A Pricing Model to Optimize Transmission Strategies for Mobile Devices

The simultaneous multiple data transmission can improve the use of the network. Unlike existing solutions in the literature, in this chapter, the authors propose a solution to the network resource allocation problem under the selfish behavior of mobile device with multiple connections to several available network interfaces simultaneously, to resolve the conflict of interest in network. They analyze the impact of interactions between users based on two conflicting factors (i.e., throughput and monetary cost). Also, a diverse set of user service types is taken into consideration, which makes the proposed approach suitable for an integrated service network. Analytical and numerical results demonstrate the validity of the proposed approach, which show that the non-cooperative game has an equilibrium point that depends on all parameters of the system, and they show that this situation between mobile devices is much more beneficial in terms of the performance of mobiles, cost, and the data transfer rate.

Investigation of Direct-Acting Oral Anticoagulants and the Incidence of Venous Thromboembolism in Patients Weighing ≥120 kg Compared to Patients Weighing <120 kg

Background: Direct oral anticoagulants (DOACs) present a favorable alternative to warfarin based on the decreased burden of monitoring and fewer drug and food interactions. Although studied in the general population, limited clinical data justifying efficacy in patients weighing ≥120 kg present concern for using DOACs in this specific population. Objective: The purpose was to identify if a difference exists in incidence of recurrent thromboembolic events in patients receiving a DOAC for the indication of venous thromboembolism (VTE) weighing ≥120 kg compared to patients weighing <120 kg. Methods: A retrospective database analysis was conducted with patients on apixaban, dabigatran, or rivaroxaban for treatment of VTE from the Veterans Integrated Service Network 8 between January 2012 and June 2017. The primary outcome was incidence of recurrent VTEs while on anticoagulation. Fisher’s exact tests were used to evaluate difference in VTEs between the groups. Results: There were 133 patients weighing ≥120 kg and 1063 patients weighing <120 kg identified within the 5-year time frame that met inclusion criteria. Although no statistically significant difference was found in incidence of recurrent VTEs between study groups (0.8% vs 1.1%; odds ratio: 0.66; 95% confidence interval: 0.09-5.14; P = .69) few events occurred limiting the power to be able to detect a difference. Conclusion: This study found no difference in VTE recurrence in patients weighing ≥120 kg compared to patients <120 kg with few events in either group. Although promising, additional studies are needed to confirm these findings.

163. Development of an Electronic Flagging Tool for Identifying Cardiac Device Infections: Insights from the VA CART Program

Background Surveillance is an essential aspect of infection prevention. Despite the high morbidity and mortality associated with procedure-related Cardiac Implantable Electronic Device (CIED) infections, methods for identifying them are limited. The objective of this study was to develop an algorithm with electronic flags to facilitate detection of CIED infections in a large, multi-center cohort. Methods A sample of patients who underwent CIED procedures entered into the VA Clinical Assessment Reporting and Tracking Electrophysiology (CART-EP) program from FY 2007 to 2015 were included in the nested case–control study. After cohort creation, data from this review process were combined with electronic variables (e.g., microbiology orders, ICD 9/10 codes) to develop a preliminary algorithm that categorized patients as high, intermediate, or low risk of CIED infection. Results A total of 1,014 unique patients out of a cohort of 5,955 procedures underwent manual review. Among these cases, 59 CIED infections and 955 controls were identified. Electronic variables predictive of CIED infection included ICD 9/10 infection codes and microbiology orders (table). ICD 9/10 codes had excellent PPV for flagging infections but sensitivity was limited (47.5%, see figure). Adding microbiology order flags increased sensitivity but lowered specificity. Specificity in patients without either flag was outstanding (99%). Conclusion Absence of ICD 9/10 and microbiology orders is highly specific for ruling out CIED infections. The discriminatory abilities of the algorithm for intermediate probability flags (+microbiology/−ICD9/10) need improvement. In patients without ICD codes, at least microbiology orders should be used as a flag to streamline review of possible device infections. Refinement of this tool using other clinical flags may improve operating characteristics and clinical utility. Disclosures W. Branch-Elliman, Veterans’ Integrated Service Network Career Development Award: Investigator, Research grant. American Heart Association: Investigator, Research grant.

An integrated service network in maternity— the implementation of a midwifery-led unit

Maternity services in Australia are in urgent need of change. During the last 10 years several reviews have highlighted the need to provide more continuity of care for women in conjunction with the rationalisation of services. One solution may lie in the development of new integrated systems of care where primary-level maternity units offer midwiferyled care and women are transferred into perinatal centres to access tertiary-level obstetric technology and staff when required. This case study outlines the introduction of caseload midwifery into an Area Health Service in metropolitan Sydney. Our objective is to explore the concept of caseload midwifery and the process of implementing the first midwifery-led unit in NSW within an integrated service network. The midwifeled unit is a small but growing phenomenon in many countries.1 However, the provision of ?continuity? and ?woman-centred? midwifery care involves radical changes to conventional hospital practice.