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Distributed denial of service (DDoS) is a type of cyberattack in which multiple compromised systems flood the bandwidth or resources of a single system, making the flooded system inaccessible to legitimate users. Since large-scale botnets based on the Internet of Things (IoT) have been hotbeds for launching DDoS attacks, it is crucial to defend against DDoS-capable IoT botnets effectively. In consideration of resource constraints and frequent state changes for IoT devices, they should be equipped with repair measures that are cost-effective and adaptive to mitigate the impact of DDoS attacks. From the mitigation perspective, we refer to the collection of repair costs at all times as a repair strategy. This paper is then devoted to studying the problem of developing a cost-effective and adaptive repair strategy (ARS). First, we establish an IoT botware propagation model that fully captures the state evolution of an IoT network under attack and defense interventions. On this basis, we model the ARS problem as a data-driven optimal control problem, aiming to realize both learning and prediction of propagation parameters based on network traffic data observed at multiple discrete time slots and control of IoT botware propagation to a desired infection level. By leveraging optimal control theory, we propose an iterative algorithm to solve the problem, numerically obtaining the learned time-varying parameters and a repair strategy. Finally, the performance of the learned parameters and the resulting strategy are examined through computer experiments., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hu, Yang. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The past decade has witnessed a significant evolution in the role of the Internet, transitioning from individual connectivity to an integral aspect of various domains. This shift has prompted a move in IP paradigms from hierarchical to distributed architectures characterized by decentralized structures. This transition empowers efficient data routing and management across diverse networks. However, traditional distributed mobility management (DMM) protocols, reliant on tunneling mechanisms, incur overheads, costs, and delays, exacerbating challenges in managing the exponential growth of mobile data traffic. This research proposes Tunnel-Free Mobility for IPv6 (TFMIPv6) as a solution to address the shortcomings of existing DMM protocols. TFMIPv6 eliminates the need for tunneling, simplifying routing processes and reducing latency. A comprehensive cost analysis and performance evaluation are conducted, comparing TFMIPv6 with traditional protocols such as MIPv6, PMIPv6, FMIPv6, and HMIPv6. The study reveals significant improvements with TFMIPv6. Signaling costs are reduced by 50%, packet delivery costs by 23%, and tunneling costs are completely eliminated (100%). Real-world network traffic datasets are used for simulation, providing statistical evidence of TFMIPv6's efficacy in supporting an uninterrupted movement of IPv6 data across networks., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Aman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Data networks, consisting of pooled electronic health data assets from health care providers serving different patient populations, promote data sharing, population and disease monitoring, and methods to assess interventions. Better understanding of data networks, and their capacity to support public health objectives, will help foster partnerships, expand resources, and grow learning health systems., Methods: We conducted semistructured interviews with 16 key informants across the United States, identified as network stakeholders based on their respective experience in advancing health information technology and network functionality. Key informants were asked about their experience with and infrastructure used to develop data networks, including each network's utility to identify and characterize populations, usage, and sustainability., Results: Among 11 identified data networks representing hundreds of thousands of patients, key informants described aggregated health care clinical data contributing to population health measures. Key informant interview responses were thematically grouped to illustrate how networks support public health, including (1) infrastructure and information sharing; (2) population health measures; and (3) network sustainability., Conclusion: Collaboration between clinical data networks and public health entities presents an opportunity to leverage infrastructure investments to support public health. Data networks can provide resources to enhance population health information and infrastructure.

Rural areas have very low revenue potential. The major issue in providing low-cost broadband to rural areas is to provide reliable backhaul connections that spread over tens or even hundreds of miles, connecting villages to the nearest service provider. Along with aerial networks of Google and Facebook, there has been a considerable amount of research toward long-distance terrestrial WiFi links. As a comparison, WiFi routers are easier to be deployed and maintained by non-technical people from the local communities, whereas the aerial networks require professional support to operate. Moreover, they are still in the experimentation phase. However, the long distance WiFi links require high-gain directional antennas and very expensive tall towers for high data rates. On the other hand, multihop paths with stronger links may provide better data rates without the need of tall towers. In this paper, we evaluated the concept of using such multihop WiFi links for long backhaul connections. Our simulation results show that these networks can possibly be a cost-effective and practical solution for rural connectivity. These initial results can serve as a first step to understand the comprehensive feasibility of using multihop WiFi networks for backhaul connections in rural area.

Due to the lack of dependency for routing initiation and an inadequate allocated sextant on responding messages, the secure geographic routing protocols for Wireless Sensor Networks (WSNs) have attracted considerable attention. However, the existing protocols are more likely to drop packets when legitimate nodes fail to respond to the routing initiation messages while attackers in the allocated sextant manage to respond. Furthermore, these protocols are designed with inefficient collection window and inadequate verification criteria which may lead to a high number of attacker selections. To prevent the failure to find an appropriate relay node and undesirable packet retransmission, this paper presents Secure Region-Based Geographic Routing Protocol (SRBGR) to increase the probability of selecting the appropriate relay node. By extending the allocated sextant and applying different message contention priorities more legitimate nodes can be admitted in the routing process. Moreover, the paper also proposed the bound collection window for a sufficient collection time and verification cost for both attacker identification and isolation. Extensive simulation experiments have been performed to evaluate the performance of the proposed protocol in comparison with other existing protocols. The results demonstrate that SRBGR increases network performance in terms of the packet delivery ratio and isolates attacks such as Sybil and Black hole., Competing Interests: The authors have declared that no competing interests exist.

This paper aims at minimizing the communication cost for collecting flow information in Software Defined Networks (SDN). Since flow-based information collecting method requires too much communication cost, and switch-based method proposed recently cannot benefit from controlling flow routing, jointly optimize flow routing and polling switch selection is proposed to reduce the communication cost. To this end, joint optimization problem is formulated as an Integer Linear Programming (ILP) model firstly. Since the ILP model is intractable in large size network, we also design an optimal algorithm for the multi-rooted tree topology and an efficient heuristic algorithm for general topology. According to extensive simulations, it is found that our method can save up to 55.76% communication cost compared with the state-of-the-art switch-based scheme.

Tree-based overlay multicast is an effective group communication method for media streaming applications. However, a group member's departure causes all of its descendants to be disconnected from the multicast tree for some time, which results in poor performance. The above problem is difficult to be addressed because overlay multicast tree is intrinsically instable. In this paper, we proposed a novel stability enhancing solution, VMCast, for tree-based overlay multicast. This solution uses two types of on-demand cloud virtual machines (VMs), i.e., multicast VMs (MVMs) and compensation VMs (CVMs). MVMs are used to disseminate the multicast data, whereas CVMs are used to offer streaming compensation. The used VMs in the same cloud datacenter constitute a VM cluster. Each VM cluster is responsible for a service domain (VMSD), and each group member belongs to a specific VMSD. The data source delivers the multicast data to MVMs through a reliable path, and MVMs further disseminate the data to group members along domain overlay multicast trees. The above approach structurally improves the stability of the overlay multicast tree. We further utilized CVM-based streaming compensation to enhance the stability of the data distribution in the VMSDs. VMCast can be used as an extension to existing tree-based overlay multicast solutions, to provide better services for media streaming applications. We applied VMCast to two application instances (i.e., HMTP and HCcast). The results show that it can obviously enhance the stability of the data distribution.

The mutualisation of analytical platforms might be used to address rising healthcare costs. Our study aimed to evaluate the feasibility of networking a unique matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) system for common use in several university hospitals in Brussels, Belgium. During a one-month period, 1,055 successive bacterial isolates from the Brugmann University Hospital were identified on-site using conventional techniques; these same isolates were also identified using a MALDI-TOF MS system at the Porte de Hal Laboratory by sending target plates and identification projects via transportation and the INFECTIO&#95;MALDI software (Infopartner, Nancy, France), respectively. The occurrence of transmission problems (<2 %) and human errors (<1 %) suggested that the system was sufficiently robust to be implemented in a network. With a median time-to-identification of 5 h and 11 min (78 min, min-max: 154-547), MALDI-TOF MS networking always provided a faster identification result than conventional techniques, except when chromogenic culture media and oxidase tests were used (p < 0.0001). However, the limited clinical benefits of the chromogenic culture media do not support their extra cost. Our financial analysis also suggested that MALDI-TOF MS networking could lead to substantial annual cost savings. MALDI-TOF MS networking presents many advantages, and few conventional techniques (optochin and oxidase tests) are required to ensure the same quality in patient care from the distant laboratory. Nevertheless, such networking should not be considered unless there is a reorganisation of workflow, efficient communication between teams, qualified technologists and a reliable IT department and helpdesk to manage potential connectivity problems.

Objective: The rapidly growing volume of multimodal electrophysiological signal data is playing a critical role in patient care and clinical research across multiple disease domains, such as epilepsy and sleep medicine. To facilitate secondary use of these data, there is an urgent need to develop novel algorithms and informatics approaches using new cloud computing technologies as well as ontologies for collaborative multicenter studies., Materials and Methods: We present the Cloudwave platform, which (a) defines parallelized algorithms for computing cardiac measures using the MapReduce parallel programming framework, (b) supports real-time interaction with large volumes of electrophysiological signals, and (c) features signal visualization and querying functionalities using an ontology-driven web-based interface. Cloudwave is currently used in the multicenter National Institute of Neurological Diseases and Stroke (NINDS)-funded Prevention and Risk Identification of SUDEP (sudden unexplained death in epilepsy) Mortality (PRISM) project to identify risk factors for sudden death in epilepsy., Results: Comparative evaluations of Cloudwave with traditional desktop approaches to compute cardiac measures (eg, QRS complexes, RR intervals, and instantaneous heart rate) on epilepsy patient data show one order of magnitude improvement for single-channel ECG data and 20 times improvement for four-channel ECG data. This enables Cloudwave to support real-time user interaction with signal data, which is semantically annotated with a novel epilepsy and seizure ontology., Discussion: Data privacy is a critical issue in using cloud infrastructure, and cloud platforms, such as Amazon Web Services, offer features to support Health Insurance Portability and Accountability Act standards., Conclusion: The Cloudwave platform is a new approach to leverage of large-scale electrophysiological data for advancing multicenter clinical research.

The power management of ICT systems, that is, data processing (Dp) and telecommunication (Tlc) systems, is becoming a relevant problem in economical terms. Dp systems totalize millions of servers and associated subsystems (processors, monitors, storage devices, etc.) all over the world that need to be electrically powered. Dp systems are also used in the government of Tlc systems, which, besides requiring Dp electrical power, also require Tlc-specific power, both for mobile networks (with their cell-phone towers and associated subsystems: base stations, subscriber stations, switching nodes, etc.) and for wired networks (with their routers, gateways, switches, etc.). ICT research is thus expected to investigate into methods to reduce Dp- and Tlc-specific power consumption. However, saving power may turn into waste of performance, in other words, into waste of ICT quality of service (QoS). This paper investigates the Dp and Tlc power management policies that look at compromises between power saving and QoS.

Providers of cloud environments must tackle the challenge of configuring their system to provide maximal performance while minimizing the cost of resources used. However, at the same time, they must guarantee an SLA (service-level agreement) to the users. The SLA is usually associated with a certain level of QoS (quality of service). As response time is perhaps the most widely used QoS metric, it was also the one chosen in this work. This paper presents a green strategy (GS) model for heterogeneous cloud systems. We provide a solution for heterogeneous job-communicating tasks and heterogeneous VMs that make up the nodes of the cloud. In addition to guaranteeing the SLA, the main goal is to optimize energy savings. The solution results in an equation that must be solved by a solver with nonlinear capabilities. The results obtained from modelling the policies to be executed by a solver demonstrate the applicability of our proposal for saving energy and guaranteeing the SLA.

Background: Until recently, genotype studies were limited to the investigation of single SNP effects due to the computational burden incurred when studying pairwise interactions of SNPs. However, some genetic effects as simple as coloring (in plants and animals) cannot be ascribed to a single locus but only understood when epistasis is taken into account [1]. It is expected that such effects are also found in complex diseases where many genes contribute to the clinical outcome of affected individuals. Only recently have such problems become feasible computationally., Objectives: The inherently parallel structure of the problem makes it a perfect candidate for massive parallelization on either grid or cloud architectures. Since we are also dealing with confidential patient data, we were not able to consider a cloud-based solution but had to find a way to process the data in-house and aimed to build a local GPU-based grid structure., Methods: Sequential epistatsis calculations were ported to GPU using CUDA at various levels. Parallelization on the CPU was compared to corresponding GPU counterparts with regards to performance and cost., Results: A cost-effective solution was created by combining custom-built nodes equipped with relatively inexpensive consumer-level graphics cards with highly parallel GPUs in a local grid. The GPU method outperforms current cluster-based systems on a price/performance criterion, as a single GPU shows speed performance comparable up to 200 CPU cores., Conclusion: The outlined approach will work for problems that easily lend themselves to massive parallelization. Code for various tasks has been made available and ongoing development of tools will further ease the transition from sequential to parallel algorithms.

Background: "Cloud" computing providers, such as the Amazon Web Services (AWS), offer stable and scalable computational resources based on hardware virtualization, with short, usually hourly, billing periods. The idea of pay-as-you-use seems appealing for biometry research units which have only limited access to university or corporate data center resources or grids., Objectives: This case study compares the costs of an existing heterogeneous on-site hardware pool in a Medical Biometry and Statistics department to a comparable AWS offer., Methods: The "total cost of ownership", including all direct costs, is determined for the on-site hardware, and hourly prices are derived, based on actual system utilization during the year 2011. Indirect costs, which are difficult to quantify are not included in this comparison, but nevertheless some rough guidance from our experience is given. To indicate the scale of costs for a methodological research project, a simulation study of a permutation-based statistical approach is performed using AWS and on-site hardware., Results: In the presented case, with a system utilization of 25-30 percent and 3-5-year amortization, on-site hardware can result in smaller costs, compared to hourly rental in the cloud dependent on the instance chosen. Renting cloud instances with sufficient main memory is a deciding factor in this comparison., Conclusions: Costs for on-site hardware may vary, depending on the specific infrastructure at a research unit, but have only moderate impact on the overall comparison and subsequent decision for obtaining affordable scientific computing resources. Overall utilization has a much stronger impact as it determines the actual computing hours needed per year. Taking this into ac count, cloud computing might still be a viable option for projects with limited maturity, or as a supplement for short peaks in demand.

Background: A hub-and-spoke telestroke network is an effective way to extend quality acute stroke care to remote hospitals and to improve patient outcomes. This study assessed the cost-effectiveness of a telestroke network in the management of acute ischemic stroke from the perspectives of a network, a hub hospital, and a spoke hospital., Methods and Results: A model was developed to compare costs and effectiveness with and without a telestroke network over a 5-year time horizon. The model considered differences in rates of teleconsultations, intravenous thrombolysis, endovascular stroke therapies, and spoke-to-hub transfers. These inputs were estimated through the use of data from Georgia Health Sciences University and Mayo Clinic telestroke networks. A network model with 1 hub and 7 spokes predicted that 45 more patients would be treated with intravenous thrombolysis and 20 more with endovascular stroke therapies per year compared with no network, leading to an estimate of 6.11 more home discharges. Each year, a telestroke network was associated with $358 435 in cost savings; each spoke had $109 080 in cost savings, whereas the hub had positive costs of $405 121. However, cost sharing can be arranged so that each hospital could achieve an equal amount of cost savings ($44 804/y). Results were sensitive to the number of spokes, marginal treatment costs in spokes and rates of transfer, and endovascular stroke therapies., Conclusions: The results of this study suggest that a telestroke network may increase the number of patients discharged home and reduce the costs borne by the network hospitals. Hospitals should consider their available resources and the network features when deciding whether to join or set up a network.

Mobile phones are among the most popular consumer devices, and the recent developments of 3G networks and smart phones enable users to watch video programs by subscribing data plans from service providers. Due to the ubiquity of mobile phones and phone-to-phone communication technologies, data-plan subscribers can redistribute the video content to nonsubscribers. Such a redistribution mechanism is a potential competitor for the mobile service provider and is very difficult to trace given users' high mobility. The service provider has to set a reasonable price for the data plan to prevent such unauthorized redistribution behavior to protect or maximize his/her own profit. In this paper, we analyze the optimal price setting for the service provider by investigating the equilibrium between the subscribers and the secondary buyers in the content-redistribution network. We model the behavior between the subscribers and the secondary buyers as a noncooperative game and find the optimal price and quantity for both groups of users. Based on the behavior of users in the redistribution network, we investigate the evolutionarily stable ratio of mobile users who decide to subscribe to the data plan. Such an analysis can help the service provider preserve his/her profit under the threat of the redistribution networks and can improve the quality of service for end users.

Innovations in, and the use of emerging information and communications technology (ICT) has rapidly increased in all development contexts, including healthcare. It is believed that the use of appropriate technologies can increase the quality and reach of both information and communication. However, decisions on what ICT to adopt have often been made without evidence of their effectiveness; or information on implications; or extensive knowledge on how to maximise benefits from their use. While it has been stated that 'healthcare ICT innovation can only succeed if design is deeply informed by practice', the large number of 'failed' ICT projects within health indicates the limited application of such an approach. There is a large and growing body of work exploring health ICT issues in the developed world, and some specifically focusing on the developing country context emerging from Africa and India; but not for the Pacific Region. Health systems in the Pacific, while diverse in many ways, are also faced with many common problems including competing demands in the face of limited resources, staff numbers, staff capacity and infrastructure. Senior health managers in the region are commonly asked to commit money, effort and scarce manpower to supporting new technologies on proposals from donor agencies or commercial companies, as well as from senior staff within their system. The first decision they must make is if the investment is both plausible and reasonable; they must also secondly decide how the investment should be made. The objective of this article is three-fold: firstly, to provide a common 'language' for categorising and discussing health information systems, particularly those in developing countries; secondly, to summarise the potential benefits and opportunities offered by the use of ICT in health; and thirdly, to discuss the critical factors countries. Overall, this article aims to illuminate the potential role of information and communication technologies in health, specifically for Pacific Island Countries and Territories (PICTs).

Objectives: To explore the feasibility of implementing an Internet-based communication network for communication of health care information during skilled nursing facility (SNF)-to-ED care transitions, and to identify potential barriers to system implementation., Methods: Qualitative., Setting: The largest SNF affiliated with the ED of an urban tertiary care center., Participants: Consecutive sample of all patients transferred from SNF to ED over 8 months between June 2007 and January 2008; ED and SNF care providers., Intervention: The development and implementation of an Internet-based communication network for use during SNF-to-ED care transitions. This network was developed by adapting a preexisting Internet-based system that is widely used to facilitate placement of hospitalized patients into SNFs. Internet-based SNF and ED surveys were used to help identify barriers to implementation., Results: There were 276/276 care transitions reviewed. The Internet-based communication network was used in 76 (28%) care transitions, with usage peaking at 40% near the end of the study. Barriers to success that were identified included lack of an electronic medical record (EMR) at the SNF; pervasive negative attitudes between ED and SNF personnel; time necessary for network use during care transitions; frustration by emergency physicians at low system usage rates by SNF personnel; and additional login requirements by ED personnel., Conclusions: Although implementing an Internet-based network for nursing home to ED communication may be feasible, significant barriers were identified in this study that are likely generalizable to other health care settings. Understanding such barriers is an essential first step toward building successful electronic communication networks in the future., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To conduct a cost-effectiveness analysis of telestroke--a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients--compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts)., Methods: A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed., Results: In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs <$50,000/QALY, a ratio commonly considered acceptable in the United States., Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States.

Wireless sensor network (WSN) technology has been successfully applied to energy saving applications in many places, and plays a significant role in achieving power conservation. However, previous studies do not discuss WSN costs and cost-recovery. The application of WSNs is currently limited to research and laboratory experiments, and not mass industrial production, largely because business owners are unfamiliar with the possible favorable return and cost-recovery on WSN investments. Therefore, this paper focuses on the cost-recovery of WSNs and how to reduce air conditioning energy consumption in convenience stores. The WSN used in this study provides feedback to the gateway and adopts the predicted mean vote (PMV) and computational fluid dynamics (CFD) methods to allow customers to shop in a comfortable yet energy-saving environment. Four convenience stores in Taipei have used the proposed WSN since 2008. In 2008, the experiment was initially designed to optimize air-conditioning for energy saving, but additions to the set-up continued beyond 2008, adding the thermal comfort and crowds peak, off-peak features in 2009 to achieve human-friendly energy savings. Comparison with 2007 data, under the same comfort conditions, shows that the power savings increased by 40% (2008) and 53% (2009), respectively. The cost of the WSN equipment was 500 US dollars. Experimental results, including three years of analysis and calculations, show that the marginal energy conservation benefit of the four convenience stores achieved energy savings of up to 53%, recovering all costs in approximately 5 months. The convenience store group participating in this study was satisfied with the efficiency of energy conservation because of the short cost-recovery period.

Background: Telemedicine has been used for many years to support doctors in the developing world. Several networks provide services in different settings and in different ways. However, to draw conclusions about which telemedicine networks are successful requires a method of evaluating them. No general consensus or validated framework exists for this purpose., Objective: To define a basic method of performance measurement that can be used to improve and compare teleconsultation networks; to employ the proposed framework in an evaluation of three existing networks; to make recommendations about the future implementation and follow-up of such networks., Methods: Analysis based on the experience of three telemedicine networks (in operation for 7-10 years) that provide services to doctors in low-resource settings and which employ the same basic design., Findings: Although there are many possible indicators and metrics that might be relevant, five measures for each of the three user groups appear to be sufficient for the proposed framework. In addition, from the societal perspective, information about clinical- and cost-effectiveness is also required. The proposed performance measurement framework was applied to three mature telemedicine networks. Despite their differences in terms of activity, size and objectives, their performance in certain respects is very similar. For example, the time to first reply from an expert is about 24 hours for each network. Although all three networks had systems in place to collect data from the user perspective, none of them collected information about the coordinator's time required or about ease of system usage. They had only limited information about quality and cost., Conclusion: Measuring the performance of a telemedicine network is essential in understanding whether the network is working as intended and what effect it is having. Based on long-term field experience, the suggested framework is a practical tool that will permit organisations to assess the performance of their own networks and to improve them by comparison with others. All telemedicine systems should provide information about setup and running costs because cost-effectiveness is crucial for sustainability.

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on management in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the 16th in a series of articles applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, Dr Clancy, the editor of this column, and co-author, Dr West, discuss how the collapse of global financial markets in 2008 may provide valuable insight into mechanisms of complex system behavior in healthcare. Dr West, a physicist and expert in the field of complex systems and network science, is author of a chapter in the book, On the Edge: Nursing in the Age of Complexity (Lindberg C, Nash S, Linberg C. Bordertown, NJ: Plexus Press; 2008) and his most recent book, Disrupted Networks: From Physics to Climate Change (West BJ, Scafetta N. Singapore: Disrupted Networks, World Scientific Publishing; 2010).

Teledermatology is essentially "dermatology at a distance", using one of many communication technologies to expand the reach of a dermatologist to those in need of their specialized knowledge. Most international teledermatology is store-and-forward in nature, a method in which images are stored on a computer and then transmitted electronically to a consulting dermatologist. This system is more convenient and less costly than real-time teledermatology. This review will focus on several of the store-and-forward teledermatology systems being developed and utilized successfully internationally. This discussion of "who" is practicing teledermatology is not comprehensive, but attempts to show some of the breadth of teledermatology practice around the world, including government national health plans, commercial endeavors, and charitable work by individuals and institutions. The goal in many instances is to provide better health outcomes through increased access, efficiency, and/or cost-effectiveness. More studies ultimately need to be conducted to develop a more comprehensive and sustainable model for teledermatology.

Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market., (Georg Thieme Verlag KG Stuttgart.New York.)

Electronic wireless sensors could cut medical costs by enabling physicians to remotely monitor vital signs such as blood pressure, blood glucose, and blood oxygenation while patients remain at home. According to the IDC report "Worldwide Bluetooth Semiconductor 2008-2012 Forecast," published November 2008, a forthcoming radio frequency communication ("wireless connectivity") standard, Bluetooth low energy, will link wireless sensors via radio signals to the 70% of cell phones and computers likely to be fitted with the next generation of Bluetooth wireless technology, leveraging a ready-built infrastructure for data transmission. Analysis of trends indicated by this data can help physicians better manage diseases such as diabetes. The technology also addresses the concerns of cost, compatibility, and interoperability that have previously stalled widespread adoption of wireless technology in medical applications., ((c) 2010 Diabetes Technology Society.)

Politicians across the political spectrum support greater investment in health care information and communications technology (ICT) and expect it to significantly decrease costs and improve health outcomes. We address three policy questions about adoption of ICT in health care: First, why is there so little adoption? Second, what policies will facilitate and accelerate adoption? Third, what is the best pace for adoption? We first describe the unusual economics of ICT, particularly network externalities, and then determine how those economics interact with and are exacerbated by the unusual economics of health care. High replacement costs and the need for technical compatibility are general barriers to ICT adoption and often result in lock-in to adopted technologies. These effects are compounded in health care because the markets for health care services, health insurance, and labor are interlinked. In addition, the government interacts with all markets in its role as an insurer. Patient heterogeneity further exacerbates these effects. Finally, ICT markets are often characterized by natural monopolies, resulting in little product diversity, an effect ill-suited to patient heterogeneity. The ongoing process for setting technical standards for health care ICT is critical but needs to include all relevant stakeholders, including patient groups. The process must be careful (i.e., slow), flexible, and allow for as much diversity as possible. We find that waiting to adopt ICT is a surprisingly wise policy.

Innovation in the fields of wireless data communications, mobile devices and biosensor technology enables the development of new types of monitoring systems that provide people with assistance anywhere and at any time. In this paper we present an architecture useful to build those kind of systems that monitor data streams generated by biological sensors attached to mobile users. We pay special attention to three aspects related to the system efficiency: selection of the optimal granularity, that is, the selection of the size of the input data stream package that has to be acquired in order to start a new processing cycle; the possible use of compression techniques to store and send the acquired input data stream and; finally, the performance of a local analysis versus a remote one. Moreover, we introduce two particular real systems to illustrate the suitability and applicability of our proposal: an anywhere and at any time monitoring system of heart arrhythmias and an apnea monitoring system.

Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours 'on-call' service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550.

The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview.

We conducted an economic analysis of a store-and-forward teledermatology system for the routine triage of skin cancer patients. A cost-identification, cost-effectiveness and sensitivity analysis under a societal perspective was used to compare teledermatology with the conventional care alternative. In the period March 2004 to July 2005, a total of 2009 teledermatology referrals were managed from 12 Primary Care Centres (PCCs) of the public health system. The unit cost was of Euro 79.78 per patient in teledermatology, and Euro 129.37 per patient in conventional care (P < 0.005), with an incremental cost of Euro 49.59 per patient in favour of teledermatology. The cost ratio between teledermatology and conventional care was 1.6. There was a significant inverse relation between the unit cost in each participating PCC and the number of teleconsultations transmitted from them (P < 0.001). Teledermatology resulted in a more cost-effective, or dominant, methodology. In a public health system equipped with an intranet, the routine use of teledermatology in skin cancer clinics is a cost-effective method of managing referrals.

Implementing a telehealth program from the technical standpoint can be an engineering and financial challenge due to associated costs such as hardware, software, networking, administration and human expertise. To maximize potential and minimize costs, it makes sense to leverage existing telecommunications infrastructures and tailor the program based on what is available. This is especially critical in developing nations where funding is often limited.

A codec is the mechanism by which video and audio signals are compressed to conserve bandwidth before transmission across a telecommunication network. It may be implemented either in hardware or software. In the past, manufacturers sometimes used proprietary codecs that were incompatible with those from other manufacturers. As network usage became more widespread, however, it became clear that standards were needed to permit interoperability between equipment from different manufacturers. Regardless of the coding standards employed, the primary concerns for the user of a codec system are the quality of the audio and video transmitted. How does one decide what kind of codec to use? For telehealth applications, good quality is important, so it is best to look at products from established manufacturers. Ultimately, the choice of a codec for telehealth depends primarily on the trade-offs between quality, cost, bandwidth requirements and interoperability required by the application(s) for the system, and the environment in which it will be used.

Recently, a remote-sensing platform based on wireless interconnection of tiny ECG sensors called Telecardiology Sensor Networks (TSN) provided a promising approach to perform low-cost real-time cardiac patient monitoring at any time in community areas (such as elder nursing homes or hospitals). The contribution of this research is the design of a practical TSN hardware/software platform for a typical U.S. healthcare community scenario (such as large nursing homes with many elder patients) to perform real-time healthcare data collections. On the other hand, due to the radio broadcasting nature of MANET, a TSN has the risk of losing the privacy of patients' data. Medical privacy has been highly emphasized by U.S. Department of Health and Human Services. This research also designs a medical security scheme with low communication overhead to achieve confidential electrocardiogram data transmission in wireless medium.

Despite the demonstrated need for a national health information network (NHIN), there has been little progress in turning this need into reality beyond limited local demonstrations. One barrier is the lack of information evaluating the potential costs of connecting these local networks to form a national network. The Center for Information Technology Leadership (CITL), in conjunction with national experts, developed assumptions around the components needed to develop the NHIN. These assumptions were largely based on the architectural approach suggested by the Connecting for Health Common Framework for such a network. Using these assumptions, CITL collected cost data from three different markets engaging in healthcare information exchange (HIE). These costs were then extrapolated to the nation based on population density data from the U.S. Census Bureau. The CITL model projected an initial deployment cost of $97 million and an annual maintenance cost of $41 million for HIE across the NHIN.

The availability of new technologies has changed how we control devices, exchange information, and communicate with others. Significant barriers, however, have prevented many individuals who use augmentative and alternative communication (AAC) from accessing the technology and computer-based activities available in today's "Information Society." In this paper we discuss the benefits and challenges to increased interoperability between AAC and mainstream technologies. We outline suggested roles and activities for six stakeholder groups: (a) individuals who use AAC, (b) individuals who assist in selecting and supporting use of AAC devices, (c) AAC researchers, (d) AAC device manufacturers, (e) mainstream application developers and technology manufacturers, and (f) public policy makers. We also provide suggestions for future research, public policy, and technical development.

Besides the overall budget for building the infrastructure of a healthcare-service-based virtual private network (VPN) in Taiwan, two issues were considered critical for its acceptance by the country's 17,000 plus medical institutions. One was who was to pay for the network (ADSL or modem) connection fee; the other was who was to pay for the firewall/anti-virus software. This paper addresses the second issue by proposing an efficient freeware firewall, named card-assisted firewall (CAF), for NHI VPN edge-hosts, which is also an add-on-value application of the National Healthcare IC card that every insurant and medical professional has. The innovative concept is that any NHI VPN site (edge-host) can establish diversified secure-authenticated connections with other sites only by an authentication mechanism, which requires a NHI Java card state machine and the Access Control List of the host. It is different from two-factor authentication cards in four ways: (1) a PIN code is not a must; (2) it requires authentication with the remote IC card Data Centre; (3) the NHI cards are already available, no modification is needed, and there is no further cost for the deployment of the cards; (4) although the cards are in the reader, the communication cannot start unless the cards are in the corresponding states; i.e. the states allow communication. An implementation, on a Microsoft Windows XP platform, demonstrated the system's feasibility over an emulation of the NHI VPN framework. It maintained a high line speed, the driver took up 39 KB of disk space, installation was simple, not requiring any extra hardware or software, and the average packet processing time of the CAF driver measured was 0.3084 ms. The average overhead in comparing the Access Control List predefined routing in card, in an FTP testing experiment, was 5.7 micros (receiving) and 8 micros (sending).