End-to-end transport protocols continue to be an active area of research and development involving (1) design and implementation of special-purpose protocols, and (2) reexamination of the design and implementation of general-purpose protocols. This work is motivated by the perceived low bandwidth and high delay, CPU, memory, and other costs of many current general-purpose transport protocol designs and implementations.This paper examines transport protocol mechanisms and implementation issues and argues that general-purpose transport protocols can be effective in a wide range of distributed applications because (1) many of the mechanisms used in the special-purpose protocols can also be used in general-purpose protocol designs and implementations,(2) special-purpose designs have hidden costs, and (3) very special operating system environments, overall system loads, application response times, and interaction patterns are required before general-purpose protocols are the main system performance bottlenecks.
To determine whether serum albumin levels, before first surgery, predict time until death, 24 glioblastoma multiforme patients newly diagnosed at Ohio State University and Cleveland Clinic Foundation Hospitals between 1993 and 1995 were followed until 1996. Patients with presurgical serum albumin levels below 3.4 mg/dL survived an average (median) of 62 days (95% confidence interval (CI): 34, 135 days) after surgery. Those with serum albumin levels of at least 3.4 mg/dL survived an average of 494 days (95% CI: 241, 624 days). The association between serum albumin level and time until death persists when adjusted for demographic and treatment variables using Cox proportional hazards regression. Adjusted hazard ratios, by quartile of presurgical serum albumin level, are: 1.0, 1.2, 0.1, 0.1 (P-value for trend test = 0.007). In addition to providing a prognostic indicator, presurgical serum albumin levels can be used to evaluate the success of randomization of clinical trials for glioblastoma multiforme therapies. Our findings are consistent with results seen for tumors at other sites. We speculate that our results may be attributable to an association between low serum albumin levels and physiological events associated with angiogenesis.
As electronic-manuscript exchange becomes more prevalent, problems arise in translating among the wide variety of electronic representations. The optimum solution is a system that can support both the use and the creation of translation tools.
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