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VDSL has much less range than ADSL, HDSL, and IDSL VDSL assumes that copper pair will connect the actual subscriber to a nearby optical network unit (ONU), which connects to the CO via fiber Total copper lengths should not exceed 300 m The ONU might be in an outside pedestal (fiber to the curb), inside a multiple-subscriber structure such as an office or apartment building (fiber to the building), or next to the home (fiber to the home) Lower-speed DSL services use a pure hub-and-spoke topology, with individual copper pairs to the serving CO As speeds increase, the medium s distance capability decreases, so remote terminals repeaters and concentrators will terminate end connections and concentrate them, creating a branched star Local loops are dedicated to individual users, and, even when concentrated at remote terminals, guarantee bandwidth to the central office At the CO, however, there may be a bottleneck If there is no router colocated at the CO, xDSL user bit streams need to be put onto a link that will carry them to the service provider The capacity of that link may not support simultaneous data flow from several users, or even full-rate bursts from individual users I have seen ADSL rates in the hundreds of kilobits offered to multiple users, but with only a 384-Kbps virtual circuit from the CO to the first provider POP Most current systems require a CO port for each user, which is more expensive than connecting a cable to a head end Work is going into methods of oversubscribing the DSLAM ports, much as conventional analog switches cannot support calls from all subscribers Going to an oversubscription model would relinquish the benefit of guaranteed bandwidth and connectivity, but that might be acceptable as a consumer service Another practical business issue for xDSL is the role of the traditional telephone company Traditionally, telephone companies, especially when an out-.

Neuropathy is equal to vascular insuf ciency in the pathogenesis of ED in diabetes This is especially pertinent because of the nonA-nonB nerve bers that are necessary in the penis to produce neuronal NO for initiation of rigidity Nijhawan et al studied men with type 1 diabetes [369] They found that 60% had cardiac autonomic neuropathy and 80% had signs of peripheral neuropathy, but that the most common symptom was ED (44%) rather than postural hypotension (28%) Bemelmans et al found that somatic and autonomic neurologic testing showed a higher incidence of more severe peripheral and autonomic neuropathy in men with diabetes who had ED [370] They also found that 85% of the men with diabetes and ED had some form of neuropathy, con rming neuropathy as an important pathophysiologic factor in diabetic ED

side plant is concerned, have been slow to implement new technologies Can you say ISDN I knew you could! Telcos became comfortable provisioning ISDN at the approximate time ISDN became obsolete ISPs, however, do not have extensive experience with local distribution An alternative may be arising with DSL wholesalers, such as Covad In a manner similar to modem pool wholesalers, these companies handle the DSL access for multiple ISPs and have the volume both to maintain an experience base and to gain economies of scale when installing equipment in COs Of course, most of them are in 11 bankruptcy, if not 7 ILECs can be very strong competitors when roused See Figure 713 for an example of how a wholesaler connects the ISPs Many xDSL providers differentiate between consumer and business use Consumer services are cheaper, but may share bandwidth from the CO to the ISP Consumer services also may implement the ATU-R as a card internal to a PC, lowering costs further SOHO business applications tend to have higher quality of service and to have an external box that may combine the ADSL transceiver unit remote (ATU-R), an Ethernet hub, and a router Using SDSL in such an implementation is the primary way I connect externally from my home office, although I do have a more complex internal structure with additional routers and firewalls My needs are more complex than those of most SOHO users

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Hyperglycemia has been noted to affect penile physiology Sobrevia and Mann, in an extensive review of the literature, noted that elevated blood sugar may cause regional hemodynamic changes and that endothelial-dependent relaxation is impaired [375] Protein kinase C is activated and oxygen radicals are generated, which inactivate NO and cause injury to the endothelial cells Bagg et al studied poorly controlled diabetic patients [376] Those patients whose HbA1C levels decreased from 102% to 82% noted a non-signi cant improvement over the short term in endothelial activation and brinolysis Christ et al found that hyperglycemia induced signi cant levels of free oxygen radicals [377] This result was completely blocked by removal of the endothelium, proving that the source of the free radicals was abnormal endothelial function At the clinical level, Romeo et al found that elevated HbA1C levels were an independent predictor of ED [378] Previously, Cartledge et al had noted that the HbA1C molecule itself interfered with NO, by impairment of acetylcholine-stimulated smooth muscle relaxation, in a dose-dependent fashion [379] This effect was reversed by a NO donor and by adding a superoxide anion scavenger The conclusion reached was that HbA1C-generated superoxide anions decrease the production and bioavailability of endothelial and neuronal NO, which might help to explain why ED is worse in men with poor diabetic control

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