An Energy-Efficient Routing Protocol with Reinforcement Learning in Software-Defined Wireless Sensor Networks.

The enormous increase in heterogeneous wireless devices operating in real-time applications for Internet of Things (IoT) applications presents new challenges, including heterogeneity, reliability, and scalability. To address these issues effectively, a novel architecture has been introduced, combining Software-Defined Wireless Sensor Networks (SDWSN) with the IoT, known as the SDWSN-IoT. However, wireless IoT devices deployed in such systems face limitations in the energy supply, unpredicted network changes, and the quality of service requirements. Such challenges necessitate the careful design of the underlying routing protocol, as failure to address them often results in constantly disconnected networks with poor network performance. In this paper, we present an intelligent, energy-efficient multi-objective routing protocol based on the Reinforcement Learning (RL) algorithm with Dynamic Objective Selection (DOS-RL). The primary goal of applying the proposed DOS-RL routing scheme is to optimize energy consumption in IoT networks, a paramount concern given the limited energy reserves of wireless IoT devices and the adaptability to network changes to facilitate a seamless adaption to sudden network changes, mitigating disruptions and optimizing the overall network performance. The algorithm considers correlated objectives with informative-shaped rewards to accelerate the learning process. Through the diverse simulations, we demonstrated improved energy efficiency and fast adaptation to unexpected network changes by enhancing the packet delivery ratio and reducing data delivery latency when compared to traditional routing protocols such as the Open Shortest Path First (OSPF) and the multi-objective Q-routing for Software-Defined Networks (SDN-Q).

A Qualitative Descriptive Study of Patient Experiences of Pain Before and After Spine Surgery.

OBJECTIVE: The purpose of this study was to describe the preoperative and postoperative experiences of spine surgery from the patient's perspective to help inform behavioral health services provided before, during, and after hospitalization. SETTING: Single urban academic tertiary care hospital. METHODS: Semistructured interviews with 14 adults who underwent spine surgery. Interview transcriptions were analyzed using content analysis by three investigators to identify emergent themes. RESULTS: Three broad domains with associated themes emerged from the analysis: 1) preoperative experience-preparation, worries, and expectations; 2) recovery process-activity and pain management strategies; and 3) postoperative support in recovery-family and social support. CONCLUSIONS: The results of this qualitative descriptive study can be used to guide future perioperative behavioral health services for patients undergoing spinal surgery. Establishing realistic expectations of spine surgery and a comprehensive pain management plan are essential for adequate preoperative preparation. Furthermore, family involvement in the preoperative preparation for surgery is important for support of the patient during the recovery process.

Telementoring for improving primary care provider knowledge and competence in managing chronic pain: A randomised controlled trial.

Introduction: Primary care providers are frequently unprepared to manage chronic pain adequately due in part to insufficient professional training. This study evaluated the effect of a telementoring intervention on knowledge and perceived competence related to chronic pain management. Methods: The study design was a cluster randomised controlled trial. Primary care clinics that were part of the University of Washington Medicine Telehealth network were the unit of randomization. Primary care providers comprised the intervention group (n = 23) and the control group (n = 18). Providers in the intervention group attended telementoring sessions through the TelePain programme and presented patient cases at the beginning and end of their enrolled patients' 12-week study period. TelePain sessions included a didactic presentation and telementoring for specific patient cases by a panel of pain specialists from the disciplines of pain medicine, internal medicine, anaesthesiology, rehabilitation medicine, psychiatry, addiction medicine, nursing and complementary and integrative pain management. Providers' baseline and end-of-study knowledge and perceived competence in managing chronic pain were assessed by three questionnaires: Knowledge and Attitudes Survey Regarding Pain, the KnowPain-12 and the Perceived Competence Scale. Results: Knowledge (Z = ­0.34, p = 0.97 (Knowledge and Attitudes Survey Regarding Pain) and Z = 0.49, p = 0.62 (KnowPain-12)) and perceived competence (Z = ­0.74, p = 0.46) did not increase for providers in the intervention group compared with providers in the control group. These providers attended on average 12.5 sessions (range 0­31) while participating in the study. Discussion: Further research is recommended to establish the effectiveness of this telementoring intervention.