A randomized trial of the glottic views with the classic Miller, Wis-Hipple and C-MAC (videolaryngoscope and direct views) straight size 1 blades in young children.

STUDY OBJECTIVE: The Miller and Wis-Hipple size 1 blades are widely used for laryngoscopy in children and the C-MAC straight blade is used increasingly in young children, although the glottic views with these blades have not been compared. To determine whether the glottic views with these blades are equivalent. DESIGN: Equivalent study. SETTING: Operating room. PATIENTS: 96 children <2 years, ASA 1 or 2, elective surgery requiring orotracheal intubation. INTERVENTIONS: Direct laryngoscopy with the Miller and Wis-Hipple or C-MAC (videolaryngoscope and direct view) straight blades size 1; photographs of the glottic opening. MEASUREMENTS: Percent of glottic opening (POGO) was measured using a standardized scale by a blinded investigator. Heart rate, systolic blood pressure and hemoglobin oxygen saturation were measured before and after laryngoscopy. RESULTS: The POGO scores with the four blades/views were equivalent (fewer than 20% of the views yielded POGO scores <80). However, a post hoc comparison of the POGO scores yielded significant differences (P = 0.0001); the C-MAC videolaryngoscope view yielded significantly better scores than the Miller, Wis-Hipple and direct C-MAC views (P = 0.0009, 0.0002 and 0.0001 respectively). The POGO score with the Miller blade was superior to that with the direct C-MAC view (P = 0.024). No adverse events or complications occurred. CONCLUSION: The four blades/glottic views were equivalent, although a post hoc analysis demonstrated that the glottic view with the C-MAC videolaryngoscope was superior overall and the view with the Miller size 1 was superior to that with the direct C-MAC view.

Aggregated Throughput Prediction for Collated Massive Machine-Type Communications in 5G Wireless Networks.

The demand for extensive data rates in dense-traffic wireless networks has expanded and needs proper controlling schemes. The fifth generation of mobile communications (5G) will accommodate these massive communications, such as massive Machine Type Communications (mMTC), which is considered to be one of its top services. To achieve optimal throughput, which is considered a mandatory quality of service (QoS) metric, the carrier sense multiple access (CSMA) transmission attempt rate needs optimization. As the gradient descent algorithms consume a long time to converge, an approximation technique that distributes a dense global network into local neighborhoods that are less complex than the global ones is presented in this paper. Newton's method of optimization was used to achieve fast convergence rates, thus, obtaining optimal throughput. The convergence rate depended only on the size of the local networks instead of global dense ones. Additionally, polynomial interpolation was used to estimate the average throughput of the network as a function of the number of nodes and target service rates. Three-dimensional planes of the average throughput were presented to give a profound description to network's performance. The fast convergence time of the proposed model and its lower complexity are more practical than the previous gradient descent algorithm.

An Optimized Load Balance Solution for Multi-homed Host in Heterogeneous Wireless Networks.

The imminent wireless technologies are demanding fusion of several networks with diverse technologies. A convenient user device for such an environment is the multihomed host, which is capable of making use of simultaneous multiple connections of heterogeneous networks and smartly distributing/receiving data among them. The aim of this work is to develop a mechanism for assessing the multihoming concept and to propose a system model for increasing its applicability. The proposed model provided a novel user-centric scheme for multihoming for multi-radio access technologies (multi-RAT). It is considered an evolution of traffic offloading for gaining more capacity, higher data rates, and real-time services. This work assumes data classifications, evaluates and ranks the available connections, and utilizes the application data in an unequal load balance scheme. This is achieved by analyzing the performance of three of the most widely used alternative-choice for multiple attributes decision making (MADM) methods. The analytical hierarchy process (AHP), along with a utility equation, is applied to the system model for unequal load balance solution. The proposed model is targeting an energy efficient mechanism which satisfies application needs. Moreover, it reveals an efficient transmission mechanism for a better quality of service, traffic management, and availability solutions. The simulation results show that the proposed system surpassed its former counterparts.