A Model for Emergency Service of VoIP through Certification and Labeling

Voice over Internet Protocol (VoIP) will transform many aspects of traditional telephony service, including the technology, the business models, and the regulatory constructs that govern such service. Perhaps not unexpectedly, this transformation is generating a host of technical, business, social, and policy problems. In attempting to respond to these problems, the Federal Communications Commission (FCC) could mandate obligations or specific solutions to VoIP policy issues; however, it is instead looking first to industry initiatives focused on the key functionality that users have come to expect of telecommunications services. High among this list of desired functionality is user access to emergency services for purposes of summoning fire, medical, and law enforcement agencies. Such services were traditionally required to be implemented (and subsequently were implemented) through state and federal regulations. An emergency service capability is a critical social concern, making it particularly important for the industry to propose viable solutions for promoting VoIP emergency services before regulators are compelled to mandate a solution. Reproducing emergency services in the VoIP space has proven to be a considerable task, mainly due to the wide and diverse variety of VoIP implementations and implementers. While technical and business communities have, in fact, made considerable progress in this area, significant uncertainty and deployment problems still exist. The question we ask is this: Can an industry-based certification and labeling process credibly address social and policy expectations regarding emergency services and VoIP, thus avoiding the need for government regulation at this critical time? We hypothesize that the answer is “yes.” In answering this question, we developed a model for VoIP emergency service compliance through industry certification and device labeling. This model is intended to support a wide range of emergency service implementations while providing users with sufficient verification that the service will operate as anticipated. To this end, we first examine possible technical implementations for VoIP emergency services. Next, we summarize the theory of certification as self-regulation and examine several relevant examples. Finally, we synthesize a specific model for certification of VoIP emergency services. We believe that the model we describe provides both short-term and long-term opportunities. In the short term, an industry-driven effort to solve the current problem of VoIP emergency services, if properly structured and overseen as we suggest, should be both effective and efficient. In the long term, such a process can serve as a self-regulatory model that can be applied to social policy goals in the telecommunications industry, making it an important tool to have as the industry becomes increasingly diverse and heterogeneous

Liposome Bupivacaine Femoral Nerve Block for Postsurgical Analgesia after Total Knee Arthroplasty

BackgroundThe authors evaluated the efficacy of liposome bupivacaine in a femoral nerve block (FNB) after total knee arthroplasty.MethodsPart 1: subjects received FNB with 20 ml liposome bupivacaine (67, 133, or 266 mg) or placebo. Part 2: subjects were randomized to FNB with liposome bupivacaine 266 mg or placebo. The primary outcome measure was area under the curve of the numeric rating scale score for pain intensity at rest through 72 h (AUC NRS-R0-72) with imputed scores after rescue medication.ResultsIn part 1, FNB with liposome bupivacaine 266 mg (n = 24) resulted in analgesia similar to that obtained with 133 mg and was chosen for part 2. In part 2, least-squares mean (standard error) AUC NRS-R0-72 was lower with liposome bupivacaine 266 mg (n = 92) than with placebo (n = 91; 419 [17] vs. 516 [17]; P < 0.0001). This outcome remained unchanged in a post hoc analysis without score imputation (221 [12] vs. 282 [12]; P = 0.0005). Least-squares mean AUC NRS-R with imputed scores was lower with liposome bupivacaine during each 24-h interval (0 to 24, 24 to 48, and 48 to 72 h) after surgery; AUC NRS-R without imputed scores was lower during the 0- to 24-h and 24- to 48-h intervals. The liposome bupivacaine group had lower mean total opioid use (76 vs. 103 mg morphine; P = 0.0016). Pain was sufficiently severe to require second-step rescue with opioids via intravenously administered patient-controlled analgesia in 92% of liposome bupivacaine patients and 81% of placebo patients. With patient-controlled analgesia and other forms of rescue analgesia, mean NRS scores with activity were moderate in both liposome bupivacaine and placebo groups throughout the part 2 study period. Incidence of adverse events was similar between the groups (part 1: 90 vs. 96%; part 2: 96 vs. 96%, respectively).ConclusionFNB with liposome bupivacaine (266 mg) resulted in modestly lower pain scores and reduced opioid requirements after surgery, with an adverse event profile similar to placebo

A Model for Emergency Service of VoIP Certification and Labeling

The diffusion of VoIP technology promises revolutionary changes to a century old model of voice telephony. Though these changes bring extraordinary opportunities, they also bring challenging policy implications for businesses and regulators. In this Article, the Authors examine the technical difficulties of providing the same quality and dependability of emergency services in VoIP based telephony as consumers have come to expect from PSTN-based telephone networks. Given the technical complexity and heterogeneity of VolP, the Authors propose industry self-regulation through an advanced certification framework as a more effective alternative to direct government regulation. After surveying a number of successful self-regulatory regimes, the Authors conclude that a multitier certification scheme will best meet regulator and consumer expectations of timely and highly intelligible emergency calls that provide the critical information necessary for effective emergency services

A distributional analysis and identification key for crayfishes (Decapoda: Cambaridae) of the Clinch and Powell river systems, Virginia

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