An Analytical Simulator for Deploying IP Telephony

Deploying IP telephony or voice over IP (VoIP) is a major and challenging task. This paper describes an analytical design and planning simulator to assess the readiness of existing IP networks for the deployment of VoIP. The analytical simulator utilizes techniques used for network flows and queueing network analysis to compute two key performance bounds for VoIP: delay and bandwidth. The simulator is GUI-based and has an interface with drag-and-drop features to easily construct any generic network topology. The simulator has an engine that automates and implements the analytical techniques. The engine determines the number of VoIP calls that can be sustained by the constructed network while satisfying VoIP QoS requirements and leaving adequate capacity for future growth. As a case study, the paper illustrates how the simulator can be utilized to assess the readiness to deploy VoIP for a typical network of a small enterprise. We have made the analytical simulator publicly available in order to improve and ease the process of VoIP deployment

An Analytical Simulator for Deploying IP Telephony

Deploying IP telephony or voice over IP (VoIP) is a major and challenging task. This paper describes an analytical design and planning simulator to assess the readiness of existing IP networks for the deployment of VoIP. The analytical simulator utilizes techniques used for network flows and queueing network analysis to compute two key performance bounds for VoIP: delay and bandwidth. The simulator is GUI-based and has an interface with drag-and-drop features to easily construct any generic network topology. The simulator has an engine that automates and implements the analytical techniques. The engine determines the number of VoIP calls that can be sustained by the constructed network while satisfying VoIP QoS requirements and leaving adequate capacity for future growth. As a case study, the paper illustrates how the simulator can be utilized to assess the readiness to deploy VoIP for a typical network of a small enterprise. We have made the analytical simulator publicly available in order to improve and ease the process of VoIP deployment

OH maser towards IRAS 06056+2131: polarization parameters and evolution status

We present high angular resolution observations of OH maser emission towards the high-mass star forming region IRAS 06056+2131. The observations were carried out using the UK radio interferometer array, Multi-Element Radio Linked Interferometer Network (MERLIN) in the OH main lines at 1665- and 1667-MHz, in addition to the OH satellite line at 1720-MHz. The results of this study revealed emission in the 1665 MHz line with an estimated total intensity of $\sim 4$ Jy. We did not detect any emission from the 1667-MHz and 1720-MHz lines. The full polarization mode of MERLIN enables us to investigate the magnetic field in the OH maser region. Our results show that IRAS 06056+2131 is a highly circularly polarized source. In this transition, a Zeeman pair is identified from which a magnetic strength of $\sim -1.5$ mG is inferred. The orientation of the linear polarization vectors suggests that the magnetic field lines at the location of the OH maser emission \textbf{might be} in agreement with the orientation of the outflow thought to be associated with this source. The star forming evolutionary status of the embedded proto-stellar object is discussed.Comment: 10 pages, 5 figure

Nurses experience of caring for patients with COVID-19 : a phenomenological study

Introduction: COVID-19 has impacted all dimensions of life and imposed serious threat on humankind. Background: In Jordan, understanding how nurses experienced providing care for patients with COVID-19 offers a framework of knowledge about similar situations within the context of Arabic culture. Aim: To explore nurses' experience with providing hands-on care to patients with active COVID-19 infection in an Arabic society. Methods: A descriptive phenomenological study interviewed 10 nurses through a purposive sampling approach until data saturation was reached. The research site was hospital designated to receive patients with active COVID-19 infection. Semi-structured interviews were used to collect the data. Findings: Three themes were generated from the data: the impact of the COVID-19 outbreak on nurses' health; unfamiliar work and social environments; and conforming to professional standards. Discussion: There are specific risks to the physical and mental wellbeing of nurses who provide hands-on care to patients with COVID-19 in an Arabic society. Implication for nursing and health policy: Health care institutions should consider establishing programs that promote nurses' wellbeing and support their productivity in a crisis. A danger pay allowance should be considered for nurses during extraordinary circumstances, such as pandemics

Technique and diagnostic utility of saline infusion sonohysterography

The introduction of saline infusion sonohysterography has significantly improved sonographic diagnosis of various endometrial pathologies. This procedure entails instillation of warm saline into the uterine cavity transcervically to provide enhanced visualization of the endometrium during transvaginal ultrasound examination. This article reviews the sonohysterography technique and current utility, as well as the spectrum of imaging features of various endometrial pathologies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135202/1/ijgo5.pd

Influence of elemental sulfur on nutrient uptake, yield and quality of cucumber grown in sandy calcareous soil

Abstract This study was carried out to investigate the effect of elemental sulfur (S 0 ) and sulfur oxidizing bacteria (Paracoccus versutus) on nutrient uptake, yield and quality of cucumber grown in sandy calcareous soils. Both elemental sulfur powder (S 0 P) and pellets of sulfur powder-Tiger 90 (S 0 T) were applied at rates of 0, 1, 5 and 10 t/ha at Al Hamraneya. On the contrary, S 0 P was used at rates of 0, 1, 5 and 10 t/ha combined with or without Paracoccus versutus (Pv) at Al Kuwaitat, United Arab Emirates (UAE). Higher concentrations of N, P, S, Mn and Zn in leaves and yield of cucumber at both locations were obtained with application of S 0 at rates of 5 and 10 t/ha. Total soluble sugar (TSS) content and vitamin C was higher with the application of S 0 at rates of 5 and 10 t/ha. Application of Pv individually or with varying levels of S 0 P had no positive effect on nutrients uptake, yield and quality of cucumber. A positive correlation was observed between shelf life and vitamin C. At Al Hamraneya S 0 P performed better than S 0 T. The results reveal that application of S 0 P at the rate of 5 t/ha in sandy calcareous soils can enhance the nutrients uptake ability, increase yield and superior quality of cucumber at both locations in UAE

Knowledge, Attitude and Training Physiotherapist Palliative Care - Gaza Strip

Background: Palliative care encompasses holistic management of patients and families facing life-threatening and life-limiting conditions. There is currently little known about Gaza strip physiotherapists’ palliative care knowledge, attitudes, beliefs, experience and training needs. Objectives: Palliative care rehabilitation has been positively associated with a high and prolonged level of independent function, which also reduces the burden on care providers(1,2). This study aimed to investigate the existing knowledge, attitudes, beliefs, training and experience of palliative care by physiotherapists working in Gaza strip. Methodology: A quantitative cross-sectional descriptive study using a face to face questionnaire included sociodemographic data, physiotherapist’s knowledge, attitude experience and training (modified PTiPC-KABE Scale)(3), the study includes eight major hospitals in the Gaza-Strip. The sample size was 120 participants, 110 were included. SPSS (version 22 for Windows) for descriptive statistics, Chi-Square, Student's t and compare mean -tests were used for the statistical analysis. Results: The total number of respondents was 110(93.3%); male 45%,and females 55%.Years of experience Palliative care intends to hasten death was significant in (p = 0.017), Palliative care does not enhance quality of life (p = 0.117), I feel a sense of personal failure when a patient dies(p=0.035), Palliative care considers dying as a complicated process (p =0.026), Caring for dying patients is traumatic for me(p = 0.004), The provision of palliative care requires emotional detachment(p = 0.009), The physical environment of my workplace is ideal for providing palliative care and rehabilitation(p = 0.026), I am often exposed to death in my workplace(p = 0.034), Conclusions: Many of Gaza's physiotherapists perform in palliative care despite inadequate training and limited knowledge in this area. Further learning and training opportunities for graduates and postgraduate students are required for physiotherapists in palliative care

The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis

: Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially