Changes In Placement Research Articles

Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach

BackgroundAlmost 21,000 youth, in the U.S., leave foster care due to "emancipation" each year. Although not well documented for this age group, nearly half of children/youth in foster care receive a disability diagnosis. There is a growing body of literature about the transition to adulthood for youth with disabilities. However, minimal research exists on the transition experiences of youth in foster care who also have a disability. This study intends to help fill this gap in the literature. ObjectiveThe purpose of the study was to uncover challenges during the transition to adulthood for youth with disabilities who experienced foster care and elucidate the supports most beneficial in addressing these challenges. Participants and settingAll participants reside in the United States pacific northwest. Seven foster care alumni aged 19–23 and five professionals serving the target population participated in the study. MethodsWe conducted semi-structured interviews with YDFC and a focus group with professionals to understand the process of the transition to adulthood for YDFC. Our findings generated an ecological model useful for transition planning prior to the youth leaving foster care. Within our model we focus on alterable factors to bring intervention points to light. ResultsBarriers uncovered included lack of consistent high school graduation requirements, high quality Independent Living Programs, positive relationships and highly skilled professionals; frequent placement changes; and inappropriate disability or mental health diagnosis. ConclusionsRecommendations include systems improvements; improved intra- and interagency collaboration; and helping youth build and maintain positive relationships.

Interdependence of balance mechanisms during bipedal locomotion.

Our main interest is to identify how humans maintain upright while walking. Balance during standing and walking is different, primarily due to a gait cycle which the nervous system must contend with a variety of body configurations and frequent perturbations (i.e., heel-strike). We have identified three mechanisms that healthy young adults use to respond to a visually perceived fall to the side. The lateral ankle mechanism and the foot placement mechanism are used to shift the center of pressure in the direction of the perceived fall, and the center of mass away from the perceived fall. The push-off mechanism, a systematic change in ankle plantarflexion angle in the trailing leg, results in fine adjustments to medial-lateral balance near the end of double stance. The focus here is to understand how the three basic balance mechanisms are coordinated to produce an overall balance response. The results indicate that lateral ankle and foot placement mechanisms are inversely related. Larger lateral ankle responses lead to smaller foot placement changes. Correlations involving the push-off mechanism, while significant, were weak. However, the consistency of the correlations across stimulus conditions suggest the push-off mechanism has the role of small adjustments to medial-lateral movement near the end of the balance response. This verifies that a fundamental feature of human bipedal gait is a highly flexible balance system that recruits and coordinates multiple mechanisms to maintain upright balance during walking to accommodate extreme changes in body configuration and frequent perturbations.

“Be supportive and understanding of the stress that youth are going through:” Foster care alumni recommendations for youth, caregivers and caseworkers on placement transitions

A growing body of research has begun to explore youth’s experiences of moving multiple placements in foster care and the impact of these transitions that lasts into adulthood. However, knowledge remains extremely limited regarding foster youth/alumni’s recommendations for improving the process of placement moves. This qualitative research study examined foster care alumni’s advice for youth in care, caregivers, and child welfare caseworkers on how to best handle placements moves. Results indicated that participants had a number of recommendations to help mitigate the emotional stress youth often experience as a result of placement instability. For youth in care, participants encouraged advocating for their voices to be heard in placement decisions and offered strategies to cope with the challenges of repeated placement moves. For caregivers, participants stressed the importance of demonstrating genuine care and support toward youth placed in their home and openly communicating with youth about upcoming placement changes. For caseworkers, participants strongly recommended better involving youth in placement decisions and developing close relationships with youth. Participants also recommended that caseworkers conduct more intensive evaluations of caregivers to ensure that youth are not placed in unsafe foster homes or with caregivers who are primarily motivated by financial compensation. Results from this study indicate alternative approaches to facilitating out-of-home placement transitions and addressing placement instability. Implications for child welfare policy, practice, and research are provided.

Adverse Childhood Experiences Associated with Children's Patterns of Out of Home Placement Over Time and Subsequent Negative Outcomes During Adolescence.

Out of home placement (OOHP) of welfare involved children is a critical problem associated with child abuse and neglect and household dysfunction. Few studies have also implicated greater instability in OOHP with more negative outcomes. However, several gaps remain. Objectives were twofold. To identify combinations of adverse childhood experiences that are associated with OOHP - based on both duration of OOHP and change in actual placement during each time point, among welfare involved youth. The second objective was to understand long-term negative outcomes during adolescence that are associated with greater placement instability. Data come from the National Survey of Child and Adolescent Wellbeing (n = 1,657). Multinomial logistic regression was used to evaluate adverse childhood experiences that were associated with specific patterns of OOHP. Multivariate regression models were estimated to evaluate delinquency, aggression as well as depressive and trauma symptoms during adolescence that were associated with specific patterns of OOHP. There were six categories of OOHP found in the sample: 1) no OOHP, 2) OOHP one time, 3) OOHP two times, 4) OOHP two times with change in placements, 5) OOHP three times, and 6) OOHP three times with change in placement. Longer duration of OOHP was associated with more adversity exposure. Longer duration and more change in placement were associated with the most negative outcomes. Findings demonstrate the need for future testing of these findings in prevention trials.

Multiscale Modeling of Dyadic Structure-Function Relation in Ventricular Cardiac Myocytes

Cardiovascular disease is often related to defects of subcellular components in cardiac myocytes, specifically in the dyadic cleft, which include changes in cleft geometry and channel placement. Modeling of these pathological changes requires both spatially resolved cleft as well as whole cell level descriptions. We use a multiscale model to create dyadic structure-function relationships to explore the impact of molecular changes on whole cell electrophysiology and calcium cycling. This multiscale model incorporates stochastic simulation of individual L-type calcium channels and ryanodine receptor channels, spatially detailed concentration dynamics in dyadic clefts, rabbit membrane potential dynamics, and a system of partial differential equations for myoplasmic and lumenal free Ca2+ and Ca2+-binding molecules in the bulk of the cell. We found action potential duration, systolic, and diastolic [Ca2+] to respond most sensitively to changes in L-type calcium channel current. The ryanodine receptor channel cluster structure inside dyadic clefts was found to affect all biomarkers investigated. The shape of clusters observed in experiments by Jayasinghe et al. and channel density within the cluster (characterized by mean occupancy) showed the strongest correlation to the effects on biomarkers.

MRI of surgical flaps in pelvic reconstructive surgery: a pictorial review of normal and abnormal findings.

Surgical flaps are commonly used for pelvic reconstruction in a subgroup of patients with locally advanced or recurrent anorectal and gynecologic malignancies and following complications of pelvic irradiation. Surgical scenarios where flaps may be placed include (but are not limited to) extended or radical abdominal perineal resection (APR) and total pelvic exenteration (PE). Surgical flaps in pelvic reconstruction serve several functions, including reducing dead space and providing structural support, facilitating wound closure and cosmetic appearance, enhancing the postsurgical healing process, protecting anastomosesand helping to prevent adhesions of organs and viscera to adjacent structures and the pelvic side wall. The most commonly used surgical flaps in pelvic reconstruction surgery include the VRAM (Vertical Rectus Abdominis Muscle), MRAM (Modified Rectus Abdominis Myocutaneous flap), gracilis, sartoriusand omental flaps. Surgical flaps can be mistaken for recurrent or residual tumor by radiologists who are not familiar with the appearance or surgical methods of flap placement, since flaps may have a mass-like appearance on cross sectional imaging, including CT and MRI. Recurrent neoplasm may be difficult to differentiate from postoperative changes of flap placement and associated postsurgical anatomic distortion. This review article focuses on understanding the nuances of surgically placed pelvic flaps and identifying their normal and abnormal appearances on magnetic resonance imaging (MRI) along a time continuum. Postsurgical complications, including hematoma, postoperative fluid collections, infection, ischemia, and necrosis as well as tumor recurrence on the initial and follow-up magnetic resonance imaging are illustrated and discussed.

Exploring Medical Foster Care as a Placement Option for Children With Medical Complexity.

Medical foster care (MFC) offers a family-home setting for children with medical complexity (CMC) who cannot be cared for by their parents. We explored MFC as a placement option for CMC via in-depth interviews with the individuals providing and monitoring care. In collaboration with an MFC agency, we recruited care team members for 15 CMC. Semistructured interviews were audiotaped and transcribed. Descriptive analyses were performed on care team composition and roles, the placement process, and child medical, placement, and quality of life (QoL) characteristics. Foster parents completed child QoL questionnaires. Conventional content analysis was applied to participant suggestions for MFC improvements. Fifty-eight interviews were conducted; a median of 4 care team members interviewed per child. An extensive network of individuals and systems are involved in providing care. Each child received care from multiple subspecialists (median = 5). Most children were technology dependent (87%), developmentally delayed (87%), and entered MFC from the hospital (73%) because of medical neglect (86%). Nearly half were in care for >2 years. Changes in placement and/or care team were common. QoL scoring showed impairments in multiple domains, whereas respondent interviews described positive aspects of QoL. Participants provided suggestions to improve care within MFC. MFC is a promising placement option for CMC. Because many CMC are entering MFC directly from the hospital and require ongoing care from pediatric subspecialists, pediatricians should be familiar with MFC, the placement process, and the various systems and individuals involved. Pediatricians can play important roles in ensuring that children in MFC receive coordinated and high-quality care.

Adaptive changes in foot placement for split-belt treadmill walking in individuals with stroke

BackgroundAdaptation to split-belt treadmill walking differs between individual stroke survivors. Many discussions only address spatiotemporal parameters that are related to movement, and the changes in interlimb spatiotemporal parameters as a consequence of adaptation are poorly understood. ObjectivesTo investigate symmetry of the center of pressure (CoP) position relative to the center of mass (CoM), and ascertain whether this can be used to identify differences in adaptation of interlimb spatiotemporal parameters among stroke survivors during split-belt walking. MethodsTwenty-two chronic post-stroke patients and nine elderly controls walked in tied- then split-belt (2:1 ratio of fast:slow) conditions. Spatiotemporal parameters were compared within groups to assess symmetry of the CoM-CoP angle at foot contact. ResultsAsymmetry of the CoM-CoP angle was associated with asymmetry of spatiotemporal parameters. Re-establishment of symmetry of CoM-CoP angle was reflected in re-established symmetry of spatiotemporal parameters in post-stroke and control participants. ConclusionsPost-stroke patients who re-establish symmetry of the COM-COP angle are able to adapt their walking for split-belt perturbation. This suggests that predictively symmetric foot placements on the fast and slow sides are necessary for adaptation in walking. Symmetrical foot placement is achieved by interlimb coordination and may contribute to dynamic stability.

Det dubbla utanförskapet

A twofold exclusion – interviews about bullying with young people in residential careYouth in residential care are at risk of living in twofold exclusion when stigmatization and bullying in school become part of their everyday life. The article presents results from semi-structured interviews with ten young people in residential care. The young people’s reflections on bullying are analysed in relation to different explanatory models of bullying. Experiences of bullying are very common among youth placed in out of home care, which calls for research on bullying and youth in residential care. The aim of the study was to present understandings of bullying among youth placed in residential care and to investigate why youth in residential care report victimization to a higher degree than young people living at home. The research questions were: 1. What descriptions do young people give of the term bullying? 2. What insights can the young people’s descriptions of bullying give to the high victimization among youth in residential care? 3. How can the young people’s descriptions of bullying be understood in relation to different understandings of bullying? The main findings are the young people’s sense of exclusion. They feel stigmatized due to their placement in care and believe they have to be secretive in school about being placed in care because of the risk of bullying. Three suggestions to decrease the twofold exclusion are presented. 1. Based on knowledge that frequent changes in groups are a risk factor in regard to bullying, placement changes need to be reduced to a minimum. 2. Schools (teachers and pupils) need education concerning care environments. 3. Young people are often placed in care due to behavioural problems and therefore residential units need advantageous conditions to work with the young people’s behaviour on both individual and group level.

The effect of tooth morphology and vertical bracket positioning on resultant stress in periodontal ligament - a three dimensional finite element study.

IntroductionThe purpose of this study is to evaluate the effect of change in vertical placement of bracket and effect of tooth morphology on stress developed on periodontal ligament with the help of three dimensional finite element modeling.MethodsA three-dimensional model of the maxillary bone, maxillary right central incisor, lateral incisor and canine was designed based on the average dimensions of the anatomy and morphology given by Wheeler’s and standard edgewise bracket with Slot of 0.022″ X 0.028″ inch was designed using the finite element method. Brackets were placed on each tooth, on the mentioned labial surface at variable distances from the cusp tip, and a full size archwire was virtually engaged into the bracket, then optimum orthodontic load of 2N is applied and PDL stress were calculated.ResultsThe lowest stress values were measured as bracket position changes from crest of teeth to the apical direction. By displacing the bracket gingivally from 1.5 to 6 mm, a 16.2% decrease in stress level for central incisor, for lateral incisor the stress level decrease by 25.8% and for canine the stress level decrease by 21.6% thus our study confirms that variation in vertical bracket position results in change in resultant stress in PDL.ConclusionIt can be concluded that the variation in the vertical position of the bracket osn different tooth can have an important effect on the stresses developed in the PDL.

Assessment of economic and environmental energy performance of EU countries using CV-TOPSIS technique

Abstract Energy production is fundamental to modern lifestyles and living standards, and as the quality of life grows, so does the demand for energy. But at the same time, an increased demand for energy has many negative effects, such as climate change and global temperature rise caused by increased carbon dioxide emissions into the atmosphere. In addition, high levels of energy use results in greater depletion of fossil fuels, oil, or natural gas. To avoid these problems, many countries are closely monitoring their energy intensity and implementing the politics and tools for its improvement. This paper aims to perform a quantitative evaluation of the energy economic and environmental performance of the EU countries using the TOPSIS techniques as one of the MCDM methods to find the most desirable alternative(s) from a set of available alternatives versus the selected criteria. Based on seven indicators weighted by the Coefficient of Variance, we have comprehensively evaluated the energy economic and environmental performance of the EU countries. Among other things, we noted the strong dominance of Sweden throughout the period under review and have recorded significant improvement progress in the overall assessment of Luxembourg. One of our conclusions is that it is not possible to combine the absolute change in the CV-TOPSIS result with a change in the overall placement, which, in addition to its own progress, reflects the progress of the whole group of subjects under analysis.

A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience.

Antipsychotic medications are used among 19%-58% of adults with intellectual disabilities to manage challenging behaviour against the NICE guideline recommendations. Studies show that it is possible to completely withdraw antipsychotics in about one third of adults with intellectual disabilities and a dose reduction of 50% or more in another third. In Cornwall, over three years the present authors developed a structured pathway to withdraw antipsychotics among adults with intellectual disabilities which involved people with intellectual disabilities and their carers, GPs, community learning disability team members and pharmacists. The present authors managed to withdraw antipsychotics totally among 46.5% (33/71) and reduced over 50% of dosage in another 11.3% (8/71) of adults with intellectual disabilities. At three months follow-up no one required hospital admission or change in placement. It is possible to withdraw/reduce antipsychotics in a high proportion of adults with intellectual disabilities if a concerted effort is made involving all stakeholders from the outset.

Impact of business model objectives on marketing innovation activities

PurposeThe purpose of this paper is to analyze the differences and similarities that arise between manufacturing and service firms with regard to the impact of business model objectives on marketing innovation activities.Design/methodology/approachThis study focuses on business model objectives and marketing innovations activities. As described by Oslo Manual, marketing innovations involve changes in product design, promotion, placement and pricing. Relationships between business model objectives and marketing innovations are based on the analysis of 9,525 firms, 5,488 of which are manufacturing companies and 4,037 of which are service companies.FindingsFindings reveal distinctive results in the adoption of marketing innovation, depending on the business model objectives being pursued and the type of companies (manufacture or service) considered.Research limitations/implicationsThis research goes further than prior studies by identifying more precisely the particularities that differentiate the manufacturing and service sectors.Practical implicationsFirm’s age and size are not significant restrictions to introduce new marketing innovations in manufacturing or service sectors. In contrast, the business model objective to enter a new market is a significant driver of marketing innovations in most cases.Originality/valueThe focus on business model objectives and their impact on marketing innovations is novel. In addition, this study focuses on a large-scale sample that allows us to compare differences between manufacturing and service companies.

Precautions for Combined Anterior and Posterior Long-Level Fusion for Adult Spinal Deformity: Perioperative Surgical Complications Related to the Anterior Procedure (Oblique Lumbar Interbody Fusion).

Study DesignRetrospective, single-center study.PurposeWe aimed to determine the perioperative complications of oblique lumbar interbody fusion (OLIF) as a first-stage procedure in combined anterior and posterior operation for adult spinal deformity (ASD) along with sagittal imbalance. Specifically, we aimed to identify the radiological and clinical types of perioperative surgical complications and the factors affecting these complications. Overview of LiteratureOLIF has recently gained popularity, and there are several reports of good outcomes and only a few of complications with OLIF; however, a few studies have focused on the perioperative surgical complications of ASD along with sagittal imbalance.MethodsThe perioperative period was a 1-week interval between the anterior and posterior procedures. All patients underwent simple radiography and magnetic resonance imaging preoperatively and postoperatively. Cage placement was evaluated for displacement (i.e., subsidence and migration) and vertebral body fracture. Clinical patient complaints were evaluated perioperatively. Student t-test was used for data analysis.ResultsA total of 46 patients were included, totaling 138 fusion segments. A week after OLIF, 14 patients/33 segments (30.4%/23.9%) demonstrated endplate injury-associated cage placement change. Subsidence was the most common cage placement-related complication. As compared with patients without endplate injury, those with endplate injuries showed significantly larger correction angles and a higher proportion of them had larger height cages than the disk height in the full-extension lateral view. Although 32.6% of the patients experienced perioperative clinical complications, they were relatively minor and transient. The most common complication was severe postoperative pain (Visual Analog Scale score of >7), and hip flexor weakness spontaneously resolved within 1 week.ConclusionsOLIF yielded more than expected endplate injuries from treatment modalities for ASD along with sagittal imbalance. Therefore, surgeons should be cautious about endplate injury during OLIF procedures. It is difficult to accomplish lordosis correction via OLIF alone; therefore, surgeons should not attempt this impractical correction goal and insert an immoderate cage.

Review of Interventions Supporting Secondary Students with Intellectual Disability in General Education Classes

Instruction and support for students with intellectual disability in general education classes should be informed by research-based interventions. In this systematic review, we examined the focus and impact of interventions delivered in inclusive classes to support middle and high school students with intellectual disability. We identified 40 intervention studies involving 177 secondary students with intellectual disability attending a range of core academic and elective classes. These multicomponent interventions fell within five primary categories: systematic instruction, peer support arrangements, self-management strategies, peer-mediated communication interventions, and educational placement changes. Although the overall focus was fairly balanced across academic, social, and behavioral outcomes, each intervention approach prioritized somewhat different dependent measures. Moreover, although the impact of the interventions on most outcomes was positive, the methodological quality of these studies was somewhat varied. We offer recommendations for future research and practice aimed at strengthening the availability and implementation of effective interventions within inclusive secondary school classes.

Children and youth in out-of-home care: What can predict an initial change in placement?

A significant proportion of children placed in out of-home care experience placement disruptions in the United States. Placement instability has deleterious effects on children's well-being. (a) To measure the time-to-initial placement change in different types of settings, including non-relative foster homes, kinship care, residential treatment centers (RTC), group homes and other types of settings; and (b) To identify predictors of the initial placement change. Data were obtained from the State Automated Child Welfare Information System operated by the child welfare agency in a Mid-Atlantic state. The sample included 4177 children who entered into the foster care and were followed over three years. Descriptive, bivariate, and survival Cox regression models were conducted. More than half (53%) of the children had experienced placement change within 3 years. The mean length for an initial change in placement was longer for children in RTC and kinship care compared to children in foster and group homes, and other placements (χ2 = 322.31, p < 0.001). Several factors significantly increased the likelihood of an initial change, including: older children (p < 0.001, HR = 1.01), children with behavioral problems (p < 0.001, HR = 1.26), parental substance abuse (p < 0.05, HR = 1.12), and cases in which the parents voluntarily gave up their parental rights (p < 0.05, HR = 1.12). The type of placement also increased the risk for placement change. Providing early interventions and services to these children and their families is essential to increase placement stability.

Educational placement of students with autism spectrum disorder and its relation to socioeconomic status, intelligence, and diagnosis

Background: Students with Autism Spectrum Disorder (ASD) have several options for placement within the education system. Placement options typically comprise inclusion, self-contained classrooms in a regular schools, or special education schools.Objectives: The current study reviewed 210 psychological records of Israeli students with ASD from 1994 to 2011 retrospectively, and sought to examine students' placement in relation to three factors: intelligence, diagnosis and socioeconomic status (SES). In addition, transition periods were examined to detect possible key periods for change in placement.Results: All three factors were related to educational placement. Specifically, students in special schools had a significantly lower mean intelligence score, and lower SES was associated with less inclusive placements. Additionally, the transition between 6th and 7th grade was found to be a key period for placement change, mainly from more inclusive placements to less inclusive ones.Conclusions: Implications for policy and practice are discussed.

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia.

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume. To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume. Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System® before and 6months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume. When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4mL) showed significant differences (p < 0.001) 6months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5mL) and after (120 ± 34.6mL) centrifugation. Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postanesthesia ultrasound facilitates creation of more preferred accesses without affecting access survival

ObjectiveThe results of preoperative ultrasound (pre-US) vein mapping for hemodialysis access creation can be affected by environmental and clinical factors, such as ambient temperature, acute illness, recent phlebotomy, and hypovolemia. These factors may inadvertently exclude otherwise viable veins as options for access creation. We hypothesized that repeating the ultrasound vein mapping immediately preoperatively after anesthesia administration (post-US) identifies additional veins not appreciated by pre-US, thereby altering the operative plan and producing more preferred accesses, particularly more forearm accesses. MethodsWe performed a retrospective cohort study of patients (N = 323) at one institution who underwent pre-US followed by creation of a permanent dialysis access (fistula or graft) between January 2008 and December 2013. By applying the Silva criteria to pre-US vein mapping reports, a preoperative surgical plan was established. There were 99 patients who underwent only pre-US (group I); an additional post-US was performed in 224 patients (group II). Using multivariable logistic regression, we tested the association of post-US (group II) with pre-US alone (group I) with a change in operative plan and placement of a more preferred access (ie, more distal and autogenous). We also analyzed access survival using multivariable Cox proportional hazards regression and determined maturation rates for accesses in groups I and II. ResultsIn group II, there were more changes in operative plan after controlling for potential confounders (adjusted odds ratio, 1.96; 95% confidence interval, 1.18-3.25), and more preferred accesses were created (adjusted odds ratio, 1.82; 95% confidence interval, 1.01-3.27). In addition, more autogenous accesses were created in group II when initially only upper arm graft options had been identified (P = .01); overall, more forearm accesses were created in group II (P = .03). There was no significant difference in access maturation and patency in comparing accesses in group I and group II, despite creation of autogenous accesses in group II that are usually associated with higher rates of access failure. In fact, forearm radial-cephalic autogenous accesses created in group II had secondary patency rates of 91% at 2 years. ConclusionsOur study supports the hypothesis that the use of post-US in addition to pre-US leads to placement of more preferred accesses while maintaining maturation and patency rates. Ultrasound evaluation after anesthesia should be considered a step in the process of care for hemodialysis access creation to improve outcomes.

Centralized vs. distributed algorithms for resilient 5G access networks

Cloud radio access networks (C-RANs), relying on network function virtualization and software-defined networking (SDN), require a proper placement of baseband functionalities (BBUs) to reach full coverage of served areas and service continuity. In this context, network resources can be shared and orchestrated to meet the flexibility required by a dynamically evolving environment. Different methodologies, based on analytical formulation or heuristic algorithms, can be applied to achieve suitable trade-offs among cost components. This paper considers both centralized and distributed algorithms to obtain BBU hotel placement in C-RAN and compares their performance, scalability and adaptability to evolving scenarios. As expected, the results obtained with the distributed approach are sub-optimal, but very close, in most cases, to the optimal solutions obtained with a centralized algorithm based on integer linear programming. In addition to off-loading the SDN orchestrator, the distributed approach, differently from the centralized one, is shown to be able to cope with the evolution of the C-RAN topology with limited incremental changes in the original placement. The limits of the centralized approach in terms of scalability that the distributed approach is able to overcome are also evidenced.