Policy-based Network Management in Home Area Networks: Interim Test Results

This paper argues that Home Area Networks (HANs) are a good candidate for advanced network management automation techniques, such as Policy-Based Network Management (PBNM). What is proposed is a simple use of policy based network management to introduce some level of Quality of Service (QoS) and Security management in the HAN, whilst hiding this complexity from the home user. In this paper we have presented the interim test results of our research experiments (based on a scenario) using the HAN testbed. After using policies to prioritize different traffic, packet loss decreased to 30% and VoIP quality improved dramatically without employing any intelligent bandwidth allocation technique

New Role of Policy-based Management in Home Area Networks – Concepts, Constraints and Challenges

The management of Home Area Networks (HANs) is problematic. On the one hand there are increasing numbers of IP enabled devices that are connecting to the HAN (wired and wirelessly), some of which need to be managed, especially in terms of granting external access to certain services running on certain devices (e.g. home security, home monitoring, external media access). On the other hand, of any area of network management, the home network is the one where there is least likely to be a capable network manager physically there. So the Internet Service Providers (ISPs) have an interesting challenge: do they leave the management to the user and risk the degraded user experience that results, or do they offer to help manage the network for the home users, at potentially very high costs? This means that automated or autonomic (self-governed) network management approaches could potentially offer a solution. Policybased Network Management (PBNM) is a promising network management paradigm that potentially makes administration tasks easier and lessens the complexity involved in the management process for the end user. In this article, we present the potential for PBNM in HAN. Significant concepts, constraints and challenges related to the PBNM implementation are discussed. The potential is that ISPs can use PBNM to improve end user experience in HANs without incurring excessive support costs

Policy-based Traffic Management in Home Area Network – An Elementary Testbed Model

Traffic management in home area network (HAN) is different from the traditional traffic management in access and core networks. Traditionally network traffic works in best effort fashion and the HAN services are usually accommodated on the basis of first-in first-out rule. However quality can deteriorate when high number of users is connected to the HAN. Moreover the bursty traffic can also impact the quality by chocking the network traffic and blocking the network resources for all other traffic. Traffic management rules can be employed in HAN to prioritise different types of traffic according to user requirements. Dynamic configuration of network resources and services is multifaceted process, which requires many skills and knowledge. Policy-based Traffic Management (PBTM) can play a significant role in managing home networks and configuring the services dynamically according to HAN user requirements. This paper presents a testbed model for HAN to simplify traffic management process based on the principles of policy-based network management

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

Measuring the health-related Sustainable Development Goals in 188 countries : a baseline analysis from the Global Burden of Disease Study 2015

Background In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). Methods We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. Findings In 2015, the median health-related SDG index was 59.3 (95% uncertainty interval 56.8-61.8) and varied widely by country, ranging from 85.5 (84.2-86.5) in Iceland to 20.4 (15.4-24.9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r(2) = 0.88) and the MDG index (r(2) = 0.2), whereas the non-MDG index had a weaker relation with SDI (r(2) = 0.79). Between 2000 and 2015, the health-related SDG index improved by a median of 7.9 (IQR 5.0-10.4), and gains on the MDG index (a median change of 10.0 [6.7-13.1]) exceeded that of the non-MDG index (a median change of 5.5 [2.1-8.9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. Interpretation GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs.Peer reviewe

Semantic Technologies for User-Centric Home Network Management

Home area network (HAN) management is problematic for ordinary home users. Lack of user expertise, potential complexity of administration tasks, extreme diversity of network devices, price pressures producing devices with minimal feature sets, and highly dynamic requirements of user applications are some of the main challenges in HANs. As networking becomes enabled in many more HAN devices, these problems are set to increase. A viable solution to address these challenges lies in various levels of automation in Home Area Network (HAN), and at a slightly deeper level of self-governance in general, now often termed as autonomic computing. HANs are good candidate for autonomic network management, such as policy-based network management (PBNM), to automate network managing tasks. However, a significant challenge here is the transformation of user requirements to a form that is understandable to the HAN system. Semantic computing enables a system interpreting semantics of instances at different levels of abstraction (e.g. concepts related to users and network) without requiring it to know the interlinks among different system concepts (e.g. how a user is linked to its networked devices and applications). The research work presented in this thesis proposes a framework for the implementation of user-driven, semantic-aware, policy-based HAN management. Our goal is to transform user preferences into network configurations so that we can give control to HAN users to make their networks behave as per their requirements

Policy Refinement for Traffic Management in Home Area Networks: Problem Statement

Traditional home area network (HAN) equipment is usually unmanaged and network traffic is served in best effort fashion. This type of unmanaged network sometimes causes quality-of-service issues in the HAN, for example loss of quality in streamed video or audio content. Traffic management rules using policies to prioritise certain types of traffic according to user requirements and to assign bandwidth limits to other traffic types. However very little work has been done yet addressing the specification of these requirements, how they would be communicated to the gateway device using policies, and how the policies would be refined into device level configurations to effectively implement the user requirements. In this paper we briefly discuss this as a research problem, placing it within the context of the research goals and an initial research methodology in the area of policy refinement for policy-based traffic management in home area networks (HANs)

Policy-Based Network Management in Home Area Networks: Interim Test Results

This paper argues that Home Area Networks (HANs) are a good candidate for advanced network management automation techniques, such as Policy-Based Network Management (PBNM). What is proposed is a simple use of policy based network management to introduce some level of Quality of Service (QoS) and Security management in the HAN, whilst hiding this complexity from the home user. In this paper we have presented the interim test results of our research experiments (based on a scenario) using the HAN testbed. After using policies to prioritize different traffic, packet loss decreased to 30% and VoIP quality improved dramatically without employing any intelligent bandwidth allocation technique

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