Here is a strategy the prisoners could employ:
1. On the first day, the prisoner who visits the switch room toggles one of the switches to the ON position.
2. On subsequent days, the prisoner toggles the other switch if it is in the OFF position, or says "all prisoners have visited" if both switches are in the ON position.
3. This strategy guarantees that after 31 days, both switches will be in the ON position, allowing the prisoner to correctly say "all prisoners have visited" and ensure all prisoners are set free.
Denial of Service Mitigation Tactics in FreeBSDSteven Kreuzer
Protecting your servers, workstations and networks can only go so far. Attacks which consume your available Internet-facing bandwidth, or overpower your CPU, can still take you offline. His presentation will discuss techniques for mitigating the effects of such attacks on servers designed to provide network intensive services such as HTTP or routing.
Denial of Service Mitigation Tactics in FreeBSDSteven Kreuzer
Protecting your servers, workstations and networks can only go so far. Attacks which consume your available Internet-facing bandwidth, or overpower your CPU, can still take you offline. His presentation will discuss techniques for mitigating the effects of such attacks on servers designed to provide network intensive services such as HTTP or routing.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. 3
Ports, End-points, & Connections
• Thus, an end-point is represented by (IP address,Port)
• Ports can be re-used between transport protocols
• A connection is (SRC IP address, SRC port, DST IP address,
DST port)
• Same end-point can be used in multiple connections
IP Layer
TCP UDP
http ftp email zoom
IP address
Protocol ID
A1 A2 A3
Transport
Port
4. 4
Active and Passive Open
• How do applications initiate a connection?
• One end (server) registers with the TCP layer instructing it to
“accept” connections at a certain port
• The other end (client) initiates a “connect” request which is
“accept”-ed by the server
5. 5
Connection Establishment & Termination
• 3-way handshake used
for connection
establishment
• Randomly chosen
sequence number is
conveyed to the other
end
• Similar FIN, FIN+ACK
exchange used for
connection termination
SYN
SYN+ACK
ACK
DATA
Server does passive open
Accept connection request
Send acceptance
Start connection
Active open
Send connection
request
7. 7
Fundamental Mechanism
• Simple stop and go protocol
• Timeout based reliability (loss
recovery)
data
retx
ack
data
ack
data
Sliding Window Protocol: 1 2 3 4 5 6 7 8 9 10 11 12 ….
• Multiple unacknowledged packets!
8. 8
Congestion Control
• Slow Start
• Start with W=1
• For every ACK, W=W+1
• Congestion Avoidance (linear
increase)
• For every ACK,
• W = W+1/W
• Congestion Control
(multiplicative decrease)
• ssthresh = W/2
• W = 1
Alternative: Fall to W/2 and start
congestion avoidance directly
10. Anatomy of a TCP Connection’s Lifetime
ssthresh1
ssthresh2
C
cw=1
cwL
cwL/2
Window
Time
1 slow-start
2
congestion
avoidance
3
multiplicative
decrease
4 loss recovery
11. 11
Flow Control
• Prevent sender from overwhelming the receiver
• Receiver in every ACK advertises the available buffer space at
its end
• Window calculation
• MIN(congestion control window, flow control window)
12. 12
Sequencing
• Byte sequence numbers
• TCP receiver buffers out of
order segments and
reassembles them later
• Starting sequence number
randomly chosen
during connection
establishment
• Why?
3
1
2
3
4
3
3
4
1 given to app
2 given to app
Loss
4 buffered (not given to app)
3 & 4 given to app
4 discarded
13. 13
TCP Segment Format
HL
16 bit SRC Port 16 bit DST Port
32 bit sequence number
32 bit ACK number
16 bit window size
resvd flags
16 bit urgent pointer
16 bit TCP checksum
Options (if any)
Data
Flags: URG, ACK,
PSH, RST, SYN,
FIN
14. 14
TCP Flavors
• TCP-Tahoe
• W=1 adaptation on congestion
• TCP-Reno
• W=W/2 adaptation on fast retransmit, W=1 on timeout
• TCP-newReno
• TCP-Reno + intelligent fast recovery
• TCP-Vegas, TCP-SACK
15. 15
TCP Tahoe
• Slow-start
• Congestion control upon time-out or DUP-ACKs
• When the sender receives 3 duplicate ACKs for the
same sequence number, sender infers a loss
• Congestion window reduced to 1 and slow-start
performed again
• Simple
• Congestion control too aggressive
16. 16
TCP Reno
• Tahoe + Fast re-transmit
• Packet loss detected both through timeouts, and
through DUP-ACKs
• Sender reduces window by half, the ssthresh is
set to half of current window, and congestion
avoidance is performed (window increases only by
1 every round-trip time)
• Fast recovery ensures that pipe does not become
empty
• Window cut-down to 1 (and subsequent slow-
start) performed only on time-out
17. 17
TCP New-Reno
• TCP-Reno with more intelligence during fast
recovery
• In TCP-Reno, the first partial ACK will bring the
sender out of the fast recovery phase
• Results in timeouts when there are multiple losses
• In TCP New-Reno, partial ACK is taken as an
indication of another lost packet (which is
immediately retransmitted).
• Sender comes out of fast recovery only after all
outstanding packets (at the time of first loss) are
ACKed
18. 18
TCP SACK
• TCP (Tahoe, Reno, and New-Reno) uses
cumulative acknowledgements
• When there are multiple losses, TCP Reno and
New-Reno can retransmit only one lost packet per
round-trip time
• What about TCP-Tahoe?
• SACK enables receiver to give more information to
sender about received packets allowing sender to
recover from multiple-packet losses faster
19. 19
TCP SACK (Example)
• Assume packets 5-25 are transmitted
• Let packets 5, 12, and 18 be lost
• Receiver sends back a CACK=5, and SACK=(6-11,13-17,19-
25)
• Sender knows that packets 5, 12, and 18 are lost and
retransmits them immediately
20. 20
Other TCP flavors
• TCP Vegas
• Uses round-trip time as an early-congestion-feedback mechanism
• Reduces losses
• TCP FACK
• Intelligently uses TCP SACK information to optimize the fast recovery
mechanism further
21. 21
User Datagram Protocol (UDP)
• Simpler cousin of TCP
• No reliability, sequencing, congestion control, flow
control, or connection management!
• Serves solely as a labeling mechanism for
demultiplexing at the receiver end
• Use predominantly by protocols that do no require
the strict service guarantees offered by TCP (e.g.
real-time multimedia protocols)
• Additional intelligence built at the application layer
if needed
22. 22
UDP Header
Src Port Dst Port
Checksum
Length
Length: length of header
+ data (min = 8)
24. Appropriate Window Size
• Many stacks use a default window size of 16KB
• Too small for many wireless environments where delay is large
• Use window-scaling
• Scale factor exchanged during start-up with SYN messages
• Scale factor a power of 2
25. Increased Initial Window Size
• TCP, by default, starts with a window size of 1
• This is problematic in two ways:
• Slow start slows down due to delayed ACK timer
• For thin connections, efficiency is compromised
• Set the initial congestion window to 4 (instead of 1 MSS)
26. Limited Transmit
• Fast retransmit and recovery kick in only after 3 DUPACKs
• What if there are fewer than 3 DUPACKs
• Limited transmit allows sender to transmit new packets even for the
first two DUPACKs
27. SACK
• Random wireless losses are typically recovered by link layer
retransmissions
• However, if link layer ARQ does not recover packets, random packet
losses can be exposed to the TCP sender
• SACK allows for faster loss recovery under such conditions
28. ECN
• ECN requires explicit congestion notification from routers
• Enables connection to avoid loss regime by preemptively reacting to
congestion
• Makes connection more efficient
29. Timestamp option
• TCP, by default, measures RTT sample only once per congestion
window
• Too coarse for a changing RTT scenario
• Timestamps allow for RTT to be measured in a fine-grained manner
• More reliable estimate of RTT
30. Header Compression
• TCP header fields can be compressed due to redundancy between
packets
• However, in a wireless network where packet losses are typical,
compression can backfire as the loss of an “anchor” packet will
render all subsequent packets useless
• Header compression should hence be turned OFF
31. 31
Puzzle
• Prison with 31 prisoners on death row
• Warden tells the prisoners:
• I will isolate all of you into independent cells tonight
• Every morning from tomorrow, I will pick one of you randomly (say X)
and walk you to a switch room
• The switch room has 2 switches, both initially in the OFF position
• The prisoner X is given the option of manipulating the switches
• The prisoner may also choose to say “all prisoners have visited the
switch room”
• If the prisoner is correct, all prisoners will be let free, otherwise all of
them will be put to death
• What is the strategy that the prisoners should employ?