, and allied health professionals working in both the public and private systems. Only 31.8% of participating respondents expressed an intention to receive the additional vaccine, despite that the majority of them agreed or strongly agreed that it would bring benefit to the community (88.9%), save lives (86.7%), reduce medical expenses (76.3%), satisfy public expectation (82.8%), and increase awareness of vaccination (86.1%). However, a significant proportion expressed concern that the vaccine could disturb the normal immunization schedule (45.5%); felt uncertain what to do in the next vaccination round (66.0%); perceived that the summer peak might not occur (48.2%); and believed that the summer peak might not be of the same virus (83.5%). Furthermore, 27.8% of all respondents expected that the additional vaccination could weaken the efficacy of previous vaccinations; 51.3% was concerned about side effects; and 61.3% estimated that there would be a low uptake rate. If the supply of vaccine was limited, higher priority groups were considered to include the elderly aged ≥65 years with chronic medical conditions (89.2%), the elderly living in residential care homes (87.4%), and long-stay residents of institutions for the disabled (80.7%). The strongest factors associated with accepting the additional vaccine included immunization with influenza vaccines in the past 3 years, higher perceived risk of contracting influenza, and higher perceived severity of the disease impact. The acceptability to an

The Copyright Law as it Relates to National Information Systems and National Programs; a Study by the Ad Hoc Task Group on Legal Aspects Involved in National Information Systems.

ERIC Educational Resources Information Center

Federal Council for Science and Technology, Washington, DC. Committee on Scientific and Technical Information.

An ad hoc task group was constituted by the Committee on Scientific and Technical Information (COSATI) to: (1) delineate present and future issues issues for COSATI, (3) recommend additions or deletions in the present copyright law or in the pending revision now in Congress, and (4) recommend other short or long-term actions related to authorship…

Vocational Education Program/Course Inventory Form PCI. Explanation and Instructional Manual.

ERIC Educational Resources Information Center

California Occupational Information Coordinating Committee, Sacramento.

This manual for teachers, administrators, and counselors both explains the Program/Course Inventory (PCI), a data collection instrument, and provides instructions for completing the PCI form. The first section describes the PCI developed by the Ventura County Superintendent of Schools staff to collect data that define vocational education…

Concurrent Transmission Based on Channel Quality in Ad Hoc Networks: A Game Theoretic Approach

NASA Astrophysics Data System (ADS)

Chen, Chen; Gao, Xinbo; Li, Xiaoji; Pei, Qingqi

In this paper, a decentralized concurrent transmission strategy in shared channel in Ad Hoc networks is proposed based on game theory. Firstly, a static concurrent transmissions game is used to determine the candidates for transmitting by channel quality threshold and to maximize the overall throughput with consideration of channel quality variation. To achieve NES (Nash Equilibrium Solution), the selfish behaviors of node to attempt to improve the channel gain unilaterally are evaluated. Therefore, this game allows each node to be distributed and to decide whether to transmit concurrently with others or not depending on NES. Secondly, as there are always some nodes with lower channel gain than NES, which are defined as hunger nodes in this paper, a hunger suppression scheme is proposed by adjusting the price function with interferences reservation and forward relay, to fairly give hunger nodes transmission opportunities. Finally, inspired by stock trading, a dynamic concurrent transmission threshold determination scheme is implemented to make the static game practical. Numerical results show that the proposed scheme is feasible to increase concurrent transmission opportunities for active nodes, and at the same time, the number of hunger nodes is greatly reduced with the least increase of threshold by interferences reservation. Also, the good performance on network goodput of the proposed model can be seen from the results.

SVANET: A Smart Vehicular Ad Hoc Network for Efficient Data Transmission with Wireless Sensors

PubMed Central

Sahoo, Prasan Kumar; Chiang, Ming-Jer; Wu, Shih-Lin

2014-01-01

Wireless sensors can sense any event, such as accidents, as well as icy roads, and can forward the rescue/warning messages through intermediate vehicles for any necessary help. In this paper, we propose a smart vehicular ad hoc network (SVANET) architecture that uses wireless sensors to detect events and vehicles to transmit the safety and non-safety messages efficiently by using different service channels and one control channel with different priorities. We have developed a data transmission protocol for the vehicles in the highway, in which data can be forwarded with the help of vehicles if they are connected with each other or data can be forwarded with the help of nearby wireless sensors. Our data transmission protocol is designed to increase the driving safety, to prevent accidents and to utilize channels efficiently by adjusting the control and service channel time intervals dynamically. Besides, our protocol can transmit information to vehicles in advance, so that drivers can decide an alternate route in case of traffic congestion. For various data sharing, we design a method that can select a few leader nodes among vehicles running along a highway to broadcast data efficiently. Simulation results show that our protocol can outperform the existing standard in terms of the end to end packet delivery ratio and latency. PMID:25429409

Evaluation of safety and efficacy of elective PCI in patients with cardiac insufficiency.

PubMed

Jing, Jiang-Xin; Zhong, Xiao-Lan; Chen, Sheng-Guo

2017-02-01

We analyzed the safety and the efficacy of the treatment with elective percutaneous coronary intervention (PCI) in patients with coronary heart disease complicated with cardiac insufficiency. We enrolled 217 patients diagnosed with chronic ischemic heart disease complicated with cardiac failure. According to the type of treatment they received, patients were divided into 3 groups: i) The conservative treatment group with 60 patients (they received standard medication); ii) the early PCI group with 82 cases (their condition was stabilized, surgical risk was assessed and PCI was taken as early as possible); and iii) the advanced PCI group with 75 cases (ischemic myocardium was corrected and then elective PCI was applied and for aggravated myocardial ischemia cases, PCI was applied after assessing the risk of surgery). Follow-up visits were set for approximately 3 years and clinical outcomes were compared. Our results showed that the survival time in the early PCI group was significantly prolonged and the survival rate was considerably increased during 3 years. Left ventricular ejection fraction in the early PCI group markedly increased and left ventricular end-diastolic diameter and pro-BNP level decreased significantly. The occurrence rates of perioperative complications in the early PCI group and major adverse cardiac events (MACE) during the follow-up period were significantly reduced. Quality of life scores in the early PCI group markedly improved. We concluded that in patients with coronary heart disease complicated with cardiac insufficiency, early PCI treatment was safe and effective.

PCI in Patients Supported With CF-LVADs: Indications, Safety, and Outcomes.

PubMed

Anyanwu, Emeka C; Ota, Takeyoshi; Sayer, Gabriel; Nathan, Sandeep; Jeevanandam, Valluvan; Shah, Atman; Uriel, Nir

2016-06-01

Patients with heart failure supported with left ventricular assist devices (LVADs) may require coronary intervention during their support. This case series seeks to explore the indications, safety, and outcomes of percutaneous coronary intervention (PCI) in this population. Electronic medical records of patients with LVADs undergoing PCI at a large academic medical center were reviewed. Demographics, reason for PCI, procedural success, complications, and outcomes were collected. From 2010-2014, a total of 6 patients underwent PCI post LVAD implantation. Three patients had PCI in the early postimplantation period (1-3 days post LVAD implantation) while the other three received it later in the LVAD support period. Three indications for PCI were found in the reviewed cases: right ventricular failure (right coronary artery stenting), bridge to left ventricular recovery, and ventricular tachycardia (VT) storm. All patients were maintained on triple blood thinning therapy (aspirin, clopidogrel, and warfarin). There were no acute complications during the interventions; however, 2 patients died in the early intervention period and 2 died much later. The 2 deaths in the early intervention period were related to fatal gastrointestinal bleeding while on dual-antiplatelet therapy and warfarin, and intractable VT that PCI did not correct. The 2 deaths in the late postintervention period occurred due to unknown causes nearly 1 and 2 years post intervention, respectively. PCI was performed in patients with continuous-flow LVAD with several possible indications and without acute complications. The utility of PCI in this patient population, however, is likely limited by the risk of bleeding related to combined antiplatelet and anticoagulation therapies as well as lack of immediate apparent benefit. Further studies are necessary to better characterize this risk as well as quantify any potential long-term benefits.

Standardization of Negative Controls in Diagnostic Immunohistochemistry: Recommendations From the International Ad Hoc Expert Panel

PubMed Central

Torlakovic, Emina E.; Francis, Glenn; Garratt, John; Gilks, Blake; Hyjek, Elizabeth; Ibrahim, Merdol; Miller, Rodney; Nielsen, Søren; Petcu, Eugen B.; Swanson, Paul E.; Taylor, Clive R.; Vyberg, Mogens

2014-01-01

Standardization of controls, both positive and negative controls, is needed for diagnostic immunohistochemistry (dIHC). The use of IHC-negative controls, irrespective of type, although well established, is not standardized. As such, the relevance and applicability of negative controls continues to challenge both pathologists and laboratory budgets. Despite the clear theoretical notion that appropriate controls serve to demonstrate the sensitivity and specificity of the dIHC test, it remains unclear which types of positive and negative controls are applicable and/or useful in day-to-day clinical practice. There is a perceived need to provide “best practice recommendations” for the use of negative controls. This perception is driven not only by logistics and cost issues, but also by increased pressure for accurate IHC testing, especially when IHC is performed for predictive markers, the number of which is rising as personalized medicine continues to develop. Herein, an international ad hoc expert panel reviews classification of negative controls relevant to clinical practice, proposes standard terminology for negative controls, considers the total evidence of IHC specificity that is available to pathologists, and develops a set of recommendations for the use of negative controls in dIHC based on “fit-for-use” principles. PMID:24714041

A Game Theory Algorithm for Intra-Cluster Data Aggregation in a Vehicular Ad Hoc Network

PubMed Central

Chen, Yuzhong; Weng, Shining; Guo, Wenzhong; Xiong, Naixue

2016-01-01

Vehicular ad hoc networks (VANETs) have an important role in urban management and planning. The effective integration of vehicle information in VANETs is critical to traffic analysis, large-scale vehicle route planning and intelligent transportation scheduling. However, given the limitations in the precision of the output information of a single sensor and the difficulty of information sharing among various sensors in a highly dynamic VANET, effectively performing data aggregation in VANETs remains a challenge. Moreover, current studies have mainly focused on data aggregation in large-scale environments but have rarely discussed the issue of intra-cluster data aggregation in VANETs. In this study, we propose a multi-player game theory algorithm for intra-cluster data aggregation in VANETs by analyzing the competitive and cooperative relationships among sensor nodes. Several sensor-centric metrics are proposed to measure the data redundancy and stability of a cluster. We then study the utility function to achieve efficient intra-cluster data aggregation by considering both data redundancy and cluster stability. In particular, we prove the existence of a unique Nash equilibrium in the game model, and conduct extensive experiments to validate the proposed algorithm. Results demonstrate that the proposed algorithm has advantages over typical data aggregation algorithms in both accuracy and efficiency. PMID:26907272

A Game Theory Algorithm for Intra-Cluster Data Aggregation in a Vehicular Ad Hoc Network.

PubMed

Chen, Yuzhong; Weng, Shining; Guo, Wenzhong; Xiong, Naixue

2016-02-19

Vehicular ad hoc networks (VANETs) have an important role in urban management and planning. The effective integration of vehicle information in VANETs is critical to traffic analysis, large-scale vehicle route planning and intelligent transportation scheduling. However, given the limitations in the precision of the output information of a single sensor and the difficulty of information sharing among various sensors in a highly dynamic VANET, effectively performing data aggregation in VANETs remains a challenge. Moreover, current studies have mainly focused on data aggregation in large-scale environments but have rarely discussed the issue of intra-cluster data aggregation in VANETs. In this study, we propose a multi-player game theory algorithm for intra-cluster data aggregation in VANETs by analyzing the competitive and cooperative relationships among sensor nodes. Several sensor-centric metrics are proposed to measure the data redundancy and stability of a cluster. We then study the utility function to achieve efficient intra-cluster data aggregation by considering both data redundancy and cluster stability. In particular, we prove the existence of a unique Nash equilibrium in the game model, and conduct extensive experiments to validate the proposed algorithm. Results demonstrate that the proposed algorithm has advantages over typical data aggregation algorithms in both accuracy and efficiency.

Great Lakes Steel -- PCI facility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eichinger, F.T.; Dake, S.H.; Wagner, E.D.

1997-12-31

This paper discusses the planning, design, and start-up of the 90 tph PCI facility for National Steel`s Great Lakes Steel Division in River Rouge, MI. This project is owned and operated by Edison Energy Services, and was implemented on a fast-track basis by Raytheon Engineers and Constructors, Babcock Material Handling, and Babcock and Wilcox. This paper presents important process issues, basic design criteria, an the challenges of engineering and building a state-of-the-art PCI facility in two existing plants. Pulverized coal is prepared at the River Rouge Power Plant of Detroit Edison, is pneumatically conveyed 6,000 feet to a storage silomore » at Great Lakes Steel, and is injected into three blast furnaces.« less

The congestion control algorithm based on queue management of each node in mobile ad hoc networks

NASA Astrophysics Data System (ADS)

Wei, Yifei; Chang, Lin; Wang, Yali; Wang, Gaoping

2016-12-01

This paper proposes an active queue management mechanism, considering the node's own ability and its importance in the network to set the queue threshold. As the network load increases, local congestion of mobile ad hoc network may lead to network performance degradation, hot node's energy consumption increase even failure. If small energy nodes congested because of forwarding data packets, then when it is used as the source node will cause a lot of packet loss. This paper proposes an active queue management mechanism, considering the node's own ability and its importance in the network to set the queue threshold. Controlling nodes buffer queue in different levels of congestion area probability by adjusting the upper limits and lower limits, thus nodes can adjust responsibility of forwarding data packets according to their own situation. The proposed algorithm will slow down the send rate hop by hop along the data package transmission direction from congestion node to source node so that to prevent further congestion from the source node. The simulation results show that, the algorithm can better play the data forwarding ability of strong nodes, protect the weak nodes, can effectively alleviate the network congestion situation.

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock.

PubMed

Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J; Noc, Marko; Goslar, Tomaž; Felix, Stephan B; Maier, Lars S; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe

2017-12-21

In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those

Comparison Between PCI and Box Girder in BridgesPrestressed Concrete Design

NASA Astrophysics Data System (ADS)

Rahmawati, Cut; Zainuddin, Z.; Is, Syafridal; Rahim, Robbi

2018-04-01

This research is done by comparing PCI and Box Girder types of prestressed concrete design. The method used is load balance. Previous studies have just discussed the differences in terms of effectiveness and economics. In this study, the researchers want to know the design process by comparing the working forces, the resulting moment, and the losses of the prestressed. As the case in this study, the researchers used the bridge with the span of 31 meters. The tendon pulling system was conducted with post-tensioning system The analysis result showed that prestressed of the Girder box type sustained the greatest moment due to the combination of its own weight, additional dead load, lane load, and wind load of 44,029 kNm, while the biggest moment of PCI Girder was 7,556.75 KNm The Girder beam box experiences greater moment and shear force than PCI Girder. This is the effect of the weight of its own Girderboxwaslarger than PCI Girder. The losses ofprestressed style of Girderboxand PCI Girder type were 24.85% and 26.32%, respectively.Moreover, it showed that the type of Girder box is cheaper, easier, and more efficient than PCI Girder.

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve.

PubMed

Xaplanteris, Panagiotis; Fournier, Stephane; Pijls, Nico H J; Fearon, William F; Barbato, Emanuele; Tonino, Pim A L; Engstrøm, Thomas; Kääb, Stefan; Dambrink, Jan-Henk; Rioufol, Gilles; Toth, Gabor G; Piroth, Zsolt; Witt, Nils; Fröbert, Ole; Kala, Petr; Linke, Axel; Jagic, Nicola; Mates, Martin; Mavromatis, Kreton; Samady, Habib; Irimpen, Anand; Oldroyd, Keith; Campo, Gianluca; Rothenbühler, Martina; Jüni, Peter; De Bruyne, Bernard

2018-05-22

Background We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. Methods Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Results A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. Conclusions In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent

Comparative Effectiveness of PCI Education's "PCI Reading Program": Phase 2--A Report of a Comparison Group Study in Brevard Public Schools and Miami-Dade County Public Schools. Research Summary

ERIC Educational Resources Information Center

Empirical Education Inc., 2010

2010-01-01

PCI Education sought scientifically based evidence on the comparative effectiveness of the "PCI Reading Program" through a five-year longitudinal study. Phase 1 of the study consisted of a randomized control trial studying the efficacy of the "PCI Reading Program-Level One" that was conducted in the 2007-2008 in Miami-Dade…

Breaking the code: What is the best post-PCI MI definition?

PubMed

Seto, Arnold H; Kern, Morton J

2017-04-01

Various definitions of post-PCI MI have been recommended by different professional societies and studies. This present study suggests that the troponin-based 3rd universal definition of post-PCI MI has prognostic value for recurrent MI but not mortality alone, unlike the CK-MB based SCAI definition. Absent a consensus on the best definition, clinical trials should report outcomes based on multiple definitions of post-PCI MI. © 2017 Wiley Periodicals, Inc.

Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry.

PubMed

Bauer, Timm; Hochadel, Matthias; Brachmann, Johannes; Schächinger, Volker; Boekstegers, Peter; Zrenner, Bernhard; Zahn, Ralf; Zeymer, Uwe

2015-10-01

This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice. The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use. Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%). Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P < 0.001) and vascular access complications (0.3 vs. 1.8%, P < 0.001%) were lower in the TR group. In the multivariate analysis radial access was associated with an improved in-hospital survival rate (OR 0.47, 95% CI 0.35-0.65). The radial approach for PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality. © 2015 Wiley Periodicals, Inc.

Efficacy and Safety of Dual Antiplatelet Therapy After Complex PCI.

PubMed

Giustino, Gennaro; Chieffo, Alaide; Palmerini, Tullio; Valgimigli, Marco; Feres, Fausto; Abizaid, Alexandre; Costa, Ricardo A; Hong, Myeong-Ki; Kim, Byeong-Keuk; Jang, Yangsoo; Kim, Hyo-Soo; Park, Kyung Woo; Gilard, Martine; Morice, Marie-Claude; Sawaya, Fadi; Sardella, Gennaro; Genereux, Philippe; Redfors, Bjorn; Leon, Martin B; Bhatt, Deepak L; Stone, Gregg W; Colombo, Antonio

2016-10-25

Optimal upfront dual antiplatelet therapy (DAPT) duration after complex percutaneous coronary intervention (PCI) with drug-eluting stents (DES) remains unclear. This study investigated the efficacy and safety of long-term (≥12 months) versus short-term (3 or 6 months) DAPT with aspirin and clopidogrel according to PCI complexity. The authors pooled patient-level data from 6 randomized controlled trials investigating DAPT durations after PCI. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. The primary efficacy endpoint was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. The primary safety endpoint was major bleeding. Intention-to-treat was the primary analytic approach. Of 9,577 patients included in the pooled dataset for whom procedural variables were available, 1,680 (17.5%) underwent complex PCI. Overall, 85% of patients received new-generation DES. At a median follow-up time of 392 days (interquartile range: 366 to 710 days), patients who underwent complex PCI had a higher risk of MACE (adjusted hazard ratio [HR]: 1.98; 95% confidence interval [CI]: 1.50 to 2.60; p < 0.0001). Compared with short-term DAPT, long-term DAPT yielded significant reductions in MACE in the complex PCI group (adjusted HR: 0.56; 95% CI: 0.35 to 0.89) versus the noncomplex PCI group (adjusted HR: 1.01; 95% CI: 0.75 to 1.35; p interaction  = 0.01). The magnitude of the benefit with long-term DAPT was progressively greater per increase in procedural complexity. Long-term DAPT was associated with increased risk for major bleeding, which was similar between groups (p interaction  = 0.96). Results were consistent by per-treatment landmark analysis. Alongside other established clinical risk factors, procedural complexity is an

Measurement of fractional flow reserve in patients with multi-vessel coronary artery disease and borderline lesions prevents unnecessary revascularisation procedures.

PubMed

Reczuch, Krzysztof; Jankowska, Ewa; Telichowski, Artur; Porada, Adam; Banasiak, Waldemar; Ponikowski, Piotr

2004-04-01

Patients with multi-vessel coronary artery disease (CAD) are selected for percutaneous coronary interventions (PCI) or surgical revascularisation. The appropriateness of "ad hoc" PCI of borderline lesions (<70% of lumen diameter) in patients with a multi-vessel CAD has not been proven. However, delayed PCI of another lesion and gaining additional information from non-invasive tests is not a widely accepted strategy. When left anterior descending (LAD) coronary artery is one of the affected vessels, selection for surgical revascularisation is most likely. To assess long-term outcome in patients with multi-vessel CAD and borderline lesions, including LAD, in whom fractional flow reserve (FFR) in all affected vessels was measured and used for selection for PCI or conservative treatment. The study group consisted of 16 patients with stable angina (11 males, mean age 60+/-9 years) with 34 lesions localised in the main epicardial coronary arteries [LAD / left main (LM) / right coronary artery (RCA) / intermediate branch (IB) / circumflex artery (Cx) - 15/1/5/5/8] of which at least two were borderline stenoses. Each lesion underwent FFR measurement. "Ad hoc" PCI was performed when FFR was <0.75, and conservative therapy was instituted when FFR was >0.75. Of 34 lesions, in 8 (23%) the FFR value was <0.75 and these lesions were treated with PCI (LAD/IB/Cx - 3/2/3). In the remaining 26 (77%) lesions, FFR was >0.75 and conservative therapy was instituted. During the mean follow-up of 15+/-6 months (range 6-28 months, median 15 months) in 8 of 9 conservatively treated patients no aggravation of anginal symptoms nor other coronary events were observed. One patient developed acute myocardial infarction due to thrombus occluding a borderline LAD lesion. Of 8 lesions treated with PCI (baseline FFR = 0.63+/-0.10 vs post-PCI FFR = 0.92+/-0.08, p=0.0002), in one case an in-stent restenosis in LAD occurred 9 months after PCI. Of a total of 26 lesions which were conservatively treated

Optical coherence tomography guided PCI - initial experience at Apollo Health City, Jubilee Hills, Hyderabad.

PubMed

Rath, Pratap Chandra; Reddy, Krupal; Agarwal, Manoj K; Purohit, Bharat V; Deb, Tripti; Reddy, Aleti Mallikarjun

2014-01-01

The capability of OCT to examine the structure of the arterial wall before or after PCI is superior to those of other imaging modalities. Therefore the application of OCT during PCI seems logical and has the potential to enhance our performance during the PCI procedures. OCT was performed in fifty-two patients out of which, 45 patients underwent PCI. Out of these 45 patients, in 25 patients both pre and post PCI OCT assessment was done. In 20 patients only post PCI OCT assessment was done. In seven patients PCI was not done due to nonsignificant obstruction, these seven patients were not included in final analysis. Over all OCT leads to management changes in 65% of the time it was used. Alteration of stent length was done in 56% of the cases when evaluated pre PCI. Alteration of stent diameter was done in 36% cases when evaluated pre PCI. Treatment of malapposition was done in 24% of total cases. Further balloon dilatation for vessel expansion was done in 15% of total cases. In one case left main stenting was done after proximal edge dissection. OCT makes better visualization of plaque, thrombus, stent malapposition, dissection, plaque prolapse and helps in optimization of PCI results. More extensive, long-term studies will be needed to assess the prognostic implications of these findings. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing.

PubMed

Suzuki, Yoriyasu; Muto, Makoto; Yamane, Masahisa; Muramatsu, Toshiya; Okamura, Atsunori; Igarashi, Yasumi; Fujita, Tsutomu; Nakamura, Shigeru; Oida, Akitsugu; Tsuchikane, Etsuo

2017-07-01

To evaluate factors for predicting retrograde CTO-PCI failure after successful collateral channel crossing. Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). A total of 5984 CTO-PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO-PCIs (27.7%). We investigated these retrograde procedures to evaluate factors for predicting retrograde CTO-PCI failure even after successful collateral channel crossing. Successful guidewire/catheter collateral crossing was achieved in 77.1% (n = 1,276) of 1656 retrograde CTO-PCI procedures. Retrograde procedural success after successful collateral crossing was achieved in 89.4% (n = 1,141). Univariate analysis showed that the predictors for retrograde CTO-PCI failure were in-stent occlusion (OR = 1.9829, 95%CI = 1.1783 - 3.3370 P = 0.0088), calcified lesions (OR = 1.9233, 95%CI = 1.2463 - 2.9679, P = 0.0027), and lesion tortuosity (OR = 1.5244, 95%CI = 1.0618 - 2.1883, P = 0.0216). On multivariate analysis, lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing (OR = 1.3472, 95%CI = 1.0614 - 1.7169, P = 0.0141). The success rate of retrograde CTO-PCI following successful guidewire/catheter collateral channel crossing was high in this registry. Lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing. Devices and techniques to overcome complex CTO lesion morphology, such as lesion calcification, are required to further improve the retrograde CTO-PCI success rate. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Performance Analysis of the IEEE 802.11p Multichannel MAC Protocol in Vehicular Ad Hoc Networks

PubMed Central

2017-01-01

Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. The safety applications require timely and reliable transmissions, while the non-safety applications require efficient and high throughput. In the IEEE 1609.4 protocol, operating interval is divided into alternating Control Channel (CCH) interval and Service Channel (SCH) interval with an identical length. During the CCH interval, nodes transmit safety-related messages and control messages, and Enhanced Distributed Channel Access (EDCA) mechanism is employed to allow four Access Categories (ACs) within a station with different priorities according to their criticality for the vehicle’s safety. During the SCH interval, the non-safety massages are transmitted. An analytical model is proposed in this paper to evaluate performance, reliability and efficiency of the IEEE 802.11p and IEEE 1609.4 protocols. The proposed model improves the existing work by taking serval aspects and the character of multichannel switching into design consideration. Extensive performance evaluations based on analysis and simulation help to validate the accuracy of the proposed model and analyze the capabilities and limitations of the IEEE 802.11p and IEEE 1609.4 protocols, and enhancement suggestions are given. PMID:29231882

Performance Analysis of the IEEE 802.11p Multichannel MAC Protocol in Vehicular Ad Hoc Networks.

PubMed

Song, Caixia

2017-12-12

Vehicular Ad Hoc Networks (VANETs) employ multichannel to provide a variety of safety and non-safety applications, based on the IEEE 802.11p and IEEE 1609.4 protocols. The safety applications require timely and reliable transmissions, while the non-safety applications require efficient and high throughput. In the IEEE 1609.4 protocol, operating interval is divided into alternating Control Channel (CCH) interval and Service Channel (SCH) interval with an identical length. During the CCH interval, nodes transmit safety-related messages and control messages, and Enhanced Distributed Channel Access (EDCA) mechanism is employed to allow four Access Categories (ACs) within a station with different priorities according to their criticality for the vehicle's safety. During the SCH interval, the non-safety massages are transmitted. An analytical model is proposed in this paper to evaluate performance, reliability and efficiency of the IEEE 802.11p and IEEE 1609.4 protocols. The proposed model improves the existing work by taking serval aspects and the character of multichannel switching into design consideration. Extensive performance evaluations based on analysis and simulation help to validate the accuracy of the proposed model and analyze the capabilities and limitations of the IEEE 802.11p and IEEE 1609.4 protocols, and enhancement suggestions are given.

International survey of vestibular rehabilitation therapists by the Barany Society Ad Hoc Committee on Vestibular Rehabilitation Therapy.

PubMed

Cohen, Helen S; Gottshall, Kim R; Graziano, Mariella; Malmstrom, Eva-Maj; Sharpe, Margaret H

2009-01-01

The goal of this study was to determine how occupational and physical therapists learn about vestibular rehabilitation therapy, their educational backgrounds, referral patterns, and their ideas about entry-level and advanced continuing education in vestibular rehabilitation therapy. The Barany Society Ad Hoc Committee for Vestibular Rehabilitation Therapy invited therapists around the world to complete an E-mail survey. Participants were either known to committee members or other Barany Society members, known to other participants, identified from their self-listings on the Internet, or volunteered after reading notices published in publications read by therapists. Responses were received from 133 therapists in 19 countries. They had a range of educational backgrounds, practice settings, and referral patterns. Few respondents had had any training about vestibular rehabilitation during their professional entry-level education. Most respondents learned about vestibular rehabilitation from continuing education courses, interactions with their colleagues, and reading. All of them endorsed the concept of developing standards and educating therapists about vestibular anatomy and physiology, vestibular diagnostic testing, vestibular disorders and current intervention strategies. Therefore, the Committee recommends the development of international standards for education and practice in vestibular rehabilitation therapy.

Road Accident Prevention with Instant Emergency Warning Message Dissemination in Vehicular Ad-Hoc Network.

PubMed

Gokulakrishnan, P; Ganeshkumar, P

2015-01-01

A Road Accident Prevention (RAP) scheme based on Vehicular Backbone Network (VBN) structure is proposed in this paper for Vehicular Ad-hoc Network (VANET). The RAP scheme attempts to prevent vehicles from highway road traffic accidents and thereby reduces death and injury rates. Once the possibility of an emergency situation (i.e. an accident) is predicted in advance, instantly RAP initiates a highway road traffic accident prevention scheme. The RAP scheme constitutes the following activities: (i) the Road Side Unit (RSU) constructs a Prediction Report (PR) based on the status of the vehicles and traffic in the highway roads, (ii) the RSU generates an Emergency Warning Message (EWM) based on an abnormal PR, (iii) the RSU forms a VBN structure and (iv) the RSU disseminates the EWM to the vehicles that holds the high Risk Factor (RF) and travels in High Risk Zone (HRZ). These vehicles might reside either within the RSU's coverage area or outside RSU's coverage area (reached using VBN structure). The RAP scheme improves the performance of EWM dissemination in terms of increase in notification and decrease in end-to-end delay. The RAP scheme also reduces infrastructure cost (number of RSUs) by formulating and deploying the VBN structure. The RAP scheme with VBN structure improves notification by 19 percent and end-to-end delay by 14.38 percent for a vehicle density of 160 vehicles. It is also proved from the simulation experiment that the performance of RAP scheme is promising in 4-lane highway roads.

Road Accident Prevention with Instant Emergency Warning Message Dissemination in Vehicular Ad-Hoc Network

PubMed Central

P, Gokulakrishnan; P, Ganeshkumar

2015-01-01

A Road Accident Prevention (RAP) scheme based on Vehicular Backbone Network (VBN) structure is proposed in this paper for Vehicular Ad-hoc Network (VANET). The RAP scheme attempts to prevent vehicles from highway road traffic accidents and thereby reduces death and injury rates. Once the possibility of an emergency situation (i.e. an accident) is predicted in advance, instantly RAP initiates a highway road traffic accident prevention scheme. The RAP scheme constitutes the following activities: (i) the Road Side Unit (RSU) constructs a Prediction Report (PR) based on the status of the vehicles and traffic in the highway roads, (ii) the RSU generates an Emergency Warning Message (EWM) based on an abnormal PR, (iii) the RSU forms a VBN structure and (iv) the RSU disseminates the EWM to the vehicles that holds the high Risk Factor (RF) and travels in High Risk Zone (HRZ). These vehicles might reside either within the RSU’s coverage area or outside RSU’s coverage area (reached using VBN structure). The RAP scheme improves the performance of EWM dissemination in terms of increase in notification and decrease in end-to-end delay. The RAP scheme also reduces infrastructure cost (number of RSUs) by formulating and deploying the VBN structure. The RAP scheme with VBN structure improves notification by 19 percent and end-to-end delay by 14.38 percent for a vehicle density of 160 vehicles. It is also proved from the simulation experiment that the performance of RAP scheme is promising in 4-lane highway roads. PMID:26636576

Randomized trial of primary PCI with or without routine manual thrombectomy.

PubMed

Jolly, Sanjit S; Cairns, John A; Yusuf, Salim; Meeks, Brandi; Pogue, Janice; Rokoss, Michael J; Kedev, Sasko; Thabane, Lehana; Stankovic, Goran; Moreno, Raul; Gershlick, Anthony; Chowdhary, Saqib; Lavi, Shahar; Niemelä, Kari; Steg, Philippe Gabriel; Bernat, Ivo; Xu, Yawei; Cantor, Warren J; Overgaard, Christopher B; Naber, Christoph K; Cheema, Asim N; Welsh, Robert C; Bertrand, Olivier F; Avezum, Alvaro; Bhindi, Ravinay; Pancholy, Samir; Rao, Sunil V; Natarajan, Madhu K; ten Berg, Jurriën M; Shestakovska, Olga; Gao, Peggy; Widimsky, Petr; Džavík, Vladimír

2015-04-09

During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P=0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P=0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P=0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P=0.02). In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.).

Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI Patients: The SMILE Trial.

PubMed

Sardella, Gennaro; Lucisano, Luigi; Garbo, Roberto; Pennacchi, Mauro; Cavallo, Erika; Stio, Rocco Edoardo; Calcagno, Simone; Ugo, Fabrizio; Boccuzzi, Giacomo; Fedele, Francesco; Mancone, Massimo

2016-01-26

A lack of clarity exists about the role of complete coronary revascularization in patients presenting with non-ST-segment elevation myocardial infarction. The aim of our study was to compare long-term outcomes in terms of major adverse cardiovascular and cerebrovascular events of 2 different complete coronary revascularization strategies in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease: 1-stage percutaneous coronary intervention (1S-PCI) during the index procedure versus multistage percutaneous coronary intervention (MS-PCI) complete coronary revascularization during the index hospitalization. In the SMILE (Impact of Different Treatment in Multivessel Non ST Elevation Myocardial Infarction Patients: One Stage Versus Multistaged Percutaneous Coronary Intervention) trial, 584 patients were randomly assigned in a 1:1 manner to 1S-PCI or MS-PCI. The primary study endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, which were defined as cardiac death, death, reinfarction, rehospitalization for unstable angina, repeat coronary revascularization (target vessel revascularization), and stroke at 1 year. The occurrence of the primary endpoint was significantly lower in the 1-stage group (1S-PCI: n = 36 [13.63%] vs. MS-PCI: n = 61 [23.19%]; hazard ratio [HR]: 0.549 [95% confidence interval (CI): 0.363 to 0.828]; p = 0.004). The 1-year rate of target vessel revascularization was significantly higher in the MS-PCI group (1S-PCI: n = 22 [8.33%] vs. MS-PCI: n = 40 [15.20%]; HR: 0.522 [95% CI: 0.310 to 0.878]; p = 0.01; p log-rank = 0.013). When the analyses were limited to cardiac death (1S-PCI: n = 9 [3.41%] vs. MS-PCI: n = 14 [5.32%]; HR: 0.624 [95% CI: 0.270 to 1.441]; p = 0.27) and myocardial infarction (1S-PCI: n = 7 [2.65%] vs. MS-PCI: n = 10 [3.80%]; HR: 0.678 [95% CI: 0.156 to 2.657]; p = 0.46), no significant differences were observed between groups. In multivessel

A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women) trial.

PubMed

Rao, Sunil V; Hess, Connie N; Barham, Britt; Aberle, Laura H; Anstrom, Kevin J; Patel, Tejan B; Jorgensen, Jesse P; Mazzaferri, Ernest L; Jolly, Sanjit S; Jacobs, Alice; Newby, L Kristin; Gibson, C Michael; Kong, David F; Mehran, Roxana; Waksman, Ron; Gilchrist, Ian C; McCourt, Brian J; Messenger, John C; Peterson, Eric D; Harrington, Robert A; Krucoff, Mitchell W

2014-08-01

This study sought to determine the effect of radial access on outcomes in women undergoing percutaneous coronary intervention (PCI) using a registry-based randomized trial. Women are at increased risk of bleeding and vascular complications after PCI. The role of radial access in women is unclear. Women undergoing cardiac catheterization or PCI were randomized to radial or femoral arterial access. Data from the CathPCI Registry and trial-specific data were merged into a final study database. The primary efficacy endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding or vascular complications requiring intervention. The primary feasibility endpoint was access site crossover. The primary analysis cohort was the subgroup undergoing PCI; sensitivity analyses were conducted in the total randomized population. The trial was stopped early for a lower than expected event rate. A total of 1,787 women (691 undergoing PCI) were randomized at 60 sites. There was no significant difference in the primary efficacy endpoint between radial or femoral access among women undergoing PCI (radial 1.2% vs. 2.9% femoral, odds ratio [OR]: 0.39; 95% confidence interval [CI]: 0.12 to 1.27); among women undergoing cardiac catheterization or PCI, radial access significantly reduced bleeding and vascular complications (0.6% vs. 1.7%; OR: 0.32; 95% CI: 0.12 to 0.90). Access site crossover was significantly higher among women assigned to radial access (PCI cohort: 6.1% vs. 1.7%; OR: 3.65; 95% CI: 1.45 to 9.17); total randomized cohort: (6.7% vs. 1.9%; OR: 3.70; 95% CI: 2.14 to 6.40). More women preferred radial access. In this pragmatic trial, which was terminated early, the radial approach did not significantly reduce bleeding or vascular complications in women undergoing PCI. Access site crossover occurred more often in women assigned to radial access. (SAFE-PCI for Women; NCT01406236). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc

Effect of Baseline Exercise Capacity on Outcomes in Patients With Stable Coronary Heart Disease (A Post Hoc Analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Trial)

PubMed Central

Padala, Santosh K.; Sidhu, Mandeep S.; Hartigan, Pamela M.; Maron, David J.; Teo, Koon K.; Spertus, John A.; John Mancini, G.B.; Sedlis, Steven P.; Chaitman, Bernard R.; Heller, Gary V.; Weintraub, William S.; Boden, William E.

2017-01-01

The impact of baseline exercise capacity on clinical outcomes in patients with stable ischemic heart disease randomized to an initial strategy of optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI) in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial has not been studied. A post hoc analysis was performed in 1,052 patients of COURAGE (PCI + OMT: n = 527, OMT: n = 525) who underwent exercise treadmill testing at baseline. Patients were categorized into 2 exercise capacity groups based on metabolic equivalents (METs) achieved during baseline exercise treadmill testing (<7 METs: n = 464, ≥7 METs: n = 588) and were followed for a median of 4.6 years. The primary composite end point of death or myocardial infarction was similar in the PCI + OMT group and the OMT group for patients with exercise capacity <7 METs (19.1% vs 16.1%, p = 0.31) and ≥7 METs (13.3% vs 10.3%, p = 0.27). After adjusting for baseline covariates, the hazard ratio (99% confidence interval) for the primary end point for the PCI + OMT group versus the OMT group was 1.42 (0.90 to 2.23, p = 0.05) and for the exercise capacity subgroups of ≥7 METs and <7 METs was 0.75 (0.46 to 1.22, p = 0.13). There was no statistically significant interaction between the original treatment arm allocation (PCI + OMT vs OMT) and baseline exercise capacity. In conclusion, there was no difference in the long-term clinical outcomes in patients with exercise capacity <7 METs compared with ≥7 METs, irrespective of whether they were assigned to initial PCI. Patients with exercise capacity <7 METs did not derive a proportionately greater clinical benefit from PCI + OMT compared with those patients who received OMT alone. Published by Elsevier Inc. (Am J Cardiol 2015;116:1509–1515) PMID:26410604

Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI.

PubMed

Al Shammeri, O; Garcia, LA

2013-01-01

Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Assess the safety and effectiveness of Early PCI. We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy. Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis. Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis.

Ad Hoc Conference on the Education of Migrants: Introductory Report on Theme I, "The Position of the Immigrant and His Family on Arrival in the Host Country" (Strasbourg, France, November 5-8, 1974).

ERIC Educational Resources Information Center

Morin, Emma

Theme I of the Ad Hoc Conference on the Education of Migrants was "measures to improve the position of the immigrant and his family at the time of arrival in the host country (including measures taken in the sending country on behalf of those intending to emigrate), primarily in respect of their educational circumstances". This report…

Higher plasma level of STIM1, OPG are correlated with stent restenosis after PCI.

PubMed

Li, Haibin; Jiang, Zhian; Liu, Xiangdong; Yang, Zhihui

2015-01-01

Percutaneous Coronary Intervention (PCI) is one of the most effective treatments for Coronary Heart Disease (CHD), but the high rate of In Stent Restenosis (ISR) has plagued clinicians after PCI. We aim to investigate the correlation of plasma Stromal Interaction Molecular 1 (STIM1) and Osteoprotegerin (OPG) level with stent restenosis after PCI. A total of 100 consecutive patients with Coronary Heart Disease (CHD) received PCI procedure were recruited. Coronary angiography was performed 8 months after their PCI. Then patients were divided into 2 groups: observation group was composed by patients who existing postoperative stenosis after intervention; Control group was composed by patients with no postoperative stenosis. The plasma levels of STIM, OPG in all patients were tested before and after intervention. Pearson correlation and multiple linear regression analysis were performed to analysis the correlation between STIM, OPG level and postoperative stenosis. 35 cases were divided into observation group and other 65 were divided into control group. The plasma levels of STIM, OPG have no statistical difference before their PCI procedure, but we observed higher level of High-sensitivity C-reactive protein (Hs-CRP) existed in observation group. We observed higher level of plasma STIM, OPG in observation group when compared with control group after PCI procedure (P < 0.05). Regression analysis demonstrated that Hs-CRP, STIM1, OPG are independent risk factors for ISR. Elevated levels of plasma STIM1, OPG are independent risk factors for ISR in patients received PCI, which could provide useful information for the restenosis control after PCI.

Risk of no-reflow in culprit lesion versus culprit vessel PCI in acute STEMI.

PubMed

Arslan, Uğur; Yaman, Mehmet; Kocaoğlu, İbrahim; Turan, Oğuzhan Ekrem; Yücel, Huriye; Aksakal, Aytekin; Günaydin, İlksen Atasoy; Hakan Ateş, Ahmet

2015-09-01

The present report describes patients with acute ST-elevation myocardial infarction who had at least two lesions in the culprit vessel (CV) during primary percutaneous coronary intervention (PCI). Here, we aimed to examine two different strategies, namely, PCI of only culprit lesion (CL) versus PCI of all lesions in the CV in the setting of acute ST-elevation myocardial infarction. Patients who underwent primary PCI were examined for the presence of an additional lesion in the infarct-related artery and divided into two groups according to the PCI strategy: CV versus CL groups. Coronary angiograms were examined for coronary thrombolysis in myocardial infarction (TIMI) flow and major clinical outcomes were determined. Of 637 patients, 472 (74.1%) underwent primary PCI for the CV (CV group) and 165 (25.9%) underwent primary PCI only for CL (CL group). TIMI flow before primary PCI and after stenting of the CL was similar; however, TIMI flow after completion of the procedure was significantly better in the CL group (P=0.022). The composite of death, nonfatal myocardial infarction and repeat revascularization was significantly better in the CL group (P=0.041) and early stent thrombosis was observed more commonly in the CV group [14 (3.0%) patients vs. 1 (0.6%) patient, P=0.09]. In the presence of an additional lesion in the CV during primary PCI, deferring stenting for the non-CL in the culprit artery after stenting the CL may be considered to prevent the development of no-reflow or slow-reflow, and thus major clinical adverse events may be reduced.

Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

PubMed

Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

2017-10-15

Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI

PubMed Central

Al Shammeri, O; Garcia, LA

2013-01-01

Objective Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Aim Assess the safety and effectiveness of Early PCI. Patients and Method We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy Results Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis Conclusion Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis. PMID:23559909

Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI.

PubMed

Ghoshhajra, Brian B; Takx, Richard A P; Stone, Luke L; Girard, Erin E; Brilakis, Emmanouil S; Lombardi, William L; Yeh, Robert W; Jaffer, Farouc A

2017-06-01

The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. • Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI. • CTA fusion data can be toggled on/off as desired during CTO PCI • Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

Emergency Situation Prediction Mechanism: A Novel Approach for Intelligent Transportation System Using Vehicular Ad Hoc Networks

PubMed Central

Gokulakrishnan, P.

2015-01-01

In Indian four-lane express highway, millions of vehicles are travelling every day. Accidents are unfortunate and frequently occurring in these highways causing deaths, increase in death toll, and damage to infrastructure. A mechanism is required to avoid such road accidents at the maximum to reduce the death toll. An Emergency Situation Prediction Mechanism, a novel and proactive approach, is proposed in this paper for achieving the best of Intelligent Transportation System using Vehicular Ad Hoc Network. ESPM intends to predict the possibility of occurrence of an accident in an Indian four-lane express highway. In ESPM, the emergency situation prediction is done by the Road Side Unit based on (i) the Status Report sent by the vehicles in the range of RSU and (ii) the road traffic flow analysis done by the RSU. Once the emergency situation or accident is predicted in advance, an Emergency Warning Message is constructed and disseminated to all vehicles in the area of RSU to alert and prevent the vehicles from accidents. ESPM performs well in emergency situation prediction in advance to the occurrence of an accident. ESPM predicts the emergency situation within 0.20 seconds which is comparatively less than the statistical value. The prediction accuracy of ESPM against vehicle density is found better in different traffic scenarios. PMID:26065014

AD Hoc Study on Human Robot Interface Issues

DTIC Science & Technology

2002-09-01

of joint range of motion limits on strength. When the angle of a fully deflected aircraft rudder/ brake pedal is beyond the limit of ankle...mobility, the pedal will seem to have excessive resistance. In addition, this will prevent the pilot from fully utilizing the brakes of the aircraft...importance and value added of HE efforts. 34 Center High-Mounted Brake Lights. In 1985, after extensive HE studies showing positive

Neuroprotection as initial therapy in acute stroke. Third Report of an Ad Hoc Consensus Group Meeting. The European Ad Hoc Consensus Group.

PubMed

1998-01-01

Although a considerable body of scientific data is now available on neuroprotection in acute ischaemic stroke, this field is not yet established in clinical practice. At its third meeting, the European Ad Hoc Consensus Group considered the potential for neuroprotection in acute stroke and the practical problems attendant on the existence of a very limited therapeutic window before irreversible brain damage occurs, and came to the following conclusions. NEUROPROTECTANTS IN CLINICAL DEVELOPMENT: Convincing clinical evidence for an efficacious neuroprotective treatment in acute stroke is still required. Caution should be exercised in interpreting and extrapolating experimental results to stroke patients, who are a very heterogeneous group. The limitations of the time windows and the outcome measures chosen in trials of acute stroke therapy have an important influence on the results. The overall distribution of functional outcomes provides more statistical information than the proportion above a threshold outcome value. Neurological outcome should also be assessed. Neuroprotectants should not be tested clinically in phase II or phase III trials in a time window that exceeds those determined in experimental studies. The harmful effects of a drug in humans may override its neuroprotective potential determined in animals. Agents that act at several different levels in the ischaemic cascade may be more effective than those with a single mechanism of action. CURRENT IN-HOSPITAL MANAGEMENT OF ACUTE STROKE: The four major physiological variables that must be monitored and managed are blood pressure, arterial blood gas levels, body temperature, and glycaemia. The effects of controlling these physiological variables have not been studied in prospective trials, though they may all contribute to the outcome of acute ischaemic stroke and affect the duration of the therapeutic window. Optimal physiological parameters are inherently neuroprotective. Trials of new agents for the

[EARLY RATHER THAN IMMEDIATE PCI IN NSTEMI; IS TIME EQUAL TO MUSCLE ONCE AGAIN?

PubMed

Carasso, Shemy; Nassar, Ali; Kuzniec, Fabio; Hazanov, Yevgeni; Salman, Nabeeh; Halhla, Yussra; Amir, Offer; Ghanem, Diab

2017-10-01

Current guidelines advocate immediate vs. non-immediate percutaneous coronary intervention (PCI) strategy in ST elevation vs. non ST elevation myocardial infarction (STEMI, NSTEMI). There is however increasing concern that "next-day PCI" in NSTEMI may adversely affect LV systolic and/or diastolic function and a more urgent aggressive approach should be taken in NSTEMI, similar to that in STEMI. In the current study we compared echocardiographic data between patients with STEMI and NSTEMI who had either primary or early PCI respectively. Prospective data of 165 consecutive patients with an acute MI were analyzed. Patients had primary PCI if they had STEMI and non-emergent PCI if they had NSTEMI. Demographic information, laboratory test results, procedure time and post-PCI echocardiographic assessment were compared between the two groups. Patients with STEMI were younger compared to patients with NSTEMI. Time to intervention was significantly longer in NSTEMI, reflecting guideline derived intervention strategy (1.9±1.7days, (median 1day) vs. 30±15min, for NSTEMI and STEMI, respectively, p<0.00001). Post-interventional LV systolic ejection fraction was better in NSTEMI compared to STEMI (53±14 vs. 48±13, respectively, p<0.05). Left atrial diameter, mitral inflow parameters and pulmonary arterial pressure were similar between the two groups. Adherence to practice guidelines delaying PCI up to 72 hours in patients with NSTEMI did not adversely affect left ventricular systolic and/or diastolic function compared to immediate PCI in patients with STEMI. Based on current data, we conclude that early PCI intervention rather than an immediate one is appropriate in NSTEMI patients.

Services oriented architectures and rapid deployment of ad-hoc health surveillance systems: lessons from Katrina relief efforts.

PubMed

Mirhaji, Parsa; Casscells, S Ward; Srinivasan, Arunkumar; Kunapareddy, Narendra; Byrne, Sean; Richards, David Mark; Arafat, Raouf

2006-01-01

During the Hurricane Katrina relief efforts, a new city was born overnight within the City of Houston to provide accommodation and health services for thousands of evacuees deprived of food, rest, medical attention, and sanitation. The hurricane victims had been exposed to flood water, toxic materials, physical injury, and mental stress. This scenario was an invitation for a variety of public health hazards, primarily infectious disease outbreaks. Early detection and monitoring of morbidity and mortality among evacuees due to unattended health conditions was an urgent priority and called for deployment of real-time surveillance to collect and analyze data at the scene, and to enable and guide appropriate response and planning activities. The University of Texas Health Science Center at Houston (UTHSC) and the Houston Department of Health and Human Services (HDHHS) deployed an ad hoc surveillance system overnight by leveraging Internet-based technologies and Services Oriented Architecture (SOA). The system was post-coordinated through the orchestration of Web Services such as information integration, natural language processing, syndromic case finding, and online analytical processing (OLAP). Here we will report the use of Internet-based and distributed architectures in providing timely, novel, and customizable solutions on demand for unprecedented events such as natural disasters.

Dynamic Key Management Schemes for Secure Group Access Control Using Hierarchical Clustering in Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Tsaur, Woei-Jiunn; Pai, Haw-Tyng

2008-11-01

The applications of group computing and communication motivate the requirement to provide group access control in mobile ad hoc networks (MANETs). The operation in MANETs' groups performs a decentralized manner and accommodated membership dynamically. Moreover, due to lack of centralized control, MANETs' groups are inherently insecure and vulnerable to attacks from both within and outside the groups. Such features make access control more challenging in MANETs. Recently, several researchers have proposed group access control mechanisms in MANETs based on a variety of threshold signatures. However, these mechanisms cannot actually satisfy MANETs' dynamic environments. This is because the threshold-based mechanisms cannot be achieved when the number of members is not up to the threshold value. Hence, by combining the efficient elliptic curve cryptosystem, self-certified public key cryptosystem and secure filter technique, we construct dynamic key management schemes based on hierarchical clustering for securing group access control in MANETs. Specifically, the proposed schemes can constantly accomplish secure group access control only by renewing the secure filters of few cluster heads, when a cluster head joins or leaves a cross-cluster. In such a new way, we can find that the proposed group access control scheme can be very effective for securing practical applications in MANETs.

Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.

PubMed

Jaski, Brian E; Grigoriadis, Christopher E; Dai, Xuming; Meredith, Richard D; Ortiz, Bryan C; Stouffer, George A; Thomas, Lorie; Smith, Sidney C

2016-08-01

Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups. Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes. © 2016, Wiley Periodicals, Inc.

Potential of Pseudomonas putida PCI2 for the Protection of Tomato Plants Against Fungal Pathogens.

PubMed

Pastor, Nicolás; Masciarelli, Oscar; Fischer, Sonia; Luna, Virginia; Rovera, Marisa

2016-09-01

Tomato is one of the most economically attractive vegetable crops due to its high yields. Diseases cause significant losses in tomato production worldwide. We carried out Polymerase Chain Reaction studies to detect the presence of genes encoding antifungal compounds in the DNA of Pseudomonas putida strain PCI2. We also used liquid chromatography-electrospray tandem mass spectrometry to detect and quantify the production of compounds that increase the resistance of plants to diseases from culture supernatants of PCI2. In addition, we investigated the presence of 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase in PCI2. Finally, PCI2 was used for inoculation of tomato seeds to study its potential biocontrol activity against Fusarium oxysporum MR193. The obtained results showed that no fragments for the encoding genes of hydrogen cyanide, pyoluteorin, 2,4-diacetylphloroglucinol, pyrrolnitrin, or phenazine-1-carboxylic acid were amplified from the DNA of PCI2. On the other hand, PCI2 produced salicylic acid and jasmonic acid in Luria-Bertani medium and grew in a culture medium containing ACC as the sole nitrogen source. We observed a reduction in disease incidence from 53.33 % in the pathogen control to 30 % in tomato plants pre-inoculated with PCI2 as well as increases in shoot and root dry weights in inoculated plants, as compared to the pathogenicity control. This study suggests that inoculation of tomato seeds with P. putida PCI2 increases the resistance of plants to root rot caused by F. oxysporum and that PCI2 produces compounds that may be involved at different levels in increasing such resistance. Thus, PCI2 could represent a non-contaminating management strategy potentially applicable in vegetable crops such as tomato.

Cluster Based Location-Aided Routing Protocol for Large Scale Mobile Ad Hoc Networks

NASA Astrophysics Data System (ADS)

Wang, Yi; Dong, Liang; Liang, Taotao; Yang, Xinyu; Zhang, Deyun

Routing algorithms with low overhead, stable link and independence of the total number of nodes in the network are essential for the design and operation of the large-scale wireless mobile ad hoc networks (MANET). In this paper, we develop and analyze the Cluster Based Location-Aided Routing Protocol for MANET (C-LAR), a scalable and effective routing algorithm for MANET. C-LAR runs on top of an adaptive cluster cover of the MANET, which can be created and maintained using, for instance, the weight-based distributed algorithm. This algorithm takes into consideration the node degree, mobility, relative distance, battery power and link stability of mobile nodes. The hierarchical structure stabilizes the end-to-end communication paths and improves the networks' scalability such that the routing overhead does not become tremendous in large scale MANET. The clusterheads form a connected virtual backbone in the network, determine the network's topology and stability, and provide an efficient approach to minimizing the flooding traffic during route discovery and speeding up this process as well. Furthermore, it is fascinating and important to investigate how to control the total number of nodes participating in a routing establishment process so as to improve the network layer performance of MANET. C-LAR is to use geographical location information provided by Global Position System to assist routing. The location information of destination node is used to predict a smaller rectangle, isosceles triangle, or circle request zone, which is selected according to the relative location of the source and the destination, that covers the estimated region in which the destination may be located. Thus, instead of searching the route in the entire network blindly, C-LAR confines the route searching space into a much smaller estimated range. Simulation results have shown that C-LAR outperforms other protocols significantly in route set up time, routing overhead, mean delay and packet

Exploring the Role of Ad Hoc Grassroots Organizations Providing Humanitarian Aid on Lesvos, Greece

PubMed Central

Kitching, George Tjensvoll; J. Haavik, Hanne; Tandstad, Birgit J.; Zaman, Muhammad; Darj, Elisabeth

2016-01-01

Introduction: Syrian refugees displaced into Turkey have attempted high-risk sea migrations to reach safer destinations in Europe, most often initially arriving on the Greek island of Lesvos. These refugees were often in need of basic humanitarian assistance that has been provided in part by a new category of ad hoc grassroots organizations (AHGOs). The aim of this study was to understand the internal and external operations of these AHGOs and their role on Lesvos. Methods: The experiences of AHGOs were investigated through a qualitative research design utilizing semi-structured interviews with organization leaders and spokespersons. AHGOs identified through media and social media sources as new Lesvos-specific organizations were purposively invited to complete an interview over phone, Skype or email. Data analysis of the transcribed interviews was performed by Systematic Text Condensation. Results: Forty-one organizations were contacted and 13 interviews were conducted. Most organizations were formed in autumn 2015 responding to the greater influx of refugees and migrants at that time and reported an absence of professional humanitarian agencies providing aid on Lesvos. Three categories emerged from the material. Features of organizations; Features of volunteers and; Evolution of AHGOs. The organizations perceived themselves capable of evaluating needs, mobilizing resources, funding and providing quick response. The volunteers came with limited humanitarian experience and from a wide variety of nationalities and professional backgrounds, and the organizations developed while on Lesvos. Discussion: Knowledge from our findings of AHGOs response to this complex disaster on Lesvos could be utilized in future catastrophes. We conclude that AHGOs may prove effective at providing humanitarian aid in a surge response when international non-governmental organizations are unable to respond quickly. In future complex disasters AHGOs should be recognized as new humanitarian

Exploring the Role of Ad Hoc Grassroots Organizations Providing Humanitarian Aid on Lesvos, Greece.

PubMed

Kitching, George Tjensvoll; J Haavik, Hanne; Tandstad, Birgit J; Zaman, Muhammad; Darj, Elisabeth

2016-11-17

Syrian refugees displaced into Turkey have attempted high-risk sea migrations to reach safer destinations in Europe, most often initially arriving on the Greek island of Lesvos. These refugees were often in need of basic humanitarian assistance that has been provided in part by a new category of ad hoc grassroots organizations (AHGOs). The aim of this study was to understand the internal and external operations of these AHGOs and their role on Lesvos. The experiences of AHGOs were investigated through a qualitative research design utilizing semi-structured interviews with organization leaders and spokespersons. AHGOs identified through media and social media sources as new Lesvos-specific organizations were purposively invited to complete an interview over phone, Skype or email. Data analysis of the transcribed interviews was performed by Systematic Text Condensation. Forty-one organizations were contacted and 13 interviews were conducted. Most organizations were formed in autumn 2015 responding to the greater influx of refugees and migrants at that time and reported an absence of professional humanitarian agencies providing aid on Lesvos. Three categories emerged from the material. Features of organizations; Features of volunteers and; Evolution of AHGOs. The organizations perceived themselves capable of evaluating needs, mobilizing resources, funding and providing quick response. The volunteers came with limited humanitarian experience and from a wide variety of nationalities and professional backgrounds, and the organizations developed while on Lesvos. Knowledge from our findings of AHGOs response to this complex disaster on Lesvos could be utilized in future catastrophes. We conclude that AHGOs may prove effective at providing humanitarian aid in a surge response when international non-governmental organizations are unable to respond quickly. In future complex disasters AHGOs should be recognized as new humanitarian actors and conditions should be made

The foundation of NCVD PCI Registry: the Malaysia's first multi-centre interventional cardiology project.

PubMed

Liew, H B; Rosli, M A; Wan Azman, W A; Robaayah, Z; Sim, K H

2008-09-01

The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.

Influence of operator experience and PCI volume on transfemoral access techniques: A collaboration of international cardiovascular societies.

PubMed

Nelson, Daniel W; Damluji, Abdulla A; Patel, Nish; Valgimigli, Marco; Windecker, Stephan; Byrne, Robert; Nolan, James; Patel, Tejas; Brilakis, Emmanouil; Banerjee, Subhash; Mayol, Jorge; Cantor, Warren J; Alfonso, Carlos E; Rao, Sunil V; Moscucci, Mauro; Cohen, Mauricio G

2018-03-01

Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied. A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016. A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (<50years: 56.4%; ≥50years: 66.8%, p<0.0039) and high PCI volume operators (<100 PCI: 57.3%; 100-299 PCI: 58.7%; ≥300 PCI: 64.3%, p<0.134) preferred palpation only without imaging (fluoroscopy or ultrasound (US)) for TFA. Most respondents preferred not to use micropuncture needle to puncture the femoral artery. Older (≥50years: 64.4%; <50years: 71.5%, p<0.04) and high PCI volume operators (≥300 PCI: 64.1%; 100-299 PCI: 72.6%; <100 PCI: 67.9%, p<0.072) tended not to perform femoral angiography (FA). Of those performing FA, the majority opted to do it at the end of the procedure. Despite best practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging for femoral access or perform femoral angiography during TF procedures. These data highlight opportunities to further reduce TFA complications. Copyright © 2017 Elsevier Inc. All rights reserved.

Obtaining appropriate interval estimates for age when multiple indicators are used: evaluation of an ad-hoc procedure.

PubMed

Fieuws, Steffen; Willems, Guy; Larsen-Tangmose, Sara; Lynnerup, Niels; Boldsen, Jesper; Thevissen, Patrick

2016-03-01

When an estimate of age is needed, typically multiple indicators are present as found in skeletal or dental information. There exists a vast literature on approaches to estimate age from such multivariate data. Application of Bayes' rule has been proposed to overcome drawbacks of classical regression models but becomes less trivial as soon as the number of indicators increases. Each of the age indicators can lead to a different point estimate ("the most plausible value for age") and a prediction interval ("the range of possible values"). The major challenge in the combination of multiple indicators is not the calculation of a combined point estimate for age but the construction of an appropriate prediction interval. Ignoring the correlation between the age indicators results in intervals being too small. Boldsen et al. (2002) presented an ad-hoc procedure to construct an approximate confidence interval without the need to model the multivariate correlation structure between the indicators. The aim of the present paper is to bring under attention this pragmatic approach and to evaluate its performance in a practical setting. This is all the more needed since recent publications ignore the need for interval estimation. To illustrate and evaluate the method, Köhler et al. (1995) third molar scores are used to estimate the age in a dataset of 3200 male subjects in the juvenile age range.

Are PCI Service Volumes Associated with 30-Day Mortality? A Population-Based Study from Taiwan.

PubMed

Yu, Tsung-Hsien; Chou, Ying-Yi; Wei, Chung-Jen; Tung, Yu-Chi

2017-11-09

The volume-outcome relationship has been discussed for over 30 years; however, the findings are inconsistent. This might be due to the heterogeneity of service volume definitions and categorization methods. This study takes percutaneous coronary intervention (PCI) as an example to examine whether the service volume was associated with PCI 30-day mortality, given different service volume definitions and categorization methods. A population-based, cross-sectional multilevel study was conducted. Two definitions of physician and hospital volume were used: (1) the cumulative PCI volume in a previous year before each PCI; (2) the cumulative PCI volume within the study period. The volume was further treated in three ways: (1) a categorical variable based on the American Heart Association's recommendation; (2) a semi-data-driven categorical variable based on k-means clustering algorithm; and (3) a data-driven categorical variable based on the Generalized Additive Model. The results showed that, after adjusting the patient-, physician-, and hospital-level covariates, physician volume was associated inversely with PCI 30-day mortality, but hospital volume was not, no matter which definitions and categorization methods of service volume were applied. Physician volume is negatively associated with PCI 30-day mortality, but the results might vary because of definition and categorization method.

Post-Hoc Study: Intravenous Hydration Treatment in Chinese Patients with High Risk of Contrast-Induced Nephropathy Following Percutaneous Coronary Intervention

PubMed Central

Bei, Weijie; Li, Hualong; Lin, Kaiyang; Wang, Kun; Chen, Shiqun; Guo, Xiaosheng; Liu, Yong; Tan, Ning; Chen, Jiyan; Yang, Xiangtai; Su, Xi; Du, Zhimin; Zeng, Qiutang; Fang, Zhenfei; Wang, Yan; Jiang, Hong; Xiong, Longgen; Hou, Yuqing; Yuan, Yong; Li, Tianfa; Hong, Lang; Wu, Yanqing; Liu, Yin; Lin, Wenhua; Jiang, Tiemin; Fu, Junhua; An, Yi; Yu, Bo; Tian, Ye; Zheng, Yang; Liu, Bin; Yang, Ping; Jiang, Xianyan; Wang, Hao; Qu, Peng; Cui, Lianqun; Li, Xueqi; Qi, Xiaoyong; Ma, Zengcai; Li, Jifu; Zhang, Lili; Liu, Shengquan; Pang, Wenyue; Li, Yibo; Yang, Manguang; Ji, Zheng; Zhao, Pitian; Li, Lu; Ge, Junbo; Jin, Huigen; Pan, Weimin; Song, Yaoming; Li, Jianmei; Xiao, Jianming; Liu, Hanxiong; Tao, Jianhong; Wu, Zhongdong; Tuo, Buxiong; Li, Wei; Xu, Yixian; Zhang, Zhaoqi; Chen, Yundai; Wang, Lefeng; Zhang, Jinying; Wang, Fengling; Jia, Yongping; Wang, Bin; Tang, Fakuan; Tang, Qiang; Wang, Wei; Sun, Yuemin; Su, Weiqing

2017-01-01

Contrast-induced nephropathy (CIN) develops after the injection of iodinated contrast media. This is a post hoc analysis of the data obtained from the TRUST study, which was a prospective, multicentre, observational study conducted to evaluate the safety and tolerability of the contrast medium iopromide in patients undergoing cardiac catheterization from August 2010 to September 2011 in China, conducted to explore the current status, trends and risk predictors of hydration treatment. The status of hydration to prevent CIN in each patient was recorded. Of the total 17,139 patients from the TRUST study (mean age, 60.33 ± 10.38 years), the overall hydration usage was 46.1% in patients undergoing percutaneous coronary intervention (PCI) and 77.4%, 51.7%, and 48.5% in patients with pre-existing renal disease, diabetes mellitus, and hypertension, respectively. The proportion of hydration use increased from 36.5% to 55.5% from August 2010 to September 2011, which was independently associated with risk predictors like older age, pre-existing renal disease, hypertension, diabetes mellitus, prior myocardial infarction, ST segment elevation MI, high contrast dose, multi-vessel disease and reduced LVEF (<45%). Overall, the usage of intravenous hydration treatment for patients with a high risk of CIN following PCI was high in China. PMID:28337989

Performance analysis of multi-radio routing protocol in cognitive radio ad hoc networks under different path failure rate

NASA Astrophysics Data System (ADS)

Che-Aron, Z.; Abdalla, A. H.; Abdullah, K.; Hassan, W. H.

2013-12-01

In recent years, Cognitive Radio (CR) technology has largely attracted significant studies and research. Cognitive Radio Ad Hoc Network (CRAHN) is an emerging self-organized, multi-hop, wireless network which allows unlicensed users to opportunistically access available licensed spectrum bands for data communication under an intelligent and cautious manner. However, in CRAHNs, a lot of failures can easily occur during data transmission caused by PU (Primary User) activity, topology change, node fault, or link degradation. In this paper, an attempt has been made to evaluate the performance of the Multi-Radio Link-Quality Source Routing (MR-LQSR) protocol in CRAHNs under different path failure rate. In the MR-LQSR protocol, the Weighted Cumulative Expected Transmission Time (WCETT) is used as the routing metric. The simulations are carried out using the NS-2 simulator. The protocol performance is evaluated with respect to performance metrics like average throughput, packet loss, average end-to-end delay and average jitter. From the simulation results, it is observed that the number of path failures depends on the PUs number and mobility rate of SUs (Secondary Users). Moreover, the protocol performance is greatly affected when the path failure rate is high, leading to major service outages.

Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects.

PubMed

Balakrishnan, Thalaivirithan Margabandu; Ramkumar, Jayagosh; Jaganmohan, Janardhanan

2017-01-01

Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. 22 patients (16 were males and 6 were females) were involved in this study between period of January 2012 and December 2016.We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region.

Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft- tissue defects

PubMed Central

Balakrishnan, Thalaivirithan Margabandu; Ramkumar, Jayagosh; Jaganmohan, Janardhanan

2017-01-01

Introduction: Lower third leg soft tissue defects with anatomical and pathological constraints are posing formidable challenges to reconstructive surgeon. Aim: This retrospective study was conducted to assess the effectiveness of ad hoc posterior tibial vessels perforator-propeller flaps for the reconstruction of small and medium sized soft tissue defects in the lower third leg. Patients and Methods: 22 patients (16 were males and 6 were females) were involved in this study between period of January 2012 and December 2016.We followed the protocol of initial non delineating exploratory incision made to find out single best perforator in all patients. All the defects in leg reconstructed with adhoc posterior tibial vessel propeller flaps. Results: All 22 flaps survived well. All in an average of 13 months follow up period, had pain free walking, with minimal scarring and acceptable aesthesis at the reconstruction sites with no need for any secondary procedure. Conclusion: With inability of preoperatively dopplering the perforators in the lower third leg region, the exploratory posterior nondelineating incision was used in all cases to secure the single best perforator for the propeller flaps. Thus adhoc posterior tibial vessel propeller flaps are dependable, easily adoptable for the reconstruction of soft tissue defects of the lower third leg region. PMID:29618863

Outcomes of PCI at hospitals with or without on-site cardiac surgery.

PubMed

Aversano, Thomas; Lemmon, Cynthia C; Liu, Li

2012-05-10

Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery. We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months. A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01). We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).

SPAR: a security- and power-aware routing protocol for wireless ad hoc and sensor networks

NASA Astrophysics Data System (ADS)

Oberoi, Vikram; Chigan, Chunxiao

2005-05-01

Wireless Ad Hoc and Sensor Networks (WAHSNs) are vulnerable to extensive attacks as well as severe resource constraints. To fulfill the security needs, many security enhancements have been proposed. Like wise, from resource constraint perspective, many power aware schemes have been proposed to save the battery power. However, we observe that for the severely resource limited and extremely vulnerable WAHSNs, taking security or power (or any other resource) alone into consideration for protocol design is rather inadequate toward the truly "secure-and-useful" WAHSNs. For example, from resource constraint perspective, we identify one of the potential problems, the Security-Capable-Congestion (SCC) behavior, for the WAHSNs routing protocols where only the security are concerned. On the other hand, the design approach where only scarce resource is concerned, such as many power-aware WAHSNs protocols, leaves security unconsidered and is undesirable to many WAHSNs application scenarios. Motivated by these observations, we propose a co-design approach, where both the high security and effective resource consumption are targeted for WAHSNs protocol design. Specifically, we propose a novel routing protocol, Security- and Power- Aware Routing (SPAR) protocol based on this co-design approach. In SPAR, the routing decisions are made based on both security and power as routing criteria. The idea of the SPAR mechanism is routing protocol independent and therefore can be broadly integrated into any of the existing WAHSNs routing protocols. The simulation results show that SPAR outperforms the WAHSNs routing protocols where security or power alone is considered, significantly. This research finding demonstrates the proposed security- and resource- aware co-design approach is promising towards the truly "secure-and-useful" WAHSNs.

The Bruton tyrosine kinase inhibitor PCI-32765 ameliorates autoimmune arthritis by inhibition of multiple effector cells

PubMed Central

2011-01-01

Introduction The aim was to determine the effect of the Bruton tyrosine kinase (Btk)-selective inhibitor PCI-32765, currently in Phase I/II studies in lymphoma trials, in arthritis and immune-complex (IC) based animal models and describe the underlying cellular mechanisms. Methods PCI-32765 was administered in a series of murine IC disease models including collagen-induced arthritis (CIA), collagen antibody-induced arthritis (CAIA), reversed passive anaphylactic reaction (RPA), and passive cutaneous anaphylaxis (PCA). Clinical and pathologic features characteristic of each model were examined following treatment. PCI-32765 was then examined in assays using immune cells relevant to the pathogenesis of arthritis, and where Btk is thought to play a functional role. These included proliferation and calcium mobilization in B cells, cytokine and chemokine production in monocytes/macrophages, degranulation of mast cells and its subsequent cytokine/chemokine production. Results PCI-32765 dose-dependently and potently reversed arthritic inflammation in a therapeutic CIA model with an ED50 of 2.6 mg/kg/day. PCI-32765 also prevented clinical arthritis in CAIA models. In both models, infiltration of monocytes and macrophages into the synovium was completely inhibited and importantly, the bone and cartilage integrity of the joints were preserved. PCI-32765 reduced inflammation in the Arthus and PCA assays. In vitro, PCI-32765 inhibited BCR-activated primary B cell proliferation (IC50 = 8 nM). Following FcγR stimulation, PCI-32765 inhibited TNFα, IL-1β and IL-6 production in primary monocytes (IC50 = 2.6, 0.5, 3.9 nM, respectively). Following FcεRI stimulation of cultured human mast cells, PCI-32765 inhibited release of histamine, PGD2, TNF-α, IL-8 and MCP-1. Conclusions PCI-32765 is efficacious in CIA, and in IC models that do not depend upon autoantibody production from B cells. Thus PCI-32765 targets not only B lymphocytes but also monocytes, macrophages and mast cells

APC-PCI complex levels for screening of AAA in patients with peripheral atherosclerosis.

PubMed

Zarrouk, Moncef; Keshavarz, Kave; Lindblad, Bengt; Gottsäter, Anders

2013-11-01

To evaluate the use of activated protein C-protein C inhibitor (APC-PCI) complex levels for detection of abdominal aortic aneurysm (AAA) in patients with peripheral atherosclerotic disease (PAD). APC-PCI levels and aortic diameter evaluated in 511 PAD patients without previously known AAA followed-up concerning survival for 4.8(0.5) years. AAA was found in 13% of patients. Aortic diameter correlated (r = 0.138; p = 0.002) with APC-PCI levels which were higher (0.40[0.45] vs. 0.30[0.49] μg/l; p = 0.004) in patients with AAA. This difference persisted in multivariate analysis (p = 0.029). A threshold value of APC-PCI ≥0.15 μg/L showed a specificity of 11%, a sensitivity of 97% and a negative predictive value of 96% for an AAA diagnosis. APC-PCI levels were higher in patients with AAA, and showed high sensitivity but low specificity for the diagnosis and can therefore not be considered as a screening tool in PAD patients. An AAA prevalence of 13% in patients with PAD indicates a need for AAA screening within this population.

A high-rate PCI-based telemetry processor system

NASA Astrophysics Data System (ADS)

Turri, R.

2002-07-01

The high performances reached by the Satellite on-board telemetry generation and transmission, as consequently, will impose the design of ground facilities with higher processing capabilities at low cost to allow a good diffusion of these ground station. The equipment normally used are based on complex, proprietary bus and computing architectures that prevent the systems from exploiting the continuous and rapid increasing in computing power available on market. The PCI bus systems now allow processing of high-rate data streams in a standard PC-system. At the same time the Windows NT operating system supports multitasking and symmetric multiprocessing, giving the capability to process high data rate signals. In addition, high-speed networking, 64 bit PCI-bus technologies and the increase in processor power and software, allow creating a system based on COTS products (which in future may be easily and inexpensively upgraded). In the frame of EUCLID RTP 9.8 project, a specific work element was dedicated to develop the architecture of a system able to acquire telemetry data of up to 600 Mbps. Laben S.p.A - a Finmeccanica Company -, entrusted of this work, has designed a PCI-based telemetry system making possible the communication between a satellite down-link and a wide area network at the required rate.

Histone deacetylase inhibitor (HDACI) PCI-24781 enhances chemotherapy induced apoptosis in multidrug resistant sarcoma cell lines

PubMed Central

Yang, Cao; Choy, Edwin; Hornicek, Francis J.; Wood, Kirkham B; Schwab, Joseph H; Liu, Xianzhe; Mankin, Henry; Duan, Zhenfeng

2013-01-01

The anti-tumor activity of histone deacetylase inhibitors (HDACI) on multi-drug resistant sarcoma cell lines has never been previously described. Four multidrug resistant sarcoma cell lines treated with HDACI PCI-24781 resulted in dose-dependent accumulation of acetylated histones, p21 and PARP cleavage products. Growth of these cell lines was inhibited by PCI-24781 at IC50 of 0.43 to 2.7. When we looked for synergy of PCI-24781 with chemotherapeutic agents, we found that PCI-24781 reverses drug resistance in all four multidrug resistant sarcoma cell lines and synergizes with chemotherapeutic agents to enhance caspase-3/7 activity. Expression of RAD51 (a marker for DNA double-strand break repair) was inhibited and the expression of GADD45α (a marker for growth arrest and DNA-damage) was induced by PCI-24781 in multidrug resistant sarcoma cell lines. In conclusion, HDACI PCI-24781 synergizes with chemotherapeutic drugs to induce apoptosis and reverses drug resistance in multidrug resistant sarcoma cell lines. PMID:21508354

Photochemical internalization (PCI) of bleomycin is equally effective in two dissimilar leiomyosarcoma xenografts in athymic mice.

PubMed

Sellevold, Simen; Peng, Qian; Fremstedal, Ane Sofie Viset; Berg, Kristian

2017-12-01

Photochemical internalization (PCI) is a novel technique for delivery of active macromolecules into cancerous cells, via light activation of a specific photosensitizer and a low dose systemic drug. Numerous pre-clinical studies and one clinical trial have confirmed the treatment potential in carcinomas. Soft tissue sarcomas are rare and generally resistant to radio- and chemotherapy. Due to treatment resistance and surgical morbidity in sarcoma care, we seek to increase knowledge on PCI effects in sarcomas by studying two different, but closely related leiomyosarcomas. MES-SA and SK-LMS-1 tumours were established in the leg muscles of athymic mice. Treatment effects after AlPcS 2a -PCI of bleomycin, PCI with no drug (photodynamic therapy, PDT) and control groups were evaluated by: 1) assessment of tumour growth, 2) uptake of contrast agent during MRI and 3) histopathology. PCI of bleomycin induced a similar and significant increase in time to reach the end point in both tumour models, while neither responded to AlPcS 2a -PDT. In the MES-SA tumours PCI reduced the growth rate, while in the SK-LMS-1 tumours the growth was blocked for 12days followed by exponential growth close to that of untreated tumours. SK-LMS-1 tumours were more homogenously and better vascularized than MES-SA. After PCI the vascular shutdown was more complete in the SK-LMS-1 tumours than in the MES-SA tumours. AlPcS2a-based PCI, but not PDT, induced significant tumour growth delay in the evaluated sarcomas. Cellular responsiveness to bleomycin and tumour vascularity are identified as predictive markers for PCI treatment effects. Copyright © 2017 Elsevier B.V. All rights reserved.

[Effects of PCI-32765 and Dasatinib on the Acute Lymphoblastic Leukemic Cells and Their Mechanisms].

PubMed

Deng, Yuan; Tao, Shan-Dong; Zhang, Xin; Ma, Jing-Jing; He, Zheng-Mei; Chen, Yue; Deng, Zhi-Kui; Yu, Liang

2017-02-01

To investigate the effects of Btk inhibitor (PCI-32765) and BCR-ABL tyrosine kinase inhibitor (Dasatinib) on proliferation and apoptosis of acute lymphoblastic leukemia (ALL) cell lines (Sup-B15, RS4;11) and the possible mechanism. RS4;11 and Sup-B15 cells were treated with PCI-32765 and Dasatinib, the cell proliferation and apoptosis were detected by CCK-8, the Btk and other apoptotic proteins were detected by Western blot. PCI-32765 could inhibit the proliferation of RS4;11 and Sup-B15 cells in a dose-dependent manner, Sup-B15 cells were more sensitive to PCI-32765 than RS4;11 cells, their IC 50 were 3 µmol/L and 8 µmol/L respectively, the difference between them was statistically significant (P<0.05). Dasatinib also could inhibit the proliferation of RS4;11 cells and Sup-B15 cells in a dose-dependent manner. The IC 50 was 5 µmol/L and 5 nmol/L, respectively, the difference between them was statistically very significant (P<0.01), and the inhibitory effect was enhanced by the combination of Damatinib with the PCI-32765(P<0.05). The cell survival rate decreased gradually in PCI-32765 or Dasatinib alone group and the combination group at the different time-point (8, 12, 24, 36, 48 and 72 h), the 2 drugs showed a synergistic effect on cells in a time-dependent manner. After being treated with PCI-32765 and Dasatinib, the RS4;11 and Sup-B15 cells showed that cell shrinkage, increase of cytoplasmic density, nuclear pyknosis, deviation and karyorrhexis, and increase of the apoptotic cells in the combination group, while the promotive effect of low dosage dasatinib on apoptosis of RS4;11 cells was not strong. PCI-32765 and Dasatinib could decrease the expression and activity of BCR-ABL, Btk, Lyn, Src in Sup-B15 and RS4;11 cells. PCI-32765 or Dasatinib can inhibit the proliferation and induce the apoptosis of Sup-B15 and RS4;11 cells, PCI-32765 and Dasatinib displayed the synergistic effects. The possible mechanism may be related with the blocking of B cell receptor

PCI is Not Predictive of Survival After Complete CRS/HIPEC in Peritoneal Dissemination from High-Grade Appendiceal Primaries.

PubMed

Votanopoulos, Konstantinos Ioannis; Bartlett, David; Moran, Brendan; Haroon, Choudry M; Russell, Greg; Pingpank, James F; Ramalingam, Lekshmi; Kandiah, Chandrakumaran; Chouliaras, Konstantinos; Shen, Perry; Levine, Edward A

2018-03-01

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option in patients with carcinomatosis from high-grade appendiceal (HGA) primaries. It is unknown if there is a Peritoneal Carcinomatosis Index (PCI) upper limit above which a complete CRS/HIPEC does not assure long-term survival. Retrospective analysis from three centers was performed. The PCI was used to grade volume of of disease. Survival in relation to PCI was studied on patients with complete cytoreduction. Overall, 521 HGA patients underwent CRS/HIPEC from 1993 to 2015, with complete CRS being achieved in 50% (260/622). Mean PCI was 14.8 (standard deviation 8.7, range 0-36). Median survival for the complete CRS cohort was 6.1 years, while 5- and 10-year survival was 51.7% (standard error [SE] 4.6) and 36.1% (SE 6.3), respectively. Arbitrary cut-off PCI limits with 5-point splits (p = 0.63) were not predictive of a detrimental effect on survival as long as a complete CRS was achieved. A linear effect of the PCI on survival (p = 0.62) was not observed, and single-point PCI cohort splits within a PCI range of < 5 to > 10 were not predictive of survival for complete CRS patients. The PCI correlated with the ability to achieve a complete CRS, with a mean PCI of 14.7 (8.7) for completeness of cytoreduction (CC)0, 22.3 (7.8) for CC1 and 26.1 (9.5) for CC2/3 resections (p = 0.0001, hazard ratio 1.12, 95% confidence interval 1.09), with an HR of 1.15 for each 1-unit increase in the PCI score. Only 21% of the cohort achieved a complete CRS with a PCI ≥ 21. The PCI correlates with the ability to achieve a complete CRS in carcinomatosis from HGA. PCI is not associated with survival as long as a complete CRS can be achieved.

Controversies in the treatment of patients with STEMI and multivessel disease: is it time for PCI of all lesions?

PubMed

Ong, Peter; Sechtem, Udo

2016-06-01

Several randomized trials have suggested a benefit for multivessel PCI in patients with STEMI and multivessel disease. However, none of the studies compared multivessel PCI with a staged PCI-approach which is the current guideline recommended approach. The results of the trials may overestimate the beneficial effect of the multivessel PCI approach because the control group did not receive any ischaemia testing for evaluation of the significance of remaining lesions. Thus, unfavourable aspects of the multivessel PCI approach such as overestimation of non-culprit lesions at the time of acute coronary angiography, complications associated with PCI of the non-culprit lesion (i.e. dissection, no-reflow, acute stent thrombosis) or increased risk for contrast induced nephropathy may have gone unnoticed as the comparative management pathway was unusual and likely inferior to the guideline recommended approach. We believe that culprit lesion only PCI and staged evaluation of remaining areas of myocardial ischaemia with subsequent PCI is still preferable in patients with STEMI and multivessel disease but a randomized study comparing this approach with multivessel PCI is needed.

The Factor Structure and Psychometric Properties of the Persian Version of the Revised Prenatal Coping Inventory (Nu-PCI).

PubMed

Faramarzi, Mahbobeh; Pasha, Hajar; Khafri, Sorayya; Heidary, Shima

2017-03-01

Familiarity with coping strategies is essential for stress management during pregnancy. The Revised Prenatal Coping Inventory (Nu-PCI) was developed to assess coping strategies during pregnancy. This study aimed to assess the factor structure and psychometric properties of the Persian version of the Nu-PCI. After forward-backward translation, the Nu-PCI was administered to 210 pregnant women who were enrolled in two teaching referral clinics in the North of the Islamic Republic of Iran (Babol). The participants completed the Persian Nu-PCI and Ways of Coping Questionnaire (WCQ), which was used to determine the validity of the Persian Nu-PCI. To test construct validity of the Persian Nu-PCI, a principal components factor analysis was performed. Principal components analysis with varimax rotation showed a best fitting 3-factor structure similar to the original with three coping subscales: planning-preparation, avoidance, and spiritual-positive coping. The Persian Nu-PCI was internally consistent and within the acceptable range (α=0.89-0.97). The alpha coefficients for the Nu-PCI and the subscales of planning-preparation, avoidance, and spiritual-positive coping were high. Test-retest coefficients for the Nu-PCI and subscales were 0.98-0.99. The Nu-PCI and its subscales correlated with the WCQ in the entire sample and within each trimester. The Persian version of the Nu-PCI and the subscales of planning-preparation, avoidance, and spiritual-positive coping represent the first reliable standardized tool for measuring coping strategies during pregnancy in the Islamic Republic of Iran. Therefore, it can be applied as a quick and accurate preliminary screening tool for evaluating coping strategies throughout pregnancy in clinics and other medical and research settings.

Myocardial Revascularization in New York State: Variations in the PCI-to-CABG Ratio and Their Implications.

PubMed

Ko, Wilson; Tranbaugh, Robert; Marmur, Jonathan D; Supino, Phyllis G; Borer, Jeffrey S

2012-04-01

During the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions. We reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were -40%, -20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: -61%, -23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher. There are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence-based revascularization strategy. (J Am Heart Assoc

Unsupervised algorithms for intrusion detection and identification in wireless ad hoc sensor networks

NASA Astrophysics Data System (ADS)

Hortos, William S.

2009-05-01

In previous work by the author, parameters across network protocol layers were selected as features in supervised algorithms that detect and identify certain intrusion attacks on wireless ad hoc sensor networks (WSNs) carrying multisensor data. The algorithms improved the residual performance of the intrusion prevention measures provided by any dynamic key-management schemes and trust models implemented among network nodes. The approach of this paper does not train algorithms on the signature of known attack traffic, but, instead, the approach is based on unsupervised anomaly detection techniques that learn the signature of normal network traffic. Unsupervised learning does not require the data to be labeled or to be purely of one type, i.e., normal or attack traffic. The approach can be augmented to add any security attributes and quantified trust levels, established during data exchanges among nodes, to the set of cross-layer features from the WSN protocols. A two-stage framework is introduced for the security algorithms to overcome the problems of input size and resource constraints. The first stage is an unsupervised clustering algorithm which reduces the payload of network data packets to a tractable size. The second stage is a traditional anomaly detection algorithm based on a variation of support vector machines (SVMs), whose efficiency is improved by the availability of data in the packet payload. In the first stage, selected algorithms are adapted to WSN platforms to meet system requirements for simple parallel distributed computation, distributed storage and data robustness. A set of mobile software agents, acting like an ant colony in securing the WSN, are distributed at the nodes to implement the algorithms. The agents move among the layers involved in the network response to the intrusions at each active node and trustworthy neighborhood, collecting parametric values and executing assigned decision tasks. This minimizes the need to move large amounts

47 CFR 61.45 - Adjustments to the PCI for Local Exchange Carriers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... change in the GDP-PI between the quarter ending six months prior to the effective date of the new annual... demand) + Z, all divided by R. PCIt = The new PCI value. PCIt −1 = the immediately preceding PCI value....5%, to the extent necessary to reduce a tariff entity's ATS charge to its Target Rate as set forth...

Performance evaluation of reactive and proactive routing protocol in IEEE 802.11 ad hoc network

NASA Astrophysics Data System (ADS)

Hamma, Salima; Cizeron, Eddy; Issaka, Hafiz; Guédon, Jean-Pierre

2006-10-01

Wireless technology based on the IEEE 802.11 standard is widely deployed. This technology is used to support multiple types of communication services (data, voice, image) with different QoS requirements. MANET (Mobile Adhoc NETwork) does not require a fixed infrastructure. Mobile nodes communicate through multihop paths. The wireless communication medium has variable and unpredictable characteristics. Furthermore, node mobility creates a continuously changing communication topology in which paths break and new one form dynamically. The routing table of each router in an adhoc network must be kept up-to-date. MANET uses Distance Vector or Link State algorithms which insure that the route to every host is always known. However, this approach must take into account the adhoc networks specific characteristics: dynamic topologies, limited bandwidth, energy constraints, limited physical security, ... Two main routing protocols categories are studied in this paper: proactive protocols (e.g. Optimised Link State Routing - OLSR) and reactive protocols (e.g. Ad hoc On Demand Distance Vector - AODV, Dynamic Source Routing - DSR). The proactive protocols are based on periodic exchanges that update the routing tables to all possible destinations, even if no traffic goes through. The reactive protocols are based on on-demand route discoveries that update routing tables only for the destination that has traffic going through. The present paper focuses on study and performance evaluation of these categories using NS2 simulations. We have considered qualitative and quantitative criteria. The first one concerns distributed operation, loop-freedom, security, sleep period operation. The second are used to assess performance of different routing protocols presented in this paper. We can list end-to-end data delay, jitter, packet delivery ratio, routing load, activity distribution. Comparative study will be presented with number of networking context consideration and the results show

An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation.

PubMed

Serefoglu, Ege Can; McMahon, Chris G; Waldinger, Marcel D; Althof, Stanley E; Shindel, Alan; Adaikan, Ganesh; Becher, Edgardo F; Dean, John; Giuliano, Francois; Hellstrom, Wayne Jg; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

2014-06-01

The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. The

An Evidence-Based Unified Definition of Lifelong and Acquired Premature Ejaculation: Report of the Second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation

PubMed Central

Serefoglu, Ege Can; McMahon, Chris G; Waldinger, Marcel D; Althof, Stanley E; Shindel, Alan; Adaikan, Ganesh; Becher, Edgardo F; Dean, John; Giuliano, Francois; Hellstrom, Wayne JG; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

2014-01-01

Introduction The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. Aim The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. Methods In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. Results The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States.

PubMed

Fanaroff, Alexander C; Zakroysky, Pearl; Dai, David; Wojdyla, Daniel; Sherwood, Matthew W; Roe, Matthew T; Wang, Tracy Y; Peterson, Eric D; Gurm, Hitinder S; Cohen, Mauricio G; Messenger, John C; Rao, Sunil V

2017-06-20

Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. Although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship

Design and Analysis of A Beacon-Less Routing Protocol for Large Volume Content Dissemination in Vehicular Ad Hoc Networks.

PubMed

Hu, Miao; Zhong, Zhangdui; Ni, Minming; Baiocchi, Andrea

2016-11-01

Large volume content dissemination is pursued by the growing number of high quality applications for Vehicular Ad hoc NETworks(VANETs), e.g., the live road surveillance service and the video-based overtaking assistant service. For the highly dynamical vehicular network topology, beacon-less routing protocols have been proven to be efficient in achieving a balance between the system performance and the control overhead. However, to the authors' best knowledge, the routing design for large volume content has not been well considered in the previous work, which will introduce new challenges, e.g., the enhanced connectivity requirement for a radio link. In this paper, a link Lifetime-aware Beacon-less Routing Protocol (LBRP) is designed for large volume content delivery in VANETs. Each vehicle makes the forwarding decision based on the message header information and its current state, including the speed and position information. A semi-Markov process analytical model is proposed to evaluate the expected delay in constructing one routing path for LBRP. Simulations show that the proposed LBRP scheme outperforms the traditional dissemination protocols in providing a low end-to-end delay. The analytical model is shown to exhibit a good match on the delay estimation with Monte Carlo simulations, as well.

Design and Analysis of A Beacon-Less Routing Protocol for Large Volume Content Dissemination in Vehicular Ad Hoc Networks

PubMed Central

Hu, Miao; Zhong, Zhangdui; Ni, Minming; Baiocchi, Andrea

2016-01-01

Large volume content dissemination is pursued by the growing number of high quality applications for Vehicular Ad hoc NETworks(VANETs), e.g., the live road surveillance service and the video-based overtaking assistant service. For the highly dynamical vehicular network topology, beacon-less routing protocols have been proven to be efficient in achieving a balance between the system performance and the control overhead. However, to the authors’ best knowledge, the routing design for large volume content has not been well considered in the previous work, which will introduce new challenges, e.g., the enhanced connectivity requirement for a radio link. In this paper, a link Lifetime-aware Beacon-less Routing Protocol (LBRP) is designed for large volume content delivery in VANETs. Each vehicle makes the forwarding decision based on the message header information and its current state, including the speed and position information. A semi-Markov process analytical model is proposed to evaluate the expected delay in constructing one routing path for LBRP. Simulations show that the proposed LBRP scheme outperforms the traditional dissemination protocols in providing a low end-to-end delay. The analytical model is shown to exhibit a good match on the delay estimation with Monte Carlo simulations, as well. PMID:27809285

The feasibility of using Patients Concerns Inventory (PCI) in managing Malaysian oral cancer patients.

PubMed

Hatta, J M M; Doss, J G; Rogers, S N

2014-02-01

The feasibility of using the Patients Concerns Inventory (PCI) to identify oral cancer patient concerns during consultation in oral and maxillofacial specialist clinics in Malaysia was assessed. A cross-sectional study was conducted using a consecutive clinical sampling technique of all new and follow-up oral cancer patients. Surgeons and counter staff were also recruited. Two-thirds of patients were elderly, 63.9% female, 55.6% Indian, 63.9% of lower-level education, and half had the lowest level household income. Patient status was mostly post-treatment (87.5%) and most were at cancer stage III/IV (63.9%); 59.7% had surgery. Patients took an average 5.9 min (95% CI 5.1-6.7 min) to complete the PCI. Physical domain appeared highest (94.4%); social/family relationship issues (4.2%) were lowest. Significant associations included patient age-personal function (P=0.02); patient education level-emotional status (P=0.05) and social/family relationship issues (P=0.04), and patient TNM staging-personal function (P=0.03). The patients' mean feasibility score for the PCI was 5.3 (95% CI 5.1-5.5) out of 6. Patients (93.1%) and surgeons (90%) found the PCI to be feasible. Only 57.1% of counter staff agreed on the use of the PCI during patient registration. Overall, the PCI was considered feasible, thus favouring its future use in routine oral cancer patient management. Copyright © 2013. Published by Elsevier Ltd.

The impact of a 600-mg loading dose of clopidogrel in diabetic and non-diabetic patients undergoing elective PCI.

PubMed

Mohareb, Mina W; Abd Elghany, Mohamed; Sabry, Nirmeen A; Farid, Samar F

2016-08-01

High platelet reactivity (HPR) and suboptimal response to dual antiplatelet therapy (DAPT) may explain high recurrent rates of ischemic events in type 1 and 2 diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to determine the effect of diabetes mellitus on clopidogrel activity in cardiac patients undergoing PCI. This is an observational study. Patients were categorized according to DM status into diabetic group (N.=30) and non-diabetic group (N.=33). All patients received clopidogrel in a loading dose of 600 mg before PCI. Platelet function was assessed using light transmittance aggregometry (LTA) technique at baseline (before clopidogrel administration), 24 hour after clopidogrel loading dose administration and 7-10 days after PCI. All patients were followed up for at least one year after PCI for recurrence of acute cardiac events. There was no statistically significant difference between the two groups with respect to 10 µm adenosine diphosphate (ADP)-induced platelet aggregation measured at baseline (P=0.64), 24 hours after PCI (P=0.874), and 7-10 days after PCI (0.643). Diabetics were not significantly different from non-diabetics in terms of post-PCI acute stent thrombosis (P=0.945), sub-acute stent thrombosis (P=0.945), unstable angina (P=0.29) and cardiac death (P=0.64). There was a statistically significant difference between patients with and without post-PCI acute events regarding ADP aggregation measured 24 hours and 7-10 days after PCI. The use of a high loading dose of clopidogrel (600 mg) in patients undergoing elective PCI can overcome the significant increase in post-PCI platelet aggregation and rate of acute cardiac events induced by diabetes mellitus as co-morbidity in those patients.

Nonemergency PCI at hospitals with or without on-site cardiac surgery.

PubMed

Jacobs, Alice K; Normand, Sharon-Lise T; Massaro, Joseph M; Cutlip, Donald E; Carrozza, Joseph P; Marks, Anthony D; Murphy, Nancy; Romm, Iyah K; Biondolillo, Madeleine; Mauri, Laura

2013-04-18

Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain. We enrolled patients with indications for nonemergency PCI who presented at hospitals in Massachusetts without on-site cardiac surgery and randomly assigned these patients, in a 3:1 ratio, to undergo PCI at that hospital or at a partner hospital that had cardiac surgery services available. A total of 10 hospitals without on-site cardiac surgery and 7 with on-site cardiac surgery participated. The coprimary end points were the rates of major adverse cardiac events--a composite of death, myocardial infarction, repeat revascularization, or stroke--at 30 days (safety end point) and at 12 months (effectiveness end point). The primary end points were analyzed according to the intention-to-treat principle and were tested with the use of multiplicative noninferiority margins of 1.5 (for safety) and 1.3 (for effectiveness). A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point. Nonemergency PCI procedures performed at hospitals in Massachusetts without on-site surgical services were noninferior to procedures performed at hospitals

The Kuroshio Extension low-frequency variability analyzed with altimeter data through an ad hoc composite index

NASA Astrophysics Data System (ADS)

Pierini, Stefano; Gentile, Vittorio; de Ruggiero, Paola; Pietranera, Luca

2017-04-01

The Kuroshio Extension (KE) low-frequency variability (LFV) is analyzed with the satellite altimeter data distributed by AVISO from January 1993 to November 2015 through a new ad hoc composite index [1] that links the mean latitudinal position L of the KE jet and an integrated wavelet amplitude A measuring the high-frequency variability (HFV) of the KE path. This approach allows one to follow the KE evolution as an orbit in the (L,A) plane, as typically done in dynamical systems theory. Three intervals, I1 (1993-1998), I2 (1998-2006) and I3 (2006-November 2015) are separately analyzed also with sea surface height (SSH) maps. In I1 and I3, L and A are mostly anti-correlated and a recharging phase (characterized by a weak convoluted jet experiencing a rapid increase of the HFV) begins when negative SSH anomalies, remotely generated by the Pacific Decadal Oscillation, reach the KE region. On the other hand, in I2 the KE evolution is described by a hysteresis loop: this starts with a weak jet state followed by a recharging phase leading, in turn, to a persistent two-meander state, to its progressive and rapid erosion and, eventually, to the reestablishment of a weak jet state. This loop is found to correspond quite closely to the highly nonlinear intrinsic relaxation oscillation obtained in numerical process studies [1,2]. This supports the hypothesis that the KE LFV may have been controlled, during I2, by an intrinsic oceanic mode of variability. [1] Pierini S., 2015. J. Climate, 28, 5873-5881. [2] Pierini S., 2006. J. Phys. Oceanogr., 36, 1605-1625.

Myocardial Revascularization in New York State: Variations in the PCI-to-CABG Ratio and Their Implications

PubMed Central

Ko, Wilson; Tranbaugh, Robert; Marmur, Jonathan D.; Supino, Phyllis G.; Borer, Jeffrey S.

2012-01-01

Background During the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions. Methods and Results We reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were −40%, −20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: −61%, −23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher. Conclusions There are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence

Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes.

PubMed

Uddin, Muezz; Bundhoo, Shantu; Mitra, Rito; Ossei-Gerning, Nicholas; Morris, Keith; Anderson, Richard; Kinnaird, Tim

2015-10-01

Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF. The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions. A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P < 0.0001) and at 1 year (37.6% vs 5.0%, P < 0.0001). Shock and MB were highly predictive of 30 day and 12 month mortality. In a default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group. © 2015, Wiley Periodicals, Inc.

Hearings before the Ad Hoc Committee on Maritime Education and Training of the Committee on Merchant Marine and Fisheries, Ninety-Third Congress; Second Session on Officer Requirements, and Session on Maritime Education Regarding Safety at Sea. Serial No. 93-44.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Merchant Marine and Fisheries.

The publication consists of Congressional hearings before the Ad Hoc Committee on Maritime Education and Training: (1) June 26, 1974 hearing pertaining to officer requirements and (2) November 19, 1974 hearing on maritime education regarding safety at sea. Estimated cost per graduate for the U. S. Merchant Marine 1973 class was $31,100. Supply and…

Protein C Inhibitor (PCI) Binds to Phosphatidylserine Exposing Cells with Implications in the Phagocytosis of Apoptotic Cells and Activated Platelets

PubMed Central

Rieger, Daniela; Assinger, Alice; Einfinger, Katrin; Sokolikova, Barbora; Geiger, Margarethe

2014-01-01

Protein C Inhibitor (PCI) is a secreted serine protease inhibitor, belonging to the family of serpins. In addition to activated protein C PCI inactivates several other proteases of the coagulation and fibrinolytic systems, suggesting a regulatory role in hemostasis. Glycosaminoglycans and certain negatively charged phospholipids, like phosphatidylserine, bind to PCI and modulate its activity. Phosphatidylerine (PS) is exposed on the surface of apoptotic cells and known as a phagocytosis marker. We hypothesized that PCI might bind to PS exposed on apoptotic cells and thereby influence their removal by phagocytosis. Using Jurkat T-lymphocytes and U937 myeloid cells, we show here that PCI binds to apoptotic cells to a similar extent at the same sites as Annexin V, but in a different manner as compared to live cells (defined spots on ∼10–30% of cells). PCI dose dependently decreased phagocytosis of apoptotic Jurkat cells by U937 macrophages. Moreover, the phagocytosis of PS exposing, activated platelets by human blood derived monocytes declined in the presence of PCI. In U937 cells the expression of PCI as well as the surface binding of PCI increased with time of phorbol ester treatment/macrophage differentiation. The results of this study suggest a role of PCI not only for the function and/or maturation of macrophages, but also as a negative regulator of apoptotic cell and activated platelets removal. PMID:25000564

PCI-24781 can improve in vitro and in vivo developmental capacity of pig somatic cell nuclear transfer embryos.

PubMed

Jin, Long; Zhu, Hai-Ying; Guo, Qing; Li, Xiao-Chen; Zhang, Yu-Chen; Zhang, Guang-Lei; Xing, Xiao-Xu; Xuan, Mei-Fu; Luo, Qi-Rong; Yin, Xi-Jun; Kang, Jin-Dan

2016-09-01

To examine the effect of PCI-24781 (abexinostat) on the blastocyst formation rate in pig somatic cell nuclear transferred (SCNT) embryos and acetylation levels of the histone H3 lysine 9 and histone H4 lysine 12. Treatment with 0.5 nM PCI-24781 for 6 h significantly improved the development of cloned embryos, in comparison to the control group (25.3 vs. 10.5 %, P < 0.05). Furthermore, PCI-24781 treatment led to elevated acetylation of H3K9 and H4K12. TUNEL assay and Hoechst 33342 staining revealed that the percentage of apoptotic cells in blastocysts was significantly lower in PCI-24781-treated SCNT embryos than in untreated embryos. Also, PCI-24781-treated embryos were transferred into three surrogate sows, one of whom became pregnant and two fetuses developed. PCI-24781 improves nuclear reprogramming and the developmental potential of pig SCNT embryos.

Prophylactic Cranial Irradiation (PCI) versus Active MRI Surveillance for Small Cell Lung Cancer: The Case for Equipoise.

PubMed

Rusthoven, Chad G; Kavanagh, Brian D

2017-12-01

Prophylactic cranial irradiation (PCI) for SCLC offers a consistent reduction in the incidence of brain metastases at the cost of measurable toxicity to neurocognitive function and quality of life, in the setting of characteristic pathologic changes to the brain. The sequelae of PCI have historically been justified by the perception of an overall survival advantage specific to SCLC. This rationale has now been challenged by a randomized trial in extensive-stage SCLC demonstrating equivalent progression-free survival and a trend toward improved overall survival with PCI omission in the context of modern magnetic resonance imaging (MRI) staging and surveillance. In this article, we critically examine the randomized trials of PCI in extensive-stage SCLC and discuss their implications on the historical data supporting PCI for limited-stage SCLC from the pre-MRI era. Further, we review the toxicity of moderate doses of radiation to the entire brain that underlie the growing interest in active MRI surveillance and PCI omission. Finally, the evidence supporting prospective investigation of radiosurgery for limited brain metastases in SCLC is reviewed. Overall, our aim is to provide an evidence-based assessment of the debate over PCI versus active MRI surveillance and to highlight the need for contemporary trials evaluating optimal central nervous system management in SCLC. Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Fuzzy Logic-based Intelligent Scheme for Enhancing QoS of Vertical Handover Decision in Vehicular Ad-hoc Networks

NASA Astrophysics Data System (ADS)

Azzali, F.; Ghazali, O.; Omar, M. H.

2017-08-01

The design of next generation networks in various technologies under the “Anywhere, Anytime” paradigm offers seamless connectivity across different coverage. A conventional algorithm such as RSSThreshold algorithm, that only uses the received strength signal (RSS) as a metric, will decrease handover performance regarding handover latency, delay, packet loss, and handover failure probability. Moreover, the RSS-based algorithm is only suitable for horizontal handover decision to examine the quality of service (QoS) compared to the vertical handover decision in advanced technologies. In the next generation network, vertical handover can be started based on the user’s convenience or choice rather than connectivity reasons. This study proposes a vertical handover decision algorithm that uses a Fuzzy Logic (FL) algorithm, to increase QoS performance in heterogeneous vehicular ad-hoc networks (VANET). The study uses network simulator 2.29 (NS 2.29) along with the mobility traffic network and generator to implement simulation scenarios and topologies. This helps the simulation to achieve a realistic VANET mobility scenario. The required analysis on the performance of QoS in the vertical handover can thus be conducted. The proposed Fuzzy Logic algorithm shows improvement over the conventional algorithm (RSSThreshold) in the average percentage of handover QoS whereby it achieves 20%, 21% and 13% improvement on handover latency, delay, and packet loss respectively. This is achieved through triggering a process in layer two and three that enhances the handover performance.

Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.

PubMed

Lupi, Alessandro; Schaffer, Alon; Lazzero, Maurizio; Tessitori, Massimo; De Martino, Leonardo; Rognoni, Andrea; Bongo, Angelo S; Porto, Italo

2016-12-01

Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion. We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint. The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups. In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

Lentiviral haemopoietic stem-cell gene therapy in early-onset metachromatic leukodystrophy: an ad-hoc analysis of a non-randomised, open-label, phase 1/2 trial.

PubMed

Sessa, Maria; Lorioli, Laura; Fumagalli, Francesca; Acquati, Serena; Redaelli, Daniela; Baldoli, Cristina; Canale, Sabrina; Lopez, Ignazio D; Morena, Francesco; Calabria, Andrea; Fiori, Rossana; Silvani, Paolo; Rancoita, Paola M V; Gabaldo, Michela; Benedicenti, Fabrizio; Antonioli, Gigliola; Assanelli, Andrea; Cicalese, Maria Pia; Del Carro, Ubaldo; Sora, Maria Grazia Natali; Martino, Sabata; Quattrini, Angelo; Montini, Eugenio; Di Serio, Clelia; Ciceri, Fabio; Roncarolo, Maria Grazia; Aiuti, Alessandro; Naldini, Luigi; Biffi, Alessandra

2016-07-30

Metachromatic leukodystrophy (a deficiency of arylsulfatase A [ARSA]) is a fatal demyelinating lysosomal disease with no approved treatment. We aimed to assess the long-term outcomes in a cohort of patients with early-onset metachromatic leukodystrophy who underwent haemopoietic stem-cell gene therapy (HSC-GT). This is an ad-hoc analysis of data from an ongoing, non-randomised, open-label, single-arm phase 1/2 trial, in which we enrolled patients with a molecular and biochemical diagnosis of metachromatic leukodystrophy (presymptomatic late-infantile or early-juvenile disease or early-symptomatic early-juvenile disease) at the Paediatric Clinical Research Unit, Ospedale San Raffaele, in Milan. Trial participants received HSC-GT, which consisted of the infusion of autologous HSCs transduced with a lentiviral vector encoding ARSA cDNA, after exposure-targeted busulfan conditioning. The primary endpoints of the trial are safety (toxicity, absence of engraftment failure or delayed haematological reconstitution, and safety of lentiviral vector-tranduced cell infusion) and efficacy (improvement in Gross Motor Function Measure [GMFM] score relative to untreated historical controls, and ARSA activity, 24 months post-treatment) of HSC-GT. For this ad-hoc analysis, we assessed safety and efficacy outcomes in all patients who had received treatment and been followed up for at least 18 months post-treatment on June 1, 2015. This trial is registered with ClinicalTrials.gov, number NCT01560182. Between April, 2010, and February, 2013, we had enrolled nine children with a diagnosis of early-onset disease (six had late-infantile disease, two had early-juvenile disease, and one had early-onset disease that could not be definitively classified). At the time of analysis all children had survived, with a median follow-up of 36 months (range 18-54). The most commonly reported adverse events were cytopenia (reported in all patients) and mucositis of different grades of severity (in five

Delay From First Medical Contact to Primary PCI and All‐Cause Mortality: A Nationwide Study of Patients With ST‐Elevation Myocardial Infarction

PubMed Central

Koul, Sasha; Andell, Pontus; Martinsson, Andreas; Gustav Smith, J.; van der Pals, Jesper; Scherstén, Fredrik; Jernberg, Tomas; Lagerqvist, Bo; Erlinge, David

2014-01-01

Background Early reperfusion in the setting of an ST‐elevation myocardial infarction (STEMI) is of utmost importance. However, the effects of early versus late reperfusion in this patient group undergoing primary percutaneous coronary intervention (PCI) have so far been inconsistent in previous studies. The purpose of this study was to evaluate in a nationwide cohort the effects of delay from first medical contact to PCI (first medical contact [FMC]‐to‐PCI) and secondarily delay from symptom‐to‐PCI on clinical outcomes. Methods and Results Using the national Swedish Coronary Angiography and Angioplasty Register (SCAAR) registry, STEMI patients undergoing primary PCI between the years 2003 and 2008 were screened for. A total of 13 790 patients were included in the FMC‐to‐PCI analysis and 11 489 patients were included in the symptom‐to‐PCI analyses. Unadjusted as well as multivariable analyses showed an overall significant association between increasing FMC‐to‐PCI delay and 1‐year mortality. A statistically significant increase in mortality was noted at FMC‐to‐PCI delays exceeding 1 hour in an incremental fashion. FMC‐to‐PCI delays in excess of 1 hour were also significantly associated with an increase in severe left ventricular dysfunction at discharge. An overall significant association between increasing symptom‐to‐PCI delays and 1‐year mortality was noted. However, when stratified into time delay cohorts, no symptom‐to‐PCI delay except for the highest time delay showed a statistically significant association with increased mortality. Conclusions Delays in FMC‐to‐PCI were strongly associated with increased mortality already at delays of more than 1 hour, possibly through an increase in severe heart failure. A goal of FMC‐to‐PCI of less than 1 hour might save patient lives. PMID:24595190

B-type Natriuretic Peptide and RISK-PCI Score in the Risk Assessment in Patients with STEMI Treated by Primary Percutaneous Coronary Intervention.

PubMed

Asanin, Milika; Mrdovic, Igor; Savic, Lidija; Matic, Dragan; Krljanac, Gordana; Vukcevic, Vladan; Orlic, Dejan; Stankovic, Goran; Marinkovic, Jelena; Stankovic, Sanja

2016-01-01

RISK-PCI score is a novel score for risk stratification of patients with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). The aim of this study was to evaluate the role of B-type natriuretic peptide (BNP) and the RISK-PCI score for early risk assessment in patients with STEMI treated by pPCI. In 120 patients with STEMI treated by pPCI, BNP was measured on admission before pPCI. The primary end point was 30-day mortality. The ROC curve analysis revealed that the most powerful predictive factors of 30-day mortality were the plasma level of BNP ≥ 206.6 pg/mL with the sensitivity of 75% and specificity of 87.5% and the RISK-PCI score ≥ 5.25 with the sensitivity of 75% and specificity of 85.7%. Thirty-day mortality was 6.7%. After multivariate adjustment, admission BNP (≥ 206.6 pg/mL) (OR 2.952, 95% CI 1.072 - 8.133, p = 0.036) and the RISK-PCI score (≥ 5.25) (OR 2.284, 95% CI 1.140-4.578, p = 0.020) were independent predictors of 30-day mortality. The area under the ROC curve using the RISK-PCI score and BNP to detect mortality was 0.828 (p = 0.002) and 0.903 (p < 0.001), respectively. Addition of BNP to RISK-PCI score increased the area under the ROC to 0.949 (p < 0.001), but this increase measured by the c-statistic was not significant (p = 0.107). Furthermore, the significant improvement in risk reclassification (p < 0.001) and the integrated discrimination index (p = 0.042) were observed with the addition of BNP to RISK-PCI score for 30-day mortality. BNP on admission and the RISK-PCI score were the independent predictors of 30-day mortality in patients with the STEMI treated by pPCI. BNP in combination with the RISK-PCI score showed the way to more accurate risk assessment in patients with STEMI treated by pPCI.

RAD51 potentiates synergistic effects of chemotherapy with PCI-24781 and cis-diamminedichloroplatinum on gastric cancer

PubMed Central

He, Wei-Ling; Li, Yu-Huang; Hou, Wei-Jian; Ke, Zun-Fu; Chen, Xin-Lin; Lu, Li-Ya; Cai, Shi-Rong; Song, Wu; Zhang, Chang-Hua; He, Yu-Long

2014-01-01

AIM: To explore the efficacy of PCI-24781, a broad-spectrum, hydroxamic acid-derived histone deacetylase inhibitor, in the treatment of gastric cancer (GC). METHODS: With or without treatment of PCI-24781 and/or cis-diamminedichloroplatinum (CDDP), GC cell lines were subjected to functional analysis, including cell growth, apoptosis and clonogenic assays. Chromatin immunoprecipitation and luciferase reporter assays were used to determine the interacting molecules and the activity of the enzyme. An in vivo study was carried out in GC xenograft mice. Cell culture-based assays were represented as mean ± SD. ANOVA tests were used to assess differences across groups. All pairwise comparisons between tumor weights among treatment groups were made using the Tukey-Kramer method for multiple comparison adjustment to control experimental-wise type I error rates. Significance was set at P < 0.05. RESULTS: PCI-24781 significantly reduced the growth of the GC cells, enhanced cell apoptosis and suppressed clonogenicity, and these effects synergized with the effects of CDDP. PCI-24781 modulated the cell cycle and significantly reduced the expression of RAD51, which is related to homologous recombination. Depletion of RAD51 augmented the biological functions of PCI-24781, CDDP and the combination treatment, whereas overexpressing RAD51 had the opposite effects. Increased binding of the transcription suppressor E2F4 on the RAD51 promoter appeared to play a major role in these processes. Furthermore, significant suppression of tumor growth and weight in vivo was obtained following PCI-24781 treatment, which synergized with the anticancer effect of CDDP. CONCLUSION: These data suggest that RAD51 potentiates the synergistic effects of chemotherapy with PCI-24781 and CDDP on GC. PMID:25110436

The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI.

PubMed

Kaymaz, Cihangir; Keleş, Nurşen; Özdemir, Nihal; Tanboğa, İbrahim Halil; Demircan, Hacer C; Can, Mehmet M; Koca, Fatih; İzgi, İbrahim Akın; Özkan, Alper; Türkmen, Muhsin; Kırma, Cevat; Esen, Ali M

2015-11-01

The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation. A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 µg/kg) was followed by infusion (0.15 µg/kg/min) for a mean (SD) duration of 22.4±6.8 hours. The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban. Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.

Angiographic and Clinical Impact of Successful Manual Thrombus Aspiration in Diabetic Patients Undergoing Primary PCI

PubMed Central

2014-01-01

Background. Diabetes mellitus is associated with worse angiographic and clinical outcomes after percutaneous coronary intervention (PCI). Aim. To investigate the impact of manual thrombus aspiration on in-stent restenosis (ISR) and clinical outcome in patients treated by bare-metal stent (BMS) implantation for ST-segment elevation myocardial infarction (STEMI). Methods. 100 diabetic patients were prospectively enrolled. They were randomly assigned to undergo either standard primary PCI (group A, 50 patients) or PCI with thrombus aspiration using Export catheter (group B, 50 patients). The primary endpoint was the rate of eight-month ISR. The secondary endpoint included follow-up for major adverse cardiac events (MACE). Results. Mean age of the study cohort was 59.86 ± 8.3 years, with 64 (64%) being males. Baseline characteristics did not differ between both groups. Eight-month angiogram showed that group B patients had significantly less late lumen loss (0.17 ± 0.35 versus 0.60 ± 0.42 mm, P < 0.001), with lower incidence of ISR (4% versus 16.6%, P < 0.001). There was a trend towards lower rate of MACE in the same group of patients. Conclusion. In diabetic patients undergoing primary PCI, manual thrombus aspiration (compared with standard PCI) was associated with better ISR rate after BMS implantation. PMID:24804102

Time-recovering PCI-AER interface for bio-inspired spiking systems

NASA Astrophysics Data System (ADS)

Paz-Vicente, R.; Linares-Barranco, A.; Cascado, D.; Vicente, S.; Jimenez, G.; Civit, A.

2005-06-01

Address Event Representation (AER) is an emergent neuromorphic interchip communication protocol that allows for real-time virtual massive connectivity between huge number neurons located on different chips. By exploiting high speed digital communication circuits (with nano-seconds timings), synaptic neural connections can be time multiplexed, while neural activity signals (with mili-seconds timings) are sampled at low frequencies. Also, neurons generate 'events' according to their activity levels. More active neurons generate more events per unit time, and access the interchip communication channel more frequently, while neurons with low activity consume less communication bandwidth. When building multi-chip muti-layered AER systems it is absolutely necessary to have a computer interface that allows (a) to read AER interchip traffic into the computer and visualize it on screen, and (b) inject a sequence of events at some point of the AER structure. This is necessary for testing and debugging complex AER systems. This paper presents a PCI to AER interface, that dispatches a sequence of events received from the PCI bus with embedded timing information to establish when each event will be delivered. A set of specialized states machines has been introduced to recovery the possible time delays introduced by the asynchronous AER bus. On the input channel, the interface capture events assigning a timestamp and delivers them through the PCI bus to MATLAB applications. It has been implemented in real time hardware using VHDL and it has been tested in a PCI-AER board, developed by authors, that includes a Spartan II 200 FPGA. The demonstration hardware is currently capable to send and receive events at a peak rate of 8,3 Mev/sec, and a typical rate of 1 Mev/sec.

Study on ultra-fast single photon counting spectrometer based on PCI

NASA Astrophysics Data System (ADS)

Zhang, Xi-feng

2010-10-01

The time-correlated single photon counting spectrometer developed uses PCI bus technology. We developed the ultrafast data acquisition card based on PCI, replace multi-channel analyzer primary. The system theory and design of the spectrometer are presented in detail, and the process of operation is introduced with the integration of the system. Many standard samples have been measured and the data have been analyzed and contrasted. Experimental results show that the spectrometer, s sensitive is single photon counting, and fluorescence life-span and time resolution is picosecond level. And the instrument could measure time-resolved spectroscopy.

Insights into the Proton Transfer Mechanism of a Bilin Reductase PcyA Following Neutron Crystallography.

PubMed

Unno, Masaki; Ishikawa-Suto, Kumiko; Kusaka, Katsuhiro; Tamada, Taro; Hagiwara, Yoshinori; Sugishima, Masakazu; Wada, Kei; Yamada, Taro; Tomoyori, Katsuaki; Hosoya, Takaaki; Tanaka, Ichiro; Niimura, Nobuo; Kuroki, Ryota; Inaka, Koji; Ishihara, Makiko; Fukuyama, Keiichi

2015-04-29

Phycocyanobilin, a light-harvesting and photoreceptor pigment in higher plants, algae, and cyanobacteria, is synthesized from biliverdin IXα (BV) by phycocyanobilin:ferredoxin oxidoreductase (PcyA) via two steps of two-proton-coupled two-electron reduction. We determined the neutron structure of PcyA from cyanobacteria complexed with BV, revealing the exact location of the hydrogen atoms involved in catalysis. Notably, approximately half of the BV bound to PcyA was BVH(+), a state in which all four pyrrole nitrogen atoms were protonated. The protonation states of BV complemented the protonation of adjacent Asp105. The "axial" water molecule that interacts with the neutral pyrrole nitrogen of the A-ring was identified. His88 Nδ was protonated to form a hydrogen bond with the lactam O atom of the BV A-ring. His88 and His74 were linked by hydrogen bonds via H3O(+). These results imply that Asp105, His88, and the axial water molecule contribute to proton transfer during PcyA catalysis.

Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX.

PubMed

Milojevic, Milan; Head, Stuart J; Parasca, Catalina A; Serruys, Patrick W; Mohr, Friedrich W; Morice, Marie-Claude; Mack, Michael J; Ståhle, Elisabeth; Feldman, Ted E; Dawkins, Keith D; Colombo, Antonio; Kappetein, A Pieter; Holmes, David R

2016-01-05

There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI). The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients. An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths. In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores. During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI

Immediate multivessel percutaneous coronary intervention versus culprit lesion intervention in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry.

PubMed

Zeymer, Uwe; Hochadel, Mathias; Thiele, Holger; Andresen, Dietrich; Schühlen, Helmut; Brachmann, Johannes; Elsässer, Albrecht; Gitt, Anselm; Zahn, Ralf

2015-07-01

Current guidelines recommend immediate multivessel percutaneous coronary intervention (PCI) in patients with cardiogenic shock, despite the lack of randomised trials. We sought to investigate the use and impact on outcome of multivessel PCI in current practice in cardiogenic shock in Germany. Between January 2008 and December 2011 a total of 735 consecutive patients with acute myocardial infarction, cardiogenic shock and multivessel coronary artery disease underwent immediate PCI in 41 hospitals in Germany. Of these, 173 (23.5%) patients were treated with immediate multivessel PCI. The acute success of PCI with respect to TIMI 3 flow did not differ between the groups (82.5% versus 79.6%). In-hospital mortality with multivessel PCI and culprit lesion PCI was 46.8% and 35.8%, respectively. In multivariate analysis multivessel PCI was associated with an increased mortality (odds ratio 1.5; 95% confidence interval 1.15-1.84). In current clinical practice in Germany multivessel PCI is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed an adverse effect of immediate multivessel PCI. Therefore, a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock.

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis.

PubMed

Ye, Ziliang; Su, Qiang; Li, Lang

2017-03-21

Many scholars have studied the effect of nicorandil on perioperative myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI), but results are inconsistent. Therefore, we performed this meta-analysis. Finally, 16 articles, including 1616 patients, were included into this meta-analysis. Meta-analysis results showed that: (1) Nicorandil can reduce the level of CK-MB after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (2) Nicorandil can reduce the level of TnT after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (3) Nicorandil can reduce the incidence of adverse reactions after PCI. (4) Nicorandil cannot reduce the level of MVP after PCI, including at 12 hours and 24 hours. (5) Subgroup analysis showed that nicorandil can reduce CK-MB and TnT level at 24 hours after PCI for Chinese's population (P < 0.05), but can not reduce CK-MB and TnT level at 24 hours after PCI for non Chinese's population (P > 0.05). Our meta-analysis indicate that nicorandil can reduce myocardial injury and reduce the incidence of adverse reaction caused by PCI for Chinese's population, but is not obvious for non Chinese's population. However, this conclusion still needs to be confirmed in the future.

Ad Hoc Influenza Vaccination During Years of Significant Antigenic Drift in a Tropical City With 2 Seasonal Peaks: A Cross-Sectional Survey Among Health Care Practitioners.

PubMed

Wong, Martin C S; Nelson, E Anthony S; Leung, Czarina; Lee, Nelson; Chan, Martin C W; Choi, Kin Wing; Rainer, Timothy H; Cheng, Frankie W T; Wong, Samuel Y S; Lai, Christopher K C; Lam, Bosco; Cheung, Tak Hong; Leung, Ting Fan; Chan, Paul K S

2016-05-01

We evaluated the acceptability of an additional ad hoc influenza vaccination among the health care professionals following seasons with significant antigenic drift.Self-administered, anonymous surveys were performed by hard copy questionnaires in public hospitals, and by an on-line platform available to all healthcare professionals, from April 1st to May 31st, 2015. A total of 1290 healthcare professionals completed the questionnaires, including doctors, nurses, and allied health professionals working in both the public and private systems.Only 31.8% of participating respondents expressed an intention to receive the additional vaccine, despite that the majority of them agreed or strongly agreed that it would bring benefit to the community (88.9%), save lives (86.7%), reduce medical expenses (76.3%), satisfy public expectation (82.8%), and increase awareness of vaccination (86.1%). However, a significant proportion expressed concern that the vaccine could disturb the normal immunization schedule (45.5%); felt uncertain what to do in the next vaccination round (66.0%); perceived that the summer peak might not occur (48.2%); and believed that the summer peak might not be of the same virus (83.5%). Furthermore, 27.8% of all respondents expected that the additional vaccination could weaken the efficacy of previous vaccinations; 51.3% was concerned about side effects; and 61.3% estimated that there would be a low uptake rate. If the supply of vaccine was limited, higher priority groups were considered to include the elderly aged ≥65 years with chronic medical conditions (89.2%), the elderly living in residential care homes (87.4%), and long-stay residents of institutions for the disabled (80.7%). The strongest factors associated with accepting the additional vaccine included immunization with influenza vaccines in the past 3 years, higher perceived risk of contracting influenza, and higher perceived severity of the disease impact.The acceptability to an additional ad

The Bruton tyrosine kinase inhibitor PCI-32765 thwarts chronic lymphocytic leukemia cell survival and tissue homing in vitro and in vivo

PubMed Central

Ponader, Sabine; Chen, Shih-Shih; Buggy, Joseph J.; Balakrishnan, Kumudha; Gandhi, Varsha; Wierda, William G.; Keating, Michael J.; O'Brien, Susan; Chiorazzi, Nicholas

2012-01-01

B-cell receptor (BCR) signaling is a critical pathway in the pathogenesis of several B-cell malignancies, including chronic lymphocytic leukemia (CLL), and can be targeted by inhibitors of BCR-associated kinases, such as Bruton tyrosine kinase (Btk). PCI-32765, a selective, irreversible Btk inhibitor, is a novel, molecularly targeted agent for patients with B-cell malignancies, and is particularly active in patients with CLL. In this study, we analyzed the mechanism of action of PCI-32765 in CLL, using in vitro and in vivo models, and performed correlative studies on specimens from patients receiving therapy with PCI-32765. PCI-32765 significantly inhibited CLL cell survival, DNA synthesis, and migration in response to tissue homing chemokines (CXCL12, CXCL13). PCI-32765 also down-regulated secretion of BCR-dependent chemokines (CCL3, CCL4) by the CLL cells, both in vitro and in vivo. In an adoptive transfer TCL1 mouse model of CLL, PCI-32765 affected disease progression. In this model, PCI-32765 caused a transient early lymphocytosis, and profoundly inhibited CLL progression, as assessed by weight, development, and extent of hepatospenomegaly, and survival. Our data demonstrate that PCI-32765 effectively inhibits CLL cell migration and survival, possibly explaining some of the characteristic clinical activity of this new targeted agent. PMID:22180443

Infrared spectra of two isomers of protonated carbonyl sulfide (HOCS+ and HSCO+) and t-HOCS in solid para-hydrogen.

PubMed

Tsuge, Masashi; Lee, Yuan-Pern

2016-10-28

We report infrared (IR) spectra of HOCS + , HSCO + , t-HOCS, and other species produced on electron bombardment of a mixture of carbonyl sulfide (OCS) and para-hydrogen (p-H 2 ) during deposition at 3.2 K. After maintenance of the matrix in darkness for 15 h, the intensities of absorption features of HOCS + at 2945.9 (ν 1 ), 1875.3 (ν 2 ), and 1041.9 (ν 3 ) cm -1 and those of HSCO + at 2506.9 (ν 1 ) and 2074.2 (ν 2 ) cm -1 decreased through neutralization with trapped electrons. Lines observed at 3563.4, 1394.8, and 1199.0 cm -1 , which decreased slightly in intensity after maintenance in darkness and were nearly depleted after irradiation at 373 nm, are assigned to a t-HOCS radical. The corresponding spectra of their 13 C- and D-isotopologues were observed. The IR spectra of HSCO + and t-HOCS and those of modes ν 2 and ν 3 of HOCS + are new. The assignments were made according to the expected chemical behavior and a comparison of experimental and calculated wavenumbers and 13 C- and D-isotopic shifts. The wavenumber of the OH stretching mode (2945.9 cm -1 ) of HOCS + in solid p-H 2 is significantly red-shifted from that (3435.16 cm -1 ) reported for gaseous HOCS + ; this shift is attributed to partial sharing of a proton between OCS and H 2 . The corresponding p-H 2 induced shift is small in HSCO + because of a much weaker interaction between HSCO + and H 2 .

RuvBL2 Is Involved in Histone Deacetylase Inhibitor PCI-24781-Induced Cell Death in SK-N-DZ Neuroblastoma Cells

PubMed Central

Zhan, Qinglei; Tsai, Sauna; Lu, Yonghai; Wang, Chunmei; Kwan, Yiuwa; Ngai, Saiming

2013-01-01

Neuroblastoma is the second most common solid tumor diagnosed during infancy. The survival rate among children with high-risk neuroblastoma is less than 40%, highlighting the urgent needs for new treatment strategies. PCI-24781 is a novel hydroxamic acid-based histone deacetylase (HDAC) inhibitor that has high efficacy and safety for cancer treatment. However, the underlying mechanisms of PCI-24781 are not clearly elucidated in neuroblastoma cells. In the present study, we demonstrated that PCI-24781 treatment significantly inhibited tumor growth at very low doses in neuroblastoma cells SK-N-DZ, not in normal cell line HS-68. However, PCI-24781 caused the accumulation of acetylated histone H3 both in SK-N-DZ and HS-68 cell line. Treatment of SK-N-DZ with PCI-24781 also induced cell cycle arrest in G2/M phase and activated apoptosis signaling pathways via the up-regulation of DR4, p21, p53 and caspase 3. Further proteomic analysis revealed differential protein expression profiles between non-treated and PCI-24781 treated SK-N-DZ cells. Totally 42 differentially expressed proteins were identified by MALDI-TOF MS system. Western blotting confirmed the expression level of five candidate proteins including prohibitin, hHR23a, RuvBL2, TRAP1 and PDCD6IP. Selective knockdown of RuvBL2 rescued cells from PCI-24781-induced cell death, implying that RuvBL2 might play an important role in anti-tumor activity of PCI-24781 in SK-N-DZ cells. The present results provide a new insight into the potential mechanism of PCI-24781 in SK-N-DZ cell line. PMID:23977108

Evaluation of the safety and efficacy of an edoxaban-based antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: Rationale and design of the ENTRUST-AF PCI trial.

PubMed

Vranckx, Pascal; Lewalter, Thorsten; Valgimigli, Marco; Tijssen, Jan G; Reimitz, Paul-Egbert; Eckardt, Lars; Lanz, Hans-Joachim; Zierhut, Wolfgang; Smolnik, Rüdiger; Goette, Andreas

2018-02-01

The optimal antithrombotic treatment after percutaneous coronary intervention (PCI) with stenting in patients with atrial fibrillation (AF) is unknown. In the ENGAGE AF-TIMI 48 trial, edoxaban was noninferior to a vitamin K antagonist (VKA) with respect to the prevention of stroke or systemic embolism and was associated with significantly lower rates of bleeding and cardiovascular death in patients with nonvalvular AF. The effects of edoxaban in combination with single- or dual-antiplatelet therapy in the setting of PCI are unexplored. The ENTRUST-AF PCI trial is a multinational, multicenter, randomized, open-label phase 3b trial with blinded end point evaluation involving 1,500 patients on oral anticoagulation for AF. Patients are randomized between 4 hours and 5 days after successful PCI to either an edoxaban-based strategy (experimental arm; 60 mg [or 30 mg according to dose reduction criteria] once daily plus a P2Y 12 antagonist [default clopidogrel, 75 mg once daily] for 12 months) or a VKA-based strategy (control arm; VKA plus a P2Y 12 antagonist [as above] plus acetylsalicylic acid [100 mg once daily] for 30 days to 12 months). The primary safety end point is the incidence of International Society on Thrombosis and Haemostasis-defined major or clinically relevant nonmajor bleeding. The main efficacy end point is the composite of cardiovascular death, stroke, systemic embolic events, spontaneous myocardial infarction, and definite stent thrombosis. The ENTRUST-AF PCI trial tests the hypothesis that an edoxaban-based antithrombotic strategy reduces the risk of bleeding complications after PCI compared with VKA plus conventional dual-antiplatelet therapy in patients with AF in need of oral anticoagulation. The relative risk of ischemic events between groups will be compared. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

PCI Versus CABG in Patients With Type 1 Diabetes and Multivessel Disease.

PubMed

Nyström, Thomas; Sartipy, Ulrik; Franzén, Stefan; Eliasson, Björn; Gudbjörnsdottir, Soffia; Miftaraj, Mervete; Lagerqvist, Bo; Svensson, Ann-Marie; Holzmann, Martin J

2017-09-19

It is unknown if coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) may offer a survival benefit in patients with type 1 diabetes (T1D) in need of multivessel revascularization. This study sought to determine if patients with T1D and multivessel disease may benefit from CABG compared with PCI. In an observational cohort study, the authors included all patients with T1D who underwent a first multivessel revascularization in Sweden from 1995 to 2013. The authors used the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register, the Swedish National Diabetes Register, and the Swedish National Patient Register to retrieve information about patient characteristics and outcomes. They estimated hazard ratios (HRs) adjusted for confounders with 95% confidence intervals (CIs) for all-cause and coronary heart disease mortality, myocardial infarction, repeat revascularization, stroke, and heart failure using inverse probability of treatment weighting based on propensity scores. In total, 683 patients who underwent CABG and 1,863 patients who underwent PCI were included. During a mean follow-up of 10.6 years, 53% of patients in the CABG group and 45% in the PCI group died. PCI, compared with CABG, was associated with a similar risk of all-cause mortality (HR: 1.14; 95% CI: 0.99 to 1.32), but higher risks of death from coronary heart disease (HR: 1.45; 95% CI: 1.21 to 1.74), myocardial infarction (HR: 1.47; 95% CI: 1.23 to 1.78), and repeat revascularization (HR: 5.64; 95% CI: 4.67 to 6.82). No differences in risks of stroke or heart failure were found. Notwithstanding the inclusion of patients with T1D who might not have been able to undergo CABG in the PCI group we found that PCI, compared with CABG, was associated with higher rates and risks of coronary heart disease mortality, myocardial infarction, and repeat revascularizations. Our

Computational Fluid Dynamics (CFD) Modeling for High Rate Pulverized Coal Injection (PCI) into the Blast Furnace

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dr. Chenn Zhou

2008-10-15

Pulverized coal injection (PCI) into the blast furnace (BF) has been recognized as an effective way to decrease the coke and total energy consumption along with minimization of environmental impacts. However, increasing the amount of coal injected into the BF is currently limited by the lack of knowledge of some issues related to the process. It is therefore important to understand the complex physical and chemical phenomena in the PCI process. Due to the difficulty in attaining trus BF measurements, Computational fluid dynamics (CFD) modeling has been identified as a useful technology to provide such knowledge. CFD simulation is powerfulmore » for providing detailed information on flow properties and performing parametric studies for process design and optimization. In this project, comprehensive 3-D CFD models have been developed to simulate the PCI process under actual furnace conditions. These models provide raceway size and flow property distributions. The results have provided guidance for optimizing the PCI process.« less

Coronary artery ectasia, an independent predictor of no-reflow after primary PCI for ST-elevation myocardial infarction.

PubMed

Schram, H C F; Hemradj, V V; Hermanides, R S; Kedhi, E; Ottervanger, J P

2018-04-25

The no-reflow phenomenon is a serious complication after primary percutaneous coronary intervention (PCI) for ST-elevation Myocardial Infarction (STEMI). Coronary artery ectasia (CAE) may increase the risk of no-reflow, however, only limited data is available on the potential impact of CAE. The aim of this study was to determine the potential association between CAE and no-reflow after primary PCI. A case control study was performed based on a prospective cohort of STEMI patients from January 2000 to December 2011. All patients with TIMI 0-1 flow post primary PCI, in the absence of dissection, thrombus, spasm or high-grade residual stenosis, were considered as no-reflow case. Control subjects were two consecutive STEMI patients after each case, with TIMI flow ≥2 after primary PCI. CAE was defined as dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. In the no-reflow group, frequency of CAE was significantly higher (33.8% vs 3.9%, p < 0.001) compared to the control group. Baseline variables were comparable between patients with and without CAE. Patients with CAE had more often TIMI 0-1 flow pre-PCI (91% vs 71% p = 0.03), less often anterior STEMI (3% vs 37%, p < 0.001) and underwent significantly less often a PCI with stenting (47% vs 74%, p = 0.003). After multivariate analysis, CAE remained a strong and independent predictor of no-reflow (OR 13.9, CI 4.7-41.2, p < 0.001). CAE is a strong and independent predictor of no-reflow after primary PCI for STEMI. Future studies should assess optimal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

IDMA: improving the defense against malicious attack for mobile ad hoc networks based on ARIP protocol

NASA Astrophysics Data System (ADS)

Peng, Chaorong; Chen, Chang Wen

2008-04-01

Malicious nodes are mounting increasingly sophisticated attacking operations on the Mobile Ad Hoc Networks (MANETs). This is mainly because the IP-based MANETs are vulnerable to attacks by various malicious nodes. However, the defense against malicious attack can be improved when a new layer of network architecture can be developed to separate true IP address from disclosing to the malicious nodes. In this paper, we propose a new algorithm to improve the defense against malicious attack (IDMA) that is based on a recently developed Assignment Router Identify Protocol (ARIP) for the clustering-based MANET management. In the ARIP protocol, we design the ARIP architecture based on the new Identity instead of the vulnerable IP addresses to provide the required security that is embedded seamlessly into the overall network architecture. We make full use of ARIP's special property to monitor gateway forward packets by Reply Request Route Packets (RREP) without additional intrusion detection layer. We name this new algorithm IDMA because of its inherent capability to improve the defense against malicious attacks. Through IDMA, a watching algorithm can be established so as to counterattack the malicious node in the routing path when it unusually drops up packets. We provide analysis examples for IDMA for the defense against a malicious node that disrupts the route discovery by impersonating the destination, or by responding with state of corrupted routing information, or by disseminating forged control traffic. The IDMA algorithm is able to counterattack the malicious node in the cases when the node lunch DoS attack by broadcast a large number of route requests, or make Target traffic congestion by delivering huge mount of data; or spoof the IP addresses and send forge packets with a fake ID to the same Target causing traffic congestion at that destination. We have implemented IDMA algorism using the GloMoSim simulator and have demonstrated its performance under a variety of

Combined PCI and minimally invasive heart valve surgery for high-risk patients.

PubMed

Umakanthan, Ramanan; Leacche, Marzia; Petracek, Michael R; Zhao, David X; Byrne, John G

2009-12-01

Combined coronary artery valvular heart disease is a major cause of morbidity and mortality in the adult patient population. The standard treatment for such disease has been open heart surgery in which coronary artery bypass grafting (CABG) is performed concurrently with valve surgery using a median sternotomy and cardiopulmonary bypass. With the increasing complexity of patients referred to surgery, some patients may prove to be poor surgical candidates for combined valve and CABG surgery. In certain selected patients who fall into this category, valve surgery and percutaneous coronary intervention (PCI) have been considered a feasible alternative. Conventionally, valve surgery is performed in the cardiac surgical operating room, whereas PCI is carried out in the cardiac catheterization laboratory. Separation of these two procedural suites has presented a logistic limitation because it impedes the concomitant performance of both procedures in one setting. Hence, PCI and valve surgery usually have been performed as a "two-stage" procedure in two different operative suites, with the procedures being separated by hours, days, or weeks. Technologic advancements have made possible the construction of a "hybrid" procedural suite that combines the facilities of a cardiac surgical operating room with those of a cardiac catheterization laboratory. This design has enabled the concept of "one-stage" or "one-stop" PCI and valve surgery, allowing both procedures to be performed in a hybrid suite in one setting, separated by minutes. The advantages of such a method could prove to be multifold by enabling a less invasive surgical approach and improving logistics, patient satisfaction, and outcomes in selected patients.

The Arabidopsis COP9 signalosome subunit 7 is a model PCI domain protein with subdomains involved in COP9 signalosome assembly.

PubMed

Dessau, Moshe; Halimi, Yair; Erez, Tamir; Chomsky-Hecht, Orna; Chamovitz, Daniel A; Hirsch, Joel A

2008-10-01

The COP9 Signalosome (CSN) is a multiprotein complex that was originally identified in Arabidopsis thaliana as a negative regulator of photomorphogenesis and subsequently shown to be a general eukaryotic regulator of developmental signaling. The CSN plays various roles, but it has been most often implicated in regulating protein degradation pathways. Six of eight CSN subunits bear a sequence motif called PCI. Here, we report studies of subunit 7 (CSN7) from Arabidopsis, which contains such a motif. Our in vitro and structural results, based on 1.5 A crystallographic data, enable a definition of a PCI domain, built from helical bundle and winged helix subdomains. Using functional binding assays, we demonstrate that the PCI domain (residues 1 to 169) interacts with two other PCI proteins, CSN8 and CSN1. CSN7 interactions with CSN8 use both PCI subdomains. Furthermore, we show that a C-terminal tail outside of this PCI domain is responsible for association with the non-PCI subunit, CSN6. In vivo studies of transgenic plants revealed that the overexpressed CSN7 PCI domain does not assemble into the CSN, nor can it complement a null mutation of CSN7. However, a CSN7 clone that contains the PCI domain plus part of the CSN6 binding domain can complement the null mutation in terms of seedling viability and photomorphogenesis. These transgenic plants, though, are defective in adult growth, suggesting that the CSN7 C-terminal tail plays additional functional roles. Together, the findings have implications for CSN assembly and function, highlighting necessary interactions between subunits.

Complete Versus culprit-Lesion only PRimary PCI Trial (CVLPRIT): a multicentre trial testing management strategies when multivessel disease is detected at the time of primary PCI: rationale and design.

PubMed

Kelly, Damian J; McCann, Gerald P; Blackman, Daniel; Curzen, Nicholas P; Dalby, Miles; Greenwood, John P; Fairbrother, Kathryn; Shipley, Lorraine; Kelion, Andrew; Heatherington, Simon; Khan, Jamal N; Nazir, Sheraz; Alahmar, Albert; Flather, Marcus; Swanton, Howard; Schofield, Peter; Gunning, Mark; Hall, Roger; Gershlick, Anthony H

2013-02-22

Primary percutaneous coronary intervention (PPCI) is the preferred strategy for acute ST-segment elevation myocardial infarction (STEMI), with evidence of improved clinical outcomes compared to fibrinolytic therapy. However, there is no consensus on how best to manage multivessel coronary disease detected at the time of PPCI, with little robust data on best management of angiographically significant stenoses detected in non-infarct-related (N-IRA) coronary arteries. CVLPRIT will determine the optimal management of N-IRA lesions detected during PPCI. CVLPRIT (Complete Versus culprit-Lesion only PRimary PCI Trial) is an open-label, prospective, randomised, multicentre trial. STEMI patients undergo verbal "assent" on presentation. Patients are included when angiographic MVD has been detected, and randomised to culprit (IRA)-only PCI (n=150) or in-patient complete multivessel PCI (n=150). Cumulative major adverse cardiac events (MACE) - all-cause mortality, recurrent MI, heart failure, need for revascularisation (PCI or CABG) will be recorded at 12 months. Secondary endpoints include safety endpoints of confirmed ischaemic stroke, intracranial haemorrhage, major non-intracranial bleeding, and repair of vascular complications. A cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage index and microvascular obstruction. A cost efficacy analysis will be undertaken. The management of multivessel coronary artery disease in the setting of PPCI for STEMI, including the timing of when to perform non-culprit-artery revascularisation if undertaken, remains unresolved. CVLPRIT will yield mechanistic insights into the myocardial consequence of N-IRA intervention undertaken during the peri-infarct period.

The Influence of Comprehensive Cardiac Rehabilitation on Heart Rate Variability Indices after CABG is More Effective than after PCI.

PubMed

Szmigielska, Katarzyna; Szmigielska-Kapłon, Anna; Jegier, Anna

2018-02-01

The aim of this study was to evaluate the influence of cardiac rehabilitation (CR) on heart rate variability (HRV) indices in men with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). The study population consisted of 131 male patients with CAD prospectively and consecutively admitted to CR after PCI n = 72, or CABG n = 59. Participants performed cycle ergometer interval training for 45 min three times a week for 8 weeks. At baseline and after 8 weeks, all patients underwent the HRV assessment. HRV indices in CAGB survivals were significantly lower in comparison to PCI patients at baseline. Significant increases were seen for SDNN, rMSSD, and HF in the CABG group and only in HF component in PCI group after 8 weeks of CR. Eight weeks of CR seems to be more effective in CABG patients than patients after PCI.

Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors.

PubMed

Egbe, Thomas Obinchemti; Tazinya, Rose-Mary Asong; Halle-Ekane, Gregory Edie; Egbe, Eta-Nkongho; Achidi, Eric Akum

2016-01-01

We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018.

PubMed

Ozaki, Yukio; Katagiri, Yuki; Onuma, Yoshinobu; Amano, Tetsuya; Muramatsu, Takashi; Kozuma, Ken; Otsuji, Satoru; Ueno, Takafumi; Shiode, Nobuo; Kawai, Kazuya; Tanaka, Nobuhiro; Ueda, Kinzo; Akasaka, Takashi; Hanaoka, Keiichi Igarashi; Uemura, Shiro; Oda, Hirotaka; Katahira, Yoshiaki; Kadota, Kazushige; Kyo, Eisho; Sato, Katsuhiko; Sato, Tadaya; Shite, Junya; Nakao, Koichi; Nishino, Masami; Hikichi, Yutaka; Honye, Junko; Matsubara, Tetsuo; Mizuno, Sumio; Muramatsu, Toshiya; Inohara, Taku; Kohsaka, Shun; Michishita, Ichiro; Yokoi, Hiroyoshi; Serruys, Patrick W; Ikari, Yuji; Nakamura, Masato

2018-04-01

While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.

Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI.

PubMed

Dehghani, Payam; Lavoie, Andrea; Lavi, Shahar; Crawford, Jennifer J; Harenberg, Sebastian; Zimmermann, Rodney H; Booker, Jeff; Kelly, Sheila; Cantor, Warren J; Mehta, Shamir R; Bagai, Akshay; Goodman, Shaun G; Cheema, Asim N

2017-10-01

Patients undergoing PCI early after fibrinolytic therapy are at high risk for both thrombotic and bleeding complications. We sought to assess the pharmacodynamic effects of ticagrelor versus clopidogrel in the fibrinolytic-treated STEMI patients undergoing early PCI. Patients undergoing PCI within 24 hours of tenecteplase (TNK), aspirin, and clopidogrel for STEMI were randomized to receive additional clopidogrel 300 mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline) at 4 and 24 hours post-PCI. The primary end point was PRU ≤208 at 4 hours. A total of 140 patients (74 in ticagrelor and 66 in clopidogrel group) were enrolled. The mean PRU values at baseline were similar for the 2 groups (257.8±52.9 vs 259.5±56.7, P=.85, respectively). Post-PCI, patients on ticagrelor, compared to those on clopidogrel, had significantly lower PRU at 4 hours (78.7±88 vs 193.6±86.5, respectively, P<.001) and at 24 hours (34.5±35.0 and 153.5±75.5, respectively, P<.001). The primary end point was observed in 87.8% (n=65) in the ticagrelor-treated patients compared to 57.6% (n=38) of clopidogrel-treated patients, P<.001. Fibrinolysis-treated STEMI patients who received clopidogrel and aspirin at the time of fibrinolysis and were undergoing early PCI frequently had PRU >208. In this high-risk population, ticagrelor provides more prompt and potent platelet inhibition compared with clopidogrel (Funded by Astra Zeneca; NCT01930591, https://clinicaltrials.gov/ct2/show/NCT01930591). Copyright © 2017 Elsevier Inc. All rights reserved.

Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion.

PubMed

Vichova, Teodora; Maly, Marek; Ulman, Jaroslav; Motovska, Zuzana

2016-03-01

Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion. Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion. A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction < 30% (P = 0.006), age > 65 years (P < 0.001), Killip class >2 (P <0.001), female gender (P = 0.019), and creatinine clearance < 30 mL/min (P < 0.001). Time delay to reperfusion is significantly related to 1-year mortality of patients with STEMI/BBB-MI and complete restoration of epicardial blood flow in culprit vessel after PCI.

Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

PubMed

Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

2018-03-29

The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

Determine Operating Reactor to Use for the 2016 PCI Level 1 Milestone

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clarno, Kevin T.

2016-01-30

The Consortium for Advanced Simulation of Light Water Reactors (LWRs) (CASL) Level 1 milestone to “Assess the analysis capability for core-wide [pressurized water reactor] PWR Pellet- Clad Interaction (PCI) screening and demonstrate detailed 3-D analysis on selected sub-region” (L1:CASL.P13.03) requires a particular type of nuclear power plant for the assessment. This report documents the operating reactor and cycles chosen for this assessment in completion of the physics integration (PHI) milestone to “Determine Operating Reactor to use for PCI L1 Milestone” (L3:PHI.CMD.P12.02). Watts Bar Unit 1 experienced (at least) one fuel rod failure in each of cycles 6 and 7, andmore » at least one was deemed to be duty related rather than being primarily related to a manufacturing defect or grid effects. This brief report documents that the data required to model cycles 1–12 of Watts Bar Unit 1 using VERA-CS contains sufficient data to model the PHI portion of the PCI challenge problem. A list of additional data needs is also provided that will be important for verification and validation of the BISON results.« less

A risk prediction score model for predicting occurrence of post-PCI vasovagal reflex syndrome: a single center study in Chinese population.

PubMed

Li, Hai-Yan; Guo, Yu-Tao; Tian, Cui; Song, Chao-Qun; Mu, Yang; Li, Yang; Chen, Yun-Dai

2017-08-01

The vasovagal reflex syndrome (VVRS) is common in the patients undergoing percutaneous coronary intervention (PCI). However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. From the hospital electronic medical database, we identified 3550 patients who received PCI (78.0% males, mean age 60 years) in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic (ROC) analysis were performed. The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation (all P < 0.001). The rate of VVRS [95% confidence interval (CI)] in patients receiving PCI was 4.5% (4.1%-5.6%). Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stents implantation in the left anterior descending (LAD), and the femoral puncture site. The multivariate analysis suggested that they were independent risk factors for predicting the incidence of VVRS (all P < 0.001). We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI (c-statistic 0.76, 95% CI: 0.72-0.79, P < 0.001). There were decreased events of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute (AUC: 0.84, 95% CI: 0.81-0.87, P < 0.001). The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be involved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.

Effect of intracoronary nitroprusside injection on flow recovery during primary PCI in acute STEMI patients.

PubMed

Yang, Lixia; Mu, Lihua; Sun, Linhui; Qi, Feng; Guo, Ruiwei

2017-04-01

The no/slow reflow phenomenon during primary percutaneous coronary intervention (PPCI) causes the destruction of the coronary microcirculation and further myocardial damage. Some studies have shown that intracoronary nitroprusside infusion is a safe and effective method for managing the no/slow reflow phenomenon. However, it is uncertain whether the injection of nitroprusside at a specific time point during PPCI can most effectively prevent no-reflow. In this study, we investigated the effect of the timing of an intracoronary nitroprusside injection on flow recovery during PPCI in patients with ST elevation acute myocardial infarction (STEMI). One hundred twenty consecutive patients with STEMI who underwent PPCI were enrolled in the study. Patients who fulfilled the eligibility criteria were randomly allocated to three groups: control group (N.=40) received no nitroprusside before they completed PCI; the second group (N.=40) received nitroprusside before balloon dilatation; and the third group (N.=40) received nitroprusside after each balloon dilatation and before contrast agent refilling. The baseline clinical variables and the details of the PCI procedure were collected. The thrombolysis in myocardial infarction (TIMI) flow grades and the corrected TIMI frame count (cTFC) were evaluated immediately after stent implantation was completed. There were no significant differences in the baseline characteristics, antithrombotic drugs given before PCI, and details of the PCI procedure among the three groups (P>0.05). The incidence of TIMI grade 3 after PCI was significantly higher in the nitroprusside group than in the control group (P=0.025), whereas cTFC was significantly lower in the nitroprusside group (26.6±15.2) than in the control group (38.1±21.3, P=0.001). The incidence of TIMI grade 3 after PCI was significantly higher in the third group than in the second group (P=0.045), and cTFC was significantly lower in the third group (21.5±9.5) than in the second

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

PubMed

Jang, Jae-Sik; Han, Kyoo-Rok; Moon, Keon-Woong; Jeon, Dong Woon; Shin, Dong-Ho; Kim, Jung-Sun; Park, Duk-Woo; Kang, Hyun-Jae; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Gwon, Hyeon-Cheol; Kim, Hyo-Soo

2017-05-01

Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.

Impella 2.5 initiated prior to unprotected left main PCI in acute myocardial infarction complicated by cardiogenic shock improves early survival.

PubMed

Meraj, Perwaiz M; Doshi, Rajkumar; Schreiber, Theodore; Maini, Brijeshwar; O'Neill, William W

2017-06-01

To assess post-procedural outcomes when Impella 2.5 percutaneous left ventricular assist device (pLVAD) support is initiated either prior to or after percutaneous coronary intervention (PCI) on unprotected left main coronary artery (ULMCA) culprit lesion in the context of acute myocardial infarction cardiogenic shock (AMICS). Initiation of Impella 2.5 pLVAD prior to PCI is associated with significant survival benefit in the setting of AMICS. Outcomes of those presenting with a ULMCA culprit lesion in this setting have not been well characterized. Thirty-six consecutive patients in the cVAD Registry supported with Impella 2.5 pLVAD for AMICS who underwent PCI on ULMCA culprit lesion were included in our multicenter study. The average age was 69.8 ± 14.2 years, 77.8% were male, 72.7% were in CS at admission, 44.4% sustained one or multiple cardiac arrests, and 30.6% had anoxic brain injury. Baseline characteristics were comparable between the Pre-PCI group (n = 20) and Post-PCI group (n = 16). Non-ST segment elevation myocardial infarction and greater coronary disease burden were significantly more frequent in the Pre-PCI group but they had significantly better survival to discharge (55.0% vs 18.8%, P = 0.041). Kaplan-Meier 30-day survival analysis showed very poor survival in Post-PCI group (48.1% vs 12.5%, Log-Rank P = 0.004). Initiation of Impella 2.5 pLVAD prior to as compared with after PCI of ULMCA for AMICS culprit lesion is associated with significant early survival. As previously described, patients supported after PCI appear to have very poor survival at 30 days. © 2017, Wiley Periodicals, Inc.

Long-term outcomes of coronary artery bypass grafting versus stent-PCI for unprotected left main disease: a meta-analysis.

PubMed

De Rosa, Salvatore; Polimeni, Alberto; Sabatino, Jolanda; Indolfi, Ciro

2017-09-06

Coronary artery bypass graft (CABG) surgery has traditionally represented the standard of care for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention with stent implantation (PCI) has more recently emerged as a valuable alternative. The long-time awaited results of the largest randomized trials on the long-term impact of PCI versus CABG in LMCA disease, the newly published NOBLE and EXCEL studies, revealed contrasting results. Thus, aim of the present meta-analysis was to review the most robust evidence from randomized comparisons of CABG versus PCI for revascularization of LMCA. Randomized studies comparing long-term clinical outcomes of CABG or Stent-PCI for the treatment of LMCA disease were searched for in PubMed, the Chochrane Library and Scopus electronic databases. A total of 5 randomized studies were selected, including 4499 patients. No significant difference between CABG and PCI was found in the primary analysis on the composite endpoint of death, stroke and myocardial infarction (OR = 1·06 95% CI 0·80-1·40; p = 0·70). Similarly, no differences were observed between CABG and PCI for all-cause death (OR = 1·03 95% CI 0·81-1·32; p = 0·81). Although not statistically significant, a lower rate of stroke was registered in the PCI arm (OR = 0·86; p = 0·67), while a lower rate of myocardial infarction was found in the CABG arm (OR = 1·43; p = 0·17). On the contrary, a significantly higher rate of repeat revascularization was registered in the PCI arm (OR = 1·76 95% CI 1·45-2·13; p < 0·001). The present meta-analysis, the most comprehensive and updated to date, including 5 randomized studies and 4499 patients, demonstrates no difference between Stent-PCI and CABG for the treatment of LMCA disease in the composite endpoint of death, stroke and myocardial infarction. Hence, a large part of patients with unprotected left main coronary artery disease can be managed equally well by means of both

Left ventricular thrombi after STEMI in the primary PCI era: A systematic review and meta-analysis.

PubMed

Robinson, Austin A; Jain, Amit; Gentry, Mark; McNamara, Robert L

2016-10-15

Left ventricular (LV) thrombus formation following myocardial infarction (MI) has not been well characterized since the advent of primary percutaneous coronary intervention (pPCI). Ascertainment of the utility of prophylactic anticoagulation is hindered by the lack of reliable information on its modern incidence. We sought to provide an estimate of the rate of LV thrombus formation in patients treated with pPCI for ST segment elevation MI (STEMI) by means of a systematic review and meta-analysis. We searched Ovid MEDLINE and Ovid EMBASE databases for studies between 1990 and 2015 documenting LV thrombi after STEMI treated with pPCI. We estimated the rate of echocardiographically-diagnosed LV thrombi within 90days of pPCI, calculating the rate of LV thrombi after STEMI in any infarct territory as well as only anterior infarcts. From an initial yield of 1144 studies, inclusion criteria were met by 19 studies, including 10,076 patients across 27 centers in 9 countries. Rate of LV thrombi after all STEMI was 2.7% (95% CI 1.9%-3.5%) and 9.1% (95% CI 6.6%-11.6%) after anterior STEMI. Among anterior STEMI, there was an inverse relationship between size of study and rate of LV thrombi. LV thrombi persist as an important part of the management of STEMI after pPCI, particularly among anterior infarcts. Estimating risk of thrombus formation and embolization as well as utility of treatment remains critical. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

PubMed Central

Jang, Jae-Sik; Han, Kyoo-Rok; Moon, Keon-Woong; Jeon, Dong Woon; Shin, Dong-Ho; Kim, Jung-Sun; Park, Duk-Woo; Kang, Hyun-Jae; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Gwon, Hyeon-Cheol

2017-01-01

Background and Objectives Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. Materials and Methods Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. Results A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. Conclusion These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research. PMID:28567083

PCI/iRMX-Based Front-End Data Acquisition for the HT-7U Experiment

NASA Astrophysics Data System (ADS)

Shu, Yantai; Luo, Jiarong; Yan, Jianbing; Zhao, Feng; Zhang, Liang

2004-06-01

A PCI/iRMX-based front-end system is being designed to serve as data acquisition (DAQ) subsystem for the HT-7U superconducting tokamak. The diagnostic instruments are connected to four analog-to-digital converter (ADC) boards that are directly plugged into the peripheral component interconnect (PCI) bus of a personal computer (PC) running the iRMX real-time operating system. Each ADC board has eight channels. The sampling rate of each channel can be up to 125 K samples per second. The acquired data are directly transferred from the ADC board into the memory of the PC, and then transferred to servers through the network. As a testbed, one PCI/iRMX subsystem has been built and has acquired data from the existing HT-7 tokamak. The DAQ can easily support a wide range of pulse lengths, even matching extremely long pulse and steady-state operation. This paper describes the system design and performance evaluation in detail.

Suggestibility, expectancy, trance state effects, and hypnotic depth: II. Assessment via the PCI-HAP.

PubMed

Pekala, Ronald J; Kumar, V K; Maurer, Ronald; Elliott-Carter, Nancy; Moon, Edward; Mullen, Karen

2010-04-01

This study sought to determine if self-reported hypnotic depth (srHD) could be predicted from the variables of the Phenomenology of Consciousness Inventory - Hypnotic Assessment Procedure (PCI-HAP) (Pekala, 1995a, 1995b; Pekala & Kumar, 2007; Pekala et al., 2010), assessing several of the processes theorized by researchers to be associated with hypnotism: trance (altered state effects), suggestibility, and expectancy. One hundred and eighty participants completed the PCI-HAP. Using regression analyses, srHD scores were predicted from the PCI-HAP pre-hypnotic and post-hypnotic assessment items, and several other variables. The results suggested that the srHD scores were found to be a function of imagoic suggestibility, expectancy (both estimated hypnotic depth and expected therapeutic efficacy), and trance state and eye catalepsy effects; effects that appear to be additive and not (statistically) interactive. The results support the theorizing of many investigators concerning the involvement of the aforementioned component processes with this particular aspect of hypnotism, the self-reported hypnotic depth score.

Effect of platelet inhibition with cangrelor during PCI on ischemic events.

PubMed

Bhatt, Deepak L; Stone, Gregg W; Mahaffey, Kenneth W; Gibson, C Michael; Steg, P Gabriel; Hamm, Christian W; Price, Matthew J; Leonardi, Sergio; Gallup, Dianne; Bramucci, Ezio; Radke, Peter W; Widimský, Petr; Tousek, Frantisek; Tauth, Jeffrey; Spriggs, Douglas; McLaurin, Brent T; Angiolillo, Dominick J; Généreux, Philippe; Liu, Tiepu; Prats, Jayne; Todd, Meredith; Skerjanec, Simona; White, Harvey D; Harrington, Robert A

2013-04-04

The intensity of antiplatelet therapy during percutaneous coronary intervention (PCI) is an important determinant of PCI-related ischemic complications. Cangrelor is a potent intravenous adenosine diphosphate (ADP)-receptor antagonist that acts rapidly and has quickly reversible effects. In a double-blind, placebo-controlled trial, we randomly assigned 11,145 patients who were undergoing either urgent or elective PCI and were receiving guideline-recommended therapy to receive a bolus and infusion of cangrelor or to receive a loading dose of 600 mg or 300 mg of clopidogrel. The primary efficacy end point was a composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours after randomization; the key secondary end point was stent thrombosis at 48 hours. The primary safety end point was severe bleeding at 48 hours. The rate of the primary efficacy end point was 4.7% in the cangrelor group and 5.9% in the clopidogrel group (adjusted odds ratio with cangrelor, 0.78; 95% confidence interval [CI], 0.66 to 0.93; P=0.005). The rate of the primary safety end point was 0.16% in the cangrelor group and 0.11% in the clopidogrel group (odds ratio, 1.50; 95% CI, 0.53 to 4.22; P=0.44). Stent thrombosis developed in 0.8% of the patients in the cangrelor group and in 1.4% in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; P=0.01). The rates of adverse events related to the study treatment were low in both groups, though transient dyspnea occurred significantly more frequently with cangrelor than with clopidogrel (1.2% vs. 0.3%). The benefit from cangrelor with respect to the primary end point was consistent across multiple prespecified subgroups. Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding. (Funded by the Medicines Company; CHAMPION PHOENIX ClinicalTrials.gov number, NCT01156571.).

Ad-hoc surface-enhanced Raman spectroscopy methodologies for the detection of artist dyestuffs: thin layer chromatography-surface enhanced Raman spectroscopy and in situ on the fiber analysis.

PubMed

Brosseau, Christa L; Gambardella, Alessa; Casadio, Francesca; Grzywacz, Cecily M; Wouters, Jan; Van Duyne, Richard P

2009-04-15

Tailored ad-hoc methods must be developed for successful identification of minute amounts of natural dyes on works of art using Surface-Enhanced Raman Spectroscopy (SERS). This article details two of these successful approaches using silver film over nanosphere (AgFON) substrates and silica gel coupled with citrate-reduced Ag colloids. The latter substrate functions as the test system for the coupling of thin-layer chromatography and SERS (TLC-SERS), which has been used in the current research to separate and characterize a mixture of several artists' dyes. The poor limit of detection of TLC is overcome by coupling with SERS, and dyes which co-elute to nearly the same spot can be distinguished from each other. In addition, in situ extractionless non-hydrolysis SERS was used to analyze dyed reference fibers, as well as historical textile fibers. Colorants such as alizarin, purpurin, carminic acid, lac dye, crocin, and Cape jasmine were thus successfully identified.

Influence of minor deterioration of renal function after PCI on outcome in patients with ST-elevation myocardial infarction.

PubMed

Kanic, Vojko; Suran, David; Vollrath, Maja; Tapajner, Alojz; Kompara, Gregor

2017-10-01

Our aim was to assess the possible impact of a deterioration of renal function (DRF) not fulfilling the criteria for acute kidney injury after percutaneous coronary intervention (PCI) on outcome in patients with ST-elevation myocardial infarction (STEMI) on 30-day and long-term outcomes. Data is lacking on the influence of DRF after PCI on outcome in patients with STEMI. The present study is an analysis of 2572 STEMI patients who underwent PCI. The group with DRF (1022 patients) and the group without DRF (1550 patients) were compared. Thirty-day and long-term all-cause mortality were observed. Data was analyzed using descriptive statistics. Similar mortality was observed in both groups at day 30 (4.2% patients with DRF died vs 3.2% without DRF; ns) but more patients had died in the DRF group (18.9% patients with DRF vs 14.0% without DRF; P = 0.001) by the end of the observation period. After adjustments, DRF did not independently predict long-term mortality. Age more than 70 years, bleeding, hyperlipidemia, renal dysfunction on admission, anemia on admission, diabetes, PCI of LAD, the use of more than 200 mL contrast, but not DRF after PCI, were identified as independent prognostic factors for increased long-term mortality. Renal dysfunction, bleeding, contrast >200 mL, hyperlipidemia, age >70 years, anemia, and PCI LAD predicted DRF. DRF identified patients at increased risk of higher long-term mortality but was not independently associated with mortality. © 2017, Wiley Periodicals, Inc.

Macrophage mediated PCI enhanced gene-directed enzyme prodrug therapy

NASA Astrophysics Data System (ADS)

Christie, Catherine E.; Zamora, Genesis; Kwon, Young J.; Berg, Kristian; Madsen, Steen J.; Hirschberg, Henry

2015-03-01

Photochemical internalization (PCI) is a photodynamic therapy-based approach for improving the delivery of macromolecules and genes into the cell cytosol. Prodrug activating gene therapy (suicide gene therapy) employing the transduction of the E. coli cytosine deaminase (CD) gene into tumor cells, is a promising method. Expression of this gene within the target cell produces an enzyme that converts the nontoxic prodrug, 5-FC, to the toxic metabolite, 5-fluorouracil (5-FU). 5-FC may be particularly suitable for brain tumors, because it can readily cross the bloodbrain barrier (BBB). In addition the bystander effect, where activated drug is exported from the transfected cancer cells into the tumor microenvironment, plays an important role by inhibiting growth of adjacent tumor cells. Tumor-associated macrophages (TAMs) are frequently found in and around glioblastomas. Monocytes or macrophages (Ma) loaded with drugs, nanoparticles or photosensitizers could therefore be used to target tumors by local synthesis of chemo attractive factors. The basic concept is to combine PCI, to enhance the ex vivo transfection of a suicide gene into Ma, employing specially designed core/shell NP as gene carrier.

LabVIEW Interface for PCI-SpaceWire Interface Card

NASA Technical Reports Server (NTRS)

Lux, James; Loya, Frank; Bachmann, Alex

2005-01-01

This software provides a LabView interface to the NT drivers for the PCISpaceWire card, which is a peripheral component interface (PCI) bus interface that conforms to the IEEE-1355/ SpaceWire standard. As SpaceWire grows in popularity, the ability to use SpaceWire links within LabVIEW will be important to electronic ground support equipment vendors. In addition, there is a need for a high-level LabVIEW interface to the low-level device- driver software supplied with the card. The LabVIEW virtual instrument (VI) provides graphical interfaces to support all (1) SpaceWire link functions, including message handling and routing; (2) monitoring as a passive tap using specialized hardware; and (3) low-level access to satellite mission-control subsystem functions. The software is supplied in a zip file that contains LabVIEW VI files, which provide various functions of the PCI-SpaceWire card, as well as higher-link-level functions. The VIs are suitably named according to the matching function names in the driver manual. A number of test programs also are provided to exercise various functions.

Structural and Computational Studies of Cp(CO)2(PCy3)MoFBF3, a Complex with a Bound BF4- Ligand

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, Tan-Yun; Szalda, David J.; Franz, James A.

2010-02-15

Hydride transfer from Cp(CO)2(PCy3)MoH to Ph3C+BF4 gives Cp(CO)2(PCy3)MoFBF3, and the crystal structure of this complex was determined. In the weakly bound FBF3 ligand, the B-F(bridging) bond length is 1.475(8) Å, which is 0.15 Å longer than the average length of the three B-F(terminal) bonds. The PCy3 and FBF3 ligands are cis to each other in the four-legged piano stool structure. Electronic structure (DFT) calculations predict the trans isomer of Cp(CO)2(PCy3)MoFBF3 to be 9.5 kcal/mol (in ΔGog,298)) less stable than the cis isomer that was crystallographically characterized. Hydride transfer from Cp(CO)2(PCy3)MoH to Ph3C+BAr'4 [Ar' = 3,5-bis(trifluoromethyl)phenyl] in CH2Cl2 solvent produces [Cp(CO)2(PCy3)Mo(ClCH2Cl)]+[BAr'4]more » , in which CH2Cl2 is coordinated to the metal. Pacific Northwest National Laboratory is operated by Battelle for the US Department of Energy.« less

Mechanistic Considerations Used in the Development of the PROFIT PCI Failure Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pankaskie, P. J.

A fuel Pellet-Zircaloy Cladding (thermo-mechanical-chemical) Interactions (PC!) failure model for estimating the probability of failure in !ransient increases in power (PROFIT) was developed. PROFIT is based on 1) standard statistical methods applied to available PC! fuel failure data and 2) a mechanistic analysis of the environmental and strain-rate-dependent stress versus strain characteristics of Zircaloy cladding. The statistical analysis of fuel failures attributable to PCI suggested that parameters in addition to power, transient increase in power, and burnup are needed to define PCI fuel failures in terms of probability estimates with known confidence limits. The PROFIT model, therefore, introduces an environmentalmore » and strain-rate dependent strain energy absorption to failure (SEAF) concept to account for the stress versus strain anomalies attributable to interstitial-disloction interaction effects in the Zircaloy cladding. Assuming that the power ramping rate is the operating corollary of strain-rate in the Zircaloy cladding, then the variables of first order importance in the PCI fuel failure phenomenon are postulated to be: 1. pre-transient fuel rod power, P{sub I}, 2. transient increase in fuel rod power, {Delta}P, 3. fuel burnup, Bu, and 4. the constitutive material property of the Zircaloy cladding, SEAF.« less

Change in Coronary Blood Flow After Percutaneous Coronary Intervention in Relation to Baseline Lesion Physiology Results of the JUSTIFY-PCI Study

PubMed Central

Nijjer, Sukhjinder S.; Petraco, Ricardo; van de Hoef, Tim P.; Sen, Sayan; van Lavieren, Martijn A.; Foale, Rodney A.; Meuwissen, Martijn; Broyd, Christopher; Echavarria-Pinto, Mauro; Al-Lamee, Rasha; Foin, Nicolas; Sethi, Amarjit; Malik, Iqbal S.; Mikhail, Ghada W.; Hughes, Alun D.; Mayet, Jamil; Francis, Darrel P.; Di Mario, Carlo; Escaned, Javier; Piek, Jan J.; Davies, Justin E.

2016-01-01

Background Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicardial obstruction. However, no study has objectively confirmed this and assessed changes in flow over different phases of the cardiac cycle. We quantified the change in resting and hyperemic flow velocity after PCI in stenoses defined physiologically by fractional flow reserve and other parameters. Methods and Results Seventy-five stenoses (67 patients) underwent paired flow velocity assessment before and after PCI. Flow velocity was measured over the whole cardiac cycle and the wave-free period. Mean fractional flow reserve was 0.68±0.02. Pre-PCI, hyperemic flow velocity is diminished in stenoses classed as physiologically significant compared with those classed nonsignificant (P<0.001). In significant stenoses, flow velocity over the resting wave-free period and hyperemic flow velocity did not differ statistically. After PCI, resting flow velocity over the wave-free period increased little (5.6±1.6 cm/s) and significantly less than hyperemic flow velocity (21.2±3 cm/s; P<0.01). The greatest increase in hyperemic flow velocity was observed when treating stenoses below physiological cut points; treating stenoses with fractional flow reserve ≤0.80 gained Δ28.5±3.8 cm/s, whereas those fractional flow reserve >0.80 had a significantly smaller gain (Δ4.6±2.3 cm/s; P<0.001). The change in pressure-only physiological indices demonstrated a curvilinear relationship to the change in hyperemic flow velocity but was flat for resting flow velocity. Conclusions Pre-PCI physiology is strongly associated with post-PCI increase in hyperemic coronary flow velocity. Hyperemic flow velocity increases 6-fold more when stenoses classed as physiologically significant undergo PCI than when nonsignificant stenoses are treated. Resting flow velocity measured over the wave-free period changes at least 4-fold less than hyperemic flow velocity after PCI. PMID:26025217

Change in coronary blood flow after percutaneous coronary intervention in relation to baseline lesion physiology: results of the JUSTIFY-PCI study.

PubMed

Nijjer, Sukhjinder S; Petraco, Ricardo; van de Hoef, Tim P; Sen, Sayan; van Lavieren, Martijn A; Foale, Rodney A; Meuwissen, Martijn; Broyd, Christopher; Echavarria-Pinto, Mauro; Al-Lamee, Rasha; Foin, Nicolas; Sethi, Amarjit; Malik, Iqbal S; Mikhail, Ghada W; Hughes, Alun D; Mayet, Jamil; Francis, Darrel P; Di Mario, Carlo; Escaned, Javier; Piek, Jan J; Davies, Justin E

2015-06-01

Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicardial obstruction. However, no study has objectively confirmed this and assessed changes in flow over different phases of the cardiac cycle. We quantified the change in resting and hyperemic flow velocity after PCI in stenoses defined physiologically by fractional flow reserve and other parameters. Seventy-five stenoses (67 patients) underwent paired flow velocity assessment before and after PCI. Flow velocity was measured over the whole cardiac cycle and the wave-free period. Mean fractional flow reserve was 0.68±0.02. Pre-PCI, hyperemic flow velocity is diminished in stenoses classed as physiologically significant compared with those classed nonsignificant (P<0.001). In significant stenoses, flow velocity over the resting wave-free period and hyperemic flow velocity did not differ statistically. After PCI, resting flow velocity over the wave-free period increased little (5.6±1.6 cm/s) and significantly less than hyperemic flow velocity (21.2±3 cm/s; P<0.01). The greatest increase in hyperemic flow velocity was observed when treating stenoses below physiological cut points; treating stenoses with fractional flow reserve ≤0.80 gained Δ28.5±3.8 cm/s, whereas those fractional flow reserve >0.80 had a significantly smaller gain (Δ4.6±2.3 cm/s; P<0.001). The change in pressure-only physiological indices demonstrated a curvilinear relationship to the change in hyperemic flow velocity but was flat for resting flow velocity. Pre-PCI physiology is strongly associated with post-PCI increase in hyperemic coronary flow velocity. Hyperemic flow velocity increases 6-fold more when stenoses classed as physiologically significant undergo PCI than when nonsignificant stenoses are treated. Resting flow velocity measured over the wave-free period changes at least 4-fold less than hyperemic flow velocity after PCI. © 2015 American Heart Association, Inc.

The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

PubMed

Gwon, Hyeon-Cheol; Jeon, Dong Woon; Kang, Hyun-Jae; Jang, Jae-Sik; Park, Duk-Woo; Shin, Dong-Ho; Moon, Keon-Woong; Kim, Jung-Sun; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Han, Kyoo-Rok; Kim, Hyo-Soo

2017-05-01

Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.

Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary Intervention).

PubMed

Mahmud, Ehtisham; Naghi, Jesse; Ang, Lawrence; Harrison, Jonathan; Behnamfar, Omid; Pourdjabbar, Ali; Reeves, Ryan; Patel, Mitul

2017-07-10

The aims of this study were to evaluate the feasibility and technical success of robotically assisted percutaneous coronary intervention (R-PCI) for the treatment of coronary artery disease (CAD) in clinical practice, especially in complex lesions, and to determine the safety and clinical success of R-PCI compared with manual percutaneous coronary intervention (M-PCI). R-PCI is safe and feasible for simple coronary lesions. The utility of R-PCI for complex coronary lesions is unknown. All consecutive PCI procedures performed robotically (study group) or manually (control group) over 18 months were included. R-PCI technical success, defined as the completion of the procedure robotically or with partial manual assistance and without a major adverse cardiovascular event, was determined. Procedures ineligible for R-PCI (i.e., atherectomy, planned 2-stent strategy for bifurcation lesion, chronic total occlusion requiring hybrid approach) were excluded for analysis from the M-PCI group. Clinical success, defined as completion of the PCI procedure without a major adverse cardiovascular event, procedure time, stent use, and fluoroscopy time were compared between groups. A total of 315 patients (mean age 67.7 ± 11.8 years; 78% men) underwent 334 PCI procedures (108 R-PCIs, 157 lesions, 78.3% type B2/C; 226 M-PCIs, 336 lesions, 68.8% type B2/C). Technical success with R-PCI was 91.7% (rate of manual assistance 11.1%, rate of manual conversion 7.4%, rate of major adverse cardiovascular events 0.93%). Clinical success (99.1% with R-PCI vs. 99.1% with M-PCI; p = 1.00), stent use (stents per procedure 1.59 ± 0.79 with R-PCI vs. 1.54 ± 0.75 with M-PCI; p = 0.73), and fluoroscopy time (18.2 ± 10.4 min with R-PCI vs. 19.2 ± 11.4 min with M-PCI; p = 0.39) were similar between the groups, although procedure time was longer in the R-PCI group (44:30 ± 26:04 min:s vs. 36:34 ± 23:03 min:s; p = 0.002). Propensity-matched analysis confirmed that procedure time was longer

Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

NASA Astrophysics Data System (ADS)

Manan, Norhafizah A.; Abidin, Basir

2015-02-01

Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

High Bolus Tirofiban vs Abciximab in Acute STEMI Patients Undergoing Primary PCI – The Tamip Study

PubMed Central

Balghith, Mohammed A.

2012-01-01

Background: Primary percutaneous coronary intervention (PCI) has been shown to be an effective therapy for patients with acute myocardial infarction (MI). Glycoprotein (GP) IIb/IIIa receptor blockers reduce thrombotic complications in patients undergoing PCI. Most available data relate to Reopro, which has been registered for this indication. GP IIb/IIIa reduce unfavorable outcome in U/A and non ST-elevation myocardial infarction (STEMI) patients. Only few studies focused on high dose Aggrastat for STEMI patients in the emergency department (ED) before PCI. The aim is to increase the patency during the time awaiting coronary angioplasty in patients with acute MI. Objectives: To study the effect of upfront high bolus dose (HDR) of tirofiban on the extent of residual ST segment deviation 1 hour after primary PCI and the incidence of TIMI 3 flow of the infarct-related artery (IRA). Materials and Methods: A randomized, open label, single center study in the ED. A total of 90 patients with acute ST-elevation MI, diagnosed clinically by ECG criteria (ST segment elevation of >2 mm in two adjacent ECG leads), and with an expectation that a patient will undergo primary PCI. Patients were aged 21-85 years and all received heparin 5000 u, aspirin 160 mg, and Plavix 600 mg. Patients were divided in two groups (group I: triofiban high bolus vs group II: Reopro) with 45 patients in each group. In group I, high bolus triofiban 25 mcg/kg over 3 min was started in the ED with maintenance infusion of 0.15 mcg/ kg/min continued for 12 hours and transferred to cath lab for PCI. Patients in group II were transferred to cath lab, where a standard dose of Reopro was given with a bolus of 0.25 mcg/kg and maintenance infusion of 0.125 mcg/kg/min over 12 hours. Results: ST segment resolution and TIMI flow were evaluated in both groups before and after PCI. Thirty-five patients (78%) enrolled in group I and 29 patients (64%) in group II had resolution of ST segment (P-value 0.24). Twenty

The association between type D personality, and depression and anxiety ten years after PCI.

PubMed

Al-Qezweny, M N A; Utens, E M W J; Dulfer, K; Hazemeijer, B A F; van Geuns, R-J; Daemen, J; van Domburg, R

2016-09-01

There are indications that type D personality and depression are associated in patients treated with percutaneous coronary intervention (PCI). However, at present it is unclear whether this relationship holds in the long term. This study's aim was to investigate the association between type D personality at 6 months post-PCI (baseline), and depression at 10-year follow-up. A secondary aim was to test the association between type D personality at baseline and anxiety at 10-year follow-up. A cohort of surviving consecutive patients (N = 534) who underwent PCI between October 2001 and October 2002. Patients completed the type D personality scale (DS14) measuring type D personality at baseline, and the Hospital Anxiety and Depression Scale (HADS) measuring anxiety and depression at baseline and at 10 years post-PCI. At baseline, the prevalence of type D personality was 25 % (135/534). Type D personality patients were more often depressed (42 %) than non-type D personality patients (9 %). Response rate of anxiety and depression questionnaires at 10 years was 75 %. At 10-year follow-up, 31 % of type D personality patients were depressed versus 13 % of non-type D personality patients. After adjustments, baseline type D personality remained independently associated with depression at 10 years (OR = 3.69; 95 % CI [1.89-7.19]). Type D showed a similar association with anxiety at 10 years, albeit somewhat lower (OR = 2.72; 95 % CI [1.31-5.63]). PCI patients with type D personality had a 3.69-fold increased risk for depression and a 2.72-fold increased risk for anxiety at 10 years of follow-up.

Excess mortality in women compared to men after PCI in STEMI: an analysis of 11,931 patients during 2000-2009.

PubMed

de Boer, Sanneke P M; Roos-Hesselink, Jolien W; van Leeuwen, Maarten A H; Lenzen, Mattie J; van Geuns, Robert-Jan; Regar, Evelyn; van Mieghem, Nicolas M; van Domburg, Ron; Zijlstra, Felix; Serruys, Patrick W; Boersma, Eric

2014-09-20

Ambiguity exists whether gender affects outcome in patients undergoing percutaneous coronary intervention (PCI). To evaluate the relationship between gender and outcome in a large cohort of PCI patients, 11,931 consecutive patients who underwent PCI for various indications during 2000-2009 were studied using survival analyses and Cox regression models. Most patients (n=8588; 72%) were men. Women were older and more often had a history of hypertension and diabetes mellitus. Men smoked more frequently, had a more extensive cardiovascular history (previous MI, PCI and CABG), a higher prevalence of renal impairment and multi-vessel disease. In STEMI patients, women had higher 31-day mortality rates than men (11.6% vs. 6.5%, respectively, p<0.001). This difference remained after adjustment for confounders (aHR at 30-days 1.54 and 95% CI 1.22-1.96). Likewise, higher mortality was observed at 1-year (15.1% vs. 9.3%) and 4-year follow-up (21.6% vs. 15.0%, aHR 1.30 and 95% CI 1.10-1.53). There were no differences in mortality between women and men in NSTE-ACS (aHR at 4-years 1.05 and 95% CI 0.85-1.28) or stable angina (HR at 4-years 0.85 and 95% CI 0.68-1.08). Women undergoing PCI for STEMI had higher mortality than men. The excess mortality in women appeared in the first month after PCI and could only partially be explained by a difference in baseline characteristics. No gender differences in outcome in patients undergoing PCI for NSTE-ACS and stable angina were observed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Sex Differences in Percutaneous Coronary Intervention-Insights From the Coronary Angiography and PCI Registry of the German Society of Cardiology.

PubMed

Heer, Tobias; Hochadel, Matthias; Schmidt, Karin; Mehilli, Julinda; Zahn, Ralf; Kuck, Karl-Heinz; Hamm, Christian; Böhm, Michael; Ertl, Georg; Hoffmeister, Hans Martin; Sack, Stefan; Senges, Jochen; Massberg, Steffen; Gitt, Anselm K; Zeymer, Uwe

2017-03-20

Several studies have suggested sex-related differences in diagnostic and invasive therapeutic coronary procedures. Data from consecutive patients who were enrolled in the Coronary Angiography and PCI Registry of the German Society of Cardiology were analyzed. We aimed to compare sex-related differences in in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease, non-ST elevation acute coronary syndromes, ST elevation myocardial infarction, and cardiogenic shock. From 2007 until the end of 2009 data from 185 312 PCIs were prospectively registered: 27.9% of the PCIs were performed in women. Primary PCI success rate was identical between the sexes (94%). There were no sex-related differences in hospital mortality among patients undergoing PCI for stable coronary artery disease, non-ST elevation acute coronary syndromes, or cardiogenic shock except among ST elevation myocardial infarction patients. Compared to men, women undergoing primary PCI for ST elevation myocardial infarction have a higher risk of in-hospital death, age-adjusted odds ratio (1.19, 95% CI 1.06-1.33), and risk of ischemic cardiac and cerebrovascular events (death, myocardial infarction, transient ischemic attack/stroke), (age-adjusted odds ratio 1.19, 95% CI 1.16-1.29). Furthermore, access-related complications were twice as high in women, irrespective of the indication. Despite identical technical success rates of PCI between the 2 sexes, women with PCI for ST elevation myocardial infarction have a 20% higher age-adjusted risk of death and of ischemic cardiac and cerebrovascular events. Further research is needed to determine the reasons for these differences. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Ad Hoc Rural Regionalism

ERIC Educational Resources Information Center

Hamin, Elisabeth M.; Marcucci, Daniel J.

2008-01-01

A new regionalism has been much documented and researched for metropolitan areas; this article documents that there is a new rural regionalism as well. In the United States, these groups appear most likely to emerge in areas that are challenged by outcomes characterizing globalization's effects on the rural condition: namely, exurban or…

Temporal Trends in the Risk Profile of Patients Undergoing Outpatient Percutaneous Coronary Intervention: A Report from the National Cardiovascular Data Registry's CathPCI Registry.

PubMed

Vora, Amit N; Dai, Dadi; Gurm, Hitinder; Amin, Amit P; Messenger, John C; Mahmud, Ehtisham; Mauri, Laura; Wang, Tracy Y; Roe, Matthew T; Curtis, Jeptha; Patel, Manesh R; Dauerman, Harold L; Peterson, Eric D; Rao, Sunil V

2016-03-01

Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated. Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (P<0.001). Patients who were admitted after PCI were older, had greater comorbidities, and experienced more post-PCI complications (all P<0.001). Among those not admitted, the proportion of patients at high risk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (P<0.001). In contrast, 16.7% of patients admitted after PCI were at low risk for mortality. Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care. © 2016 American Heart Association, Inc.

An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation.

PubMed

Serefoglu, Ege Can; McMahon, Chris G; Waldinger, Marcel D; Althof, Stanley E; Shindel, Alan; Adaikan, Ganesh; Becher, Edgardo F; Dean, John; Giuliano, Francois; Hellstrom, Wayne J G; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

2014-06-01

The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE. The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE. In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India. The same evidence-based systematic approach to literature search, retrieval, and evaluation used by the original committee was adopted. The committee unanimously agreed that men with lifelong and acquired PE appear to share the dimensions of short ejaculatory latency, reduced or absent perceived ejaculatory control, and the presence of negative personal consequences. Men with acquired PE are older, have higher incidences of erectile dysfunction, comorbid disease, and cardiovascular risk factors, and have a longer intravaginal ejaculation latency time (IELT) as compared with men with lifelong PE. A self-estimated or stopwatch IELT of 3 minutes was identified as a valid IELT cut-off for diagnosing acquired PE. On this basis, the committee agreed on a unified definition of both acquired and lifelong PE as a male sexual dysfunction characterized by (i) ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE); (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations; and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. The

"PCI Reading Program": The Final Report of a Three Year Experimental Study in Brevard Public Schools and Miami-Dade County Public Schools. Research Report

ERIC Educational Resources Information Center

Toby, Megan; Jaciw, Andrew; Ma, Boya; Lipton, Akiko

2011-01-01

PCI Education conducted a three-year longitudinal study to determine the comparative effectiveness of the "PCI Reading Program" ("PCI") for students with severe disabilities as implemented in Florida's Brevard Public Schools and Miami-Dade County Public Schools. The primary question addressed by the study is whether students…

trans-[Pt(BCat')Me(PCy3)2]: an experimental case study of reductive elimination processes in Pt-Boryls through associative mechanisms.

PubMed

Braunschweig, Holger; Bertermann, Rüdiger; Brenner, Peter; Burzler, Michael; Dewhurst, Rian D; Radacki, Krzysztof; Seeler, Fabian

2011-10-10

A stable trans-(alkyl)(boryl) platinum complex trans-[Pt(BCat')Me(PCy(3))(2)] (Cat'=Cat-4-tBu; Cy=cyclohexyl=C(6)H(11)) was synthesised by salt metathesis reaction of trans-[Pt(BCat')Br(PCy(3))(2)] with LiMe and was fully characterised. Investigation of the reactivity of the title compound showed complete reductive elimination of Cat'BMe at 80 °C within four weeks. This process may be accelerated by the addition of a variety of alkynes, thereby leading to the formation of the corresponding η(2) -alkyne platinum complexes, of which [Pt(η(2)-MeCCMe)(PCy(3))(2)] was characterised by X-ray crystallography. Conversion of the trans-configured title compound to a cis derivative remained unsuccessful due to an instantaneous reductive elimination process during the reaction with chelating phosphines. Treatment of trans-[Pt(BCat')Me(PCy(3))(2)] with Cat(2)B(2) led to the formation of CatBMe and Cat'BMe. In the course of further investigations into this reaction, indications for two indistinguishable reaction mechanisms were found: 1) associative formation of a six-coordinate platinum centre prior to reductive elimination and 2) σ-bond metathesis of B-B and C-Pt bonds. Mechanism 1 provides a straightforward explanation for the formation of both methylboranes. Scrambling of diboranes(4) Cat(2)B(2) and Cat'(2)B(2) in the presence of [Pt(PCy(3))(2)], fully reductive elimination of CatBMe or Cat'BMe from trans-[Pt(BCat')Me(PCy(3))(2)] in the presence of sub-stoichiometric amounts of Cat(2)B(2), and evidence for the reversibility of the oxidative addition of Cat(2)B(2) to [Pt(PCy(3))(2)] all support mechanism 2, which consists of sequential equilibria reactions. Furthermore, the solid-state molecular structure of cis-[Pt(BCat)(2)(PCy(3))(2)] and cis-[Pt(BCat')(2)(PCy(3))(2)] were investigated. The remarkably short B-B separations in both bis(boryl) complexes suggest that the two boryl ligands in each case are more loosely bound to the Pt(II) centre than in related bis

Comparison of anterior chamber depth measurements by 3-dimensional optical coherence tomography, partial coherence interferometry biometry, Scheimpflug rotating camera imaging, and ultrasound biomicroscopy.

PubMed

Nakakura, Shunsuke; Mori, Etsuko; Nagatomi, Nozomi; Tabuchi, Hitoshi; Kiuchi, Yoshiaki

2012-07-01

To evaluate the congruity of anterior chamber depth (ACD) measurements using 4 devices. Saneikai Tsukazaki Hospital, Himeji City, Japan. Comparative case series. In 1 eye of 42 healthy participants, the ACD was measured by 3-dimensional corneal and anterior segment optical coherence tomography (CAS-OCT), partial coherence interferometry (PCI), Scheimpflug imaging, and ultrasound biomicroscopy (UBM). The differences between the measurements were evaluated by 2-way analysis of variance and post hoc analysis. Agreement between the measurements was evaluated using Bland-Altman analysis. To evaluate the true ACD using PCI, the automatically calculated ACD minus the central corneal thickness measured by CAS-OCT was defined as PCI true. Two ACD measurements were also taken with CAS-OCT. The mean ACD was 3.72 mm ± 0.23 (SD) (PCI), 3.18 ± 0.23 mm (PCI true), 3.24 ± 0.25 mm (Scheimpflug), 3.03 ± 0.25 mm (UBM), 3.14 ± 0.24 mm (CAS-OCT auto), and 3.12 ± 0.24 mm (CAS-OCT manual). A significant difference was observed between PCI biometry, Scheimpflug imaging, and UBM measurements and the other methods. Post hoc analysis showed no significant differences between PCI true and CAS-OCT auto or between CAS-OCT auto and CAS-OCT manual. Strong correlations were observed between all measurements; however, Bland-Altman analysis showed good agreement only between PCI true and Scheimpflug imaging and between CAS-OCT auto and CAS OCT manual. The ACD measurements obtained from PCI biometry, Scheimpflug imaging, CAS-OCT, and UBM were significantly different and not interchangeable except for PCI true and CAS-OCT auto and CAS-OCT auto and CAS-OCT manual. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Refuting the ticagrelor-aspirin black box warning: and proposing a ticagrelor early-PCI black box warning.

PubMed

DiNicolantonio, James J; Serebruany, Victor L; Tomek, Ales

2013-10-03

Ticagrelor, a novel reversible antiplatelet agent, has a black box warning to avoid maintenance doses of aspirin>100mg. However, a significant ticagrelor-early percutaneous coronary intervention (PCI) interaction exists. To discuss the inappropriateness of the black box warning for aspirin doses>100mg with ticagrelor and the appropriateness (and need) for a black box warning for ticagrelor patients needing early (within 24 hours of randomization) PCI. The FDA Complete Response Review for ticagrelor indicates that aspirin doses ≥ 300 mg/daily was not a significant interaction. In the ticagrelor-aspirin ≥ 300 mg cohort, all-cause mortality (through study end) and cardiovascular (CV) mortality (through study end) were not significantly increased (HR=1.27; 95% CI, 0.84-1.93, p=0.262 and HR=1.39; 95% CI:0.87-2.2, p=0.170), respectively. However, in patients treated with early (within 24 hours) PCI, ticagrelor significantly increased all-cause mortality (30 day: HR=1.89; 95% CI: 1.26-2.81, p=0.002, and through study end, HR=1.41; 95% CI,1.08-1.84, p=0.012) and increased CV mortality (30 day: HR=1.31; 95% CI: 0.97-1.77, p=0.075, and through study end, HR=1.35; 95% CI, 0.995-1.82, p=0.054) compared to clopidogrel. Early-PCI was more prevalent in the US versus outside-US regions (61% versus 49%). The black box warning for the use of maintenance aspirin doses over 100mg/daily with ticagrelor is inappropriate and ignores the more important, credible, and highly significant ticagrelor-early PCI adverse interaction in PLATO. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry.

PubMed

Alhaddad, Imad A; Tabbalat, Ramzi; Khader, Yousef; Al-Mousa, Eyas; Izraiq, Mahmoud; Nammas, Assem; Jarrah, Mohammad; Saleh, Akram; Hammoudeh, Ayman

2017-01-01

This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.

Measurement of microvascular function in patients presenting with thrombolysis for ST elevation myocardial infarction, and PCI for non-ST elevation myocardial infarction.

PubMed

Palmer, Sonny; Layland, Jamie; Adams, Heath; Ashokkumar, Srikkumar; Williams, Paul D; Judkins, Christopher; La Gerche, Andre; Burns, Andrew T; Whitbourn, Robert J; MacIsaac, Andrew I; Wilson, Andrew M

2018-04-12

In this prospective study, we compared the invasive measures of microvascular function in two subsets: patients with pharmacoinvasive thrombolysis for STEMI, and patients undergoing percutaneous coronary intervention (PCI) for NSTEMI. The study consisted of 17 patients with STEMI referred for cardiac catheterisation post thrombolysis, and 20 patients with NSTEMI. Coronary physiological indexes were measured in each patient before and after PCI. The median pre-PCI index of microcirculatory function (IMR) at baseline was significantly higher in the STEMI group than the NSTEMI group (26 units vs. 15 units, p = 0.02). Following PCI, IMR decreased in both groups (STEMI 20 units vs. NSTEMI 14 units, p = 0.10). There was an inverse correlation between post PCI IMR and left ventricular ejection fraction (LVEF) (r = -0.52, p = 0.001). Furthermore, post PCI IMR was an independent predictor of index admission LVEF in the total population (β = -0.388, p = 0.02). Invasive measures of microvascular function are inferior in a pharmacoinvasive STEMI group compared to a clinically stable NSTEMI group. In the STEMI population, the IMR following coronary intervention appears to predict LVEF. Copyright © 2018 Elsevier Inc. All rights reserved.

Ad-hoc and context-dependent adjustments of selective attention in conflict control: an ERP study with visual probes.

PubMed

Nigbur, R; Schneider, J; Sommer, W; Dimigen, O; Stürmer, B

2015-02-15

Cognitive conflict control in flanker tasks has often been described using the zoom-lens metaphor of selective attention. However, whether and how selective attention - in terms of suppression and enhancement - operates in this context has remained unclear. To examine the dynamic interplay of selective attention and cognitive control we used electrophysiological measures and presented task-irrelevant visual probe stimuli at foveal, parafoveal, and peripheral display positions. Target-flanker congruency varied either randomly from trial to trial (mixed-block) or block-wise (fixed-block) in order to induce reactive versus proactive control modes, respectively. Three EEG measures were used to capture ad-hoc adjustments within trials as well as effects of context-based predictions: the N1 component of the visual evoked potential (VEP) to probes, the VEP to targets, and the conflict-related midfrontal N2 component. Results from probe-VEPs indicate that enhanced processing of the foveal target rather than suppression of the peripheral flankers supports interference control. In incongruent mixed-block trials VEPs were larger to probes near the targets. In the fixed-blocks probe-VEPs were not modulated, but contrary to the mixed-block the preceding target-related VEP was affected by congruency. Results of the control-related N2 reveal largest amplitudes in the unpredictable context, which did not differentiate for stimulus and response incongruency. In contrast, in the predictable context, N2 amplitudes were reduced overall and differentiated between stimulus and response incongruency. Taken together these results imply that predictability alters interference control by a reconfiguration of stimulus processing. During unpredictable sequences participants adjust their attentional focus dynamically on a trial-by-trial basis as reflected in congruency-dependent probe-VEP-modulation. This reactive control mode also elicits larger N2 amplitudes. In contrast, when task demands

Calculations concerning the HCO(+)/HOC(+) abundance ratio in dense interstellar clouds

NASA Technical Reports Server (NTRS)

Defrees, D. J.; Mclean, A. D.; Herbst, E.

1984-01-01

Calculations have been performed to determine the rate coefficients of several reactions involved in both the formation and depletion of interstellar HCO(+) and HOC(+). The abundance of HOC(+) deduced from these calculations is consistent with the tentative identification of HOC(+) in Sgr B2 by Woods et al. (1983). The large HCO(+)/HOC(+) abundance ratio observed by Woods et al. is due at least in part to a more rapid formation rate for HCO(+) and probably due as well to a more rapid depletion rate for HOC(+).

Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease.

PubMed

Sedlis, Steven P; Hartigan, Pamela M; Teo, Koon K; Maron, David J; Spertus, John A; Mancini, G B John; Kostuk, William; Chaitman, Bernard R; Berman, Daniel; Lorin, Jeffrey D; Dada, Marcin; Weintraub, William S; Boden, William E

2015-11-12

Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years. We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan-Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics. Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P=0.76). During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA

[Current strategy in PCI for CTO].

PubMed

Asakura, Yasushi

2011-02-01

Recently, CTO PCI has come into wide use all over the world and it has been standardized. The 1st step is an antegrade approach using single wire. The 2nd strategy would be parallel wire technique. And the next would be a retrograde approach. In this method, retrograde wiring with Corsair is done at first. If it is successful, externalization is established using 300 cm wire, and this system is able to provide strong back-up support. If it fails, reverse CART technique is the next step. IVUS guided wiring is a last resort. The 2nd wire is manipulated with IVUS guidance. Now, initial success rate is more than 90% with these methods.

Retrograde CTO-PCI of Native Coronary Arteries Via Left Internal Mammary Artery Grafts: Insights From a Multicenter U.S. Registry.

PubMed

Tajti, Peter; Karatasakis, Aris; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A; Yeh, Robert W; Patel, Mitul; Mahmud, Ehtisham; Choi, James W; Doing, Anthony H; Toma, Catalin; Uretsky, Barry; Garcia, Santiago; Moses, Jeffrey W; Parikh, Manish; Kirtane, Ajay; Ali, Ziad A; Hatem, Raja; Karacsonyi, Judit; Danek, Barbara A; Rangan, Bavana V; Banerjee, Subhash; Ungi, Imre; Brilakis, Emmanouil S

2018-03-01

Retrograde percutaneous coronary intervention (PCI) of native coronary artery chronic total occlusion (CTO) via left internal mammary artery (LIMA) graft has received limited study. We compared the clinical and procedural characteristics and outcomes of retrograde CTO-PCI through LIMA grafts vs other conduits in a contemporary multicenter CTO registry. The LIMA was used as the collateral channel in 20 of 990 retrograde CTO-PCIs (2.02%) performed at 18 United States centers. The mean age of the study patients was 69 ± 7 years and 95% were men. The most common CTO target vessel was the right coronary artery (55%). The mean J-CTO score in the LIMA group was high (3.45 ± 0.76). The technical success rates were 70% for retrograde PCI via LIMA graft vs 81.05% for retrograde via other conduits (P=.25), while procedural success rates were 70% for retrograde PCI via LIMA graft and 78.19% for retrograde via other conduits (P=.41). The incidence of major in-hospital complications was also similar between the LIMA and non-LIMA retrograde groups (5% vs 6%; P>.99). Use of guide-catheter extensions (40% vs 28%; P=.22), intravascular ultrasound (45% vs 31%; P=.20), and left ventricular assist devices (24% vs 10%; P=.08) was numerically higher in retrograde CTO-PCIs via LIMA grafts. Retrograde CTO-PCI is infrequently performed via LIMA grafts and is associated with similar success and major in-hospital complication rates as retrograde CTO-PCI performed via other conduits.

Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.

PubMed

Rodriguez, Alfredo E; Fernandez-Pereira, Carlos; Mieres, Juan; Pavlovsky, Hernan; Del Pozo, Juan; Rodriguez-Granillo, Alfredo M; Antoniucci, David

2018-02-13

In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required. Four years ago, we built a new angiographic score in order to guide PCI strategy avoiding stent deployment both in intermediate stenosis as in small vessels, therefore these were not scored (ERACI risk score). The purpose of this mini review is to validate the strategy of PCI guided by this scoring, taking into account long term follow up outcomes of two observational and prospective registries where this policy was used. With this new risk score we have modified risk profile of our patient's candidates for PCI or coronary artery bypass surgery lowering the risk and <20% of them are now included anatomically as high risk for PCI. The simple exclusion of small vessels and intermediate stenosis from the revascularization approach resulted in clinical outcome comparable with the one of fractional flow reserve guided revascularization. Low events rate at late follow up observed in both studies was also in agreement with guided PCI by functional lesion assessment observed by Syntax II registry, where investigators found lower events rate in spite of a few number of stents implanted per patient. use of ERACI risk scores may significantly reclassify patients into a lower risk category and be associated with low adverse events rate. Copyright © 2018. Published by Elsevier Inc.

THE BTK INHIBITOR PCI-32765 SYNERGISTICALLY INCREASES PROTEASOME INHIBITOR ACTIVITY IN DLBCL AND MCL CELLS SENSITIVE OR RESISTANT TO BORTEZOMIB

PubMed Central

Dasmahapatra, Girija; Patel, Hiral; Dent, Paul; Fisher, Richard I.; Friedberg, Jonathan; Grant, Steven

2012-01-01

Summary Interactions between the Bruton tyrosine kinase (BTK) inhibitor PCI-32765 and the proteasome inhibitor (bortezomib) were examined in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells, including those highly resistant to bortezomib. Co-administration of PCI-32765/bortezomib synergistically increased mitochondrial injury and apoptosis in germinal centre- or activated B-cell-like-DLBCL cells and in MCL cells. These events were accompanied by marked AKT and nuclear factor (NF)-κB (NFKB1) inactivation, down-regulation of Mcl-1 (MCL1), Bcl-xL (BCL2L1), and XIAP, and enhanced DNA damage (e.g., γH2A.X formation) and endoplasmic reticulum (ER) stress. Similar interactions were observed in highly bortezomib-resistant DLBCL and MCL cells, and in primary DLBCL cells. In contrast, PCI-32765/bortezomib regimens displayed minimal toxicity toward normal CD34+ bone marrow cells. Transfection of DLBCL cells with a constitutively active AKT construct attenuated AKT inactivation and significantly diminished cell death, whereas expression of an NF-κB “super-repressor” (IκBαser34/36) increased both PCI-32765 and bortezomib lethality. Moreover, cells in which the ER stress response was disabled by a dominant-negative eIF2α construct were resistant to this regimen. Finally, combined exposure to PCI-32765 and bortezomib resulted in more pronounced and sustained reactive oxygen species (ROS) generation, and ROS scavengers significantly diminished lethality. Given promising early clinical results for PCI-32765 in DLBCL and MCL, a strategy combining BTK/ proteasome inhibitor warrants attention in these malignancies. PMID:23360303

Ibrutinib (PCI-32765) in chronic lymphocytic leukemia.

PubMed

Jain, Nitin; O'Brien, Susan

2013-08-01

B-cell receptor (BCR) signaling is essential for chronic lymphocytic leukemia (CLL) cell survival. Many kinases in the BCR signaling pathway are being studied as potential therapeutic targets. Ibrutinib (PCI-32765) is a novel first-in-class selective inhibitor of Bruton tyrosine kinase. Preclinical evidence suggests that ibrutinib inhibits CLL cell survival and proliferation and affects CLL cell migration and homing. Early clinical data in patients with CLL and non-Hodgkin lymphoma is encouraging. It is likely that ibrutinib and other drugs targeting the BCR pathway will become an integral component of CLL therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

A validation study of the Brazilian version of the pornography consumption inventory (PCI) in a sample of female university students.

PubMed

Baltieri, Danilo Antonio; Luísa de Souza Gatti, Ana; Henrique de Oliveira, Vitor; Junqueira Aguiar, Ana Saito; Almeida de Souza Aranha e Silva, Renata

2016-02-01

Although men constitute the widest consumer group of pornography, the Internet has facilitated both the production of and access to pornographic material by women as well. However, few measures are available to examine pornography-use constructs, which can compromise the reliability of statements regarding the harmful use of pornography. Our study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory (PCI) in a sample of female university students in Brazil. The PCI is a four-factor, 15-item, five-point Likert-type scale. After translation and back-translation of the PCI, it was administered to 105 female medical students. Exploratory and confirmatory factor analyses were conducted to examine the construct validity. The results supported the four-factor model of the PCI. The model showed adequate internal reliability and good fit indices (comparative fit index (CFI) = 0.95, Tucker-Lewis index (TLI) = 0.94, root mean square error of approximation (RMSEA) = 0.07 (95% confidence interval (CI) = 0.04-0.09), and standardized root mean square residual (SRMR) = 0.08). Overall, the findings from this study support the use of the PCI in Portuguese-speaking women. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome.

PubMed

Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

2017-12-31

To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.

Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome

PubMed Central

Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

2017-01-01

Aim To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). Methods This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). Results The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC = 0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC = 0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC = 0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC = 0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC = 0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC = 0.88; 95% CI 1.018-1.072) and on discharge (AUC = 0.78; 95% CI 1.000-1.058). Conclusions In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR. PMID:29308832

Sea Training at Maritime Academies Oversight. Hearings Before the Ad Hoc Select Subcommittee on Maritime Education and Training of the Committee on Merchant Marine and Fisheries, House of Representatives, Ninety-Sixth Congress, Second Session on Sea Training of United States Merchant Marine Officers and Different Ways of Satisfying This Requirement at the Various Maritime Academies.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Merchant Marine and Fisheries.

Recorded are minutes of hearings before the House Ad Hoc Select Subcommittee on Maritime Education and Training regarding the sea training of United States Merchant Marine officers. Examined are various approaches to meeting the sea training requirement, especially the options of maritime academy training vessels, sailing on U.S.-flag merchant…

Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.

PubMed

Cannon, Christopher P; Bhatt, Deepak L; Oldgren, Jonas; Lip, Gregory Y H; Ellis, Stephen G; Kimura, Takeshi; Maeng, Michael; Merkely, Bela; Zeymer, Uwe; Gropper, Savion; Nordaby, Matias; Kleine, Eva; Harper, Ruth; Manassie, Jenny; Januzzi, James L; Ten Berg, Jurrien M; Steg, P Gabriel; Hohnloser, Stefan H

2017-10-19

Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y 12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y 12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization. The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for

PCI-24781 down-regulates EZH2 expression and then promotes glioma apoptosis by suppressing the PIK3K/Akt/mTOR pathway.

PubMed

Zhang, Wei; Lv, Shengqing; Liu, Jun; Zang, Zhenle; Yin, Junyi; An, Ning; Yang, Hui; Song, Yechun

2014-10-01

PCI-24781 is a novel histone deacetylase inhibitor that inhibits tumor proliferation and promotes cell apoptosis. However, it is unclear whether PCI-24781 inhibits Enhancer of Zeste 2 (EZH2) expression in malignant gliomas. In this work, three glioma cell lines were incubated with various concentrations of PCI-24781 (0, 0.25, 0.5, 1, 2.5 and 5 μM) and analyzed for cell proliferation by the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay and colony formation, and cell cycle and apoptosis were assessed by flow cytometry. The expression of EZH2 and apoptosis-related proteins was assessed by western blotting. Malignant glioma cells were also transfected with EZH2 siRNA to examine how PCI-24781 suppresses tumor cells. EZH2 was highly expressed in the three glioma cell lines. Incubation with PCI-24781 reduced cell proliferation and increased cell apoptosis by down-regulating EZH2 in a concentration-dependent manner. These effects were simulated by EZH2 siRNA. In addition, PCI-24781 or EZH2 siRNA accelerated cell apoptosis by down-regulating the expression of AKT, mTOR, p70 ribosomal protein S6 kinase (p70s6k), glycogen synthase kinase 3A and B (GSK3a/b) and eukaryotic initiation factor 4E binding protein 1 (4E-BP1). These data suggest that PCI-24781 may be a promising therapeutic agent for treating gliomas by down-regulating EZH2 which promotes cell apoptosis by suppressing the phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of the rapamycin (mTOR) pathway.

Feelings of being disabled as a prognostic factor for mortality in men and women post-PCI up to 12years.

PubMed

Bergmann, Michael J; Utens, Elisabeth M W J; de Jager, Tom A J; Radhoe, Sumant P; Daemen, Joost; Lenzen, Mattie J; van Domburg, Ron T; Dulfer, Karolijn

2017-12-15

It remains unclear whether feelings of being disabled are a relevant psychological factor that determines long term outcome after percutaneous coronary intervention (PCI). Therefore, we evaluated 'feelings of being disabled' as an independent risk factor for mortality 12years post-PCI. The study population comprised a consecutive series of CAD patients (n=845) treated with PCI as part of the Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registry. Of these patients n=646 (age 63years, 75% male) completed the subscale 'feelings of being disabled' of the Heart Patients Psychological Questionnaire (HPPQ), within the first month after PCI. At 12year follow-up, n=209 patients (32%) died. Of the 162 females n=73 (45%) experienced high feelings of being disabled (High-FOBD) and of the 484 males, n=134 (28%) reported high-FOBD. Patients with high feelings of being disabled had a two-fold increased risk of mortality at 12-year follow-up (HR=1.86, 95% CI=1.41-2.45). After adjusting, high feelings of being disabled remained a predictor of 12-year mortality (HR=2.53, 95% CI=1.30-4.90). This study confirms that psychosocial variables like feelings of being disabled influence cardiac morbidity and mortality. Furthermore, there is no difference in mortality between men and women with high feelings of being disabled 12years post-PCI. It is important that clinicians are aware that PCI-patients who feel disabled have a less favorable survival and that the difference in survival is even greater for women who feel disabled. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Five-year outcomes of percutaneous versus surgical coronary revascularization in patients with diabetes mellitus (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

PubMed

Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

2015-04-15

We investigated the impact of diabetes mellitus on long-term outcomes of percutaneous coronary intervention (PCI) in the drug-eluting stent era versus coronary artery bypass grafting (CABG) in a real-world population with advanced coronary disease. We identified 3,982 patients with 3-vessel and/or left main disease of 15,939 patients with first coronary revascularization enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (patients without diabetes: n = 1,984 [PCI: n = 1,123 and CABG: n = 861], and patients with diabetes: n = 1,998 [PCI: n = 1,065 and CABG: n = 933]). Cumulative 5-year incidence of all-cause death after PCI was significantly higher than after CABG both in patients without and with diabetes (19.8% vs 16.2%, p = 0.01, and 22.9% vs 19.0%, p = 0.046, respectively). After adjusting confounders, the excess mortality risk of PCI relative to CABG was no longer significant (hazard ratio [HR] 1.16; 95% confidence interval [CI] 0.88 to 1.54; p = 0.29) in patients without diabetes, whereas it remained significant (HR 1.31; 95% CI 1.01 to 1.70; p = 0.04) in patients with diabetes. The excess adjusted risks of PCI relative to CABG for cardiac death, myocardial infarction (MI), and any coronary revascularization were significant in both patients without (HR 1.59, 95% CI 1.01 to 2.51, p = 0.047; HR 2.16, 95% CI 1.20 to 3.87, p = 0.01; and HR 3.30, 95% CI 2.55 to 4.25, p <0.001, respectively) and with diabetes (HR 1.45, 95% CI 1.00 to 2.51, p = 0.047; HR 2.31, 95% CI 1.31 to 4.08, p = 0.004; and HR 3.70, 95% CI 2.91 to 4.69, p <0.001, respectively). There was no interaction between diabetic status and the effect of PCI relative to CABG for all-cause death, cardiac death, MI, and any revascularization. In conclusion, in both patients without and with diabetes with 3-vessel and/or left main disease, CABG compared with PCI was associated with better 5-year outcomes in terms of cardiac death, MI, and any coronary

Achieving Congestion Mitigation Using Distributed Power Control for Spectrum Sensor Nodes in Sensor Network-Aided Cognitive Radio Ad Hoc Networks

PubMed Central

Zhuo, Fan; Duan, Hucai

2017-01-01

The data sequence of spectrum sensing results injected from dedicated spectrum sensor nodes (SSNs) and the data traffic from upstream secondary users (SUs) lead to unpredictable data loads in a sensor network-aided cognitive radio ad hoc network (SN-CRN). As a result, network congestion may occur at a SU acting as fusion center when the offered data load exceeds its available capacity, which degrades network performance. In this paper, we present an effective approach to mitigate congestion of bottlenecked SUs via a proposed distributed power control framework for SSNs over a rectangular grid based SN-CRN, aiming to balance resource load and avoid excessive congestion. To achieve this goal, a distributed power control framework for SSNs from interior tier (IT) and middle tier (MT) is proposed to achieve the tradeoff between channel capacity and energy consumption. In particular, we firstly devise two pricing factors by considering stability of local spectrum sensing and spectrum sensing quality for SSNs. By the aid of pricing factors, the utility function of this power control problem is formulated by jointly taking into account the revenue of power reduction and the cost of energy consumption for IT or MT SSN. By bearing in mind the utility function maximization and linear differential equation constraint of energy consumption, we further formulate the power control problem as a differential game model under a cooperation or noncooperation scenario, and rigorously obtain the optimal solutions to this game model by employing dynamic programming. Then the congestion mitigation for bottlenecked SUs is derived by alleviating the buffer load over their internal buffers. Simulation results are presented to show the effectiveness of the proposed approach under the rectangular grid based SN-CRN scenario. PMID:28914803

Effect of rosuvastatin dose-loading on serum sLox-1, hs-CRP, and postoperative prognosis in diabetic patients with acute coronary syndromes undergoing selected percutaneous coronary intervention (PCI).

PubMed

Jiao, Yungen; Hu, Feng; Zhang, Zhengang; Gong, Kaizheng; Sun, Xiaoning; Li, Aihua; Liu, Naifeng

2015-01-01

To investigate the effect of rosuvastatin dose-loading on serum levels of lectin-like oxidized low-density lipoprotein receptor-1 (Lox-1) and high-sensitivity c-reactive protein (hs-CRP) and postoperative prognosis in patients with diabetes and non-ST segment elevation acute coronary syndromes (NSTEACS) undergoing selected percutaneous coronary intervention (PCI). A total of 72 patients with diabetes and NSTEACS were randomized to either the group treated with 20 mg rosuvastatin 12 hours prior to PCI with a second dose administered just before PCI (n = 33), or a control group treated with standard method according guideline (n = 39). Serum levels of sLox-1, hs-CRP, CK-MB, and cTnI were measured prior to PCI, and at 24 hours and 30 days after PCI. The 30-day incidence of major adverse cardiac events (MACE) was recorded in both groups. Compared to pre-PCI, serum levels of sLox-1 and hs-CRP of the two groups were increased at 24 hours after PCI (P < 0.05); the levels of CK-MB and cTnI were also improved (P < 0.01); however, the ascended values of sLox-1, hs-CRP, CK-MB, and cTnI were significantly lower in the loading-dose rosuvastatin-treated group than in the control-treated group. Serum levels of sLox-1 and hs-CRP were higher in the loading-dose rosuvastatin-treated group than in the control-treated group at 30 days after PCI (P < 0.05); compared to pre-PCI, the levels of TC and LDL-C were not changed at 24 hours after PCI (P > 0.05) until 30 days after PCI (P < 0.05), but there were no difference between the two groups. The levels of ALT and Scr had no significant difference between the two groups before and after PCI; the 30-day incidence of MACE occurred in 6.06% of patients in the loading-dose rosuvastatin-treated group and in 23.08% of patients in the control-treated group (P < 0.05). The therapy of dose-loading rosuvastatin for patients with diabetes and non-ST segment elevation acute coronary syndromes undergoing selected percutaneous coronary intervention

Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial.

PubMed

van Nunen, Lokien X; Zimmermann, Frederik M; Tonino, Pim A L; Barbato, Emanuele; Baumbach, Andreas; Engstrøm, Thomas; Klauss, Volker; MacCarthy, Philip A; Manoharan, Ganesh; Oldroyd, Keith G; Ver Lee, Peter N; Van't Veer, Marcel; Fearon, William F; De Bruyne, Bernard; Pijls, Nico H J

2015-11-07

In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had FFR measurements of all stenotic arteries and PCI was done only if FFR was 0·80 or less. No one was masked to treatment assignment. The primary endpoint was major adverse cardiac events at 1 year, and the data for the 5-year follow-up are reported here. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00267774. After 5 years, major adverse cardiac events occurred in 31% of patients (154 of 496) in the angiography-guided group versus 28% (143 of 509 patients) in the FFR-guided group (relative risk 0·91, 95% CI 0·75-1·10; p=0·31). The number of stents placed per patient was significantly higher in the angiography-guided group than in the FFR-guided group (mean 2·7 [SD 1·2] vs 1·9 [1·3], p<0·0001). The results confirm the long-term safety of FFR-guided PCI in patients with multivessel disease. A strategy of FFR-guided PCI resulted in a significant decrease of major adverse cardiac events for up to 2 years after the index procedure. From 2 years to 5 years, the risks for both groups developed similarly. This clinical outcome in the FFR

Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusion Performed by Highly Experienced Japanese Specialists: The First Report From the Japanese CTO-PCI Expert Registry.

PubMed

Suzuki, Yoriyasu; Tsuchikane, Etsuo; Katoh, Osamu; Muramatsu, Toshiya; Muto, Makoto; Kishi, Koichi; Hamazaki, Yuji; Oikawa, Yuji; Kawasaki, Tomohiro; Okamura, Atsunori

2017-11-13

This report describes the registry and presents an initial analysis of outcomes for the different PCI approaches taken by the specialists. Strategies for percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are complex. The Japanese Board of CTO Interventional Specialists has developed a prospective, nonrandomized registry of patients undergoing CTO-PCIs performed by 41 highly experienced Japanese specialists. Over the study period of January 2014 to December 2015, the registry included 2,846 consecutive CTO-PCI cases undertaken in Japan. The authors compared clinical outcomes between the different PCI approaches, following the intention-to-treat principle. The overall technical success rate of the procedures was 89.9%. The specialists frequently chose a retrograde approach as the primary CTO-PCI strategy (in 27.8% of cases). The technical success rate of the primary antegrade approach was significantly better than that of the primary retrograde approach (91.0% vs. 87.3%; p < 0.0001). The technical success rate decreased to 78.0% with the rescue retrograde approach. Parallel guidewire crossing and intravascular ultrasound-guided wire crossing were performed after guidewire escalation during antegrade CTO-PCI with a high technical success rate (75.0% to 88.9%). Severe lesion calcification was a strong predictor of failed CTO-PCI. CTO-PCI performed by highly experienced specialists achieved a high technical success rate. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Use and impact of thrombectomy in primary percutaneous coronary intervention for acute myocardial infarction with persistent ST-segment elevation: results of the prospective ALKK PCI-registry.

PubMed

Härle, Tobias; Zeymer, Uwe; Hochadel, Matthias; Schmidt, Karin; Zahn, Ralf; Darius, Harald; Behrens, Steffen; Lauer, Bernward; Mudra, Harald; Schächinger, Volker; Elsässer, Albrecht

2015-10-01

Data about the impact of thrombectomy in primary percutaneous coronary intervention (PCI) are inconsistent. The aim of our study was an evaluation of both the real-world use of thrombectomy and the impact of thrombectomy on outcome in unselected patients treated with primary PCI for ST-elevation myocardial infarction (STEMI). We used the data of the prospective ALKK PCI-registry of 35 hospitals from January 2010 to December 2013. A total of 10,755 patients receiving single-vessel primary PCI for acute STEMI were included. In 2176 patients (20.2 %) thrombectomy was performed. There was a wide range of use of thrombectomy in the different ALKK hospitals from 1.1 to 61.7 % (median 18.6 %, quartiles 6.0 and 40.3 %) with a general increase of use over the first years of the study period. In patients with and without thrombectomy there was TIMI 0 flow present before PCI in 6010 patients, TIMI 1 in 1338, TIMI 2 in 2002, and TIMI 3 in 1405. Patients with acute heart failure or cardiogenic shock received significantly more often thrombectomy. Fluoroscopy time (8.1 vs. 7.3 min, p < 0.0001) and dose area product (5373 cGy × cm(2) vs. 4802 cGy × cm(2), p < 0.0001) were significantly higher in patients treated with thrombectomy. The subgroup of patients with TIMI 0 flow before PCI had significantly higher rates of TIMI 3 flow after PCI when treated with thrombectomy (87.1 vs. 84.1 %, p < 0.01), while there was no difference in post-PCI TIMI 3 flow in patients with TIMI 1, 2 or 3 flow before PCI. Rates of major adverse cardiac and cerebrovascular events were similar in both groups in general and in all subgroups of TIMI flow. The use of thrombectomy in patients with STEMI is heterogenous between hospitals. Overall, there was no impact of thrombectomy on TIMI 3 patency or mortality after PCI. In the subgroup of STEMI patients with TIMI 0 flow before PCI individualized thrombectomy had a positive impact on restoration of normal blood flow.

Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology.

PubMed

McKenzie, Nicole; Williams, Teresa A; Ho, Kwok M; Inoue, Madoka; Bailey, Paul; Celenza, Antonio; Fatovich, Daniel; Jenkins, Ian; Finn, Judith

2018-05-02

To compare survival outcomes of adults with out-of-hospital cardiac arrest (OHCA) of medical aetiology directly transported to a percutaneous-coronary-intervention capable (PCI-capable) hospital (direct transport) with patients transferred to a PCI-capable hospital via another hospital without PCI services available (indirect transport) by emergency medical services (EMS). This retrospective cohort study used the St John Ambulance Western Australia OHCA Database and medical chart review. We included OHCA patients (≥18 years) admitted to any one of five PCI-capable hospitals in Perth between January 2012 and December 2015. Survival to hospital discharge (STHD) and survival up to 12-months after OHCA were compared between the direct and indirect transport groups using multivariable logistic and Cox-proportional hazards regression, respectively, while adjusting for so-called "Utstein variables" and other potential confounders. Of the 509 included patients, 404 (79.4%) were directly transported to a PCI-capable hospital and 105 (20.6%) transferred via another hospital to a PCI-capable hospital; 274/509 (53.8%) patients STHD and 253/509 (49.7%) survived to 12-months after OHCA. Direct transport patients were twice as likely to STHD (adjusted odds ratio 1.97, 95% confidence interval [CI] 1.13-3.43) than those transferred via another hospital. Indirect transport was also associated with a possible increased risk of death, up to 12-months, compared to direct transport (adjusted hazard ratio 1.36, 95% CI 1.00-1.84). Direct transport to a PCI-capable hospital for post-resuscitation care is associated with a survival advantage for adults with OHCA of medical aetiology. This has implications for EMS transport protocols for patients with OHCA. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluation of changes in left ventricular structure and function in hypertensive patients with coronary artery disease after PCI using real-time three-dimensional echocardiography.

PubMed

Meng, Yanhong; Zong, Ling; Zhang, Ziteng; Han, Youdong; Wang, Yanhui

2018-02-01

We aimed to evaluate the changes in left ventricular structure and function in hypertensive patients with coronary artery disease before and after percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography. Two hundred and eighty hypertensive patients with coronary artery disease undergoing PCI and 120 cases who did not receive PCI in our hospital were selected as the subjects of our study. All patients were administered with routine antiplatelet, anticoagulant, lipid-lowering, antihypertensive, dilating coronary artery and other medications. The left ventricular systolic function and systolic synchrony index changes before and after subjects were treated by PCI were analyzed using three-dimensional echocardiography. At 2 days before surgery, there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-systolic volume (LVESV) and ejection fraction (EF) between the two patient groups (P>0.05). At 3 months and 9 months, the two key time points after PCI, the LVESV level in the PCI group was distinctly decreased, while EF was significantly increased (P<0.05). In addition, before treatment, there were no significant differences in the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in two patient groups, such as Tmsv-16SD, Tmsv-16Dif, Tmsv-12SD, Tmsv-12Dif, Tmsv-6SD and Tmsv-6Dif (P>0.05); however, the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in patients in the PCI group were significantly reduced at 3 and 9 months after surgery (P<0.05). Three-dimensional echocardiography can evaluate the critical parameters in the prognosis of hypertensive patients with coronary artery disease after PCI accurately and in real-time, which may play a significant role.

When high-volume PCI operators in high-volume hospitals move to lower volume hospitals-Do they still maintain high volume and quality of outcomes?

PubMed

Lu, Tsung-Hsueh; Li, Sheng-Tun; Liang, Fu-Wen; Lee, Jo-Chi; Yin, Wei-Hsian

2017-10-31

The aim of this quasi-experimental study was to examine whether high-volume percutaneous coronary intervention (PCI) operators still maintain high volume and quality of outcomes when they moved to lower volume hospitals. Systematic reviews have indicated that high-volume PCI operators and hospitals have higher quality outcomes. However, little is known on whether high PCI volume and high quality outcomes are mainly due to operator characteristics (i.e., skill and experience) and is portable across organizations or whether it is due to hospital characteristics (i.e., equipment, team, and management system) and is less portable. We used Taiwan National Health Insurance claims data 2000-2012 to identify 98 high-volume PCI operators, 10 of whom moved from one hospital to another during the study period. We compared the PCI volume, risk-adjusted mortality ratio, and major adverse cardiovascular event (MACE) ratio before and after moving. Of the 10 high-volume operators who moved, 6 moved from high- to moderate- or low-volume hospitals, with median annual PCI volumes (interquartile range) of 130 (117-165) in prior hospitals and 54 (46-84) in subsequent hospitals (the hospital the operator moved to), and the remaining 4 moved from high to high-volume hospitals, with median annual PCI volumes (interquartile range) of 151 (133-162) in prior hospitals and 193 (178-239) in subsequent hospitals. No significant differences were observed in the risk-adjusted mortality ratios and MACE ratios between high-volume operators and matched controls before and after moving. High-volume operators cannot maintain high volume when they moved from high to moderate or low-volume hospitals; however, the quality of care is maintained. High PCI volume and high-quality outcomes are less portable and more hospital bound. © 2017 Wiley Periodicals, Inc.

Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients: insights from the Dartmouth Dynamic Registry.

PubMed

Li, Shawn X; Chaudry, Hannah I; Lee, Jiyong; Curran, Theodore B; Kumar, Vishesh; Wong, Kendrew K; Andrus, Bruce W; DeVries, James T

2018-02-01

Very elderly patients (age ≥ 85 years) are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention (PCI). However, the relationship between bleeding and mortality in the very elderly is unknown. Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission (bleeding requiring transfusion, access site hematoma > 5 cm, pseudoaneurysm, and retroperitoneal bleed) and in-hospital mortality were reported for four age groups (< 65 years, 65-74 years, 75-84 years, and ≥ 85 years). The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age < 85 years and age ≥ 85 years. Of 17,378 patients studied, 1019 (5.9%) experienced bleeding and 369 (2.1%) died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age (mortality: 0.94%, 2.27%, 4.24% and 4.58%; bleeding: 3.96%, 6.62%, 10.68% and 13.99% for ages < 65, 65-74, 75-84 and ≥ 85 years, respectively). On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥ 85 years [odds ratio (95% CI): age < 65 years, 3.65 (1.99-6.74); age 65-74 years, 2.83 (1.62-4.94); age 75-84 years, 3.86 (2.56-5.82), age ≥ 85 years: 1.39 (0.49-3.95)]. Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.

Comparative effectiveness of coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) in elderly patients with diabetes.

PubMed

Shah, Ruchit; Yang, Yi; Bentley, John P; Banahan, Benjamin F

2016-11-01

To compare the relative effectiveness of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among elderly patients with diabetes regarding acute myocardial infarction (AMI), stroke, repeat revascularization, and all-cause mortality. A retrospective cohort study was conducted using the 2006-2008 5% national sample of Medicare claims data. Elderly (≥65 years) beneficiaries with at least two claims of diabetes separated by ≥30 days and who had at least one inpatient claim for multi-vessel CABG or PCI between 1 July 2006 and 30 June 2008 were identified. The date of beneficiary's first CABG or PCI was defined as the index date. All patients were followed from the index date to 31 December 2008 for outcomes. CABG and PCI patients were 1:1 matched on propensity scores and index dates. Cox proportional hazards models were used to compare postoperative outcomes between patients undergoing CABG versus PCI. The matched sample consisted of 4430 patients (2215 in each group). The Cox proportional hazards models showed that, compared to patients undergoing PCI, CABG was associated with a lower risk of postoperative AMI (hazard ratio [HR]: 0.494; 95% CI: 0.396-0.616; p < .0001), repeat revascularization (HR: 0.194; 95% CI: 0.149-0.252; p < .0001), the composite outcome (HR: 0.523; 95% CI: 0.460-0.595; p < .0001), and all-cause mortality (HR: 0.775; 95% CI: 0.658-0.914; p = .0024); postoperative risk of stroke was not significantly different between the two groups (HR: 0.965; 95% CI: 0.812-1.148; p = .691). CABG appears to be the preferred revascularization strategy for elderly patients with diabetes and coronary heart disease. However, this result should be interpreted considering study limitations, for example, several patient clinical variables and physician-related factors which may affect procedure outcomes are not available in the data. Clinical decisions should be individualized considering all patient- and physician

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital.

PubMed

Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

2016-10-01

ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground

Bruton tyrosine kinase represents a promising therapeutic target for treatment of chronic lymphocytic leukemia and is effectively targeted by PCI-32765

PubMed Central

Herman, Sarah E. M.; Gordon, Amber L.; Hertlein, Erin; Ramanunni, Asha; Zhang, Xiaoli; Jaglowski, Samantha; Flynn, Joseph; Jones, Jeffrey; Blum, Kristie A.; Buggy, Joseph J.; Hamdy, Ahmed

2011-01-01

B-cell receptor (BCR) signaling is aberrantly activated in chronic lymphocytic leukemia (CLL). Bruton tyrosine kinase (BTK) is essential to BCR signaling and in knockout mouse models its mutation has a relatively B cell–specific phenotype. Herein, we demonstrate that BTK protein and mRNA are significantly over expressed in CLL compared with normal B cells. Although BTK is not always constitutively active in CLL cells, BCR or CD40 signaling is accompanied by effective activation of this pathway. Using the irreversible BTK inhibitor PCI-32765, we demonstrate modest apoptosis in CLL cells that is greater than that observed in normal B cells. No influence of PCI-32765 on T-cell survival is observed. Treatment of CD40 or BCR activated CLL cells with PCI-32765 results in inhibition of BTK tyrosine phosphorylation and also effectively abrogates downstream survival pathways activated by this kinase including ERK1/2, PI3K, and NF-κB. In addition, PCI-32765 inhibits activation-induced proliferation of CLL cells in vitro, and effectively blocks survival signals provided externally to CLL cells from the microenvironment including soluble factors (CD40L, BAFF, IL-6, IL-4, and TNF-α), fibronectin engagement, and stromal cell contact. Based on these collective data, future efforts targeting BTK with the irreversible inhibitor PCI-32765 in clinical trials of CLL patients is warranted. PMID:21422473

Observational Prospective study to esTIMAte the rates of outcomes in patients undergoing PCI with drug-eluting stent implantation who take statins -follow-up (OPTIMA II).

PubMed

Karpov, Yu; Logunova, N; Tomilova, D; Buza, V; Khomitskaya, Yu

2017-02-01

The OPTIMA II study sought to evaluate rates of major adverse cardiac and cerebrovascular events (MACCEs) during the long-term follow-up of chronic statin users who underwent percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent (DES). OPTIMA II was a non-interventional, observational study conducted at a single center in the Russian Federation. Included patients were aged ≥18 years with stable angina who had received long-term (≥1 month) statin therapy prior to elective PCI with DES implantation and who had participated in the original OPTIMA study. Patients received treatment for stable angina after PCI as per routine study site clinical practice. Study data were collected from patient medical records and a routine visit 4 years after PCI. NCT02099565. Rate of MACCEs 4 years after PCI. Overall, 543 patients agreed to participate in the study (90.2% of patients in the original OPTIMA study). The mean (± standard deviation [SD]) duration of follow-up from the date of PCI to data collection was 4.42 ± 0.58 (range: 0.28-5.56) years. The frequency of MACCEs (including data in patients who died) was 30.8% (95% confidence interval: 27.0-34.7); half of MACCEs occurred in the first year of follow-up. After PCI, the majority of patients had no clinical signs of angina. Overall, 24.3% of patients discontinued statin intake in the 4 years after PCI. Only 7.7% of patients achieved a low-density lipoprotein (LDL) cholesterol goal of <1.8 mmol/L. Key limitations of this study related to its observational nature; for example, the sample size was small, the clinical results were derived from outpatients and hospitalized medical records, only one follow-up visit was performed at the end of the study (after 4 years' follow-up), only depersonalized medical information was made available for statistical analysis, and adherence to statin treatment was evaluated on the basis of patient questionnaire. Long-term follow-up of patients who underwent

Percutaneous coronary intervention versus coronary artery bypass grafting in patients with end-stage renal disease requiring dialysis (5-year outcomes of the CREDO-Kyoto PCI/CABG Registry Cohort-2).

PubMed

Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

2014-08-15

Ischemic heart disease is a major risk factor for morbidity and mortality in patients with end-stage renal disease. However, long-term benefits of percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in those patients is still unclear in the drug-eluting stent era. We identified 388 patients with multivessel and/or left main disease with end-stage renal disease requiring dialysis among 15,939 patients undergoing first coronary revascularization enrolled in the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2 (PCI: 258 patients and CABG: 130 patients). The CABG group included more patients with 3-vessel (38% vs 57%, p <0.001) and left main disease (10% vs 34%, p <0.001). Preprocedural Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score in the CABG group was significantly higher than that in the PCI group (23.5 ± 8.7 vs 29.4 ± 11.0, p <0.001). Unadjusted 30-day mortality was 2.7% for PCI and 5.4% for CABG. Cumulative 5-year all-cause mortality was 52.3% for PCI and 49.9% for CABG. Propensity score-adjusted all-cause mortality was not different between PCI and CABG (hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.85 to 2.09, p = 0.219). However, the excess risk of PCI relative to CABG for cardiac death was significant (HR 2.10, 95% CI 1.11 to 3.96, p = 0.02). The risk of sudden death was also higher after PCI (HR 4.83, 95% CI 1.01 to 23.08, p = 0.049). The risk of myocardial infarction after PCI tended to be higher than after CABG (HR 3.30, 95% CI 0.72 to 15.09, p = 0.12). The risk of any coronary revascularization after PCI was markedly higher after CABG (HR 3.78, 95% CI 1.91 to 7.50, p <0.001). Among the 201 patients who died during the follow-up, 94 patients (47%) died from noncardiac morbidities such as stroke, respiratory failure, and renal failure. In patients with multivessel and/or left main disease undergoing dialysis, 5-year

Cross-layer design for intrusion detection and data security in wireless ad hoc sensor networks

NASA Astrophysics Data System (ADS)

Hortos, William S.

2007-09-01

A wireless ad hoc sensor network is a configuration for area surveillance that affords rapid, flexible deployment in arbitrary threat environments. There is no infrastructure support and sensor nodes communicate with each other only when they are in transmission range. The nodes are severely resource-constrained, with limited processing, memory and power capacities and must operate cooperatively to fulfill a common mission in typically unattended modes. In a wireless sensor network (WSN), each sensor at a node can observe locally some underlying physical phenomenon and sends a quantized version of the observation to sink (destination) nodes via wireless links. Since the wireless medium can be easily eavesdropped, links can be compromised by intrusion attacks from nodes that may mount denial-of-service attacks or insert spurious information into routing packets, leading to routing loops, long timeouts, impersonation, and node exhaustion. A cross-layer design based on protocol-layer interactions is proposed for detection and identification of various intrusion attacks on WSN operation. A feature set is formed from selected cross-layer parameters of the WSN protocol to detect and identify security threats due to intrusion attacks. A separate protocol is not constructed from the cross-layer design; instead, security attributes and quantified trust levels at and among nodes established during data exchanges complement customary WSN metrics of energy usage, reliability, route availability, and end-to-end quality-of-service (QoS) provisioning. Statistical pattern recognition algorithms are applied that use observed feature-set patterns observed during network operations, viewed as security audit logs. These algorithms provide the "best" network global performance in the presence of various intrusion attacks. A set of mobile (software) agents distributed at the nodes implement the algorithms, by moving among the layers involved in the network response at each active node

The clinically active BTK inhibitor PCI-32765 targets B-cell receptor- and chemokine-controlled adhesion and migration in chronic lymphocytic leukemia.

PubMed

de Rooij, Martin F M; Kuil, Annemieke; Geest, Christian R; Eldering, Eric; Chang, Betty Y; Buggy, Joseph J; Pals, Steven T; Spaargaren, Marcel

2012-03-15

Small-molecule drugs that target the B-cell antigen receptor (BCR) signalosome show clinical efficacy in the treatment of B-cell non-Hodgkin lymphoma. These agents, including the Bruton tyrosine kinase (BTK) inhibitor PCI-32765, display an unexpected response in patients with chronic lymphocytic leukemia (CLL): a rapid and sustained reduction of lymphadenopathy accompanied by transient lymphocytosis, which is reversible upon temporary drug deprivation. We hypothesized that this clinical response reflects impaired integrin-mediated adhesion and/or migration. Here, we show that PCI-32765 strongly inhibits BCR-controlled signaling and integrin α(4)β(1)-mediated adhesion to fibronectin and VCAM-1 of lymphoma cell lines and primary CLL cells. Furthermore, PCI-32765 also inhibits CXCL12-, CXCL13-, and CCL19-induced signaling, adhesion, and migration of primary CLL cells. Our data indicate that inhibition of BTK by PCI-32765 overcomes BCR- and chemokine-controlled integrin-mediated retention and homing of malignant B cells in their growth- and survival-supporting lymph node and bone marrow microenvironment, which results in clinically evident CLL regression.

Evaluation of absorbent materials for use as ad hoc dry decontaminants during mass casualty incidents as part of the UK’s Initial Operational Response (IOR)

PubMed Central

Kassouf, Nick; Syed, Sara; Larner, Joanne; Amlôt, Richard

2017-01-01

The UK’s Initial Operational Response (IOR) is a revised process for the medical management of mass casualties potentially contaminated with hazardous materials. A critical element of the IOR is the introduction of immediate, on-scene disrobing and decontamination of casualties to limit the adverse health effects of exposure. Ad hoc cleansing of the skin with dry absorbent materials has previously been identified as a potential means of facilitating emergency decontamination. The purpose of this study was to evaluate the in vitro oil and water absorbency of a range of materials commonly found in the domestic and clinical environments and to determine the effectiveness of a small, but representative selection of such materials in skin decontamination, using an established ex vivo model. Five contaminants were used in the study: methyl salicylate, parathion, diethyl malonate, phorate and potassium cyanide. In vitro measurements of water and oil absorbency did not correlate with ex vivo measurements of skin decontamination. When measured ex vivo, dry decontamination was consistently more effective than a standard wet decontamination method (“rinse-wipe-rinse”) for removing liquid contaminants. However, dry decontamination was ineffective against particulate contamination. Collectively, these data confirm that absorbent materials such as wound dressings and tissue paper provide an effective, generic capability for emergency removal of liquid contaminants from the skin surface, but that wet decontamination should be used for non-liquid contaminants. PMID:28152053

The Bruton tyrosine kinase inhibitor PCI-32765 blocks B-cell activation and is efficacious in models of autoimmune disease and B-cell malignancy

PubMed Central

Honigberg, Lee A.; Smith, Ashley M.; Sirisawad, Mint; Verner, Erik; Loury, David; Chang, Betty; Li, Shyr; Pan, Zhengying; Thamm, Douglas H.; Miller, Richard A.; Buggy, Joseph J.

2010-01-01

Activation of the B-cell antigen receptor (BCR) signaling pathway contributes to the initiation and maintenance of B-cell malignancies and autoimmune diseases. The Bruton tyrosine kinase (Btk) is specifically required for BCR signaling as demonstrated by human and mouse mutations that disrupt Btk function and prevent B-cell maturation at steps that require a functional BCR pathway. Herein we describe a selective and irreversible Btk inhibitor, PCI-32765, that is currently under clinical development in patients with B-cell non-Hodgkin lymphoma. We have used this inhibitor to investigate the biologic effects of Btk inhibition on mature B-cell function and the progression of B cell-associated diseases in vivo. PCI-32765 blocked BCR signaling in human peripheral B cells at concentrations that did not affect T cell receptor signaling. In mice with collagen-induced arthritis, orally administered PCI-32765 reduced the level of circulating autoantibodies and completely suppressed disease. PCI-32765 also inhibited autoantibody production and the development of kidney disease in the MRL-Fas(lpr) lupus model. Occupancy of the Btk active site by PCI-32765 was monitored in vitro and in vivo using a fluorescent affinity probe for Btk. Active site occupancy of Btk was tightly correlated with the blockade of BCR signaling and in vivo efficacy. Finally, PCI-32765 induced objective clinical responses in dogs with spontaneous B-cell non-Hodgkin lymphoma. These findings support Btk inhibition as a therapeutic approach for the treatment of human diseases associated with activation of the BCR pathway. PMID:20615965

Reinfarction Following PCI or Medical Management using the Universal Definition in Patients With Total Occlusion After Myocardial Infarction: Results from Long Term Follow up of the OAT Cohort

PubMed Central

White, Harvey D.; Reynolds, Harmony R.; Carvalho, Antonio C.; Pearte, Camille A.; Liu, Li; Martin, C. Edwin; Knatterud, Genell L.; Džavík, Vladimír; Kruk, Mariusz; Steg, Philippe Gabriel; Cantor, Warren J.; Menon, Venu; Lamas, Gervasio A.; Hochman, Judith S.

2014-01-01

Background The Occluded Artery Trial (OAT) randomized 2201 patients with a totally occluded infarct-related artery on days 3–28 (>24 hours) following myocardial infarction (MI) to percutaneous coronary intervention (PCI) or medical treatment (MED). There was no difference in the primary endpoint of death, reinfarction or heart failure at 2.9 year or 6-year mean follow-up. However in patients randomized to PCI there was a trend for an increase in reinfarction. Methods We analyzed the characteristics and types of reinfarction according to the universal definition. Independent predictors of reinfarction were determined using Cox proportional hazard models with follow up to 9 years. Results There were 169 reinfarctions; 9.4% PCI vs 8.0% MED, HR 1.31, 95% CI 0.97 −1.77, p=0.08. Spontaneous reinfarction (type 1) occurred with similar frequency in the groups; 4.9% PCI vs 6.7% MED, HR 0.78, 95% CI 0.53 – 1.15, p=0.21. Rates of type 2 (secondary) and 3 (sudden death) MI were similar in both groups. There was an increase in type 4a reinfarctions (related to protocol or repeat PCI), 0.8% PCI vs 0.1% MED, p=0.01 and type 4b reinfarctions (stent thrombosis); 2.7% PCI vs 0.6% MED, p<0.001. Multivariate predictors of reinfarction were history of PCI prior to study entry (p=0.001), diabetes (p=0.005), and absence of new Q waves with the index infarction (p=0.01). Conclusions There was a trend for reMI to be more frequent with PCI. Opening an occluded infarct-related artery in stable patients late post-MI exposes them to a risk of subsequent reinfarction related to reocclusion and stent thrombosis. PMID:22520521

Clopidogrel-Proton Pump Inhibitor Drug-Drug Interaction and Risk of Adverse Clinical Outcomes Among PCI-Treated ACS Patients: A Meta-analysis.

PubMed

Serbin, Michael A; Guzauskas, Gregory F; Veenstra, David L

2016-08-01

Uncertainty regarding clopidogrel effectiveness attenuation because of a drug-drug interaction with proton pump inhibitors (PPI) has led to conflicting guidelines on concomitant therapy. In particular, the effect of this interaction in patients who undergo a percutaneous coronary intervention (PCI), a population known to have increased risk of adverse cardiovascular events, has not been systematically evaluated. To synthesize the evidence of the effect of clopidogrel-PPI drug interaction on adverse cardiovascular outcomes in a PCI patient population. We conducted a systematic literature review for studies reporting clinical outcomes in patients who underwent a PCI and were initiated on clopidogrel with or without a PPI. Studies were included in the analysis if they reported at least 1 of the clinical outcomes of interest (major adverse cardiovascular event [MACE], cardiovascular death, all-cause death, myocardial infarction, stroke, stent thrombosis, and bleed events). We excluded studies that were not exclusive to PCI patients or had no PCI subgroup analysis and/or did not report at least a 6-month follow-up. Statistical and clinical heterogeneity were evaluated and HRs and 95% CIs for adverse clinical events were pooled using the DerSimonian and Laird random-effects meta-analysis method. We identified 12 studies comprising 50,277 PCI patients that met our inclusion and exclusion criteria. Our analysis included retrospective analyses of randomized controlled trials (2), health registries (3), claims databases (2), and institutional records (5); no prospective studies of PCI patients were identified. On average, patients were in their mid-60s, male, and had an array of comorbidities, including hyperlipidemia, diabetes, hypertension, and smoking history. Concomitant therapy following PCI resulted in statistically significant increases in composite MACE (HR = 1.28; 95% CI = 1.24-1.32), myocardial infarction (HR = 1.51; 95% CI = 1.40-1.62), and stroke (HR = 1.46; 95

Post hoc analyses: after the facts.

PubMed

Srinivas, Titte R; Ho, Bing; Kang, Joseph; Kaplan, Bruce

2015-01-01

Prospective clinical trials are constructed with high levels of internal validity. Sample size and power considerations usually address primary endpoints. Primary endpoints have traditionally included events that are becoming increasingly less common and thus have led to growing use of composite endpoints and noninferiority trial designs in transplantation. This approach may mask real clinical benefit in one or the other domain with regard to either clinically relevant secondary endpoints or other unexpected findings. In addition, endpoints solely chosen based on power considerations are prone to misjudgment of actual treatment effect size as well as consistency of that effect. In the instances where treatment effects may have been underestimated, valuable information may be lost if buried within a composite endpoint. In all these cases, analyses and post hoc analyses of data become relevant in informing practitioners about clinical benefits or safety signals that may not be captured by the primary endpoint. On the other hand, there are many pitfalls in using post hoc determined endpoints. This short review is meant to allow readers to appreciate post hoc analysis not as an entity with a single approach, but rather as an analysis with unique limitations and strengths that often raise new questions to be addressed in further inquiries.

High-risk PCI: how to define it today?

PubMed

DE Marzo, Vincenzo; D'Amario, Domenico; Galli, Mattia; Vergallo, Rocco; Porto, Italo

2018-04-11

Before the percutaneous spread, the mortality rate of patients with coronary heart disease not suitable for cardiac surgery was markedly high. This limit has been progressively exceeded with the advent of minimally invasive approaches, which, although was initially intended exclusively for low risk patients, was then employed in complex patients often too compromised to undergo cardiac surgery. Given to the rising of high-risk population, due to an increase of patients with multiple chronic conditions linked to the best care offered, we are witnessing an expansion of the high-risk percutaneous coronary interventions (PCI) population. Despite defining what high-risk is remains still unclear, all proposed definitions of high-risk PCI combine features related to three clinical areas: 1) patient risk factors and comorbidities (incorporating those which preclude surgical or percutaneous revascularization such as diabetes, COPD, CKD, lung disease, frailty, advanced age); 2) location of the disease and complexity of coronary anatomy (including multi-vessel disease, left main disease, CTO, bifurcations); 3) hemodynamic clinical status (ventricular dysfunction, concomitant valvular disease or unstable characteristics). Since cardiologists have ascertained the encouraging results in terms of efficacy and rewards compared to the low-risks patients, the important role of treating high-risk patients is becoming more and more relevant to the point that current guidelines have now changed the appropriateness of percutaneous interventions indications. Considering the complexity in managing higher-risk patients with coronary artery disease, the next step to ensure the best care for this type of patients is to create a team-based model of cooperation in order to properly establish the right treatment for the right patient.

Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI) for Acute ST-Segment Elevation Myocardial Infarction (STEMI)

PubMed Central

Cao, Bangming; Wang, Haipeng; Zhang, Chi; Xia, Ming

2018-01-01

Background The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Material/Methods Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. Results Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (P<0.01), a significantly increased left ventricular ejection fraction (LVEF) (P=0.01), a significantly lower rate of AKI (P<0.01) a significantly increased eGFR (P<0.01), and decreased area under the curve (AUC) of CK-MB, NO and SDF-1α. Conclusions RIPC of the upper arm following primary PCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO. PMID:29456238

Remote Ischemic Postconditioning (RIPC) of the Upper Arm Results in Protection from Cardiac Ischemia-Reperfusion Injury Following Primary Percutaneous Coronary Intervention (PCI) for Acute ST-Segment Elevation Myocardial Infarction (STEMI).

PubMed

Cao, Bangming; Wang, Haipeng; Zhang, Chi; Xia, Ming; Yang, Xiangjun

2018-02-19

BACKGROUND The aim of this study was to evaluate the role of remote ischemic postconditioning (RIPC) of the upper arm on protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS Eighty patients with STEMI were randomized into two groups: primary PCI (N=44) and primary PCI+RIPC (N=36). RIPC consisted of four cycles of 5 minutes of occlusion and five minutes of reperfusion by cuff inflation and deflation of the upper arm, commencing within one minute of the first PCI balloon dilatation. Peripheral venous blood samples were collected before PCI and at 0.5, 8, 24, 48, and 72 hours after PCI. Levels of creatine kinase-MB (CK-MB), serum creatinine (Cr), nitric oxide (NO), and stromal cell-derived factor-1α (SDF-1α) were measured. The rates of acute kidney injury (AKI) and the estimated glomerular filtration rate (eGFR) were calculated. RESULTS Patients in the primary PCI+RIPC group, compared with the primary PCI group, had significantly lower peak CK-MB concentrations (P<0.01), a significantly increased left ventricular ejection fraction (LVEF) (P=0.01), a significantly lower rate of AKI (P<0.01) a significantly increased eGFR (P<0.01), and decreased area under the curve (AUC) of CK-MB, NO and SDF-1α. CONCLUSIONS RIPC of the upper arm following primary PCI in patients with acute STEMI might provide cardiac and renal protection from ischemia-reperfusion injury via the actions of SDF-1α, and NO.

Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial.

PubMed

Elias, Joëlle; van Dongen, Ivo M; Hoebers, Loes P; Ouweneel, Dagmar M; Claessen, Bimmer E P M; Råmunddal, Truls; Laanmets, Peep; Eriksen, Erlend; van der Schaaf, René J; Ioanes, Dan; Nijveldt, Robin; Tijssen, Jan G; Hirsch, Alexander; Henriques, José P S

2017-07-19

The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory. Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment. In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2-3 collaterals compared to grade 0-1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04). CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome. Trialregister.nl NTR1108 , Date registered NTR: 30-okt-2007.

On the Post Hoc Power in Testing Mean Differences

ERIC Educational Resources Information Center

Yuan, Ke-Hai; Maxwell, Scott

2005-01-01

Retrospective or post hoc power analysis is recommended by reviewers and editors of many journals. Little literature has been found that gave a serious study of the post hoc power. When the sample size is large, the observed effect size is a good estimator of the true power. This article studies whether such a power estimator provides valuable…

Newly developed photon-cell interactive Monte Carlo (pciMC) simulation for non-invasive and continuous diagnosis of blood during extracorporeal circulation support

NASA Astrophysics Data System (ADS)

Sakota, Daisuke; Takatani, Setsuo

2011-07-01

We have sought for non-invasive diagnosis of blood during the extracorporeal circulation support. To achieve the goal, we have newly developed a photon-cell interactive Monte Carlo (pciMC) model for optical propagation through blood. The pciMC actually describes the interaction of photons with 3-dimentional biconcave RBCs. The scattering is described by micro-scopical RBC boundary condition based on geometric optics. By using pciMC, we modeled the RBCs inside the extracorporeal circuit will be oriented by the blood flow. The RBCs' orientation was defined as their long axis being directed to the center of the circulation tube. Simultaneously the RBCs were allowed to randomly rotate about the long axis direction. As a result, as flow rate increased, the orientation rate increased and converged to approximately 22% at 0.5 L/min flow rate and above. And finally, by using this model, the pciMC non-invasively and absolutely predicted Hct and hemoglobin with the accuracies of 0.84+/-0.82 [HCT%] and 0.42+/-0.28 [g/dL] respectively against measurements by a blood gas analyzer.

Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications.

PubMed

Rafie, Ihsan M; Uddin, Muez M; Ossei-Gerning, Nicholas; Anderson, Richard A; Kinnaird, Timothy D

2014-02-01

Radial artery (RA) access for PCI has a lower incidence of vascular access-site (VAS) complications than the femoral artery (FA) approach. However, even for default radial operators certain patients are intervened upon from the FA. We examined the demographics and incidence of VAS complications when default radial operators resort to the FA for PCI. The demographics and VAS complications were compared by access site retrospectively for all PCI cases performed by default radial operators (n=1,392). A modified ACUITY trial definition of major VAS complication was used. FA puncture occurred in 25.2% (351/1,392) of cases. Patients were more likely to be female, older and weigh less than patients undergoing PCI from the RA. The FA procedure was likely to be more complex with larger sheaths, more left main stem, graft and multivessel intervention, and there was a greater proportion of emergency cases. Despite increased case complexity, glycoprotein inhibitors were used less frequently in femoral cases (26.5% vs. 36.8%, p<0.001). A VAS complication occurred in 12.5% (44/351) of cases. The risk factors for access-site bleeding are disproportionately high in the population requiring FA puncture by default radial operators, and as a result such patients have a high rate of vascular access-site complications.

A reanalysis of the HCO(+)/HOC(+) abundance ratio in dense interstellar clouds

NASA Technical Reports Server (NTRS)

Jarrold, M. F.; Bowers, M. T.; Defrees, D. J.; Mclean, A. D.; Herbst, E.

1986-01-01

New theoretical and experimental results have prompted a reinvestigation of the HCO(+)/HOC(+) abundance ratio in dense interstellar clouds. These results pertain principally but not exclusively to the reaction between HOC(+) and H2, which was previously calculated by DeFrees et al. (1984) to possess a large activation energy barrier. New calculations, reported here, indicate that this activation energy barrier is quite small and may well be zero. In addition, experimental results at higher energy and temperature indicate strongly that the reaction proceeds efficiently at interstellar temperatures. If HOC(+) does indeed react efficiently with H2 in interstellar clouds, the calculated HCO(+)/HOC(+) abundance ratio rises to a substantially greater value under standard dense cloud conditions than is deduced via the tentative observation of HOC(+) in Sgr B2.

Patient awareness of stent type, risk of cardiac events, and symptoms of myocardial infarction among PCI patients: a missed educational opportunity?

PubMed

D'Elia, Alexis A; Hafiz, Abdul Moiz; Naidu, Srihari S; Marzo, Kevin P

2011-04-01

 Timely and successful treatment of myocardial infarction (MI) requires accurate recognition by the patient of the signs and symptoms. As patients who have undergone percutaneous coronary intervention (PCI) remain at risk for cardiac events, it is important that they have a basic understanding of their cardiac status.  We surveyed 80 consecutive patients following elective PCI using a simple multiple-choice questionnaire. Type of stent (bare metal or drug-eluting), how they perceive the procedure would affect their cardiovascular health, their perceived risk of a future MI, and whether they recalled specific education on how to recognize symptoms of an MI were queried.  45% (n = 36) of patients were unaware of stent type. 10% stated PCI was performed to relieve symptoms of angina, 30% (n = 24) stated it would prevent MI, 56.3% (n = 45) stated that it would both prevent MI and reduce symptoms of angina, while 3.8% stated it would do neither. 86.3% (n = 69) stated they remained at risk for MI despite the procedure. However, 42.5% (n = 34) of patients did not perceive to have received specific education on the signs and symptoms of MI during their hospital stay.  Patient understanding of stent type, expected cardiovascular outcomes, and recognition of MI post-PCI appears low in the real-world setting. A systematic approach to post-PCI education should be incorporated into routine care, in order to capitalize on the educational opportunity afforded by this high risk population. ©2010, Wiley Periodicals, Inc.

Scale-space for empty catheter segmentation in PCI fluoroscopic images.

PubMed

Bacchuwar, Ketan; Cousty, Jean; Vaillant, Régis; Najman, Laurent

2017-07-01

In this article, we present a method for empty guiding catheter segmentation in fluoroscopic X-ray images. The guiding catheter, being a commonly visible landmark, its segmentation is an important and a difficult brick for Percutaneous Coronary Intervention (PCI) procedure modeling. In number of clinical situations, the catheter is empty and appears as a low contrasted structure with two parallel and partially disconnected edges. To segment it, we work on the level-set scale-space of image, the min tree, to extract curve blobs. We then propose a novel structural scale-space, a hierarchy built on these curve blobs. The deep connected component, i.e. the cluster of curve blobs on this hierarchy, that maximizes the likelihood to be an empty catheter is retained as final segmentation. We evaluate the performance of the algorithm on a database of 1250 fluoroscopic images from 6 patients. As a result, we obtain very good qualitative and quantitative segmentation performance, with mean precision and recall of 80.48 and 63.04% respectively. We develop a novel structural scale-space to segment a structured object, the empty catheter, in challenging situations where the information content is very sparse in the images. Fully-automatic empty catheter segmentation in X-ray fluoroscopic images is an important and preliminary step in PCI procedure modeling, as it aids in tagging the arrival and removal location of other interventional tools.

Design and Rationale for the Endothelin-1 Receptor Antagonism in the Prevention of Microvascular Injury in Patients with non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (ENDORA-PCI) Trial.

PubMed

Liou, Kevin; Jepson, Nigel; Buckley, Nicolas; Chen, Vivien; Thomas, Shane; Russell, Elizabeth Anne; Ooi, Sze-Yuan

2016-04-01

Peri-procedural myocardial infarction (PMI) occurs in a small but significant portion of patients undergoing percutaneous intervention (PCI). The underlying mechanisms are complex and may include neurohormonal activation and release of vasoactive substances resulting in disruption of the coronary microcirculation. Endothelin in particular has been found in abundance in atherosclerotic plaques and in systemic circulation following PCI, and may be a potential culprit for PMI through its action on microvascular vasoconstriction, and platelet and neutrophil activation. In this study we aim to characterize the behavior of the coronary microcirculation during a PCI with the index of microvascular resistance (IMR) and the effect of peri-procedural endothelin antagonism. The ENDORA-PCI trial is a randomized, double-blind, placebo-controlled, single-center clinical trial designed to evaluate the efficacy of endothelin antagonism in attenuating the peri-procedural rise in IMR as a surrogate marker for PMI. The patients of interest are those with non-ST elevation acute coronary syndrome (NSTEACS) undergoing PCI, and we aim to recruit 52 patients overall to give the study a power of 80 % at an α level of 5 %. Patients will be randomized in a 1:1 fashion to either Ambrisentan, an endothelin antagonist, or placebo, prior to their PCI. IMR will be measured before and after PCI. The primary endpoint is the difference in peri-procedural changes in patients' IMR between the two groups. The ENDORA-PCI study will investigate whether endothelin antagonism with Ambrisentan attenuates the peri-procedural rise in IMR in patients with NSTEACS undergoing PCI, and thus potentially the risk of PMI.

PCI fuel failure analysis: a report on a cooperative program undertaken by Pacific Northwest Laboratory and Chalk River Nuclear Laboratories.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohr, C.L.; Pankaskie, P.J.; Heasler, P.G.

Reactor fuel failure data sets in the form of initial power (P/sub i/), final power (P/sub f/), transient increase in power (..delta..P), and burnup (Bu) were obtained for pressurized heavy water reactors (PHWRs), boiling water reactors (BWRs), and pressurized water reactors (PWRs). These data sets were evaluated and used as the basis for developing two predictive fuel failure models, a graphical concept called the PCI-OGRAM, and a nonlinear regression based model called PROFIT. The PCI-OGRAM is an extension of the FUELOGRAM developed by AECL. It is based on a critical threshold concept for stress dependent stress corrosion cracking. The PROFITmore » model, developed at Pacific Northwest Laboratory, is the result of applying standard statistical regression methods to the available PCI fuel failure data and an analysis of the environmental and strain rate dependent stress-strain properties of the Zircaloy cladding.« less