The key concerns to enhance the lifetime of IoT-enabled Underwater Wireless Sensor Networks (IoT-UWSNs) are energy-efficiency and reliable data delivery under constrained resource. Traditional transmission approaches increase the communication overhead, which results in congestion and affect the reliable data delivery. Currently, many routing protocols have been proposed for UWSNs to ensure reliable data delivery and to conserve the node's battery with minimum communication overhead (by avoiding void holes in the network). In this paper, adaptive energy-efficient routing protocols are proposed to tackle the aforementioned problems using the Shortest Path First (SPF) with least number of active nodes strategy. These novel protocols have been developed by integrating the prominent features of Forward Layered Multi-path Power Control One (FLMPC-One) routing protocol, which uses 2-hop neighbor information, Forward Layered Multi-path Power Control Two (FLMPC-Two) routing protocol, which uses 3-hop neighbor information and 'Dijkstra' algorithm (for shortest path selection). Different Packet Sizes (PSs) with different Data Rates (DRs) are also taken into consideration to check the dynamicity of the proposed protocols. The achieved outcomes clearly validate the proposed protocols, namely: Shortest Path First using 3-hop neighbors information (SPF-Three) and Breadth First Search with Shortest Path First using 3-hop neighbors information (BFS-SPF-Three). Simulation results show the effectiveness of the proposed protocols in terms of minimum Energy Consumption (EC) and Required Packet Error Rate (RPER) with a minimum number of active nodes at the cost of affordable delay.
There are reports of high rates of antibiotic prescribing among hospitalized patients with COVID-19 around the world. To date, however, there are few reports of prescribing in relation to COVID-19 in Pakistan. Herein, we describe a point prevalence survey of antibiotic prescribing amongst patients hospitalized with suspected or proven COVID-19 in Pakistan. A Point Prevalence Survey (PPS) was undertaken in seven tertiary care health facilities in Punjab Provence, Pakistan. Baseline information about antimicrobial use according to the World Health Organization (WHO) standardized methodology was collected on a single day between 5th and 30 April 2021. A total of 617 patients' records were reviewed and 578 (97.3%) were documented to be receiving an antibiotic on the day of the survey. The majority (84.9%) were COVID-19 PCR positive, 61.1% were male and 34.9% were age 36 to 44 years. One quarter presented with severe disease, and cardiovascular disease was the major comorbidity in 13%. Secondary bacterial infection or co-infection (bacterial infection concurrent with COVID-19) was identified in only 1.4%. On the day of the survey, a mean of 1.7 antibiotics was prescribed per patient and 85.4% antibiotics were recorded as being prescribed for 'prophylaxis'. The most frequently prescribed antibiotics were azithromycin (35.6%), ceftriaxone (32.9%) and meropenem (7.6%). The majority (96.3%) of the antibiotics were empirical and all were from WHO Watch or Reserve categories. Overall, a very high consumption of antibiotics in patients hospitalized with suspected or proven COVID-19 was observed in Pakistan and this is concerning in view of already high rates of antimicrobial resistance in the region. Antimicrobial stewardship programs need to urgently address unnecessary prescribing in the context of COVID-19 infection.