In telecommunications in general and in GSM in particular, the handover is a feature that guarantees a smooth transition of a call from one base station - that is for the purpose of this project an antenna - to another. In the recent ten years, the amount of data traffic through mobile telecommunications has doubled annually, putting an enormous strain on the network and forcing operators to upgrade with more and more base stations and new features. Although 3G and 4G are responsible for data traffic in most countries, GSM still provides more than 80% of the coverage for mobile devices around the world. Due to the increase in data traffic, 3G and 4G need to use more and more frequencies at the expense of GSM. An optimization of the GSM network is thus vital. In this project, we research two methods to automatically choose the parameters of interest (PoI) that govern the handover feature in each cell which is, roughly speaking, the area of coverage of one antenna. In one of these methods, the choice of cell- and cell-to-cell-specific parameters has its origins in control theory while the other method is based on mathematical optimization. In the mathematical sense, our goal is to optimize the quality of service over PoIs. Extensive simulations have been run using these PoIs in order to evaluate if and how the two different methods can effectively be used in reality. Several useful insights have been gained that will provide the basis for future work. The optimization approach in particular has proved to deliver good results within the limitations of the simulated environment used for testing.

SAMMANFATTNING Överlämnandet av patienter och överrapportering är nödvändigt. Det sker under många tillfällen i vårdkedjan, exempelvis vid överlämnandet av patienter till en akutmottagning och vid skiftbyte från en sjuksköterska till en annan sjuksköterska. Syfte med studien var att undersöka sjuksköterskors upplevelser av överrapportering av patienter mellan ambulanssjukvården och akutmottagningen. Metoden var en kvalitativ intervjustudie. Två semistrukturerade intervjuer genomfördes i fokusgrupper. Informanterna var åtta stycken legitimerade sjuksköterskor från akutmottagningen och ambulanssjukvården. Intervjuerna analyserades utifrån en kvalitativ innehållsanalys. Resultatet av upplevelserna som sjuksköterskorna upplevde presenterades i fem kategorier; Kommunikation vid överrapportering, risker vid överrapportering, patientsäker överrapportering, struktur och verktyg vid överrapportering och omvårdnadsrelaterad information vid överrapportering. Sjuksköterskorna upplevde att överrapportering var en central del i deras arbete inom både ambulanssjukvården och på akutmottagningen. Stress upplevdes som en risk för att skapa brister i kommunikationen, vilket i sin tur kunde medföra negativa konsekvenser för patienten och bidra till en försämrad patientsäkerhet. Sjuksköterskorna upplevde även att en samsyn i vad som skall rapporteras och när, torde förbättra tillfället av överrapportering. Sjuksköterskorna föredrog en kort, koncis och tydlig rapport. Genom användandet av ett standardiserat verktyg för överrapportering blir det tydligare vilken information som skall ges och det bidrar det till en säkrare vård.

Made available in DSpace on 2014-06-12T16:00:39Z (GMT). No. of bitstreams: 2 arquivo6834_1.pdf: 2552234 bytes, checksum: ff18190fd071f2e26f6470e29f084e5a (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2011 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Com a crescente popularidade das redes sem fio e as tecnologias Wi-Fi (Wireless Fidelity), WiMAX (Worldwide Interoperability for Microwave Access), surgiu a necessidade de se promover uma convergência entre elas, visando oferecer ao usuário diversas oportunidades de conectividade e a possibilidade de estabelecer uma comunicação sem interrupções. Neste contexto, o trabalho tem como objetivo propor um mecanismo de seleção de rede baseado na qualidade de experiência do usuário (QoE - Quality of Experience). A partir dos resultados coletados nas simulações realizadas no Network Simulator (ns-2), foi construída uma base de dados com o histórico de valores obtidos com a métrica de Relação Sinal/Ruído (PSNR Peak Signal Noise Ratio), utilizada com o auxilio do protocolo IEEE 802.21 para a execução da tomada de decisão de handover. Dentre as contribuições deste trabalho, a principal consiste na seleção de redes heterogêneas em que a decisão de handover considera a percepção do usuário, com uso da métrica de QoE. Os resultados demonstram que a decisão de handover baseada em QoE reflete no aumento de 15 % na qualidade do vídeo

This thesis proposes a new multi-homing mobile architecture for future heterogeneous network environment. First, a new multi-homed mobile architecture called Multi Network Switching enabled Mobile IPv6 (MNS-MIP6) is proposed which enables a Mobile Node (MN) having multiple communication paths between itself and its Correspondent Node (CN) to take full advantage of being multi-homed. Multiple communication paths exist because MN, CN, or both are simultaneously attached to multiple access networks. A new sub layer is introduced within IP layer of the host’s protocol stack. A context is established between the MN and the CN. Through this context, additional IP addresses are exchanged between the two. Our MNS-MIP6 architecture allows one communication to smoothly switch from one interface/communication path to another. This switch remains transparent to other layers above IP. Second, to make communication more reliable in multi-homed mobile environments, a new failure detection and recovery mechanism called Mobile Reach ability Protocol (M-REAP) is designed within the proposed MNS-MIP6 architecture. The analysis shows that our new mechanism makes communication more reliable than the existing failure detection and recovery procedures in multi-homed mobile environments. Third, a new network selection mechanism is introduced in the proposed architecture which enables a multi-homed MN to choose the network best suited for particular application traffic. A Policy Engine is defined which takes parameters from iv the available networks, compares them according to application profiles and user preferences, and chooses the best network. The results show that in multi-homed mobile environment, load can be shared among different networks/interfaces through our proposed load sharing mechanism. Fourth, a seamless handover procedure is introduced in the system which enables multi-homed MN to seamlessly roam in a heterogeneous network environment. Layer 2 triggers are defined which assist in handover process. When Signal to Noise Ratio (SNR) on a currently used active interface becomes low, a switch is made to a different active interface. We show through mathematical and simulation analysis that our proposed scheme outperforms the existing popular handover management enhancement scheme in MIPv6 networks namely Fast Handover for MIPv6 (FMIPv6). Finally, a mechanism is introduced to allow legacy hosts to communicate with MNS-MIP6 MNs and gain the benefits of reliability, load sharing and seamless handover. The mechanism involves introducing middle boxes in CN’s network. These boxes are called Proxy-MNS boxes. Context is established between the middle boxes and a multi-homed MN.

The recent advancements in the communication area have enabled the Internet of Things, a paradigm which extends the Internet to everyday objects. The Internet of Things enables many new applications, but also comes with great challenges; effective communication under limited power supply being the perhaps most important one. This thesis presents the design, implementation, and evaluation of an energy-efficient handover algorithm for the main building block in the creation of the Internet of Things: wireless sensor networks. Our low-power handover design is based on a careful breakdown and analysis of the potential power consumption of different components of the handover process. With the scanning part of the process being identified as the main drain of energy, the algorithm is designed to place the majority of the scanning responsibility on the mains powered access points, rather than on the low-power mobile nodes. The proposed algorithm has been implemented and its functionality and low power consumption have been empirically evaluated. We show that the design can reduce the energy consumption by several orders of magnitude compared to existing handover algorithms for wireless sensor networks. In addition, interesting fading effects were discovered in a sparsely deployed network scenario with limited access point coverage; most likely due to multipath propagation. For this case the handover performance was greatly reduced, relative our more normal coverage scenario. While these results illustrate that the absolute energy savings will differ from scenario to scenario, the potential energy savings made possible by the proposed algorithm significantly reduce the battery requirements of the devices in the emerging landscape of the Internet of Things; potentially even opening the door for new devices to connect.

Vårdenheter i dagens sjukvård arbetar ofta och återkommande i överbeläggningssituationer. Detta kan innebära konsekvenser för patientsäkerheten. En litteraturstudie gjordes med granskning av 9 artiklar med syftet att belysa konsekvenser för patienter vid överbeläggningar inom somatisk slutenvård. Som största konsekvenser för patienter vid överbeläggningar identifierades brister i överrapporteringssituationer av patienternas fortsatta vård och konsekvenser av utlokalisering av patienter. För vårdpersonalen innebär utlokaliserade patienter ökade belastningar på flera nivåer, framförallt på grund av skillnader i kompetens och otillräckliga erfarenheter för att kunna tillgodose patienters omvårdnadsbehov. Kommunikationsbrist visades vara en bidragande faktor till vårdskador. Brister i basal omvårdnad kan leda till ökat lidande, förlängd vårdtid och komplikationer. Fortsatt forskning är angelägen, då det finns flera aspekter på ämnet som behöver belysas. / Health care units are frequently and repeatedly working with overcrowding situations. This can pose consequences to patient safety. A literature review was done with the review of nine articles with the aim to illuminate the consequences for patients with overcrowding wards at inpatient care units. Main consequences for patients with overcrowding wards were identified as lack of information at handoff situations regarding to the care of the patients and the consequences of the relocation of patients. Relocated patients implies increased loads on several levels for nursing staff , mainly due to differences in skills and insufficient experience to meet the care needs of patients. Lack of communication was shown to be a contributing factor to adverse events. Deficiencies in basic nursing care can lead to increased suffering, prolonged hospital stay and complications. Continued research is important, since there are several interesting aspects that need to be elucidated.

A new realm of discourse research has started examining medical interactions in the crowded space – hospitals (Iedema, 2007). Beyond clinical settings and dyadic doctor-patient interactions, scholars have begun investigating doctors’ interactions in various hospital settings including Emergency Rooms and hospitals’ wards (e.g., Eggins & Slade, 2012; Slade & Eggins, 2016; Slade et al., 2015). Other investigations have expanded this scope of discourse research to include other health professionals, such as nurses (e.g., Staples, 2015). Drawing on discourse analytic approaches (Critical Discourse Analysis, Halliday’s Systemic Functional Grammar, and Interactional Sociolinguistics), this study examined nurse-to-nurse handoff interactions in two hospitals in Saudi Arabia. Nursing handoff – the transfer of patient information, professional responsibility, and accountability between departing and incoming nursing teams (Manser et al., 2010; Riesenberg et al., 2010; Slade & Eggins, 2016; Wood et al., 2014) – is a critical communicative practice which ensures the continuity and quality of care provided to hospitalized patients. The aim of this study was to provide detailed analyses of the language used in this type of nursing discourse and its impact on the quality of handoffs. The data included 80 nursing handoff interactions, which were observed and audio-recorded in 7 different wards at two sectors (National Guard Hospital and King Fahad General Hospital) in Saudi Arabia including: Intensive Care Units, General-Adult, General- Pediatric, Oncology-Pediatric, Oncology-Palliative, ENT, Urology and Surgical wards. The nurse participants come from various cultural backgrounds including Philippines, Indonesia, India, Malaysia, Morocco, South Africa, Egypt, Jordan, and Saudi Arabia. The analyses provided a detailed description of this type of nursing discourse including the discourse pragmatic features (i.e., linguistic, interactional, and interpersonal features) which nurses use while delivering and receiving patient information. In addition, the findings provide insights into the various discourse features that contributed either positively (e.g., using discourse markers, presenting complete thoughts, presenting sufficient detailed patient information) or negatively (e.g., producing questions instead of statements, shifting verb tenses, focusing on one patient issue as opposed to providing detailed patient information report) to the nursing handoff practices in this setting. The findings also point to the vital role that head nurses play in this nursing discourse and its impact on enhancing the quality of nursing handoffs. Additionally, a six-stage nursing handoff model was developed from the data, which could be used for nursing training in the National Guard Hospital and its branches in Saudi Arabia. Finally, the findings provide further support for Eggins and Slade’s (2012) claim that communicatively effective handovers are achieved interactionally and with the collaboration of both departing and incoming teams. Furthermore, the use of standardized protocols (like SBAR) alone proved to be insufficient in guaranteeing effective nursing handoff.

This thesis proposes the use of Machine Learning (ML) to two very distinct, yet compelling, applications – predicting cardiac arrhythmia episodes and predicting base station association in 5G networks comprising of virtual cells. In the first scenario, Support Vector Machines (SVMs) are used to classify features extracted from electrocardiogram (EKG) signals. The second problem requires a different formulation departing from traditional ML classification where the objective is to partition feature space into constituent class regions. Instead, the intention here is to identify temporal patterns in unequal-length sequences. Using Recurrent Neural Networks (RNNs), it is demonstrated that accurate predictions can be made as to the base station most likely to provide connectivity for a mobile device as it moves. Atrial Fibrillation (AF) is a common cardiac arrhythmia affecting several million people in the United States. It is a condition in which the upper chambers of the heart are unable to contract effectively leading to inhibited blood flow to the ventricles. The stagnation of blood is one of the major risk factors for stroke. The Computers in Cardiology Challenge 2001 was organized to further research into the prediction of episodes of AF. This research revisits the problem with some modifications. Patient-specific classifiers are developed for AF prediction using a different dataset and employing shorter EKG signal epochs. SVM classification yielded an average accuracy of just above 95% in identifying EKG epochs appearing just prior to fibrillatory rhythms. 5G cellular networks were envisaged to provide enhanced data rates for mobile broadband, support low-latency communication, and enable the Internet of Things (IoT). Handovers contribute to latency as mobile devices are switched between base stations due to movements. Given that customers may not be willing to continuously share their exact locations due to privacy concerns and the establishment of a mobile network architecture with dynamically created virtual cells, this research presents a solution for proactive mobility management using RNNs. A RNN is trained to identify patterns in variable-length sequences of Received Signal Strength (RSS) values, where a mobile device is permitted to connect to more than a single base station at a time. A classification accuracy of over 98% was achieved in a simulation model that was set up emulating an urban environment.

Inledning: En patientsäker vård bygger på korrekt information och att den informationen överförs på ett tillfredsställande sätt för att inga viktiga delar ska missas. Vårdprocessen är komplex och innehåller många viktiga bitar som behövs för en patientsäker vård. Vid omhändertagandet av en kritiskt sjuk patient arbetar vårdpersonalen ofta i team bestående av olika specialiteter och yrkeskategorier, vilka är beroende av en effektiv kommunikation och god samarbetsförmåga. En kritiskt sjuk patient flyttas ofta mellan olika enheter och vårdkedjan innebär ofta många överrapporteringar utmed vägen. Vid varje överflyttning finns en risk att något missas som kan få konsekvenser för den fortsatta vården. Syftet med den här studien var att identifiera riskfaktorer för patientsäkerheten vid överrapportering av kritiskt sjuka patienter. Metod: Författarna har använt sig av integrerad litteraturstudie för att kunna använda olika typer av studier. Resultat: Studiens resultat presenteras i fyra kategorier: Störningar, Brister i organisationen, Avsaknad av struktur för överrapportering och Samarbetssvårigheter. Konklusion: Riskfaktorer för patientsäkerheten vid överrapportering innefattar olika typer av störningar såsom bullrig miljö och avbrott i rapporten. Brister i organisationen yttrade sig som ett missnöje över att det inte gavs utrymme att förbereda sig och utföra överrapporteringen optimalt. Själva överrapporteringen verkade sakna struktur, en del använde checklistor andra improviserade rapporten. Vårdpersonalen tycktes även sakna ett gemensamt språk och hade en bristande respekt och förståelse för varandras arbetsuppgifter. / Introduction: Correct information and safe transmission of information without information loss are necessary for patient safety. The care process is complex and consists of many important pieces needed for a patient safe care. While caring for a critically ill patient, the caregivers often work in teams consisting of different medical specialties and disciplines. They are depending on an effective communication and smooth cooperative ability. A critically ill patient is often transmitted to several different units along the caregiving pathway. At every transmission there is a risk of information loss that may result in consequences during further caregiving process. The Aim of this study was to identify risk factors for patient safety at the handover of critically ill patients.  Method: This is an integrative review, which is a method for literature review that allows the use of different types of studies. Result: The result of this study is presented in four categories: Interruptions, Organization flaws, Lack of structure for handover and Cooperative difficulties. Conclusion: Risk factors for patient safety during handover included interruptions such as noisy environment and disruptions. The studies showed a dissatisfaction with the lack of space and time for preparation and to perform the handover optimally. The handover seemed to lack structure. Some used checklists, others improvised the handover. They seemed to be missing a common language and also a lack of respect and understanding for each other’s work assignments.

Mobile networks have changed from circuit switched to IP-based mobile wireless packet switched networks. This paradigm shift led to new possibilities and challenges. The development of new capabilities based on IP-based networks is ongoing and raises new problems that have to be tackled, for example, the heterogeneity of current radio access networks and the wide range of data rates, coupled with user requirements and behaviour. A typical example of this shift is the nature of traffic, which is currently mostly data-based; further, forecasts based on market and usage trends indicate a data traffic increase of nearly 11 times between 2013 and 2018. The majority of this data traffic is predicted to be multimedia traffic, such as video streaming and live video streaming combined with voice traffic, all prone to delay, jitter, and packet loss and demanding high data rates and a high Quality of Service (QoS) to enable the provision of valuable service to the end-user. While the demands on the network are increasing, the end-user devices become more mobile and end-user demand for the capability of being always on, anytime and anywhere. The combination of end-user devices mobility, the required services, and the significant traffic loads generated by all the end-users leads to a pressing demand for adequate measures to enable the fulfilment of these requirements. The aim of this research is to propose an architecture which provides smart, intelligent and per end-user device individualised traffic steering for heterogeneous mobile networks to cope with the traffic volume and to fulfil the new requirements on QoS, mobility, and real-time capabilities. The proposed architecture provides traffic steering mechanisms based on individual context data per end-user device enabling the generation of individual commands and recommendations. In order to provide valuable services for the end-user, the commands and recommendations are distributed to the end-user devices in real-time. The proposed architecture does not require any proprietary protocols to facilitate its integration into the existing network infrastructure of a mobile network operator. The proposed architecture has been evaluated through a number of use cases. A proof-of-concept of the proposed architecture, including its core functionality, was implemented using the ns-3 network simulator. The simulation results have shown that the proposed architecture achieves improvements for traffic steering including traffic offload and handover. Further use cases have demonstrated that it is possible to achieve benefits in multiple other areas, such as for example improving the energy efficiency, improving frequency interference management, and providing additional or more accurate data to 3rd party to improve their services.