Objective:To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.Design:Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups g

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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Current software-based microarchitecture simulators are many orders of magnitude slower than the hardware they simulate. Hence, most microarchitecture design studies draw their conclusions from drastically truncated benchmark simulations that are often inaccurate and misleading. This paper presents the Sampling Microarchitecture Simulation (SMARTS) framework as an approach to enable fast and accurate performance measurements of full-length benchmarks. SMARTS accelerates simulation by selectively measuring in detail only an appropriate benchmark subset. SMARTS prescribes a statistically sound procedure for configuring a systematic sampling simulation run to achieve a desired quantifiable confidence in estimates.Analysis of 41 of the 45 possible SPEC2K benchmark/input combinations show CPI and energy per instruction (EPI) can be estimated to within ±3% with 99.7% confidence by measuring fewer than 50 million instructions per benchmark. In practice, inaccuracy in microarchitectural state initialization introduces an additional uncertainty which we empirically bound to ∼2% for the tested benchmarks. Our implementation of SMARTS achieves an actual average error of only 0.64% on CPI and 0.59% on EPI for the tested benchmarks, running with average speedups of 35 and 60 over detailed simulation of 8-way and 16-way out-of-order processors, respectively.

/pdf/smarts-accelerating-microarchitecture-simulation-via-ym8ynpdh7r.pdf

SMARTS: accelerating microarchitecture simulation via rigorous statistical sampling

Different types of traffic requiring different inactivity timer settings are assigned to different bearers or to different QoS classes. Different inactivity timer settings are established for different traffic types. Individual bearers or individual QoS classes are linked to a corresponding inactivity timer profile. The link may be accomplished in a number of ways. For example, an additional QoS parameter may be employed in a 3GPP QoS profile, or a new QoS class identifier may be mapped to an inactivity timer setting. Different inactivity timer settings allows both UE battery power conservation to be prioritized for some traffic and end-user experience (quick subsequent response times) to be prioritized for other traffic.

Inactivity monitoring for different traffic or service classifications

Today's cellular systems are designed to achieve 90-95 percent coverage for voice users (i.e., the ratio of signal to interference plus noise must be above a design target over 90 to 95 percent of the cell area). This ensures that the desired data rate which achieves good voice quality can be provided "everywhere". As a result, SINRs that are much larger than the target are achieved over a large portion of the cellular coverage area. For a packet data service, the larger SINR can be used to provide higher data rates by reducing coding or spreading and/or increasing the constellation density. It is straight-forward to see that cellular spectral efficiency (in terms of b/s/Hz/sector) can be increased by a factor of two or more if users with better links are served at higher data rates. Procedures that exploit this are already in place for all the major cellular standards in the world. In this article, we describe data rate adaptation procedures for CDMA (IS-95), wideband CDMA (cdma2000 and UMTS WCDMA), TDMA (IS-136), and GSM (GPRS and EDGE).

Adaptation techniques in wireless packet data services

In this paper we advocate exploiting channel descriptor information in packet data communication networks to gain transmission capacity. Besides the normal data transmission also the channel descriptor (or character of the channel) can be used to convey data. This novel access technique is suitable for wired as well as for wireless networks. By the example of a wireless spread spectrum system with pseudo?noise spreading sequences, we can report that a gain of nearly an order of magnitude in terms of capacity can be achieved compared to the standard spread spectrum transmission for a given scenario. Our approach is not limited to spread spectrum technologies, but applies to all systems with the property that the number of channel descriptors is larger than the actual number of simultaneously usable resources.

The Medium is the Message

Sleep deprivation is common among intensive care patients and may be associated with delirium. We investigated whether the implementation of a bundle of non-pharmacological interventions, consisting of environmental noise and light reduction designed to reduce disturbing patients during the night, was associated with improved sleep and a reduced incidence of delirium. The study was divided into two parts, before and after changing our practice. One hundred and sixty-seven and 171 patients were screened for delirium pre- and post-intervention, respectively. Compliance with the interventions was > 90%. The bundle of interventions led to an increased mean (SD) sleep efficiency index (60.8 (3.5) before vs 75.9 (2.2) after, p = 0.031); reduced mean sound (68.8 (4.2) dB before vs 61.8 (9.1) dB after, p = 0.002) and light levels (594 (88.2) lux before vs 301 (53.5) lux after, p = 0.003); and reduced number of awakenings caused by care activities overnight (11.0 (1.1) before vs 9.0 (1.2) after, p = 0.003). In addition, the introduction of the care bundle led to a reduced incidence of delirium (55/167 (33%) before vs 24/171 (14%) after, p < 0.001), and less time spent in delirium (3.4 (1.4) days before vs 1.2 (0.9) days after, p = 0.021). Increases in sleep efficiency index were associated with a lower odds ratio of developing delirium (OR 0.90, 95% CI 0.84-0.97). The introduction of an environmental noise and light reduction programme as a bundle of non-pharmacological interventions in the intensive care unit was effective in reducing sleep deprivation and delirium, and we propose a similar programme should be implemented more widely.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/anae.12638

The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients

Existing IS-95-based CDMA systems support circuit-mode and packet-mode data services at a data rate limited to 9.6-14.4 kb/s. Fueled by the explosive growth of the Internet, applications and market opportunities are demanding that higher capacity, higher data rates, and advanced multimedia services be supported in the near future. The evolution of the IS-95 CDMA standard to higher data rates and more advanced services occurs in two steps. The first step, IS-95-B, is an enhancement to the IS-95-A standard and offers the highest possible performance without breaking current IS-95-A air interface design characteristics, thereby maintaining strict compatibility with existing base station hardware. The proposed standard will support a high data rate (64 kb/s) in both directions, to and from the mobile device. A new burst mode packet data service is defined to allow better interference management and capacity utilization. The second evolution step, cdma2000, provides next-generation capacity, data rates, and services. The cdma2000 system includes a greatly enhanced air interface supporting CDMA over wider bandwidths for improved capacity and higher data rates while also maintaining backward compatibility with existing IS-95 CDMA end-user devices. The cdma2000 system also includes a sophisticated MAC feature to effectively support very-high-data-rate services (up to 2 Mb/s) and multiple concurrent data and voice services. This article describes the design and performance of the high-data-rate service provided by second- and third-generation CDMA systems.

Evolution of wireless data services: IS-95 to cdma2000

Trace-driven simulation is a simple way of evaluating cache memory systems with varying hardware parameters. But to evaluate realistic workloads, simulating even a few million addresses is not adequate and such large scale simulation is impractical from the consideration of space and time requirements. New methods of simulation based on statistical techniques are proposed for decreasing the need for large trace measurements and for predicting true program behavior. In the method, sampling techniques are applied while collecting the address trace from a workload. This drastically reduces the space and time needed to collect the trace. New simulation techniques are developed to use the sample data not only to predict the mean miss rate of the cache, but also to provide an empirical estimate of its actual distribution. Finally, a new concept of primed cache is introduced to simulate large caches by the sampling-based method. >

Accurate low-cost methods for performance evaluation of cache memory systems

The method provides for a first network controller, operating according to a first radio technology, to form and send a relay message to a second network controller, operating according to a different, second radio technology. The relay message includes an embedded message for the second network controller. The embedded message may be a transition message requesting transition of a packet switched call for a mobile station handled by the first network controller to a call for the mobile station handled by the second network controller. The method further provides selection of another wireless element for service at a wireless unit, using a current wireless element. A wireless unit receives a message identifying at least one other wireless element, available to the wireless unit and to which a wireless element currently in communication with the wireless unit is also in communication with and the wireless unit selects another wireless element for possible future service based on the message.

Method of transferring call transition messages between network controllers of different radio technologies

The present invention permits the transmission of variable size PDUs using a Hierarchical Sequence Numbering Space approach that supports ARQ protocols in a variable transmission rate environment. Some of the key attributes of this scheme are: (1) Support for arbitrarily variable PDU sizes; (2) Variable length sequence numbers in protocol headers; (3) Variable depth sequence numbers in protocol headers; (4) Dynamic sequence number context to minimize the size of sequence numbers transmitted in PDUs; (5) Protocol control schemes to coordinate and communicate sequence number space information between peer protocol entities; and (6) Data structures and approaches for the efficient implementation of Hierarchical Sequence Number Space schemes.

Subhasis Laha

Papers

The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients

Evolution of wireless data services: IS-95 to cdma2000

Accurate low-cost methods for performance evaluation of cache memory systems

Method of transferring call transition messages between network controllers of different radio technologies

ARQ protocol support for variable size transmission data unit sizes using a hierarchically structured sequence number approach