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The Internet of Medical Things (IoMT) is poised to play a pivotal role in future medical support systems, enabling pervasive health monitoring in smart cities. Alzheimer's disease (AD) afflicts millions globally, and this paper explores the potential of electroencephalogram (EEG) data in addressing this challenge. We propose the Convolutional Learning Attention-Bidirectional Time-Aware Long-Short-Term Memory (CL-ATBiLSTM) model, a deep learning approach designed to classify different AD phases through EEG data analysis. The model utilizes Discrete Wavelet Transform (DWT) to decompose EEG data into distinct frequency bands, allowing for targeted analysis of AD-related brain activity patterns. Additionally, the data is segmented into smaller windows to handle the dynamic nature of EEG signals, and these segments are transformed into spectrogram images, visually depicting brain activity distribution over time and frequency. The CL-ATBiLSTM model incorporates convolutional layers to capture spatial features, attention mechanisms to emphasize crucial data, and BiLSTM networks to explore temporal relationships within the sequences. To optimize the model's performance, Bayesian optimization is employed to fine-tune the hyperparameters of the ATBiLSTM network, enhancing its ability to generalize and accurately classify AD stages. Incorporating Bayesian learning ensures the most effective model configuration, improving sensitivity and specificity for identifying AD-related patterns. Our model extracts discriminative features from EEG data to differentiate between AD, Mild Cognitive Impairment (MCI), and healthy controls (CO), offering a more comprehensive approach than existing two-class detection algorithms. By including the MCI category, our method facilitates earlier identification and potentially more impactful therapy interventions. Achieving a 96.52% accuracy on Figshare datasets containing AD, MCI, and CO groups, our approach demonstrates strong potential for practical use, accelerating AD identification, enhancing patient care, and contributing to the development of targeted treatments for this debilitating condition., (© 2024. The Author(s).)

The continuous evolution of the IoT paradigm has been extensively applied across various application domains, including air traffic control, education, healthcare, agriculture, transportation, smart home appliances, and others. Our primary focus revolves around exploring the applications of IoT, particularly within healthcare, where it assumes a pivotal role in facilitating secure and real-time remote patient-monitoring systems. This innovation aims to enhance the quality of service and ultimately improve people's lives. A key component in this ecosystem is the Healthcare Monitoring System (HMS), a technology-based framework designed to continuously monitor and manage patient and healthcare provider data in real time. This system integrates various components, such as software, medical devices, and processes, aimed at improvi1g patient care and supporting healthcare providers in making well-informed decisions. This fosters proactive healthcare management and enables timely interventions when needed. However, data transmission in these systems poses significant security threats during the transfer process, as malicious actors may attempt to breach security protocols.This jeopardizes the integrity of the Internet of Medical Things (IoMT) and ultimately endangers patient safety. Two feature sets-biometric and network flow metric-have been incorporated to enhance detection in healthcare systems. Another major challenge lies in the scarcity of publicly available balanced datasets for analyzing diverse IoMT attack patterns. To address this, the Auxiliary Classifier Generative Adversarial Network (ACGAN) was employed to generate synthetic samples that resemble minority class samples. ACGAN operates with two objectives: the discriminator differentiates between real and synthetic samples while also predicting the correct class labels. This dual functionality ensures that the discriminator learns detailed features for both tasks. Meanwhile, the generator produces high-quality samples that are classified as real by the discriminator and correctly labeled by the auxiliary classifier. The performance of this approach, evaluated using the IoMT dataset, consistently outperforms the existing baseline model across key metrics, including accuracy, precision, recall, F1-score, area under curve (AUC), and confusion matrix results.

This paper presents the development of a vital sign monitoring system designed specifically for professional athletes, with a focus on runners. The system aims to enhance athletic performance and mitigate health risks associated with intense training regimens. It comprises a wearable glove that monitors key physiological parameters such as heart rate, blood oxygen saturation (SpO2), body temperature, and gyroscope data used to calculate linear speed, among other relevant metrics. Additionally, environmental variables, including ambient temperature, are tracked. To ensure accuracy, the system incorporates an onboard filtering algorithm to minimize false positives, allowing for timely intervention during instances of physiological abnormalities. The study demonstrates the system's potential to optimize performance and protect athlete well-being by facilitating real-time adjustments to training intensity and duration. The experimental results show that the system adheres to the classical "220-age" formula for calculating maximum heart rate, responds promptly to predefined thresholds, and outperforms a moving average filter in noise reduction, with the Gaussian filter delivering superior performance.

The Internet of Medical Things (IoMT) has revolutionized healthcare with remote patient monitoring and real-time diagnosis, but securing patient data remains a critical challenge due to sophisticated cyber threats and the sensitivity of medical information. Traditional machine learning methods struggle to capture the complex patterns in IoMT data, and conventional intrusion detection systems often fail to identify unknown attacks, leading to high false positive rates and compromised patient data security. To address these issues, we propose RCLNet, an effective Anomaly-based Intrusion Detection System (A-IDS) for IoMT. RCLNet employs a multi-faceted approach, including Random Forest (RF) for feature selection, the integration of Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) models to enhance pattern recognition, and a Self-Adaptive Attention Layer Mechanism (SAALM) designed specifically for the unique challenges of IoMT. Additionally, RCLNet utilizes focal loss (FL) to manage imbalanced data distributions, a common challenge in IoMT datasets. Evaluation using the WUSTL-EHMS-2020 healthcare dataset demonstrates that RCLNet outperforms recent state-of-the-art methods, achieving a remarkable accuracy of 99.78%, highlighting its potential to significantly improve the security and confidentiality of patient data in IoMT healthcare systems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Shaikh, Wang, Muhammad, Arshad, Owais, Alnashwan, Chelloug and Muthanna.)

The Internet of Medical Things (IoMTs) is a network of connected medical equipment such as pacemakers, prosthetics, and smartwatches. Utilizing the IoMT-based system, a huge amount of data is generated, offering experts a valuable resource for tasks such as prediction, real-time monitoring, and diagnosis. To do so, the patient's health data must be transferred to database storage for processing because of the limitations of the storage and computation capabilities of IoMT devices. Consequently, concerns regarding security and privacy can arise due to the limited control over the transmitted information and reliance on wireless transmission, which leaves the network vulnerable to several kinds of attacks. Motivated by this, in this study, we aim to build and improve an efficient intrusion detection system (IDS) for IoMT networks. The proposed IDS leverages tree-based machine learning classifiers combined with filter-based feature selection techniques to enhance detection accuracy and efficiency. The proposed model is used for monitoring and identifying unauthorized or malicious activities within medical devices and networks. To optimize performance and minimize computation costs, we utilize Mutual Information (MI) and XGBoost as filter-based feature selection methods. Then, to reduce the number of the chosen features selected, we apply a mathematical set (intersection) to extract the common features. The proposed method can detect intruders while data are being transferred, allowing for the accurate and efficient analysis of healthcare data at the network's edge. The system's performance is assessed using the CICIDS2017 dataset. We evaluate the proposed model in terms of accuracy, F1 score, recall, precision, true positive rate, and false positive rate. The proposed model achieves 98.79% accuracy and a low false alarm rate 0.007 FAR on the CICIDS2017 dataset according to the experimental results. While this study focuses on binary classification for intrusion detection, we are planning to build a multi-classification approach for future work which will be able to not only detect the attacks but also categorize them. Additionally, we will consider using our proposed feature selection technique for different ML classifiers and evaluate the model's performance empirically in real-world IoMT scenarios.

Background and Objective: The Internet of Medical Things (IoMT) has revolutionized telemedicine by enabling the remote monitoring and management of patient care. Nevertheless, the process of regeneration presents the difficulty of effectively prioritizing the information of emergency patients in light of the extensive amount of data generated by several integrated health care devices. The main goal of this study is to be improving the procedure of prioritizing emergency patients by implementing the Real-time Triage Optimization Framework (RTOF), an innovative method that utilizes diverse data from the Internet of Medical Things (IoMT)., Methods: The study's methodology utilized a variety of Internet of Medical Things (IoMT) data, such as sensor data and texts derived from electronic medical records. Tier 1 supplies sensor and textual data, and Tier 3 imports textual data from electronic medical records. We employed our methodologies to handle and examine data from a sample of 100,000 patients afflicted with hypertension and heart disease, employing artificial intelligence algorithms. We utilized five machine-learning algorithms to enhance the accuracy of triage., Results: The RTOF approach has remarkable efficacy in a simulated telemedicine environment, with a triage accuracy rate of 98%. The Random Forest algorithm exhibited superior performance compared to the other approaches under scrutiny. The performance characteristics attained were an accuracy rate of 98%, a precision rate of 99%, a sensitivity rate of 98%, and a specificity rate of 100%. The findings show a significant improvement compared to the present triage methods., Conclusions: The efficiency of RTOF surpasses that of existing triage frameworks, showcasing its significant ability to enhance the quality and efficacy of telemedicine solutions. This work showcases substantial enhancements compared to existing triage approaches, while also providing a scalable approach to tackle hospital congestion and optimize resource allocation in real-time. The results of our study emphasize the capacity of RTOF to mitigate hospital overcrowding, expedite medical intervention, and enable the creation of adaptable telemedicine networks. This study highlights potential avenues for further investigation into the integration of the Internet of Medical Things (IoMT) with machine learning to develop cutting-edge medical technologies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The Internet of Medical Things (IoMT) has transformed healthcare by connecting medical devices, sensors, and patients, significantly improving patient care. However, the sensitive data exchanged through IoMT is vulnerable to security attacks, raising serious privacy concerns. Traditional key sharing mechanisms are susceptible to compromise, posing risks to data integrity. This paper proposes a Timestamp-based Secret Key Generation (T-SKG) scheme for resource-constrained devices, generating a secret key at the patient's device and regenerating it at the doctor's device, thus eliminating direct key sharing and minimizing key compromise risks. Simulation results using MATLAB and Java demonstrate the T-SKG scheme's resilience against guessing, birthday, and brute force attacks. Specifically, there is only a 9 % chance of key compromise in a guessing attack if the attacker knows the key sequence pattern, while the scheme remains secure against brute force and birthday attacks within a specified timeframe. The T-SKG scheme is integrated into a healthcare framework to securely transmit health vitals collected using the MySignals sensor kit. For confidentiality, the Data Encryption Standard (DES) with various Cipher Block modes (ECB, CBC, CTR) is employed., Competing Interests: Authors of this manuscript declare that they have no conflict of interest.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

This study explores integrating blockchain technology into the Internet of Medical Things (IoMT) to address security and privacy challenges. Blockchain's transparency, confidentiality, and decentralization offer significant potential benefits in the healthcare domain. The research examines various blockchain components, layers, and protocols, highlighting their role in IoMT. It also explores IoMT applications, security challenges, and methods for integrating blockchain to enhance security. Blockchain integration can be vital in securing and managing this data while preserving patient privacy. It also opens up new possibilities in healthcare, medical research, and data management. The results provide a practical approach to handling a large amount of data from IoMT devices. This strategy makes effective use of data resource fragmentation and encryption techniques. It is essential to have well-defined standards and norms, especially in the healthcare sector, where upholding safety and protecting the confidentiality of information are critical. These results illustrate that it is essential to follow standards like HIPAA, and blockchain technology can help ensure these criteria are met. Furthermore, the study explores the potential benefits of blockchain technology for enhancing inter-system communication in the healthcare industry while maintaining patient privacy protection. The results highlight the effectiveness of blockchain's consistency and cryptographic techniques in combining identity management and healthcare data protection, protecting patient privacy and data integrity. Blockchain is an unchangeable distributed ledger system. In short, the paper provides important insights into how blockchain technology may transform the healthcare industry by effectively addressing significant challenges and generating legal, safe, and interoperable solutions. Researchers, doctors, and graduate students are the audience for our paper., (© 2024. The Author(s).)

This paper investigates the application of ensemble learning techniques, specifically meta-learning, in intrusion detection systems (IDS) for the Internet of Medical Things (IoMT). It underscores the existing challenges posed by the heterogeneous and dynamic nature of IoMT environments, which necessitate adaptive, robust security solutions. By harnessing meta-learning alongside various ensemble strategies such as stacking and bagging, the paper aims to refine IDS mechanisms to effectively counter evolving cyber threats. The study proposes a performance-driven weighted meta-learning technique for dynamic assignment of voting weights to classifiers based on accuracy, loss, and confidence levels. This approach significantly enhances the intrusion detection capabilities for the IoMT by dynamically optimizing ensemble IDS models. Extensive experiments demonstrate the proposed model's superior performance in terms of accuracy, detection rate, F1 score, and false positive rate compared to existing models, particularly when analyzing various sizes of input features. The findings highlight the potential of integrating meta-learning in ensemble-based IDS to enhance the security and integrity of IoMT networks, suggesting avenues for future research to further advance IDS performance in protecting sensitive medical data and IoT infrastructures.

The availability of drugs across the country is a direct measure for fairer public health. Several issues have been reported drastically related to various organizations that fail to provide quality medicines on time. There has been a consistent increase in cases where the treatment, as well as exempted drugs, were supplied due to the unavailability of proper traceability of the supply chain. Several parties are involved in the supply and have similar interests that may defer the adequate shareability of the drugs. The existing system for managing the drug supply chain suffers from several backlogs. The loss of information, unavailability of resources to track the proper medicinal storage, transparency of information sharing between various stakeholders and sequential access. The applicability of the decentralized model emerging from the blockchain can apply to one of the perfect solutions in this case. The drug traceability chain can be deployed to a Ledger-based blockchain that may result in decentralized information. Continuous supply from the Internet of Things (IoT) based devices might be handy as the middleware for providing a trustworthy, safe, and proper transaction-oriented system. The data integrity, along with the provenance resulting from the IoT-connected devices, is an effective solution towards managing the supply chain and drug traceability. This study presents a model that can provide a token-based blockchain that will help provide a cost-efficient and secure system for a reliable drug supply chain., Competing Interests: The authors declare that they have no competing interests., (© 2024 Alshahrani.)

The rapidly expanding Internet of Medical Things (IoMT) landscape fosters enormous opportunities for personalized healthcare, yet it also exposes patients and healthcare systems to diverse security threats. Heterogeneous IoMT devices present challenges that need comprehensive risk assessment due to their varying functionality, protocols, and vulnerabilities. Hence, to achieve the goal of having risk-free IoMT devices, the authors used a hybrid approach using fuzzy logic and the Fuzzy Analytical Hierarchy Process (FAHP) to evaluate risks, providing effective and useful results for developers and researchers. The presented approach specifies qualitative descriptors such as the frequency of occurrence, consequence severity, weight factor, and risk level. A case study with risk events in three different IoMT devices was carried out to illustrate the proposed method. We performed a Bluetooth Low Energy (BLE) attack on an oximeter, smartwatch, and smart peak flow meter to discover their vulnerabilities. Using the FAHP method, we calculated fuzzy weights and risk levels, which helped us to prioritize criteria and alternatives in decision-making. Smartwatches were found to have a risk level of 8.57 for injection attacks, which is of extreme importance and needs immediate attention. Conversely, jamming attacks registered the lowest risk level of 1, with 9 being the maximum risk level and 1 the minimum. Based on this risk assessment, appropriate security measures can be implemented to address the severity of potential threats. The findings will assist healthcare industry decision-makers in evaluating the relative importance of risk factors, aiding informed decisions through weight comparison.

The emergence of remote health monitoring and increased at-home care emphasizes the importance of patient adherence outside the clinical setting. This is particularly pertinent in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in pediatric patients, as the population inherently has difficulty remembering and initiating treatment tasks. Neurostimulation is an emerging treatment modality for pediatric ADHD and requires strict adherence to a treatment regimen to be followed in an at-home setting. Thus, to achieve the desired therapeutic effect, careful attention must be paid to design features that can passively promote and effectively monitor therapeutic adherence. This work describes instrumentation designed to support a clinical trial protocol that tests whether choice of color, or color itself, can statistically significantly increase adherence rates in pediatric ADHD patients in an extraclinical environment. This is made possible through the development and application of an internet-of-things approach in a remote adherence monitoring technology that can be implemented in forthcoming neurostimulation devices for pediatric patient use. This instrumentation requires minimal input from the user, is durable and resistant to physical damage, and provides accurate adherence data to parents and physicians, increasing assurance that neurostimulation devices are effective for at-home care.

Reinforcement of the Internet of Medical Things (IoMT) network security has become extremely significant as these networks enable both patients and healthcare providers to communicate with each other by exchanging medical signals, data, and vital reports in a safe way. To ensure the safe transmission of sensitive information, robust and secure access mechanisms are paramount. Vulnerabilities in these networks, particularly at the access points, could expose patients to significant risks. Among the possible security measures, biometric authentication is becoming a more feasible choice, with a focus on leveraging regularly-monitored biomedical signals like Electrocardiogram (ECG) signals due to their unique characteristics. A notable challenge within all biometric authentication systems is the risk of losing original biometric traits, if hackers successfully compromise the biometric template storage space. Current research endorses replacement of the original biometrics used in access control with cancellable templates. These are produced using encryption or non-invertible transformation, which improves security by enabling the biometric templates to be changed in case an unwanted access is detected. This study presents a comprehensive framework for ECG-based recognition with cancellable templates. This framework may be used for accessing IoMT networks. An innovative methodology is introduced through non-invertible modification of ECG signals using blind signal separation and lightweight encryption. The basic idea here depends on the assumption that if the ECG signal and an auxiliary audio signal for the same person are subjected to a separation algorithm, the algorithm will yield two uncorrelated components through the minimization of a correlation cost function. Hence, the obtained outputs from the separation algorithm will be distorted versions of the ECG as well as the audio signals. The distorted versions of the ECG signals can be treated with a lightweight encryption stage and used as cancellable templates. Security enhancement is achieved through the utilization of the lightweight encryption stage based on a user-specific pattern and XOR operation, thereby reducing the processing burden associated with conventional encryption methods. The proposed framework efficacy is demonstrated through its application on the ECG-ID and MIT-BIH datasets, yielding promising results. The experimental evaluation reveals an Equal Error Rate (EER) of 0.134 on the ECG-ID dataset and 0.4 on the MIT-BIH dataset, alongside an exceptionally large Area under the Receiver Operating Characteristic curve (AROC) of 99.96% for both datasets. These results underscore the framework potential in securing IoMT networks through cancellable biometrics, offering a hybrid security model that combines the strengths of non-invertible transformations and lightweight encryption., (© 2024. The Author(s).)

Background: The massive expansion of the Internet of medical things (IoMT) technology brings many opportunities for improving healthcare. At the same time, their use increases security risks, brings security and privacy concerns, and threatens the functioning of healthcare facilities or healthcare provision., Purpose: This scoping review aims to identify progress in designing risk assessment and management frameworks for IoMT security. The frameworks found are divided into two groups according to whether frameworks address the technological design of risk management or assess technological measures to ensure the security of the IoMT environment. Furthermore, the article intends to find out whether frameworks also include an assessment of organisational measures related to IoMT security., Methods: This review was prepared using PRISMA ScR guidelines. Relevant studies were searched in the citation databases Web of Science and Scopus. The search was limited to articles published in English between 2018 and 17 September 2023. The initial search yielded 1341 articles, of which 44 (3.3%) were included in the scoping review. A qualitative content analysis focused on selected security perspectives and progress in the given area was carried out., Results: Thirty-two articles describe the design of risk assessment and management frameworks. Twelve articles describe the design of frameworks for assessing the security of IoMT devices and possibly offer a comparison of different IoMT alternatives. A description of the included articles was prepared from the selected security perspectives., Conclusion: The review shows the need to create comprehensive or holistic frameworks for operational security and privacy risk management at all layers of the IoMT architecture. It includes the design of specific technological solutions and frameworks for continuously assessing the overall level of information security and privacy of the IoMT environment. Unfortunately, none of the found frameworks offer an assessment of organizational measures even though the importance of the organization measures was highlighted in articles. Another area of interest for researchers could be the design of a general risk management database for IoMT, which would include potential IoMT-related risks connected to a particular device., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Svandova and Smutny.)

Goal: To establish Pulse2AI as a reproducible data preprocessing framework for pulsatile signals that generate high-quality machine-learning-ready datasets from raw wearable recordings. Methods: We proposed an end-to-end data preprocessing framework that adapts multiple pulsatile signal modalities and generates machine-learning-ready datasets agnostic to downstream medical tasks. Results: a dataset preprocessed by Pulse2AI improved systolic blood pressure estimation by 29.58%, from 11.41 to 8.03 mmHg in root-mean-square-error (RMSE) and its diastolic counterpart by 26.01%, from 7.93 to 5.87 mmHg in RMSE. For respiration rate (RR) estimation, Pulse2AI boosted performance by 19.69%, from 1.47 to 1.18 breaths per minute (BrPM) in mean-absolute-error (MAE). Conclusion: Pulse2AI turns pulsatile signals into machine learning (ML) ready datasets for arbitrary remote health monitoring tasks. We tested Pulse2AI on multiple pulsatile modalities and demonstrated its efficacy in two medical applications. This work bridges valuable assets in remote sensing and internet of medical things to ML-ready datasets for medical modeling., Competing Interests: All authors declare no conflict of interest., (© 2024 The Authors.)

Aims: Epilepsy, the tendency to have recurrent seizures, can have various causes, including brain tumors, genetics, stroke, brain injury, infections, and developmental disorders. Epileptic seizures are usually transient events. They normally leave no trace after the postictal recovery period has passed., Background: An electroencephalogram (EEG) can only detect brain activity during the recording. It will be detected if an epileptogenic focus or generalized abnormality is active during the recording., Objective: This work demonstrated a smart seizure detection system for Healthcare IoT, which is a challenging problem of EEG data analysis., Method: The study suggested an integrated methodology in recognition of the drawbacks of manual identification and the significant negative effects of uncontrollable seizures on patients' lives., Result: The research shows remarkable accuracy, up to 100% in some experiments, by combining classifier ensembles like Decision Trees, Logistic Regression, and Support Vector Machine with different signal processing techniques like Discrete Wavelet Transform, Hjorth Parameters, and statistical features. The results were compared using the kNN classifier, compared with other datasets and other state-of-the-art techniques., Conclusion: Healthcare IoT is further utilized by the methodology, which takes a comprehensive approach using classifier ensembles and signal processing approaches resulting in real-time data to help them make better decisions. This demonstrates how well the suggested method works for smart seizure detection, which is a crucial development for better patient outcomes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The Internet of Things (IoT) is still a relatively new field of research, and its potential to be used in the healthcare and medical sectors is enormous. In the last five years, IoT has been a go-to option for various applications such as using sensors for different features, machine-to-machine communication, etc., but precisely in the medical sector, it is still lagging far behind compared to other sectors. Hence, this study emphasises IoT applications in medical fields, Medical IoT sensors and devices, IoT platforms for data visualisation, and artificial intelligence in medical applications. A systematic review considering PRISMA guidelines on research articles as well as the websites on IoMT sensors and devices has been carried out. After the year 2001, an integrated outcome of 986 articles was initially selected, and by applying the inclusion-exclusion criterion, a total of 597 articles were identified. 23 new studies have been finally found, including records from websites and citations. This review then analyses different sensor monitoring circuits in detail, considering an Intensive Care Unit (ICU) scenario, device applications, and the data management system, including IoT platforms for the patients. Lastly, detailed discussion and challenges have been outlined, and possible prospects have been presented.

The rapid evolution of emerging technologies in healthcare is reshaping the field of medical practices and patient outcomes, ushering in an era of unprecedented innovation. This narrative review touches upon the transformative impacts of various technologies, including virtual reality (VR), augmented reality (AR), the internet of medical things (IoMT), remote patient monitoring (RPM), financial technology (fintech) integration, cloud migration, and the pivotal role of machine learning (ML). It emphasizes the collaborative impact of these technologies, which is reshaping the healthcare landscape. Virtual reality and AR revolutionize medical training, IoMT extends healthcare boundaries, RPM facilitates proactive care, and fintech integration enhances financial processes. Cloud migration ensures scalable and efficient data management, while ML harnesses algorithms for diagnostic precision and personalized treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Yadav et al.)

Lactate, once merely regarded as an indicator of tissue hypoxia and muscular fatigue, has now gained prominence as a pivotal biomarker across various medical disciplines. Recent research has unveiled its critical role as a high-value prognostic marker in critical care medicine. The current practice of lactate detection involves periodic blood sampling. This approach is invasive and confined to measurements at six-hour intervals, leading to resource expenditure, time consumption, and patient discomfort. This review addresses non-invasive sensors that enable continuous monitoring of lactate in critical care patients. After the introduction, it discusses the iontophoresis system, followed by a description of the structural materials that are universally employed to create an interface between the integumentary system and the sensor. Subsequently, each method is detailed according to its physical principle, outlining its advantages, limitations, and pertinent aspects. The study concludes with a discussion and conclusions, aiming at the design of an intelligent sensor (Internet of Medical Things or IoMT) to facilitate continuous lactate monitoring and enhance the clinical decision-making support system in critical care medicine.

The Internet of Medical Things (IoMT) is being incorporated into current healthcare systems. This technology intends to connect patients, IoMT devices, and hospitals over mobile networks, allowing for more secure, quick, and convenient health monitoring and intelligent healthcare services. However, existing intelligent healthcare applications typically rely on large-scale AI models, and standard IoMT devices have significant resource constraints. To alleviate this paradox, in this paper, we propose a Knowledge Distillation (KD)-based IoMT end-edge-cloud orchestrated architecture for medical image segmentation tasks, called Light-M, aiming to deploy a lightweight medical model in resource-constrained IoMT devices. Specifically, Light-M trains a large teacher model in the cloud server and employs computation in local nodes through imitation of the performance of the teacher model using knowledge distillation. Light-M contains two KD strategies: (1) active exploration and passive transfer (AEPT) and (2) self-attention-based inter-class feature variation (AIFV) distillation for the medical image segmentation task. The AEPT encourages the student model to learn undiscovered knowledge/features of the teacher model without additional feature layers, aiming to explore new features and outperform the teacher. To improve the distinguishability of the student for different classes, the student learns the self-attention-based feature variation (AIFV) between classes. Since the proposed AEPT and AIFV only appear in the training process, our framework does not involve any additional computation burden for a student model during the segmentation task deployment. Extensive experiments on cardiac images and public real-scene datasets demonstrate that our approach improves student model learning representations and outperforms state-of-the-art methods by combining two knowledge distillation strategies. Moreover, when deployed on the IoT device, the distilled student model takes only 29.6 ms for one sample at the inference step., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Utilizing digital healthcare services for patients who use wheelchairs is a vital and effective means to enhance their healthcare. Digital healthcare integrates various healthcare facilities, including local laboratories and centralized hospitals, to provide healthcare services for individuals in wheelchairs. In digital healthcare, the Internet of Medical Things (IoMT) allows local wheelchairs to connect with remote digital healthcare services and generate sensors from wheelchairs to monitor and process healthcare. Recently, it has been observed that wheelchair patients, when older than thirty, suffer from high blood pressure, heart disease, body glucose, and others due to less activity because of their disabilities. However, existing wheelchair IoMT applications are straightforward and do not consider the healthcare of wheelchair patients with their diseases during their disabilities. This paper presents a novel digital healthcare framework for patients with disabilities based on deep-federated learning schemes. In the proposed framework, we offer the federated learning deep convolutional neural network schemes (FL-DCNNS) that consist of different sub-schemes. The offloading scheme collects the sensors from integrated wheelchair bio-sensors as smartwatches such as blood pressure, heartbeat, body glucose, and oxygen. The smartwatches worked with wearable devices for disabled patients in our framework. We present the federated learning-enabled laboratories for data training and share the updated weights with the data security to the centralized node for decision and prediction. We present the decision forest for centralized healthcare nodes to decide on aggregation with the different constraints: cost, energy, time, and accuracy. We implemented a deep CNN scheme in each laboratory to train and validate the model locally on the node with the consideration of resources. Simulation results show that FL-DCNNS obtained the optimal results on the sensor data and minimized the energy by 25%, time 19%, cost 28%, and improved the accuracy of disease prediction by 99% as compared to existing digital healthcare schemes for wheelchair patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Recently, the use of the Internet of Medical Things (IoMT) has gained popularity across various sections of the health sector. The historical security risks of IoMT devices themselves and the data flowing from them are major concerns. Deploying many devices, sensors, services, and networks that connect the IoMT systems is gaining popularity. This study focuses on identifying the use of blockchain in innovative healthcare units empowered by federated learning. A collective use of blockchain with intrusion detection management (IDM) is beneficial to detect and prevent malicious activity across the storage nodes. Data accumulated at a centralized storage node is analyzed with the help of machine learning algorithms to diagnose disease and allow appropriate medication to be prescribed by a medical healthcare professional. The model proposed in this study focuses on the effective use of such models for healthcare monitoring. The amalgamation of federated learning and the proposed model makes it possible to reach 93.89 percent accuracy for disease analysis and addiction. Further, intrusion detection ensures a success rate of 97.13 percent in this study., Competing Interests: The authors declare there are no competing interests., (©2024 Almalki et al.)

HT-29 has an epithelial appearance as a human colorectal cancer cell line. Early detection of colorectal cancer can enhance survival rates. This study aims to detect and count HT-29 cells using a deep-learning approach (ResNet-50). The cell lines were procured from Procell Life Science & Technology Co., Ltd. (Wuhan, China). Further, the dataset is self-prepared in lab experiments, cell culture, and collected 566 images. These images contain two classes; the HT-29 human colorectal adenocarcinoma cells (blue shapes in bunches) and impurities (tinny circular grey shapes). These images are annotated with the help of an image labeller as impurity and cancer cells. Then afterwards, the images are trained, validated, and tested against the deep learning approach ResNet50. Finally, in each image, the number of impurity and cancer cells are counted to find the accuracy of the proposed model. Accuracy and computational expense are used to gauge the network's performance. Each model is tested ten times with a non-overlapping train and random test splits. The effect of data pre-processing is also examined and shown in several tasks. The results show an accuracy of 95.5% during training and 95.3% in validation for detecting and counting HT-29 cells. HT-29 cell detection and counting using deep learning is novel due to the scarcity of research in this area, the application of deep learning, and potential performance improvements over traditional methods. By addressing a gap in the literature, employing a unique dataset, and using custom model architecture, this approach contributes to advancing colon cancer understanding and diagnosis techniques., Competing Interests: The authors declare there are no competing interests., (©2023 Haq et al.)

The Internet of Medical Things (IoMT) is a growing trend within the rapidly expanding Internet of Things, enhancing healthcare operations and remote patient monitoring. However, these devices are vulnerable to cyber-attacks, posing risks to healthcare operations and patient safety. To detect and counteract attacks on the IoMT, methods such as intrusion detection systems, log monitoring, and threat intelligence are utilized. However, as attackers refine their methods, there is an increasing shift toward using machine learning and deep learning for more accurate and predictive attack detection. In this paper, we propose a fuzzy-based self-tuning Long Short-Term Memory (LSTM) intrusion detection system (IDS) for the IoMT. Our approach dynamically adjusts the number of epochs and utilizes early stopping to prevent overfitting and underfitting. We conducted extensive experiments to evaluate the performance of our proposed model, comparing it with existing IDS models for the IoMT. The results show that our model achieves high accuracy, low false positive rates, and high detection rates, indicating its effectiveness in identifying intrusions. We also discuss the challenges of using static epochs and batch sizes in deep learning models and highlight the importance of dynamic adjustment. The findings of this study contribute to the development of more efficient and accurate IDS models for IoMT scenarios.

The field of automated lung cancer diagnosis using Computed Tomography (CT) scans has been significantly advanced by the precise predictions offered by Convolutional Neural Network (CNN)-based classifiers. Critical areas of study include improving image quality, optimizing learning algorithms, and enhancing diagnostic accuracy. To facilitate a seamless transition from research laboratories to real-world applications, it is crucial to improve the technology's usability-a factor often neglected in current state-of-the-art research. Yet, current state-of-the-art research in this field frequently overlooks the need for expediting this process. This paper introduces Healthcare-As-A-Service (HAAS), an innovative concept inspired by Software-As-A-Service (SAAS) within the cloud computing paradigm. As a comprehensive lung cancer diagnosis service system, HAAS has the potential to reduce lung cancer mortality rates by providing early diagnosis opportunities to everyone. We present HAASNet, a cloud-compatible CNN that boasts an accuracy rate of 96.07%. By integrating HAASNet predictions with physio-symptomatic data from the Internet of Medical Things (IoMT), the proposed HAAS model generates accurate and reliable lung cancer diagnosis reports. Leveraging IoMT and cloud technology, the proposed service is globally accessible via the Internet, transcending geographic boundaries. This groundbreaking lung cancer diagnosis service achieves average precision, recall, and F1-scores of 96.47%, 95.39%, and 94.81%, respectively., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Melanoma is one of the deadliest tumors in the world. Early detection is critical for first-line therapy in this tumor pathology and it remains challenging due to the need for histological analysis to ensure correctness in diagnosis. Therefore, multiple computer-aided diagnosis (CAD) systems working on melanoma images were proposed to mitigate the need of a biopsy. However, although the high global accuracy is declared in literature results, the CAD systems for the health fields must focus on the lowest false negative rate (FNR) possible to qualify as a diagnosis support system. The final goal must be to avoid classification type 2 errors to prevent life-threatening situations. Another goal could be to create an easy-to-use system for both physicians and patients., Results: To achieve the minimization of type 2 error, we performed a wide exploratory analysis of the principal convolutional neural network (CNN) architectures published for the multiple image classification problem; we adapted these networks to the melanoma clinical image binary classification problem (MCIBCP). We collected and analyzed performance data to identify the best CNN architecture, in terms of FNR, usable for solving the MCIBCP problem. Then, to provide a starting point for an easy-to-use CAD system, we used a clinical image dataset (MED-NODE) because clinical images are easier to access: they can be taken by a smartphone or other hand-size devices. Despite the lower resolution than dermoscopic images, the results in the literature would suggest that it would be possible to achieve high classification performance by using clinical images. In this work, we used MED-NODE, which consists of 170 clinical images (70 images of melanoma and 100 images of naevi). We optimized the following CNNs for the MCIBCP problem: Alexnet, DenseNet, GoogleNet Inception V3, GoogleNet, MobileNet, ShuffleNet, SqueezeNet, and VGG16., Conclusions: The results suggest that a CNN built on the VGG or AlexNet structure can ensure the lowest FNR (0.07) and (0.13), respectively. In both cases, discrete global performance is ensured: 73% (accuracy), 82% (sensitivity) and 59% (specificity) for VGG; 89% (accuracy), 87% (sensitivity) and 90% (specificity) for AlexNet., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The Internet of Things (IoT) such as devices and sensors are a fast growth reality which our bureaucratical and archaic institutional system is not yet ready to embrace its functionalities. In the health system, many developments are made, and smart devices are the key to preventing, studying, investigating, and solving a lot of diseases and improving our health system. But along with this, innovation is necessary for the hospitals, for example, to have a proper system that provides storage of health data information and respects the General Data Protection Regulation (GDPR) with the use of smart contracts that secure the integrity and disclosure of the patient's data, since the majority of hospitals still use paper, physical records to store data. In this study, we will briefly analyse and explain three different suggested methods to deal with the challenges that Internet of Medical Things (IoMT) encounters. We will not choose which one is the best because of the different features and the countries they are proposed but will emphasize the benefits and challenges which one has., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

The Internet of Things (IoT) generates a large volume of data whenever devices are interconnected and exchange data across a network. Consequently, a variety of services with diverse needs arises, including capacity requirements, data quality, and latency demands. These services operate on fog computing devices, which are limited in power and bandwidth compared to the cloud. The primary challenge lies in determining the optimal location for service implementation: in the fog, in the cloud, or in a hybrid setup. This paper introduces an efficient allocation technique that moves processing closer to the network's fog side. It explores the optimal allocation of devices and services while maintaining resource utilization within an IoT architecture. The paper also examines the significance of allocating services to devices and optimizing resource utilization in fog computing. In IoT scenarios, where a wide range of services and devices coexist, it becomes crucial to effectively assign services to devices. We propose priority-based service allocation (PSA) and sort-based service allocation (SSA) techniques, which are employed to determine the optimal order for the utilizing devices to perform different services. Experimental results demonstrate that our proposed technique reduces data communication over the network by 88%, which is achieved by allocating most services locally in the fog. We increased the distribution of services to fog devices by 96%, while simultaneously minimizing the wastage of fog resources.

According to the Pan American Health Organization, cardiovascular disease is the leading cause of death worldwide, claiming an estimated 17.9 million lives each year. This paper presents a systematic review to highlight the use of IoT, IoMT, and machine learning to detect, predict, or monitor cardiovascular disease. We had a final sample of 164 high-impact journal papers, focusing on two categories: cardiovascular disease detection using IoT/IoMT technologies and cardiovascular disease using machine learning techniques. For the first category, we found 82 proposals, while for the second, we found 85 proposals. The research highlights list of IoT/IoMT technologies, machine learning techniques, datasets, and the most discussed cardiovascular diseases. Neural networks have been popularly used, achieving an accuracy of over 90%, followed by random forest, XGBoost, k-NN, and SVM. Based on the results, we conclude that IoT/IoMT technologies can predict cardiovascular diseases in real time, ensemble techniques obtained one of the best performances in the accuracy metric, and hypertension and arrhythmia were the most discussed diseases. Finally, we identified the lack of public data as one of the main obstacles for machine learning approaches for cardiovascular disease prediction., Competing Interests: The authors declare no conflicts of interest.

Diagnosing the patients remotely, controlling the medical equipment, and monitoring the quarantined patients are some of the necessary and frequent activities in COVID-19. Internet of Medical Things (IoMT) makes this works easy and feasible. Sharing information from patients and sensors associated with the patients to doctors is always an integral part of IoMT. Unauthorized access to such information may invite adversaries to disturb patients financially and mentally; furthermore, leaks in its confidentiality will lead to dangerous health concerns for patients. While ensuring authentication and confidentiality, We must focus on the constraints of IoMT, such as low energy consumption, deficient memory, and the dynamic nature of devices. Numerous protocols have been proposed for authentication in healthcare systems such as IoMT and telemedicine. However, many of these protocols were neither computationally efficient nor provided confidentiality, anonymity, and resistance against several attacks. In the proposed protocol, we have considered the most common scenario of IoMT and tried to overcome the limitations of existing works. Describing the system module and security analysis proves it is a panacea for COVID-19 and future pandemics., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Elsevier B.V. All rights reserved.)

Background: Around 15 million premature babies are born annually, requiring specialized care. Incubators are vital for maintaining their body temperature, which is crucial for their well-being. Ensuring optimal conditions in incubators, including constant temperature, oxygen control, and comfort, is essential for improving the care and survival rates of these infants., Methods: To address this, an IoT-based monitoring system was developed in a hospital setting. The system comprised hardware components such as sensors and a microcontroller, along with software components including a database and a web application. The microcontroller collected data from the sensors, which was then transmitted to a broker via WiFi using the MQTT protocol. The broker validated and stored the data in the database, while the web application provided real-time access, alerts, and event recording., Results: Two certified devices were created, employing high quality components. The system was successfully implemented and tested in both the biomedical engineering laboratory and the neonatology service of the hospital. The results of the pilot test supported the concept of IoT-based technology, demonstrating satisfactory responses in temperature, humidity, and sound variables within the incubators., Conclusions: The monitoring system facilitated efficient record traceability, allowing access to data over various timeframes. It also captured event records (alerts) related to variable problems, providing information on duration, date, hour, and minutes. Overall, the system offered valuable insights and enhanced monitoring capabilities for neonatal care.

Background: This paper explores the use of blockchain technology and smart contracts in the Internet of Medical Things (IoMT). It aims to identify the challenges and benefits of implementing smart contracts based on blockchain technology in the IoMT. It provides solutions and evaluates the IoMT uses in e-healthcare performance., Methods: A quantitative approach used an online survey from public and private hospital administrative departments in Dubai, United Arab Emirates (UAE). ANOVA, t -test, correlation, and regression analysis were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain)., Patients and Methods: A mixed method was used in this research, a quantitative approach for data analysis utilizing online surveys from public and private hospitals' administrative departments in Dubai, UAE. A correlation, regression through ANOVA, and independent two-sample t -test were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain)., Results: Blockchain application in smart contracts has proven to be significant in the healthcare sector. Results highlight the importance of integrating smart contracts and blockchain technology in the IoMT infrastructure to improve efficiency, transparency, and security. The study provides empirical evidence to support the implementation of smart contracts in the e-healthcare sector and suggests improved e-healthcare performance through this transition., Conclusion: The emergence of e-healthcare systems with upgraded smart contracts and blockchain technology brings continuous health monitoring, time-effective operations, and cost-effectiveness to the healthcare sector., Competing Interests: The authors have no competing interests to declare relevant to this article’s content., (© 2023 El Khatib et al.)

In healthcare, the Internet of Things (IoT) is used to remotely monitor patients and provide real-time diagnoses, which is referred to as the Internet of Medical Things (IoMT). This integration poses a risk from cybersecurity threats that can harm patient data and well-being. Hackers can manipulate biometric data from biosensors or disrupt the IoMT system, which is a major concern. To address this issue, intrusion detection systems (IDS) have been proposed, particularly using deep learning algorithms. However, developing IDS for IoMT is challenging due to high data dimensionality leading to model overfitting and degraded detection accuracy. Feature selection has been proposed to prevent overfitting, but the existing methods assume that feature redundancy increases linearly with the size of the selected features. Such an assumption does not hold, as the amount of information a feature carries about the attack pattern varies from feature to feature, especially when dealing with early patterns, due to data sparsity that makes it difficult to perceive the common characteristics of selected features. This negatively affects the ability of the mutual information feature selection (MIFS) goal function to estimate the redundancy coefficient accurately. To overcome this issue, this paper proposes an enhanced feature selection technique called Logistic Redundancy Coefficient Gradual Upweighting MIFS (LRGU-MIFS) that evaluates candidate features individually instead of comparing them with common characteristics of the already-selected features. Unlike the existing feature selection techniques, LRGU calculates the redundancy score of a feature using the logistic function. It increases the redundancy value based on the logistic curve, which reflects the nonlinearity of the relationship of the mutual information between features in the selected set. Then, the LRGU was incorporated into the goal function of MIFS as a redundancy coefficient. The experimental evaluation shows that the proposed LRGU was able to identify a compact set of significant features that outperformed those selected by the existing techniques. The proposed technique overcomes the challenge of perceiving common characteristics in cases of insufficient attack patterns and outperforms existing techniques in identifying significant features.

Most types of dementia, including Alzheimer's disease, are not curable. However, there are risk factors, such as obesity or hypertension, that can promote the development of dementia. Holistic treatment of these risk factors can prevent the onset of dementia or delay it in its early stages. To support individualized treatment of risk factors in dementia, this paper presents a model-driven digital platform. It enables monitoring of biomarkers using smart devices from the internet of medical things (IoMT) for the target group. The collected data from such devices can be used to optimize and adjust treatment in a patient in the loop manner. To this end, providers such as Google Fit and Withings have been connected to the platform as example data sources. To achieve treatment and monitoring data interoperability with existing medical systems, internationally accepted standards such as FHIR are used. The configuration and control of the personalized treatment processes are achieved using a self-developed domain-specific language. For this language, an associated diagram editor was implemented, which allows the management of the treatment processes through graphical models. This graphical representation should help treatment providers to understand and manage these processes more easily. To investigate this hypothesis, a usability study was conducted with twelve participants. We were able to show that such graphical representations provide advantages in clarity in reviewing the system, but lack in easy set-up (compared to wizard-style systems).

The new coronavirus disease (COVID-19) has increased the need for new technologies such as the Internet of Medical Things (IoMT), Wireless Body Area Networks (WBANs), and cloud computing in the health sector as well as in many areas. These technologies have also made it possible for billions of devices to connect to the internet and communicate with each other. In this study, an Internet of Medical Things (IoMT) framework consisting of Wireless Body Area Networks (WBANs) has been designed and the health big data from WBANs have been analyzed using fog and cloud computing technologies. Fog computing is used for fast and easy analysis, and cloud computing is used for time-consuming and complex analysis. The proposed IoMT framework is presented with a diabetes prediction scenario. The diabetes prediction process is carried out on fog with fuzzy logic decision-making and is achieved on cloud with support vector machine (SVM), random forest (RF), and artificial neural network (ANN) as machine learning algorithms. The dataset produced in WBANs is used for big data analysis in the scenario for both fuzzy logic and machine learning algorithm. The fuzzy logic gives 64% accuracy performance in fog and SVM, RF, and ANN have 89.5%, 88.4%, and 87.2% accuracy performance respectively in the cloud for diabetes prediction. In addition, the throughput and delay results of heterogeneous nodes with different priorities in the WBAN scenario created using the IEEE 802.15.6 standard and AODV routing protocol have been also analyzed. Fog-Cloud architecture-driven for IoMT networks • An IoMT framework is designed with important components and functions such as fog and cloud node capabilities. •Real-time data has been obtained from WBANs in Riverbed Modeler for a more realistic performance analysis of IoMT. •Fuzzy logic and machine learning algorithms (RF, SVM, and ANN) are used for diabetes predictions. •Intra and Inter-WBAN communications (IEEE 802.15.6 standard) are modeled as essential components of the IoMT framework with all functions., (© 2023. International Federation for Medical and Biological Engineering.)

The physical and mental health of people can be enhanced through yoga, an excellent form of exercise. As part of the breathing procedure, yoga involves stretching the body organs. The guidance and monitoring of yoga are crucial to ripe the full benefits of it, as wrong postures possess multiple antagonistic effects, including physical hazards and stroke. The detection and monitoring of the yoga postures are possible with the Intelligent Internet of Things (IIoT), which is the integration of intelligent approaches (machine learning) and the Internet of Things (IoT). Considering the increment in yoga practitioners in recent years, the integration of IIoT and yoga has led to the successful implementation of IIoT-based yoga training systems. This paper provides a comprehensive survey on integrating yoga with IIoT. The paper also discusses the multiple types of yoga and the procedure for the detection of yoga using IIoT. Additionally, this paper highlights various applications of yoga, safety measures, various challenges, and future directions. This survey provides the latest developments and findings on yoga and its integration with IIoT.

Wearable devices with 5G technology are currently more ingrained in our daily lives, and they will now be a part of our bodies too. The requirement for personal health monitoring and preventive disease is increasing due to the predictable dramatic increase in the number of aging people. Technologies with 5G in wearables and healthcare can intensely reduce the cost of diagnosing and preventing diseases and saving patient lives. This paper reviewed the benefits of 5G technologies, which are implemented in healthcare and wearable devices such as patient health monitoring using 5G, continuous monitoring of chronic diseases using 5G, management of preventing infectious diseases using 5G, robotic surgery using 5G, and 5G with future of wearables. It has the potential to have a direct effect on clinical decision making. This technology could improve patient rehabilitation outside of hospitals and monitor human physical activity continuously. This paper draws the conclusion that the widespread adoption of 5G technology by healthcare systems enables sick people to access specialists who would be unavailable and receive correct care more conveniently.

The COVID-19 outburst has encouraged the adoption of Internet of Medical Things (IoMT) network to empower the antiquated healthcare system and alleviate the health care costs. To realise the functionalities of the IoMT network, 5G heterogeneous networks emerged as an exemplary connectivity solution as it facilitates diversified service provisioning in the service delivery model at more convenient care. However, the crucial challenge for 5G heterogeneous wireless connectivity solution is to facilitate agile differentiated service provisioning. Lately, considerable research endeavour has been noted in this direction but multiservice consideration and battery optimisation have not been addressed. Motivated by the gaps in the existing literature, an intelligent radio access technology selection approach has been proposed to ensure Quality of Service provisioning in a multiservice scenario on the premise of battery optimisation. In particular, the proposed approach leverages the concept of Double Deep Reinforcement Learning to attain an optimal network selection policy. Eventually, the proposed approach corroborated by the rigorous simulations demonstrated a substantial improvement in the overall system utility. Subsequently, the performance evaluation underlines the efficacy of the proposed scheme in terms of convergence and complexity., Competing Interests: Conflict of interestThe authors declare no conflict of interest, financial or otherwise., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The unavailability of appropriate mechanisms for timely detection of diseases and successive treatment causes the death of a large number of people around the globe. The timely diagnosis of grave diseases like different forms of cancer and other life-threatening diseases can save a valuable life or at least extend the life span of an afflicted individual. The advancement of the Internet of Medical Things (IoMT) enabled healthcare technologies can provide effective medical facilities to the population and contribute greatly towards the recuperation of patients. The usage of IoMT in the diagnosis and study of histopathological images can enable real-time identification of diseases and corresponding remedial actions can be taken to save an affected individual. This can be achieved by the use of imaging apparatus with the capacity of auto-analysis of captured images. However, most deep learning-based image classifying models are bulk in size and are inappropriate for use in IoT based imaging devices. The objective of this research work is to design a deep learning-based lightweight model suitable for histopathological image analysis with appreciable accuracy. This paper presents a novel lightweight deep learning-based model "ReducedFireNet", for auto-classification of histopathological images. The proposed method attained a mean accuracy of 96.88% and an F1 score of 0.968 on evaluating an actual histopathological image data set. The results are encouraging, considering the complexity of histopathological images. In addition to the high accuracy the lightweight design (size in few KBs) of the ReducedFireNet model, makes it suitable for IoMT imaging equipment. The simulation results show the proposed model has computational requirement of 0.201 GFLOPS and has a mere size of only 0.391 MB., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Because of recent COVID-19 epidemic, the Internet-of-Medical-Things (IoMT) has acquired a significant impetus to diagnose patients remotely, regulate medical equipment, and track quarantined patients via smart electronic devices installed at the patient's end. Nevertheless, the IoMT confronts various security and privacy issues, such as entity authentication, confidentiality, and integrity of health-related data, among others, rendering this technology vulnerable to different attacks. To address these concerns, a number of security procedures based on traditional cryptographic approaches, such as discrete logarithm and integer factorization problems, have been developed. All of these protocols, however, are vulnerable to quantum attacks. This paper, in this context, presents a data authentication and access control protocol for IoMT systems that can withstand quantum attacks. A comprehensive formal security assessment demonstrates that the proposed algorithm can endure both current and future threats. In terms of data computing, transmission, and key storage overheads, it also surpasses other related techniques., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The Internet of medical things (IoMT) provides an ecosystem in which to connect humans, devices, sensors, and systems and improve healthcare services through modern technologies. The IoMT has been around for quite some time, and many architectures/systems have been proposed to exploit its true potential. Healthcare through the Internet of things (IoT) is envisioned to be efficient, accessible, and secure in all possible ways. Even though the personalized health service through IoT is not limited to time or location, many associated challenges have emerged at an exponential pace. With the rapid shift toward IoT-enabled healthcare systems, there is an extensive need to examine possible threats and propose countermeasures. Authentication is one of the key processes in a system's security, where an individual, device, or another system is validated for its identity. This survey explores authentication techniques proposed for IoT-enabled healthcare systems. The exploration of the literature is categorized with respect to the technology deployment region, as in cloud, fog, and edge. A taxonomy of attacks, comprehensive analysis, and comparison of existing authentication techniques opens up possible future directions and paves the road ahead.

Due to an aging population, assisted-care options are required so that senior citizens may maintain their independence at home for a longer time and rely less on caretakers. Ambient Assisted Living (AAL) encourages the creation of solutions that can help to optimize the environment for senior citizens with assistance while greatly reducing their challenges. A framework based on the Internet of Medical Things (IoMT) is used in the current study for the implementation of AAL technology to help patients with Type-2 diabetes. A glucose oxide sensor is used to monitor diabetic elderly people continuously. Spectrogram images are created from the recorded data from the sensor to assess and detect aberrant glucose levels. DenseNet-169 examines and analyzes the spectrogram pictures, and messages are sent to caregivers when aberrant glucose levels are detected. The current work describes both the spectrogram image analysis and the signal-to-spectrogram generating method. The study presents a future perspective model for a mobile application for real-time patient monitoring. Benchmark metrics evaluate the application's performances, including sensitivity, specificity, accuracy, and F1-score. Several cross--validations are used to evaluate the model's performance. The findings demonstrate that the proposed model can correctly identify patients with abnormal blood glucose levels.

In recent years, the global Internet of Medical Things (IoMT) industry has evolved at a tremendous speed. Security and privacy are key concerns on the IoMT, owing to the huge scale and deployment of IoMT networks. Machine learning (ML) and blockchain (BC) technologies have significantly enhanced the capabilities and facilities of healthcare 5.0, spawning a new area known as "Smart Healthcare." By identifying concerns early, a smart healthcare system can help avoid long-term damage. This will enhance the quality of life for patients while reducing their stress and healthcare costs. The IoMT enables a range of functionalities in the field of information technology, one of which is smart and interactive health care. However, combining medical data into a single storage location to train a powerful machine learning model raises concerns about privacy, ownership, and compliance with greater concentration. Federated learning (FL) overcomes the preceding difficulties by utilizing a centralized aggregate server to disseminate a global learning model. Simultaneously, the local participant keeps control of patient information, assuring data confidentiality and security. This article conducts a comprehensive analysis of the findings on blockchain technology entangled with federated learning in healthcare. 5.0. The purpose of this study is to construct a secure health monitoring system in healthcare 5.0 by utilizing a blockchain technology and Intrusion Detection System (IDS) to detect any malicious activity in a healthcare network and enables physicians to monitor patients through medical sensors and take necessary measures periodically by predicting diseases. The proposed system demonstrates that the approach is optimized effectively for healthcare monitoring. In contrast, the proposed healthcare 5.0 system entangled with FL Approach achieves 93.22% accuracy for disease prediction, and the proposed RTS-DELM-based secure healthcare 5.0 system achieves 96.18% accuracy for the estimation of intrusion detection., Competing Interests: Declaration of competing interest It declares there is no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Kidney cancer is a very dangerous and lethal cancerous disease caused by kidney tumors or by genetic renal disease, and very few patients survive because there is no method for early prediction of kidney cancer. Early prediction of kidney cancer helps doctors start proper therapy and treatment for the patients, preventing kidney tumors and renal transplantation. With the adaptation of artificial intelligence, automated tools empowered with different deep learning and machine learning algorithms can predict cancers. In this study, the proposed model used the Internet of Medical Things (IoMT)-based transfer learning technique with different deep learning algorithms to predict kidney cancer in its early stages, and for the patient's data security, the proposed model incorporates blockchain technology-based private clouds and transfer-learning trained models. To predict kidney cancer, the proposed model used biopsies of cancerous kidneys consisting of three classes. The proposed model achieved the highest training accuracy and prediction accuracy of 99.8% and 99.20%, respectively, empowered with data augmentation and without augmentation, and the proposed model achieved 93.75% prediction accuracy during validation. Transfer learning provides a promising framework with the combination of IoMT technologies and blockchain technology layers to enhance the diagnosing capabilities of kidney cancer.

Patients usually deviate from prescribed medication schedules and show reduced adherence. Even when the adherence is sufficient, there are conditions where the medication schedule should be modified. Crucial drug-drug, food-drug, and supplement-drug interactions can lead to treatment failure. We present the development of an internet of medical things (IoMT) platform to improve medication adherence and enable remote treatment modifications. Based on photos of food and supplements provided by the patient, using a camera integrated to a portable 3D-printed low-power pillbox, dangerous interactions with treatment medicines can be detected and prevented. We compare the medication adherence of 14 participants following a complex medication schedule using a functional prototype that automatically receives remote adjustments, to a dummy pillbox where the adjustments are sent with text messages. The system usability scale (SUS) score was 86.79, which denotes excellent user acceptance. Total errors (wrong/no pill) between the functional prototype and the dummy pillbox did not demonstrate any statistically significant difference ( p = 0.57), but the total delay of the intake time was higher ( p = 0.03) during dummy pillbox use. Thus, the proposed low-cost IoMT pillbox improves medication adherence even with a complex regimen while supporting remote dose adjustment.

Bone tumors, such as osteosarcomas, can occur anywhere in the bones, though they usually occur in the extremities of long bones near metaphyseal growth plates. Osteosarcoma is a malignant lesion caused by a malignant osteoid growing from primitive mesenchymal cells. In most cases, osteosarcoma develops as a solitary lesion within the most rapidly growing areas of the long bones in children. The distal femur, proximal tibia, and proximal humerus are the most frequently affected bones, but virtually any bone can be affected. Early detection can reduce mortality rates. Osteosarcoma's manual detection requires expertise, and it can be tedious. With the assistance of modern technology, medical images can now be analyzed and classified automatically, which enables faster and more efficient data processing. A deep learning-based automatic detection system based on whole slide images (WSIs) is presented in this paper to detect osteosarcoma automatically. Experiments conducted on a large dataset of WSIs yielded up to 99.3% accuracy. This model ensures the privacy and integrity of patient information with the implementation of blockchain technology. Utilizing edge computing and fog computing technologies, the model reduces the load on centralized servers and improves efficiency.

In general, the adoption of IoT applications among end users in healthcare is very low. Healthcare professionals present major challenges to the successful implementation of IoT for providing healthcare services. Many studies have offered important insights into IoT adoption in healthcare. Nevertheless, there is still a need to thoroughly review the effective factors of IoT adoption in a systematic manner. The purpose of this study is to accumulate existing knowledge about the factors that influence medical professionals to adopt IoT applications in the healthcare sector. This study reviews, compiles, analyzes, and systematically synthesizes the relevant data. This review employs both automatic and manual search methods to collect relevant studies from 2015 to 2021. A systematic search of the articles was carried out on nine major scientific databases: Google Scholar, Science Direct, Emerald, Wiley, PubMed, Springer, MDPI, IEEE, and Scopus. A total of 22 articles were selected as per the inclusion criteria. The findings show that TAM, TPB, TRA, and UTAUT theories are the most widely used adoption theories in these studies. Furthermore, the main perceived adoption factors of IoT applications in healthcare at the individual level are: social influence, attitude, and personal inattentiveness. The IoT adoption factors at the technology level are perceived usefulness, perceived ease of use, performance expectancy, and effort expectations. In addition, the main factor at the security level is perceived privacy risk. Furthermore, at the health level, the main factors are perceived severity and perceived health risk, respectively. Moreover, financial cost, and facilitating conditions are considered as the main factors at the environmental level. Physicians, patients, and health workers were among the participants who were involved in the included publications. Various types of IoT applications in existing studies are as follows: a wearable device, monitoring devices, rehabilitation devices, telehealth, behavior modification, smart city, and smart home. Most of the studies about IoT adoption were conducted in France and Pakistan in the year 2020. This systematic review identifies the essential factors that enable an understanding of the barriers and possibilities for healthcare providers to implement IoT applications. Finally, the expected influence of COVID-19 on IoT adoption in healthcare was evaluated in this study.

In the wake of the COVID-19 outbreak, automated disease detection has become a crucial part of medical science given the infectious nature of the coronavirus. This research aims to introduce a deep ensemble framework of transfer learning models for early prediction of COVID-19 from the respective chest X-ray images of the patients. The dataset used in this research was taken from the Kaggle repository having two classes-COVID-19 Positive and COVID-19 Negative. The proposed model achieved high accuracy on the test sample with minimum false positive prediction. It can assist doctors and technicians with early detection of COVID-19 infection. The patient's health can further be monitored remotely with the help of connected devices with the Internet, which may be termed as the Internet of Medical Things (IoMT). The proposed IoMT-based solution for the automatic detection of COVID-19 can be a significant step toward fighting the pandemic., Competing Interests: No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.compeleceng.2022.108018., (© 2022 Elsevier Ltd. All rights reserved.)

An identity management system is essential in any organisation to provide quality services to each authenticated user. The smart healthcare system should use reliable identity management to ensure timely service to authorised users. Traditional healthcare uses a paper-based identity system which is converted into centralised identity management in a smart healthcare system. Centralised identity management has security issues such as denial of service attacks, single-point failure, information breaches of patients, and many privacy issues. Decentralisedidentity management can be a robust solution to these security and privacy issues. We proposed a Self-Sovereign identity management system for the smart healthcare system (SSI-SHS), which manages the identity of each stakeholder, including medical devices or sensors, in a decentralisedmanner in the Internet of Medical Things (IoMT) Environment. The proposed system gives the user complete control of their data at each point. Further, we analysed the proposed identity management system against Allen and Cameron's identity management guidelines. We also present the performance analysis of SSI as compared to the state-of-the-art techniques.

Congestive heart failure (CHF) is a chronic heart disease that causes debilitating symptoms and leads to higher mortality and morbidity. In this paper, we present HARPER, a novel automatic detector of CHF episodes able to distinguish between Normal Sinus Rhythm (NSR), CHF, and no-CHF. The main advantages of HARPER are its reliability and its capability of providing an early diagnosis. Indeed, the method is based on evaluating real-time features and observing a brief segment of ECG signal. HARPER is an independent tool meaning that it does not need any ECG annotation or segmentation algorithms to provide detection. The approach was submitted to complete experimentation by involving both the intra- and inter-patient validation schemes. The results are comparable to the state-of-art methods, highlighting the suitability of HARPER to be used in modern IoMT systems as a multi-class, fast, and highly accurate detector of CHF. We also provide guidelines for configuring a temporal window to be used in the automatic detection of CHF episodes.