Quantity and Quality of Healthcare Professionals, Transfer Delay and In-Hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China

Background Transfer delay provokes prolongation of prehospital time, which contributes to treatment delay that endangers patients with ST-segment elevation myocardial infarction (STEMI). A key constraint in reducing transfer delay is the shortage of emergency healthcare workers. This study was to explore the influence of the quality and quantity of healthcare professionals at emergency medical stations on transfer delay and in-hospital mortality among STEMI patients. Methods A cross-sectional study using mixed methods was conducted at 89 emergency stations in 9 districts in China’s Shenzhen province. Based on a sample of 31 hospitals, 1255 healthcare professionals, and 3131 patients with STEMI, a generalized linear model was used to explore the associations between the quality and quantity of healthcare professionals and transfer delay and in-hospital mortality among STEMI patients. Qualitative data were collected and analyzed to explore the reasons for the lack of qualified healthcare professionals at emergency medical stations. Results The analysis of the quantity of healthcare professionals showed that an increase of one physician per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 5.087 min (95% CI − 6.722, − 3.452; P < 0.001). An increase of one nurse per 100,000 individuals was associated with decreased transfer delay by 1.471 min (95% CI − 2.943, 0.002; P = 0.050). Analysis of the quality of healthcare professionals showed that an increase of one physician with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 8.508 min (95% CI − 10.457, − 6.558; P < 0.001). An increase of one nurse with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay by 6.645 min (95% CI − 8.218, − 5.072; P < 0.001). Qualitative analysis illustrated that the main reasons for low satisfaction of healthcare professionals at emergency medical stations included low income, limited promotion opportunities, and poor working environment. Conclusions The quantity and quality of emergency healthcare professionals are key factors influencing transfer delay in STEMI patients. The government should increase the quantity of healthcare professionals at emergency medical stations, strengthen the training, and improve their performance by linking with clinical pathways to enhance job enthusiasm among emergency healthcare professionals.

A Network Slicing Framework for UAV-Aided Vehicular Networks

In a fifth generation (5G) vehicular network architecture, several point of access (PoA) types, including both road side units (RSUs) and aerial relay nodes (ARNs), can be leveraged to undertake the service of an increasing number of vehicular users. In such an architecture, the application of efficient resource allocation schemes is indispensable. In this direction, this paper describes a network slicing scheme for 5G vehicular networks that aims to optimize the performance of modern network services. The proposed architecture consists of ground RSUs and unmanned aerial vehicles (UAVs) acting as ARNs enabling the communication between ground vehicular nodes and providing additional communication resources. Both RSUs and ARNs implement the LTE vehicle-to-everything (LTE-V2X) technology, while the position of each ARN is optimized by applying a fuzzy multi-attribute decision-making (fuzzy MADM) technique. With regard to the proposed network architecture, each RSU maintains a local virtual resource pool (LVRP) which contains local RBs (LRBs) and shared RBs (SRBs), while an SDN controller maintains a virtual resource pool (VRP), where the SRBs of the RSUs are stored. In addition, each ARN maintains its own resource blocks (RBs). For users connected to the RSUs, if the remaining RBs of the current RSU can satisfy the predefined threshold value, the LRBs of the RSU are allocated to user services. On the contrary, if the remaining RBs of the current RSU cannot satisfy the threshold, extra RBs from the VRP are allocated to user services. Similarly, for users connected to ARNs, the satisfaction grade of each user service is monitored considering both the QoS and the signal-to-noise plus interference (SINR) factors. If the satisfaction grade is higher than the predefined threshold value, the service requirements can be satisfied by the remaining RBs of the ARN. On the contrary, if the estimated satisfaction grade is lower than the predefined threshold value, the ARN borrows extra RBs from the LVRP of the corresponding RSU to achieve the required satisfaction grade. Performance evaluation shows that the suggested method optimizes the resource allocation and improves the performance of the offered services in terms of throughput, packet transfer delay, jitter and packet loss ratio, since the use of ARNs that obtain optimal positions improves the channel conditions observed from each vehicular user.

Quantity and Quality of Healthcare Professionals, Transfer Delay and In-hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China

Background: The purpose of the present study was to explore the influence of the quality and quantity of healthcare professionals at emergency medical stations on transfer delay and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI).Methods: A cross-sectional study using mixed methods was conducted at 89 emergency stations in 9 districts in China’s Shenzhen province. Based on a sample of 31 hospitals, 1255 healthcare professionals, and 3131 patients with STEMI, a generalized linear model was used to explore the associations between the quality and quantity of healthcare professionals and transfer delay and in-hospital mortality among patients with STEMI. Qualitative data were also collected and analyzed to explore the reasons for the lack of quantity and quality of healthcare professionals at emergency medical stations.Results: The analysis of the quantity of healthcare professionals showed that an increase of one physician per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 5.087 min (95% CI −6.722, −3.452; P<0.001). An increase of one nurse per 100,000 individuals was associated with decreased transfer delay by 1.471 min (95% CI −2.943, 0.002; P=0.050). Analysis of the quality of healthcare professionals showed that an increase of one physician with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 8.508 min (95% CI −10.457, −6.558; P<0.001). An increase of one nurse with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay by 6.645 min (95% CI −8.218, −5.072; P<0.001). Qualitative analysis illustrated that the main reasons for low satisfaction of healthcare professionals at emergency medical stations included low income, limited promotion opportunities, and poor working environment.Conclusions: The quantity and quality of emergency healthcare professionals are key factors influencing transfer delay in patients with STEMI. The government should increase the quantity of healthcare professionals at emergency medical stations, strengthen the training, and improve their performance by linking with clinical pathways to enhance job enthusiasm among emergency healthcare professionals.

Enabling Reliable UAV Control by Utilizing Multiple Protocols and Paths for Transmitting Duplicated Control Packets

In the last ten years, supported by the advances in technologies for unmanned aerial vehicles (UAVs), UAVs have developed rapidly and are utilized for a wide range of applications. To operate UAVs safely, by exchanging control packets continuously, operators should be able to monitor UAVs in real-time and deal with any problems immediately. However, due to any networking problems or unstable wireless communications, control packets can be lost or transmissions can be delayed, which causes the unstable drone control. To overcome this limitation, in this paper, we propose MuTran for enabling reliable UAV control. MuTran considers the packet type and duplicates only control packets, not data packets. After that, MuTran transmits the original and duplicate packets through multiple protocols and paths to improve the reliability of control packet transmissions. We designed MuTran and conducted a lot of theoretical analyses to demonstrate the validity of MuTran and analyze it from various aspects. We implemented MuTran on real devices and evaluated MuTran using the devices. We conducted experiments to verify the limitations of the existing systems and demonstrate that control packets can be transmitted more stably by using MuTran. Through the analysis and experimental results, we confirmed that MuTran reduces the control packet transfer delay, which improves the reliability and stability of controlling UAVs.

Embedding the three pass protocol messages into transmission control protocol header

<span>Transmission control protocol provides reliable communication between two or more parties. Each transmitted packet is acknowledged to make sure successful deliveries. Transport layer security protocols send security information exchange as TCP loads. As results, the handshaking stage experiences longer delay as TCP acknowledgement process has already been delay prone. Furthermore, the security message transfers may have their own risks as they are not well protected yet. This paper proposes TCP-embedded three pass protocol for dynamic key exchange. The key exchange is embedded into TCP headers so that transmission delay is reduced, and message transfer is secured. The proposed protocol was assessed on self network by using socket programming in lossless environment. The assessments showed that the proposed protocol reduced three-pass protocol message transfer delay up to 25.8% on lossless channel. The assessment on security also showed that TCP-embedded three pass protocol successfully secured each transmitted TCP load using a unique key; that is much securer than the compared method.</span>