IMS Core Research Articles

Using 4G Elements to Provide Secure Services Network Access

The entire telecommunications and services world has focused its attention on the newest 3GPP architecture, 4G. Proposing high speed data transfer, all flat-IP network for the core systems and stronger authentication and AAA methods, this architecture seems to be the answer for the mobile networks of the future. Another architecture, described by 3GPP as well, but based on IETF standards is the IMS architecture. This is focused on mobile services, mainly VoIP, but also presence, push-to-talk, location and multimedia and broadcast services. The IMS core network has its own security mechanisms, which are constantly tested and improved. Looking in the perspective, the user equipment, specially the one found in roaming has to do a lot of signaling in order to authenticate to both networks and use the services available for it in a secure manner. From the provider’s point of view, the issue is even more complicated, because it has to secure its network, securely interoperate with other networks, be able to obtain granular charging information and also provide lawful interception capabilities for the government institutions. This paper reviews the authentication security architecture available in 3GPP for providing secure access to application services, with emphasis on the interaction of 4G and IMS components, being the first step in a larger 4GIMS interaction study with regards to security.

Imatinib for Chronic Myeloid Leukemia Patients: A Single Institution Experience

Abstract 4429 BackgroundImatinib mesylate (IM) is considered the mainstay of chronic myeloid leukemia (CML) treatment for almost a decade. The primary goal of the study is to share data of a substantial number of CML patients followed at one center. MethodsWe analyzed data from 177 CML patients who were treated in our institution and received IM for at least 24 months. They were stratified into low, intermediate and high risk groups based on Sokal score. Early chronic phase (ECP) (within one year from diagnosis to IM start), late chronic phase (LCP) (≥ 12 months from diagnosis), and accelerated phase (AP) CML patients were included in the study. Patients were evaluated for hematologic, cytogenetic and molecular responses, event-free survival (EFS) and overall survival (OS), frequency of adverse events. ResultsThe median age was 51.2 years (range, 22–86 years), with 77 females and 100 males. Patients were followed for a median of 60 months (range, 24–116 months). IM was started at a dose of 400 mg daily. 97.7% were in chronic phase, and 2.3% were in accelerated phase.75.1% of chronic phase CML patients were in early and 24.9% in late chronic phase. 42% of patients were low Sokal risk, 44% intermediate and 14% were high risk patients. 12% of the patients did not receive any prior therapy, 1% had received prior therapy with interferon (IFN), 73% were treated with hydroxyurea (HU) (mostly short course) and 14% with both HU and IFN. Complete hematologic response (CHR) was achieved in 90% of patients at 3 months (median time, 2.02 months). Cumulative rates of cytogenetic and molecular responses at 6, 12, 18 and 24 months are summarized in Table 1. Complete cytogenetic response (CCyR) was achieved in a significantly higher proportion of patients within the low and intermediate Sokal risk group (79.4%, 85.2%) compared with the high risk patients (14.3%, p=0.001). There was a significant difference in the complete molecular response (CMR) ratio achieved by low, intermediate and high Sokal risk patients (70.4%, 63.8% and 33.3%, p<0.05). 5-year OS rates were 100% and 84% among low-intermediate and high Sokal risk patients (p=0.0001) (Figure 1). The EFS at 5 years was 77%, 81%, and 63% in low, intermediate and high Sokal risk patients (p=0.001) (Figure 2). ECP CML patients achieved higher CCyR rates (87%) compared with LCP CML patients (48.6%, p=0.001). CMR rates were 67.7% and 46.9% in ECP and LCP CML patients (p<0.05). 62.2% of the patients remained on 400 mg/day IM treatment and in 3.4% the dose was increased to 600 mg/day. Second-generation tyrosine kinase inhibitors (TKIs) were initiated in 21% of the study population. Hematological and non-hematological toxicities were experienced in 23.7% and 56.7% of our patients. In 6.2% a dose reduction and in 3.4% a switch to a second generation TKI was necessary due to toxicity. 5-year OS and EFS rates of the entire cohort were calculated as 97% and 77%. EFS rates at 5 years were significantly higher among patients achieving CCyR compared with those without a CCyR (92%, 64%, p=0.0001) (Figure 3A). 5-year EFS rates were significantly higher in patients achieving CMR compared with those who did not (95%, 58%, p=0.0001) (Figure 3B).Table 1Cumulative rates of cytogenetic and molecular responses at 6, 12, 18, and 24 months (MCyR=major cytogenetic response; CCyR=complete cytogenetic response; MMR=major molecular response; CMR=complete molecular response).Response6 mo (%)12 mo (%)18 mo (%)24 mo (%)MCyR50.371.877.481.4CCyR42.962.169.476.3MMR40.17173.480.2CMR34.548.16067.3 [Display omitted] [Display omitted] [Display omitted] ConclusionIn the current report, we described the outcome of unselected CML patients, treated outside of clinical trials. Grouping patients according to their Sokal prognostic score predicted IM response in this cohort. A longer interval from diagnosis to the start of IM and high Sokal risk score were adverse prognostic factors. 'Real life' data of our study are in accordance with the previous data reflecting the prognostic impact of cytogenetic and molecular responses on survival. Close follow-up of the responses and timely initiation of second-generation tyrosine kinase inhibitors were associated with high survival rates. Disclosures:No relevant conflicts of interest to declare.

Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK

Objective:To compare the cost-utility of exenatide once weekly (EQW) and insulin glargine in patients with type 2 diabetes in the United Kingdom (UK).Research design and methods:The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with type 2 diabetes treated with EQW or insulin glargine. Treatment effects and patient baseline characteristics (mean age: 58 years, mean glycohaemoglobin: 8.3%) were taken from the DURATION-3 study. Unit costs and health state utility values were derived from published sources. As the price of EQW is not yet known, the prices of two currently available glucagon-like peptide-1 products were used as benchmarks. To reflect diabetes progression, patients started on EQW switched to insulin glargine after 5 years. The analysis was conducted from the perspective of the UK National Health Service over a time horizon of 50 years with costs and outcomes discounted at 3.5%. Sensitivity analyses explored the impact of changes in input data and assumptions and investigated the cost utility of EQW in specific body mass index (BMI) subgroups.Main outcome measures:Incremental cost-effectiveness ratio (ICER) for EQW compared with insulin glargine.Results:At a price equivalent to liraglutide 1.2 mg, EQW was more effective and more costly than insulin glargine, with a base case ICER of £10,597 per quality-adjusted life-year (QALY) gained. EQW was associated with an increased time to development of any diabetes-related complication of 0.21 years, compared with insulin glargine. Three BMI subgroups investigated (<30, 30–35 and >35 kg/m2) reported ICERs for EQW compared with insulin glargine ranging from £9425 to £12,956 per QALY gained.Conclusions:At the prices investigated, the cost per QALY gained for EQW when compared with insulin glargine in type 2 diabetes in the UK setting, was within the range normally considered cost effective by NICE. Cost effectiveness in practice will depend on the final price of EQW and the extent to which benefits observed in short-term randomised trials are replicated in long-term use.

Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden

To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial. Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was used to estimate life-expectancy, quality-adjusted life expectancy and both direct medical costs and indirect costs. Basal-bolus therapy with insulin detemir was projected to improve life expectancy by 0.14 years (15.02 ± 0.19 versus 14.88 ± 0.18 years) and quality-adjusted life expectancy by 0.53 quality-adjusted life years (QALYs) versus NPH (8.35 ± 0.11 versus 7.82 ± 0.10 QALYs). Improvements in QALYs were driven by avoided or delayed diabetes-related complications and fewer hypoglycaemic events. Direct medical costs over patient lifetimes were SEK 26,144 higher in the insulin detemir arm (SEK 995,025 ± 19,580 versus 968,881 ± 19,769), leading to an incremental cost-effectiveness ratio of SEK 49,757 per QALY gained. Capturing indirect costs led to insulin detemir being cost saving over patient lifetimes, by SEK 80,113, compared to NPH (SEK 2,959,909 ± 64,727 versus 3,040,022 ± 62,317). Compared with NPH, insulin detemir is likely to be cost-effective from a healthcare payer perspective and dominant from a societal perspective in patients with type 1 diabetes in Sweden.

A prediction model based on an artificial intelligence system for moderate to severe obstructive sleep apnea

Obstructive sleep apnea (OSA) is a major concern in modern medicine; however, it is difficult to diagnose. Screening questionnaires such as the Berlin questionnaire, Rome questionnaire, and BASH'IM score are used to identify patients with OSA. However, the sensitivity and specificity of these tools are not satisfactory. We aim to introduce an artificial intelligence method to screen moderate to severe OSA patients (apnea-hypopnea index ≧15). One hundred twenty patients were asked to complete a newly developed questionnaire before undergoing an overnight polysomnography (PSG) study. One hundred ten validated questionnaires were enrolled in this study. Genetic algorithm (GA) was used to build the five best models based on these questionnaires. The same data were analyzed with logistic regression (LR) for comparison. The sensitivity of the GA models varied from 81.8% to 88.0%, with a specificity of 95% to 97%. On the other hand, the sensitivity and specificity of the LR model were 55.6% and 57.9%, respectively. GA provides a good solution to build models for screening moderate to severe OSA patients, who require PSG evaluation and medical intervention. The questionnaire did not require any special biochemistry data and was easily self-administered. The sensitivity and specificity of the GA models are satisfactory and may improve when more patients are recruited.

Quality of experience (QoE) driven adaptation scheme for voice/video over IP

Network quality of service (NQoS) of IP networks is unpredictable and impacts the quality of networked multimedia services. Adaptive voice and video schemes are therefore vital for the provision of voice over IP (VoIP) services for optimised quality of experience (QoE). Traditional adaptation schemes based on NQoS do not take perceived quality into consideration even though the user is the best judge of quality. Additionally, uncertainties inherent in NQoS parameter measurements make the design of adaptation schemes difficult and their performance suboptimal. This paper presents a QoE-driven adaptation scheme for voice and video over IP to solve the optimisation problem to provide optimal QoE for networked voice and video applications. The adaptive VoIP architecture was implemented and tested both in NS2 and in an Open IMS Core network to allow extensive simulation and test-bed evaluation. Results show that the scheme was optimally responsive to available network bandwidth and congestion for both voice and video and optimised delivered QoE for different network conditions, and is friendly to TCP traffic.

Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting

Objectives: To evaluate the cost-effectiveness of switching to biphasic insulin aspart (BIAsp 30) from human premix insulin for type 2 diabetes patients in the United States (US) setting.Methods: The previously published and validated IMS Core Diabetes Model was used to project life expectancy, quality-adjusted life expectancy (QALE) and costs over 30 years. Patient characteristics and treatment effects were based on Canadian patients included the IMPROVE observational study (n = 311). Mean glycohaemoglobin (HbA1c) was 8.4%, duration of diabetes 16 years and prevalence of complications high at baseline. Simulations were conducted from the perspective of a third-party payer, with costs accounted in 2008 US dollars ($).Results: BIAsp 30 was projected to improve life expectancy by 0.202 years and QALE by 0.301 quality-adjusted life-years (QALYs), due to a reduced incidence of most diabetes-related complications. BIAsp 30 was associated with increased lifetime direct medical costs ($76,517 vs. 67,518) and an incremental cost-effectiveness ratio of $29,870 per QALY gained. Long-term outcomes were sensitive to the impact of BIAsp 30 on hypoglycaemia and changes in HbA1c.Conclusions: BIAsp 30 may represent a cost-effective treatment option in the US setting for advanced type 2 diabetes patients experiencing poor glycaemic control or hypoglycaemia on human premix insulin.Limitations: The application of treatment effect data derived from a Canadian cohort to the US setting was a limitation of the cost-effectiveness analysis. The findings of this cost-effectiveness analysis are not applicable to insulin-naïve diabetes patients.

Design and implementation of a distributed service invocation function for the IP multimedia subsystem

Within the standard IMS framework, the value-added service is executed in the Application Server (AS) when the expected event happens. In order to be aware of the event, the AS should be inserted into the SIP signaling path at the beginning of the call to monitor the call progress. As a result, all SIP messages related to the session have to be relayed to the AS to determine whether the service is to be executed or not. However, some services are rarely executed; that is, the procedure of relaying messages to the AS seems unnecessary for most cases of these services. This paper proposes a distributed service invocation function (DSIF) to eliminate the unnecessary relay. The DSIF works as an overlay on the top of the current IMS infrastructure that enables operators to deploy it without any change in the existing IMS core; thus, it can be applied transparently to SIP dialogs between the S-CSCF and the AS. The DSIF consists of two functional entities: the Core network-SIF (C-SIF) and the Application side-SIF (A-SIF), and one database node: DB-DSIF. The C-SIF is responsible for allowing the messages to be relayed to the AS only when the service really needs to be executed. The operation of C-SIF is based on two new defined types of filter criteria: trigger Filter Criteria (tFC) and execution Filter Criteria (eFC), which are stored in the DB-DSIF. The A-SIF is in charge of interacting with the AS for service invocation. Our study indicates that the DSIF achieves a shorter service invocation time with a lower message transmission cost. We also demonstrate its feasibility by implementing a prototype on Open IMS Core platform.

Cost-Effectiveness of Switching to Biphasic Insulin Aspart 30 from Human Insulin in Patients with Poorly Controlled Type 2 Diabetes in South Korea

To estimate the cost-effectiveness of switching patients with poorly controlled type 2 diabetes mellitus from human insulin (HI) to biphasic insulin aspart 30 (BIAsp 30) in South Korea. A published and validated diabetes computer simulation model (the IMS CORE Diabetes Model) was used to evaluate the long-term clinical and economic outcomes associated with switching to BIAsp 30, using treatment effects from the South Korean subgroup of the Physician's Routine Evaluation of Safety and Efficacy of NovoMix 30 Therapy study and cost data collected through primary research. Outcomes included life expectancy, quality-adjusted life expectancy, incidence of complications, direct medical costs, and cost-effectiveness. Analyses were performed from a third-party payer perspective over a 30-year time horizon. Future costs and clinical benefits were discounted at 5% per annum. Extensive sensitivity analyses were performed. Switching patients uncontrolled on HI to BIAsp 30 was projected to increase discounted mean life expectancy by 0.15 +/- 0.18 years per patient (8.62 +/- 0.13 years vs. 8.47 +/- 0.13 years) and improve discounted mean quality-adjusted life expectancy by 0.30 +/- 0.12 quality-adjusted life-years (QALYs) per patient (5.68 +/- 0.09 QALYs vs. 5.38 +/- 0.09 QALYs). Conversion to BIAsp 30 was associated with a mean increase in direct costs of South Korean Won (KRW) 1,777,323 +/- 359,209 over patient lifetimes. BIAsp 30 was associated with an incremental cost-effectiveness ratio of KRW5,916,758 per QALY gained versus HI. Switching patients uncontrolled on HI to BIAsp 30 was projected to improve life expectancy and quality-adjusted life expectancy. This analysis suggests that BIAsp 30 could be a cost-effective treatment option in type 2 diabetes patients poorly controlled on HI in South Korea.

Cost-effectiveness of insulin detemir compared with neutral protamine Hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in five European countries

Objectives: The aim of this analysis was to evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine Hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Belgian, French, German, Italian and Spanish settings.Methods: The published and validated IMS CORE Diabetes Model was used to make long-term projections of life expectancy, quality-adjusted life expectancy and direct medical costs. The analysis was based on patient characteristics and treatment effects from a 2-year randomised controlled trial. Events were projected for a time horizon of 50 years. Potential uncertainty using a modelling approach was addressed.Results: Basal-bolus therapy with insulin detemir was projected to improve quality-adjusted life expectancy by 0.45 years versus NPH in the German setting, with similar improvements in the other countries. Insulin detemir was associated with cost savings in Belgium, Germany and Spain. In France and Italy, lifetime costs were slightly higher in the detemir arm, leading to incremental cost-effectiveness ratios of €519 per QALY gained and €3,256 per QALY gained, respectively.Conclusions: Compared to NPH, insulin detemir is likely to be a dominant treatment strategy in Belgium, Germany and Spain and highly cost-effective in France and Italy in patients with type 1 diabetes.

An empirical investigation of the influence of social desirability on the factor structure of the Chinese 16PF

This study examined whether social desirability affects the factor structure of the Chinese 16PF. Participants were 4645 Chinese first-year undergraduate and graduate students who completed the Chinese 16PF as part of a mandatory psychological assessment. Based on students’ score on the Impression Management scale (Paulhus, 1998), two groups were formed: (a) the high socially desirable responding group, consisting of students whose IM scores fell within the upper 20% of the distribution, and (b) the low socially desirable responding group, consisting of students whose IM scores fell within the bottom 25% of the distribution. A series of exploratory and confirmatory factor analyses indicated that the factor pattern and factor loadings of the Chinese 16PF were invariant across these two groups.

Presence Network Agent: A Simple Way to Improve the Presence Service

The article examines a possible way of improving the performance of the presence service within IMS networks without modifying the presence and group management enabler. This can be achieved by means of a presence network agent (PNA). The PNA has been defined by 3GPP; it is a new logic entity within the IMS core network that is able to publish the presence information on behalf of the presentity user agent. The PNA improves performance because it reduces the presence signaling load within the radio access network without downgrading the freshness and richness of the presence information. The article's goal is to provide the reader with useful information about the PNA and our experience with PNA implementation and deployment. We first describe the PNA concept as defined by 3GPP, highlighting the open issues still present in the standardization and the possible optimizations, subsequently we present an actual implementation of a PNA handling busy/idle states for IMS calls.

Aspects of network security for VoIP solutions using IMS core network and Wi-Fi access

Aspects of network security for VoIP solutions using IMS core network and Wi-Fi access

Revisiting an Old Question with a New Technology: Gender Differences on a Neuro-Cognitive Temporal Tracking Task

Gender differences exist, but the strength and importance of those differences is debatable. This study examined differences in performance among men (n = 64) and women (n = 56) on 14 neuro-cognitive temporal tasks. No adult norms exist for these tasks. Therefore, the goals were to 1) record and compare scores achieved by men and women, and 2) investigate differences in terms of performance (grade point average and physical fitness score) during Army Health Care Specialist Advanced Individual Training (AIT). Descriptive statistics and t-tests identified and compared scores by gender, while IM scores and performance relationships were explored with Pearson product-moment correlations and regression analysis. Men's temporal responses were closer to the reference beat than women's on 14.3% of tasks (p &lt; 0.05). There were no significant relationships between temporal responses and physical fitness performance scores and only two correlations between temporal responses and grade point average (right hand tapping, Task Average and Super Right On (percent within ±15ms of the target beat) ( r = 0.189, p = 0.04; and r = 0.20, p = 0.03). While this research upheld findings of differences between men and women in temporal abilities, the differences did not impact functional performance during AIT.

Aspects of network security for VoIP solutions using IMS core network and Wi-Fi access

A network providing Voice over Internet Protocol (VoIP) service requires many network elements. Each network element may have its own set of security capabilities, but not all security capabilities...

Gap Analysis and Deployment Architectures for 3GPP2 MMD Networks

Mobile and fixed operators are offering broadband access to the Internet by either adding wireless access to their existing core networks (e.g., CDMA IxEVDO. GPRS, and WiFi) or continuing to evolve existing broadband infrastructures (e.g., DSL, Cable and FTTx). Consequently, IMS and MMD architectures as defined by 3GPP and 3GPP2 are becoming increasingly important to network operators, in particular, for offering ubiquitous service and seamless mobility to end users, along with management and control Although 3GPP2 MMD architecture has adopted most of the 3GPP IMS core functionalities and interfaces, it added several other unique functional components and interfaces to fit the specific need of CDMA2000 access networks Therefore, it is important to understand the gaps and issues associated with the 3GPP2 MMD architecture with regard to the 3GPP IMS architecture. In this paper, we first analyze the functional and protocol level differences between IMS and MMD architectures. Based on our analysis, we then articulate several deployment architectural alternatives for 3GPP2 MMD networks and finally analyze the pros and cons of each architecture.

Histological risk markers for non-cardia early gastric cancer

There are limited data regarding the prognostic value of the pattern of mucin expression in IM. To examine the role of the type of IM and pattern of mucin expression in IM as histological risk markers of gastric cancer, 80 patients with a history of endoscopic mucosal resection (EMR) for early gastric cancer and 80 sex and age-matched controls were studied. Serum levels of pepsinogen (PG) were measured by RIA, and MUC2, MUC5AC and MUC6 were evaluated immunohistochemically. There is a significant association between types of IM and atrophic scores or PG levels. The most incomplete IM (type II and III) preserving gastric mucin is the gastric and intestinal mixed (GI) type, whereas the complete type is the intestinal (I) type especially in the corpus lesser curve. Gastric cancer was most significantly associated with incomplete IM in the corpus lesser curve (OR=6.4; 95% CI, 2.0-21, p=0.002). Asynchronous multiple lesions were associated with incomplete IM in the corpus greater curve (OR=4.8; 95% CI, 1.4-16, p=0.01). Classification of IM obtained using fixed-point biopsy samples may enhance the ability of surveillance programs to detect patients at increased risk of gastric cancer.

Cross-validation of prediction equations for Wechsler Memory Scale-III Indexes.

Six prediction equations were previously found to predict to Wechsler Memory Scale-III (WMS-3) Immediate Memory Index (IM) and General Memory Index (GM) using two- or three-subtest combinations. The equations were cross-validated on a sample of 214 mixed clinical patients from an entirely different location in the Midwest. The two three-subtest prediction equations (including Logical Memory, Verbal Paired Associates, and either Faces or Family Pictures) better estimated IM and GM than did the two-subtest equations (Logical Memory and Verbal Paired Associates). Correlations for the former equations correlated .97 and .96 with full WMS-3 IM and GM, respectively. In addition, at least 95% of the predicted scores were within two SEMs of obtained IM and GM scores. The two-subtest equations correlated only .89 for IM and .92 for GM. The predicted scores that fell within two SEMs captured 78% and 88% of the cases for IM and GM, respectively. The results provide support for the use of the three-subtest prorated forms of the WMS-3 to estimate IM and GM.

Detection of Salmonella from raw food samples using Dynabeads® anti- Salmonella and a conventional reference method

A Dynal core method has been established using Dynabeads® anti- Salmonella to detect Salmonella from all categories of food samples. The protocol consists of the standard pre-enrichment of samples in buffered peptone water followed by immunomagnetic separation and subsequent selective enrichment of the bead-bacteria complexes in Rappaport-Vassiliadis Soya Peptone broth before plating onto Salmonella selective media. This modified IMS cultural method is intended to replace or augment traditional cultural methods used for Salmonella detection due to its specificity and increased sensitivity. The optional direct plating of bead-bacteria complexes onto solid media using a swab-streak technique is suitable for processed foods or samples known to have a history of very low resident flora. In an evaluation using 100 naturally contaminated samples, this IMS core method detected 39 of the 44 positive samples detected by all the methods combined, compared to 31 detected by the conventional ISO 6579 reference method. Furthermore, in ten different food matrices inoculated with low levels (1–5 cells/25 g) of twenty Salmonella serovariants, frozen for one month before being examined, the IMS core method, showed a 90% concordance with the ISO method and isolated two more Salmonella positive samples than the conventional ISO method.

DEGREE OF BRONCHIAL METAPLASIA IN HEAVY SMOKERS AND ITS REGRESSION AFTER TREATMENT WITH A RETINOID

70 volunteers who had had at least 15 packetyears of smoking experience underwent bronchoscopy and bronchial biopsy. The degree of metaplasia (IM, index of metaplasia) was calculated for each of them. The 34 who had an IM of >15% were given a 6-month course of a retinoid, etretinate. 12 have completed the course, and their IM scores have dropped significantly.