MROM scheme to improve handoff performance in mobile networks

Mobile Router (MR) mobility supported by Network Mobility Basic Support Protocol (NEMO BS) is a Mobile IPv6 (MIPv6) extension that supports Host Mobility. Proposed Multihoming and Route Optimization for MANEMO (MROM) scheme is designed to provide Route Optimization (RO) and Multihomed in NEMO architectures. This paper proposes two novel schemes; MANEMO routing scheme and Multihoming-based scheme. These are to provide support for next generation networks. The proposed MROM scheme differs from other schemes for NEMO environment because it considers the requirements of more application flows parameters as packet lost delivery, handoff delay as well as throughput). Another difference is that not only the network infrastructure can begin the functionality of flow routing, but also an Edge Mobile Router (EMR) can do this flow for routing. Moreover, it utilizes the state of the art and presently active access network to perform the separation of each flow in mobile network. Thus, proposed MROM exhibits multihoming features and improves handoff performance by initiating flow-based fast registration process in NEMO environment. A handoff method is proposed with enhanced functionalities of the Local Mobility Anchors (LMA), Mobile Routers (MRs) and signaling messages with a view to achieve continuous connectivity through handoff in NEMO. Both analytical and simulation approaches are used. Analytical evaluation is carried out to analyze packet delivery lost and handoff delay of our proposed scheme. It was also shown that cost of signaling messages and packet delivery are contributing to total handoff cost. At the simulation part, network simulator 3 (NS 3) has been used as the tool to get performance metrics that have been considered like packet delivery ratio, handoff delay, and packet loss. Our proposed scheme (MROM) has been benchmarking to the standard NEMO BS Protocol and P-NEMO. In this paper, we discuss proposed MROM for next generation networks, providing detailed analysis with a numerical model, proposed MROM, by maximizing the handoff performance, has been justified to have better mobility support than the ordinary NEMO BS Protocol and PNEMO. Keywords—MROM, MANEMO, RO, Multihomed, Handoff

Numerical analysis of manemo routing scheme in multihoming environment

NEMO-BSP is the result of MIPV6 development that lacks mobility support in NEMO. Therefore, in this letter we discuss MANEMO routing and multihoming (MROM) providing detailed analysis with a numerical model. MROM, by maximizing the handoff performance, has been justified to have better mobility support than the ordinary NEMO-BSP and P-NEMO

MROM Scheme to Improve Handoff Performance in Mobile Networks

Mobile Router (MR) mobility supported by Network Mobility Basic Support Protocol (NEMO BS) is a Mobile IPv6 (MIPv6) extension that supports Host Mobility. Proposed Multihoming and Route Optimization for MANEMO (MROM) scheme is designed to provide Route Optimization (RO) and Multihomed in NEMO architectures. This paper proposes two novel schemes; MANEMO routing scheme and Multihoming-based scheme. These are to provide support for next generation networks. The proposed MROM scheme differs from other schemes for NEMO environment because it considers the requirements of more application flows parameters as packet lost delivery, handoff delay as well as throughput). Another difference is that not only the network infrastructure can begin the functionality of flow routing, but also an Edge Mobile Router (EMR) can do this flow for routing. Moreover, it utilizes the state of the art and presently active access network to perform the separation of each flow in mobile network. Thus, proposed MROM exhibits multihoming features and improves handoff performance by initiating flow-based fast registration process in NEMO environment. A handoff method is proposed with enhanced functionalities of the Local Mobility Anchors (LMA), Mobile Routers (MRs) and signaling messages with a view to achieve continuous connectivity through handoff in NEMO. Both analytical and simulation approaches are used. Analytical evaluation is carried out to analyze packet delivery lost and handoff delay of our proposed scheme. It was also shown that cost of signaling messages and packet delivery are contributing to total handoff cost. At the simulation part, network simulator 3 (NS 3) has been used as the tool to get performance metrics that have been considered like packet delivery ratio, handoff delay, and packet loss. Our proposed scheme (MROM) has been benchmarking to the standard NEMO BS Protocol and P-NEMO. In this paper, we discuss proposed MROM for next generation networks, providing detailed analysis with a numerical model, proposed MROM, by maximizing the handoff performance, has been justified to have better mobility support than the ordinary NEMO BS Protocol and PNEMO

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