The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.

ObjectivesWe conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan.Design, settings and participantsMultistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of the participants. Overall and stratified prevalence of type 2 diabetes and its association with risk factors were estimated using logistic regression models.Main outcome measuresPrevalence of prediabetes and type 2 diabetes.ResultsOf 18 856 eligible participants the prevalence of prediabetes was 10.91% (95% CI 10.46 to 11.36, n=2057) and type 2 diabetes was 16.98% (95% CI 16.44 to 17.51, n=3201). Overall, the mean HbA1c level was 5.62% (SD 1.96), and among newly diagnosed was 8.56% (SD 2.08). The prevalence was highest in age 51–60 years (26.03%, p<0.001), no formal education (17.66%, p<0.001), class III obese (35.09%, p<0.001), family history (31.29%, p<0.001) and female (17.80%, p=0.009). On multivariate analysis, there was a significant association between type 2 diabetes and older age, increase in body mass index and central obesity, positive family history, and having hypertension and an inverse relation with education as a categorical variable. On a subsample (n=1027), summary statistics for diagnosis of diabetes on HbA1c showed a sensitivity of 84.7%, specificity of 87.2% and area under the receiver operating characteristic curve 0.86, compared with OGTT.ConclusionsThe prevalence of type 2 diabetes and prediabetes is much higher than previously thought in Pakistan. Comprehensive strategies need to be developed to incorporate screening, prevention and treatment of type 2 diabetes at a community level.

Costs for HAI were considerable from hospital and societal perspectives. This suggests that HAI prevention expenditures would be balanced by savings in medical costs, lives saved and available hospital days that could be used by overcrowded hospitals to enhance available services. Our results obtained by applying different economic methods to a single detailed dataset may inform future cost analyses.

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Underwater Wireless Sensor Networks (UWSNs) face numerous challenges due to small bandwidth, long propagation delay, limited energy resources and high deployment cost. Development of efficient routing strategies is, therefore, mandatory and has remained the focus of researchers over the past few years. To address these challenges and to further improve the performance of the existing protocols, many routing protocols have been designed. In Weighting Depth and Forwarding Area Division-Depth Based Routing (WDFAD-DBR), the forwarding decision is based on the weighting depth difference, which is not an efficient way for void hole avoidance. In this paper, we propose a depth-based routing mechanism called Energy Balanced Efficient and Reliable Routing (EBER 2) protocol for UWSNs. First, energy balancing among neighbors and reliability are achieved by considering residual energy and the number of Potential Forwarding Nodes (PFNs) of the forwarder node, respectively. Secondly, energy efficiency is enhanced by dividing the transmission range into power levels, and the forwarders are allowed to adaptively adjust their transmission power according to the farthest node in their neighbor list. Thirdly, duplicate packets are reduced by comparing depths, residual energy and PFNs among the neighbors. Moreover, network latency is decreased by deploying two sinks at those areas of the network that have high traffic density. The results of our simulations show that EBER 2 has higher Packet Delivery Ratio (PDR), lower energy tax, and lesser duplicate packets than the WDFAD-DBR routing protocol. INDEX TERMS Underwater wireless sensor networks (UWSNs), potential forwarding nodes (PFNs), packet delivery ratio (PDR), end-to-end delay (E2ED), void hole.

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