Non-critical Services Research Articles

Prevalence and types of drug interactions in hospitalized pediatric patients in Mexico City

ObjectiveDrug-drug interactions may modify the therapeutic effect or the safety profile of the medicines used in pediatric populations. Although interest on potential drug interactions in these age groups has increased, information on clinically relevant drug-drug interactions is still scarce. The aim of this study was to explore the prevalence and characteristics of potential and clinically relevant drug-drug interactions among pediatric patients hospitalized in two pediatric hospitals of Mexico City. MethodA cross-sectional study was conducted on patient records in critical, oncological, burns and other non-critical services by a pediatric resident physician at both hospitals. Micromedex® was used as a source of potential drug-drug interactions data. Subsequently, each interaction's prevalence, severity and evidence level were estimated. Additionally, drug-drug interaction causality with regard to diverse clinical outcomes of hospitalized patients was determined through the Drug Interaction Probability Scale. The clinical consequences of each interaction were classified by severity. ResultsThe observed prevalence of one or more potential drug-drug interactions in hospitalized patients was 61.3% (52.2-70.4%), whilst the prevalence of real drug-drug interactions was 3.6% (0.1-7.1%). Of potential drug-drug interactions, 60.5% were considered major and only 5.1% contraindicated. These were generally more common in intensive care and burn units. The main pharmacological agents involved in potential drug-drug interactions were opioids analgesics and anti-infective and neurologic agents. Four clinically relevant drug-drug interactions required a regimen change and another prompted an extension of the patient's hospital stay. ConclusionsPotential drug-drug interactions were common in the pediatric patients studied, whereas the frequency of real drug-drug interactions was low. However, some drug-drug interactions required medical actions in addition to routine monitoring. More information is needed on real drug-drug interactions as those related to failed efficacy might be underestimated.

Terahertz Communication with MIMO-OFDM in FANETs for 6G

Background: Unmanned aerial vehicles (UAVs) are envisioned in several intelligent transport system (ITS) application fields due to their autonomous operation, mobility, and communication/processing capabilities. Methods: In order to increase performance, dependability, and customer satisfaction, wireless communications are being used for essential and noncritical services in a variety of transportation systems. Terahertz (THz) communication aims to raise the wireless communication frequency band to the terahertz level and is one of the technologies that shows the most promise in addressing needs like the exponential increase in the number of devices, the necessity for higher data rates, and the need for larger channel capacity. For meeting the demands of 5G and 6G users, the hybrid combination of multiple input multiple output (MIMO) and orthogonal frequency division multiplexing (OFDM) appears to be an excellent technology. Therefore, it is essential to investigate the performance of THz communication with MIMO-OFDM in flying ad hoc networks (FANETs) for 6G. FANETs are multi-UAV systems arranged in an ad hoc way. Results: In this paper, the performance of the THz communication with MIMO-OFDM in FANETs for 6G is evaluated. The Markov chain model-based analytical study is used to derive how parameters and performance measures relate to one another. Conclusion: The equations for path loss, outage probability, bit error rate, and throughput are attained. Moreover, numerical results are shown to justify the outcomes of the analytical studies.

Heterogeneous LoRaWan deployment for application dependent IOT networks

In this study, we present an application-dependent heterogeneous LoRa network. Previous studies on LoRaWAN and particularly studies that rely on the use of adaptive data rate to optimize the performance of the network are based purely on the path loss of the nodes in the network with the assumption that all nodes in the network have similar requirements in terms of data rate and latency. In a real-life full-scale deployment, this is unlikely to be the case as the current LoRaWAN deployment trend shows that practical implementations are service-based. This approach means that critical applications will suffer reliability issues since they will have to compete with non-critical services for the same resources. To address this problem, we propose a heterogeneous LoRaWAN that is capable of providing support for applications ranging from delay-tolerant to delay intolerant with improved reliability through preferential transmission parameter allocation. Our study shows that this approach can increase the probability of successful uplink transmission of the critical applications by up to 44 percent and for transmitting nodes within a 3 km radius of the gateway, heterogeneous LoRaWAN possesses a 20 percent higher uplink packet delivery rate in comparison with the homogeneous network at the cost of slightly higher energy consumption.

A multi-stage graph based algorithm for survivable Service Function Chain orchestration with backup resource sharing

Network softwarisation introduces flexibility in network management by enabling the deployment of network functions as software modules running on virtual machines. However, this creates new concerns for service availability and reliability due to multiple sources of failures at both software and hardware levels, potentially resulting in service degradations and penalties due to Service Level Agreement (SLA) violations. The survivability of critical services can best be guaranteed by pro-actively provisioning dedicated backup resources for these services, but at the cost of a high resource consumption. Aware of the divergent requirements of future services, a promising alternative is envisaged, allowing non-critical users to use the unused backup resources of high priority users. However, this approach poses a stringent challenge if a critical service disruption occurs, requiring the computation of a traffic rerouting solution for the non-critical requests when preempted from their borrowed resources. In this paper we first propose a generic multi-stage graph based algorithm as an alternative algorithm for Service Function Chain (SFC) deployments. Simulation results demonstrate that the proposed algorithm is optimized in terms of resource utilization, resulting in a 10% improvement in terms of acceptance ratio compared to a given state of the art algorithm, and within a 4% margin of the optimal solution. Based on the mentioned algorithm, we propose a new migration-aware algorithm for the mapping of non-critical services, enabling the non-critical services to borrow the unused backup resources from the critical services while minimizing the probability of preemption they could experience. The migration-aware algorithm results in more than an 8% resource saving, in most scenarios, compared to a dedicated backup strategy, and more than a 70% performance improvement in terms of the number of service preemptions, compared to a cost based algorithm. Additionally, whenever low priority users are preempted from their borrowed resources, we propose a new QoS-aware global-rerouting algorithm for remapping those users, reducing the impact of the service interruption thanks to avoiding the migration of surviving VNFs and virtual links when feasible. The proposed algorithm is shown to outperform a service restoration strategy based on local rerouting, in terms of successful service restoration and resource consumption.

Report highlights pharmacists' contributions during the pandemic

Medication therapy management, self-care recommendations, point-of-care testing, and administration of vaccinations are some of the critical contributions community pharmacists have made during the COVID-19 pandemic, according to a recent report featured in CDC's journal Preventing Chronic Disease. “The physical proximity and constant presence of the community pharmacist during the COVID-19 pandemic has been a tremendous resource to communities,” said Mark A. Strand, PhD, CPH, professor of pharmacy practice and master of public health program at North Dakota State University, and lead author of the recent publication. “Pharmacists have ensured patients have access to their medications, and their importance will only increase as CLIA-waived point-of-care testing for SARS-CoV-2 ramps up and eventually as more than 100 million doses of a vaccine need to be administered.” The report highlighted the opportunity pharmacists have in addressing racial and ethnic disparities in health care delivery during the pandemic. The coronavirus has disproportionally affected minority populations, resulting in exponentially higher mortality rates as the prevalence of comorbidities (e.g., hypertension, diabetes, respiratory diseases), as well as preexisting racial and socioeconomic inequalities in health care access, are higher in these groups. In the report, Strand and colleagues pointed out how pharmacies located close to at-risk populations have been able to ensure individuals in these communities have access to essential medications via curbside pickup, larger refill quantities, and home deliveries. When many health care organizations restricted patient access to noncritical services in the early stages of the pandemic, most pharmacies remained open and supported patients, the authors noted. Pharmacists also educated patients about the risks of COVID-19 and the measures they could take to protect themselves. Community pharmacists are experienced in providing point-of-care testing, with more than 10,000 pharmacies already providing CLIA-waived tests for influenza, streptococcal pharyngitis, and chronic diseases (glucose, lipids, etc.). Strand and colleagues said that community pharmacists can play a key role in COVID-19 testing, which will help provide ongoing surveillance to communities. Increased access to testing will lead to early detection, and quarantine of detected patients will help reduce transmission. The authors wrote that the U.S. Department of Health and Human Services has authorized all pharmacists to provide these COVID-19 services and that CMS is reimbursing pharmacies for COVID-19 testing. The authors also highlighted the important role pharmacists have in not only helping patients stay up to date on recommended vaccinations, but also the impact they will have in the large-scale administration of the SARS-CoV-2 vaccine once it becomes available. Pharmacists are well-equipped to provide numerous interventions during the COVID-19 pandemic (see sidebar) and have an opportunity to make a substantial impact on public health. In the report, Strand and colleagues discussed how a deeper integration of pharmacy within the public health infrastructure is needed. Since pharmacies are likely to be located near acute and chronic disease hotspots and have real-time communication links to public health and primary care authorities, pharmacists can play a role in helping public health leaders detect and prepare for surges of known and novel diseases. Pharmacist interventions during the pandemic□Disease self-care and support□Medication therapy review□Medication monitoring •Provide appropriate preventative medications•Address any access issues□Patient education •Medications, vaccinations, and COVID-19 disease□Point-of-care testing •COVID-19 testing•Screening for acute and chronic diseases□Vaccinations •All appropriate vaccine-preventable diseases•SARS-CoV-2 vaccine once availableAdapted from Prev Chronic Dis. 2020;17:200317. □Disease self-care and support□Medication therapy review□Medication monitoring •Provide appropriate preventative medications•Address any access issues□Patient education •Medications, vaccinations, and COVID-19 disease□Point-of-care testing •COVID-19 testing•Screening for acute and chronic diseases□Vaccinations •All appropriate vaccine-preventable diseases•SARS-CoV-2 vaccine once available Adapted from Prev Chronic Dis. 2020;17:200317. “I am a strong advocate for intersectoral collaboration, so pharmacy managers should be present at the public health table during this time,” said Strand. “They should be advocating for full utilization and financial support for community pharmacies, which includes a Test-Treat-Immunize model, where they can conduct and interpret tests, initiate treatment in collaborative practice agreements, and administer all FDA-approved vaccines.”

Supporting cardiac patients during the COVID-19 pandemic

Supporting cardiac patients during the COVID-19 pandemic

Radio Communication in Curved Tunnels: MIMO Channel Capacity for Rail Transit Applications

The rail transportation industry has seen a growing interest in the use of radio-access technology (RAT) for critical and noncritical services to improve safety/reliability, performance, and passenger experience. There is a practical incentive to investigate how to improve wayside-onboard wireless channel throughput and transmission reliability to address the different requirements of data transmission. To this end, during the past two decades, the theory and practice of multiple-input/multiple-output (MIMO) communications has solidified to the point where MIMO is now the main infrastructure for several legacy and emerging radioaccess standards.

Disease-related malnutrition in hospitalized chronic patients with complex needs

Disease-related malnutrition is a prevalent condition that can be associated with multimorbidity. The purposes of this study were to assess the prevalence of disease-related malnutrition in a cohort of chronic patients with complex needs (CPCN) admitted to two University hospitals, and to evaluate the impact of malnutrition in their hospitalization outcomes. All CPCN admitted on a previously agreed day in non-critical services of two University hospitals in Catalonia were included. Nutritional risk was evaluated with Mini-Nutritional Assessment Tool and Nutritional Risk Screening 2002. Hospitalization outcome data were evaluated, including length of the hospital stay, mortality during admission and placement when discharged. After five months, a new evaluation was performed to assess mortality and readmissions. A total of 101 patients were included, 83% of which were at nutritional risk when screened with NRS-2002; when using MNA, 86% of them were found to be either at nutritional risk or malnourished. Malnourished patients had a greater need for home care/intermediate care hospital at discharge (41.8% vs 22.9%, p<0.01), and a higher mortality rate during admission (16.7% vs 1.6%, p<0.01). Mortality at 5 months was also higher in the malnourished group (30.5% vs 9.8%, p<0.01). Factors associated with malnutrition were BMI and gender (malnutrition was more prevalent in women). In our cohort, malnutrition was the sole independent predictor of mortality at 5 months. The prevalence of both malnutrition and risk of malnutrition is very high in hospital-admitted CPCN, and has a profound impact on placement at discharge and mortality. This high prevalence is not explained by the multimorbidity pattern. Other factors need to be evaluated in this group of high-need, high-cost patients.

Guest Editorial Ultra-Reliable Low-Latency Communications in Wireless Networks

Ultra-high reliability and low latency have not been in the mainstream in most wireless networks. Mobile networks have been driven so far by human-centric communications, delay-tolerant content, and non-critical services. The main target have been to boosting data rate and increasing coverage, adopting a rather best-effort networking approach. As wireless connectivity starts to get the status of a commodity, there is an increasing focus on support of services that rely critically on wireless links and therefore the reliability of the wireless connections. Next generation wireless systems, mainly 5G and beyond, are designed to provide wireless connectivity for massive machine-type communications (mMTC) and to support ultra-reliable, low latency communication (URLLC) for mission-critical services. URLLC scenarios impose stringent requirements in terms of latency (ranging from 1 ms and below to few milliseconds end-to-end latency depending on the use cases) and reliability (higher than 99.9999%). This does not mean that there are interesting applications where reliability is of paramount importance, while latency can be in the order of seconds, as in e.g. certain remote healthcare applications. Nevertheless, the coupling of low-latency networking and reliable communication is mainly driven by the need to push the technology boundaries and address a plethora of socially useful services and business domains that could benefit greatly from it. Some of the most challenging use cases are factory automation and industrial control, automated driving/flying, haptic communications, and real-time remote healthcare. URLLC is also expected to revolutionize processes in the areas of smart cities, smart farming, smart grid, remote manufacturing, and algorithmic trading. Although the URLLC constraints and the nature of real-time mission-critical applications imply the predominance of short packets and low-rate transmissions, future evolution of URLLC may also consider rate requirements. The emergence of immersive services, such as augmented and virtual reality (AR/VR), high-definition entertainment and gaming, and consumer robotics, calls for real-time, high-fidelity, broadband networks operating at latencies of few milliseconds.

If it is easy to remember, then it is not secure: Metacognitive beliefs affect password selection

SummaryIn this research, we applied current theories of metacognition to study computer security and tested the idea that users' password selection is affected by the metacognitive belief that if a password is memorable, then it is not secure. In two experiments, different types of eight‐character passwords and longer, more secure sentences were presented. Participants rated perceived memorability and perceived security of the passwords and indicated whether they would use them in a critical and in a noncritical service. The results confirmed the belief. Sentences that are in fact highly secure and perceived as highly memorable were also perceived as weak passwords. The belief strongly affected password selection for critical services, but it had no effect on noncritical services. In sum, long sentences are a particularly interesting type of password because they meet both security and memorability criteria, but their use is limited by a false belief.

Wireless Communications in Smart Rail Transportation Systems

Railway, subway, airplane, and other transportation systems have drawn an increasing interest on the use of wireless communications for critical and noncritical services to improve performance, reliability, and passengers experience. Smart transportation systems require the use of critical communications for operation and control, and wideband services can be provided using noncritical communications. High speed train (HST) is one of the best test cases for the analysis of communication links and specification of the general requirements for train control and supervision, passenger communications, and onboard and infrastructure wireless sensors. In this paper, we analyze in detail critical and noncritical networks mainly using the HST as a test case. First, the different types of links for smart rail transportation are described, specifying the main requirements of the transportation systems, communications, and their applications for different services. Then, we propose a network architecture and requirements of the communication technologies for critical and noncritical data. Finally, an analysis is made for the future technologies, including the fifth-generation (5G) communications, millimeter wave (mmWave), terahertz (THz), and satellites for critical and high-capacity communications in transportation.

Dynamic Map and Diffserv Based AR Selection for Handoff in HMIPv6 Networks

In HMIPv6 Networks, most of the existing handoff decision mechanisms deal mainly with the selection of Mobility Anchor Point (MAP), ignoring the selection of access router (AR) under each MAP. In this paper, we propose a new mechanism called “Dynamic MAP and Diffserv based ARs selection for Handoff in HMIPv6 networks” and it deals with selecting the MAP as well as ARs. MAP will be selected dynamically by checking load, session mobility ratio (SMR), Binding update cost and Location Rate. After selecting the best MAP, the Diffserv approach is used to select the AR under the MAP, based on its resource availability. The AR is implemented at the edge router of Diffserv. DiffServ can be used to provide low-latency to critical network traffic such as voice or streaming media while providing simple best-effort service to non-critical services such as web traffic or file transfers. By using this mechanism, we can assure that better resource utilization and throughput can be attained during Handoff in HMIPv6 networks. .

Interpreting Patterns of Public Service Utilization in Rural Areas

Public service provision in rural areas is an important focus of research in geography and in related disciplines, but studies to date have been hampered by the paucity of theory on public service utilization. This paper synthesizes existing theory within a conceptual framework and evaluates its major components using a Canadian data set. The case study substantiates elements of both aggregate and behavioral conceptualizations. However, a fuller understanding of revealed relationships is forthcoming only when the two conceptualizations and the links between them (especially “action space”) are considered together. In addition, the results underline the importance of discriminating between critical and non-critical services and between use of service and use of facility.