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Background Human Immunodeficiency Virus (HIV) is a global public health threat, and all frontline Health care workers (HCWs) are at a higher risk of exposure to body fluids from potential HIV patients and to sharp instruments. Though timely Post Exposure Prophylaxis (PEP) decreases the possibility of seroconversion to HIV after occupational exposure, most HCWs rarely adhere to the PEP protocol. This study aims to determine the predictors of adherence to PEP among frontline healthcare workers in the Ho Teaching Hospital, Ghana. Methods A facility-based cross-sectional study was conducted among 199 frontline HCWs. Data were collected using a pretested self-administered questionnaire and analyzed using STATA version 14 software. Binomial logistic regression was performed at the 0.05 level of significance and 95% confidence interval. Findings Overall, 17.9% of HCWs adhered to PEP. Frontline HCWs who perceived they had low and very low risk of occupational exposure to HIV transmission were 96% [AOR = 0.04 (95% C.I: 0.00, 0.39) P = 0.006] and 94% [AOR = 0.06 (95% C.I: 0.00, 0.62) P = 0.019] respectively less likely to adhere to PEP. HCWs who received training on PEP were 4 times more likely to adhere to PEP compared to those who had never received it [AOR = 4.24 (1.31, 13.19) P = 0.013]. Conclusion Adherence to PEP protocol among HCWs was low. Therefore, there is a need for interventions to increase the perception of risk of occupational exposure to HIV transmission and to intensify training on PEP among frontline HCWs in the Ho Teaching Hospital. This will go a long way to increase their adherence to PEP.

The European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017) is an international survey for men who have sex with men (MSM) designed to measure the level and distribution of four dimensions: (a) sexual health outcomes, (b) risk and precaution behaviors, (c) health promotion needs, and (d) coverage/uptake of interventions. The aim of the current work is to provide an overview of key demographics and findings for MSM in Greece covering the abovementioned dimensions of EMIS-2017, especially regarding HIV. Overall, 2909 men met the inclusion criteria for the analysis. The participants’ age ranged between 15 and 74 years old (median 35 years). According to the descriptive analysis, 14.4% of the participants reported moderate and 8.9% severe anxiety and depression. The self-reported HIV prevalence was 11%. A high number of participants had non-steady male partners (74%, n = 2153). The number of non-steady intercourse partners in the last 12 months was over two for about 61.5% (n = 1321) of the participants. A very small number of participants had ever tried to get pre-exposure prophylaxis (PrEP) (2.2%, n = 63), and 41.2% of the participants (n = 1199) were unaware of PrEP. About half of the participants (51.6%, n = 1501) did not know that vaccination against both hepatitis A and B viruses is recommended for MSM. The results of EMIS-2017 identify important needs and can help policy making and prevention planning.

Background Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition. Methods The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life. Discussion If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR’s effectiveness in PTSD symptom reduction. Trial registration ISRCTN registry ISRCTN55239132. Registered on 19 December 2017.

Introduction: Rabies is a viral zoonosis still posing a significant threat to public health worldwide, especially in developing countries. The disease can be controlled by animal vaccination and appropriate post-exposure prophylaxis in humans administered in the earliest possible time. Aim: To study and analyze animal-related injuries and post-exposure prophylaxis for rabies. Materials and methods: Between 2014 and 2018, a retrospective epidemiological study was conducted in Varna region, which in-cluded 1462 persons who suffered injuries from animals. The study was based on the official data in the annual analysis of the Regional Health Inspectorate (RHI) in Varna. The information was summarized, analyzed, and graphically illustrated. The results were statisti-cally analysed using SPSS v. 20 employing variational and comparative (χ2) analyses. The statistical significance level was set at p Results: Of 1462 registered post-injury care seekers, 642 (42.7%) had to be given post-exposure prophylaxis on an emergency basis. The latter were mainly city residents (91.8%). Immunization against rabies was given in the first two days after exposure in 477 (76.4%) subjects. The average number of doses per immunized person was 3.63. The injuries were mainly from stray dogs (58.14%), followed by domestic (37.41%) and wild (4.45%) animals. According to the anatomical site of injury, limb injuries predominated in 88.65% (lower limbs 45% and upper limbs 43.64%). Most of the injuries were light (71.54%), followed by moderate (18.91%) and severe injuries (9.61%). Conclusions: Rabies prevention can be much more facilitated by the combined efforts of doctors, veterinarians, animal welfare orga-nizations and, last but not least, responsible population behavior. Post-exposure prophylaxis is an integral part of successfully curbing rabies programs but effective disease control can be achieved only through health education and vaccination of animals.

International audience; This article proposes a discussion on the strengths, weaknesses, opportunities, and threats related to the deployment of QUIC end-to-end from a satellite-operator point-of-view. The deployment of QUIC is an opportunity for improving the quality of experience when exploiting satellite broadband accesses. Indeed, the fast establishment of secured connections reduces the transmission time of short files. Moreover, removing transport-layer performance-enhancing proxies reduces the cost of network infrastructures and improves the integration of satellite systems. However, the congestion and flow controls at end points are not always suitable for satellite communications due to the intrinsic high bandwidth-delay product. Further acceptance of QUIC in satellite systems would be guaranteed if its performance in specific use cases were increased. Based on an emulated platform and on open-source software, this paper proposes values of performance metrics as one piece of the puzzle. The final performance objective requires consensus among the different actors. The objective should at least provide acceptable performance for satellite operators to allow QUIC traffic but reasonable enough to keep QUIC deployable on the Internet.

International audience; Several end-to-end encryption technologies for emails such as PGP and S/MIME exist since decades. However, end-to-end encryption is barely applied. To understand why users hesitate to secure their email communication and which usability issues they face with PGP, S/MIME as well as with pEp (Pretty Easy Privacy), a fairly new technology, we conducted an online survey and user testing. We found that more than 60% of e-mail users are unaware of the existence of such encryption technologies and never tried to use one. We observed that above all, users are overwhelmed with the management of public keys and struggle with the setup of encryption technology in their mail software. Even though users struggle to put email encryption into practice, we experienced roughly the same number of users being aware of the importance of email encryption. Particularly, we found that users are very concerned about identity theft, as 78% want to make sure that no other person is able to write email in their name.

Introduction: Risk of post-ERC pancreatitis (PEP) in patients with primary sclerosing cholangitis (PSC) is 1-7.8%. PSC is often associated with inflammatory bowel disease and autoimmune hepatitis, which are usually treated with thiopurines. The role of thiopurines in PEP risk is still unclear. Aims and methods: We evaluated the thiopurine use in PEP. The data of 354 PSC patients who underwent 985 ERCs between 2009 and 2018 were collected. 177 patients treated with thiopurines (study group, SG) and 177 controls (CG) were matched with a propensity score (PSM). Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated. Multivariable logistic regression analysis and generalized linear mixed model were performed. The P-value < 0.05 was significant. Results: In matched data, 472 ERCs were performed in SG and 513 in CG. Thiopurines were used in 373/472 (79.0%) ERCs in SG. The PEP rate was 5.3% in SG and 5.7% in CG ( p = 0.889). Unintentional pancreatic duct cannulation (OR 1.28, 95%CI 1.07-1.51, p = 0.004), and periampullary diverticulum (OR 4.87, 95%CI 1.72-11.98, p = 0.001) increased the risk of PEP. Conclusion: Prior or present thiopurine use did not increase the risk of PEP. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Background: Human Immunodeficiency Virus (HIV) post exposure prophylaxis (PEP) consists of administering antiretroviral therapy within 72 hours of viral exposure and continued for four weeks. PEP has been shown to be an important means of preventing and decreasing the number of new HIV infections in the general population. The purpose of this study was to describe the profile of patients who consulted at the HIV/AIDS Care and Treatment Center of the Yaounde Central Hospital (YCH) for PEP following non-occupational exposure to HIV. To attain our objective, we carried out a 10-year retrospective review of patient records of all persons who consulted for accidental HIV exposure at the YCH, Cameroon. Methods: This study was an observational, retrospective analysis of hospital records of persons who consulted for PEP following accidental exposure to HIV in the outpatient HIV clinic at YCH between January 2007 and December 2016. Data extracted from patients’ records were: type of HIV exposure, sex, age, profession, level of education, HIV status of source and time to consultation. Descriptive and inferential statistics were analyzed using STATA IC 12.0. Results were presented as median and interquartile range for continuous variables. Categorical variables were expressed as frequencies and proportions. Results: There were 628 consultations for PEP of which 48% (299/628) were as a result of nonoccupational post exposure prophylaxis (nPEP). Of those who consulted for HIV PEP following nonoccupational exposure, 78% (234/299) were females; adolescents group (15-19 years) and young adults group (20 – 24yrs.) constituted 41% (125/299). Forty percent (1208/299) were secondary or high school students (level of education) and 88% (262/299) were non-healthcare workers. The median timeto- consultation for non-occupational PEP (nPEP) was 19 hours (IQR: 12.4-25.0) and HIV status of the source was unknown in 64% (191/299) of cases and positive for 8% (25/299) of cases. The most frequent indications for consulting were sexual assault, 75% (224/299); condom slippage or breakage, 10% (30/299); and unprotected consensual sexual intercourse, 15% (45/299). Conclusion and Global Health Implications: Consultations for nPEP are as frequent as those occupational PEP (48% vs 52% in this study) in clinical practice at YCH. A good history of the source is important as it prevents unnecessary prescriptions of ART (which themselves have potential side effects) for persons consulting for potential HIV non-occupational exposure. In our study, we found that 27% (82/299) unnecessary ART prescriptions were avoided by determining that the exposure source person had negative HIV status. In addition, adolescent or young females consulting for nPEP in clinics could be potential victims of sexual assault or gender-based violence. Where possible, we recommend that clinicians consider the source of suspected viral exposure in clinical practice prior to administering ART for PEP. Key words: • Human Immunodeficiency Virus • Yaounde Central Hospital (Hôpital Central Yaoundé) • Post-exposure Prophylaxis • Cameroon • Sexual exposure • Non-occupational Post Exposure Prophylaxis • HIV • PEP • nPEP • AIDS Copyright © 2019 Kouanfack et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Stephen Milan, Praveen Bondalapati, Michael Megally, Eshan Patel, Pramil Vaghasia, Liam Gross, Elizabeth M Bachman, Puja Chadha, Jeremy A Weingarten Weill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USACorrespondence: Jeremy A WeingartenWeill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USATel +1 718 780 5835Fax +1 718 780 5836Email jaw9031@nyp.orgIntroduction: Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD.Methods: Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS.Results: In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0–4.3) days in the OPEP group and 4.8 (95% CI 3.9–6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had a median hospital LOS of 4.2 days (95% CI 3.8–5.1) versus 5.2 days (95% CI 4.4–6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (p=0.04).Conclusion: Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings.Clinical trial registration number: NCT03094806.Keywords: length of stay, acute exacerbation of COPD, PEP, hospitalization

Background After an animal-associated injury (AAI) in rabies-endemic regions, post-exposure prophylaxis (PEP) is needed to prevent infection.1,2 PEP consists of rabies vaccinations (RV) and in some cases also additional rabies immune globulins (RIG). Not always PEP medication, and RIG in particular, is accessible. Along with an increased number of exposure notifications among Dutch travellers, this might lead to treatment delay and thus to increased health risks. Until now, research mainly focused on factors associated with exposition, but none on which factors are associated with PEP delay. This study aimed to identify which general sample characteristics are associated with PEP delay while being abroad. Methods A quantitative retrospective observational study was conducted. The study population consisted of insured Dutch international travellers who actively contacted their medical assistance company (2015–2019) because of an animal-associated injury (AAI) (N = 691). The association between general sample characteristics and delay of different PEP treatments was studied using survival analysis. Results Travellers without pre-exposure prophylaxis (PrEP) had an increased hazard, and therefore a shorter delay, for receiving their first RV as compared to travellers with PrEP (HR:1.11, 95%CI:1.01–1.22). The travellers needing both RV and RIG had a decreased hazard, and therefore a longer delay, as compared to travellers only needing RV (HR:0.81, 95%CI:0.67–0.96). General sample characteristic associated with RIG administration delay was travel destination. Travellers to Central and South America, East Mediterranean and Europe had a decreased hazard, and therefore a longer delay, for receiving RIG treatments relative to travellers to South East Asia (HR:0.31, 95%CI:0.13–0.70; HR:0.34, 95%CI:0.19–0.61; HR:0.46, 95%CI:0.24–0.89; HR:0.48, 95%CI:0.12–0.81, respectively). Conclusions Our results suggest that the advice for PrEP should be given based on travel destination, as this was found to be the main factor for PEP delay, among travellers going to rabies-endemic countries.

Bipolar disorder (BD) in adolescents is associated with risky behaviors, including high risk for sexually transmitted infections. When exposed, post exposure prophylaxis (PEP) is recommended within 72 hours for a period of 28 days. The medications used for PEP are known to have common neuropsychiatric side effects, renal toxicity and risk of hepatic injury. The concomitant use of PEP and bipolar medications may have serious additive adverse effects which needs careful assessment and monitoring. PEP medications, in particular raltegravir, are known to have a common side effect of insomnia. The medication options may be more limited during this period and since insomnia is also known to precipitate mania it needs to be addressed. The knowledge of these side effects of PEP medications, understanding its interactions with mood stabilizers like lithium and valproic acid is important when caring for these individuals. The medication options of monotherapy or combination regimen for BD must be discussed with the patient and informed choices would yield better clinical outcomes. Although there is no established standard, but weekly monitoring of complete blood counts and liver functions until PEP is completed would be highly recommended to prevent serious negative events.

Introduction: Preventing human immunodeficiency virus (HIV) infection is central to containing the HIV pandemic. For pre- and post-exposure prophylaxis (PrEP and PEP), drugs approved in Germany are available. Basic information on this should be obtained from physicians in further training to become specialists in General Practice (GP) since they may have to deal with this topic of high relevance for the health of patients at risk and also the physicians' health after a possible exposure in the professional context. Methodology: A multiple-choice questionnaire was handed out to doctors in further training in General Practice on seminar days of the Competence Centre for General Practice Saxony-Anhalt for an immediate answer. Results: Of the 109 doctors, 73 completed the questionnaire. A general high relevance of the topic HIV was stated by 95%. In contrast, 71% said it was relevant for family doctor activities. The knowledge questions on the prevalence were answered correctly for all questions with less than 40%; 21% stated that they knew the indication prerequisite for a PEP; 49% answered the question about the period of the highest efficacy of PEP correctly. PrEP as a drug option for prophylaxis is known to a part of the respondents, 79% would prescribe PrEP, 69% were in favour of a health insurance benefit. Discussion: The results show that the necessary basic knowledge about HIV is partly available. Basic knowledge on structured action in the fields of HIV testing, PEP and PrEP should be taught in a manner appropriate to the relevance of the topic in the context of the German general practice setting. Even a basic knowledge about PEP may help to ensure that the general practice teams receive proper measures after a possible exposition.

The QUIC (Quick UDP Internet Connection) protocol suite is going to approach its final stages of standardization to become part of the official Internet standards (RFCs) and of the new HTTP/3 specification. Some of its disruptive characteristics, such as the 0-RTT establishment of secure communications and a connection-oriented management over a UDP-based connection-less transport, can be reused and tailored in the framework of a Performance Enhancing Proxy (PEP) architecture for the effective management of multiple links. In this paper, we describe the design and implementation of a QUIC-based splitting solution to enhance the communication across multiple backhaul links, each associated with a different network technology (e.g., satellite and terrestrial). After discussing the working principles of the designed QUIC-based proxy, we present a software implementation, as well as preliminary results obtained, through a set of meaningful test-cases deployed over a Linux based testbed.

Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

BACKGROUND: Positive expiratory pressure (PEP) devices are widely used in clinical settings, yet the performance characteristics of these devices remain relatively unknown. This study compared the performance characteristics of 6 airway clearance devices by varying resistance and flow. METHODS: Mean PEP, peak PEP, oscillation frequency, and amplitude PEP of the Flutter, Pari PEP S, Acapella Choice, Acapella DM, Acapella DH, and Aerobika devices were obtained across flows of 5, 10, 15, 20, 25 and 30 L/min and at low, medium, and high resistance using an experimental apparatus custom-built for this bench study. RESULTS: Performance characteristics of the devices differed across flows and resistance settings (device × flow/resistance interaction; P < .001). At a fixed resistance, increasing flows increased mean PEP produced by the Acapella Choice, Acapella DH, Aerobika, and Pari PEP S. Increasing flow resulted in minimal change in mean PEP produced by the Flutter and Acapella DM. Increasing flow increased peak PEP and amplitude PEP produced by all devices except the Acapella DH and Acapella Choice. Increasing flow maintained or increased oscillation frequency for all devices except the Flutter. At a fixed flow, increasing resistance increased mean PEP produced by all devices except the Acapella Choice. Increasing resistance increased peak PEP produced by the Acapella DM, Aerobika, and Pari PEP S but resulted in minimal change in peak PEP for the Flutter and Acapella Choice. Increasing resistance either maintained or increased oscillation frequency for all devices. Amplitude PEP was either maintained or increased during oscillations when increasing resistance for all devices except the Flutter. CONCLUSIONS: PEP devices produced small but statistically significant variations in performance characteristics across a range of flows and resistance settings. There appear to be flow-dependent and non–flow-dependent devices. Varying flow or resistance typically maintained or increased the production of mean, peak, and amplitude PEP and oscillation frequency.

Physiotherapy plays a very important role in cystic fibrosis. Its basic aim is to regularly clear bronchial passages of mucus which is responsible for exacerbation of bronchoalveolar symptoms. Positive Expiratory Pressure (PEP) and Oscillating Positive Expiratory Pressure (OPEP) are among the most commonly used bronchi clearance methods. It is not entirely clear which technique should be applied in what situations and whether these techniques are similar to other drainage techniques in terms of effectiveness. The aim of this study is to review the literature and analyse the effectiveness of both techniques, to summarise the existing evidence and to point to gaps in the knowledge about this issue.

Background: Mitochondrial genome has been used across multiple fields in research, diagnosis, and toxicogenomics. Several compounds damage mitochondrial DNA (mtDNA), including biological and therapeutic agents like the human immunodeficiency virus (HIV) but also its antiretroviral treatment, leading to adverse clinical manifestations. HIV-infected and treated patients may show impaired mitochondrial and metabolic profile, but specific contribution of viral or treatment toxicity remains elusive. The evaluation of HIV consequences without treatment interference has been performed in naïve (non-treated) patients, but assessment of treatment toxicity without viral interference is usually restricted to in vitro assays.Objective: The objective of the present study is to determine whether antiretroviral treatment without HIV interference can lead to mtDNA disturbances. We studied clinical, mitochondrial, and metabolic toxicity in non-infected healthy patients who received HIV post-exposure prophylaxis (PEP) to prevent further infection. We assessed two different PEP regimens according to their composition to ascertain if they were the cause of tolerability issues and derived toxicity.Methods: We analyzed reasons for PEP discontinuation and main secondary effects of treatment withdrawal, mtDNA content from peripheral blood mononuclear cells and metabolic profile, before and after 28 days of PEP, in 23 patients classified depending on PEP composition: one protease inhibitor (PI) plus Zidovudine/Lamivudine (PI plus AZT + 3TC; n = 9) or PI plus Tenofovir/Emtricitabine (PI plus TDF + FTC; n = 14).Results: Zidovudine-containing-regimens showed an increased risk for drug discontinuation (RR = 9.33; 95% CI = 1.34–65.23) due to adverse effects of medication related to gastrointestinal complications. In the absence of metabolic disturbances, 4-week PEP containing PI plus AZT + 3TC led to higher mitochondrial toxicity (−17.9 ± 25.8 decrease in mtDNA/nDNA levels) than PI plus TDF + FTC (which increased by 43.2 ± 24.3 units mtDNA/nDNA; p < 0.05 between groups). MtDNA changes showed a significant and negative correlation with baseline alanine transaminase levels (p < 0.05), suggesting that a proper hepatic function may protect from antiretroviral toxicity.Conclusions: In absence of HIV infection, preventive short antiretroviral treatment can cause secondary effects responsible for treatment discontinuation and subclinical mitochondrial damage, especially pyrimidine analogs such as AZT, which still rank as the alternative option and first choice in certain cohorts for PEP. Forthcoming efforts should be focused on launching new strategies with safer clinical and mitotoxic profile.

This article proposes a discussion on the strengths, weaknesses, opportunities and threats related to the deployment of QUIC end-to-end from a satellite-operator point-of-view. The deployment of QUIC is an opportunity for improving the quality of experience when exploiting satellite broadband accesses. Indeed, the fast establishment of secured connections reduces the short files transmission time. Moreover, removing transport layer performance enhancing proxies reduces the cost of network infrastructures and improves the integration of satellite systems. However, the congestion and flow controls at end points are not always suitable for satellite communications due to the intrinsic high bandwidth-delay product., Further acceptance of QUIC in satellite systems would be guaranteed if its performance in specific use-cases is increased. We propose a running code for an IETF document, and based on an emulated platform and on open-source software, this paper proposes values of performance metrics just as one piece of the puzzle. The final performance objective requires consensus among the different actors. The objective should be challenging enough for satellite operators to allow QUIC traffic but reasonable enough to keep QUIC Internet.

Abnormal colonic motility may be associated with dysfunction of the autonomic nervous system (ANS). Our aim was to evaluate if associations between colonic motor patterns and autonomic neural activity could be demonstrated by assessing changes in heart rate variability (HRV) in healthy volunteers. A total of 145 colonic motor patterns were assessed in 11 healthy volunteers by High-Resolution Colonic Manometry (HRCM) using an 84-channel water-perfused catheter. Motor patterns were evoked by balloon distention, a meal and luminal bisacodyl. The electrocardiogram (ECG) and cardiac impedance were assessed during colonic manometry. Respiratory sinus arrhythmia (RSA) and root mean square of successive differences of beat-to-beat intervals (RMSSD) served as measures of parasympathetic reactivity while the Baevsky's Stress Index (SI) and the pre-ejection period (PEP) were used as measures of sympathetic reactivity. Taking all motor patterns into account, our data show that colonic motor patterns are accompanied by increased parasympathetic activity and decreased sympathetic activity that may occur without eliciting a significant change in heart rate. Motor Complexes (more than one motor pattern occurring in close proximity), High-Amplitude Propagating Pressure Waves followed by Simultaneous Pressure Waves (HAPW-SPWs) and HAPWs without SPWs are all associated with an increase in RSA and a decrease in SI. Hence RSA and SI may best reflect autonomic activity in the colon during these motor patterns as compared to RMSSD and PEP. SI and PEP do not measure identical sympathetic reactivity. The SPW, which is a very low amplitude pressure wave, did not significantly change the autonomic measures employed here. In conclusion, colonic motor patterns are associated with activity in the ANS which is reflected in autonomic measures of heart rate variability. These autonomic measures may serve as proxies for autonomic neural dysfunction in patients with colonic dysmotility.

Background and Aims: The before-procedure or after-procedure rectal indomethacin administration was shown to be useful in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. We designed this prospective randomized study to compare the efficacy of single-dose and double-dose rectal indomethacin administration in preventing post-ERCP pancreatitis (PEP). Methods: We enrolled patients who underwent the ERCP in Taipei Mackay Memorial Hospital from 2016 June to 2017 November. Patients were randomly assigned to 2 groups: single and double-dose groups. The primary endpoint was the frequency of post-ERCP pancreatitis. Results: A total 162 patients participated in this study, and there were 87 patients randomly assigned to the single-dose group, and 75 patients were assigned to the double-dose group. In the high-risk patients, the incidence of PEP was lower in double-dose patients (4.8%) than the single-dose patients (9.5%), but there was no significant difference (P =.24). Difficult cannulation was the only 1 risk factor for PEP after rectal indomethacin treatment. Conclusions: Single-dose rectal indomethacin administration immediately after ERCP in general population is good enough to prevent PEP, but difficult cannulation could induce the PEP frequency up to 15.4% even under rectal indomethacin use.

Cell culture rabies vaccines were initially licensed in the 1980s and are essential in the prevention of human rabies. The first post-exposure prophylaxis (PEP) vaccination regimen recommended by the World Health Organization (WHO) was administered intramuscularly over a lengthy three-month period. In efforts to reduce the cost of PEP without impinging on safety, additional research on two strategies was encouraged by the WHO including the development of less expensive production methods for CCVs and the administration of reduced volumes of CCVs via the intradermal (ID) route. Numerous clinical trials have provided sufficient data to support a reduction in the number of doses, a shorter timeline required for PEP, and the approval of the intradermal route of administration for PEP and pre-exposure prophylaxis (PreP). However, the plethora of data that have been published since the development of CCVs can be overwhelming for public health officials wishing to review and make a decision as to the most appropriate PEP and PreP regimen for their region. In this review, we examine three critical benchmarks that can serve as guidance for health officials when reviewing data to implement new PEP and PreP regimens for their region including: evidence of immunogenicity after vaccination; proof of efficacy against development of disease; and confirmation that the regimen being considered elicits a rapid anamnestic response after booster vaccination.

Background Globally, the number of HIV cases continue to increase, despite the development of multiple prevention strategies. New cases of HIV have been reported disproportionately more in men who have sex with men and other vulnerable populations. Issues such as internalized and structural homophobia prevent these men from accessing prevention strategies such as postexposure prophylaxis (PEP). Mobile health (mHealth) interventions are known to be one of the newest and preferred options to enhance PEP knowledge and access. Objective The aim of this study was to identify and analyze the mobile apps addressing PEP for HIV infections. Methods We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis, and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines adapted for an integrative review in the databases of PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure, and CINAHL. The patent analysis was performed by exploring the databases of the Brazilian National Institute of Industrial Property, the United States Patent and Trademark Office, and the European Patent Office. For the systematic search, we analyzed mHealth apps related to HIV in 2 major app libraries, that is, Google Play Store and App Store. The apps were evaluated by name, characteristics, functions, and availability in iPhone operating system/Android phones. Results We analyzed 22 studies, of which 2 were selected for the final stage. Both studies present the use of apps as mHealth strategies aimed at improving the sexual health of men who have sex with men, and they were classified as decision support systems. The search in the patent databases showed only 1 result, which was not related to the topic since it was a drug intervention. In the app libraries, 25 apps were found and analyzed, with 15 (60%) apps available for Android systems but only 3 (12%) addressing PEP. In general, the apps inform about HIV and HIV prevention and treatment, with the focus users being health care providers, people with HIV, or the general population, but they have only limited features available, that is, mainly text, images, and videos. The 3 apps exclusively focusing on PEP were created by researchers from Brazilian universities. Conclusions Our review found no connection between the scientific studies, registered patents, and the available apps related to PEP; this finding indicates that these available apps do not have a theoretical or a methodological background in their creation. Thus, since the scientific knowledge on HIV is not translated into technological products, preventing the emergence of new infections, especially in the more vulnerable groups, is difficult. In the future, researchers and the community must work in synergy to create more mHealth tools aimed at PEP.

We present the design and implementation aspects of a virtualized Performance Enhancing Proxy (vPEP), in a 5G compliant architecture involving the satellite as an alternate, additional backhaul link. The deployment of hybrid terrestrial-satellite configurations is realized through the vPEP agent, meant as a chain of Virtual Network Functions (VNFs), enhancing protocol performance and/or bringing value-added services in the end-to-end path. To this end, we discuss a possible integration approach of the satellite link into the 5G service-based architecture, outlining key functional components. In addition, we present a preliminary evaluation study employing a vPEP embodying the QUIC protocol in a possible web-browsing, 5G optimized slice.

International audience; Postexposure prophylaxis (PEP) prevents human rabies and is accessible in Cambodia principally in Phnom Penh, the capital. Timely, affordable access to PEP is a challenge for the mainly rural population. We aimed to identify districts independently associated with PEP noncompletion to position frontline vaccination centers. We analyzed the 2009–2013 database at the Rabies Prevention Center at the Institut Pasteur du Cambodge, Phnom Penh. Logistic regressions identified nongeographic determinants of PEP noncompletion as well as the districts that were independently associated with noncompletion after adjustment for these determinants. The influence of distance by road was estimated using a boosted regression-trees model. We computed a population attributable fraction (rabies index (RI)) for each district and developed a map of this RI distribution. A cartographic analysis based on the statistic developed by Getis and Ord identified clusters of high-RI districts. Factors independently associated with noncompletion were pa-tients' district of residence, male sex, age 15–49 years, initial visit during rice harvest, the dog's status (culled or disappeared), and a prescribed PEP protocol requiring more than 3 PEP sessions (4 or 5). Four clusters of high-RI districts were identified using this analytical strategy, which is applicable to many vaccination or other health services. Positioning frontline PEP centers in these districts could significantly widen access to timely and adequate PEP.

To the Editor: Dog bites are a serious public health problem because of the associated risk for rabies virus exposure in countries to which the virus is endemic (1,2). Human rabies can be prevented by administration of postexposure prophylaxis (PEP). However, PEP rabies vaccine may be unavailable or prohibitively expensive (3). Delay in or failure to receive PEP after possible rabies virus exposure contributes to increased incidence of human rabies deaths (3). We performed a retrospective investigation of animal bites and postbite treatment in Laikipia North sub-county, Kenya, during January 2013–February 2014. Laikipia North is 1 of 3 sub-counties in Laikipia County and has a population of 32,726 (4). Our investigation was instigated by 3 suspected human rabies deaths that were informally reported to the Kenya Government Zoonotic Disease Unit (ZDU) during early 2014. We reviewed animal bite records from sub-county health facilities and veterinary offices and administered a structured household questionnaire to determine outcomes, knowledge of rabies, bite management, healthcare-seeking behavior, and economic costs. This public health response was government coordinated and approved; no personal identifiers were retained. During January 1, 2013–February 10, 2014, a total of 106 bites were recorded by 6 government-run health facilities in Laikipia North. Median reported bite incidence per month was 24 bites/100,000 persons (range 6–45 bites/100,000 persons). The median age of bite victims was 13 years (range 1–81 years); 61 (58%) bites occurred in males. Of all bites recorded, 94 (88%) were by dogs, 8 (8%) by scorpions, and 4 (4%) by humans. The deaths of 3 humans reported to the ZDU occurred in November and December 2013. To assess whether these cases were part of an exposure cluster, we followed up on bite cases during November 1–December 31, 2013. During this period, 17 additional animal bite cases were recorded. Of these 20 bite cases, we successfully traced the households of 11 (55%) case-patients, including 2 of the 3 who died from rabies. Bites were predominantly received from owned pets (82%), and most bites (82%) were reported to be unprovoked. All bites were inflicted on extremities, and almost all (91%) were single-bite injuries (Table). Table Responses to questionnaire interview of 11 animal bite victims assessed for rabies, Laikipia County, Kenya, 2014* Of 11 animals that bit case-patients, 7 had unknown histories of rabies vaccination and 4 were not vaccinated (Table). Four of the 11 animals were suspected to be rabid, including 1 cat and 3 dogs. All the suspected rabid animals were reported to exhibit aggressive or abnormal behavior, drooling or salivation, vocalization, and roaming tendencies (5; Technical Appendix Table 1). Three of the animals reportedly died; status was unknown for 1. Of the 11 traced bite case-patients, 9 washed their wound before going to a healthcare facility and 8 were prescribed PEP. The median time from bite to reporting to a health facility was 1 day (range 0–3 days). Four respondents delayed in starting PEP: 3 after 3 days, and 1 after 2 days. Reasons given for delay included the high cost of PEP by 3 (including 1 who died); a health facility being too far away by 1, who died; and vaccine unavailable at nearest health facility by 2, 1 of whom died. Of 8 respondents who received PEP, 7 traveled >10 km to reach the nearest health facility. PEP availability was inconsistent at the sub-county hospital and local dispensaries; 6 of 8 respondents seeking PEP visited multiple facilities to receive PEP, including a county referral facility that was >100 km away. The World Health Organization’s 5-dose PEP regimen is recommended in Kenya (1). However, only 3 case-patients were prescribed and received 5 doses. Five respondents were prescribed 3, 4, or 6 doses (Technical Appendix Table 2). This finding indicates large inconsistencies in the PEP prescribing practices in this region of Kenya, a pattern that is similar in other parts of East Africa (6). Respondents bore all medical costs without subsidy. Direct medical costs were ≈$2–$500 (US) per bite victim, and indirect medical costs were ≈$4–$100. The average cost of obtaining a single dose of PEP ranged from $8 to $120 (Table; Technical Appendix Table 2). All respondents had heard of rabies. Nine (82%) knew it was transmitted to humans through a bite from a rabid dog, and 4 (36%) knew that rabies among dogs could be prevented through vaccination. During 2014, at least 3 suspected human rabies deaths and 4 domestic animal deaths were associated with this cluster. Postbite care, including PEP, is a heavy economic burden on this community, moreso because rabies vaccine is not always locally accessible. Dog vaccination rates are low in this region and rabies in suspected animals is rarely definitively diagnosed, increasing risks for human rabies virus exposures and the economic burden of PEP administration. We recommend implementation of regular and comprehensive mass dog vaccination campaigns, in line with Kenya’s National Rabies Elimination Strategy (7), and further detailed studies on the epidemiology of rabies in this ecosystem, which supports human, wildlife, and domestic dog populations. Technical Appendix. Questionnaire for persons bitten by animals to assess rabies status of the animals and discussion of direct and indirect costs related to rabies post-exposure prophylaxis. Click here to view.(151K, pdf)

Carolyne Ajema,1 Charity Mbugua,2 Peter Memiah,3 Camille Wood,3 Courtney Cook,4 Ronald Kotut,2 Lina Digolo1 1Research and Strategic Information Department, LVCT Health, Nairobi, Kenya; 2Post Rape Care Department, LVCT Health, Nairobi, Kenya; 3Department of Public Health, University of West Florida, University Parkway, Pensacola, FL, USA; 4Biology Department, University of West Florida, University Parkway, Pensacola, FL, USA Purpose: Child sexual abuse and HIV are key health challenges in Kenya. In 2015, LVCT Health conducted a study aimed at assessing the quality of HIV-related services offered to child survivors of sexual violence in public health facilities.Materials and methods: A qualitative data collection approach was utilized. Qualitative data were collected through in-depth interviews with 31 providers. Quantitative methods included a retrospective review of 164 records of child survivors of rape who had accessed services 6 months prior to the commencement of the study. SPSS Version 22 was used in the descriptive analysis of the medical records. Client exit interviews and observation data were analyzed using MS Excel. In-depth interviews were analyzed using a thematic analytical approach.Results: Twenty-seven percent (n=164) survivors were documented to have received the first dose of postexposure prophylaxis (PEP). Providers did not conduct HIV pre- and posttest counseling for the survivors. There were no longitudinal follow-up mechanisms to ensure child survivors initiated on PEP adhered to the treatment plan. Less than 30% of survivors returned to the facility for PEP adherence counseling and follow-up HIV testing. Twenty providers cited capacity gaps in undertaking HIV risk assessment for child survivors. Limited availability of PEP is a barrier to HIV prevention, as most departments only offer services between 8 am and 5 pm. HIV tests were only available on weekdays before 5 pm. PEP being out of stock remains a barrier to HIV prevention.Conclusion: Existing post-rape care services are not adequately structured to facilitate delivery of quality HIV-related services to child survivors. Health provider capacity in the management of children remains weak due to lack of skill-based training on the dynamics of responding to the needs of child survivors. There is a need for standard operating procedures and training modules on the prevention of HIV in the context of child sexual abuse. Keywords: child sexual abuse, post-rape care, sexual violence, HIV, PEP, children in Kenya

Background The purpose of this study was to describe what is known about HIV infection and other sexually transmitted diseases, infection transmission routes, care, and sources of information, from the viewpoint of men having sex with men. Methods National data (n = 2,072) was collected from June to August 2010 in Finland as part of a joint internet-based survey conducted in 38 countries (EMIS, European MSM Internet Sex Survey). Results The respondents’ age, place of residence, highest education and employment status were statistically significantly related to how often the respondent sought information on HIV, testing and treatments, and what they knew about infection transmission routes. The respondents’ information seeking behavior was not seen as active regarding HIV infection and other sexually transmitted diseases. Conclusions We should also consider the possibility of using internet-based interventions, especially in smaller and northern catchment areas, in order to improve the knowledge level of men having sex with men.

The non-invasively measured initial systolic time interval (ISTI) reflects a time difference between the electrical and pumping activity of the heart and depends on cardiac preload, afterload, autonomic nervous control and training level. However, the duration of the ISTI has not yet been compared to other time markers of the heart cycle. The present study gauges the duration of the ISTI by comparing the end point of this interval, the C-point, with heart cycle markers obtained by echocardiography. The heart rate of 16 healthy subjects was varied by means of an exercise stimulus. It was found that the C-point, and therefore the end point of ISTI, occurred around the moment of the maximum diameter of the aortic arch in all subjects and at all heart rates. However, while the time difference between the opening of the aortic valves and the maximum diameter of the aortic arch decreased significantly with decreasing RR-interval, the time difference with respect to the moment of the C-point remained constant within the subjects. This means that the shortening of the ISTI with increasing heart rate in response to an exercise stimulus was caused by a shortening of the pre-ejection period (PEP). It is concluded that the ISTI can be used as a non-invasive parameter indicating the time difference between the electrical and mechanical pumping activity of the heart, both inside and outside the clinic.

Non-occupational post-exposure prophylaxis (nPEP) use is an HIV prevention strategy that has been recommended by the CDC to prevent HIV infection after a high risk sexual exposure since 1997. In a behavioral intervention trial of 4,295 MSM we assessed perceptions and use of nPEP over 4 years in six cities across the United States. Overall, 1.9% of MSM reported use of nPEP prior to enrollment, and 6.3% at least once during the trial. Awareness of nPEP was reported by 47.5%, with higher awareness in two sites with funded nPEP programs. Three seroconversions occurred in the 384 visits where nPEP courses were reported, with no effect of nPEP on risk of HIV acquisition in this cohort (hazard ratio = 0.91, 95% confidence interval [0.29, 2.86]). NPEP users were a riskier group: increased odds of nPEP use were observed in association with multiple partners and unprotected receptive and insertive anal sex with HIV infected partners and partners with unknown HIV status. NPEP use was also associated with use of illicit drugs (injection drugs, crack cocaine, hallucinogens, and amphetamines). Importantly, willingness to use nPEP after high risk sex was associated with lower odds of high risk sex. After an episode of nPEP use, nPEP users remained more likely to report high risk sex than those in this cohort who had not previously used nPEP. However, within the subset of people who had previously reported high risk sex, previous nPEP use was not associated with higher odds of high risk sex, thus allaying fears that availability of nPEP would lead to an increase in high risk sex.

Post-exposure prophylaxis (PEP) has been proposed as a strategy to prevent the acquisition of HIV infection after certain high-risk exposures, and treatment as prevention (TasP) is also being advocated as a means to reduce sexual transmission of HIV. The aim of this study was to investigate the prevalence of PEP and TasP awareness and their demographic, behavioral, and social correlates in Italy. We conducted a cross-sectional survey of 1,028 high-risk heterosexual men and women, 1,874 non-HIV positive MSM (men who have sex with men), and 694 people living with HIV/AIDS (PLWHA). The majority of the participants was aware of PEP and unaware of TasP. MSM were less knowledgeable about PEP and TasP than were PLWHA and more knowledgeable about PEP and TasP than were high-risk heterosexual participants. The variables most consistently associated with PEP and TasP awareness were contact with HIV/AIDS organizations, HIV testing, and HIV stigma. A positive relationship between unprotected sexual intercourse and PEP and TasP awareness was found among high risk heterosexual participants, while this association was not significant among MSM and PLWHA. Because PEP and TasP are currently recommended, effective educational and dissemination strategies are needed to increase the level of knowledge about PEP and TasP.

HIV post-exposure prophylaxis (PEP) prescriptions are not uniformly monitored in the United States. We developed a method to identify PEP-related visits in New York City emergency departments (EDs). Using ED data, we observed a threefold increase in PEP-related visits to NYC EDs from 2002-2013. 73% of PEP-related visits were among males, and 45% among adults ages 25-34 years. Incorporation of this method of PEP monitoring in the NYC syndromic surveillance system will be used to observe trends and inform HIV outreach efforts.

In order to improve TCP performance, a method using a PEP (Perfonnance Enhancing Proxy) is proposed. The PEP operates on a router along a TCP connection. When a data packet arrives at the PEP, it forwards the packet to the destination host, transmits the corresponding ACK (premature ACK) to the source host in behalf of the destination host and stores the copy of the packet into its own buffer (PEP buffer) in case of the retransmission of the packet. In this paper, under the strategy which keeps the number of packets in the PEP buffer for which premature ACKs have been returned being less than or equal to a fixed threshold value (watermark value), we investigate the relation between the watermark value and the maximum throughput. Extensive simulation runs show that the simulation results are roughly classified into two cases. One case is that the maximum throughput becomes larger for larger watermark value and becomes a constant value when the watermark value is over a value. The other case is that though the maximum throughput becomes larger for lager watermark value in the same way, it reversely decreases when the watermark value is over a value. We also show that the latter (former) case is easier to occur as the propagation delay in the input side network ofthe PEP becomes smaller (larger) and the propagation delay in the output side network of the PEP becomes larger (smaller) and the PEP buffer capacity becomes smaller (larger).

Mobile user terminals allow to access different networks through several interfaces. Seamless communications is an essential requirement and service continuity is its main metric from user perspective. Mobile IPv6, ad-hoc routing, dynamic link layer protocol, SDN paradigm greatly facilitate mobility and network flexibility. Nonetheless, full mobility is limited by NAT routers or proxy agents, which break end-to-end semantic, as Performance Enhancing Proxies (PEPs), mandatory component over satellite networks to optimize performance. PEP spoofs TCP connections to end-users and hides connection context to the end-user control. Thus, any dynamic path change leads to the drop of the ongoing connections impairing service continuity. In this paper, we present an enhanced PEP implementation, Mobile-PEP, able to manage handovers without connection context transfer. Main operations and added value in several satellite-based operational scenarios are herein shown, leveraging on a Mobile-PEP prototype implementation.

Post-Exposure Prophylaxis (PEP) is a preventive strategy that aims to avert the transmission of HIV to an exposed individual following occupational and non-occupational exposure, e.g. sexual contact, injecting drug use (IDU), needle stick injuries. Timely access to PEP (Within 72 hours) is an integral component to treatment as prevention alongside early treatment to achieve a significant reduction in a new transmission of HIV. In Queensland, it is estimated that around 5000 people live with HIV. The year 2014 saw an increase of 35% newly diagnosed cases of HIV as compared to the year 2013, thus the need to impede the spread of this pandemic is crucial. This project aims to improve the out of hour access to PEP in Queensland through Emergency Departments(ED). A mapping activity of access to PEP across Queensland was carried out by the project team through: • Consultation with the Queensland Department of Health, Communicable Diseases Branch (CDB) • A Community Survey to scope the experiences of people accessing PEP. • Consultation with Community organisations, Public/Private hospitals, HIV Public Health Team, Sexual Health Clinics to scope issues received regarding access to PEP. • Enquiry to all HHS Emergency Departments, Directors of Emergency Medicine and Nurse Unit Managers prescribing PEP to obtain local PEP protocol implementation. A PEP working group was formed that comprised of state-wide representatives from HIVFQ, sexual health clinics, hospital emergency dept., community groups and the Communicable Disease Branch of Queensland Department of Health. Some of the key points identified by the working group were: • Demand for PEP is steadily increasing each year. • People have positive experiences accessing PEP at sexual health clinics, however, some negative experiences were reported by those accessing PEP out of hours at Hospital Emergency Departments (EDs). • Some hospital EDs were less knowledgeable about PEP and were unable to locate the clinical guidelines in a timely manner. • Wait times in EDs averaged 4 hours, which was an added stressor for people waiting for PEP. • Some people experienced stigma, discrimination and judgements when trying to access PEP at EDs. The working group met to review the current PEP landscape and developed the following interventions to improve access to PEP: • Development of a user-friendly PEP Folder for Emergency and Pharmacy Departments including algorithms and flowcharts. This will be rolled out with nursing and pharmacy champions around Queensland, who are best placed to raise awareness of PEP (and PrEP3). • Coordination of resources available to the community including updating the clinic search tool on the ENDHIV website and PEP Emergency Card. • Production of PEP education/training videos for hospital staff to be incorporated into all Queensland hospital pre-vocational trainings and other clinical inductions • Endorsement of the resources from the Queensland Emergency Department State Advisory Panel. We hope these interventions will not only help reduce new transmission of HIV, but also educate clinicians and community on testing, treatment and stigma associated with HIV, thus working towards an HIV-free generation

DVB-RCS2 is the second generation of DVB standards for the return link in interactive satellite systems, which is combined with the well consolidated DVB-S2 standard, applicable to forward links. This paper presents a DVB-S2/RCS2 testbed, able to reproduce all functionalities specified for higher and lower layers (HL and LL) of the protocol stack, down to the physical layer characteristics, which are instead accounted by means of a channel emulator for both return and forward links. The presented testbed turns out to be a formidable tool for research investigation and overall system design thanks to the implemented features and the flexible architecture, allowing easy reconfiguration and extensions of functionalities according to specific purposes. Some merit figures shown at the end of the paper also prove the possibility to plug the testbed to external systems and carry out performance monitoring/tracking tasks through regular Simple Network Management Protocol (SNMP) agents.

This paper focuses on geostationary satellite scenarios and investigates the performance of several Transmission Control Protocol (TCP) variants in a novel Performance Enhancing Proxy (PEP) architecture solution, whose added value is the use of network coding beneath the transport layer. Comparison of TCP New-Reno, Vegas, Scalable, CUBIC, Hybla, and HTCP and the cases where these transport protocols are used along with network coding is carried out by means of simulation campaigns. The obtained results show the potentials of the proposed network coding technique, resulting in the improvement of TCP connections performance in a wide range of channel conditions and the possible exploitation of future increase of the satellite link capacity.