The extensive loss of teeth and surrounding tissues due to mandibulectomy for an oral tumor not only impacts negatively on appearance, but also often causes various functional disorders, decreasing quality of life (QOL). In the present case, reconstruction with a scapular flap was carried out along with segmental mandibulectomy, aiming for functional restoration through restoration-driven implant treatment. A good outcome was obtained, with improvement of masticatory function and QOL following the prosthetic treatment.The patient was a 37-year-old woman diagnosed with ossifying fibroma in the left side of the mandible. Segmental mandibulectomy and reconstruction with a scapular flap were carried out. Implant diagnostic simulation was performed, and based on the result, secondary reconstruction using a particulate cancellous bone and marrow graft was carried out by an oral surgeon. After wound healing was complete, implant placement was performed twice, and the final prosthodontic treatment was completed. Masticatory performance and maximum bite force, which are indices of masticatory function, were improved from before to after prosthetic treatment. In addition, oral health-related QOL was improved from before to after prosthetic treatment.In the present case, restoration-driven implant treatment was performed in a patient following segmental mandibulectomy for a mandibular tumor, with a good outcome. Planning the treatment measures with a focus on the final prosthetic vision can lead to improvement of oral function in patients with extensive mandibular defects. In cases of mandibulectomy for an oral tumor, the extensive loss of teeth and surrounding tissues not only impacts negatively on appearance, but also often causes various functional disorders of mastication, swallowing, and articulation , decreasThe first choice for reconstruction in cases of mandibulectomy is often a vascularized free flap using bone from the ilium, fibula, scapula, etc. . Of thesHowever, full recovery of appearance and oral function after mandibulectomy can only be achieved with appropriate postoperative prosthetic treatment. An implant prosthesis can give a high level of patient satisfaction in terms of both esthetics and function , 6, but In the present case, a case of segmental mandibulectomy was treated by carrying out reconstruction with a scapular flap, aiming for functional restoration through restoration-driven implant treatment. A good outcome was obtained, with improvement of masticatory function and QOL following the prosthetic treatment.2 and an osseous flap of 8 × 2.5 cm2, which were lifted with vascularization. The cutaneous flap and the osseous flap were adjusted in size to match the extent of the defect and implanted into the bone defect. For fixation of the osseous flap to the mandible, 2 titanium 4-hole miniplates were used at the mandibular body (anterior) and 1 4-hole miniplate and 1 2-hole miniplate were used at the mandibular branch (posterior). For revascularization of the cutaneous flap, the circumflex scapular artery in the flap was anastomosed to the left facial artery on the neck side, and the circumflex scapular vein was anastomosed to the left facial vein on the neck side to restore blood flow. The defect in the oral cavity was closed with the scapular cutaneous flap.The patient was a 37-year-old woman. She was diagnosed with ossifying fibroma in the left side of the mandible, for which segmental mandibulectomy and scapular flap reconstruction were carried out in October 2018 at the Division of Oral and Maxillofacial Disease, Osaka University Dental Hospital  graft was performed by an oral surgeon in February 2020 on the basis of the results of the above simulation. First, an incision was made in the lower part of the left side of the mandible, and the inferior left margin of the mandible and the inferior margin of the scapula bone (the graft bone) were identified. The soft tissue attached to the graft bone was detached buccolingually to expose the whole area around the graft. Next, a titanium mesh plate that had been prepared in advance was placed, following the morphology of the bone from the inferior margin of the mandible and graft bone and fixed in position with screws Fig. . In the After the wound had healed, cone-beam CT was carried out to reconfirm the quantity of grafted bone, and a final simulation of the implant placement was performed Fig. . A surgiAfter a 5-month unloading period, a second surgical procedure was performed to place the abutment and healing cap. Placement of the implant superstructure was judged to be difficult because the intraoral cutaneous flap had become thicker due to subcutaneous fatty tissue; therefore, the oral surgeon performed alveolar ridge plasty by reducing the amount of subcutaneous fatty tissue on the cutaneous flap and correcting the shape of the flap. The abutment and healing cap were then placed by the prosthetist. After waiting for the wound from the second procedure to heal, impressions were taken using the open-tray method, and provisional restorations were placed. After placement, peri-implant cleanliness and the occlusal relationship were carefully checked, precise impressions were taken again using the open-tray method, and a fixed partial denture fabricated by monolithic zirconia was tighten by fixing screws Figs. , 8, 9. TIn the present case, placement of a fixed prosthetic device by means of implants was selected for prosthetic treatment following extensive resection of the mandible due to an oral tumor. A simulation was performed to determine the optimal implant sites, and secondary reconstruction was carried out for the bone growth necessary for the implants. As a result, an appropriate occlusal relationship at the mandibular defect site was created.To date, there have been numerous reports of cases of implant treatment for mandibular defects following mandibulectomy. In most of these, however, reconstruction using fibular bone and a plate was performed followed by implant therapy on the grafted bone, which is by no means sufficient for implants. In the present case, the desirable implant placement sites were considered in advance by envisaging the final appearance and occlusal status, after which sufficient bone volume was made up by secondary reconstruction. This allowed placement of the implant device at the optimal implant site. Guided bone regeneration (GBR), in which regeneration of bone tissue into areas of insufficient bone tissue is promoted, is routinely performed for implant treatment at many dental clinics . HoweverIn the present case, a plan with the aim of restoring not only the patient’s appearance, but also her masticatory function, which were lost as a result of mandibulectomy, was drawn up. There are numerous methods available for evaluating a patient’s masticatory function, but it is important that the evaluation is objective and quantitative. In the present case, the method of evaluating the degree of comminution using gummy jelly intended for measurement of masticatory ability was used. In this method, the gummy jelly is freely chewed 30 times, and the degree of comminution is visually evaluated by comparing it against a score table.  Since thWhen judging the results of dental treatment, it is important to evaluate the subjective level of satisfaction, as well as objective measures of oral function. In the present case, oral health-related QOL was evaluated as an indicator of the subjective level of satisfaction. The results showed that oral health-related QOL improved after the prosthetic treatment. Various other scales in addition to the OHIP-14 have been developed for evaluating oral health-related QOL, including the OHIP-49  and the In the present case, restoration-driven implant treatment was performed in a patient following segmental mandibulectomy for a mandibular tumor, with a good outcome. In addition, it was possible to visualize and accurately judge the effects of the treatment by conducting objective evaluation of masticatory function and subjective evaluation of the patient’s level of satisfaction before and after the prosthetic treatment. Planning the treatment measures with a focus on the final prosthetic vision while making use of the expertise of specialists from different fields, as in the present case, can lead to improvement of oral function in patients with extensive mandibular defects. At the same time, the soft tissue around implant was skin graft, which is completely different with normal oral mucosa. In this case, we did not perform mucosal transplantation such as free gingival graft or vestibuloplasty. Therefore, strict maintenance protocol including professional care and oral hygiene instruction is applied to this patient. It thinks to be better to obtain the keratinized tissue around implant to ensure better cleanability around implant prosthesis if applicable.


Dose fractionation has different effects on the immune microenvironment, and the tumor microenvironment after SRT also changes over time, all of which have an impact on SRT combined immunotherapy. Although much research on the immune microenvironment of SRT has been conducted, many problems still require further exploration.Stereotactic radiotherapy (SRT) is one of the main treatment modalities for lung cancer, and the current SRT approach combined with immunotherapy has initially presented good clinical efficacy in lung cancer. SRT activates the immune system through  Compaimmunity  and vascimmunity . Dose frimmunity , and theThe TME is the internal environment for tumor survival and progression, and is related to tumor growth and metastasis . The tumin situ tumor-specific antigens. In early preclinical studies, the effects of hypofractionated radiotherapy protocols on the TIME are better than those of the conventional protocol, and the expression of MHC-I and related tumor peptides is higher with increasing radiotherapy dose  or stereotactic ablative radiotherapy refers to a one-time dose of 20–34 Gy or a single dose of 10–15 Gy for a total of 3–5 times , 27, as The TIME has different manifestations before and after SRT. In a preliminary study, changes in circulating blood immune cell populations were observed in lung tumor patients treated with SRT, which included an increase in immunoreactive components and a decrease in immunosuppressive components. Although these changes did not show statistical significance, they appeared 72 h after SBRT and continued until 6 months after treatment . Zhang eBuchwal et al. reviewed several preclinical studies and suggested that, ideally, anti-PD-1/L1 and RT should be conducted simultaneously; if not, at least RT should be conducted at first . In a reWith the emerging efficacy of SRT combined with immunotherapy, the mechanism of SRT effects on the immune microenvironment needs to be explored. Although there have been many studies on the SRT immune microenvironment, there are still some problems.Although there are increasing preclinical and clinical data on the combination of radiotherapy and immunomodulators, and the application prospect is exciting, most of the available data are currently from retrospective or small cohorts. Many problems related to the use of SRT to improve clinical conversion to immunotherapy efficacy remain unsolved, such as dose fractionation, treatment sequence, selection of immunomodulators, and biomarkers predicting treatment response . In partThe immune microenvironment varies in different tumors, pathological types, and stages of tumor progression. The effect of SRT on the TIME is also different. Thus, more targeted studies are needed to identify the dominant population and to implement individualized treatment to maximize the clinical benefits.All types of studies must ultimately serve the clinic. SRT studies on the immune microenvironment aim to solve the clinical problems of SRT patients, improve clinical outcomes to a maximum extent, and contribute to the eventual implementation of survival benefits.Concept and design: HZ. Drafting and revision of the manuscript: YX. Obtained funding: HZ. All authors contributed to the article and approved the submitted version.This work was jointly supported by the National Key Research and Development Program of China for the development of the proton beam transmission system and proton therapy nozzle (No. 2019YFF01014403).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs .Logistic regression analyses were used to determine household correlates of household burden of malnutrition.Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia. Historically, malnutrition has been linked with different population sub-groups, and the divide has mostly been by socio-economic status; undernutrition was linked to resource poor populations, while overweight and obesity were associated with the affluent. This predisposition often led to a functional divide when addressing malnutrition challenges. However, over the past two decades, there have been indications that undernutrition and overweight/obesity are increasingly co-occurring and becoming a public health problem with no socio-demographic and or wealth/income groupings spared. Additionally, although globally, no regional block has been exempted from the rising prevalence of overweight/obesity which has translated into the current obesity pandemic, sub-Saharan Africa (SSA) has been observed to be experiencing a rapid rise in overweight/obesity, and the region also continues to be the only region where undernutrition is on the rise in almost all its sub-regions. The rise in the burden of overweight and obesity in low-resource countries was highlighted by Barry Popkin in his seminal work on the nutrition transition, in which he projected that the rate of dietary changes such as consumption of energy-dense foods and increasing decline in physical activity among the poor could result in an upsurge of overweight and obesity in developing countries,8.The 2020 Lancet series on the ‘dynamics of the double burden of malnutrition and the changing nutrition reality’ suggests that the global health community has been slow in acknowledging and responding to the high prevalence of the double burden of malnutrition, particularly in low and middle countries,10. Furthermore, the commercial determinants of health, defined as ‘strategies and approaches used by the private sector to promote products and choices that are detrimental to health’, are now viewed as a critical element in understanding ways of addressing the current levels of malnutrition. Additionally, the increasing penetration and intense advertising of sugar-sweetened beverages by both international and local food companies have a significant influence on the intake of sugars and thus contribute to overweight and obesity. This trend has edged some researchers to advocate for increased attention to be given to both the commercial and social determinants of health,12, especially as it relates to malnutrition, particularly overweight and obesity.These changes in lifestyle habits could also be viewed as socially constructed choices that are modulated or influenced by various commercial interests. The work of the Intergovernmental Panel on Climate Change provides adequate evidence about the link between climate change, food insecurity and undernutrition, particularly among vulnerable populations in sub-Saharan Africa, due to crop failures, reduced food production and increased foodborne diseases. The interaction between climate change and food security is complex and its impact on malnutrition is multifaceted. On the one hand, there is evidence that whereas severe food insecurity could lower obesity, on the other hand, mild to moderate food insecurity has been shown to be associated with obesity. The dynamics of how this paradox impacts household burden of malnutrition needs to be researched.In addition to the aforementioned challenges, the SSA region is also the hardest hit with regard to the consequence of climate change. The increasing temperatures and extreme rainfall that characterise climate change are altering suitable conditions for farming. Additionally, given its impact on agricultural systems, climate change significantly slows down progress towards improving the food security of households in SSA,15. Malnutrition at the household level is often observed among children and women, but this does not mean men are not affected,17. The pattern of malnutrition among children and women in SSA is changing from the previously observed undernutrition among women and children to undernutrition among children and overweight/obesity among women and even more recently to overweight/obesity among both women and children. A more nuanced examination shows the existence of even more permutations of undernutrition and overweight/obesity among women and children in the same household.Increasingly, undernutrition and overweight/obesity are being observed to occur in the same community, in the same household and among different members of the same household. Currently, the prevalence of iron-deficiency anaemia is the highest among all nutritional deficiencies around the world and in developing countries. Unfortunately, over the past decade, SSA has achieved the lowest progress with respect to reducing the prevalence of iron-deficiency,23. Consequently, SSA is particularly vulnerable to the burden of all forms of malnutrition; undernutrition, overweight/obesity and micronutrient deficiency and even worse, their simultaneous co-existence. And regardless of the condition of malnutrition, the consequences are largely negative. Childhood undernutrition for instance is associated with increased risk of mortality and poor cognitive development, while overweight/obesity is associated with increased incidence of chronic non-communicable diseases. Maternal overweight/obesity on the other hand is linked with various adverse maternal as well as fetal outcomes. Consequently, the co-existence of undernutrition, overweight/obesity and anaemia exacerbate the burden of ill-health and retards development among household members.Aside undernutrition and overweight/obesity, other nutritional disorders with equally grave public health implications include micronutrient deficiencies with iron-deficiency anaemia being the most widespread,28, while triple burden of malnutrition (TBM) refers to the co-existence of overweight/obesity, undernutrition and micronutrient deficiency,30 in the same household. It is also worth stating that, there could be the co-existence of overweight/obesity and micronutrient deficiency in the same individual and this could occur in either a child or the mother (adult woman). A child can also simultaneously be overweight/obese and stunted. This is also another form of individual-level double burden of malnutrition.Household burden of malnutrition can be classified by the collective burden among individual members of the household. Double/dual burden of malnutrition (DBM) is considered as the co-existence of maternal overweight and obesity along with child undernutrition within the same household,32. Additionally, whereas structural and institutional changes such as unregulated marketing of cheap processed foods and sugar-sweetened beverages and the lack of physical activity and physical activity spaces are identified as critical factors driving overweight/obesity,34, the region’s continued high levels of food insecurity, HIV prevalence and per capita income have been identified to be associated with undernutrition. Furthermore, although the double and triple burden of malnutrition is often reported as a regional or global phenomenon, its expressions and impacts are experienced at the micro-level in households. Thus, exploring correlates of malnutrition, particularly the double and triple burden of malnutrition at the household level, is critical for both public health programmers and policy makers to guide the development and implementation of appropriate policy interventions.Double and triple burden malnutrition households are becoming more common and rising rapidly in SSA partly due to the ongoing rapidly evolving nutrition transition which aims at reducing all forms of malnutrition is to be achieved, the household drivers of the burden of malnutrition need to be effectively understood. Considering the above-mentioned context, we use nationally representative data across SSA, to explore correlates of the different classifications of household malnutrition, i.e. undernutrition, overweight/obesity, anaemia (as an indicator of micronutrient deficiency) as well as their co-existence in the same household. Such analysis will contribute significantly to effective ways of addressing the co-existence of undernutrition, overweight/obesity and anaemia in households in SSA.Addressing the double and triple burden of malnutrition in SSA will require understanding the intricacies and characteristics of households that have been affected. To our knowledge, overweight/obesity, undernutrition and anaemia in woman–child pairs within the same household have not yet been explored using nationally representative data across SSA. But considering that SSA already has weak health infrastructure, the emergence of this nutritional paradox compromises the regions development even further. Furthermore, if target 2·2 of the Sustainable Development Goals. IPUMS uses a data warehousing approach to extract, transform and load data from numerous nationally representative surveys into a single-view schema to ensure that data sources become compatible. A total of twenty-six sub-Saharan African countries were initially extracted from the IPUMS website for analysis in the current study. Appendix 1 shows the characteristics of households as well as the characteristics of women and children under 5 years that were available for each country. Notably, Hb concentration readings for measuring anaemia were not captured for women in the Angola, Kenya, Nigeria, Zambia and Sudan data sets. Additionally, the Sudan data set had no indicator of nutritional status for women and children, while Angola had no data on nutritional status indicators for women. The final analytical sample therefore includes twenty-three countries with valid data on all variables of interest.The current study used data from the most recent Demographic and Health Survey (DHS) conducted across SSA where data were available. The DHS are standard nationally representative cross-sectional household-based surveys that are conducted approximately every 5 years. Data from the DHS provide indicators on population and health for multi-country comparison. The DHS programme started in the 1980s and has contributed to advancing global knowledge on health and population trends in low- and middle-income countries. All DHS are conducted using a standardised survey design and data collection procedures across participating countries. Typically, the DHS uses a stratified cluster sampling technique to select census enumeration areas based on probability proportional to the size of the enumeration area. This is then followed by a random selection of households within selected enumeration areas. Data collection for the survey is done through face-to-face interviews using questionnaires which are administered to household heads and selected household individuals including women in the reproductive age (15–49 years) who consent to be interviewed. For the purposes of the current study, the following inclusion criteria; (i) only sub-Saharan African countries, (ii) most recent survey conducted between 2008 and 2017 and (iii) the survey included indicators of children’s nutritional status  and women’s nutritional status (i.e. BMI and Hb level) were applied in extracting data for the analysis. Based on these criteria, a total sample of 145 020 households with women–child pairs from twenty-three countries was realised  in the household.The study focused on measuring five categories of household burden of malnutrition as dependent variables. These were undernutrition, overweight/obesity, anaemia (micronutrient deficiency), double burden and triple burden malnutrition. These conditions were measured among women (15–49 years) and children (6–59 months) in the household. Undernutrition among children was measured using height-for-age and weight for height z-scores < –2) or wasted (weight-for-height age z-scores <– 2). An undernourished woman is considered as one with a BMI <18·5 kg/m2. An overweight/obese household is characterised as a household having an overweight child and or an overweight/obese woman. An overweight child is one with a weight-for-height z-score > 2, while an overweight/obese woman is one with a BMI > 24·9 kg/m2. Anaemic households are households with either an anaemic child or anaemic woman or both. Children with Hb concentration of ≤ 110–119 g/l and women with Hb concentration of ≤ 100–109 g/l were considered to be anaemic.Household undernutrition also referred to as undernutrition only or undernourished households is characterised by households with either an undernourished child and or undernourished woman. A child is considered to be undernourished when she/he is either stunted , household access to improved water and sanitation (toilet facilities) and the wealth quintile of the household. The location of the household was considered as whether households were in a rural or urban area. The available individual characteristics include the age of children (under 5 years) and women (15–49 years) in the household.P < 0·05).The characteristics of the study sample including the characteristics of the households and the women and children in the households were described using means and percentages. The various categories of household burden of malnutrition were categorised as binary outcomes, that is, households with an undernourished child and/or woman were classified as 1 and 0 otherwise, households with an overweight/obese child and/or woman are represented as 1 and 0 otherwise, households with either an anaemic child and or anaemic woman were represented as 1 and 0 otherwise. Similarly, households that qualify as having a double burden of malnutrition were assigned a score of 1 and 0 otherwise. The same scale was used for households that had triple burden malnutrition. Per these categorisation and given that the various types of household burden of malnutrition were categorised as binary outcomes, the analysis technique employed to explore the correlates of the various malnutrition outcomes was a binary logistic regression. All statistical analyses were performed using the Stata statistical software package version 14·2 . Statistical significance was set at the 5 % α-level  who is anaemic or both. The results in Fig. The country-level results presented in Table The results presented in Table The results with regard to household wealth status indicate that, on the one hand one, increasing household wealth status was associated with a lower likelihood of a household being undernourished or anaemic, but on the other hand, increasing household wealth was associated with a higher likelihood of the household being overweight/obese. Similarly, the chances of a household being a dual burden malnutrition household increased with increasing household wealth but considering triple burden of malnutrition, only households in the richer wealth category were found to be at increased risk. The location of a household, whether rural or urban, was found to be associated with undernutrition such that rural households were more likely to be undernourished. However, rural households were less likely to be overweight/obese, anaemic or double burden malnutrition households.Considering the characteristics of reproductive age women and under 5 children in the household, the findings indicate that the chances of a household having an undernourished child and or an underweight woman increases with increasing age of a child under 5, but the chances of a household having an overweight/obese adult woman and or child decreased with increasing age of a child under 5. Additionally, there was a higher likelihood of a household having an anaemic child and or anaemic woman with increasing age of a child under 5; however, the odds was lower at older ages for the child. There was a lower likelihood of a household having a double burden of malnutrition with increasing age of a child under 5 from 6 to 23 months, but statistical significance was only achieved for infants who were aged 6 to 11 months compared with 0–5-month-old infants. Again, the chances of a household having a triple burden of malnutrition generally increased with increasing age of a child under 5 in the household.Considering the age of women in the reproductive age in the household, the findings indicate that the chances of a household being an undernourished household decreased with increasing age of women from age 20 to 49 years. Similar results were observed for anaemia, but the results were only statistically significant for women aged 25–49 years. The chances of a household being overweight/obese was observed to increase with increasing age of reproductive age women in the household. Again, the chances of a household having a double or triple burden of malnutrition increased with increasing age of reproductive age women from age 25 to 49 and 35 to 49 years, respectively, compared with when a woman in the household is 15–19 years old. The marital status of women in the household only showed a statistically significant association with the chances of a household being overweight/obese. Households with a woman in the reproductive age who was married showed a 26·7 % higher chance of being overweight/obese. Also, increasing level of education among women of reproductive age in the household was associated with a lower likelihood of the household being undernourished or anaemic, but increasing level of education among reproductive age women in the household was associated with increased likelihood of a household being overweight/obese. However, considering the level of education of women in the reproductive age in the household and household double and triple burden of malnutrition, only tertiary level of education (among women in the reproductive age) was observed to be associated with a lower likelihood of a household having a double or triple burden of malnutrition.Finally, the chances of a household being undernourished decreased in more recent survey years except in 2016, whereas the chances of a household being overweight/obese or anaemic or having a double or triple burden of malnutrition increased in recent survey years.The current study sought to examine the correlates of different classifications of household burden of malnutrition in SSA. To the best of our knowledge, this is the largest analysis examining household covariates of various conditions of malnutrition; undernutrition, overweight/obesity and anaemia and the co-occurrence of these conditions in the same household, using nationally representative data across sub-Saharan African.,40. Our results show that micronutrient deficiency measured as anaemia is the commonest burden of malnutrition among women (15–49 years) and children under 5 in households across SSA. This burden of anaemia corroborates with studies conducted in Arab and Middle East countries,42. Reasons for the high prevalence of anaemia in the SSA region are multifaceted. Besides low intake of iron-rich foods, factors such as inadequate hygiene and sanitary conditions are documented as contributors to anaemia in this region. Additionally, conditions such as glucose-6-phosphate dehydrogenase deficiency, haemoglobinopathies endemic diseases such as malaria and sickle cell all contribute significantly to the regions’ anaemia prevalence–45. The present study reveals that undernutrition occurs in one in two households, while overweight/obesity was present in about one in every four households in SSA. The results of the current study suggest that the prevalence of single conditions of malnutrition is comparatively higher than double and triple burden of malnutrition. However, the level of DBM as found in the current study is comparable to the level in Nepal (6·60 %). This notwithstanding, an earlier study conducted in Bangladesh, Nepal, Pakistan and Myanmar found the level of household DBM to be slightly lower than that of the present study, but the level of TBM as was found in the present study is slightly lower (4·6 %) than what was found in Nepal (7·0 %) by Sunuwar et al..The findings suggest that despite the stereotype image of skeletal children with severe hunger in SSA, the current study like many others, shows that overweight/obesity is also a public health concern in this region. The size of the household on the other hand was associated with a higher likelihood of undernutrition and anaemia as has been found in other studies. These findings are plausible because increasing household size affects access to food such as fruits, vegetables, meat and fish which tend to be relatively more expensive. The absence or reduction of such foods contributes significantly to iron-deficiency, causing anaemia. Household size was, however, found to be associated with a lower likelihood of the household having either an overweight/obese woman or child or both. Other household characteristics such as the type of toilet facility was found to be associated with the household’s likelihood of having either an overweight/obese woman or child and also double and triple burden of malnutrition in the household. The mechanism of impact of type of toilet facility on the household burden of malnutrition as found in the present study could be operating through wealth or socio-economic status. Households with improved toilet facilities tend to be relatively wealthier compared with households with unimproved toilet facilities, and such wealthier households have been found to have higher burden of overweight/obesity, especially among women, and this could be what is driving the household burden of overweight/obesity, double and triple burden of malnutrition as was observed in the present study.In addition to the levels of household burden of malnutrition, which was realised, the results indicate that the prevalence of the various forms of household burden of malnutrition and their underlying household influencing factors are different. For example, whereas increasing age of the household head was associated with a lower likelihood of the household being undernourished, the same variable was associated with a higher likelihood of the household being overweight/obese and anaemic. But unlike the age of the household head, the sex of the head of the household head was not associated with any of the forms of household burden of malnutrition. This is contrary to a study conducted in Indonesia that reported some nutritional inequality among female-headed households. Some of the plausible reasons for this finding are that while rich households may be more food secure,51 and also benefit from a more diverse diet, thus reducing the risk of undernutrition and micronutrient deficiency, rich households are also at a higher risk of overweight/obesity due to consumption of energy-dense foods and lower levels of physical activity. The location of a household, whether rural or urban, was also found to be associated with household burden of malnutrition. Rural households were found to have a lower likelihood of being overweight/obese or anaemic. Contrarily, other studies in some SSA countries, for example Ghana found that rural residence is associated with a high likelihood of micronutrient deficiency. Another study conducted in the Gambia did not find significant difference in anaemia among non-pregnant females by residence. These results do show the possible variability in the conditions contributing to anaemia in the region.In terms of household wealth status, the results indicate that while richer households are less likely to be undernourished or anaemic, they are more likely to be overweight/obese and also, have double burden or triple burden malnutrition conditions. Similar findings have been reported in Nepal where mothers from the richest households were more likely to have double or triple burden of malnutrition, while in Pakistan and Myanmar, Anik and colleagues found that child’s age (24–59 months) was associated with a higher likelihood of the household experiencing a double burden of malnutrition. Additionally, the present study found that child’s age was significantly associated with a higher likelihood of the household being undernourished as was found in Sierra Leone before the Ebola outbreak. The effect of the age of children on the household burden of malnutrition could be a result of child feeding practices especially during complementary feeding and the weaning period. Poor feeding practices, feeding children with poor quality and or unbalanced diets and unhygienic feeding practices in the complementary feeding/weaning period increase the likelihood of undernutrition and micronutrient deficiency among children, and this contributes to the household burden of malnutrition.The present study found that increasing age of children under 5 years was associated with a higher likelihood of household TBM contrary to the findings of Sunuwar and colleagues in Nepal. Increasing age among women was associated with a higher chance of the household experiencing double and triple burden of malnutrition. The higher chance of overweight and obesity among older women in sub-Saharan Africa is one of the possible drivers of the higher likelihood of household DBM and TBM as was found in the present study. Again, being in a marital union (for women of reproductive age) was found to be associated with a higher chance of the household being overweight/obese. This could also be because of the higher likelihood of married/cohabiting women being overweight/obese compared with their counterparts who are not married or in union. The level of education of women in the household also showed expected results. Higher level of education among women in the household was associated with a lower likelihood of the household being undernourished or anaemic on one hand but a higher likelihood of household overweight/obesity on the other hand. This pattern of results is likely being driven by other mechanisms influenced by education. For example, educated women are more likely to be employed and or gain income and thus they can contribute to meeting the food expenditure needs of their household which lowers the risk of food insufficiency thereby reducing the chances of undernutrition while also ensuring that the household consumes a balanced and diversified diet and thereby reducing the chances of micronutrient deficiency. But on the other hand, households with educated women may also be at risk of having overweight/obese individuals because of frequent consumption of high calorie energy-dense foods such as polished rice, sweetened carbonated drinks and high-fat high sugar snacks.Considering the characteristics of reproductive age women who are members of the household, the findings with regard to their age were as expected and similar findings have been found among women in Nepalet al..The findings regarding the year the survey was conducted gives indication of the ongoing nutrition transition in sub-Saharan Africa. The chances of household undernutrition generally decreased in more recent years, whereas the chances of overweight/obesity and anaemia increased in recent years. Again, the chances of double and triple burden of malnutrition were found to increase in more recent years. Changing dietary behaviours from consumption of nutritious staple/traditional diets rich in fibre and complex carbohydrates to the consumption of high calorie, energy-dense, fatty foods and food with simple sugars in recent years could be contributing to the higher likelihood of overweight/obesity and anaemia and the higher risk of double and triple burden of malnutrition in households in SSA. The high prevalence and higher likelihood of anaemia is particularly concerning. Governments of SSA countries and the international community need to pay attention to this as emphasised by Jiwani . These can be achieved through integrated initiatives, policies and programmes involving different sectors such as the various health and agricultural sectors in countries. Thus, working within ‘institutional silos’ should be avoided as much as possible when addressing the double and triple burden of malnutrition.In tackling the double and triple burden of malnutrition, the WHO suggests ‘Double-duty’ actionsThe findings of the current study reveal some important findings about the dynamics between household factors and household burden of malnutrition. The current study is one of the few studies that uses nationally representative data across SSA to investigate correlates of household burden of malnutrition from the perspective of influencing household factors. Other studies have mostly investigated individual-level risk factors while controlling for some household characteristics. The current study is also among the few studies that attempt to investigate the prevalence and influencing factors of double and triple burden of malnutrition at the household level across SSA. The study is, however, challenged by some limitations. For example, it would have been helpful to include dietary diversity at the household level in the analysis but not all countries collected data on this indicator; therefore, household dietary diversity could not be included in the analysis. Including this variable in the analysis if it was available may have given some more insights into the findings of the present study. Another limitation with the current study is the use of anaemia as the only indicator of micronutrient deficiency. It will be helpful for future research to measure other indicators of micronutrient deficiency if such data are available. Additionally, the use of IPUMS data has some limitations due to the differing content of questionnaires used in different countries and the suppression of low-level geographic detail. The latter is, however, done to protect confidentiality of respondents. Additionally, although the DHS to a large extent has consistent variables that are collected across the participating countries, there are some variables that may be missing or collected differently. This presents a situation where the sample (number of respondent) may vary during pooled data analysis as was the case in the present study. These challenges notwithstanding, the current study provides insights into the prevalence and household factors that influence the burden of malnutrition at the household level in sub-Saharan Africa.. Efficiently managing household double and triple burden of malnutrition will require a life-course approach as suggested by Darnton-Hill et al.. This is important because undernutrition among children could result in overweight/obesity in later adult years, and undernourished women are likely to give birth to underweight children who are at risk of becoming overweight/obese in later years. Unfortunately, knowledge of the current scenario of DBM and TBM has not necessarily translated in concrete policy action in some countries. For example, even though the ‘Roadmap for Nutrition in South Africa 2013–2017’ and Ghana’s ‘National Nutrition Policy For Ghana 2013–2017’,60 both acknowledge the presence of both under and overweight/obesity, no clear recommendation is provided towards curbing their co-occurrence in same households. It thus goes without saying that nutrition programming interventions need to address both undernutrition which is dominated by childhood stunting and increasing overweight/obesity among both children and adults and the co-existence of all these conditions in the same household if SSA is to achieve success in combating the burden of malnutrition in the region.The findings of the current study reveal a high prevalence of various forms of household burden of malnutrition particularly the single burden of anaemia, undernutrition and overweight/obesity. The findings further indicate that undernutrition and now overweight/obesity are not the only forms of malnutrition that affect households in SSA. Anaemia is indeed a persistent problem that needs urgent policy attention. Although rapid economic development and urbanisation in the SSA region has created favourable conditions for overweight/obesity, the persistence of poverty and poor access to resources continue to drive the prevalence of anaemia and undernutrition, and the co-existence of extreme spectrums of malnutrition, i.e. double and triple burden of malnutrition in the same household. Though individuals and/or households may respond differently to similar diet and lifestyles, diet quality is a major factor influencing single, double and triple burden of malnutrition


In recent years, the use of drones in health emergencies has increased. Among their main benefits are avoiding endangering rescuers, travelling long distances in a short time, or contacting victims in risky situations; but despite their multiple advantages, their use has not been fully demonstrated.This study aims to identify the available evidence on the use of drones in emergency health care compared to traditional health care.Systematic review of the literature was conducted. Search protocols were developed to locate studies that met the established selection criteria. Six experimental or quasi-experimental studies with high methodological quality published from the beginning of indexing until 2020 were included.Drones covered a significantly larger area than other traditional tracking methods and were very useful for performing preliminary triage, determining needs, and knowing the scene prior to the arrival of rescuers. In addition, drones reduced the time required to locate the victim.Drones are an element to be taken into account when attending health emergencies as they significantly improve the distance travelled to locate accident victims, have the possibility of performing triage prior to the arrival of the health care units, and improve the time and quality of the care provided. In the health care field, the use of new technologies will allow for efficient and rapid care, reducing the time required for action, which on many occasions can have a direct impact on the survival of people.Today’s society is inconceivable without new technologies and the digital universe, and their application in the nursing profession is undoubtedly a growing and continuously advancing field. They also offer the advantage of covering long distances in a short time; they facilitate approaching places where rescuers would not be able to go, such as rural areas difficult to access or accident zones where an approach without risk to rescuers cannot be guaranteed sooner than would be possible by traditional means. Drones are notable for their ease of transport and flexibility of deployment as they do not require specific infrastructures.Recently, the use of Unmanned Aircraft Systems (UAS), or drones, in health emergencies has increased. One of the main benefits of drones is to avoid endangering rescuers in shootings, fires, radiation, the presence of infectious agents, explosives, smoke, or gases.However, when assessing all their functionalities, there are some limitations regarding their use in health care. For example, they cannot carry much weight, they are challenging to use in adverse weather conditions, and their initial investment is significant, although their cost is low compared to existing standard methods such as manned aerial vehicles-helicopters. Additionally, legislation is needed to make their use safe, regulated, and controlled. has compared standard practice with the use of drones in triage at a multi-casualty incident using the Simple Treatment and Rapid Transport (START) model of triage. Both groups were tested for accuracy in the first step of identifying walking (green) patients and simultaneously providing instructions through a loudspeaker, demonstrating the feasibility of triage of green casualties before the arrival of the first responders. Furthermore, although triage with a drone was 3.5 minutes slower, it could arrive 93% faster than an Emergency Medical Service, allowing remote triage before emergency services arrive and prioritizing care more effectively.One of the possible applications of drones in emergency care is for triaging patients in multiple-casualty accidents. Previous research by Jain, et al used drones to initiate the first step of SALT triage . Additionally, with the images provided by the drone, they assessed the ability to identify hazards at the scene and to designate the best areas for the second step of triage and the deployment of operational areas . The results showed that 82% of the participants correctly classified 12 of the 15 victims.Another triage method used with drone assistance was the Sort, Assess, Life-Saving Interventions, Treatment/Transport (SALT) method where Sibley, et al developed a remote triage procedure using drones. This triage procedure comprises an algorithm that assesses essential aspects such as bleeding, gait, presence of consciousness, and signs of life and subsequently classifies the injured into various priority categories. Additionally, with the help of bystanders recruited through messages broadcast through a public address system onboard the drone, this algorithm includes the possibility of indicating interventions such as compression of bleeding injuries or adaptation of the lateral safety position.Recently, Álvarez-García C, et alLikewise, among the possibilities for the use of drones in health care, it is worth highlighting the incorporation of instruments to transmit bio-parameters such as body temperature, heart rate, respiratory rate, and even electrocardiography or oxygen saturation so that emergency teams can prioritize care and consider in greater depth the characteristics of care that are going to be required. Previous research has shown that the results have similar reliability values to other vital sign measurements such as pulse oximetry or a respiratory transducer belt.These new possibilities provided by UAS are due to the development of photo-stimulus imaging, video-analysis, and motion magnification technology, as video cameras can detect changes in facial skin imperceptible to the human eye and cardiorespiratory movements in the chest of accident victims to determine signs of life.Additionally, it has been shown that the preview of the situation that the emergency team will face through thermal cameras makes it possible to prepare the rescuers better to evacuate the victims even when there is little visibility.Thus, this study identifies the available evidence on the use of drones in emergency care compared to traditional health care.A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.The search for published studies was conducted in the following bibliographic databases: Cuiden Plus ; Global Health ; LILACS ; Web of Science ; Scopus ; Cochrane ; CINAHL ; Health and Medical Complete ; IME ; Science Direct ; and Dialnet Plus  with no date limit from the start of indexing of each database until March 2020 and using the terms: “drone,” “emergencies,” “uav,” “triage,” “unmanned aerial vehicle,” “drones,” “triage,” and “emergency medicine.” The individual search strings for each database can be found in Table Population: Adult patients requiring care for an urgent or emergency situation.Intervention: Care using a UAS or drone.Comparator: Health care by traditional means.Outcome: Distance covered for locating accident victims, priority order applied to victims by triage, or effectiveness for transporting biological samples.Study Design: Experimental or quasi-experimental studies.Studies were included if they met the following inclusion criteria:Articles in Spanish and English were included concerning the application of drones in medicine. However, it was not considered appropriate to limit the search to a specific emergency health application due to the limited information available on the subject.Studies were selected based on their title and abstract and were obtained in full text for further analysis.The results of the review were grouped according to the variable studied: surface area covered by the drone, effectiveness of drones for victim location, aspects related to victim triage, or transport of samples or biological substances. for randomized clinical trials and the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines for quasi-experimental studies. Included in the review were all experimental studies that obtained three affirmative answers to the first three questions of the CASPe guide and a score equal to or higher than eight points on the overall scale. Quasi-experimental studies were assessed for compliance with the criteria of transparency in the sample selection, treatment assignment, the analysis of potential confounding variables, extrapolability, and overall methodological robustness as a criterion of high methodological quality. The results of the evaluation of the studies are presented in Table ,The methodological quality of the included studies was assessed using the Critical Appraisal Skills Program, Spanish (CASPe) guidelinesA form was used to collect the research design, characteristics of the participants, intervention, comparator, and main results. To ensure the quality of the process, two members of the research team conducted the literature search, and the article selection process was carried out by three members other than those who conducted the search. Thus, the included studies required the consensus of three researchers.The search strategy resulted in 314 papers identified in the cited databases. After reviewing the titles, 95 papers were selected, of which 23 were duplicates, resulting in 72 references that were then analyzed by title and abstract. Of these, 26 were eliminated as they did not line up with the objective of the research. Next, the full text of the resulting 46 papers were analyzed. Nine of these papers were eliminated as they were opinion studies, 33 were research projects or descriptive studies and did not provide comparative results, and four addressed topics different from the research. Finally, six studies were included in the review  between two sites. The studies were carried out in African countries in areas often constrained by poor road conditions, difficult geographical terrain, and insecurity. Both studies found that drones were significantly more effective at distances greater than 75 kilometers. For shorter distances, Ochieng, et al found that transport with a motorbike was more economical than transport with a drone.Two studiesThe objective of this review was to evaluate the available evidence on the possibilities of using drones in emergency health care, finding them to be a novel and beneficial element in patient care. found that the images provided by the drones can be very useful in a real scenario for carrying out a preliminary triage, having knowledge of the scenario prior to arrival, and determining the needs that will be required to attend to the disaster.Drones provided benefits over traditional care in addressing health emergencies, with study results centered on improved care by health care workers. However, the benefits go beyond improved care. Through interviews with doctors attending disasters, Hart, et al showed that it is beneficial in a simulated cardiac arrest situation where a drone is used to communicate with emergency service and simultaneously provide an automated external defibrillator/AED. In this situation, and when two observers witness the arrest, the degree of calmness is greater and the time without contact with the victim is representatively reduced compared to a situation with a single observer and where only telephone contact with the emergency service is made.Research by Sanfridsson, et al who found that drones covered 43% more surface area than the ground tracking group; however, statistical differences between the two groups were not evaluated. The ideal option would be to have drone networks that could reach an accident in less than three minutes, or even a network capable of covering 90% of the population in less than one minute, providing early health care.A variable analyzed in this review was the surface area covered by the drone for victim location, finding that drones offer significant benefits over a traditional search process, a result similar to that reported by Pulver, et al described that over 75% of victims were correctly located using drones; their greater effectiveness compared to other location methods cannot be confirmed, but they can be used as a complementary element or when there are risk factors for health teams. On the other hand, these authors have shown that younger people classify victims better, perhaps due to their greater confidence in new technologies.Another of the study variables was the effectiveness of drones in locating victims. Sibley, et al and assess the general condition of victims, helping to determine their degree of consciousness or assessing the presence of respiratory movements.Drones can help in the search for survivors, gather information on the number of patients in need of care in disaster situations, assess injuries related to chemical, biological, and nuclear weapons, assist in surgical procedures being performed in difficult environments, Among the regulations determined in some countries are that they must be operated by a certified pilot, during daylight hours, with the drone in line of sight, and flight only in controlled airspace. It would also be necessary to control the drone’s intrinsic factors, such as flight speed, the payload it can carry, the characteristics and sensors that a medical drone must have, as well as extrinsic factors such as the weather conditions in which it can fly.Drones provide potential benefits in health care; however, world-wide regulations should be developed for their correct use, taking into account the locations and situations where their use would be permitted by carrying out a risk-benefit analysis. allude to ethical issues such as respect for confidentiality that may be breached if outsiders observe patient data or the delivery of medication. They also refer to the possibility of technical failure, the risk of collision, weather conditions, or the temperature difference that may alter the normal functioning of the device. Although as previously described, several studies have evaluated the feasibility of transporting biological material showing promising results that may improve the availability of samples, mainly in areas of difficult access, and optimize the cost of transporting them.Bhatt K, et alDespite the potential advantages found in the review, the available evidence is limited because the technology underpinning drone flight and the functionalities of drones are constantly evolving. Hence, their characteristics can be improved to make them more functional in various critical situations and their benefits are expected to be greater. Another potential limitation is the lack of statistical significance in some of the outcome variables studied, as well as the heterogeneity of the results due to the different methodologies used.Drones can be considered a complementary element to traditional care when attending health emergencies, significantly improving the distance travelled to locate accident victims, providing the possibility of performing triage prior to the arrival of the health care units, and improving the time and quality of the care provided.


With the construction and development of modern and smart cities, people’s lives are becoming more intelligent and diversified. Surveillance systems increasingly play an active role in target tracking, vehicle identification, traffic management, etc. In the 6G network environment, facing the massive and large-scale data information in the monitoring system, it is difficult for the ordinary processing platform to meet this computing demand. This paper provides a data governance solution based on a 6G environment. The shortcomings of critical technologies in wireless sensor networks are addressed through ZigBee energy optimization to address the shortage of energy supply and high energy consumption in the practical application of wireless sensor networks. At the same time, this improved routing algorithm is combined with embedded cloud computing to optimize the monitoring system and achieve efficient data processing. The ZigBee-optimized wireless sensor network consumes less energy in practice and also increases the service life of the network, as proven by research and experiments. This optimized data monitoring system ensures data security and reliability. With the acceleration of urban modernization, people pay more attention to improving safety control awareness. The monitoring system has become essential to ensure people’s daily travel and traffic safety . The traIt can be seen from With the maturity of the 5G standard and the gradual expansion of commercial applications, 6G has quickly entered the industry’s vision. Many institutions and organizations have released white papers on 6G technology, pointing out the direction for future 6G technology indicators and applications. However, 5G is still in the primary stage of commercial application. There is still great uncertainty as to whether 5G supports various vertical applications. Relevant technologies are not yet mature, and business models still need to be explored. Any generation of systems has revolutionary changes in wireless access technology or network architecture. The development of mobile communication has the characteristics of continuity. Therefore, while discussing 6G, we should also think about how to effectively continue the development of mobile communications based on 5G and, at the same time, continue to absorb advanced technologies to continuously improve the technical content of mobile networks and reduce the use cost. Under such limited conditions, the large-scale data transmitted by embedded and cloud computing platforms quickly cause data congestion in wireless sensor networks, increasing the energy consumption of transmission nodes and causing network paralysis at any time [Therefore, we found from the literature survey that ZigBee energy optimization technology can solve the above problems well. As a new communication technology with low power consumption, high efficiency, and a faster speed, this technology reduces network delay to a specific range by its advantages. Additionally, it improves the data storage capacity limit in wireless sensor networks . With thThe research innovation contribution lies in solving the problem of insufficient energy supply and high power consumption in the practical application of wireless sensor networks. ZigBee energy optimization is used to solve the defects of critical technologies in wireless sensor networks by using the embedded cloud computing platform to process data in a distributed manner, and forming a multi-point computing structure based on real-time processing virtualization and integration. The redundancy in network data operation is reduced, and the problem of excessive energy consumption in wireless sensor network applications is reduced. Through a simple analysis of ZigBee technology, a clustering algorithm is proposed to optimize the routing protocol with high energy consumption. In the optimization process, the AODVjr algorithm is added as the comparison result of energy consumption. Adding dynamic monitoring data to the multi-task joint processing process improves the cloud storage capacity of the monitoring system and shortens the response time for processing monitoring data. In actual use, it consumes less energy and improves the service life of the network. This optimized data monitoring system ensures the security and reliability of data.In the future, the 6G spectrum will be extended to terahertz. In terms of coverage, 6G will use satellite communication, UAV communication, new airport technology, etc., to realize the seamless coverage of the communication network in the air, space, earth, and sea and the wide-area intelligent connection at the global business level of people, machines, and things. Therefore, the 6G network needs to be deeply integrated with computing to complete the integration and access of massive heterogeneous networks and allocate and cooperate full-time and frequently with airspace resources. In addition, it can meet the requirements of an intelligent, ubiquitous, and secure connection for the seamless coverage communication of 6G space, space, sea, and human–machine and object. In the Internet of Things and communication era, digital life affects people’s behavior changes . EveryonFAJIT is mainly committed to solving the problem of parent node selection in heterogeneous networks to different aggregate types of data packets to improve energy efficiency. Bhushan et al. compared the results of FAJIT with the distributed algorithm for integrated tree construction and data aggregation (DICA) on various parameters: average scheduling length, energy consumption data interval, the total number of transmission time slots, control overhead, and energy consumption in the control phase. The results show that the proposed algorithm has better energy efficiency . The emeZigBee technology is a wireless technology with high efficiency, low latency, low cost, and long duration. It conforms to the specification of network control protocol and is applied to sensor networks and remote control in the form of the complete structure. This new wireless communication technology uses a free frequency band for signal transmission, which is simple and consumes less energy . The wirIt can be seen from In some areas with desired and sufficient coverage, the operation schedule of the node is set to activate some sensors to ensure necessary coverage and disable other sensors. This has dramatically reduced the energy demand. A mobile node improves coverage when a cell is deprived of proper or sufficient coverage. The method proposed by Nilsaz and Barati has more advantages than its comparative technology, especially in the area ratio of a network domain, energy consumption, and network life . Karimi Therefore, in our design of the data monitoring system, adding the above technologies is also a critical scheme to increase the system operation time and improve the data processing speed and stability.In 6G applications, the impact of the access side will be more and more far-reaching, and the requirements for the rate and delay of service applications will become greater and greater. The role of embedded cloud computing in wireless sensor network routing algorithms will also be more prominent . The wirIt can be seen from It can be seen from It can be seen from It can be seen from It can be seen from xC, the address offset can be obtained according to the following formula:It can be seen from The formula represents the offset factor. After the subnodes of the same type join the network structure, we calculate that the address assigned to this node is:If the joined node has its own route, we reallocate the address from the parent node to the child node:From the above formula, you can obtain a calculated instance path. Next, the data transmission of network nodes is scheduled according to the clustering tree routing algorithm. We upload the network data according to the relationship between the child node and the parent node in turn, and finally form a data transportation rule. This static routing only needs to ensure that the relationship between nodes is orderly, avoiding the problem of resource consumption when the route is updated. When judging whether a node has reached the parent node branch, it can be calculated by the following formula:pK represents the distance coefficient for data transmission. If the child node location is found to be incorrect, the formula for retransmitting data is:In the formula, This clustering tree routing is relatively simple and suitable for devices with low power consumption in wireless sensors. It can also make up for the lack of energy supply of the monitoring system to a certain extent. However, due to the low efficiency of routing, the established data transmission path is not the best solution, so there will be a large delay problem when facing a large number of dynamic data. Therefore, in the experimental design, we also introduced the path optimization scheme to improve the local network and realized the energy optimization in the ZigBee network. Check the node location information before and after data transmission, and reduce the network transportation cost and consumption according to the optimal path strategy. This improves the performance of wireless sensor networks, reduces the total consumption of the whole network during system operation, and extends the working time and service life. Next, we also studied the optimization of embedded cloud computing in data processing to further improve the performance and reliability of the monitoring system in processing dynamic data information.While the access side network and computing capabilities are improved, the capabilities of many terminals can be further optimized in the future. Some general businesses can be moved to the cloud computing data monitoring system platform. This will significantly simplify terminal implementation and reduce the difficulty of business implementation and operating costs. At that time, the 6G network will develop into an integrated network integrating the cloud, network, edge, end, and use on the access side. In many fields, the support of a monitoring system is needed to complete the task and purpose. It can be seen that video monitoring and data monitoring have become the primary means of urban security and construction protection. When the coverage of the monitoring system gradually increases, the demand for data collection and analysis also grows. The traditional monitoring system is small in scale and prone to low efficiency and error when processing dynamic data. Therefore, the data monitoring system under the embedded cloud computing mode provides practical help for target detection, target tracking, traffic monitoring, police monitoring, and other links. Data monitoring has started to develop in the direction of massive, intelligent, fast processing technology. The embedded cloud computing platform takes its virtualization and integration as the management basis of monitoring information. It can be effectively combined with wireless sensor networks to form the interconnection effect between multi-platform nodes. The internal architecture of this high-performance computing mode is shown in It can be seen from It can be seen from Each element in the data set represents that the uploaded monitoring information is within a quality range and defines different data types, such as text, video, image, sound, etc. Among them, set definitions are performed for different data types:Z represents the video monitoring data type. We find that in practical applications, most of the data uploaded by monitoring is video based. Therefore, in computing tasks, we can find the average value of the quality between videos:In the formula, For each data node, the formula for the average processing time is:s represents the total time spent processing surveillance video data. Based on the above definitions, the system running time required for long videos in each processing set is calculated:In the formula, p1 represents the time node for uploading data, and pR1 the time node represents the end of video data processing. Because of the combination of embedded cloud computing and wireless sensor networks, it is easy to process duplicate information when computing large amounts of data. Therefore, we clean up the data of multiple associated nodes before calculating the system runtime:Among them, According to the above formula, we ran the data monitoring system in practical applications and found that the running speed of embedded cloud computing was significantly improved. We compared the efficiency of ordinary data monitoring systems and the embedded cloud computing system in multi-task and multi-node data transmissions, as shown in It can be seen from With powerful AI and extensive data analysis and calculation, the 6G network will become a computing and data network for the converged cloud, network, edge, and end. The hardware in the 6G network can rely on the unique hardware platform, general hardware platform, open source hardware platform, etc. We are adopting different degrees of open source and open strategies to decouple network elements and functions deeply. Resources will help build a universal and open network architecture for customized services, support the reconfiguration and plug-and-play of 6G networks, meet the needs of telecom operators for efficient and scalable networks, flexible and diversified services, and open industry ecology, and thus promote the business development of vertical applications. Since the cloud server cannot reach the bandwidth we need, we deployed the embedded cloud platform monitoring system and the simulation model on the physical server and installed a 10 GbE network card. The download and upload speed can reach about 10 Gbps simultaneously due to the short transmission distance and very low latency. In the experiment, the speed and delay standards of the 6G network environment can be achieved. ZigBee technology is a short-range wireless communication technology with low power consumption. The industry considers it most likely to be used in industrial control applications of wireless methods. It also uses the 2.4 GHz band, frequency hopping technology, and spread spectrum technology. The most important thing is that it can be networked with 254 nodes. The characteristics of ZigBee technology allow it to have great potential for industrial monitoring, sensor networks, home monitoring, security systems, and other fields. In security performance, ZigBee adopts the encryption algorithm of AES-128, and each application can flexibly determine its security attributes. It provides a data packet integrity check function based on cyclic redundancy check (CRC) and supports authentication. Although the traditional wireless sensor network can achieve fast data transmission in a small range, it has apparent defects in the node data transmission and power consumption stability. We compared various methods from wireless communication and sensor technology and chose ZigBee technology as the energy optimization method of the wireless sensor network. ZigBee energy optimization adopts a clustering routing algorithm to find the best sensor node path through the routing target before data transmission to reduce the energy loss caused by invalid paths during system operation. However, ordinary routing optimization needs to add all network nodes to the calculation, and most packets have no practical significance. This large-scale inaccurate calculation results in many redundant data, which increases energy consumption. Thus, we added the AODVjr algorithm as the fusion part to find the best solution for sensor nodes. In the AODVjr algorithm, many data packet controls exist, including route response, route request, and route error return. We show the process of this algorithm in monitoring data transmission.As shown in It can be further proved from It can be seen from To support the application of intelligent services, the network layer needs to perceive the services of the application layer to complete the intelligent and automatic management, scheduling, and allocation of computing resources in all parts of the network. In the 6G era, the network may realize the unified management of physical machines, virtual machines, containers, and other cloud network infrastructure resources by building a unified cloud network integration operating system; by building a unified network and application orchestration system to achieve on-demand orchestration and invocation of network functions and business applications; and by combine edge computing and edge AI capabilities to achieve intelligent data analysis and governance. Cloud computing and embedded data processing are combined through multiple tasks, parallel processing, distributed structure, and other combinations, which can provide users with more convenient, fast, and intelligent services. In cloud monitoring and large-scale video monitoring tasks, the embedded cloud system platform can directly connect the monitoring sensor node with the management end. This real-time interactive system is more in line with the needs of modern society. After the server is connected to the cloud system, it can handle a variety of data types uploaded by the physical monitoring layer to achieve the purpose of resource sharing and information analysis. The traditional monitoring system can only complete the monitoring task through a single sensor node when it is initially deployed. The data monitoring platform is developing towards a wider range with the introduction of wireless sensor networks. We built a virtual model of the data monitoring range under the wireless sensor network, as shown in It can be seen from It can be seen from It can be seen from The development of 6G will realize the coordinated development of terminals and networks and use wireless sensor networks to meet the needs of many intelligent terminals and application services for computing, storage, and services. The ubiquitous terminal requires high intelligence, strong computing power, and microservice capabilities. End–cloud collaboration can transfer this demand to the edge computing platform to reduce the manufacturing and holding costs of 6G ubiquitous intelligent terminals, thus effectively improving the popularity of 6G applications and services. Application scenarios should guide the development of end–cloud collaboration. Based on the background of the deep integration and close collaboration of the cloud and network edge, the industry should not only accelerate the construction of end–cloud collaboration standard systems, but we also need to start from the overall layout of 6G, based on the network, and conduct research and design under the framework of the central cloud, edge cloud, and 6G ubiquitous intelligent terminals.The construction of the 6G network will be based on the microservice architecture. For the basic service unit, the network needs to meet the differentiated needs of vertical industries and combine network capacity opening, cloud edge collaboration, and intelligent analysis to achieve different levels of capacity opening and network industry integration. As the monitoring system develops toward the goal of large-scale, big data and intelligence, many technologies for processing system data will also need to begin to progress towards the direction of science and technology. The traditional monitoring mode can only complete a single data transmission, which cannot meet the needs of modern cities in terms of layout scope, working hours, data transmission efficiency, data security, etc. Therefore, wireless sensor networks and embedded cloud computing systems become the primary means to solve the above problems. Cloud computing and embedded technology have noticeable effects in monitoring data and reconstructing video information. This distributed system processing method also provides help for extensive data analysis. Standard wireless sensor networks have apparent defects in node distribution and work continuity. This paper proposes improving the energy supply and service life of wireless sensor networks based on ZigBee energy optimization technology and improving the data monitoring systems’ distribution range. First, the ZigBee technology is analyzed, and a clustering algorithm is proposed to optimize the routing protocol for high energy consumption. In the optimization process, the AODVjr algorithm is added as the comparison result of energy consumption. It is found that the two optimization methods cannot significantly reduce the unnecessary consumption generated by the operation of the monitoring system. Therefore, the two algorithms are integrated into ZigBee technology to reduce data redundancy and repeated processing times during the use of wireless sensor networks and reduce network consumption. Finally, embedded cloud computing is used to distribute the computing data content with multiple data types as the boundary when processing the monitoring data. The dynamic monitoring data are added to the process of multi-task joint processing, which improves the cloud storage of the monitoring system and reduces the response time of processing monitoring data. The results show that using ZigBee energy to optimize wireless sensor networks in embedded cloud computing data monitoring systems can improve system operation efficiency. It not only reduces the running loss of the system but also ensures the security of the data and realizes a wide range of monitoring coverage. As ZigBee energy optimization is used for wireless sensor network access, the data monitoring system can support a broader range of data transmission and work. Finally, we use the simulation model to apply the embedded cloud computing data monitoring system under wireless sensor networks to urban areas. The analysis shows that the data monitoring system using embedded cloud computing and a wireless sensor network can improve the urban security environment. Although the experimental results of this study are relatively good in the simulated simulation environment, it is currently impossible to detect and verify the energy consumption in the actual data transmission due to the limitations of the physical environment, which is our next research goal.Due to the current global development of 6G, first of all, we need to meet the more extensive bandwidth, lower latency, and higher rate to realize the interconnection of hundreds of millions of various devices to meet the geometrically dramatic increase in data traffic, and our spectrum resources are becoming increasingly tight. Moreover, due to the lack of maturity of the chip and physical layer technology, we cannot reach the terahertz band, the visible light band, etc. On the other hand, the lack of energy efficiency of the current communication network will cause a variety of types of energy conversion waste, including photoelectric conversion, resulting in a large amount of energy loss for long-distance transmission within cities or information transmission between cities. However, with the current progress of various network communication and chip technologies, the continuous evolution of 6G, and the integration of new services, a new era of communication can be realized.


Interpretation and inference of data was relatively low with only 60% or so. Also, the probabilities of mastering the rest of attributes were about 70% on average. It was expected that this study would provide a new cognitive diagnostic perspective on the assessment of students’ essential data analysis abilities.Ability of data analysis, as one of the essential core qualities of modern citizens, has received widespread attention from the international education community. How to evaluate students’ data analysis ability and obtain the detailed diagnosis information is one of the key issues for schools to improve education quality. With an employment of cognitive diagnostic assessment (CDA) as the basic theoretical framework, this study constructed the cognitive model of data analysis ability for 503 Grade 9 students in China. The follow-up analyses including the learning path, learning progression and corresponding personalized assessment were also provided. The result indicated that first, almost all the students had the data awareness. Furthermore, the probability of mastering the attribute  With the arrival of big data era, substantial changes have taken place in different fields of society, such as the emergence of artificial intelligence, machine learning, precision medicine, and computational education . Data haCommonly cultivated by means of statistical disciplines or statistical content, data analysis ability tightly relates with statistics and can be extracted from statistical literacy. However, statistical literacy so far has not been well defined and there is no consensus achieved on its definition among statistics educators, statisticians, and researchers globally . Moore aData Collection, Data Tabulation and Representation, Data Reduction, and Interpretation and Inference. Using the Structure of the Observed Learning Outcome . It exhibits great advantages in understanding the overall status of students’ data analysis ability, however, it cannot provide students with more fine-grained diagnostic information, which is the key to promoting students’ development . The newData organization, Data representation, Data analysis, and Data interpretation. In this model, the continual process of data analysis was systematically presented. What’s more, they also made detailed operational definitions for each attribute and coded them accordingly. Data description, Data organization and generalization, Data representation, Data analysis, and interpretation. Data collection, Data tabulation and presentation, Data summarization, interpretation, and inference in the established statistical thinking framework. (a) Data representation and interpretation, (b) Sample interpretation, (c) Statistical methods selection, (d) Understanding and application. These studies provided the basis for the classification of data analysis ability attributes.In the attribute classification of data analysis ability, data processing includes organization, description, presentation, and analysis of data, which strongly depends on the representation of various graphics and icons . Jones eThe construction of the cognitive model, especially the construction of the relationship between the attributes in the cognitive model, is more complex. Normally, expert method is used to analyze the cognitive process of students in a certain field, to obtain the relationship between different attributes. In this study, five experts were selected, including three middle school math teachers who were awarded the title of Guizhou Provincial or Municipal Famous Teachers, with rich teaching experience and knowledge of students. Another expert was a mathematics education researcher who focuses on the assessment of data analysis ability and can inspect the cognitive model of data analysis ability from the theoretical level. The last expert we invited was a doctoral student majoring in mathematics education, who has been engaging in the teaching of data problem-solving for a long time, and can examine the cognitive model of data analysis ability from the perspective of assessment.Through open questionnaires, experts were required to enumerate the attributes of data analysis ability and draw the structural relationships between the attributes. Results of the expert method were presented in Based on the common elements in The subjects of this study were 503 Grade 9 students from 10 classes in two middle schools in Guizhou Province, China. Guizhou is a relatively underdeveloped province in terms of education. Based on the annual proportion of admission to the secondary school entrance examination, the two schools selected belong to the upper middle level in Guizhou Province. The test was 1 h long and all Grade 9 students in both schools took the test. Informed consent was obtained from all the students and teachers before the implementation of test.According to the method of constructing the Q-matrix in the Rule Space Model (RSM), the adjacency matrix was obtained according to the cognitive model shown in According to Trends in International Mathematics and Science Study (TIMSS) as the first round of items selected. Through coding the attributes of these items by the five experts, 22 items with high label consistency were finally selected as the assessment tools.CDA can not only reflect the internal relationship between the test items and cognitive attributes, but also demonstrate the relationship between the subject’s knowledge state and attributes . One of Comparison and selection of models play a vital role in CDA process. A large number of cognitive diagnostic practices have shown that choosing an appropriate CDM is an important prerequisite for accurate diagnosis and classification of subjects . Since tTwo criteria are generally considered in the selection of CDMs, which are Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). The number of parameters represents the load in the model evaluation process. The smaller the value of AIC and BIC, the smaller the load and the better the model fitting . ThroughThe GDM is a model that adapts to multi-level response variables and has two or more skill levels. It extends the commonly used IRT model to a multivariate, multiskilled classification model . Like otx is in a given condition , students’ abilities were calculated in each type of knowledge state, and students in different knowledge state categories were divided . The abiAccording to the attributes of the knowledge states in the different stages in Accurately depicting the knowledge state of each student is the greatest advantage of CDA. To fully illustrate the fine-grained information that CDA can provide for each student, three students numbered 337, 476 and 424 were selected for the analysis. The radar chart of their attribute mastery was shown in The characteristic of the three students shown in Know data, but students’ mastery of Interpretation and inference of data was relatively poor. Data analysis ability can be clearly divided into five levels of learning progression and students with the same scores differed obviously in the knowledge state.This study constructed a reasonable cognitive model for students’ data analysis ability based on the expert method. Results showed that students had a good attribute mastery of As one of the essential core qualities of modern citizens, the importance of data analysis ability has been recognized by all walks of life. The accurate assessment of data analysis ability is a topic that is worthy further exploration. As a new generation of assessment theory, CDA is designed to detect students’ specific knowledge structure or operational skills in a certain field, so as to provide students with more fine-grained diagnostic information on cognitive strengths and weaknesses . It is eIn this study, we also explored the learning path and learning progression of students’ data analysis ability. The learning path depicted student’s thinking and learning in a specific field of mathematics, reflecting student’s learning process through a series of instructive tasks. These tasks were designed to promote the development of students’ mental process and thinking level . The leaThis study provided a more complete and standardized research method, constructed a cognitive model of data analysis ability, and made contributions to the theory as well as methods to a certain degree. However, due to the limited material and financial resources, this study also had some shortcomings inevitably. First, the sample size available was limited. With only approximately 500 students in China, the result of the study lacked generalizability to some extent. In addition, any assessment cannot make without the discipline itself. The evaluation content should be analyzed based on the characteristics of the discipline . Last, a18198689070@126.com.The data analyzed in this study is subject to the following licenses/restrictions: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Requests to access these datasets should be directed to XW, Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.XW designed the study and wrote this manuscript. YZ contributed to the manuscript writing and the continued revision provided by the reviewers. XT collected the data and wrote this manuscript. RW and TX have revised the language of the article and provided comments. All authors contributed to the article and approved the submitted version.This work was support by 2021 Humanities and Social Science Research project of Ministry of Education of China: Cognitive Diagnosis and Evaluation of Mathematics Core Literacy (21YJC880102). Teacher Education “JIEBANGLINGTI” Project of Northeast Normal University: Learning Progression Construction and Learning Path Analysis Based on Cognitive Diagnosis (JSJY20220305).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.