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The rapid development of the digital healthcare and the electronic health records (EHR) requires smooth networking infrastructure to access data using Hypertext Transfer Protocol (HTTP)-based applications. The new HTTP/3 standard should provide performance and security improvements over HTTP/2. The goal of our work was to test the performance of HTTP/2 and HTTP/3 in the context of the EHRs. We used 45,000 test FHIR Patient resources downloaded and uploaded using 20, 50, 100 and 200 resources per Bundle, which resulted in 2251, 901, 451 and 226 HTTP GET and POST requests respectively. The first test downloading 20 resources per Bundle showed that HTTP/3 outperformed HTTP/2 in the local (mean request time 16.57 ms ± 7.2 standard deviation [SD]) and in the remote network (71.45 ms ± 43.5 SD) which is almost 3 times faster. In the 50 and 100 resources per Bundle test the HTTP/3 protocol demonstrated again more than two times gain in downloading performance for remote requests with mean request time 91.13 ms ± 34.54 SD and 88.09 ms ± 21.66 SD respectively. Furthermore, HTTP/3 outperformed HTTP/2 in the constructed clinical dataset remote transfer. In the upload tests HTTP/3 showed only a slight gain in performance merely in the remote network. The HTTP/3 protocol is a relatively new development and a major improvement for the worldwide web. This new technology is still missing in the digital health and EHRs. Its use could offer a major performance gain in situations where data is gathered from multiple remote locations., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In the research on energy-efficient networking methods for precision agriculture, a hot topic is the energy issue of sensing nodes for individual wireless sensor networks. The sensing nodes of the wireless sensor network should be enabled to provide better services with limited energy to support wide-range and multi-scenario acquisition and transmission of three-dimensional crop information. Further, the life cycle of the sensing nodes should be maximized under limited energy. The transmission direction and node power consumption are considered, and the forward and high-energy nodes are selected as the preferred cluster heads or data-forwarding nodes. Taking the cropland cultivation of ginseng as the background, we put forward a particle swarm optimization-based networking algorithm for wireless sensor networks with excellent performance. This algorithm can be used for precision agriculture and achieve optimal equipment configuration in a network under limited energy, while ensuring reliable communication in the network. The node scale is configured as 50 to 300 nodes in the range of 500 × 500 m2, and simulated testing is conducted with the LEACH, BCDCP, and ECHERP routing protocols. Compared with the existing LEACH, BCDCP, and ECHERP routing protocols, the proposed networking method can achieve the network lifetime prolongation and mitigate the decreased degree and decreasing trend of the distance between the sensing nodes and center nodes of the sensor network, which results in a longer network life cycle and stronger environment suitability. It is an effective method that improves the sensing node lifetime for a wireless sensor network applied to cropland cultivation of ginseng., Competing Interests: The authors have declared that no competing interests exist.

Background: The Harvey Cushing/John Hay Whitney Medical Library serves a community of over 22,000 individuals primarily from the Yale Schools of Medicine, Public Health, and Nursing and the Yale New Haven Hospital. Though they are geographically close to one another, reaching these disparate populations can be a challenge. Having a clear and thorough communication plan has proved invaluable in transcending communication chasms, especially in recent times of crisis., Case Presentation: This article describes the Harvey Cushing/John Hay Whitney Medical Library's methods for communicating and promoting its remote resources and services in response to coronavirus disease 2019 (COVID-19). It details our communication strategies and messages leading up to, and after, the Yale campus was closed and specifies how we pivoted from reaching users inside the library to reaching our audiences remotely., Conclusions: Our communication plan has provided the foundation for all of our messaging, be it print or digital media. In recent moments of crisis, it has been especially helpful for planning and executing large scale messaging. Similarly, knowing whom to contact around our organization to promote our message in different and broader ways has been extremely beneficial., (Copyright © 2021 Dana Haugh.)

Background: Modern healthcare devices can be connected to computer networks and many western healthcare institutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence that cybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively, the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked., Methods: To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitals and especially University Medical Center UMCs., Results: The results show a strong correlation between the networking degree and the number of medical devices. The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual key users of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, Nuclear Medicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medical devices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strong correlation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquired hospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion of competencies on an organizational level facilitates the right behavior here. Most hospitals rated themselves predominantly positively in the self-assessment but also stated the usefulness of IT security insurance., Conclusions: Concluding our results, hospitals are already facing the consequences of omitted measures within their growing pool of medical devices. Continuously relying on historically grown structures without adaption and trusting manufactures to solve vectors is a critical behavior that could seriously endanger patients.

Background: Traditional nurse call systems used in residential care facilities rely on patients to summon assistance for routine or emergency needs. Wireless nurse call systems (WNCS) offer new affordances for persons unable to actively or consciously engage with the system, allowing detection of hazardous situations, prevention and timely treatment, as well as enhanced nurse workflows. This study aimed to explore facilitators and barriers of implementation of WNCSs in residential care facilities., Methods: The study had a cross-sectional descriptive design. We collected data from care providers (n = 98) based on the Measurement Instrument for Determinants of Innovation (MIDI) framework in five Norwegian residential care facilities during the first year of WNCS implementation. The self-reporting MIDI questionnaire was adapted to the contexts. Descriptive statistics were used to explore participant characteristics and MIDI item and determinant scores. MIDI items to which ≥20% of participants disagreed/totally disagreed were regarded as barriers and items to which ≥80% of participants agreed/totally agreed were regarded as facilitators for implementation., Results: More facilitators (n = 22) than barriers (n = 6) were identified. The greatest facilitators, reported by 98% of the care providers, were the expected outcomes: the importance and probability of achieving prompt call responses and increased safety, and the normative belief of unit managers. During the implementation process, 87% became familiar with the systems, and 86 and 90%, respectively regarded themselves and their colleagues as competent users of the WNCS. The most salient barriers, reported by 37%, were their lack of prior knowledge and that they found the WNCS difficult to learn. No features of the technology were identified as barriers., Conclusions: Overall, the care providers gave a positive evaluation of the WNCS implementation. The barriers to implementation were addressed by training and practicing technological skills, facilitated by the influence and support by the manager and the colleagues within the residential care unit. WNCSs offer a range of advanced applications and services, and further research is needed as more WNCS functionalities are implemented into residential care services.

Big data (BD) in pediatric medication safety research provides many opportunities to improve the safety and health of children. The number of pediatric medication and device trials has increased in part because of the past 20 years of US legislation requiring and incentivizing study of the effects of medical products in children (Food and Drug Administration Modernization Act of 1997, Pediatric Rule in 1998, Best Pharmaceuticals for Children Act of 2002, and Pediatric Research Equity Act of 2003). There are some limitations of traditional approaches to studying medication safety in children. Randomized clinical trials within the regulatory context may not enroll patients who are representative of the general pediatric population, provide the power to detect rare safety signals, or provide long-term safety data. BD sources may have these capabilities. In recent years, medical records have become digitized, and cell phones and personal devices have proliferated. In this process, the field of biomedical science has progressively used BD from those records coupled with other data sources, both digital and traditional. Additionally, large distributed databases that include pediatric-specific outcome variables are available. A workshop entitled "Advancing the Development of Pediatric Therapeutics: Application of 'Big Data' to Pediatric Safety Studies" held September 18 to 19, 2017, in Silver Spring, Maryland, formed the basis of many of the ideas outlined in this article, which are intended to identify key examples, critical issues, and future directions in this early phase of an anticipated dramatic change in the availability and use of BD., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Real-time and ubiquitous patient monitoring demands the use of wireless data acquisition through resource constrained medical sensors, mostly configured with No-input No-output (NiNo) capabilities. Bluetooth is one of the most popular and widely adopted means of communicating this sensed information to a mobile terminal. However, over simplified implementations of Bluetooth low energy (BLE) protocol in eHealth sector is susceptible to several wireless attacks, in particular the Man-in-the-Middle (MITM) attack. The issue arises due to a lack of mutual authentication and integrity protection between the communicating devices, which may lead to compromise of confidentiality, availability and even the integrity of this safety-critical information. This research paper presents a novel framework named MARC to detect, analyze, and mitigate Bluetooth security flaws while focusing upon MITM attack against NiNo devices. For this purpose, a comprehensive solution has been proposed, which can detect MITM signatures based upon four novel anomaly detection metrics: analyzing Malicious scan requests, Advertisement intervals, RSSI levels, and Cloned node addresses. The proposed solution has been evaluated through practical implementation and demonstration of different attack scenarios, which show promising results concerning accurate and efficient detection of MITM attacks.

Objective: To develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data., Methods: For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system. Social network analysis was used to examine and visualize communication network structures, identify principal care teams, and detect meaningful structural differences across networks. We conducted a non-parametric multivariate analysis of variance (MANOVA) to test the association between care teams' communication network structures and patients' cancer stage and site., Results: The 100 communication networks showed substantial variations in size and structures. Principal care teams, the subset of HCPs who formed the core of the communication networks, had higher proportions of nurses, physicians, and pharmacists and a lower proportion of laboratory medical technologists than the overall networks. The distributions of conditional uniform graph quantiles suggested that our network-construction technique captured meaningful underlying structures that were different from random unstructured networks. MANOVA results found that the networks' topologies were associated with patients' cancer stage and site., Conclusions: This study demonstrates that it is feasible to use EHR access-log data to measure and examine communication networks in virtual care teams. The proposed methods captured salient communication patterns in care teams that were associated with patients' clinical differences., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months. Methods: Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available. Results: In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208. Conclusions: Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.

Objective: An intranet portal that combines cost-free, open-source software technology with easy set-up features can be beneficial for daily hospital processes. We describe the short-term adoption rates of a costless content management system (CMS) in the intranet of a tertiary Greek hospital., Design: Dashboard statistics of our CMS platform were the implementation assessment of our system., Results: In a period of 10 months of running the software, the results indicate the employees overcame 'Resistance to Change' status. The average growth rate of end users who exploit the portal services is calculated as 2.73 every 3.3 months., Conclusion: We found our intranet web-based portal to be acceptable and helpful so far. Exploitation of an open-source CMS within the hospital intranet can influence healthcare management and the employees' way of working as well., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Objective: To analyze the network of human and non-human actors involved in the computerization of primary health care in the Brazilian federal government., Method: A qualitative study that used as a theoretical reference the actor-network theory and as a methodological reference the cartography of controversies. Data analysis was carried out using Gephi software, and through the extraction of reports, informed by the actor-network theory., Results: We found a network of 288 connections among 33 actors, composed mainly of nonhuman influencers of computerization. These actors are distributed throughout 3 inter-related communities, and manage the network by defining obligations, penalties, conflicts and intentionalities, thus influencing the success of the intended computerization., Final Considerations: The network of actors at the federal level generates situations that, in many cases, hamper the successful implementation of a nationwide computerization strategy.

Executives at large health systems across the United States have an interest in developing or expanding telehealth programs. While interest is increasing, telehealth implementation teams (or e-health teams) often face challenges that can hinder the successful transition from pilot to full-scale implementation. Here we share lessons learned by four large health systems that have faced and largely surmounted these challenges. For e-health teams to successfully engage senior leaders in new telehealth initiatives, it is essential to align proposals with the strategic goals of the institution and use patient stories to highlight the benefits of telehealth. To manage the demand for telehealth offerings from patients and dozens of clinical departments, e-health teams should develop a framework for deciding what's most important. To get large medical staffs to adopt telehealth workflows, e-health teams should nurture telehealth champions at each staff level and incentivize them with career development opportunities and rewards. To enroll a heterogeneous population of patients in telehealth programs, e-health teams should use multiple methods of education to accommodate different learning styles. And finally, health systems should develop telehealth-specific outcome measures and repeatedly use them to motivate improvement.

Objectives: The library website is the virtual front door to the variety of services that the authors' library offers. Library staff found confusion arose focused on two areas: how to reserve rooms in the library and how to reuse images using best practices. Two interactive forms were created that would hide and reveal content based on choices and lead the patron to answers., Methods: Brainstorming meetings were held to create a flow chart that identified the specific questions to be answered that would lead users to a logical answer. Once the correct flow was created, we approached each of these challenges by creating a custom module decision tree, using code through Drupal's application programming interface (API) for forms., Results: The image reuse decision tree went live on the library website on February 17, 2017, and the room reservation wizard went live on August 27, 2017. By the end of the spring 2018 semester on May 18, 2018, the room reservation wizard had been accessed 1,945 times and risen to number 7 on the list of top-accessed website pages, and the image reuse wizard had been accessed 484 times., Conclusions: The popularity of both the decision tree pages is exciting. Both "wizards" have empowered users to find an answer to their questions virtually, especially during nonbusiness hours.

Despite having an ideal setup in their labs for wet work, researchers often lack the computational infrastructure to analyze the magnitude of data that result from "-omics" experiments. In this innovative project, the library supports analysis of high-throughput data from global molecular profiling experiments by offering a high-performance computer with open source software along with expert bioinformationist support. The audience for this new service is faculty, staff, and students for whom using the university's large scale, CORE computational resources is not warranted because these resources exceed the needs of smaller projects. In the library's approach, users are empowered to analyze high-throughput data that they otherwise would not be able to on their own computers. To develop the project, the library's bioinformationist identified the ideal computing hardware and a group of open source bioinformatics software to provide analysis options for experimental data such as scientific images, sequence reads, and flow cytometry files. To close the loop between learning and practice, the bioinformationist developed self-guided learning materials and workshops or consultations on topics such as the National Center for Biotechnology Information's BLAST, Bioinformatics on the Cloud, and ImageJ. Researchers apply the data analysis techniques that they learned in the classroom in the library's ideal computing environment.

Objective: To assess the feasibility of a novel, partnered technology development process to co-create mobile health applications (apps) addressing community health priorities, using psychoeducation of cognitive behavioral therapy (CBT) principles for enhancing resilience as an example., Design: Stakeholder engagement, workgroups, pilot feasibility study using mixed methods during October 2013 through January 2016 over three phases: 1) defining the vision of the project and increasing technical capacity, 2) co-development and pilot testing of the app, and 3) planning for sustainability., Setting: An academic-community partnership in South Los Angeles, California., Participants: Eight stakeholders; 30 pilot participants from the community., Main Outcome Measures: Qualitative analysis of audio-recordings of the app development process and stakeholder interviews, surveys of stakeholders' perception of the development process, app use data, and feedback from pilot participants., Results: The participatory technology development process resulted in creation and pilot-testing of a resiliency-focused text messaging app. Of the 1,107 messages sent, 23 out of 30 (77%) app users responded to explore interactive content. Stakeholders reported increased perceived competency in creating mobile apps and that the process fostered a culture of co-leadership. There was also sustained engagement in mobile app development by stakeholders beyond the initial project period., Conclusions: This is the first study, to our knowledge, to demonstrate the feasibility of participatory technology development, an approach involving direct participation in the development, tailoring and maintenance of a mobile app by a broad set of stakeholders with high representation from racial/ethnic minorities from an under-resourced community. Participatory technology development is a promising approach for creating sustainable, relevant and engaging health technologies across different technological, clinical and community settings., Competing Interests: Competing Interests: AA developed the Chorus platform used in this study and is founder of Insight Health Systems, Inc. (a technology company that licenses Chorus) and founder of Arevian Technologies, Inc. and the non-profit Open Science Initiative.

How can we find patterns and anomalies in a tensor, i.e., multi-dimensional array, in an efficient and directly interpretable way? How can we do this in an online environment, where a new tensor arrives at each time step? Finding patterns and anomalies in multi-dimensional data have many important applications, including building safety monitoring, health monitoring, cyber security, terrorist detection, and fake user detection in social networks. Standard tensor decomposition results are not directly interpretable and few methods that propose to increase interpretability need to be made faster, more memory efficient, and more accurate for large and quickly generated data in the online environment. We propose two versions of a fast, accurate, and directly interpretable tensor decomposition method we call CTD that is based on efficient sampling method. First is the static version of CTD, i.e., CTD-S, that provably guarantees up to 11× higher accuracy than that of the state-of-the-art method. Also, CTD-S is made up to 2.3× faster and up to 24× more memory-efficient than the state-of-the-art method by removing redundancy. Second is the dynamic version of CTD, i.e. CTD-D, which is the first interpretable dynamic tensor decomposition method ever proposed. It is also made up to 82× faster than the already fast CTD-S by exploiting factors at previous time step and by reordering operations. With CTD, we demonstrate how the results can be effectively interpreted in online distributed denial of service (DDoS) attack detection and online troll detection., Competing Interests: The authors have declared that no competing interests exist.

With the convergence of various broadcasting systems, the amount of content available in mobile terminals including IPTV has significantly increased. In this paper, we propose a system that enables users to schedule programs considering both section video clips and full video clips based on the user detection method with similar preference. And, since the system constituting the contents can be classified according to the program, the proposed method can store a program desired by the user, and thus create and schedule a kind of individual channel. Experimental results show that the proposed method has a higher prediction accuracy; this is accomplished by comparing existing channel recommendation methods with the program recommendation methods proposed in this paper., Competing Interests: The authors have declared that no competing interests exist.

Medical cyber-physical systems (MCPS) are healthcare critical integration of a network of medical devices. These systems are progressively used in hospitals to achieve a continuous high-quality healthcare. The MCPS design faces numerous challenges, including inoperability, security/privacy, and high assurance in the system software. In the current work, the infrastructure of the cyber-physical systems (CPS) are reviewed and discussed. This article enriched the researches of the networked Medical Device (MD) systems to increase the efficiency and safety of the healthcare. It also can assist the specialists of medical device to overcome crucial issues related to medical devices, and the challenges facing the design of the medical device's network. The concept of the social networking and its security along with the concept of the wireless sensor networks (WSNs) are addressed. Afterward, the CPS systems and platforms have been established, where more focus was directed toward CPS-based healthcare. The big data framework of CPSs is also included.

Digitization in the health sector embodies opportunities and risks. These consist of patient and data confidentiality. Vulnerability of data concerning integrity and availability can lead to financial losses and to damage of the health of data subjects. Those risks must be tackled by privacy or data protection law. For this purpose we have the European Data Protection Regulation as a comprehensive legal framework and a harmonizing bracket.This framework contains regulations on consent, purpose binding and data transfer, on rights of the data subject, technical and organizational measures and procedural arrangements. Recently, codes of conduct and certification schemes have been added as instruments. The frame of privacy law is completed by the law on medical products and information security regulations.Unfortunately, German legislation did not grip the opportunity of the European regulation to modernize, tighten and harmonize national privacy law in the health sector. This led to a lack of clarity, particularly because of the parallel applicability of privacy law and professional law. Central issues - for instance concerning transparency for data subjects, official supervision, analytics and processing for research purposes - remain dysfunctional. The German legislation should adjust those deficits. Corporations and the chambers for health professionals could and should also be active for this concern.

Background: Local hospitals must deal with large numbers of patients during mass casualty incidents, and the wireless sensor networks (WSNs) can help in these situations by monitoring vital signs. Conventional ZigBee nodes can obtain the ID of a device by assigning a unique 16-bit short address or by burning firmware into an IC. These methods tend to complicate node management and lack portability., Objective: The study developed a node management mechanism to deal with a large number of patients in real-time, through the wireless monitoring of physiological signals. The mechanism proposed for the ZigBee WSN is based on a three-layer (Coordinator, Control Router, and End Device) tree topology., Methods: The proposed system includes a node deployment process to formulate a ZigBee WSN as a tree topology, an algorithm to automatically number ZigBee nodes for monitoring and control system (MCS), and an algorithm to automatically obtain the short addresses of nodes for data collection. Specifically, an algorithm automatically collects data from ZigBee nodes for display on a computer graphical user interface (GUI). We also developed a reliable data transmission method capable of resolving the problem of packet loss., Results: The proposed method has been applied in a local hospital. Our research findings provide a valuable reference for the development of ZigBee-based MCS., Conclusions: The proposed node management mechanism is faster, more reliable, and more intuitive to use, than traditional methods.

Doctors usually require patients' medical records before medical examinations. Nevertheless, obtaining such records may take time. Hence, Near Field Communication (NFC) could be used to store and send medical records between doctors and patients. Another issue is that there could be a threat such as, Man In The Middle Attack and eavesdropping, thus, a security method is required to secure the data. Furthermore, the information regarding the key and initialisation vector in NFC cannot be sent using one data package, hence, the data transmission should be done several times. Therefore, the initialisation vector that changed in each transmission is implemented, and the key utilised is based on the component agreed by both parties. This study aims at applying the cryptography process that does disturb and hinder the speed of data transmission. The result demonstrated that the data transmitted could be secured and the encryption process did not hinder data exchange. Also, different number of characters in plaintexts required different amount of time for encryption and decryption. It could be affected by the specifications of the devices used and the processes happening in the devices.

Objective: This study aims to improve the management quality of chronic obstructive pulmonary disease (COPD) in rural areas., Methods: Two hundred forty discharged COPD patients were divided into an intervention group and a control group. In the intervention group, 120 patients established contact with doctors through the network consulting room, i.e., the doctor's mobile platform, and were managed through video, voice, and text by the doctors, kept close contact with the doctors after discharge (education, consultation), and received electronic prescriptions, and drugs were sent to the patients' door by online retailers. The patients in the control group were managed in the traditional manner. One year later, the predicted forced expiratory volume in 1 s (FEV1)%, FEV1/forced vital capacity (FVC), and CAT scores and the number of rehospitalized patients were compared between these 2 groups., Results: After 1 year of follow-up, the predicted FEV1% and the FEV1/FVC ratio were significantly higher in the intervention group than in the control group (p < 0.05). CAT scores were lower for patients in the intervention group than for those in the control group after 1 year of follow-up (p < 0.05). After 1 year of follow-up, 22 (18.33%) patients were rehospitalized in the intervention group and 58 (48.33%) patients were rehospitalized in the control group (p < 0.05)., Conclusion: Doctors can improve the quality of life of patients with COPD and reduce the number of rehospitalizations through use of the network consulting room., (© 2018 The Author(s) Published by S. Karger AG, Basel.)

Purpose of Review: Participatory medicine and the availability of commercial technologies have given patients more options to view and track their health information and to communicate with their providers. This shift in the clinical process may be of particular importance in mental healthcare where rapport plays a significant role in the therapeutic process., Recent Findings: In this review, we examined literature related to the impact of technology on the clinical workflow and patient-provider rapport in the mental health field between January 2014 and June 2017. Thirty three relevant articles, of 226 identified articles, were summarized. The use of technology clinically has evolved from making care more accessible and efficient to leveraging technology to improve care, communication, and patient-provider rapport. Evidence exists demonstrating that information and communication technologies may improve care by better connecting patients and providers and by improving patient-provider rapport, although further research is needed.

Mobility prediction is a technique in which the future location of a user is identified in a given network. Mobility prediction provides solutions to many day-to-day life problems. It helps in seamless handovers in wireless networks to provide better location based services and to recalculate paths in Mobile Ad hoc Networks (MANET). In the present study, a framework is presented which predicts user mobility in presence and absence of mobility history. Naïve Bayesian classification algorithm and Markov Model are used to predict user future location when user mobility history is available. An attempt is made to predict user future location by using Short Message Service (SMS) and instantaneous Geological coordinates in the absence of mobility patterns. The proposed technique compares the performance metrics with commonly used Markov Chain model. From the experimental results it is evident that the techniques used in this work gives better results when considering both spatial and temporal information. The proposed method predicts user's future location in the absence of mobility history quite fairly. The proposed work is applied to predict the mobility of medical rescue vehicles and social security systems.

Planning a research strategy and formulating the right research questions at various stages of developing a telehealth intervention are essential for producing scientific evidence. The aim of research at each stage should correspond to the maturity of the intervention and will require a variety of study designs. Although there are several published evaluation frameworks for telemedicine or telehealth as a subset of broader eHealth domain, there is currently no simple model to guide research planning. In this paper we propose a five-stage model as a framework for planning a comprehensive telehealth research program for a new intervention or service system. The stages are: (1) Concept development, (2) Service design, (3) Pre-implementation, (4) Implementation, (5) Post-implementation, and at each stage a number of studies are considered. Robust evaluation is important for the widespread acceptance and implementation of telehealth. We hope this framework enables researchers, service administrators and clinicians to conceptualise, undertake and appraise telehealth research from the point of view of being able to assess how applicable and valid the research is for their particular circumstances.

Some incident response practitioners feel that they have been locked in a battle with cyber criminals since the popular adoption of the internet. Initially, organisations made great inroads in preventing and containing cyber attacks. In the last few years, however, cyber criminals have become adept at eluding defence security technologies and rapidly modifying their exploit strategies for financial or political gains. Similar to changes in military combat tactics, cyber criminals utilise distributed attack cells, real-time communications, and rapidly mutating exploits to minimise the potential for detection. Cyber criminals have changed their attack paradigm. This paper describes a new incident response paradigm aimed at combating the new model of cyber attacks with an emphasis on agility to increase the organisation's ability to respond rapidly to these new challenges.

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.

We study secondary random access in multi-input multi-output cognitive radio networks, where a slotted ALOHA-type protocol and successive interference cancellation are used. We first introduce three types of transmit beamforming performed by secondary users, where multiple antennas are used to suppress the interference at the primary base station and/or to increase the received signal power at the secondary base station. Then, we show a simple decentralized power allocation along with the equivalent single-antenna conversion. To exploit the multiuser diversity gain, an opportunistic transmission protocol is proposed, where the secondary users generating less interference are opportunistically selected, resulting in a further reduction of the interference temperature. The proposed methods are validated via computer simulations. Numerical results show that increasing the number of transmit antennas can greatly reduce the interference temperature, while increasing the number of receive antennas leads to a reduction of the total transmit power. Optimal parameter values of the opportunistic transmission protocol are examined according to three types of beamforming and different antenna configurations, in terms of maximizing the cognitive transmission capacity. All the beamforming, decentralized power allocation, and opportunistic transmission protocol are performed by the secondary users in a decentralized manner, thus resulting in an easy implementation in practice., Competing Interests: The authors have declared that no competing interests exist.

Healthcare, like many other industries, has become reliant on technology to manage daily operations. Often, technology downtimes are managed within the information technology departments to ensure the technical staff can return the hardware or software to the end users as quickly as possible. However, if managed strictly through IT departments, such incidents lack critical communication components and an understanding of the impact on end users. This paper argues that such technological incidents need to be managed not just rapidly but also in conjunction with the emergency preparedness department. It presents the example of a healthcare system from the US Midwest where the IT department has worked closely with the emergency preparedness department to design a major incident management system that closely resembles the hospital incident command structure. The development and implementation of this process has improved several metrics, including time to declare (declaration of an incident) and mean time to restore (returning the technology back to the end users). This paper will describe how this collaboration between information technology and emergency preparedness has improved the impact on healthcare operations, and will highlight the metrics used to monitor success.

Telemedicine has become an effective means of delivering quality healthcare in the world. Across the African continent, Telemedicine is increasingly being recognized as a way of improving access to quality healthcare. The use of technology to deliver quality healthcare has been demonstrated as an effective way of overcoming geographic barriers to healthcare in pilot Telemedicine projects in certain parts of Kumasi, Ghana. However because of poor network connectivity experienced in the pilot projects, the success of the pilot networks could not be extended to cover the whole city of Kumasi and other surrounding villages. Fortunately, recent deployment of WiMAX in Ghana has delivered higher data rates at longer distances with improved network connectivity. This paper examines the feasibility of using WiMAX in deploying a city wide Mobile Telemedicine solution. The network architecture and network parameter simulations of the proposed Mobile Telemedicine network using WiMAX are presented. Five WiMAX Base Stations have been suggested to give ubiquitous coverage to the proposed Mobile Telemedicine sites in the network using adaptive 4 × 4 MIMO antenna configurations.

Research on mobile ad hoc networks (MANETs) has become a hot research topic since the middle 1990's. Over the first decade, most research focused on networking techniques, ignoring data management issues. We, however, realized early the importance of data management in MANETs, and have been conducting studies in this area for 15 years. In this review, we summarize some key technical issues related to data management in MANETs, and the studies we have done in addressing these issues, which include placement of data replicas, update management, and query processing with security management. The techniques proposed in our studies have been designed with deep considerations of MANET features including network partitioning, node participation/disappearance, limited network bandwidth, and energy efficiency. Our studies published in early 2000's have developed a new research field as data management in MANETs. Also, our recent studies are expected to be significant guidelines of new research directions. We conclude the review by discussing some future directions for research.

Background: The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving., Objective: This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture., Methods: The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution., Results: The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data., Conclusions: The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved.