Socially-aware congestion control in ad-hoc networks: Current status and the way forward

Ad-hoc social networks (ASNETs) represent a special type of traditional ad-hoc network in whicha user’s social properties (such as the social connections and communications metadata as wellas application data) are leveraged for offering enhanced services in a distributed infrastructurelessenvironments. However, the wireless medium, due to limited bandwidth, can easily suffer from theproblem of congestion when social metadata and application data are exchanged among nodes—a problem that is compounded by the fact that some nodes may act selfishly and not share itsresources. While a number of congestion control schemes have been proposed for the traditional ad-hoc networks, there has been limited focus on incorporating social awareness into congestion controlschemes. We revisit the existing traditional ad-hoc congestion control and data distribution protocolsand motivate the need for embedding social awareness into these protocols to improve performance.We report that although some work is available in opportunistic network that uses socially-awaretechniques to control the congestion issue, this area is largely unexplored and warrants more researchattention. In this regards, we highlight the current research progress and identify multiple futuredirections of research

Chinese Quest for Strategic Maritime Security of Energy Supplies Trough Gawadar Seaport

China has been having serious concerns with reference to likelihood of interruptions for smooth transportation of the oil & gas shipment vessels towards China approaching from Africa and the region of Gulf via Strait of Malacca in relations for prone to be attacks by terrorists and pirates, as 80% of Chinese oil supplies has been coming through strategic energy chokepoint of the Strait of Malacca. China desires for reduction of its dependency on the Strait of Malacca and has been looking for alternate prospects to safeguard its energy supplies. The position of Gawadar Seaport in close proximity to Central & South Asia and more so to Middle Eastern States has transformed it to be western-most interlink under Chinese ‘String of Pearls’ strategy on accounts of which it has considered getting hold to key-strategic seaports at Gawadar, Sri Lanka, Bangladesh, Thailand, Cambodia, Burma, and the South China Sea. Gawadar Seaport may help China with regard for extending its presence in the Persian Gulf region and the Arabian Sea from where it has been importing 60% supplies of energy requirements. The presence of China at Gawadar may provide not only admittance to Indian Ocean and facilities of basing but also chances for taking control of Strait of Hormuz for ensuring smooth supplies of energy demands coming through West Asia. Pakistan may be capable of playing the role of a transit facility by providing China admittance towards the markets of Central Asian and its energy resources. This paper makes an analytical study of the need for maritime energy security, geostrategic potential of Gawadar Seaport in the Chinese and regional perspective and the Chinese quest for maritime energy security through Gawadar Seaport

The Problem of Institutionalization of Political Power in Pakistan: An Appraisal of the Zia Period (1977-1988)

Since its establishment in 1947, Pakistan has repeatedly been on starting point or even somewhat beyond the starting point, because of the malfunctioning or non-existence of the state institutions; on such occasions, instead of correcting or rectifying the malfunctioning, the basic infrastructure was altogether demolished while the institutions were abolished thus placing the country on a restart from zero point. Perhaps the Zero point in Islamabad indicates the psychological dimensions of the establishment that they place the country repeatedly at Zero point to start another exercise of trial and error. The military rule by General Ziaul Haq (1977-1988) provides an interesting insight of the above notion since the start of authoritative rather autocratic Islamization during the said regime turned the country back into late 1940s when the proposed Islamization under the Objectives Resolution of 1949 was criticized by the non-Muslim and neutral foreign observers alike. The instant study aims to evaluate whether the state institutions were empowered or strengthened by the Zia regime. It will also evaluate how General Zia’s arbitrary use of power affected the performance of government functionaries and public departments

NOTCH3 p.Arg1231Cys is markedly enriched in South Asians and associated with stroke.

The genetic factors of stroke in South Asians are largely unexplored. Exome-wide sequencing and association analysis (ExWAS) in 75 K Pakistanis identified NM_000435.3(NOTCH3):c.3691 C > T, encoding the missense amino acid substitution p.Arg1231Cys, enriched in South Asians (alternate allele frequency = 0.58% compared to 0.019% in Western Europeans), and associated with subcortical hemorrhagic stroke [odds ratio (OR) = 3.39, 95% confidence interval (CI) = [2.26, 5.10], p = 3.87 × 10-9), and all strokes (OR [CI] = 2.30 [1.77, 3.01], p = 7.79 × 10-10). NOTCH3 p.Arg231Cys was strongly associated with white matter hyperintensity on MRI in United Kingdom Biobank (UKB) participants (effect [95% CI] in SD units = 1.1 [0.61, 1.5], p = 3.0 × 10-6). The variant is attributable for approximately 2.0% of hemorrhagic strokes and 1.1% of all strokes in South Asians. These findings highlight the value of diversity in genetic studies and have major implications for genomic medicine and therapeutic development in South Asian populations

NOTCH3 p.Arg1231Cys is markedly enriched in South Asians and associated with stroke

Acknowledgements: Supported by Regeneron Pharmaceuticals, Inc. This research has been conducted using the UK Biobank Resource (project 26041). The authors thank everyone who made this work possible, particularly the UK Biobank team, their funders, the professionals from the member institutions who contributed to and supported this work, and most especially the UK Biobank participants, without whom this research would not be possible. The exome sequencing was funded by the UK Biobank Exome Sequencing Consortium (Bristol Myers Squibb, Regeneron, Biogen, Takeda, Abbvie, Alnylam, AstraZeneca and Pfizer). Ethical approval for the UK Biobank was previously obtained from the North West Center for Research Ethics Committee (11/NW/0382). Disclosure forms provided by the authors are available with the full text of this article.The genetic factors of stroke in South Asians are largely unexplored. Exome-wide sequencing and association analysis (ExWAS) in 75 K Pakistanis identified NM_000435.3(NOTCH3):c.3691 C > T, encoding the missense amino acid substitution p.Arg1231Cys, enriched in South Asians (alternate allele frequency = 0.58% compared to 0.019% in Western Europeans), and associated with subcortical hemorrhagic stroke [odds ratio (OR) = 3.39, 95% confidence interval (CI) = [2.26, 5.10], p = 3.87 × 10−9), and all strokes (OR [CI] = 2.30 [1.77, 3.01], p = 7.79 × 10−10). NOTCH3 p.Arg231Cys was strongly associated with white matter hyperintensity on MRI in United Kingdom Biobank (UKB) participants (effect [95% CI] in SD units = 1.1 [0.61, 1.5], p = 3.0 × 10−6). The variant is attributable for approximately 2.0% of hemorrhagic strokes and 1.1% of all strokes in South Asians. These findings highlight the value of diversity in genetic studies and have major implications for genomic medicine and therapeutic development in South Asian populations

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research