The experiences of migrating a large scale, high performance healthcare network
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Partners Healthcare migrated their large-scale Caché database from a mixed Windows and UNIX environment to a new highly available UNIX architecture using HP servers. They took a phased approach, first benchmarking performance on test systems, then migrating the database tier and finally the application tier. Benchmarking revealed optimizations that improved performance in production. The new environment provided improved availability, scalability and reduced maintenance needs to support continued rapid growth of the healthcare network.
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Looking ahead, the presentation discusses future prospects such as enhanced delivery systems, precision targeting, and highly personalized gene therapy approaches that could revolutionize neurological care. Overall, gene therapy is presented as an exciting yet challenging frontier, requiring scientific innovation, rigorous ethical scrutiny, and comprehensive regulatory frameworks to ensure that its full potential
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If you are a male and looking for a sexologist doctor for personal treatment or medicine then this information is helpful for you. As we know a sexologist doctor is a specialist in his medical faculty to treat patients who are suffering from any kind of sexual problems. He is a specialist in the study of sexuality, sexology, sexual dysfunction, sexual desire, behavior, gender-identity, anatomy and reproductive health issues. He practices in a clinic or hospital to provide his treatment and medicine privileges.
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Common Sexual Problems in men:
Based on his daily practice, treatments and research; he says that both married and unmarried men can struggle with their sexual problems. He says that men struggle with erectile dysfunction, premature ejaculation, lack of sexual desire, culture-specific syndromes, ejaculation disorders, sexually transmitted infections, performance anxiety disorder and other sexual problems. Various factors are responsible for sexual problems and among them; physical, psychological, lifestyle, hormonal, medical conditions and emotional factors play a vital role in leading a person to sexual problems.
Ayurvedic Treatment for Overall Male Sexual Problems:
Dr. Sunil Dubey says that Ayurveda has infallible solutions to deal with all sexual problems of men. The approach of Ayurveda focuses on balancing the doshas in the body, which are the cause of sexual disorders. It has a natural system to cure problems, which is the basis of all medicines. He provides his comprehensive treatment to each and every sexual patient with the help of Ayurveda.
First, he identifies the underlying medical conditions (diabetes, cardiac problems, kidney disease and chronic illness) that play a vital role in this sexual problem. He also helps in identifying psychological factors (stress, depression, anxiety, relationship issues and emotional factors) that indirectly affect sexual health. Providing a holistic approach of treatment, he provides clinically proven Ayurvedic medicine, herbal remedies, quality-proven Ayurvedic Bhasma and vital guidance of sexual wellness.
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ORCID: 0000-0002-9393-1933
Abstract
Low-grade astrocytomas are considered low-grade gliomas. Low-grade gliomas are brain tumors that grow slowly and require specialized care.
They are a group of tumors that include: fibrillary astrocytoma, protoplasmic astrocytoma and gemistocytic astrocytoma. They differ from their counterpart high-grade astrocytomas, because they have a better prognosis and longer survival, although each of them is a different disease with a different course and prognosis.As a group, they represent 26.6% of all tumors derived from glial cells in the brain.Separated by age, they represent approximately 15% of intracranial tumors in adults and 25% in children. (1 -8)
The age of presentation of these tumors in adults is around the 4th decade of life. The frontal lobe is the most frequent location, followed by the temporal and parietal lobes.
Currently, technology has increased the safety of surgical procedures, with the arrival of techniques such as neuronavigation, stereotaxy, transoperative brain mapping, transoperative ultrasound or ultrasonic aspirator; all of them in contemporary times must be used with reasoning for the greater benefit of the patient.
A craniotomy is a complex neurological procedure that involves opening the skull, performing the necessary operation, and closing the skull, securing the bone in its original position. (4 -10)
Awake craniotomy is mainly used for mapping and resection of lesions in vitally important brain areas where imaging is not sufficiently sensitive. These are most commonly speech and motor areas. In all sedation-anesthesia techniques, the patients are awake and able to speak and/or move during the mapping phase.
It is a technique used to improve perioperative outcomes, achieving a faster recovery of the patient with a reduction in the percentage of postoperative complications.
Artificial Intelligence in Oncology: Transforming Cancer Carepptx
Artificial Intelligence in Oncology: Transforming Cancer CarepptxNEIGRIHMS, SHILLONG Artificial Intelligence (AI) is transforming oncology by enabling faster, more accurate, and personalized cancer care. AI uses technologies like machine learning (ML), deep learning (DL), and natural language processing (NLP) to analyze complex medical data, helping doctors make better decisions at every stage of cancer care.
Key Applications of AI in Oncology:
Cancer Detection & Diagnosis:
AI analyzes radiology (CT, MRI, mammography) and pathology images to detect tumors early and accurately.
Tools like PathAI, Aidoc, and DeepMind are used in clinical imaging.
Precision Medicine & Genomics:
AI interprets genetic mutations to match patients with targeted therapies.
Platforms like Tempus and OncoKB support personalized cancer treatment.
Radiation Oncology:
AI automates contouring, treatment planning, and dose optimization.
Reduces planning time and improves consistency in radiation delivery.
Drug Discovery & Clinical Trials:
AI helps discover new cancer drugs and match patients to trials.
Companies like BenevolentAI and Insilico Medicine lead this space.
Prognostics & Monitoring:
AI predicts survival, recurrence, and side effects using patient data.
Wearables and mobile apps track symptoms and alert doctors in real time.
Benefits of AI in Oncology:
Early and accurate diagnosis
Faster workflows and reduced workload
Personalized treatments
Improved patient outcomes
Challenges:
Data privacy and bias
Lack of clinical validation
Interpretability of AI decisions
Integration into hospital systems
Conclusion:
AI is not replacing oncologists but empowering them with better tools to diagnose, plan, and treat cancer more effectively. With ongoing research and responsible use, AI will play a crucial role in the future of oncology.
BIOMECHANICS & KINESIOLOGY OF THEHIP COMPLEX.pptx
BIOMECHANICS & KINESIOLOGY OF THEHIP COMPLEX.pptxdrnidhimnd The cuplike concave socket of the hip joint is called the acetabulum and is located on the lateral aspect of the pelvic bone (innominate or os coxa).
Until full ossification of the pelvis occurs between 20 and 25 years of age.
The periphery of the acetabulum (lunate surface) is covered with hyaline cartilage.
This horseshoe-shaped area of cartilage articulates with the head of the femur and allows for contact stress to be uniformly distributed.
The inferior aspect of the lunate surface (the base of the horseshoe) is interrupted by a deep notch called the acetabular notch.
The acetabular notch is spanned by a fibrous band, the transverse acetabular ligament, that connects the two ends of the horseshoe.
The acetabulum is deepened by the fibrocartilaginous acetabular labrum, which surrounds the periphery of the acetabulum. The acetabular fossa is non-articular; the femoral head does not contact this surface.
The acetabular fossa contains fibroelastic fat covered with synovial membrane.
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil Dubey
Common Male Sexual Problems | Best Sexologist in Patna, Bihar | Dr. Sunil DubeySexologist Dr. Sunil Dubey - Dubey Clinic
Meeting dissolution requirements M.Pharmacy sem 2nd biopharmaceutics &pharmac...
Meeting dissolution requirements M.Pharmacy sem 2nd biopharmaceutics &pharmac...Swami ramanand teerth marathwada university
Terminologies of adverse medication related events , Regulatory terminologies.
Terminologies of adverse medication related events , Regulatory terminologies.Dr. Koppala R.V.S. Chaitanya
Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...
Awake Craniotomy with endoscopic support, guided by intraoperative ultrasound...Dr. Damian Lastra Copello
The experiences of migrating a large scale, high performance healthcare network
- 1. The experiences of migrating a large scale, high performance healthcare network Larry Williams Corporate Manager, Partners HealthCare
- 2. In the next half hour… Partners Healthcare System overview Caché platform architecture & metrics The need to migrate Phased migration approach Benchmark testing and results Discoveries and production enhancements Post database migration results Future milestones
- 3. Partners Healthcare System Founded in 1994 Brigham & Women’s Hospital Massachusetts General Hospital Now includes: Community physician network (1200 + 3500 MD’s) PCHi 3 community hospitals 2 rehab hospitals 3 specialty institutions Enterprise-wide Information Systems 1100 employees Annual budget FY05 approximately $160 million
- 4. Anchor Hospitals & Airport BWH MGH Logan Airport 10 km 6 km
- 5. Acute Care Hospitals MGH BWH Newton- Wellesley Community Physician Practices
- 6. Partners Domain Devices Internet 12,000 Printers 32,000 Desktops Firewall ~30,000 other devices 1,450 Servers Closely Managed Assumed Managed
- 7. Current Mixed-Mode Production Architecture
- 8. Enterprise Integration Over 30% are to and from Caché database Change from prior year Daily Average Est. Annual Transactions # of Interfaces 196 170 192 167 37% 4,659,035 1,330,962,017 2007 40% 3,399,211 1,240,712,044 2006 45% 2,431,917 887,649,802 2005 1,673,515 610,833,080 2004
- 10. Annual Database Growth Rate
- 11. Database Utilization Average Database References per day in Billions
- 12. The Need to Migrate - Availability Monthly Downtime Current State Business need
- 13. Additional Business Requirements Increase availability and reliability Decrease database risk from 5 single points of failure More robust hardware and OS Many less servers and OS instances to manage Clustering and automated failover Reduce monthly maintenance needs, updates once or twice per year -------------------------------------------------------- Improve Performance 64 bit OS, more memory for cache Caché 5.0.20 to Caché 2008.1, significantly improved ECP performance Increase Scalability 91 Terabytes available on EMC SAN DMX3 On-demand addition of processor cores
- 14. Caché Migration Decision Making Process Only considered first tier vendors and support (IBM, HP) HP assumed much more risk with Professional Services Existing HP business yields more leverage & visibility with regional office More headroom in HP configuration Price was not a distinguishing factor
- 15. Phased migration approach Proof of Concept (benchmark testing) Completed 10/15/07 Phase 1 – Database tier Completed 4/14/08 Phase 2 – Application tier Big Bang migration 12/14/08 (includes Cache 2008.1 UNIX platform upgrade) Phase 3 – Disaster Recovery Now implemented as part of Phase 2, leveraging HP Blade servers
- 16. UNIX DataBase Tier Benchmark Environment
- 17. UNIX Application Tier Benchmark Environment
- 18. Benchmark Load Testing Results Goals Simulate current Production user counts & transaction loads Verify support for load increases up to 3x Benchmark Environment Isolated LAN, new DMX3 SAN 20 new Windows blade servers (10 app servers, 10 script ‘players’) Scripts for 8 apps (represent heaviest use, Web/Telnet/VB apps) 2 batch jobs (screensaver simulation, NullGen LMR functions) Conclusions Able to simulate production load, 1.5x and 3x load 2 HP rx8640 can handle growth projections 0.66 0.15 0.32 LMR avg Caché app time (in sec.) 40,000 40,000 11,806 LMR transactions (5 min. period) 135,000 30,000 35,000 Database Global Refs / sec. Benchmark full script load Benchmark “paced” script load Production peak (8/21, 11:20 am) Metric
- 19. Design and Configuration Considerations Database configuration simulation testing 1 to 5 Caché database instances were assessed 1 vs. 5 ECP channels per Caché instance were assessed Number of active cores were accessed (4 active, 2 reserved) Results and unexpected discoveries Identify 5 Caché database instance as optimal design configuration Maintain same data distribution across 5 DB instances Journal synch bottleneck the biggest issue High Transaction Journal deamon maintains ECP durability to guarantee transaction (1 per Caché instance) Determine 1 ECP channel per instance optimal Additional channels did not improve throughput, still have only 1 Journal Deamon
- 20. Benchmark Discoveries Led to Production Improvements (the rules have changed) References to Undefined globals using $Data and $Get These commands require network round trip Use of $increment Each call to $I requires network round trip Excessive use of Cache locks Forces more than 1 round trip Use of large strings Strings that require more than 3900–4000 bytes to represent the string value are big strings and never cached on the ECP client. Lesson Learned - Each trip to the database server results in overhead caused by a Journal Synch. Increasing the Journal Synch rate causes bottlenecks in the ECP channel which increase the risk of long transactions.
- 21. Post UNIX DB migration - 50% Reduction in Outlier Transaction
- 22. Monthly Average Caché Web Transaction Time
- 23. Unprecedented Growth - The LMR
- 25. Parallel Migration Testing and Certification Effort DEV VC/m DEV QA PROD QA auto copy on promote promote check-out & check-in Developer test Analyst cert Production release promote auto copy on check-in Caché Environment 5.0 (WIN) 2008.1 (UNIX)
- 26. Application Models Old New Browser client Web server Cache Cache VB client .Net server Cache Cache .Net client Browser client Web server Cache Web Services Browser client .Net client Scalability/Connection pooling, robustness/error handling, Vism Managed Provider Vism.ocx (MServices) Managed Provider Cache Web Services WebLink
- 27. The experiences of migrating a large scale, high performance healthcare network Larry Williams Corporate Manager, Partners HealthCare