Current Implementation of the Flooding Time Synchronization Protocol in Wireless Sensor Networks

Time synchronization is an issue that affects data accuracy within wireless sensor networks (WSNs). This issue is due to the complex nature of the wireless medium and can be mitigated with accurate time synchronization. This research focuses on the Flooding Time Synchronization Protocol (FTSP) since it is considered as the gold standard for accuracy in WSNs. FTSP minimizes the synchronization error by executing an algorithm that creates a unified time for the network reporting micro-second accuracy. Most synchronization protocols use the FTSP implementation as a benchmark for comparison. The current and only FTSP implementation runs on the TinyOS platform and is fully available online on GitHub. However, this implementation contains flaws that make micro-second accuracy impossible. This study reports a complete FTSP implementation that achieves micro-second accuracy after applying modifications to the current implementation. The new implementation provides a new standard to be used by future researches as a benchmark

Peripartum screening for postpartum hypertension in women with hypertensive disorders of pregnancy

Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP). This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP. In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT. At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P 75 g/m , relative wall thickness >0.42, and E/e' ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90). This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease. [Abstract copyright: Copyright © 2022 American College of Cardiology Foundation. All rights reserved.

Postpartum cardiovascular function in patients with hypertensive disorders of pregnancy: A longitudinal study

Women with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of cardiovascular diseases that are usually mediated by the development of cardiovascular risk factors, such as chronic hypertension, metabolic syndrome or subclinical myocardial dysfunction. Increasing evidence has been showing that little time elapses between the end of pregnancy and the development of these cardiovascular risk factors. To assess the persistence of hypertension and myocardial dysfunction at four months postpartum in a cohort of women with HDP and to compare the echocardiographic parameters between the peripartum and the postpartum period. In a longitudinal prospective study, a cohort of women with preterm or term HDP and an unmatched group of women with term normotensive pregnancy were recruited. Women with pre-existing chronic hypertension (n=29) were included in the HDP cohort. All participants underwent two cardiovascular assessments: the first was conducted either before or within one week of delivery (V1: peripartum assessment), and the second was between three and 12 months following giving birth (V2: postpartum assessment). The cardiovascular evaluation included blood pressure profile, maternal transthoracic echocardiography (left ventricular mass index (LVMI), relative wall thickness (RWT), left atrial volume index (LAVI), E/A, E/e', peak velocity of tricuspid regurgitation (TR), ejection fraction (EF), and LV global longitudinal strain (GLS) and twist) and metabolic assessment (fasting glycemia, insulin, lipid profile and waist measurement). Echocardiographic data were compared between V1 and V2 using paired t-test or McNemar test in HDP and in the control groups. Among 260 patients with pregnancies complicated by HDP and 33 patients with normotensive pregnancies, 219 (84.2%) and 30 (90.9%) attended postpartum follow-up, respectively. Patients were evaluated at a median (IQR) of 124 (103-145) days after delivery. Paired comparisons of echocardiographic findings demonstrated significant improvements in cardiac remodeling rates (left ventricular mass index (g/m2) 63.4±14.4 vs 78.9±16.2, p<0.0001; relative wall thickness 0.35±0.1 vs 0.42±0.1, p<0.0001), most diastolic indices (E/E' 6.3±1.6 vs 7.4±1.9, p<0.0001), ejection fraction (EF<55%: 9 (4.1%) vs 28 (13.0%), p<0.0001) and global longitudinal strain (-17.3±2.6% vs -16.2±2.4%, p<0.0001) in the postpartum period compared to the peripartum. The same improvements in cardiac indices were observed in the normotensive group. However, at the postnatal assessment, 153/219 (69.9%) had either hypertension (76/219, 34.7%) or an abnormal global longitudinal strain (125/219, 57.1%), 13/67 (19.4%) had metabolic syndrome and 18/67 (26.9%) exhibited insulin resistance. Although persistent postpartum cardiovascular impairment was evident in a substantial proportion of these patients since more than two-thirds had either hypertension or myocardial dysfunction postpartum, cardiac modifications due to pregnancy-related overload and hypertension were significantly more pronounced in the peripartum than in the postpartum periods. [Abstract copyright: Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

THE EFFECT OF ANTI HYPERTENSIVE THERAPY ON HAEMODYNAMIC AND PLACENTAL MARKERS IN HYPERTENSIVE DISORDERS IN PREGNANCY

PhdThe aim of this thesis was to investigate the effect of antihypertensive therapy on vascular function and placental markers in hypertensive disorders in pregnancy (HTD). We prospectively studied 208 women at the Homerton and University College London Hospitals. Vascular and serum markers were measured in 80 with HTD [51 pre-eclampsia (PE), 29 gestational hypertension (GH)] and 80 normotensive controls. The same markers were measured in placental samples from another 48 women (14 PE, 10 GH, 24 controls). Pulse wave analysis indices [augmentation pressure (AP) and augmentation index at heart rate 75/minute (Aix-75)], serum and placental concentrations of soluble fms-like tyrosine-kinase-1 (sFlt-1), soluble endoglin (sEng), placental growth factor (PIGF), vascular endothelial growth factor (VEGF), inhibin A, activin A, and uterine artery Doppler were measured before, and 24-48 hours after, initiating antihypertensive therapy. The three study groups were compared using ANOVA multiple comparisons with Bonferroni post hoc testing. Marker levels before and after antihypertensives were compared using paired t-test. In both pre-eclampsia (P<0.0001) and gestational hypertension (P<0.05), serum sFlt-1 was increased and PIGF reduced (P<0.001) compared to controls. Serum sEng levels were also increased in pre-eclampsia. Placental sFlt-1 and sEng were significantly higher (P<0.0001), and PIGF lower (P = 0.008), in pre-eclampsia compared to controls and gestational hypertension. Antihypertensive therapy was associated with a significant fall in serum and placental sFlt-1 and sEng in pre-eclampsia only (P<0.05). In pre-eclampsia, but not gestational hypertension, treatment was associated with significantly (P< 0.05) lower serum and placental inhibin A and activin A. In women with pre-eclampsia or gestational hypertension, both AP (P<0.0001 and P<0.05) and Aix-75 (P<0.0001 and P<0.001) were significantly higher than controls. Antihypertensive therapy resulted in a significant fall in both AP and Aix-75 in pre-eclampsia only (P<0.0001). Anti hypertensive drugs may have an effect on the pathophysiology of pre-eclampsia other than their known anti hypertensive actio

Comparison of High Intensity Non-Invasive Ventilation With Low Intensity Non-Invasive Ventilation In Patients With Acute Copd Exacerbation

Objective: To determine the outcome of high intensity non-invasive positive pressure ventilation (HI-NPPV) as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations. Methodology: This Randomized controlled trial Department of PulmonologyFauji Foundation Hospital Rawalpindi from  31st December 2016 to 30thJune 2017. Arterial blood gases will be taken at admission. If values of pH and paCO2 meet the criteria for non-invasive ventilation then patients will be enrolled in the study. Patients will be randomly divided into two groups by lottery method. GROUP A and GROUP B. GROUP A will receive high intensity NIV (HI-NPPV) and GROUP B will receive low intensity NIV (LI-NPPV) by TRIOLOGY machine. Expiratory positive airway pressure (EPAP) will remain between 4 to 6 cmH2O.  Arterial blood gases (ABGs) will be done at baseline and then 72 hours after admission. Improvement in PaCO2, HCO3, and FEV1 will be recorded 72 hours from baseline and collected on proforma (attached). Results: Mean age (years) in the study was 55.54+3.81. There were 08 male patients included the study meeting the inclusion criteria. Of these, 05 and 03 male patients among both the groups respectively. Similarly, there were 92 female patients included the study meeting the inclusion criteria, of these, 45 and 47 female patients among both the groups respectively. Outcome of the study was assessed in terms of mean PaCO2 (mmHg), HCO3 (mmol/L) and FEV1 at baseline and after 72 hours. Mean PaCO2, HCO3 and FEV1 at baseline was 64.87+5.22, 33.75+4.17 and 0.66+0.04 respectively. After 72 hours, mean PaCO2 (mmHg) , HCO3(mmol/L), and FEV1 among both the groups was 63.98+6.58 vs 41.46+2.40, 33.10+4.81 vs 23.12+2.01, 0.66+0.05 vs 0.72+0.04 with following P value of (0,000, 0.000, 0.000) respectively. Conclusion: High intensity non-invasive positive pressure ventilation (HI-NPPV) has no different outcome as compared to low intensity non-invasive positive pressure ventilation (LI-NPPV) in patients with acute COPD exacerbations

Comparison of the WHO Retreatment Regimen with the Six Drugs Regimen in Patients of Pulmonary Tuberculosis

Objective: To compare the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment Category patients.Study design: Randomized control trial (RCT)Place and Duration: Chest Department, Fauji Foundation Hospital Rawalpindi from 22nd May 2016 to 22nd November 2016.Methodology: Patients who had previously been treated for pulmonary tuberculosis for at least 1 month duration and is a failure, relapse or defaulter case presenting in Fauji Foundation Hospital Rawalpindi, both indoor and outdoor were enrolled in the study. Patients were randomized by lottery method to either of the two treatment arms; WHO retreatment regimen or six drug formulations. Clinical features were documented, baseline investigations, AFB smear, Gene Xpert and AFB Culture were sent. Drugs were given on once daily dosage. AFB smear and AFB culture were repeated at 3rd month of treatment. They had a regular follow up in Chest OPD and had monthly visits to the ophthalmology department for visual acuity, fundoscopy and to ENT department for audiometry. Their chest X-ray was done baseline then 3 months. Blood complete picture and liver function tests, serum uric acid, renal function tests were performed baseline, at 2 weeks then 3 months. After their treatment was completed they were followed to look for relapse.Results: Total 490 patients were included according to the inclusion criteria of the study. Patients were divided into two equal groups. Mean age (years) in the study was 40.00+21.10. There were 33 (6.7) male and 457 (93.3) female patients whereas the frequency of early response of WHO retreatment regimen with the six drugs regimen in pulmonary tuberculosis retreatment category patients was 187 (76.3) and 211 (86.1) respectively which was statistically significant (p-value 0.000).Conclusion: The study concludes that six drug regimen was superior to WHO standard regimen in the success rate of pulmonary tuberculosis retreatment category patients which useful in bringing new facts regarding management of retreatment category patient in our country as well as worldwide because of the limited research was done on this category of tuberculosis

Maximum allowable delay bound estimation using Lambert W function

The widespread of communication networks make them very promising to play a great role in future control systems. The communication networks will be present in the feedback control system which makes it a kind of time delay system. Closing the feedback system through a communication network introduces many challenges for the controller designers. Communication networks induce inherent time delay and some of the data may be lost which can destabilize the control system or result in poor system performance. It is important to identify the maximum time delay that the control system can withstand. In this paper, we report the application of the Lambert W function for calculating the maximum allowable delay bound in linear time delay control systems. The results of the calculation are compared with the most widely used Linear Matrix Inequalities based method. © 2017 IEEE