Design a new proposed route optimization scheme based NEMO-Centric MANEMO (NCM)

Route Optimization (RO) refers to any approach that optimizes the transmission of packets between a Mobile Network Node/Mobile Router and a Corresponding Node/Home Agent. RO would mean that a binding between the address of an MNN/MR and the location of the mobile network is registered at the CE/HA. Technically, route optimization mechanism comes up with a complementing solution for the pinball problem by avoiding the MRHA Bidirectional Tunnel(BT) that is to be used. This paper discusses the RO issues for NEMO and more specifically issues of Nested NEMO such astunneling redundant, HA dependency, processing delay, bottleneck, traffic congestion, ER selection, and scalability in the design consideration. In order to address NEMO ROsuboptimal, this work utilizes the NCM protocol plus to PHA. The proposed MANEMO RO scheme is a layer three solution to support RO for mobile networks. Additionally, the paper proposes the design to address Nested NEMO issues in a post disaster scenario by using Proxy Home Agent (PHA) in the infrastructure with using Neighbor Discovery protocol(TDP/NINA) for localizing communications. Thus, thesignaling message flow and the algorithm are written to give proposed scheme more flexibilit

Development of duststorm attenuation model for microwave links

Duststorms are significant meteorological phenomenon occur for a significant percentage of time in arid and semi arid areas especially at African Sahara and Middle East. Measurements at existing microwave links show that the duststorms can potentially result in serious attenuation in signal level especially at Ku band and higher frequencies with direct impact on telecommunications system performance. Very limited research has been done to predict the attenuation even the scarcity of measured data forces the researcher to work for the duststorm prediction modeling

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

Peer reviewe

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Total and soluble fluoride concentration present in various commercial brands of children toothpastes available in Saudi Arabia – A pilot study

Objective: The aim of this pilot study was to perform chemical analysis and investigate the total and soluble fluoride concentrations in various brands of children toothpastes. Materials and methods: Three samples of five different commercial brands of children toothpastes were collected and divided into five groups; group A – Biorepair Oral Care toothpaste containing no fluoride (control), group B – Signal Kids Strawberry toothpaste having 500 ppm fluoride, group C – Aquafresh Milk Teeth toothpaste having 500 ppm fluoride, group D – Aquafresh Little Teeth toothpaste having 500 ppm fluoride, and group E – Siwak F Junior having 400 ppm F. The total fluoride (TF) and total soluble fluoride (TSF) concentration of the toothpastes was determined using fluoride ion selective electrode. Data were analysed using Paired sample t-test. Results: The measured TF values were inconsistent with that of the declared concentrations by the manufacturers. Mean TF found in the toothpastes ranged between 2.37 and 515.74 ppm whereas, the mean TSF ranged between 2.00 and 503.4 ppm. For two groups, TF was more than the declared TF whereas for the other three groups, it was less than the declared concentration. All the differences between the declared and observed TF concentration were statistically significant (p < .05) except for one group. All the toothpastes demonstrated mean TSF slightly lower than their respective observed mean TF concentrations. Conclusion: The analysis of TF and TSF concentrations revealed variations from the labelled claims. Therefore, some of the toothpastes may have doubtful anti-caries effectiveness owing to deficiency of total and soluble fluoride. Keywords: Fluoride, Fluoride ion electrode, Total fluoride, Total soluble fluoride, Toothpaste

Global Prevalence of Periodontal Disease and Lack of Its Surveillance

Background. Periodontal disease is a public health problem and is strongly associated with systemic diseases; however, its worldwide distribution is not fully understood. Objective. To evaluate global data of periodontal disease: (1) among adolescents, adults, and older population and (2) in low-, middle-, and high-income countries. Methods. This ecological study included data of periodontal disease from the World Health Organization’s data bank which are based on the Community Periodontal Index of Treatment Needs (CPITN code: 0 = no disease; 1 = bleeding on probing; 2 = calculus; 3 = periodontal pocket (PD) 4-5 mm; 4 = PD (6+ mm). Age- and income-related periodontal disease inequalities were evaluated across the globe. Results. Compared with 9.3% of adults and 9.7% of older persons, 21.2% of adolescents had no periodontal disease (P=0.005). Nearly 18.8% of adolescents compared with 8.9% of adults and 5% of older persons had bleeding on probing (P≤0.001). Similarly, 50.3% of adolescents, 44.6% of adults, and 31.9% older persons demonstrated the occurrence of calculus (P=0.01). On the other hand, older persons had the highest prevalence of PD 4-5 mm and PD 6+ mm than adults and adolescents (P≤0.001). The distribution of periodontitis (CPITN code 3 + 4) in adults differed significantly in low- (28.7%), lower-middle- (10%), upper-middle- (42.5%), and high-income countries (43.7%) (P=0.04). However, no significant differences in periodontitis (CPITN code 3 + 4) were observed in adolescents and older persons in low- to high-income countries. Conclusions. Within the limitations of data, this study found that the distribution of periodontal disease increases with age. Periodontitis was the most common in older persons and in population from high-income countries