Throughput and range characterization of IEEE 802.11ah

The most essential part of Internet of Things (IoT) infrastructure is the wireless communication system that acts as a bridge for the delivery of data and control messages. However, the existing wireless technologies lack the ability to support a huge amount of data exchange from many battery driven devices spread over a wide area. In order to support the IoT paradigm, the IEEE 802.11 standard committee is in process of introducing a new standard, called IEEE 802.11ah. This is one of the most promising and appealing standards, which aims to bridge the gap between traditional mobile networks and the demands of the IoT. In this paper, we first discuss the main PHY and MAC layer amendments proposed for IEEE 802.11ah. Furthermore, we investigate the operability of IEEE 802.11ah as a backhaul link to connect devices over a long range. Additionally, we compare the aforementioned standard with previous notable IEEE 802.11 amendments (i.e. IEEE 802.11n and IEEE 802.11ac) in terms of throughput (with and without frame aggregation) by utilizing the most robust modulation schemes. The results show an improved performance of IEEE 802.11ah (in terms of power received at long range while experiencing different packet error rates) as compared to previous IEEE 802.11 standards.Comment: 7 pages, 6 figures, 5 table

Joint Access-Backhaul Perspective on Mobility Management in 5G Networks

The ongoing efforts in the research development and standardization of 5G, by both industry and academia, have resulted in the identification of enablers (Software Defined Networks, Network Function Virtualization, Distributed Mobility Management, etc.) and critical areas (Mobility management, Interference management, Joint access-backhaul mechanisms, etc.) that will help achieve the 5G objectives. During these efforts, it has also been identified that the 5G networks due to their high degree of heterogeneity, high QoS demand and the inevitable density (both in terms of access points and users), will need to have efficient joint backhaul and access mechanisms as well as enhanced mobility management mechanisms in order to be effective, efficient and ubiquitous. Therefore, in this paper we first provide a discussion on the evolution of the backhaul scenario, and the necessity for joint access and backhaul optimization. Subsequently, and since mobility management mechanisms can entail the availability, reliability and heterogeneity of the future backhaul/fronthaul networks as parameters in determining the most optimal solution for a given context, a study with regards to the effect of future backhaul/fronthaul scenarios on the design and implementation of mobility management solutions in 5G networks has been performed.Comment: IEEE Conference on Standards for Communications & Networking, September 2017, Helsinki, Finlan

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Genetic Algorithm-Based Grouping Strategy for IEEE 802.11ah Networks

The IEEE 802.11ah standard is intended to adapt the specifications of IEEE 802.11 to the Internet of Things (IoT) scenario. One of the main features of IEEE 802.11ah consists of the Restricted Access Window (RAW) mechanism, designed for scheduling transmissions of groups of stations within certain periods of time or windows. With an appropriate configuration, the RAW feature reduces contention and improves energy efficiency. However, the standard specification does not provide mechanisms for the optimal setting of RAW parameters. In this way, this paper presents a grouping strategy based on a genetic algorithm (GA) for IEEE 802.11ah networks operating under the RAW mechanism and considering heterogeneous stations, that is, stations using different modulation and coding schemes (MCS). We define a fitness function from the combination of the predicted system throughput and fairness, and provide the tuning of the GA parameters to obtain the best result in a short time. The paper also includes a comparison of different alternatives with regard to the stages of the GA, i.e., parent selection, crossover, and mutation methods. As a proof of concept, the proposed GA-based RAW grouping is tested on a more constrained device, a Raspberry Pi 3B+, where the grouping method converges in around 5 s. The evaluation concludes with a comparison of the GA-based grouping strategy with other grouping approaches, thus showing that the proposed mechanism provides a good trade-off between throughput and fairness performance

Genetic Algorithm-Based Grouping Strategy for IEEE 802.11ah Networks

The IEEE 802.11ah standard is intended to adapt the specifications of IEEE 802.11 to the Internet of Things (IoT) scenario. One of the main features of IEEE 802.11ah consists of the Restricted Access Window (RAW) mechanism, designed for scheduling transmissions of groups of stations within certain periods of time or windows. With an appropriate configuration, the RAW feature reduces contention and improves energy efficiency. However, the standard specification does not provide mechanisms for the optimal setting of RAW parameters. In this way, this paper presents a grouping strategy based on a genetic algorithm (GA) for IEEE 802.11ah networks operating under the RAW mechanism and considering heterogeneous stations, that is, stations using different modulation and coding schemes (MCS). We define a fitness function from the combination of the predicted system throughput and fairness, and provide the tuning of the GA parameters to obtain the best result in a short time. The paper also includes a comparison of different alternatives with regard to the stages of the GA, i.e., parent selection, crossover, and mutation methods. As a proof of concept, the proposed GA-based RAW grouping is tested on a more constrained device, a Raspberry Pi 3B+, where the grouping method converges in around 5 s. The evaluation concludes with a comparison of the GA-based grouping strategy with other grouping approaches, thus showing that the proposed mechanism provides a good trade-off between throughput and fairness performance

IEEE 802.11ah: A Technology to Face the IoT Challenge

Since the conception of the Internet of things (IoT), a large number of promising applications and technologies have been developed, which will change different aspects in our daily life. This paper explores the key characteristics of the forthcoming IEEE 802.11ah specification. This future IEEE 802.11 standard aims to amend the IEEE 802.11 legacy specification to support IoT requirements. We present a thorough evaluation of the foregoing amendment in comparison to the most notable IEEE 802.11 standards. In addition, we expose the capabilities of future IEEE 802.11ah in supporting different IoT applications. Also, we provide a brief overview of the technology contenders that are competing to cover the IoT communications framework. Numerical results are presented showing how the future IEEE 802.11ah specification offers the features required by IoT communications, thus putting forward IEEE 802.11ah as a technology to cater the needs of the Internet of Things paradigm