Search Results (32)

Efficient and intelligent spectrum access is crucial for meeting the diverse Quality of Service (QoS) demands of Vehicular Internet of Things (V-IoT) systems in next-generation cellular networks. This work proposes a novel reinforcement learning (RL)-based priority-aware spectrum management (RL-PASM) framework, a centralized self-learning priority-aware spectrum management framework operating through Roadside Units (RSUs). RL-PASM dynamically allocates spectrum resources across three traffic classes: high-priority (HP), low-priority (LP), and best-effort (BE), utilizing reinforcement learning (RL). This work compares four RL algorithms: Q-Learning, Double Q-Learning, Deep Q-Network (DQN), and Actor-Critic (AC) methods. The environment is modeled as a discrete-time Markov Decision Process (MDP), and a context-sensitive reward function guides fairness-preserving decisions for access, preemption, coexistence, and hand-off. Extensive simulations conducted under realistic vehicular load conditions evaluate the performance across key metrics, including throughput, delay, energy efficiency, fairness, blocking, and interruption probability. Unlike prior approaches, RL-PASM introduces a unified multi-objective reward formulation and centralized RSU-based control to support adaptive priority-aware access for dynamic vehicular environments. Simulation results confirm that RL-PASM balances throughput, latency, fairness, and energy efficiency, demonstrating its suitability for scalable and resource-constrained deployments. The results also demonstrate that DQN achieves the highest average throughput, followed by vanilla QL. DQL and AC maintain fairness at high levels and low average interruption probability. QL demonstrates the lowest average delay and the highest energy efficiency, making it a suitable candidate for edge-constrained vehicular deployments. Selecting the appropriate RL method, RL-PASM offers a robust and adaptable solution for scalable, intelligent, and priority-aware spectrum access in vehicular communication infrastructures. Full article

Background: Patient safety culture (PSC) is a fundamental aspect of healthcare that significantly impacts care quality and patient outcomes. Examining PSC is vital for identifying areas of improvement and implementing effective, targeted interventions. Objective: This study aimed to evaluate trends in PSC across U.S. hospitals to identify strengths and weaknesses in PSC over time. Methodology: A retrospective descriptive analysis was performed using the Hospital Survey on Patient Safety Culture version 1.0 (HSOPSC 1.0) comparative dataset. This study comprised responses from 1601 hospitals and over 993,000 healthcare providers. Twelve dimensions of PSC, reporting events, and safety grade were analyzed using descriptive statistics to evaluate variations in several indicators, such as means and average positive, negative, and neutral response percentages, across different PSC dimensions and hospital characteristics over time. Considering this study’s exploratory nature, no corrections for multiple testing were applied. Results: The overall PSC scores averaged 65% across years, declining from 67% in 2013 to 64% in 2020, reflecting a moderately positive perception of PSC over time. Key strengths across all years included “Supervisor/Manager Expectations” and “Teamwork within Units”, while persistent weaknesses were observed in “Nonpunitive Response to Error” and “Handoffs and Transitions”. Hospitals in the Southern and Central regions reported the highest positive perceptions. Smaller hospitals and non-teaching hospitals also reported more positive perceptions of PSC. Conclusions: This study underscores the complexities of enhancing PSC and, more importantly, the challenges of sustaining a consistently positive culture over time. The findings highlight the importance of ongoing monitoring and tailored interventions to improve PSC. Promoting a “Just Culture” that prioritizes learning from errors is critical for advancing patient safety in healthcare settings, and enhancing reporting systems is required. Full article

Background/Objectives: Among the factors contributing to medical errors and misdiagnosis, patient handoffs play a significant role. The negative impact of handoffs includes miscommunications, omissions, and information loss. Patient handoffs are inherent to emergency department (ED) patient care and are recognized as high-risk events. The aim of this study was to use a mixed-methods approach, incorporating a retrospective chart review and qualitative analysis, to understand emergency physicians’ perceptions of handoffs, including their impact on patient safety, patient flow, and patient satisfaction, as well as the strategies employed to manage handoffs and their perceived efficacy. Methods: A seven-question online survey was distributed to 120 attending ED physicians employed across a large academic health system comprising six hospitals. Additionally, a 3-year retrospective chart review provided insights into avoidable handoffs in the ED. Results: The survey responses showed that 69% of physicians believed that handoffs reduced patient safety, 55% felt that they reduced patient satisfaction, and 66% perceived them as contributing to longer patient stays. Additionally, 86% of physicians preferred to hand off no more than two patients, while 79% preferred to receive no more than two. Thematic content analysis identified key factors influencing physician preferences, including ownership, patient safety, patient flow, cooperation and colleagueship, and the challenges of continuing workups. To minimize handoffs, ED physicians primarily reported strategies such as staying late after shifts, restricting patient signups, and planning patient disposition toward the end of their shifts. Lastly, retrospective data analysis suggested that implementing one-hour overlapping shifts and restricting patient signups could reduce ED handoffs by 30%. Conclusions: ED physicians perceive handoffs as affecting patient safety, patient satisfaction, and patient flow negatively and prefer fewer handoffs. Overlapping shifts and selective patient signup strategies may reduce handoffs. Full article

Background: ISO certification is widely implemented as a quality assurance tool in healthcare services; however, its impact on patient safety culture (PSC) in public hospitals remains insufficiently explored. Aim: This study aims to assess the effect of ISO certification procedures on different dimensions of PSC in public hospital departments by comparing ISO-certified and non-certified departments across two phases (Phase A: pre-certification; Phase B: 18 months post-certification). Methods: A two-phase cross-sectional study was conducted in a tertiary public hospital in Greece. Healthcare professionals from both ISO-certified and non-certified departments participated. The Hospital Survey on Patient Safety Culture (HSOPSC v1.0) was administered at two time points (Phase A: baseline, pre-certification; Phase B: 18 months post-certification). A repeated measures analysis was performed to assess the changes over time and differences between the two groups. Results: The findings suggest that ISO certification has a mixed impact on the PSC dimensions. A significant improvement was observed in “Supervisor’s/Manager’s Expectations and Actions Promoting Safety” (p = 0.012), while “Teamwork Within Units” (p = 0.026) and “Handoffs and Transitions” (p = 0.037) showed statistically significant changes. These results indicate that certification may enhance structured managerial oversight and interdepartmental collaboration, but at the same time, may negatively impact the teamwork within hospital units. However, no statistically significant changes were observed in “Overall Perception of Safety” (p = 0.135) and “Non-Punitive Response to Error” (p = 0.101), suggesting that while there was a trend towards a stricter safety evaluation, this was not statistically confirmed. Additionally, the staffing perceptions remained unchanged (p = 0.745). Conclusions: ISO certification appears to reinforce managerial safety expectations and interdepartmental teamwork, yet does not significantly improve the overall perceptions of patient safety or non-punitive error responses. The results indicate the need for targeted interventions to ensure that certification processes do not increase administrative burdens or negatively impact staff perceptions. Future research should explore whether these effects persist over time and how hospitals can optimize certification processes to strengthen PSC without unintended consequences. Full article

The proposed novel algorithm named decision-making algorithm with geographic mobility (DMAGM) includes detailed analysis of decision-making for cognitive radio (CR) that considers a multivariable algorithm with geographic mobility (GM). Scarce research work considers the analysis of GM in depth, even though it plays a crucial role to improve communication performance. The DMAGM considerably reduces latency in order to accurately determine the best communication channels and includes GM analysis, which is not addressed in other algorithms found in the literature. The DMAGM was evaluated and validated by simulating a cognitive radio network that comprises a base station (BS), primary users (PUs), and CRs considering random arrivals and disappearance of mobile devices. The proposed algorithm exhibits better performance, through the reduction in latency and computational complexity, than other algorithms used for comparison using 200 channel tests per simulation. The DMAGM significantly reduces the decision-making process from 12.77% to 94.27% compared with ATDDiM, FAHP, AHP, and Dijkstra algorithms in terms of latency reduction. An improved version of the DMAGM is also proposed where feedback of the output is incorporated. This version is named feedback-decision-making algorithm with geographic mobility (FDMAGM), and it shows that a feedback system has the advantage of being able to continually adjust and adapt based on the feedback received. In addition, the feedback version helps to identify and correct problems, which can be beneficial in situations where the quality of communication is critical. Despite the fact that the FDMAGM may take longer than the DMAGM to calculate the best communication channel, constant feedback improves efficiency and effectiveness over time. Both the DMAGM and the FDMAGM improve performance in practical scenarios, the former in terms of latency and the latter in terms of accuracy and stability. Full article

Named Data Networking (NDN) has emerged as a promising architecture to overcome the limitations of the conventional Internet Protocol (IP) architecture, particularly in terms of mobility, security, and data availability. However, despite the advantages it offers, producer mobility management remains a significant challenge for NDN, especially for moving vehicles and emerging technologies such as Unmanned Aerial Vehicles (UAVs), known for their high-speed and unpredictable movements, which makes it difficult for NDN to maintain seamless communication. To solve this mobility problem, we propose a Distributed Mobility Management Scheme (DMMS) to support UAV mobility and ensure low-latency content delivery in NDN architecture. DMMS utilizes decentralized Anchors to forward proactively the consumer’s Interest packets toward the producer’s predicted location when handoff occurs. Moreover, it introduces a new forwarding approach that combines the standard and location-based forwarding strategy to improve forwarding efficiency under producer mobility without changing the network structure. Using a realistic scenario, DMMS is evaluated and compared against two well-known solutions, namely MAP-ME and Kite, using the ndnSIM simulations. We demonstrate that DMMS achieves better results compared to Kite and MAP-ME solutions in terms of network cost and consumer quality-of-service metrics. Full article

Handoff mechanisms are very important in fifth-generation (5G) mobile networks because of the cellular architecture employed to maximize spectrum utilization. Together with call admission control (CAC) mechanisms, they enable better optimization of bandwidth use. The primary objective of the research presented in this article is to analyze traffic levels, aiming to optimize traffic management and handling. This article considers the two most popular CAC mechanisms: the resource reservation mechanism and the threshold mechanism. It presents an analytical approach to occupancy distribution and blocking probability calculation in 5G mobile networks, incorporating connection handoff and CAC mechanisms for managing multiple traffic streams generated by multi-service sources. Due to the fact that the developed analytical model is an approximate model, its accuracy was also examined. For this purpose, the results of analytical calculations of the blocking probability in a group of 5G cells are compared with the simulation data. This paper is an extended version of our paper published in 17th ConTEL 2023. Full article

(1) Background: Although numerous studies related to communication in a nursing context have been conducted, there is a lack of research considering the effects of personal and organisational communication factors on the self-efficacy for handoffs. This study aimed to identify the impact of communication competence and intra-organisational communication satisfaction on self-efficacy for handoffs among nurses. (2) Methods: This cross-sectional research was conducted between September and October 2018. In total, 203 registered nurses were invited to participate in the study by convenience sampling from five general hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson’s correlation coefficients, and multiple regression analysis. (3) Results: In the final regression model, the adjusted R square was significant, explaining 24.2% of the variance in self-efficacy for handoffs (F = 22.43, p = 0.001) when the variable horizontal communication (β = 0.282, p < 0.001) was included in intra-organisational communication satisfaction. In addition, the longer the nurse’s experience in the current unit and the higher the communication competence, the more statistically significant the self-efficacy for handoffs was found to be (β = 0.215, p = 0.001 and β = 0.180, p = 0.008). (4) Conclusions: To enhance the self-efficacy for handoffs, nurse managers should foster an atmosphere that allows their staff nurses to interact freely and establish specific guidelines for handoffs through mutual communication. Full article

Background: The utilization of neoadjuvant chemotherapy (NAC) remains highly variable in clinical practice. The implementation of NAC requires coordination of handoffs between a multidisciplinary team (MDT). This study aims to assess the outcomes of an MDT in the management of early-stage breast cancer patients undergoing neoadjuvant chemotherapy at a community cancer center. Methods: We conducted a retrospective case series on patients receiving NAC for early-stage operable or locally advanced breast cancer coordinated by an MDT. Outcomes of interest included the rate of downstaging of cancer in the breast and axilla, time from biopsy to NAC, time from completion of NAC to surgery, and time from surgery to radiation therapy (RT). Results: Ninety-four patients underwent NAC; 84% were White and mean age was 56.5 yrs. Of them, 87 (92.5%) had clinical stage II or III cancer, and 43 (45.8%) had positive lymph nodes. Thirty-nine patients (42.9%) were triple negative, 28 (30.8%) were human epidermal growth factor receptor (HER-2)+, and 24 (26.2%) were estrogen receptor (ER) +HER-2−. Of 91 patients, 23 (25.3%) achieved pCR; 84 patients (91.4%) had downstaging of the breast tumor, and 30 (33%) had axillary downstaging. The median time from diagnosis to NAC was 37.5 days, the time from completion of NAC to surgery was 29 days, and the time from surgery to RT was 49.5 days. Conclusions: Our MDT provided timely, coordinated, and consistent care for patients with early-stage breast cancer undergoing NAC as evidenced by time to treatment outcomes consistent with recommended national trends. Full article

The internet’s future architecture, known as Named Data Networking (NDN), is a creative way to offer content-based services. NDN is more appropriate for content distribution because of its special characteristics, such as naming conventions for packets and methods for in-network caching. Mobility is one of the main study areas for this innovative internet architecture. The software-defined networking (SDN) method, which is employed to provide mobility management in NDN, is one of the feasible strategies. Decoupling the network control plane from the data plane creates an improved programmable platform and makes it possible for outside applications to specify how a network behaves. The SDN is a straightforward and scalable network due to its key characteristics, including programmability, flexibility, and decentralized control. To address the problem of consumer mobility, we proposed an efficient SDPCACM (software-defined proactive caching architecture for consumer mobility) in NDN that extends the SDN model to allow mobility control for the NDN architecture (NDNA), through which the MC (mobile consumer) receives the data proactively after handover while the MC is moving. When an MC is watching a real-time video in a state of mobility and changing their position from one attachment point to another, the controllers in the SDN preserve the network layout and topology as well as link metrics to transfer updated routes with the occurrence of the handoff or handover scenario, and through the proactive caching mechanism, the previous access router proactively sends the desired packets to the new connected routers. Furthermore, the intra-domain and inter-domain handover processing situations in the SDPCACM for NDNA are described here in detail. Moreover, we conduct a simulation of the proposed SDPCACM for NDN that offers an illustrative methodology and parameter configuration for virtual machines (VMs), OpenFlow switches, and an ODL controller. The simulation result demonstrates that the proposed scheme has significant improvements in terms of CPU usage, reduced delay time, jitter, throughput, and packet loss ratio. Full article

Software-defined networking (SDN) is an evolving technology providing proper segregation between the control part and data-forwarding domain of network devices. The expansion of the Internet of Things (IoTs) and embedded mobile devices increases the volume of traffic at the network backbone and causes processing costs in the control plane. This directly affects the Ternary Content Addressable Memory (TCAM) of the switches because insufficient space makes it more challenging to manage the flow-entries. In this situation, providing services to specific users who newly authenticate after the successful handoff from the previous SDN domain is challenging. This paper proposes a method for implanting the users’ primary domain’s flow-rules in the serving SDN domain. As the TCAM is already suffering from a short space, it is hard to handle the flow-tables of multiple SDN domains in limited TCAM storage. The SDN-based Integration of the Interdomain Flow-rule in the SDN (IIF-SDN) scheme maximizes the proficiency of the switches by effectively storing flow-table and flow-entries. The effectiveness of the proposed scheme is benchmarked with proactive and reactive SDN approaches. Full article

At our institution, we observed inconsistency in the application of structural facilitators for interprofessional teamwork such as handoffs and communication of contingency planning, complete formation and engagement of teams on interprofessional rounds, regular situation monitoring, interprofessional huddles, use of “check back” during code situations, and standard debriefings after codes and procedures (TeamSTEPPS^®). To enhance team performance, we piloted TeamSTEPPS^® training and reinforcement for all healthcare team members in the medical intensive care unit (MICU), inclusive of trainees, advanced practice providers (APPs), nurses, and respiratory therapists rotating through the unit. Seven months after the training launch, the initial COVID-19 surge interrupted the reinforcement stage of the pilot providing an opportunity to study the retention of TeamSTEPPS^® principles and its potential role in response to a crisis. We conducted interprofessional focus groups after a year of crisis management during the pandemic. Themes revealed how TeamSTEPPS^® training impacted teamwork and communication, as well as factors that influenced the use of TeamSTEPPS^®. This work points to the value of team training in unexpected scenarios. Additional studies at multiple sites are needed to determine scalability for all MICU teams or for onboarding new team members. Full article

A cognitive radio network (CRN) is an intelligent network that can detect unoccupied spectrum space without interfering with the primary user (PU). Spectrum scarcity arises due to the stable channel allocation, which the CRN handles. Spectrum handoff management is a critical problem that must be addressed in the CRN to ensure indefinite connection and profitable use of unallocated spectrum space for secondary users (SUs). Spectrum handoff (SHO) has some disadvantages, i.e., communication delay and power consumption. To overcome these drawbacks, a reduction in handoff should be a priority. This study proposes the use of dynamic spectrum access (DSA) to check for available channels for SU during handoff using a metaheuristic algorithm depending on machine learning. The simulation results show that the proposed “support vector machine-based red deer algorithm” (SVM-RDA) is resilient and has low complexity. The suggested algorithm’s experimental setup offers several handoffs, unsuccessful handoffs, handoff delay, throughput, signal-to-noise ratio (SNR), SU bandwidth, and total spectrum bandwidth. This study provides an improved system performance during SHO. The inferred technique anticipates handoff delay and minimizes the handoff numbers. The results show that the recommended method is better at making predictions with fewer handoffs compared to the other three. Full article

Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient’s bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers. Full article

In view of the shortage of medical staff, the quality and continuity of care may be improved by employing advanced practice providers (APPs). This study aims to assess the quality of these APPs in critical care. In a large teaching hospital, rapid response team (RRT) interventions led by APPs were assessed by independent observers and intensivists and compared to those led by medical residents MRs. In addition to mortality, the MAELOR tool (assessment of RRT intervention), time from RRT call until arrival at the scene and time until completion of clinical investigations were assessed. Process outcomes were assessed with the crisis management skills checklist, the Ottawa global rating scale and the Mayo high-performance teamwork scale. The intensivists assessed performance with the handoff CEX recipient scale. Mortality, MAELOR tool, time until arrival and clinical investigation in both groups were the same. Process outcomes and performance observer scores were also equal. The CEX recipient scores, however, showed differences between MRs and APPs that increased with experience. Experienced APPs had significantly better situational awareness, better organization, better evaluations and better judgment than MRs with equal experience (p < 0.05). This study shows that APPs perform well in leading an RRT and may provide added quality over a resident. RRTs should seriously consider the deployment of APPs instead of junior clinicians. Full article