With the rapid advancement of the Internet of Things (IoT), there is a global surge in network traffic. Software-Defined Networks (SDNs) provide a holistic network perspective, facilitating ...software-based traffic analysis, and are more suitable to handle dynamic loads than a traditional network. The standard SDN architecture control plane has been designed for a single controller or multiple distributed controllers; however, a logically centralized single controller faces severe bottleneck issues. Most proposed solutions in the literature are based on the static deployment of multiple controllers without the consideration of flow fluctuations and traffic bursts, which ultimately leads to a lack of load balancing among controllers in real time, resulting in increased network latency. Moreover, some methods addressing dynamic controller mapping in multi-controller SDNs consider load fluctuation and latency but face controller placement problems. Earlier, we proposed priority scheduling and congestion control algorithm (eSDN) and dynamic mapping of controllers for dynamic SDN (dSDN) to address this issue. However, the future growth of IoT is unpredictable and potentially exponential; to accommodate this futuristic trend, we need an intelligent solution to handle the complexity of growing heterogeneous devices and minimize network latency. Therefore, this paper continues our previous research and proposes temporal deep Q learning in the dSDN controller. A Temporal Deep Q learning Network (tDQN) serves as a self-learning reinforcement-based model. The agent in the tDQN learns to improve decision-making for switch-controller mapping through a reward-punish scheme, maximizing the goal of reducing network latency during the iterative learning process. Our approach-tDQN-effectively addresses dynamic flow mapping and latency optimization without increasing the number of optimally placed controllers. A multi-objective optimization problem for flow fluctuation is formulated to divert the traffic to the best-suited controller dynamically. Extensive simulation results with varied network scenarios and traffic show that the tDQN outperforms traditional networks, eSDNs, and dSDNs in terms of throughput, delay, jitter, packet delivery ratio, and packet loss.
Software-defined networks (SDN) has a holistic view of the network. It is highly suitable for handling dynamic loads in the traditional network with a minimal update in the network infrastructure. ...However, the standard SDN architecture control plane has been designed for single or multiple distributed SDN controllers facing severe bottleneck issues. Our initial research created a reference model for the traditional network, using the standard SDN (referred to as SDN hereafter) in a network simulator called NetSim. Based on the network traffic, the reference models consisted of light, modest and heavy networks depending on the number of connected IoT devices. Furthermore, a priority scheduling and congestion control algorithm is proposed in the standard SDN, named extended SDN (eSDN), which minimises congestion and performs better than the standard SDN. However, the enhancement was suitable only for the small-scale network because, in a large-scale network, the eSDN does not support dynamic SDN controller mapping. Often, the same SDN controller gets overloaded, leading to a single point of failure. Our literature review shows that most proposed solutions are based on static SDN controller deployment without considering flow fluctuations and traffic bursts that lead to a lack of load balancing among the SDN controllers in real-time, eventually increasing the network latency. Therefore, to maintain the Quality of Service (QoS) in the network, it becomes imperative for the static SDN controller to neutralise the on-the-fly traffic burst. Thus, our novel dynamic controller mapping algorithm with multiple-controller placement in the SDN is critical to solving the identified issues. In dSDN, the SDN controllers are mapped dynamically with the load fluctuation. If any SDN controller reaches its maximum threshold, the rest of the traffic will be diverted to another controller, significantly reducing delay and enhancing the overall performance. Our technique considers the latency and load fluctuation in the network and manages the situations where static mapping is ineffective in dealing with the dynamic flow variation.
Aims/Objectives: This study was conducted to assess the utilization patterns of anticancer agents in patients with breast cancer and to provide practice recommendations/educational interventions to ...optimize medication use in patients with breast cancer.
Materials and Methods: This was an ambispective study conducted for a period of 3 years at a private, specialty oncology care hospital in South India. In the initial phase, the selection of anticancer agents, dosage of anticancer agents, and management of chemotherapy-induced nausea and vomiting (CINV) were reviewed retrospectively (using paper medical records) with respect to the National Cancer Comprehensive Network guidelines. The administration of anticancer agents and anti-emetics were reviewed with respect to the hospital drug administration policies. The deviations from the standards were reported, and practice recommendations/educational interventions were developed. Treatment patterns were reevaluated prospectively after providing educational interventions. Descriptive statistics were used to report and compare the results from both phases.
Results: During retrospective phase, we observed 80% compliance in the selection of anticancer drugs, 74% compliance in drug dosing, and 63.5% compliance in the administration of anti-cancer agents. After the implementation of educational interventions, we observed 85% compliance in the selection of anticancer agents, 82.3% in their dosing, and 86.9% compliance in the administration of anticancer agents. For the management of CINV, we observed 75% compliance in the selection of drugs (vs. 53% during preintervention), 92% compliance in their dosing (vs. 90% during preintervention), 85.1% compliance in the administration of anti-emetics (vs. 50% during preintervention), and 80% compliance in the management of delayed CINV (vs. 60% during preintervention).
Conclusions: Treatment patterns of breast cancer were improved with respect to treatment standards after educational interventions to oncology care team.
Abstract Leprosy is a silent disease with protean manifestations, especially during lepra reactions (LRs). Cases with atypical leprosy or LR simulate a number of conditions misdiagnosed frequently. ...Here, three classical cases of leprosy are reported for their complex presentation. Leprosy was hidden in Case 1 due to co-existing diabetes. COVID vaccination induced LR unmasked all leprosy lesions, which were extensive, large, bizarre and spreading to various immune zones. Case 2 presented with high-grade fever, tachycardia, generalized erythema and body aches. A detailed workup unveiled his leprosy with a rare presentation of Type 1 lepra reaction (T1LR) with erythroderma and severe systemic symptoms. Case 3 mimicked sarcoidosis and lupus erythematosus (LE) on routine workup. She had facial lesions in the malar area, photosensitivity, joint pains, raised angiotensin-converting enzyme (ACE) levels and positive anti-nuclear antibodies. Peri-appendageal granulomas on histopathology and therapeutic response to multidrug therapy helped in the early diagnosis of leprosy.
Diabetic amyotrophy Sharma, Aakanksha; Jattan, Aaron
Canadian family physician,
08/2023, Letnik:
69, Številka:
8
Journal Article
Recenzirano
Odprti dostop
A 74-year-old male with multiple medical comorbidities, including type 2 diabetes, was admitted to a family medicine hospital ward for an acute kidney injury. During his admission he developed acute ...right leg weakness and pain. A stroke evaluation was not suggestive of a cerebrovascular event. Further imaging studies, including magnetic resonance imaging (MRI) of his lumbar spine and angiography, were not suggestive of radiculopathy or acute vascular ischemia. Subsequent electromyography (EMG) and nerve conduction studies were consistent with a diagnosis of diabetic amyotrophy. This debilitating condition prolonged the patient's stay in hospital to more than a month and eventually required transfer to a long-term care facility. Physicians should be aware of this rare complication of type 2 diabetes that presents differently from typical diabetic neuropathies, which are commonly distal, symmetric, and sensorimotor. Diabetic amyotrophy is characterized by an asymmetric loss of proximal motor function, muscle atrophy, and severe neuropathic pain.
Background
Ondansetron is a selective 5-hydroxytryptamine type 3 serotonin-receptor antagonist with antiemetic properties used inadvertently in the emergency department for controlling nausea. ...However, ondansetron is linked with a number of adverse effects, including prolongation of the QT interval. Therefore, the purpose of this meta-analysis was to assess the occurrence of QT prolongation in pediatric, adult, and elderly patients receiving oral or intravenously administered ondansetron.
Methods
A thorough electronic search was conducted on PubMed (Medline) and Cochrane Library from the databases' inception to August 10, 2022. Only those studies were considered in which ondansetron was administered orally or intravenously to participants for the treatment of nausea and vomiting. The prevalence of QT prolongation in multiple predefined age groups was the outcome variable. Analyses were conducted using Review manager 5.4 (Cochrane collaboration, 2020).
Results
A total of 10 studies involving 687 ondansetron group participants were statistically analyzed. The administration of ondansetron was associated with a statistically significant prevalence of QT prolongation in all age groups. An age-wise subgroup analysis was conducted which revealed that the prevalence of QT prolongation among participants younger than 18 years was not statistically significant, whereas it was statistically significant among participants aged 18–50 years and among patients older than 50 years.
Conclusions
The present meta-analysis provides further evidence that oral or intravenous administration of Ondansetron may lead to QT prolongation, particularly among patients older than 18 years of age.
Ischemic optic neuropathy is classified into anterior and posterior ischemic optic neuropathy depending upon the part of optic nerve involved. In anterior optic neuropathy, optic nerve head is ...involved and in posterior ischemic optic neuropathy(PION) retrobulbar portion is involved. There is sudden loss of vision in both the entities but there are optic disc changes in anterior optic neuropathy while in posterior ischemic optic neuropathy optic disc is normal initially. Etiologically, posterior ischemic optic neuropathy is divided into non arteritic non-surgical, arteritic and perioperative non arteritic posterior ischemic optic neuropathy.
Improved power quality is the driving capability for today's modern manufacturers. Consumer awareness regarding reliable power supply has risen enormously in the last decade. This has led to an ...additional impact in the development of small distributed generation (DG). Small isolated DG sets can feed local loads, leading to enhancement in the authenticity of power with low capital investment. These systems also increase importance in remote areas where transmission using overhead conductors or cables is unrealistic or prohibitive due to high cost and other circumstances. Small generation systems in rural areas, islands, hilly terrains, marine plants, aircraft, etc., can be efficiently used in developing countries too. However, these DG sets have to be de-rated if the induction motor loads are instantaneously started. One practical choice is to use DSTATCOM in a shunt structure with the central system to efficiently utilize the full capacity of producing sets. DSTATCOM consists of a voltage source converter (VSC), and it internally has the required capacitive and inductive reactive power. Its control is high-speed and can provide acceptable reactive power compensation to the system to which it is connected. The method of DSTATCOM for solving power quality problems due to voltage fall/dip, flickers, swell, etc., has been suggested. The purpose of DSTATCOM is to provide efficient voltage regulation at the point of standard coupling (PCC) and thus prevent significant voltage dips.
