Optimizing the Performance of Pure ALOHA for LoRa-Based ESL

(1) Background: The scientific development in the field of industrialization demands the automization of electronic shelf labels (ESLs). COVID-19 has limited the manpower responsible for the frequent updating of the ESL system. The current ESL uses QR (quick response) codes, NFC (near-field communication), and RFID (radio-frequency identification). These technologies have a short range or need more manpower. LoRa is one of the prominent contenders in this category as it provides long-range connectivity with less energy harvesting and location tracking. It uses many gateways (GWs) to transmit the same data packet to a node, which causes collision at the receiver side. The restriction of the duty cycle (DC) and dependency of acknowledgment makes it unsuitable for use by the common person. The maximum efficiency of pure ALOHA is 18.4%, while that of slotted ALOHA is 36.8%, which makes LoRa unsuitable for industrial use. It can be used for applications that need a low data rate, i.e., up to approximately 27 Kbps. The ALOHA mechanism can cause inefficiency by not eliminating fast saturation even with the increasing number of gateways. The increasing number of gateways can only improve the global performance for generating packets with Poisson law having a uniform distribution of payload of 1~51 bytes. The maximum expected channel capacity usage is similar to the pure ALOHA throughput. (2) Methods: In this paper, the improved ALOHA mechanism is used, which is based on the orthogonal combination of spreading factor (SF) and bandwidth (BW), to maximize the throughput of LoRa for ESL. The varying distances (D) of the end nodes (ENs) are arranged based on the K-means machine learning algorithm (MLA) using the parameter selection principle of ISM (industrial, scientific and medical) regulation with a 1% DC for transmission to minimize the saturation. (3) Results: The performance of the improved ALOHA degraded with the increasing number of SFs and as well ENs. However, after using K-mapping, the network changes and the different number of gateways had a greater impact on the probability of successful transmission. The saturation decreased from 57% to 1~2% by using MLA. The RSSI (Received Signal Strength Indicator) plays a key role in determining the exact position of the ENs, which helps to improve the possibility of successful transmission and synchronization at higher BW (250 kHz). In addition, a high BW has lower energy consumption than a low BW at the same DC with a double-bit rate and almost half the ToA (time on-air).

Quality indicators development and prioritisation for emergency medical call centres: a stakeholder consensus

IntroductionEmergency medical regulation is a risky activity. In France, emergency medical societies have proposed activity and performance indicators, but their lists are non-exhaustive, unstructured and used heterogeneously among emergency medical call centres (Centres de Réception et de Régulation des Appels, CRRA). Our objective was to build by means of regional stakeholder consensus an operational quality dashboard for CRRAs.MethodsWe conducted an observational step in a French CRRA from June to September 2018 and at the same time listed existing activity and quality indicators through a rapid international literature review. We adapted and classified all indicators identified in a structured table. We prioritised them from April to September 2019 by seeking consensus with one regulator physician and one medical regulation assistant from the 13 CRRAs of the largest French region. We used an adapted Delphi method with a prioritisation scale from 1 to 9.ResultsThe rapid review of literature included 33 studies among the 414 identified and, with the first observational step, resulted in a list of 360 quality indicators covering the following areas: material resources, human resources, quality approach, call handling and postcall support. 15 of the 26 members participated in the entire process. Seventy indicators were considered as priorities with strong agreement among participants. We built an operational dashboard of quality indicators deemed high priority and provided 70 descriptive indicator sheets.ConclusionOur study allowed to build an operational quality dashboard for CRRAs as a ready-to-use support for an internal audit, for prioritisation of quality approach actions and for national and international benchmarking.

Strategies to Enhance Boards of Medicine Responses to Medical Error

ABSTRACT Current models governing how boards of medicine regulate the practice of medicine rely heavily on concepts from the past. Changes in our understanding of how medical errors occur, as well as in the organization and delivery of health care, have created challenges for boards when addressing medical errors. We conducted a qualitative study to explore the principles that boards use to respond to medical errors and to identify opportunities for improvement. Twenty key informant interviews were conducted with board members and staff, followed by two focus group discussions with 16 participants who actively participate in the process of medical regulation. Our results show that the major principles guiding boards of medicine in regulation around medical errors include fairness, consistency, efficiency and transparency. Implementation of these principles proved difficult, partly because of boards’ lack of authority over health care institutions. We recommend the development of a broader array of tools for boards to use in response to medical errors. Increased efforts are also needed to strengthen communication and collaboration among boards, physicians and health care organizations. Additionally, we suggest that boards implement and report performance metrics to promote public engagement and enhance trust in them.

Desiring the restructuring of physiology laboratories for digital way of teaching: Perceptions of medical teachers in India

Objectives: The medical college curriculum in India has not seen a change for the past several years. An initiative has been taken by the Medical Council of India (MCI) in the Graduate Medical Regulation 2018 to bring a uniform change in teaching-learning methods. This change is necessary in all fields of medical education. Restructuring the physiology laboratories to teach practical procedures using digital computerised equipment and techniques could bring about deeper learning. The past several years have made physiology merely imaginative rather than experiential. Materials and Methods: A qualitative study was done using a questionnaire to obtain the perceptions of medical teachers of both genders engaged in teaching medical physiology. Desires and opinions of physiology teachers in changing the way physiology is taught were obtained. Results: Medical teachers felt that a change is necessary to provide better learning experience. More than 80% opined that computerised equipment provide better practical experience with wider understanding of the concepts which students can relate to theoretical concepts. About 85% of teachers supported the move to suggest to MCI on restructuring the laboratories with computerised equipment. More importantly, many teachers expressed that the digital laboratories would make learning very interesting, autonomous and self-directed. The study is not just a platform for opinions but is intended to prompt reflection and bring clarity to the regulatory bodies showing a way forward to change the laboratory setup urgently. Conclusion: Most of the medical teachers in India are finding it appropriate to employ digital ways in teaching Physiology to have better learning outcomes.

The Law and Politics of Registering Doctors: Lessons from New South Wales, 1937–42

Doctors who fled from Nazi-occupied and dominated Europe sought to pursue their profession wherever they could. Those who arrived in Australia confronted substantial impediments to doing so. In New South Wales (‘NSW’), doctors who represented, registered and educated the medical profession and Members of Parliament attempted to prevent ‘refugee doctors’, as they were described, from practising medicine. Due largely to protectionism and prejudice, many refugee doctors were denied registration to practise medicine irrespective of their qualifications, skills and experience, and despite the low number of refugee doctors who settled in NSW. This article focuses on the law and politics of registering the medical profession. It analyses the treatment of refugee doctors who sought to practise medicine in NSW between 1937 and 1942, and then reflects on the contemporary relevance of this episode in Australia’s history of medical regulation. The article discusses cautionary lessons we might learn from the past so that capable overseas-trained doctors to whom Australia grants refuge are permitted to practise their profession and provide valuable medical services to the community. This article also considers whether changes to the law since that time might constitute some safeguard against repetition of past discrimination.