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On-chip interconnection networks are fast becoming significant power consumers in high-performance chip multiprocessors. Increased power consumption leads to more heat, degrades system reliability, and may increase the cost of coo...
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On-chip interconnection networks are fast becoming significant power consumers in high-performance chip multiprocessors. Increased power consumption leads to more heat, degrades system reliability, and may increase the cost of cooling integrated circuit packages. This situation is becoming worse as bulk CMOS technology scales further into the nanometer regime because of the excessive leakage power caused by short-channel effects. In this paper, we explore the use of FinFETs, which are promising substitutes for bulk CMOS at the 22-nm node and beyond, to design on-chip network routers. We present a detailed design of a variable-pipeline-stage router (VPSR) targeted at FinFET technology. We employ a dynamic power management scheme, which we call adaptive back-gate biasing, for FinFET implementations. We propose enhanced token flow control (ETFC), a flow control mechanism that improves upon the energy/delay/throughput of the previous state-of-the-art token flow control mechanism. We evaluate VPSR and ETFC on a simulation platform specifically designed for power/performance simulations of FinFET-based interconnection networks. The results show that VPSR is able to successfully adapt its power consumption to incoming traffic, with a resultant 21.5% reduction in power with almost no impact on latency.
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Data-driven machine-learning techniques enable the modeling and interpretation of complex physiological signals. The energy consumption of these techniques, however, can be excessive, due to the complexity of the models required. ...
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Data-driven machine-learning techniques enable the modeling and interpretation of complex physiological signals. The energy consumption of these techniques, however, can be excessive, due to the complexity of the models required. In this paper, we study the tradeoffs and limitations imposed by the energy consumption of high-order detection models implemented in devices designed for intelligent biomedical sensing. Based on the flexibility and efficiency needs at various processing stages in data-driven biomedical algorithms, we explore options for hardware specialization through architectures based on custom instruction and coprocessor computations. We identify the limitations in the former, and propose a coprocessor-based platform that exploits parallelism in computation as well as voltage scaling to operate at a subthreshold minimum-energy point. We present results from post-layout simulation of cardiac arrhythmia detection with patient data from the MIT-BIH database. After wavelet-based feature extraction, which consumes 12.28 $mu{rm J}$, we demonstrate classification computations in the 12.00–120.05 $mu{rm J}$ range using 10000–100000 support vectors. This represents $1170times$ lower energy than that of a low-power processor with custom instructions alone. After morphological feature extraction, which consumes 8.65 $mu{rm J}$ of energy, the corresponding energy numbers are 10.24–24.51 $mu{rm J}$, which is $1548times$ smaller than one based on a custom-instruction design. Results correspond to ${rm V}_{dd}=0.4~{rm V}$ and a data precision of 8 b.
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Characterization of communication links in Aerial Wireless Sensor Networks (AWSN) is of paramount importance for achieving acceptable network performance. Protocols based on an arbitrary link performance threshold may exhibit inco...
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Characterization of communication links in Aerial Wireless Sensor Networks (AWSN) is of paramount importance for achieving acceptable network performance. Protocols based on an arbitrary link performance threshold may exhibit inconsistent behavior due to link behavior not considered during the design stage. It is thus necessary to account for factors that affect the link performance in real deployments. This paper details observations from an extensive set of experiments designed to characterize the behavior of communication links in AWSN. We employ the widely used TelosB sensor platform for these experiments. The experimental results highlight the fact that apart from the usual outdoor environmental factors affecting the link performance, two major contributors to the link degradation in AWSN are the antenna orientation, and the multi-path fading effect due to ground reflections. Based on these observations, we propose a Link Aware Protocol for AWSN (LAAWN) that takes into account the effect of these potential sources of performance degradation. This paper details the design and performance evaluation of our proposed LAAWN protocol. We evaluated the LAAWN protocol in two real-world use cases namely delay-tolerant and real-time AWSN. The simulation results show that on average, LAAWN improves the overall network performance by reducing the percentage of dropped packets from about 34% to less than 4% for an AWSN that requires real-time data transfer.
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BACKGROUND: Our aim was to evaluate the prevalence and relationship of symptoms with reduced dietary intake, weight, and functional capacity in patients with head and neck cancer. METHODS: Three hundred forty-one patients were pro...
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BACKGROUND: Our aim was to evaluate the prevalence and relationship of symptoms with reduced dietary intake, weight, and functional capacity in patients with head and neck cancer. METHODS: Three hundred forty-one patients were prospectively screened with the patient-generated subjective global assessment before treatment. Logistic analysis was used to relate symptoms to reduced dietary intake, weight, and functional capacity. Cumulative hazard analysis was performed to determine the time and risk of weight loss of each symptom. Survival analysis was performed with Cox proportional hazards model. RESULTS: Anorexia, dysphagia, mouth sores, and others were significant predictors of reduced dietary intake and weight. Symptom presence accelerated the time and probability of weight loss. Body mass index < or = 18.5 related to overall survival (p value = .001). CONCLUSIONS: Symptoms present before treatment may adversely affect the dietary intake, weight, and functional capacity of patients. Symptom treatment and management is critical to weight loss prevention.
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Background-: Although pay for performance (P4P) has become common, many worry that P4P will lead providers to avoid offering surgical procedures to the sickest patients out of concern that poor outcomes will lead to financial pena...
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Background-: Although pay for performance (P4P) has become common, many worry that P4P will lead providers to avoid offering surgical procedures to the sickest patients out of concern that poor outcomes will lead to financial penalties.Methods and Results-: We used Medicare data to compare change in rates of coronary artery bypass graft surgery between 2002 to 2003 and 2008 to 2009 among patients with acute myocardial infarction (AMI) admitted to 126 hospitals participating in Medicare's Premier Hospital Quality Incentive Demonstration P4P program with patients in 848 control hospitals participating in public reporting through the Health Quality Alliance. We examined rates for all patients with AMI and those in the top decile of predicted mortality based on demographics, medical comorbidities, and AMI characteristics. We identified 91 393 patients admitted for AMI in Premier hospitals and 502 536 Medicare patients admitted for AMI in control hospitals. Coronary artery bypass graft surgery rates for patients with AMI in Premier decreased from 13.6% in 2002 to 2003 to 10.4% in 2008 to 2009; there was a comparable decrease in non-Premier hospitals (13.6%-10.6%; P value for comparison of changes between Premier and non-Premier, 0.67). Coronary artery bypass graft surgery rates for high-risk patients in Premier decreased from 8.4% in FY 2002 to 203 to 8.2% in 2008 to 2009. Patterns were similar in non-Premier hospitals (8.4%-8.3%; P value for comparison of changes between Premier and non-Premier, 0.82).Conclusions-: Our results show no evidence of a deleterious effect of P4P on access to coronary artery bypass graft surgery for high-risk patients with AMI. These results should be reassuring to those concerned about the potential negative effect of P4P on high-risk patients.
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Objective: US hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expect...
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Objective: US hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. Design: We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for nonresponse and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs. Results: We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared with non-SNHs (P-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, P<0.04) or verbally communicate (31.5% vs. 39.8%, P<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, P<0.001), or enroll patients in postdischarge programs (13.3% vs. 17.2%, P<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and postdischarge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies. Conclusions: Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the Hospital Readmissions Reduction Program.
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Health is influenced by many factors outside the health system. This is often expressed by decomposing contributors to health into factors that sum to 100 percent. In this commentary, we assess the (few) strengths and (many) limit...
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Health is influenced by many factors outside the health system. This is often expressed by decomposing contributors to health into factors that sum to 100 percent. In this commentary, we assess the (few) strengths and (many) limitations of such decompositions. We conclude that they fail to be useful for policy guidance. We conclude by proposing an alternative approach to assessing how various factors affect health: evaluations of interventions. ? 2020 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust
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Objectives: Although we know that healthcare costs are concentrated among a small number of patients, we know much less about the concentration of these costs among providers or markets. This is important because it could help us ...
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Objectives: Although we know that healthcare costs are concentrated among a small number of patients, we know much less about the concentration of these costs among providers or markets. This is important because it could help us to understand why some patients are higher-cost compared with others and enable us to develop interventions to reduce costs for these patients. Study Design: Observational study. Methods: We used a 20% sample of Medicare fee-for-service claims data from 2011 and 2012, and defined high-cost patients as those in the top 10% of standardized costs. We then characterized highconcentration hospitals as those with the highest proportion of high-cost patient claims, and highconcentration markets as the Hospital Referral Regions (HRRs) with the highest proportion of high-cost patients. We compared the characteristics and outcomes of each. Results: High-concentration hospitals had 69% of their inpatient Medicare claims from high-cost Medicare beneficiaries compared with 51% for the remaining 90% of hospitals. These hospitals were more likely to be for-profit and major teaching hospitals, located in urban settings, and have higher readmission rates. High-concentration HRRs had 13% high-cost patients compared with 9.5% for the remaining 90% of HRRs. These HRRs had a smaller supply of total physicians, a greater supply of cardiologists, higher rates of emergency department visits, and significantly higher expenditures on care in the last 6 months of life. Conclusions: High-cost beneficiaries are only modestly concentrated in specific hospitals and healthcare markets.
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The Src pathway in activated in about one-third of non-small cell lung cancer (NSCLC) tumors. Dasatinib has Src-inhibitor activity. We examined the activity of dasatinib in 37 patients with advanced, previously treated NSCLC. Amon...
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The Src pathway in activated in about one-third of non-small cell lung cancer (NSCLC) tumors. Dasatinib has Src-inhibitor activity. We examined the activity of dasatinib in 37 patients with advanced, previously treated NSCLC. Among the 29 patients who underwent pre-treatment biopsy for RNA biomarker analysis, 25 were treated with dasatinib 70 mg twice daily. There were no responses. Five patients discontinued treatment due to toxicity. Three patients had minor biopsy-related pneumothoraces. Given the lack of responses, no biomarkers were analyzed. Dasatinib 70 mg twice daily does not have activity nor is it well tolerated in unselected patients with advanced stage, previously treated NSCLC.
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Wearable and implantable medical devices are commonly used for diagnosing, monitoring, and treating various medical conditions. Increasingly complex software and wireless connectivity have enabled great improvements in the quality...
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Wearable and implantable medical devices are commonly used for diagnosing, monitoring, and treating various medical conditions. Increasingly complex software and wireless connectivity have enabled great improvements in the quality of care and convenience for users of such devices. However, an unfortunate side-effect of these trends has been the emergence of security concerns. In this letter, we propose the use of formal verification techniques to verify temporal safety properties and improve the trustworthiness of medical device software. We demonstrate how to bridge the gap between traditional formal verification and the needs of medical device software. We apply the proposed approach to cardiac pacemaker software and demonstrate its ability to detect a range of software vulnerabilities that compromise security and safety.
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