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Objective : Angiolipomas are usually found in the subcutaneous tissue of the trunk and limbs. Spinal angiolipomas (SALs) are uncommon and have rarely been reported. We report a series of nine SALs patients who received surgical treatment in our department. To summarize the clinical characteristics of SALs, propose our surgical strategies, and evaluate the effects of the operation.Methods : This was a retrospective review of nine SALs patients who received surgical treatment from August 2015 to March 2020. Total or subtotal resection was determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. The outcomes were assessed based on the modified Japanese Orthopaedic Association (mJOA) scoring system utilized before surgery and at various follow-up points.Results : Among the nine patients, the mean mJOA score before surgery was 6.6±2.3, compared with 10.1±1.1 at the last follow-up time point (33.4±11.8 months). All patients achieved good outcomes, even in cases of subtotal resection.Conclusion : Early surgical resection of SALs is recommended, and the specific procedures should be determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. Most of the patients had a good prognosis, even in cases of subtotal resection.

Introduction Limited data were published on the management of direct oral anticoagulants in the insertion of pacemaker and cardiac monitoring devices. This study describes the management and outcomes of edoxaban, a direct oral factor Xa inhibitor, in patients undergoing pacemaker or monitoring device implantation in routine clinical practice. Methods and results EMIT-AF/VTE collected data of patients from Europe, Korea, and Taiwan. Timing and duration of peri-procedural interruption of edoxaban were at the treating physician's discretion. Pacemakers or monitoring devices were implanted into 136 patients who were evaluated from five days pre- until 30 days post-procedure. The primary outcomes were the incidences of acute thromboembolic events (ATE), ischemic events, and International Society on Thrombosis and Haemostasis defined Major Bleeding; secondary outcomes included incidence of Clinically Relevant Non-Major Bleeding (CRNMB) and perioperative edoxaban interruption times. Conformance with European Heart Rhythm Association (EHRA) Guidance on interruption of DOAC therapy was variable: of the cardiac monitoring device patients, where no interruption of therapy would be expected, nonetheless, 62.5% had interruption of treatment, whereas in pacemaker procedures, where interruption would be expected, 23.4% had no interruption. No ATE or ischemic events occurred. One case of CRNMB and two of minor bleeding occurred. All bleedings occurred more than three days after the procedure. Conclusion/relevance The periprocedural complication risk for edoxaban treated patients undergoing pacemaker or invasive cardiac monitoring implantation was low. This population of patients was well managed in routine practice. This article is protected by copyright. All rights reserved.

Background: Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. Methods: In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. Results: Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63–0.92]; P =0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56–0.87]; P =0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50–0.81]; P =0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%–10.2%) in first events, with a number needed to treat of 16 (95% CI, 10–44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P =0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. Conclusions: In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01492361.

BACKGROUND The role of direct oral anticoagulants as compared with vitamin K antagonists for atrial fibrillation after successful transcatheter aortic-valve replacement (TAVR) has not been well studied. METHODS We conducted a multicenter, prospective, randomized, open-label, adjudicator-masked trial comparing edoxaban with vitamin K antagonists in patients with prevalent or incident atrial fibrillation as the indication for oral anticoagulation after successful TAVR. The primary efficacy outcome was a composite of adverse events consisting of death from any cause, myocardial infarction, ischemic stroke, systemic thromboembolism, valve thrombosis, or major bleeding. The primary safety outcome was major bleeding. On the basis of a hierarchical testing plan, the primary efficacy and safety outcomes were tested sequentially for noninferiority, with noninferiority of edoxaban established if the upper boundary of the 95% confidence interval for the hazard ratio did not exceed 1.38. Superiority testing of edoxaban for efficacy would follow if noninferiority and superiority were established for major bleeding. RESULTS A total of 1426 patients were enrolled (713 in each group). The mean age of the patients was 82.1 years, and 47.5% of the patients were women. Almost all the patients had atrial fibrillation before TAVR. The rate of the composite primary efficacy outcome was 17.3 per 100 person-years in the edoxaban group and 16.5 per 100 person-years in the vitamin K antagonist group (hazard ratio, 1.05; 95% confidence interval [CI], 0.85 to 1.31; P���=���0.01 for noninferiority). Rates of major bleeding were 9.7 per 100 person-years and 7.0 per 100 person-years, respectively (hazard ratio, 1.40; 95% CI, 1.03 to 1.91; P���=���0.93 for noninferiority); the difference between groups was mainly due to more gastrointestinal bleeding with edoxaban. Rates of death from any cause or stroke were 10.0 per 100 person-years in the edoxaban group and 11.7 per 100 person-years in the vitamin K antagonist group (hazard ratio, 0.85; 95% CI, 0.66 to 1.11). CONCLUSIONS In patients with mainly prevalent atrial fibrillation who underwent successful TAVR, edoxaban was noninferior to vitamin K antagonists as determined by a hazard ratio margin of 38% for a composite primary outcome of adverse clinical events. The incidence of major bleeding was higher with edoxaban than with vitamin K antagonists. (Funded by Daiichi Sankyo; ENVISAGE-TAVI AF ClinicalTrials.gov number, NCT02943785.).

Anal fissure is a common condition that can be treated medically or surgically. Chemical sphincterotomy is often used before surgical intervention. This study aims to evaluate the effectiveness of topical agents for chemical sphincterotomy on healing of anal fissures and side-effects. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant systematic review was performed using MEDLINE, EMBASE, Scopus, and CENTRAL databases. Eligible studies included randomized controlled trials which compared topical sphincterotomy agents with topical placebo agents or each other. Studies that included surgical treatments were excluded. Overall evidence was synthesized according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Thirty-seven studies met the study selection criteria. Seventeen studies show that glyceryl trinitrate (GTN) was significantly more likely to heal anal fissure than placebo (relative risk (RR) = 1.96, 95% confidence interval (95%CI) = 1.35–2.84, I2 = 80%). Eleven studies showed a marginally significant difference between healing rates for diltiazem vs GTN, RR = 1.16, (1.01–1.33) I2 = 48%. There was no significant difference in healing between diltiazem and placebo, RR = 1.65, (0.64–4.23), I2 = 92%. GTN significantly reduced pain on the visual analog scale compared to the placebo group, MD–0.97 (–1.64 to –0.29) I2 = 92%. There was high certainty of evidence that GTN was significantly more likely to cause headache than placebo (RR = 2.73 (1.82–4.10) I2 = 58%) and diltiazem RR = 6.88 (2.19–21.63) I2 = 17%. There is low certainty evidence topical nitrates are an effective treatment for anal fissure healing and pain reduction compared to placebo. Despite widespread use of topical diltiazem, more evidence is required to establish the effectiveness of calcium channel blockers compared to placebo.

Background: Trauma mortality in low- and middle-income countries (LMICs) remains high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to decrease trauma mortality. Methods: A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country trauma systems was conducted from November 1989 to August 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC population according to World Bank Income Classification, occurred in a trauma setting, and measured the effect of implementation and its impact. The primary outcome was trauma mortality. Results: Of 37,575 search results, 30 studies were included from 15 LMICs covering five WHO regions in a qualitative synthesis. Twenty-seven articles were included in a meta-analysis. Implementing a pre-hospital trauma system reduced overall trauma mortality by 45% (risk ratio (RR) 0.55, 95% CI 0.4 to 0.75). Training first responders resulted in an overall decrease in mortality (RR 0.47, 95% CI 0.28 to 0.78). In-hospital trauma training with certified courses resulted in a reduction of mortality (RR 0.71, 95% CI 0.62 to 0.78). Trauma audits and trauma protocols resulted in varying improvements in trauma mortality. Conclusion: There is evidence that quality improvement processes, interventions, and structure can improve mortality in the trauma systems in LMICs.

AIM Haemorrhoids are frequently encountered by the general or colorectal surgeon. Although a benign disease, those with symptomatic, advanced grades frequently require excisional haemorrhoidectomy for definitive management. Despite their widespread nature, the epidemiological burden of haemorrhoids and haemorrhoidectomies on populations is not well described. This study seeks to establish the incidence of both haemorrhoids diagnosed and haemorrhoidectomies performed in New Zealand. METHOD This is a population-based cross-sectional study examining the incidence of all patients who were newly diagnosed with haemorrhoids in New Zealand public hospital outpatient clinics and those who received excisional haemorrhoidectomy in New Zealand public hospitals from 2007 to 2016. Data were extracted and linked using the New Zealand National Minimum Dataset and the National Non-Admitted Patient Collection. Variables collected included age group, sex, ethnicity and geographical location. RESULTS A total of 46 095 recorded diagnoses of haemorrhoids were made, with a total of 18 739 haemorrhoidectomies in the 10-year period recorded. The incidence rate of diagnosis increased from 84.6 to 120.5 per 100 000 and the incidence rate of haemorrhoidectomies performed from 30.4 to 51.1 per 100 000, a significantly increased annual incidence. There was a unimodal peak prevalence in the fifth decade of life with women more affected. Europeans formed the largest group affected, with Asians showing the highest rate of increased incidence. CONCLUSION There is an increasing incidence of patients with symptomatic haemorrhoids presenting to the New Zealand public healthcare system, with a preponderance in working age adults, especially women.

Aim Haemorrhoidal disease can severely affect a patient's quality of life. Its classification is commonly based on morphology of the degree of prolapse; however, this does not take into account the symptoms and impact on the quality of life. The aim of this systematic review was to determine the most appropriate instruments that classify the severity of disease according to symptoms. Method A PRISMA-compliant search was conducted in December 2019 to identify studies that described the validation of a haemorrhoidal symptom score. The measurement properties of the scoring systems were assessed based on the consensus-based standards for the selection of health status measurement instruments (COSMIN) methodology for systematic reviews for patient-reported outcome measures. Results A total of 5288 articles were identified, with five articles included. Three studies developed a scoring system based on a set of core symptoms for a cohort of patients and validated the score against treatment outcomes. One study developed a disease-specific quality of life questionnaire based on symptoms to evaluate disease burden. One study combined both quality of life and symptom measures and tested measurement properties on two cohorts of patients. Only one study demonstrated satisfactory valid, reliable and responsive measurement criteria. Conclusion A single study demonstrated sufficient quality in measurement properties to be recommended for clinical use. Further studies in this area should utilize consensus-based standards for designing and reporting validation research to ensure that the appropriate evidence base is acquired if any further patient-reported outcome measures are to be recommended.

There has been an increasing prevalence of ad-hoc networks for various purposes and applications. These include Low Power Wide Area Networks (LPWAN) and Wireless Body Area Networks (WBAN) which have emerging applications in health monitoring as well as user location tracking in emergency settings. Further applications can include real-time actuation of IoT equipment, and activation of emergency alarms through the inference of a user's situation using sensors and personal devices through a LPWAN. This has potential benefits for military networks and applications regarding the health of soldiers and field personnel during a mission. Due to the wireless nature of ad-hoc network devices, it is crucial to conserve battery power for sensors and equipment which transmit data to a central server. An inference system can be applied to devices to reduce data size for transfer and subsequently reduce battery consumption, however this could result in compromising accuracy. This paper presents a framework for secure automated messaging and data fusion as a solution to address the challenges of requiring data size reduction whilst maintaining a satisfactory accuracy rate. A Multilayer Inference System (MIS) was used to conserve the battery power of devices such as wearables and sensor devices. The results for this system showed a data reduction of 97.9% whilst maintaining satisfactory accuracy against existing single layer inference methods. Authentication accuracy can be further enhanced with additional biometrics and health data information.

Background: Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes. Methods: A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542. Result: Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46–1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48–0.93). Conclusion: There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Background The optimal periprocedural management of direct oral anticoagulants (DOAC), including edoxaban, in patients undergoing catheter-based cardiovascular procedures is unknown, and mainly based on physician opinion and experience. Purpose To assess real-world management of edoxaban in patients undergoing cardiovascular procedures, and to report their clinical events. Methods Global EMIT-AF/VTE is a prospective study of periprocedural management in edoxaban-treated patients undergoing diagnostic and therapeutic procedures. We report the data from patients undergoing cardiovascular procedures. Timing and duration of edoxaban interruption were at the treating physician’s discretion. Outcomes were collected from 5 days before until 30 days post procedure. Primary outcome was the incidence of major bleeding (MB); secondary outcomes included incidence of clinically relevant non-major bleeding (CRNMB) and acute thromboembolic events (ATE). Results Data was collected from 301 and 311 procedures with arterial or venous access, respectively. Baseline characteristics are shown in Table 1. Edoxaban was not interrupted in 36.9% of arterial and 52.7% of venous procedures. Edoxaban was interrupted pre-procedure in 41% of arterial and 32.8% of venous procedures. The median periprocedural interruption was 2 days. The overall incidence of bleeding was very low. Any bleeding was reported in 8 patients undergoing arterial and 10 patients undergoing venous procedures (2.7% and 3.2%). MB or CRNMB occurred in 2 arterial and 3 venous procedures (0.7% and 1.0%) and ATE occurred in 5 arterial and 1 venous procedure (1.7% and 0.3%, Table 1). Conclusions In this study, the periprocedural risks of bleeding and thrombotic events were low. About a third of arterial access procedures and half of venous access procedures were performed without edoxaban interruption. Arterial(n = 301) Venous(n = 311) Baseline characteristics Age, year, mean (SD)Male, n (%)Weight (kg), mean (SD) 71.9 (8.5)211 (70.1%)80.8 (16.7) 64.6 (11.1)215 (69.1%)84.1 (17.4) CrCL (mL/min), mean (SD) CHA2DS2-VASc score, mean (SD)HAS-BLED score, mean (SD) 73.5 (29.8) 3.3 (1.5)2.0 (1.0) 88.9 (35.5) 2.2 (1.5)1.3 (1.0) Edoxaban 60 mg / 30 mg, % 73% / 26% 88% / 26% Coronary heart disease, n (%) Congestive heart failure, n (%) 101 (33.6%) 58 (19.3%) 51 (16.4%) 33 (10.6%) Interruption of edoxaban, n (%) No interruption Pre-procedure only Post-procedure only Pre- and post-procedure 111 (36.9%)125 (41.5%)12 (4.0%)53 (17.6%) 164 (52.7%)102 (32.8%)8 (2.6%)37 (11.9%) Clinical events, n (%) MB or CRNMBACSStroke/Transient ischemic attackCV mortalityAll-cause mortality 2 (0.7%)2 (0.7%)3 (1.0%)1 (0.3%)2 (0.7%) 3 (1.0%) 01 (0.3%)00

Deep learning models are efficient in learning the features that assist in understanding complex patterns precisely. This study proposed a computerized process of classifying skin disease through deep learning based MobileNet V2 and Long Short Term Memory (LSTM). The MobileNet V2 model proved to be efficient with a better accuracy that can work on lightweight computational devices. The proposed model is efficient in maintaining stateful information for precise predictions. A grey-level co-occurrence matrix is used for assessing the progress of diseased growth. The performance has been compared against other state-of-the-art models such as Fine-Tuned Neural Networks (FTNN), Convolutional Neural Network (CNN), Very Deep Convolutional Networks for Large-Scale Image Recognition developed by Visual Geometry Group (VGG), and convolutional neural network architecture that expanded with few changes. The HAM10000 dataset is used and the proposed method has outperformed other methods with more than 85% accuracy. Its robustness in recognizing the affected region much faster with almost 2× lesser computations than the conventional MobileNet model results in minimal computational efforts. Furthermore, a mobile application is designed for instant and proper action. It helps the patient and dermatologists identify the type of disease from the affected region’s image at the initial stage of the skin disease. These findings suggest that the proposed system can help general practitioners efficiently and effectively diagnose skin conditions, thereby reducing further complications and morbidity.

Sin financiación 4.153 JCR (2019) Q2, 35/138 Cardiac & Cardiovascular Systems 2.902 SJR (2019) Q1, 17/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Annually 10% of patients with atrial fibrillation on oral anticoagulation undergo invasive procedures. Optimal peri-procedural management of anticoagulation, as judged by major bleeding and thromboembolic events, especially in the elderly, is still debated.Procedures from 1442 patients were evaluated. Peri-procedural edoxaban management was guided only by the experience of the attending physician. The primary safety outcome was the rate of major bleeding. Secondary outcomes included the peri-procedural administration of edoxaban, other bleeding events, and the main efficacy outcome, a composite of acute coronary syndrome, non-hemorrhagic stroke, transient ischemic attack, systemic embolic events, deep vein thrombosis, pulmonary embolism, and mortality.Of the 1442 patients, 280 (19%) were 65, 550 (38%) were 65-74, 514 (36%) 75-84, and 98 (7%) were 85 years old or older. With increasing age, comorbidities and risk scores were higher. Any bleeding complications were uncommon across all ages, ranging from 3.9% in patients 65 to 4.1% in those 85 years or older; major bleeding rates in any age group were ≤ 0.6%. Interruption rates and duration increased with advancing age. Thromboembolic events were more common in the elderly, with all nine events occurring in those 65, and seven in patients aged 75 years.Despite increased bleeding risk factors in the elderly, bleeding rates were small and similar across all age groups. However, there was a trend toward more thromboembolic complications with advancing age. Further efforts to identify the optimal management to reduce ischemic complications are needed.NCT# 02950168, October 31, 2016.

Privacy protection in electronic healthcare applications is an important consideration, due to the sensitive nature of personal health data. Internet of Health Things (IoHT) networks that are used within a healthcare setting have unique challenges and security requirements (integrity, authentication, privacy, and availability) that must also be balanced with the need to maintain efficiency in order to conserve battery power, which can be a significant limitation in IoHT devices and networks. Data are usually transferred without undergoing filtering or optimization, and this traffic can overload sensors and cause rapid battery consumption when interacting with IoHT networks. This poses certain restrictions on the practical implementation of these devices. In order to address these issues, this paper proposes a privacy-preserving two-tier data inference framework solution that conserves battery consumption by inferring the sensed data and reducing data size for transmission, while also protecting sensitive data from leakage to adversaries. The results from experimental evaluations on efficiency and privacy show the validity of the proposed scheme, as well as significant data savings without compromising data transmission accuracy, which contributes to energy efficiency of IoHT sensor devices.

As COVID-19 rampages throughout the world and has a major impact on the healthcare system, non-emergency medical procedures have nearly come to a halt due to appropriate resource reallocation. However, pain never stops, particularly for patients with chronic intractable pain and implanted spinal cord stimulation (SCS) devices. The isolation required to fight this pandemic makes it impossible for such patients to adjust the parameters or configuration of the device on site. Although telemedicine has shown a great effect in many healthcare scenarios, there have been fewer applications of such technology focusing on the interaction with implanted devices. Here, we introduce the first remote and wireless programming system that enables healthcare providers to perform video-based real-time programming and palliative medicine for pain patients with a SCS implant. During the COVID-19 pandemic from January 23, 2020, the date of lockdown of Wuhan, to April 30, 2020, 34 sessions of remote programming were conducted with 16 patients. Thirteen of the 16 patients required programming for parameter optimization. Improvement was achieved with programming adjustment in 12 of 13 (92.3%) cases. Eleven of the 16 (68.8%) patients reported that the system was user-friendly and met their needs. Five patients complained of an unstable connection resulting from the low network speed initially, and three of these patients solved this problem. In summary, we demonstrated that a remote wireless programming system can deliver safe and effective programming operations of implantable SCS device, thereby providing palliative care of value to the most vulnerable chronic pain patients during a pandemic.Clinical Trial Registrationwww.clinicaltrials.gov, identifier NCT 03858790.

Biometric-based authentication has come into recent prevalence in competition to traditional password- and/or token-based authentication in many applications, both for user convenience and the stability/uniqueness of biometric traits. However, biometric template data, uniquely linking to a user's identity, are considered to be sensitive information. Therefore, it should be secured to prevent privacy leakage. In this paper, we propose a homomorphic encryption-based fingerprint authentication system to provide access control, while protecting sensitive biometric template data. Using homomorphic encryption, matching of biometric data can be performed in the encrypted domain, increasing the difficulty for attackers to obtain the original biometric template without knowing the private key. Moreover, the trade-off between the computational overload and authentication accuracy is studied and experimentally verified on a publicly available fingerprint database, FVC2002 DB2.

Networks for military applications have unique characteristics as they have high security requirements and adaptability to changing circumstances and landscape. As a result, they are usually composed of unstructured networks. Ad hoc networks are unstructured in nature and are increasing in prevalence with such examples being Low Power Wide Area Networks (LPWAN) and Wireless Body Area Networks (WBAN). These are emerging alongside various applications such as health monitoring and emergency user location identification, which can be further augmented with alarm detection that raises alarms from the inference of a user’s situation via the use of sensors and personal devices within an LPWAN. During a military operation, injured personnel or those at emergent health risks could be identified and located from an automatic alarm activation in such an application. This paper discusses the design and aspects of a network for secure automated messaging and data fusion which could be applicable to a military setting.

Background In ENSURE-AF study, edoxaban had similar efficacy and safety profile versus enoxaparin–warfarin (enox–warf) in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. Objectives To evaluate the efficacy and safety of edoxaban versus enox–warf in patients who were vitamin K antagonists (VKA) naïve or experienced at time of randomisation into ENSURE-AF trial. Methods The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular death during the overall study period, 28 days on study drug after cardioversion and 30 days follow-up. The primary safety endpoint was the composite of major and clinically relevant nonmajor bleeding during the on-medication period from time of first dose to last dose of study drug taken + 3 days. Results Of 2199 patients enrolled in ENSURE-AF, 1095 were randomised to edoxaban and 1104 to enox–warf. There were numerically fewer primary efficacy endpoint events with edoxaban than enox–warf irrespective of whether VKA experienced or naïve (0.5% vs. 0.9%, 0.3% vs. 1.4%, respectively). There were no significant differences in the primary safety endpoint [odds ratio (OR) 2.09, 95% confidence interval (CI) 0.72–6.81 in anticoagulant experienced patients, OR 0.77, 95% CI 0.15–3.60 in anticoagulant naïve patients] and in major bleeding rates regardless of treatment or VKA experience (OR 0.69, 95%CI 0.06–6.04, OR 0.48, 95% CI 0.01–9.25, respectively). Conclusions Edoxaban had comparable efficacy and safety to optimized anticoagulation with enox–warf. The primary efficacy and safety endpoint outcomes were broadly similar between VKA experienced or naïve patients.

Privacy protection in electronic healthcare applications is an important consideration due to the sensitive nature of personal health data. Internet of Health Things (IoHT) networks have privacy requirements within a healthcare setting. However, these networks have unique challenges and security requirements (integrity, authentication, privacy and availability) must also be balanced with the need to maintain efficiency in order to conserve battery power, which can be a significant limitation in IoHT devices and networks. Data are usually transferred without undergoing filtering or optimization, and this traffic can overload sensors and cause rapid battery consumption when interacting with IoHT networks. This consequently poses restrictions on the practical implementation of these devices. As a solution to address the issues, this paper proposes a privacy-preserving two-tier data inference framework - this can conserve battery consumption by reducing the data size required to transmit through inferring the sensed data and can also protect the sensitive data from leakage to adversaries. Results from experimental evaluations on privacy show the validity of the proposed scheme as well as significant data savings without compromising the accuracy of the data transmission, which contributes to energy efficiency of IoHT sensor devices.

Background EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation evaluated use of nonvitamin K antagonist oral anticoagulant edoxaban vs enoxaparin‐warfarin in patients with nonvalvular atrial fibrillation undergoing electrical cardioversion. Hypothesis To assess clinical factors related to successful or unsuccessful cardioversion. To evaluate whether differences in adverse events based on anticoagulation strategy may exist. Methods In this multicenter prospective randomized open‐label blinded end‐point evaluation trial, 2199 patients were randomized to edoxaban 60 mg once daily (30 mg for creatinine clearance 15‐50 mL/min, weight ≤ 60 kg, and/or concomitant use of P‐glycoprotein inhibitor) or enoxaparin‐warfarin. Successful cardioversion was confirmed by 12‐lead electrocardiography‐documented sinus rhythm. Results Cardioversion was successful in 1578 patients; in 355 patients, cardioversion was unsuccessful. Male, high body weight, high body mass index (BMI), coronary artery disease, concomitant aspirin, or prior statins use were more common in patients with unsuccessful cardioversion; international normalized ratio control did not differ by cardioversion success. On multivariate analysis, gender (P

Affordable and expandable low power networks such as 5G and Low Power Wide Area Networks (LPWAN) in the public and private network areas have improved network bandwidth capacities and processing performance. Internet of Things (IoT) technologies are increasing in popularity with numerous applications and devices being developed for smart environments and health-related applications. This raises security concerns in these networks, as many IoT devices handle confidential information such as IP/MAC addresses, which could be used to identify a user's location. As a result, there is vulnerability to data tampering by man-in-the-middle (MITM) attacks, which feature two observable characteristics: (1) there is a measurable delay in the session and (2) has unusual travel times compared to prior normal transactions. To improve the detection of these attacks, this paper proposes a novel scheme using a hybrid routing mechanism, which involves appointing dedicated nodes for enforcing routing between IoT devices and users with minimal intervention and workload to the network. The function of dedicated devices with more computational and battery power can provide three advantages: (1) determine secured paths within the network by avoiding suspicious nodes and networks, (2) provide stable travel times (less fluctuations) for a trusted time server (TTS) to improve the accuracy of estimated travel times, and (3) provide packet inspection for security checks. This proposed solution contributes towards increasing the security of IoT networks by enabling the real-time detection of intruders.

Aims In ENSURE-AF (NCT02072434), the oral Factor Xa inhibitor edoxaban showed similar efficacy and safety vs enoxaparin–warfarin in patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). This ancillary analysis compares primary efficacy and safety end points for patients receiving vs not receiving concomitant antiplatelet therapy (APT) in ENSURE-AF. Methods The primary efficacy end point was a composite of stroke, systemic embolic events, myocardial infarction, and cardiovascular death during 28 days on study drug after cardioversion plus 30 days of follow-up. The primary safety end point was the composite of major and clinically relevant non-major bleeding occurring between the first and the last dose of study drug. Results Of 2199 patients enrolled, 1095 were randomized to edoxaban and 1104 to enoxaparin–warfarin. Patients receiving concomitant APT were older; more naïve to vitamin K antagonist; had lower creatinine clearance; and more likely to have history of coronary artery disease, hypertension, diabetes, or ischemic stroke/transient ischemic attack. In patients receiving vs not receiving concomitant APT, primary efficacy event rate was numerically higher (0.92% vs 0.60%, p = 0.64) and primary safety event rate was significantly higher (3.21% vs 0.92%, p = 0.0096). Stepwise logistic regression analysis identified age and APT as covariates correlated with bleeding. There was a trend toward increased bleeding risk in elderly patients receiving vs not receiving concomitant APT. Conclusion In ENSURE-AF, thromboembolic events were rare and absolute bleeding event rates were higher with concomitant APT. These findings may be relevant for AF-patients considered for dual therapy; even for a short treatment duration of 1 month. Sin financiación 5.460 JCR (2020) Q2, 36/142 Cardiac & Cardiovascular Systems 1.838 SJR (2020) Q1, 41/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

Background: The optimal interruption schedule for NOACs in patients undergoing invasive procedures has not been determined. This analysis describes periprocedural interruption of edoxaban in real world EMIT AF/VTE study. Methods: EMIT AF/VTE was a prospective, non-interventional study conducted in 7 European countries that collected detailed information on periprocedural management of edoxaban from 5 days before to 30 days after procedure in patients with AF or VTE. Results: Among 1155 patients, pre-procedural interruption occurred in 781 (68%) patients (median 2 days, IQR 1.0-2.0) and post-procedural interruption in 308 (27%) patients (median 3 days, IQR 1.0-8.0); 279 (24.2%) patients had both pre- and post-procedural interruption. Edoxaban interruption in some patients differed from 2018 EHRA Recommendations for NOAC use in AF. Of 294 patients receiving minor risk procedures, for whom no interruption is recommended, 173 (58.8%) had preprocedural interruption (median 1 day). Of 581 patients with low bleeding risk procedures, for whom ≥24h preprocedural interruption is recommended, 188 (32.4%) had no interruption. Of 280 patients receiving high bleeding risk procedures, for whom ≥48h interruption is recommended, 46 (16.4%) had no interruption. Clinical events are shown in Table. Conclusion: Edoxaban interruption schedules in routine practice were not always consistent with EHRA guidelines; nevertheless, rates of clinically significant bleeding or acute thromboembolic events or coronary syndromes were low in the EMIT study. Table Disclosures Colonna: Boehringer Ingelheim: Honoraria; Daiichi Sankyo: Honoraria; BayerAG: Honoraria; Italian Cardiology Association: Other: Non-financial support; European Society of Cardiology: Other: Non-financial support; Pfizer/BMS: Honoraria. von Heymann:Daiichi Sankyo: Honoraria, Research Funding; Boehringer Ingelheim: Honoraria; Bayer AG: Honoraria; Pfizer GmBH: Honoraria; CSL Behring: Honoraria; NovoNordisk Pharma: Honoraria; EACTA and EACTS: Other; DGGG: Other; Mitsubishi Pharma: Honoraria; Ferring GmbH: Honoraria; Biotest GmbH: Honoraria; Leo Pharma GmBH: Honoraria; German Society of Anaesthesiology and Intensive Care Medicine: Other. Saxena:Daiichi Sankyo: Honoraria, Research Funding. Vanassche:Boehringer Ingelheim: Honoraria; 367 Leo Pharma: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Honoraria, Research Funding. Jin:Daiichi Sankyo: Current Employment. Wilkins:Daiichi Sankyo: Honoraria. Chen:Daiichi Sankyo: Current Employment. Unverdorben:Daiichi Sankyo: Current Employment.

In the era of mass agriculture to keep up with the increasing demand for food production, advanced monitoring systems are required in order to handle several challenges such as perishable products, food waste, unpredictable supply variations and stringent food safety and sustainability requirements. The evolution of Internet of Things have provided means for collecting, processing, and communicating data associated with agricultural processes. This have opened several opportunities to sustain, improve productivity and reduce waste in every step in the food supply chain system. On the hand, this resulted in several new challenges, such as, the security of the data, recording and representation of data, providing real time control, reliability of the system, and dealing with big data. This paper proposes an architecture for security of big data in the agricultural supply chain management system. This can help in reducing food waste, increasing the reliability of the supply chain, and enhance the performance of the food supply chain system.

In the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation study (NCT 02072434), edoxaban showed similar efficacy and safety versus enoxaparin-warfarin in patients underwent electrical cardioversion of nonvalvular atrial fibrillation. In this ancillary analysis, we compared the primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, cardiovascular death, and overall study period) and safety (composite of major and clinically relevant nonmajor bleeding, on-treatment) end points in relation to body mass index (BMI; = 30 kg/m(2)). We also compared cardioversion outcomes in relation to BMI. Of 2,199 patients enrolled, 1,095 were randomized to edoxaban and 1,104 to enoxaparin-warfarin. Mean age was 64 +/- 10 and 64 +/- 11 years and mean BMI 30.6 and 30.7 kg/m(2), respectively. Cardiovascular and metabolic diseases were more prevalent in obese (n = 1067) than nonobese patients. Overall ischemic event rates were low; rates in the BMI = 30 kg/m(2) subgroup, but not significantly different (odds ratio [OR], 0.74 [95% confidence interval 0.23, 2.24]). Composite major + clinically relevant nonmajor bleeding rates were low and numerically lower, but not significantly different (OR 0.88 [0.38, 2.04]), between the edoxaban and enoxaparin-warfarin arms and across weight categories. Successful cardioversion rate was higher in the BMI = 30 kg/m(2) subgroup (73.9% vs 69.9%; OR 1.22 [1.01 to 1.48]). In EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation, BMI did not significantly impact the relative efficacy and safety of edoxaban versus enoxaparin-warfarin. Nevertheless, the nonobese group had a higher rate of cardioversion success than the obese group. Daiichi Sankyo 2.570 JCR (2019) Q2, 63/138 Cardiac & Cardiovascular Systems 1.479 SJR (2019) Q1, 54/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Transferring data from a sensor or monitoring device in electronic health, vehicular informatics, or Internet of Things (IoT) networks has had the enduring challenge of improving data accuracy with relative efficiency. Previous works have proposed the use of an inference system at the sensor device to minimize the data transfer frequency as well as the size of data to save network usage and battery resources. This has been implemented using various algorithms in sampling and inference, with a tradeoff between accuracy and efficiency. This paper proposes to enhance the accuracy without compromising efficiency by introducing new algorithms in sampling through a hybrid inference method. The experimental results show that accuracy can be significantly improved, whilst the efficiency is not diminished. These algorithms will contribute to saving operation and maintenance costs in data sampling, where resources of computational and battery are constrained and limited, such as in wireless personal area networks emerged with IoT networks.

Long distance driving is highly prone to road accidents and incidents due to various factors, in particular the health conditions of the driver. Professional long-distance drivers such as truck drivers having high health risks could benefit from the recent developments of mobile health (mHealth) technologies that can monitor various health parameters through wearable devices used in the vehicle. This paper proposes a novel method of combining mHealth data of the driver along with vehicular data for improving the vehicle safety system. The key objective is to minimise road accidents by integrating the emerging mHealth technologies with vehicular applications through the use of wireless body area network sensors and devices. The prime contribution of this paper is that the integrated system provides advance and real-time alarming notification for current and predicted emergency situations to drivers as well as their related parties such as health service providers and the company headquarter and forcing the ability to even safely immobilise a vehicle, if needed. In addition, the information gathered by the integrated system could also be used by other parties such as health service providers to address the driver’s root causes of potential health deteriorations or other circumstances that are contributing factors to road accidents.

The ability to predict life expectancy (LE) for an individual or a group of people has been in demand for long, however the accuracy and validity of results are difficult to enhance due to the numerous variables required for consideration. The main causes of issues are that human behaviour and activities can be so different and unpredictable that it is almost impossible to measure, classify, define and predict against generic statistic values, which themselves are too numerous in variables to determine. However, health-related data are becoming increasingly available with the emergence of data science technologies and there has been an increase of smartphone and wearable device applications that allow for health and fitness tracking to aid these demands. Some health-related data, such as calorie expenditure and sleep and heart rate monitoring can be provided by apps that are collected by sensors and processed in the cloud. A personalized life expectancy (PLE) can be provided for individuals to improve wellbeing and encourage healthy lifestyle changes. There is currently no work that has addressed a PLE information that can be customized for the individual. This article proposes a novel and innovative idea of calculating and predicting LE. This paper provides a solution that improves the accuracy of a group LE based on individual health data as well as encouraging individuals to change their lifestyle by monitoring their own PLE to improve their quality of their life.

Rationale: Clear cell meningioma (CCM) is one of the rarest but most aggressive forms of meningioma, with a tendency to occur at a high recurrence rate. Intraspinal CCM, especially the nondura-based type, is even rarer than the intracranial CCM. Patient concerns: We report a case of a 45-year-old woman who presented with a 1-month history of episodic pain in the lower back and in both thighs in the front side. Femoral nerve stretch tests were positive on both sides. Magnetic resonance imaging (MRI) demonstrated an intradural tumor at the L3 level, which was isointense on T1- and T2-weighted images (WI) and homogeneously enhanced on gadolinium-contrast T1 WI. Diagnoses: The space-occupying lesion was pathologically confirmed as CCM. Interventions: During surgery, we found that the tumor adhered to a nerve root, without dural attachment. The nerve root was partially removed to achieve complete resection. Outcomes: The pain disappeared after the operation. The 1 year follow-up MRI revealed no evidence of tumor recurrence or metastasis. Lessons: Nondura-based intraspinal CCM is easier to completely remove, and such complete removal should be achieved during the first operation. Although the recurrence rate of this particular type of meningioma appears to be lower than that of other types, close clinical and radiological follow-up is necessary.

Current physiological sensors are passive and transmit sensed data to Monitoring centre (MC) through wireless body area network (WBAN) without processing data intelligently. We propose a solution to discern data requestors for prioritising and inferring data to reduce transactions and conserve battery power, which is important requirements of mobile health (mHealth). However, there is a problem for alarm determination without knowing the activity of the user. For example, 170 beats per minute of heart rate can be normal during exercising, however an alarm should be raised if this figure has been sensed during sleep. To solve this problem, we suggest utilising the existing activity recognition (AR) applications. Most of health related wearable devices include accelerometers along with physiological sensors. This paper presents a novel approach and solution to utilise physiological data with AR so that they can provide not only improved and efficient services such as alarm determination but also provide richer health information which may provide content for new markets as well as additional application services such as converged mobile health with aged care services. This has been verified by experimented tests and examples of using vital signs such as heart pulse rate, respiration rate and body temperature with a demonstrated outcome of AR accelerometer sensors integrated with an Android app.

Patients with Friedreich ataxia typically die of cardiomyopathy, marked by myocardial fibrosis and abnormal left ventricular (LV) geometry. We measured procollagen I carboxyterminal propeptide (PICP), a serum biomarker of collagen production, and characterized genotypes, phenotypes, and outcomes in these patients. Twenty-nine patients with Friedreich ataxia (mean age, 34.2 ± 2.2 yr) and 29 healthy subjects (mean age, 32.5 ± 1.1 yr) underwent serum PICP measurements. Patients underwent cardiac magnetic resonance imaging and outcome evaluations at baseline and 12 months. Baseline PICP values were significantly higher in the patients than in the control group (1,048 ± 77 vs 614 ± 23 ng/mL; P We conclude that PICP, a serum marker of collagen synthesis, is elevated in Friedreich ataxia and indicates baseline abnormal LV geometry and subsequent dilation. Cardiac magnetic resonance and PICP warrant consideration as complementary biomarkers in therapeutic trials of Friedreich ataxia cardiomyopathy.

Smartphone technology has become more popular and innovative over the last few years, and technology companies are now introducing wearable devices into the market. By emerging and converging with technologies such as Cloud, Internet of Things (IoT) and Virtualization, requirements to personal sensor devices are immense and essential to support existing networks, e.g. mobile health (mHealth) as well as IoT users. Traditional physiological and biological medical sensors in mHealth provide health data either periodically or on-demand. Both of these situations can cause rapid battery consumption, consume significant bandwidth, and raise privacy issues, because these sensors do not consider or understand sensor status when converged together. The aim of this research is to provide a novel approach and solution to managing and controlling personal sensors that can be used in various areas such as the health, military, aged care, IoT and sport. This paper presents an inference system to transfer health data collected by personal sensors efficiently and effectively to other networks in a secure and effective manner without burdening workload on sensor devices.

Background Anticoagulation in patients with malignancy and atrial fibrillation is challenging because of enhanced risks for thrombosis and bleeding and the frequent need for invasive procedures. Data on direct oral antagonists in such patients are sparse. Methods and Results The ENGAGE AF ‐ TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction Study 48) trial randomized 21 105 patients with atrial fibrillation to edoxaban or warfarin. Patients with malignancy, defined as a postrandomization new diagnosis or recurrence of remote cancer, were followed up over a median of 2.8 years. Adjusted Cox proportional hazard models were used to evaluate the safety and efficacy of edoxaban versus warfarin. Over a median of 495 days (interquartile range, 230–771 days), 1153 patients (5.5%) were diagnosed with new or recurrent malignancy, most commonly involving the gastrointestinal tract (20.6%), prostate (13.6%), and lung (11.1%). Malignancy was associated with increased risk of death (adjusted hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.78–3.50) and major bleeding (adjusted HR, 2.45; 95% CI, 2.07–2.89), but not stroke/systemic embolism (adjusted HR, 1.08; 95% CI, 0.83–1.42). Relative outcomes with higher‐dose edoxaban versus warfarin were consistent regardless of malignancy status for stroke/systemic embolism ( HR , 0.60 [95% CI, 0.31–1.15] for malignancy versus HR , 0.89 [95% CI, 0.76–1.05] for no malignancy; interaction P =0.25) and major bleeding ( HR , 0.98 [95% CI, 0.69–1.40] for malignancy versus HR , 0.79 [95% CI, 0.69–1.05] for no malignancy; interaction P =0.31). There was, however, a significant treatment interaction for the composite ischemic end point (ischemic stroke/systemic embolism/myocardial infarction), with greater efficacy of higher‐dose edoxaban versus warfarin in patients with malignancy ( HR , 0.54; 95% CI, 0.31–0.93) compared with no malignancy ( HR , 1.02; 95% CI, 0.88–1.18; interaction P =0.026). Conclusions In patients with atrial fibrillation who develop malignancy, the efficacy and safety profile of edoxaban relative to warfarin is preserved, and it may represent a more practical alternative.

With the emergence of technologies such as electronic health and mobile health (eHealth/mHealth), cloud computing, big data, and the Internet of Things (IoT), health related data are increasing and many applications such as smartphone apps and wearable devices that provide wellness and fitness tracking are entering the market. Some apps provide health related data such as sleep monitoring, heart rate measuring, and calorie expenditure collected and processed by the devices and servers in the cloud. These requirements can be extended to provide a personalized life expectancy (PLE) for the purpose of wellbeing and encouraging lifestyle improvement. No existing works provide this PLE information that is developed and customized for the individual. This article is based on the concurrent models and methodologies to calculate and predict life expectancy (LE) and proposes an idea of using multi-phased approaches to the solution as the project requires an immense and broad range of work to accomplish. As a result, the current prediction of LE, which was found to be up to a maximum of five years could potentially be extended to a lifetime prediction by utilizing generic health data. In this article, the novel idea of the solution proposing a PLE on an individual basis, which can be extended to lifetime is presented in addition to the existing works.

In the EdoxabaN versus warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study, edoxaban was compared with enoxaparin–warfarin in patients who underwent electrical cardioversion of nonvalvular atrial fibrillation, showing comparable low rates of bleeding and thromboembolism. The present study is an ancillary analysis investigating differences in relation to stroke and bleeding risk profiles. It also determined the relation of patients’ clinical risk profiles to the quality of anticoagulation control in the warfarin arm. Primary efficacy (composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular death) and safety (composite of major and clinically relevant nonmajor bleeding) outcomes and time to therapeutic range (TtTR) and time in therapeutic range (TiTR) were analyzed in relation to CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, stroke (2 points), vascular disease, age 65–74 years, sex category) and HAS-BLED (hypertension, age, stroke, bleeding tendency/predisposition, labile INRs, elderly age/frailty, drugs such as concomitant aspirin/nonsteroidal anti-inflammatory drugs or alcohol excess) scores. A total of 1,095 patients were randomized to edoxaban and 1,104 received enoxaparin–warfarin. Mean age was 64.3 ± 10 and 64.2 ± 11 years, respectively. Mean CHA2DS2-VASc score was 2.6 (standard deviation [SD] 1.5 and 1.4, respectively) and mean HAS-BLED score was 0.9 (SD 0.8) in both arms. There were nonsignificant trends toward lower odds ratios (ORs) for the efficacy end point in patients with CHA2DS2-VASc scores >2 and higher ORs with HAS-BLED score ≥3. Mean TiTR was >67%, with no differences between stroke or bleeding risk strata. The correlation between CHA2DS2-VASc and TtTR (p = 0.0286) and HAS-BLED and TiTR (p = 0.0286) were statistically significant. In patients who were at high risk of stroke, edoxaban had numerically lower primary efficacy end-point events and showed a trend for higher ORs, with HAS-BLED scores ≥3 compared with enoxaparin–warfarin. TtTR was shorter with higher CHA2DS2-VASc scores, whereas bleeding risk was inversely correlated with quality of anticoagulation control. Sin financiación 2.843 JCR (2018) Q2, 59/136 Cardiac & Cardiovascular Systems 1.734 SJR (2018) Q1, 43/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Low Power Wide Area Networks (LPWAN) are used in a number of applications, including disaster monitoring and recovery networks. LPWAN sensors capture data bits and transmit them via dedicated gateways, which are connected to public carrier networks (e.g., cellular networks). One of the challenges encountered in disaster management scenarios revolves around the carry/forward sensed data and geographical location information dissemination to the disaster relief operatives (Disaster Relief Agency; DRA) to identify, characterise, and prioritise the affected areas. There are network topology options, including cellular, circuit switched, and peer-to-peer networks to reach the destination. From the natural disaster predictions point of view, collecting geographical location data and timestamp is vital. This paper proposes the usage of Pseudo A Number (PAN), that is, the calling party address, which is used by every network to include the location information instead of the actual calling party address of the gateway in LPWAN. This PAN information can further be analysed by the DRA to identify the affected areas as well as to predict the complications of the disaster impacts in addition to the past history of the damages. This paper aims to propose a solution that can predict disaster advancement based on propagation and the velocity of impact using vector calculation of location data and timestamp, which are transmitted by sensors through PAN of gateway in LPWAN.

Some applications, including disaster monitoring and recovery networks, use low-power wide-area networks (LPWAN). LPWAN sensors capture data bits and transmit them to public carrier networks (e.g., cellular networks) via dedicated gateways. One of the challenges encountered in disaster management scenarios revolves around the carry/forward sensed data and geographical location information dissemination to the disaster relief operatives (disaster relief agency; DRA) to identify, characterise, and prioritise the affected areas. There are network topology options to reach its destination, including cellular, circuit switched, and peer-to-peer networks. In the context of natural disaster prediction, it is vital to access geographical location data as well as the timestamp. This paper proposes the usage of Pseudo A Number (PAN), that is, the calling party address, which is used by every network to include the location information instead of the actual calling party address of the gateway in LPWAN. This PAN information can be further analysed by the DRA to identify the affected areas and predict the complications of the disaster impacts in addition to the past history of damages. This paper aims to propose a solution that can predict disaster proceedings based on propagation and the velocity of impact using vector calculation of the location data and the timestamp, which are transmitted by sensors through the PAN of the gateway in LPWAN.

Activity Recognition (AR), Internet of Things (IoT), and speech recognition are emerging technologies in the context of wearable devices and Mobile health (mHealth) networks. Applications of mHealth sensors on human bodies can involve the measurement of physiological data, and may be utilized to initiate an alarm in an emergency health situation. AR devices such as accelerometers may also be used for a similar application in determining the activity and posture status of the user. However, there is always the possibility of false alarms, and to avoid these occurrences, we propose a user feedback system for alarm confirmation via a smart device. As users may be unable to physically respond in some situations, such as a state of immobility from injury, this paper proposes to improve the user feedback system with a voice confirmation functionality utilizing speech recognition embedded within smart devices. The potentials of this user feedback system in mHealth can not only contribute towards improve the alarm accuracy, but may reduce the occurrence of false alarms. Its functionality can also be enhanced via real-time communication with their health service provider who can assess the user health status with the data from the sensors.

Smart device and body sensors have become innovative and converged with health informatics. To reduce the battery power consumption and bandwidth usage in wireless body area networks, it is proposed to infer sensed data in sensor nodes, which can raise an alarm when the user is in an urgent situation by analysing the sensed data against the user's activity status utilising accelerometer sensors. However when the activity changes frequently, there may be an increase in false alarms which increases sensing and transferring of data resulting in higher resource consumption. To reduce and mitigate the problem, we propose to verify the alarm using a smart device or smartwatch application so that a user can respond to whether the alarm is true or false, and thus provide feedback to the system to improve activity recognition. This paper presents a user-feedback system for use in activity recognition to mitigate and improve possible false alarm situations, which will consequently result in helping sensors to reduce the frequency of transactions and transmissions in wireless body area networks.

Wearable devices have become popular and innovative and are converging with technologies such as big data, Cloud and Internet of Things (IoT). Traditional physiological sensors in fitness tracking and mHealth provide health data periodically or are captured manually when required. In future, physicians as well as IoT devices will benefit from this data to provide their services. These situations can cause rapid battery consumption, consume significant bandwidth, and raise privacy issues. There have been many attempts to extend battery life and improve communication methodologies; however, they have not been able to solve the resource constraints arising from physical hardware limits, such as the size of sensors. As an alternative, this paper presents a novel approach and solution to controlling body sensors to reduce both unnecessary data transmission and battery consumption. This can be done by implementing an inference system on sensors using sensed data to transfer it efficiently to other networks without burdening the workload from IoT onto sensor devices. In this paper, we experimented with reducing the bandwidth requirements for heart-rate sensors. Our results show savings in resource usage of between 66% and 99%. Such savings have the potential of making always-on mHealth devices a practical reality.

Among the various factors affecting long distance driving are the risks imposed by a driver&rsquo, s health, which could result in road accidents. Internet of Things (IoT) and mobile health (mHealth) technologies are increasingly being recognized for their role in monitoring various health parameters of such drivers. IoT devices such as wearable devices could be used efficiently in vehicles by professional long-distance drivers. However, the adoption of such technologies is limited by security and privacy issues. This paper proposes a novel vehicular alarm notification system by integrating mHealth data of the driver with vehicular data for improving vehicle safety. The purpose of the system is to minimize road accidents by integrating the emerging mHealth technologies with the vehicular information system (VIS) using wireless body area network sensors and devices in a secure and lightweight framework. An integrated secure system could facilitate adoptability to provide timely notifications of emergencies to drivers in order to avoid road accidents and take appropriate follow-up actions. Furthermore, the information gathered by the integrated system could assist health service providers to address the driver&rsquo, s root cause of potential health risks. The lightweight security framework adopted in this study is based on an efficient trust model that can improve the adoption of an mHealth integrated vehicular alarm notification system. Our contribution is to provide a real-time alarm notification service to avoid potential traffic accidents by monitoring the health status of long-distance drivers, achieved through incorporating an affordable and lightweight security system to secure health data transfer.

Background Edoxaban, an oral factor Xa inhibitor, is non-inferior for prevention of stroke and systemic embolism in patients with atrial fibrillation and is associated with less bleeding than well controlled warfarin therapy. Few safety data about edoxaban in patients undergoing electrical cardioversion are available. Methods We did a multicentre, prospective, randomised, open-label, blinded-endpoint evaluation trial in 19 countries with 239 sites comparing edoxaban 60 mg per day with enoxaparin–warfarin in patients undergoing electrical cardioversion of non-valvular atrial fibrillation. The dose of edoxaban was reduced to 30 mg per day if one or more factors (creatinine clearance 15–50 mL/min, low bodyweight [≤60 kg], or concomitant use of P-glycoprotein inhibitors) were present. Block randomisation (block size four)—stratified by cardioversion approach (transoesophageal echocardiography [TEE] or not), anticoagulant experience, selected edoxaban dose, and region—was done through a voice-web system. The primary efficacy endpoint was a composite of stroke, systemic embolic event, myocardial infarction, and cardiovascular mortality, analysed by intention to treat. The primary safety endpoint was major and clinically relevant non-major (CRNM) bleeding in patients who received at least one dose of study drug. Follow-up was 28 days on study drug after cardioversion plus 30 days to assess safety. This trial is registered with ClinicalTrials.gov, number NCT02072434. Findings Between March 25, 2014, and Oct 28, 2015, 2199 patients were enrolled and randomly assigned to receive edoxaban (n=1095) or enoxaparin–warfarin (n=1104). The mean age was 64 years (SD 10·54) and mean CHA2DS2-VASc score was 2·6 (SD 1·4). Mean time in therapeutic range on warfarin was 70·8% (SD 27·4). The primary efficacy endpoint occurred in five (

Background Elderly patients with atrial fibrillation are at higher risk of both ischemic and bleeding events compared to younger patients. In a prespecified analysis from the ENGAGE AF ‐ TIMI 48 trial, we evaluate clinical outcomes with edoxaban versus warfarin according to age. Methods and Results Twenty‐one thousand one‐hundred and five patients enrolled in the ENGAGE AF ‐ TIMI 48 trial were stratified into 3 prespecified age groups: P P trend Conclusions Age has a greater influence on major bleeding than thromboembolic risk in patients with atrial fibrillation. Given the higher rates of bleeding and death with increasing age, treatment of elderly patients with edoxaban provides an even greater absolute reduction in safety events over warfarin, compared to treatment with edoxaban versus warfarin in younger patients. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00781391.

When wearable and personal health device and sensors capture data such as heart rate and body temperature for fitness tracking and health services, they simply transfer data without filtering or optimising. This can cause overloading to the sensors as well as rapid battery consumption when they interact with Internet of Things (IoT) networks, which are expected to increase and demand more health data from device wearers. To solve the problem, this paper proposes to infer sensed data to reduce the data volume, which will affect the bandwidth and battery power reduction that are essential requirements to sensor devices. This is achieved by applying beacon data points after the inferencing of data processing utilising variance rates, which compare the sensed data with adjacent data before and after. This novel approach verifies by experiments that data volume can be saved by up to 99.5 % with a 98.62 % accuracy. Whilst most existing works focus on sensor network improvements such as routing, operation and reading data algorithms, we efficiently reduce data volume to reduce bandwidth and battery power consumption while maintaining accuracy by implementing intelligence and optimisation in sensor devices.