A Vehicle-Edge-Cloud Framework for Computational Analysis of a Fine-Tuned Deep Learning Model.

The cooperative, connected, and automated mobility (CCAM) infrastructure plays a key role in understanding and enhancing the environmental perception of autonomous vehicles (AVs) driving in complex urban settings. However, the deployment of CCAM infrastructure necessitates the efficient selection of the computational processing layer and deployment of machine learning (ML) and deep learning (DL) models to achieve greater performance of AVs in complex urban environments. In this paper, we propose a computational framework and analyze the effectiveness of a custom-trained DL model (YOLOv8) when deployed in diverse devices and settings at the vehicle-edge-cloud-layered architecture. Our main focus is to understand the interplay and relationship between the DL model's accuracy and execution time during deployment at the layered framework. Therefore, we investigate the trade-offs between accuracy and time by the deployment process of the YOLOv8 model over each layer of the computational framework. We consider the CCAM infrastructures, i.e., sensory devices, computation, and communication at each layer. The findings reveal that the performance metrics results (e.g., 0.842 mAP@0.5) of deployed DL models remain consistent regardless of the device type across any layer of the framework. However, we observe that inference times for object detection tasks tend to decrease when the DL model is subjected to different environmental conditions. For instance, the Jetson AGX (non-GPU) outperforms the Raspberry Pi (non-GPU) by reducing inference time by 72%, whereas the Jetson AGX Xavier (GPU) outperforms the Jetson AGX ARMv8 (non-GPU) by reducing inference time by 90%. A complete average time comparison analysis for the transfer time, preprocess time, and total time of devices Apple M2 Max, Intel Xeon, Tesla T4, NVIDIA A100, Tesla V100, etc., is provided in the paper. Our findings direct the researchers and practitioners to select the most appropriate device type and environment for the deployment of DL models required for production.

Collaborative Perception-The Missing Piece in Realizing Fully Autonomous Driving.

Environment perception plays a crucial role in enabling collaborative driving automation, which is considered to be the ground-breaking solution to tackling the safety, mobility, and sustainability challenges of contemporary transportation systems. Despite the fact that computer vision for object perception is undergoing an extraordinary evolution, single-vehicle systems' constrained receptive fields and inherent physical occlusion make it difficult for state-of-the-art perception techniques to cope with complex real-world traffic settings. Collaborative perception (CP) based on various geographically separated perception nodes was developed to break the perception bottleneck for driving automation. CP leverages vehicle-to-vehicle and vehicle-to-infrastructure communication to enable vehicles and infrastructure to combine and share information to comprehend the surrounding environment beyond the line of sight and field of view to enhance perception accuracy, lower latency, and remove perception blind spots. In this article, we highlight the need for an evolved version of the collaborative perception that should address the challenges hindering the realization of level 5 AD use cases by comprehensively studying the transition from classical perception to collaborative perception. In particular, we discuss and review perception creation at two different levels: vehicle and infrastructure. Furthermore, we also study the communication technologies and three different collaborative perception message-sharing models, their comparison analyzing the trade-off between the accuracy of the transmitted data and the communication bandwidth used for data transmission, and the challenges therein. Finally, we discuss a range of crucial challenges and future directions of collaborative perception that need to be addressed before a higher level of autonomy hits the roads.

Dynamic Repositioning of Aerial Base Stations for Enhanced User Experience in 5G and Beyond.

The ultra-dense deployment (UDD) of small cells in 5G and beyond to enhance capacity and data rate is promising, but since user densities continually change, the static deployment of small cells can lead to wastes of capital, the underutilization of resources, and user dissatisfaction. This work proposes the use of Aerial Base Stations (ABSs) wherein small cells are mounted on Unmanned Aerial Vehicles (UAVs), which can be deployed to a set of candidate locations. Furthermore, based on the current user densities, this work studies the optimal placement of the ABSs, at a subset of potential candidate positions, to maximize the total received power and signal-to-interference ratio. The problems of the optimal placement for increasing received power and signal-to-interference ratio are formulated, and optimal placement solutions are designed. The proposed solutions compute the optimal candidate locations for the ABSs based on the current user densities. When the user densities change significantly, the proposed solutions can be re-executed to re-compute the optimal candidate locations for the ABSs, and hence the ABSs can be moved to their new candidate locations. Simulation results show that a 22% or more increase in the total received power can be achieved through the optimal placement of the Aerial BSs and that more than 60% users have more than 80% chance to have their individual received power increased.

Analyzing Factors Influencing Situation Awareness in Autonomous Vehicles-A Survey.

Autonomous driving of higher automation levels asks for optimal execution of critical maneuvers in all environments. A crucial prerequisite for such optimal decision-making instances is accurate situation awareness of automated and connected vehicles. For this, vehicles rely on the sensory data captured from onboard sensors and information collected through V2X communication. The classical onboard sensors exhibit different capabilities and hence a heterogeneous set of sensors is required to create better situation awareness. Fusion of the sensory data from such a set of heterogeneous sensors poses critical challenges when it comes to creating an accurate environment context for effective decision-making in AVs. Hence this exclusive survey analyses the influence of mandatory factors like data pre-processing preferably data fusion along with situation awareness toward effective decision-making in the AVs. A wide range of recent and related articles are analyzed from various perceptive, to pick the major hiccups, which can be further addressed to focus on the goals of higher automation levels. A section of the solution sketch is provided that directs the readers to the potential research directions for achieving accurate contextual awareness. To the best of our knowledge, this survey is uniquely positioned for its scope, taxonomy, and future directions.

Advancing C-V2X for Level 5 Autonomous Driving from the Perspective of 3GPP Standards.

Cellular vehicle-to-everything (C-V2X) is one of the enabling vehicular communication technologies gaining momentum from the standardization bodies, industry, and researchers aiming to realize fully autonomous driving and intelligent transportation systems. The 3rd Generation Partnership Project (3GPP) standardization body has actively been developing the standards evolving from 4G-V2X to 5G-V2X providing ultra-reliable low-latency communications and higher throughput to deliver the solutions for advanced C-V2X services. In this survey, we analyze the 3GPP standard documents relevant to V2X communication to present the complete vision of 3GPP-enabled C-V2X. To better equip the readers with knowledge of the topic, we describe the underlying concepts and an overview of the evolution of 3GPP C-V2X standardization. Furthermore, we provide the details of the enabling concepts for V2X support by 3GPP. In this connection, we carry out an exhaustive study of the 3GPP standard documents and provide a logical taxonomy of C-V2X related 3GPP standard documents divided into three categories: 4G, 4G & 5G, and 5G based V2X services. We provide a detailed analysis of these categories discussing the system architecture, network support, key issues, and potential solution approaches supported by the 3GPP. We also highlight the gap and the need for intelligence in the execution of different operations to enable the use-case scenarios of Level-5 autonomous driving. We believe, the paper will equip readers to comprehend the technological standards for the delivery of different ITS services of the higher level of autonomous driving.

Unlocking Mutual Gains-An Experimental Study on Collaborative Autonomous Driving in Urban Environment.

Convoy driving, a specialized form of collaborative autonomous driving, offers a promising solution to the multifaceted challenges that transportation systems face, including traffic congestion, pollutant emissions, and the coexistence of connected autonomous vehicles (CAVs) and human-driven vehicles on the road, resulting in mixed traffic flow. While extensive research has focused on the collective societal benefits of convoy driving, such as safety and comfort, one critical aspect that has been overlooked is the willingness of individual vehicles to participate in convoy formations. While the collective benefits are evident, individual vehicles may not readily embrace this paradigm shift without explicit tangible benefits and incentives to motivate them. Moreover, the objective of convoy driving is not solely to deliver societal benefits but also to provide incentives and reduce costs at the individual level. Therefore, this research bridges this gap by designing and modeling the societal benefits, including traffic flow optimization and pollutant emissions, and individual-level incentives necessary to promote convoy driving. We model a fundamental diagram of mixed traffic flow, considering various factors such as CAV penetration rates, coalition intensity, and coalition sizes to investigate their relationships and their impact on traffic flow. Furthermore, we model the collaborative convoy driving problem using the coalitional game framework and propose a novel utility function encompassing incentives like car insurance discounts, traffic fine reductions, and toll discounts to encourage vehicle participation in convoys. Our experimental findings emphasize the need to strike a balance between CAV penetration rate, coalition intensity, size, and speed to realize the benefits of convoy driving at both collective and individual levels. This research aims to align the interests of road authorities seeking sustainable transportation systems and individual vehicle owners desiring tangible benefits, envisioning a future where convoy driving becomes a mutually beneficial solution.

High-Flux dialyzer 2.6 m2 is promising for free light chains removal in high-flux hemodialysis and in hemodiafiltration.

Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains (FLC) removal using dialyzer surface area (SA) 2.6m2 in high-flux dialysis (HF-HD) versus hemodiafiltration (HDF) and its relation to cumulative dialysate albumin loss. This pilot cross-over study included 25 patients who underwent hemodialysis (HD) using dialyzer surface area 2.6m2 on HF-HD followed by online post-dilution HDF with washout period of 2 weeks using high-flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre/post dialysis levels of FLC Kappa (Κ) and Lambda (λ) by ELISA. Dialyzer (SA) 2.6m2 showed a significant reduction in post-dialysis kappa and lambda level in comparison to pre-dialysis level on HF-HD and hemodiafiltration (P<0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 %, 28.68 ± 4.36 %, respectively compared to HF-HD (29.52 ± 6.38 %, 19.48 ± 1.96, respectively, P<0.001 for both). Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.97; 1.98 - 3.37 gm] compared to HF-HD [median (IQR) 0.67; 0.49 - 1.13 gm] (P <0.001). In conclusion, high-flux dialyzer 2.6 m2 (SA) may be effective in free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.

How Do Autonomous Vehicles Decide?

The advancement in sensor technologies, mobile network technologies, and artificial intelligence has pushed the boundaries of different verticals, e.g., eHealth and autonomous driving. Statistics show that more than one million people are killed in traffic accidents yearly, where the vast majority of the accidents are caused by human negligence. Higher-level autonomous driving has great potential to enhance road safety and traffic efficiency. One of the most crucial links to building an autonomous system is the task of decision-making. The ability of a vehicle to make robust decisions on its own by anticipating and evaluating future outcomes is what makes it intelligent. Planning and decision-making technology in autonomous driving becomes even more challenging, due to the diversity of the dynamic environments the vehicle operates in, the uncertainty in the sensor information, and the complex interaction with other road participants. A significant amount of research has been carried out toward deploying autonomous vehicles to solve plenty of issues, however, how to deal with the high-level decision-making in a complex, uncertain, and urban environment is a comparatively less explored area. This paper provides an analysis of decision-making solutions approaches for autonomous driving. Various categories of approaches are analyzed with a comparison to classical decision-making approaches. Following, a crucial range of research gaps and open challenges have been highlighted that need to be addressed before higher-level autonomous vehicles hit the roads. We believe this survey will contribute to the research of decision-making methods for autonomous vehicles in the future by equipping the researchers with an overview of decision-making technology, its potential solution approaches, and challenges.

Collaborative Autonomous Driving-A Survey of Solution Approaches and Future Challenges.

Sooner than expected, roads will be populated with a plethora of connected and autonomous vehicles serving diverse mobility needs. Rather than being stand-alone, vehicles will be required to cooperate and coordinate with each other, referred to as cooperative driving executing the mobility tasks properly. Cooperative driving leverages Vehicle to Vehicle (V2V) and Vehicle to Infrastructure (V2I) communication technologies aiming to carry out cooperative functionalities: (i) cooperative sensing and (ii) cooperative maneuvering. To better equip the readers with background knowledge on the topic, we firstly provide the detailed taxonomy section describing the underlying concepts and various aspects of cooperation in cooperative driving. In this survey, we review the current solution approaches in cooperation for autonomous vehicles, based on various cooperative driving applications, i.e., smart car parking, lane change and merge, intersection management, and platooning. The role and functionality of such cooperation become more crucial in platooning use-cases, which is why we also focus on providing more details of platooning use-cases and focus on one of the challenges, electing a leader in high-level platooning. Following, we highlight a crucial range of research gaps and open challenges that need to be addressed before cooperative autonomous vehicles hit the roads. We believe that this survey will assist the researchers in better understanding vehicular cooperation, its various scenarios, solution approaches, and challenges.

Exploiting Mobile Edge Computing for Enhancing Vehicular Applications in Smart Cities.

Mobile edge computing (MEC) has been recently proposed to bring computing capabilities closer to mobile endpoints, with the aim of providing low latency and real-time access to network information via applications and services. Several attempts have been made to integrate MEC in intelligent transportation systems (ITS), including new architectures, communication frameworks, deployment strategies and applications. In this paper, we explore existing architecture proposals for integrating MEC in vehicular environments, which would allow the evolution of the next generation ITS in smart cities. Moreover, we classify the desired applications into four major categories. We rely on a MEC architecture with three layers to propose a data dissemination protocol, which can be utilized by traffic safety and travel convenience applications in vehicular networks. Furthermore, we provide a simulation-based prototype to evaluate the performance of our protocol. Simulation results show that our proposed protocol can significantly improve the performance of data dissemination in terms of data delivery, communication overhead and delay. In addition, we highlight challenges and open issues to integrate MEC in vehicular networking environments for further research.

Correction to: The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries.

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Accurate Traffic Flow Prediction in Heterogeneous Vehicular Networks in an Intelligent Transport System Using a Supervised Non-Parametric Classifier.

Heterogeneous vehicular networks (HETVNETs) evolve from vehicular ad hoc networks (VANETs), which allow vehicles to always be connected so as to obtain safety services within intelligent transportation systems (ITSs). The services and data provided by HETVNETs should be neither interrupted nor delayed. Therefore, Quality of Service (QoS) improvement of HETVNETs is one of the topics attracting the attention of researchers and the manufacturing community. Several methodologies and frameworks have been devised by researchers to address QoS-prediction service issues. In this paper, to improve QoS, we evaluate various traffic characteristics of HETVNETs and propose a new supervised learning model to capture knowledge on all possible traffic patterns. This model is a refinement of support vector machine (SVM) kernels with a radial basis function (RBF). The proposed model produces better results than SVMs, and outperforms other prediction methods used in a traffic context, as it has lower computational complexity and higher prediction accuracy.

Female Sex Hormones Pattern and Its Relation to Disease Severity and Treatment in Pre- and Postmenopausal Patients with Chronic Hepatitis C Virus (Genotype 4) Infection.

Chronic hepatitis C (CHC) course revealed differences between men and women. Male gender and postmenopausal women are thought to be of the critical factors affecting HCV infection progression. The study aimed to assess female sex hormones and their relation to disease severity and treatment in HCV infected females. Subjects were divided to 2 groups: 44 CHC female patients and 44 controls. Both groups were classified to premenopausal and postmenopausal females. Serum estradiol (E2), progesterone (PRG), and total testosterone (TT) were assessed using chemiluminescent immunoassay. Our results showed that menopausal patients had significantly higher levels of estradiol, total testosterone, and progesterone compared to controls (P < 0.001). Reproductive aged patients had lower level of total testosterone compared to menopausal patients (P < 0.001). HCV infected females of reproductive age had higher level of progesterone compared to menopausal HCV infected females (P = 0.0014). Indicators of disease severity and treatment response were significantly worse in menopausal women compared to reproductive aged women (fibrosis: P < 0.001, activity: P = 0.045, and treatment: P < 0.001). We observed that lower estradiol level may be related to fibrosis severity in CHC females. Higher total testosterone and progesterone levels may be related to fibrosis severity and poor response to treatment in CHC menopausal females only.

The prevalence of underweight, overweight, obesity and associated risk factors among school-going adolescents in seven African countries.

BACKGROUND: The burden caused by the coexistence of obesity and underweight in Low and Middle Income Countries is a challenge to public health. While prevalence of underweight among youth has been well documented in these countries, overweight, obesity and their associated risk factors are not well understood unlike in high income countries. METHODS: Cross-sectional data from the Global School-based Student Health Survey (GSHS) conducted in seven African countries were used for this study. The survey used a clustered design to obtain a representative sample (n = 23496) from randomly selected schools. 53.6% of the sample was male, and participants ranged in age from 11-17 years old. Body Mass Index (BMI) was calculated using age and sex adjusted self-reported heights and weights. Classification of weight status was based on the 2007 World Health Organization growth charts (BMI-for-age and sex). Multivariable Logistic Regression reporting Odds Ratios was used to assess potential risk factors on BMI, adjusting for age, sex, and country. Statistical analyses were performed with Stata with an alpha of 0.05 and reporting 95% confidence intervals. RESULTS: Unadjusted rates of being underweight varied from 12.6% (Egypt) to 31.9% (Djibouti), while being overweight ranged from 8.7% (Ghana) to 31.4% (Egypt). Obesity rates ranged from 0.6% (Benin) to 9.3% (Egypt). Females had a higher overweight prevalence for every age group in five of the countries, exceptions being Egypt and Malawi. Overall, being overweight was more prevalent among younger (≤12) adolescents and decreased with age. Males had a higher prevalence of being underweight than females for every country. There was a tendency for the prevalence of being underweight to increase starting in the early teens and decrease between ages 15 and 16. Most of the potential risk factors captured by the GSHS were not significantly associated with weight status. CONCLUSIONS: The prevalence of both overweight and underweight was relatively high, demonstrating the existence of the double burden of malnutrition among adolescents in developing countries. Several factors were not associated with weight status suggesting the need to explore other potential risk factors for overweight and underweight, including genetic factors and socioeconomic status.

The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt.

BACKGROUND: The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC). OBJECTIVES: To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth. PARTICIPANTS AND INTERVENTIONS: A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length. RESULTS: CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004). CONCLUSION AND RECOMMENDATIONS: Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.

Seatbelt use and speeding on three major roads in Egypt: a brief report.

OBJECTIVE: Road traffic injuries pose a significant threat to the Egyptian population. Recent estimates revealed that Egypt experiences 42 road traffic deaths per 100,000 population (1.8% of all deaths in the country), which is the highest death rate in the region. More than half of the road traffic crashes that resulted in injuries occurred on the country's highways. Despite the significance of this public health problem, very little risk factor information currently exists. The overall goal of this paper is to understand the burden of speeding and the level of seatbelt and child restraint use on a highway (Cairo Ring Road) and two urban roads crossing Alexandria city (Kornish and Gamal Abd-Elnaser roads). METHODS: Two rounds of seatbelt and child restraint observational studies and one round of speed observational study were carried out between 2011 and 2012. RESULTS: Findings revealed that seatbelt use among drivers and front seat passengers were low for all three sites (range: 11.1% to 19.8% for drivers; 2.9% to 4.0% for front seat passengers). Similarly, child restraint use in cars with children was very low ranging from 1.1% to 3.9% on all three roads. All three roads experienced a high percentage of vehicles driving above the speed limit (39.4% on Kornish Road, 22.6% on Cairo Ring Road, 11.8% on Gamal Abd-Elnaser Road), with the majority of these vehicles driving 1 to 10 kilometer above the speed limit. CONCLUSION: Future interventions need to focus on enhancing enforcement of speed and seatbelt wearing, closing gaps in legislation, and standardizing existing data systems to help inform good road safety policies.

Obstetricians' perspective towards cesarean section delivery based on professional level: experience from Egypt.

OBJECTIVES: (1) To investigate Egyptian obstetricians' views towards cesarean delivery on maternal request, (2) to investigate Egyptian obstetricians' views towards some of the "potentially neglected" or controversial obstetrical skills or maneuvers as external cephalic version (ECV), fetal scalp pH measurement or tubal ligation during CS and (3) to examine the effect of professional level on the above factors. STUDY DESIGN: This is a descriptive study performed at the 8th annual Obstetrics and Gynecology conference of Suez Canal University held at Ismailia city in Egypt in June 2011 via a structured self administered questionnaire. Questionnaire was distributed to 223 conference attendants from the three professional levels (consultants, specialists and registrars) working at the two major institutions in Egypt: University and Ministry of Health. The structured questionnaire was based on informed opinion and professional guidelines. In total, 167 (75%) completed the questionnaire. RESULTS: Cesarean delivery on maternal request was accepted by 66% of the studied group and acceptance was significantly higher among consultants. There was no difference in all physicians' practices of cesarean section in both private and public settings. Limited access to medical equipment such as cardiotocogram (CTG) was shown in consultant group reflecting improper private sector preparations. The study revealed that 59% of obstetricians accepted vaginal breech delivery, and only 14% would consider ECV. Fetal scalp pH taking in cases of abnormal CTG was accepted by only 16.3% and 49% rejected the practice of instrumental delivery. There were significant differences among the three professional and the two institutional groups regarding these attitudes. There were different views regarding tubal sterilization during CS. CONCLUSIONS: Lack of knowledge, the need to improve some clinical skills and some professional attitudes may shed light on rising CS rates in Egypt.

Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study.

OBJECTIVE: A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. METHODS: Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59 months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. RESULTS: Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. CONCLUSIONS: Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings.

Trends in childhood trauma mortality in the fast economically developing State of Qatar.

BACKGROUND: the aim of this study was to explore the trends in injury mortality in children aged 0-18 years in the State of Qatar. No such study has been conducted previously in Qatar. METHODS: univariate statistical analysis was used in this retrospective descriptive study. A total of 2934 children aged 0-18 years who died due to injuries in the period of 1 January 1993 to 31 December 2007 were studied. RESULTS: the leading causes of death were road traffi c injuries (RTIs) (71.3%), drowning (9.3%) and accidental falls (6.0%). Injury death rates were higher in citizens (57.7%) than in non-citizens (42.3%). The children of 15-18 years old had the highest frequency of injury deaths (34.4%), followed by children of 10-14 years old (21.3%). The mortality rate of RTI per 100 000 population increased remarkably in the year 2005 compared to previous years. CONCLUSIONS: the present study suggests that RTI is a major cause of childhood death. Injury mortality is higher in boys than in girls. During the period of 1993-2007, there was a dramatic increase in childhood mortality caused by RTI. This study highlights the burden of RTI caused mortalities in children, which requires immediate action.

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

BACKGROUND: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients. METHODS: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury, and was described with the following categories: bleeding, vascular occlusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN86750102, Clinicaltrials.govNCT00375258, and South African Clinical Trial RegisterDOH-27-0607-1919. FINDINGS: 10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14.5%] tranexamic acid group vs 1613 [16.0%] placebo group; relative risk 0.91, 95% CI 0.85-0.97; p=0.0035). The risk of death due to bleeding was significantly reduced (489 [4.9%] vs 574 [5.7%]; relative risk 0.85, 95% CI 0.76-0.96; p=0.0077). INTERPRETATION: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients. FUNDING: UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation.