Figure 1.17. Gerber test42
The above test has the disadvantage that it cannot be performed when the patient has limited internal rotation of the arm due to pain and is only positive when at least 75% of the tendon is damaged, so it is not an accurate test when there is damage to the upper part of the subscapularis tendon.
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![Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output ports bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the routers service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a routers per-hop behavior is based only on the packets marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being frozen, or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the routers buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connections shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Qos Assurance Methods for Multimedia Communications
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low. The EF PHB requires a sufficiently large number of output ports to provide low delay, low loss, and low jitter.
EF PHBs can be implemented if the output port's bandwidth is sufficiently large, combined with small buffer sizes and other network resources dedicated to EF packets, to allow the router's service rate for EF packets on an output port to exceed the arrival rate λ of packets at that port.
This means that packets with PHB EF are considered with a pre-allocated amount of output bandwidth and a priority that ensures minimum loss, minimum delay and minimum jitter before being put into operation.
PHB EF is suitable for channel simulation, leased line simulation, and real-time services such as voice, video without compromising on high loss, delay and jitter values.
Figure 2.10 Example of EF installation
Figure 2.10 shows an example of an EF PHB implementation. This is a simple priority queue scheduling technique. At the edges of the DS domain, EF packet traffic is prioritized according to the values agreed upon by the SLA. The EF queue in the figure needs to output packets at a rate higher than the packet arrival rate λ. To provide an EF PHB over an end-to-end DS domain, bandwidth at the output ports of the core routers needs to be allocated in advance to ensure the requirement μ > λ. This can be done by a pre-configured provisioning process. In the figure, EF packets are placed in the priority queue (the upper queue). With such a length, the queue can operate with μ > λ.
Since EF was primarily used for real-time services such as voice and video, and since real-time services use UDP instead of TCP, RED is generally
not suitable for EF queues because applications using UDP will not respond to random packet drop and RED will strip unnecessary packets.
2.2.4.2 Assured Forwarding (AF) PHB
PHB AF is defined by RFC 2597. The purpose of PHB AF is to deliver packets reliably and therefore delay and jitter are considered less important than packet loss. PHB AF is suitable for non-real-time services such as applications using TCP. PHB AF first defines four classes: AF1, AF2, AF3, AF4. For each of these AF classes, packets are then classified into three subclasses with three distinct priority levels.
Table 2.8 shows the four AF classes and 12 AF subclasses and the DSCP values for the 12 AF subclasses defined by RFC 2597. RFC 2597 also allows for more than three separate priority levels to be added for internal use. However, these separate priority levels will only have internal significance.
PHB Class
PHB Subclass
Package type
DSCP
AF4
AF41
Short
100010
AF42
Medium
100100
AF43
High
100110
AF3
AF31
Short
011010
AF32
Medium
011100
AF33
High
011110
AF2
AF21
Short
010010
AF22
Medium
010100
AF23
High
010110
AF1
AF11
Short
001010
AF12
Medium
001100
AF13
High
001110
Table 2.8 AF DSCPs
The AF PHB ensures that packets are forwarded with a high probability of delivery to the destination within the bounds of the rate agreed upon in an SLA. If AF traffic at an ingress port exceeds the pre-priority rate, which is considered non-compliant or “out of profile”, the excess packets will not be delivered to the destination with the same probability as the packets belonging to the defined traffic or “in profile” packets. When there is network congestion, the out of profile packets are dropped before the in profile packets are dropped.
When service levels are defined using AF classes, different quantity and quality between AF classes can be realized by allocating different amounts of bandwidth and buffer space to the four AF classes. Unlike
EF, most AF traffic is non-real-time traffic using TCP, and the RED queue management strategy is an AQM (Adaptive Queue Management) strategy suitable for use in AF PHBs. The four AF PHB layers can be implemented as four separate queues. The output port bandwidth is divided into four AF queues. For each AF queue, packets are marked with three “colors” corresponding to three separate priority levels.
In addition to the 32 DSCP 1 groups defined in Table 2.8, 21 DSCPs have been standardized as follows: one for PHB EF, 12 for PHB AF, and 8 for CSCP. There are 11 DSCP 1 groups still available for other standards.
2.2.5.Example of Differentiated Services
We will look at an example of the Differentiated Service model and mechanism of operation. The architecture of Differentiated Service consists of two basic sets of functions:
Edge functions: include packet classification and traffic conditioning. At the inbound edge of the network, incoming packets are marked. In particular, the DS field in the packet header is set to a certain value. For example, in Figure 2.12, packets sent from H1 to H3 are marked at R1, while packets from H2 to H4 are marked at R2. The labels on the received packets identify the service class to which they belong. Different traffic classes receive different services in the core network. The RFC definition uses the term behavior aggregate rather than the term traffic class. After being marked, a packet can be forwarded immediately into the network, delayed for a period of time before being forwarded, or dropped. We will see that there are many factors that affect how a packet is marked, and whether it is forwarded immediately, delayed, or dropped.
Figure 2.12 DiffServ Example
Core functionality: When a DS-marked packet arrives at a Diffservcapable router, the packet is forwarded to the next router based on
Per-hop behavior is associated with packet classes. Per-hop behavior affects router buffers and the bandwidth shared between competing classes. An important principle of the Differentiated Service architecture is that a router's per-hop behavior is based only on the packet's marking or the class to which it belongs. Therefore, if packets sent from H1 to H3 as shown in the figure receive the same marking as packets from H2 to H4, then the network routers treat the packets exactly the same, regardless of whether the packet originated from H1 or H2. For example, R3 does not distinguish between packets from h1 and H2 when forwarding packets to R4. Therefore, the Differentiated Service architecture avoids the need to maintain router state about separate source-destination pairs, which is important for network scalability.
Chapter Conclusion
Chapter 2 has presented and clarified two main models of deploying and installing quality of service in IP networks. While the traditional best-effort model has many disadvantages, later models such as IntServ and DiffServ have partly solved the problems that best-effort could not solve. IntServ follows the direction of ensuring quality of service for each separate flow, it is built similar to the circuit switching model with the use of the RSVP resource reservation protocol. IntSer is suitable for services that require fixed bandwidth that is not shared such as VoIP services, multicast TV services. However, IntSer has disadvantages such as using a lot of network resources, low scalability and lack of flexibility. DiffServ was born with the idea of solving the disadvantages of the IntServ model.
DiffServ follows the direction of ensuring quality based on the principle of hop-by-hop behavior based on the priority of marked packets. The policy for different types of traffic is decided by the administrator and can be changed according to reality, so it is very flexible. DiffServ makes better use of network resources, avoiding idle bandwidth and processing capacity on routers. In addition, the DifServ model can be deployed on many independent domains, so the ability to expand the network becomes easy.
Chapter 3: METHODS TO ENSURE QoS FOR MULTIMEDIA COMMUNICATIONS
In packet-switched networks, different packet flows often have to share the transmission medium all the way to the destination station. To ensure the fair and efficient allocation of bandwidth to flows, appropriate serving mechanisms are required at network nodes, especially at gateways or routers, where many different data flows often pass through. The scheduler is responsible for serving packets of the selected flow and deciding which packet will be served next. Here, a flow is understood as a set of packets belonging to the same priority class, or originating from the same source, or having the same source and destination addresses, etc.
In normal state when there is no congestion, packets will be sent as soon as they are delivered. In case of congestion, if QoS assurance methods are not applied, prolonged congestion can cause packet drops, affecting service quality. In some cases, congestion is prolonged and widespread in the network, which can easily lead to the network being "frozen", or many packets being dropped, seriously affecting service quality.
Therefore, in this chapter, in sections 3.2 and 3.3, we introduce some typical network traffic load monitoring techniques to predict and prevent congestion before it occurs through the measure of dropping (removing) packets early when there are signs of impending congestion.
3.1. DropTail method
DropTail is a simple, traditional queue management method based on FIFO mechanism. All incoming packets are placed in the queue, when the queue is full, the later packets are dropped.
Due to its simplicity and ease of implementation, DropTail has been used for many years on Internet router systems. However, this algorithm has the following disadvantages:
− Cannot avoid the phenomenon of “Lock out”: Occurs when 1 or several traffic streams monopolize the queue, making packets of other connections unable to pass through the router. This phenomenon greatly affects reliable transmission protocols such as TCP. According to the anti-congestion algorithm, when locked out, the TCP connection stream will reduce the window size and reduce the packet transmission speed exponentially.
− Can cause Global Synchronization: This is the result of a severe “Lock out” phenomenon. Some neighboring routers have their queues monopolized by a number of connections, causing a series of other TCP connections to be unable to pass through and simultaneously reducing the transmission speed. After those monopolized connections are temporarily suspended,
Once the queue is cleared, it takes a considerable amount of time for TCP connections to return to their original speed.
− Full Queue phenomenon: Data transmitted on the Internet often has an explosion, packets arriving at the router are often in clusters rather than in turn. Therefore, the operating mechanism of DropTail makes the queue easily full for a long period of time, leading to the average delay time of large packets. To avoid this phenomenon, with DropTail, the only way is to increase the router's buffer, this method is very expensive and ineffective.
− No QoS guarantee: With the DropTail mechanism, there is no way to prioritize important packets to be transmitted through the router earlier when all are in the queue. Meanwhile, with multimedia communication, ensuring connection and stable speed is extremely important and the DropTail algorithm cannot satisfy.
The problem of choosing the buffer size of the routers in the network is to “absorb” short bursts of traffic without causing too much queuing delay. This is necessary in bursty data transmission. The queue size determines the size of the packet bursts (traffic spikes) that we want to be able to transmit without being dropped at the routers.
In IP-based application networks, packet dropping is an important mechanism for indirectly reporting congestion to end stations. A solution that prevents router queues from filling up while reducing the packet drop rate is called dynamic queue management.
3.2. Random elimination method – RED
3.2.1 Overview
RED (Random Early Detection of congestion; Random Early Drop) is one of the first AQM algorithms proposed in 1993 by Sally Floyd and Van Jacobson, two scientists at the Lawrence Berkeley Laboratory of the University of California, USA. Due to its outstanding advantages compared to previous queue management algorithms, RED has been widely installed and deployed on the Internet.
The most fundamental point of their work is that the most effective place to detect congestion and react to it is at the gateway or router.
Source entities (senders) can also do this by estimating end-to-end delay, throughput variability, or the rate of packet retransmissions due to drop. However, the sender and receiver view of a particular connection cannot tell which gateways on the network are congested, and cannot distinguish between propagation delay and queuing delay. Only the gateway has a true view of the state of the queue, the link share of the connections passing through it at any given time, and the quality of service requirements of the
traffic flows. The RED gateway monitors the average queue length, which detects early signs of impending congestion (average queue length exceeding a predetermined threshold) and reacts appropriately in one of two ways:
− Drop incoming packets with a certain probability, to indirectly inform the source of congestion, the source needs to reduce the transmission rate to keep the queue from filling up, maintaining the ability to absorb incoming traffic spikes.
− Mark “congestion” with a certain probability in the ECN field in the header of TCP packets to notify the source (the receiving entity will copy this bit into the acknowledgement packet).
Figure 3. 1 RED algorithm
The main goal of RED is to avoid congestion by keeping the average queue size within a sufficiently small and stable region, which also means keeping the queuing delay sufficiently small and stable. Achieving this goal also helps: avoid global synchronization, not resist bursty traffic flows (i.e. flows with low average throughput but high volatility), and maintain an upper bound on the average queue size even in the absence of cooperation from transport layer protocols.
To achieve the above goals, RED gateways must do the following:
− The first is to detect congestion early and react appropriately to keep the average queue size small enough to keep the network operating in the low latency, high throughput region, while still allowing the queue size to fluctuate within a certain range to absorb short-term fluctuations. As discussed above, the gateway is the most appropriate place to detect congestion and is also the most appropriate place to decide which specific connection to report congestion to.
− The second thing is to notify the source of congestion. This is done by marking and notifying the source to reduce traffic. Normally the RED gateway will randomly drop packets. However, if congestion
If congestion is detected before the queue is full, it should be combined with packet marking to signal congestion. The RED gateway has two options: drop or mark; where marking is done by marking the ECN field of the packet with a certain probability, to signal the source to reduce the traffic entering the network.
− An important goal that RED gateways need to achieve is to avoid global synchronization and not to resist traffic flows that have a sudden characteristic. Global synchronization occurs when all connections simultaneously reduce their transmission window size, leading to a severe drop in throughput at the same time. On the other hand, Drop Tail or Random Drop strategies are very sensitive to sudden flows; that is, the gateway queue will often overflow when packets from these flows arrive. To avoid these two phenomena, gateways can use special algorithms to detect congestion and decide which connections will be notified of congestion at the gateway. The RED gateway randomly selects incoming packets to mark; with this method, the probability of marking a packet from a particular connection is proportional to the connection's shared bandwidth at the gateway.
− Another goal is to control the average queue size even without cooperation from the source entities. This can be done by dropping packets when the average size exceeds an upper threshold (instead of marking it). This approach is necessary in cases where most connections have transmission times that are less than the round-trip time, or where the source entities are not able to reduce traffic in response to marking or dropping packets (such as UDP flows).
3.2.2 Algorithm
This section describes the algorithm for RED gateways. RED gateways calculate the average queue size using a low-pass filter. This average queue size is compared with two thresholds: minth and maxth. When the average queue size is less than the lower threshold, no incoming packets are marked or dropped; when the average queue size is greater than the upper threshold, all incoming packets are dropped. When the average queue size is between minth and maxth, each incoming packet is marked or dropped with a probability pa, where pa is a function of the average queue size avg; the probability of marking or dropping a packet for a particular connection is proportional to the bandwidth share of that connection at the gateway. The general algorithm for a RED gateway is described as follows: [5]
For each packet arrival
Caculate the average queue size avg If minth ≤ avg < maxth
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Identify Rating Levels and Rating Scales
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zt2a3gstourism,quan lan,quang ninh,ecology,ecotourism,minh chau,van don,geography,geographical basis,tourism development,science
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of the islanders. Therefore, this indicator will be divided into two sub-indicators:
a1. Natural tourism attractiveness a2. Cultural tourism attractiveness
b. Tourist capacity
The two island communes in Quan Lan have different capacities to receive tourists. Minh Chau Commune is home to many standard hotels and resorts, attracting high-income domestic and international tourists. Meanwhile, Quan Lan Commune has many motels mainly built and operated by local people, so the scale and quality are not high, and will be suitable for ordinary tourists such as students.
c. Time of exploitation of Quan Lan Island Commune:
Quan Lan tourism is seasonal due to weather and climate conditions and festivals only take place on certain days of the year, specifically in spring. In Quan Lan commune, the period from April to June and from September to November is considered the best time to visit Quan Lan because the cultural tourism activities are mainly associated with festivals taking place during this time.
Minh Chau island commune:
Tourism exploitation time is all year round, because this is a place with a number of tourist attractions with diverse ecosystems such as Bai Tu Long National Park Research Center, Tram forest, Turtle Laying Beach, so besides coming to the beach for tourism and vacation in the summer, Minh Chau will attract research groups to come for tourism combined with research at other times of the year.
d. Sustainability
The sustainability of ecotourism sites in Quan Lan and Minh Chau communes depends on the sensitivity of the ecosystems to climate changes.
landscape. In general, these tourist destinations have a fairly high level of sustainability, because they are natural ecosystems, planned and protected. However, if a large number of tourists gather at certain times, it can exceed the carrying capacity and affect the sustainability of the environment (polluted beaches, damaged trees, animals moving away from their habitats, etc.), then the sustainability of the above ecosystems (natural ecosystems, human ecosystems) will also be affected and become less sustainable.
e. Location and accessibility
Both island communes have ports to take tourists to visit from Van Don wharf:
- Quan Lan – Van Don traffic route:
Phuc Thinh – Viet Anh high-speed boat and Quang Minh high-speed boat, depart at 8am and 2pm from Van Don to Quan Lan, and at 7am and 1pm from Quan Lan to Van Don. There are also wooden boats departing at 7am and 1pm.
- Van Don - Minh Chau traffic route:
Chung Huong high-speed train, Minh Chau train, morning 7:30 and afternoon 13:30 from Van Don to Minh Chau, morning 6:30 and afternoon 13:00 from Minh Chau to Van Don.
f. Infrastructure
Despite receiving investment attention, the issue of infrastructure and technical facilities for tourism on Quan Lan Island is still an issue that needs to be resolved because it has a direct impact on the implementation of ecotourism activities. The minimum conditions for serving tourists such as accommodation, electricity, water, communication, especially medical services, and security work need to be given top priority. Ecotourism spots in Minh Chau commune are assessed to have better infrastructure and technical facilities for tourism because there are quite complete and synchronous conditions for serving tourists, meeting many needs of domestic and foreign tourists.
3.2.1.4. Determine assessment levels and assessment scales
Corresponding to the levels of each criterion, the index is the score of those levels in the order of 4, 3, 2, 1 decreasing according to the standard of each level: very attractive (4), attractive (3), average (2), less attractive (1).
3.2.1.5. Determining the coefficients of the criteria
For the assessment of DLST in the two communes of Quan Lan and Minh Chau islands, the students added evaluation coefficients to show the importance of the criteria and indicators as follows:
Coefficient 3 with criteria: Attractiveness, Exploitation time. These are the 2 most important criteria for attracting tourists to tourism in general and eco-tourism in particular, so they have the highest coefficient.
Coefficient 2 with criteria: Capacity, Infrastructure, Location and accessibility . Because the assessment area is an island commune of Van Don district, the above criteria are selected by the author with appropriate coefficients at the average level.
Coefficient 1 with criteria: Sustainability. Quan Lan has natural and human-made ecotourism sites, with high biodiversity and little impact from local human factors. Most of the ecotourism sites are still wild, so they are highly sustainable.
3.2.1.6. Results of DLST assessment on Quan Lan island
a. Assessment of the potential for natural tourism development
For Minh Chau commune:
+ Natural tourism attractiveness is determined to be very attractive (4 points) and the most important coefficient (coefficient 3), so the score of the Attractiveness criterion is 4 x 3 = 12.
+ Capacity is determined as average (2 points) and the coefficient is quite important (coefficient 2), then the score of Capacity criterion is 2 x 2 = 4.
+ Exploitation time is long (4 points), the most important coefficient (coefficient 3) so the score of the Exploitation time criterion is 4 x 3 = 12.
+ Sustainability is determined as sustainable (4 points), the important coefficient is the average coefficient (coefficient 1), so the score of the Sustainability criterion is 4 x 1 = 4 points
+ Location and accessibility are determined to be quite favorable (2 points), the coefficient is quite important (coefficient 2), the criterion score is 2 x 2 = 4 points.
+ Infrastructure is assessed as good (3 points), the coefficient is quite important (coefficient 2), then the score of the Infrastructure criterion is 3 x 2 = 6 points.
The total score for evaluating DLST in Minh Chau commune according to 6 evaluation criteria is determined as: 12 + 4 + 12 + 4 + 4 + 6 = 42 points
Similar assessment for Quan Lan commune, we have the following table:
Table 3.3: Assessment of the potential for natural ecotourism development in Quan Lan and Minh Chau communes
Attractiveness of self-tourismof course
Capacity
Mining time
Sustainability
Location and accessibility
Infrastructure
Result
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
CommuneMinh Chau
12
12
4
8
12
12
4
4
4
8
6
8
42/52
Quan CommuneLan
6
12
6
8
9
12
4
4
4
8
4
8
33/52
b. Assessment of the potential for humanistic tourism development
For Quan Lan commune:
+ The attractiveness of human tourism is determined to be very attractive (4 points) and the most important coefficient (coefficient 3), so the score of the Attractiveness criterion is 4 x 3 = 12.
+ Capacity is determined to be large (3 points) and the coefficient is quite important (coefficient 2), then the score of the Capacity criterion is 3 x 2 = 6.
+ Mining time is average (3 points), the most important coefficient (coefficient 3) so the score of the Mining time criterion is 3 x 3 = 9.
+ Sustainability is determined as sustainable (4 points), the important coefficient is the average coefficient (coefficient 1), so the score of the Sustainability criterion is 4 x 1 = 4 points.
+ Location and accessibility are determined to be quite favorable (2 points), the coefficient is quite important (coefficient 2), the criterion score is 2 x 2 = 4 points.
+ Infrastructure is rated as average (2 points), the coefficient is quite important (coefficient 2), then the score of the Infrastructure criterion is 2 x 2 = 4 points.
The total score for evaluating DLST in Quan Lan commune according to 6 evaluation criteria is determined as: 12 + 6 + 6 + 4 + 4 + 4 = 36 points.
Similar assessment with Minh Chau commune we have the following table:
Table 3.4: Assessment of the potential for developing humanistic eco-tourism in Quan Lan and Minh Chau communes
Attractiveness of human tourismliterature
Capacity
Mining time
Sustainability
Location and accessibility
Infrastructure
Result
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Point
DarkMulti
Quan CommuneLan
12
12
6
8
9
12
4
4
4
8
4
8
39/52
Minh CommuneChau
6
12
4
8
12
12
4
4
4
8
6
8
36/52
Basically, both Minh Chau and Quan Lan localities have quite favorable conditions for developing ecotourism. However, Quan Lan commune has more advantages to develop ecotourism in a humanistic direction, because this is an area with many famous historical relics such as Quan Lan Communal House, Quan Lan Pagoda, Temple worshiping the hero Tran Khanh Du, ... along with local festivals held annually such as the wind praying ceremony (March 15), Quan Lan festival (June 10-19); due to its location near the port and long exploitation time, the beaches in Quan Lan commune (especially Quan Lan beach) are no longer hygienic and clean to ensure the needs of tourists coming to relax and swim; this is also an area with many beautiful landscapes such as Got Beo wind pass, Ong Phong head, Voi Voi cave, but the ability to access these places is still very limited (dirt hill road, lots of gravel and rocks), especially during rainy and windy times; In addition, other natural resources such as mangrove forests and sea worms have not been really exploited for tourism purposes and ecotourism development. On the contrary, Minh Chau commune has more advantages in developing ecotourism in the direction of natural tourism, this is an area with diverse ecosystems such as at Rua De Beach, Bai Tu Long National Park Conservation Center...; Minh Chau beach is highly appreciated for its natural beauty and cleanliness, ranked in the top ten most beautiful beaches in Vietnam; Minh Chau commune is also home to Tram forest with a large area and a purity of up to 90%, suitable for building bridges through the forest (a very effective type of natural ecotourism currently applied by many countries) for tourists to sightsee, as well as for the purpose of studying and researching.
Figure 3.1: Thenmala Forest Bridge (India) Source: https://www.thenmalaecotourism.com/(August 21, 2019)
3.2.2. Using SWOT matrix to evaluate Quan Lan island tourism
General assessment of current tourism activities of Quan Lan island is shown through the following SWOT matrix:
Table 3.5: SWOT matrix evaluating tourism activities on Quan Lan island
Internal agent
Strengths- There is a lot of potential for tourism development, especially natural ecotourism and humanistic ecotourism.- The unskilled labor force is relatively abundant.- resource environmentunpolluted, still
Weaknesses- Poorly developed infrastructure, especially traffic routes to tourist destinations on the island.- The team of professional staff is still weak.- Tourism products in general
quite wild, originalintact
general and DLST in particularalone is monotonous.
External agents
Opportunity- Tourism is a key industry in the socio-economic development strategy of the province and Van Don economic zone.- Quan Lan was selected as a pilot area for eco-tourism development within the framework of the green growth project between Quang Ninh province and the Japanese organization JICA.- The flow of tourists and especially ecotourism in the world tends toincreasing
Challenge- Weather and climate change abnormally.- Competition in tourism products is increasingly fierce, especially with other localities in the province such as Ha Long, Mong Cai...- Awareness of tourists, especially domestic tourists, about ecotourism and nature conservation is not high.
Through summary analysis using SWOT matrix we see that:
To exploit strengths and take advantage of opportunities, it is necessary to:
- Diversify products and service types (build more tourism routes aimed at specific needs of tourists: experiential tourism immersed in nature, spiritual cultural tourism...)
- Effective exploitation of resources and differentiated products (natural resources and human resources)
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Therefore, to test the upper part of the subscapularis tendon, we use the Bear Hug test. This test is positive when the patient places his hand on the opposite shoulder that is painful, or when the examiner lifts his hand off the shoulder, there is pain.
Figure 1.18. Bear hug test46
Test to detect large rotator cuff tears:
Drop arm test : This test is common in complete and large tears of CX.
Figure 1.19. Falling arm test 42.
1.3.1.3. Paraclinical
a. Routine X-ray47,48
Includes anteroposterior shoulder X-ray and Lamy lateral shoulder X-ray
Based on the anteroposterior view, we can determine the shape of the greater tuberosity of the humerus, the humeral head KC, and the inferior surface of the MCV. Narrowing of the KC indicates upward displacement of the humeral head, which has been associated with tears of the CX tendon, especially the supraspinatus muscle.
Figure 1.20. Anteroposterior shoulder X-ray in large tear. CX shows the humeral head right next to the inferior aspect of the MCV bone.
Source: According to AAOS (American Academy of Orthopedic Surgeons)
Lamy lateral shoulder X-ray allows to see the supraspinatus and infraspinatus fossa, indirectly shows the entire CX surrounding the humeral head, allows to locate the CX muscle calcification, see the CX tendon tear when injecting contrast agent, analyze the shape of the distal part of the coracoid process, coracoid process and scapula.
Figure 1.21. Illustration of calcification of the CX tendon of the shoulder joint viewed in Lamy's position
Source: According to AAOS (American Academy of Orthopedic Surgeons)
b. Computed tomography (CT)
Contrast-enhanced computed tomography: Sensitivity is 99%, specificity is 100% for the diagnosis of supraspinatus tendon tears, for infraspinatus tendon these rates are 97.44% and 99.52%, respectively, for subscapularis tendon are 64.71% and 98.17%. For injuries of the long head of the biceps tendon are 45.76% and 99.57%49 .
c. Magnetic resonance imaging (MRI)
On the cutting planes we can see and determine the calcification of the coracoid ligament or the presence of a bony spur below the MCV.
MRI shows pathological images of CX, it has a sensitivity and specificity greater than 90% especially when contrast agent is injected.
Signs of CX tendinopathy on contrast-enhanced radiographs include:
CX tendonitis: unevenly thickened tendon image, increased signal on PD fatsat but not as high as fluid signal. Tendonitis is often accompanied by
with signs of swelling or partial tearing of the tendon. Accompanying soft tissue injuries: ligament damage, joint capsule, synovial sheath, etc.
Partial tendon tear: On the film, there is a defect in the muscle tendon surface on the joint surface or the synovial surface 50. The joint capsule is not torn, so there is no contrast agent leakage outside the joint cavity.
Complete tendon tear: See the image of continuous loss of the entire thickness of the tendon from the joint surface to the synovial surface. If the tear is complete, there are signs of muscle contraction towards the origin. Indirect signs on contrast-enhanced MRI can see contrast agent leaking out of the synovial membrane below the MCV and below the Deltoid muscle.
Supersonic.
Figure 1.22. Complete tear of the supraspinatus tendon 51
Has a sensitivity and specificity greater than 90% according to foreign reports.
There is no domestic research published on sensitivity and specificity.
Image of fluid in the sub-MCV and sub-coracoid spaces, image of sub-MCV bursitis, CX tendonitis, rotator cuff tendon tear, biceps tendonitis.
Figure 1.23. Ultrasound illustration, white arrow shows complete supraspinatus tendon tear52 .
1.3.2. Classification of complete rotator cuff tears
There are many different ways to classify RCX, based on the classification of tears, it is possible to predict and provide appropriate treatment for each type of tear.
By shape53
With complete tear:
- Figure C
- U-shape
- L-shape
- Very big tear
Figure 1.24. CX53 completely torn shapes .
According to the level of tendon contraction
According to Patte's classification, there are 3 levels of shrinkage54 :
Grade 1: the contracted tendon is located on the outside of the humeral head.
Grade 2: the contracted tendon is located at the top of the humeral head.
Grade 3: the contracted tendon is located at the level of the glenoid cavity of the shoulder blade.
Figure 1.25. Patte classification of tendon contracture degree54 .
According to Cofield RH size
This classification of complete tears is based on the largest diameter55 :
- Small tear <1cm.
- Moderate tear: 1-3cm.
- Large tear: 3-5cm.
- Massive tear: >5cm. Massive tear is a tear that is accompanied by a lot of contraction, high fat degeneration and may not be able to be repaired with sutures.
According to the level of fatty degeneration in the body
According to Goutallier, there are five degrees of fatty degeneration in muscle56 .
Grade 0: normal muscle
Grade 1: there are a few bands of fat in the muscle
Grade 2: fat accounts for <50% of muscle
Level 3: fat ratio accounts for 50% of body
Grade 4: fat ratio >50% of body
Figure 1.26. Degree of fatty degeneration in muscle according to Goutallier 56
1.4. TREATMENT OF ROTATORS TEAR
Regarding the choice of treatment method, many factors must be considered such as: the patient's desire for quality of life, the need for exercise; general condition, age and personal constitution, response to conservative treatment; and even the economic issue of treatment must be considered.
1.4.1. Non-surgical treatment
1.4.1.1. Indications2,46,57,58
- When there is no clear history of trauma and the symptoms are not severe, there are small tear lesions on MRI.
- For patients with pseudo-paralysis or limited mobility, medical treatment with VLTL exercises should also be prescribed to improve surrounding muscle strength as well as joint flexibility before surgery.
- Large and very large tears where the patient only needs minimal movement (basic activities) or systemic diseases contraindicate surgery. At this time, the goal of conservative treatment is to reduce pain and improve joint function as much as possible.
1.4.1.2. Method 2 59
- Cold compresses, NSAIDs, changes in activity habits (especially overhead arm movements).
- When the patient's pain is relieved, physical therapy and rehabilitation exercises will be performed, including maintaining range of motion, strengthening the Delta muscle, stabilizing the shoulder blade and CX muscle.
- If the above measures are not effective, steroids can be injected directly into the subacromial space. However, steroids can cause tendon rupture as well as side effects, so it is not a long-term treatment for CX as well as other diseases in the shoulder area. The treatment regimen that some authors suggest is that if the patient comes to the doctor with progressive inflammation and pain, 3 corticosteroid injections in the first 3 months, then maintain 1 injection per year.
- Some recent studies are delving into the effectiveness of platelet-rich plasma (PRP) injections, but the results are not yet clear.
1.4.2. Surgical treatment
1.4.2.1. Indications2,46,57,58
- Patients who failed conservative treatment: Patients who have been treated with conservative regimens for 3-6 months without response to treatment, or have very slow response to treatment, accompanied by dissatisfaction with the patient's quality of life.
- RCX due to trauma when previously the shoulder joint function was normal.
- Large CX tears cause shoulder weakness and limit shoulder joint function while the quality of the tendons and muscles is still good.
1.4.2.2. Open surgery
Indications for open surgery to repair CX lesions are classic methods in the history of disease treatment, when there was no development in endoscopic techniques. However, one thing that all authors agree on is that open surgery involves a large intervention in the Delta muscle (depending on the extent of CX damage, it can be large or small), which leads to a long recovery time for the Delta muscle, thus affecting the process of recovering shoulder function after surgery.
1.4.2.3. Endoscopic surgery
Shoulder arthroscopy has developed significantly over the past few decades, with many advantages and advantages over open surgery such as less invasiveness, faster postoperative recovery time, reduced pain and risk of postoperative stiffness, preservation of the Deltoid muscle attachment points, overcoming the Deltoid muscle atrophy of open surgery. For experienced surgeons, this technique can help surgeons to examine all related pathologies of the glenohumeral joint, along with the ability to fully describe the tear patterns60,61 .
However, this method also has disadvantages such as longer surgery time and higher cost. The technique is also more difficult, requiring surgeons with experience in the field of arthroscopy.
1.5. ARTHROSCOPIC TECHNIQUE FOR ROTATORS TENDON REPAIR
1.5.1. Bone anchoring technique
1.5.1.1. Theory of anchor angle
By observing the new fence system under construction, author Burkhart saw that at the corner posts of the fence, the builders had placed a