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Cholestatic liver diseases (CLDs) are a group of diseases characterized by jaundice and cholestasis as the main presentation with different complications, which have considerable impact on the liver and can lead to end-stage liver disease, cirrhosis, and liver-related complications. In the last few years, tremendous progress has been made in understanding the pathophysiology, diagnosis, and treatment of patients with these conditions. However, several aspects related to the management of CLDs remain deficient and unclear. Due to the lack of recommendations that can help in the management, treatment of those conditions, the Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has created a task force group to develop guidelines related to CLDs management in order to provide a standard of care for patients in need. These guidelines provide general guidance for health care professionals to optimize medical care for patients with CLDs for both adult and pediatric populations, in association with clinical judgments to be considered on a case-by-case basis. These guidelines describe common CLDs in Saudi Arabia, with recommendations on the best approach for diagnosis and management of different diseases based on the Grading of Recommendation Assessment (GRADE), combined with a level of evidence available in the literature.

Highlights • Osteochondral patella fractures commonly associated with soft tissue injuries. • We report a rare case of a child with isolated osteochondral patella fracture. • Open reduction and internal fixation of the dicplaced fragment was successful with good outcome., Introduction Osteochondral fracture of the patella is a fairly common pathology, but almost always associated with a spectrum of soft tissue injuries including anterior cruciate ligament (ACL) rupture. We present a rare case of an osteochondral fracture of the patella in the absence of ligament or soft tissue injuries and with no dislocation of the patella in a pediatric patient. Presentation of case An 11-year-old male presented to the orthopedic clinic on crutches following a football injury. The patient had pain in his left knee with flexion deformity. Plain film radiography of the left knee was taken, and an osteochondral fracture of the patella was suspected. Further imaging studies were conducted including computed tomography (CT) and magnetic resonance imaging (MRI) which revealed an isolated osteochondral fracture of the patella with no other associated injuries. Open reduction and internal fixation of the displaced fragment was successfully preformed with favorable outcomes. During follow-up, almost full range of motion was regained, and plain film radiography revealed healed fracture with a normal appearance of the patella. Discussion Traumatic osteochondral fracture of the patella is a common injury and most of these injuries are commonly accompanied by an acute dislocation of the patella or soft tissue injuries such as rupture of the anterior cruciate ligament (ACL) and almost half of all patellar dislocations incidence are associated with osteochondral fractures of the patella. This case had an isolated osteochondral fracture of patella. Conclusion As demonstrated in this case, osteochondral fractures are common among younger population and patients need to be thoroughly evaluated. Advanced Imaging such as MRI and CT are essential to exclude soft tissue injuries. Although management is highly variable, the importance of open reduction and early fixation should be emphasized for optimal outcomes.

Purpose: Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS.Materials and Methods: A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS.Results: A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure.Conclusion: Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.

Introduction The impact of Ramadan fasting, a type of intermittent fasting, on the management of diabetes has not been well investigated. Physical activity, sleep duration, and time of sleep are susceptible to alterations during Ramadan due to the changes in the times and numbers of meals. This study compared physical activity and sleep patterns of individuals with type 2 diabetes mellitus (T2DM) during and after Ramadan using the international physical activity questionnaire (IPAQ) and a Fitbit Flex 2 accelerometer. Methods Saudi individuals (n = 36) with T2DM completed a self-reported questionnaire and wore a Fitbit device for seven consecutive days during and after Ramadan. Fitbit generated weekly step counts, activity intensities, sedentary time, and sleep durations and times. IPAQ was used to estimate the physical activity and sitting time of participants in each period. Sleep patterns were assessed in each period by a self-reported questionnaire. Results Both Fitbit and IPAQ indicated a high prevalence of low physical activity among the participants with non-significant variances between the during and after Ramadan periods. Also, a significant short daily total sleeping hours and daily night-time sleeping hours was seen during the Ramadan period. The duration of night-time sleep was observed to be low in each period. Conclusions This is the first study to use a Fitbit device to monitor individuals with T2DM who chose to fast during Ramadan. The study shows a high prevalence of low physical activity among Saudi individuals with T2DM in each period, and short sleep durations in the during Ramadan period compared to after Ramadan period. A high prevalence of short night-time sleep duration and excessive daytime sleeping was observed in both periods and significantly in the during Ramadan period. A larger study is needed in the future covering before, during, and after Ramadan to evaluate the impact of lifestyle changes related to Ramadan fasting on type 2 diabetes. Electronic Supplementary Material The online version of this article (10.1007/s13300-020-00825-x) contains supplementary material, which is available to authorized users.

Highlights • Chylous ascites due to intestinal malrotation is a rare occurrence, especially in adolescent and adult patients. • Chylous ascites due to intestinal malrotation typically occurs early in life with painless distension of the abdomen. • Our case is a male adolescent who presented with abdominal pain and a history of congenital hernia repair. • Ladd’s procedure was successfully performed in our case with no complications., Introduction Intestinal malrotation is a rare etiology of chylous ascites in adolescents. Chylous ascites is caused by lymphatic system disarrangement, which can result in an anomalous build-up of a lymphatic fluid rich in lipid, namely chyle in the peritoneal cavity. Presentation of case We present a case of a 16-year-old Saudi Arabian male who came to the emergency department with right upper quadrant pain associated with difficulty in passing stool for one day and a history of congenital diaphragmatic hernia (CDH) repair at the age of 4 months. Free fluid in the abdomen was noticed in the bedside ultrasound. Abdominopelvic computed tomography revealed dilated small bowel loops and a whirl sign of the mesentery, which indicated intestinal torsion. The patient was treated using Ladd’s procedure, and a large volume of chylous fluid was removed from the abdomen. Postoperatively, the abdominal drain revealed no chyle, and the patient was followed-up as an outpatient at which point, he reported no abdominal pain. Discussion Intestinal malrotation is more commonly reported in children and associated with congenital chylous ascites. Chylous ascites by itself is a rare occurrence, and very few cases attribute it to intestinal malrotation in adults. Surgical management with Ladd’s procedure is a well-documented surgery in pediatric patients, and yet it was successfully performed in our adolescent patient. Conclusion Surgical management of chylous ascites secondary to intestinal malrotation in an adolescent, which is considered novel in this age group, including peritoneal lavage of chyle, resulted in favorable outcomes.

Background The Kingdom of Saudi Arabia (KSA) was the first country in the Middle East to adopt the hepatitis B virus (HBV) vaccine. Despite an expanded HBV immunization program and significant progress in HBV prevention in the country, HBV infection is a significant public health burden. This review lists coordinated solutions for healthcare stakeholders, patients, and health authorities to curb HBV and its impact in KSA. It further aims to draw policymakers' attention to key priorities to bridge HBV care gaps in the country. Methods As part of the pre-engagement activity, medical experts across KSA were interviewed to gain a preliminary understanding of the current unmet needs in HBV management in the country. Top-recommended action points derived from the pre-engagement activity were discussed. Key priority action points to curb the impact of HBV in KSA were identified. Results The priority action points together with the challenges and unmet needs in the management and care of HBV in KSA were: (a) establish a national-level registry, (b) implement screening campaigns, (c) improve linkage of care between primary care physicians (PCPs) and specialists, and (d) increase PCP education and awareness. Conclusion This work is an endeavor to set the stage for a strategic policy framework aimed at eliminating HBV in KSA. The action points/steps for the identified priorities must run parallelly across various regions in KSA, to successfully manage and further eliminate the threat of HBV.

Background: Glycated haemoglobin (HbA1c) is the gold standard measurement in the screening, diagnosis and monitoring of diabetes mellitus. Saudi Arabia has a high prevalence of diabetes mellitus that is expected to rise, and the HbA1c test is commonly used in the screening, diagnosis and monitoring of diabetes. Objective: This study aims to assess the impact of age and gender on HbA1c levels, and the influence of menopausal status on HbA1c variation in a large group of Saudis. Method: Age, gender, and HbA1c results of 168,614 Saudi adult individuals were obtained from their medical records. Patients’ records were extracted irrespective of their status regarding the presence of diabetes and the status of glycaemic control. Linear regression models were used for predicting HbA1c from age and gender, and their interaction term. HbA1c levels were compared between genders in different age groups and different HbA1c categories. Results: There was a statistically significant positive correlation between age and HbA1c levels, where for each ten years increase in age, HbA1c increased by 0.35%. Although the overall mean HbA1c in women was significantly lower than in men (P < 0.001), women showed a significant increase in HbA1c with older age compared to men (B = 0.014, P < 0.001). Furthermore, the mean HbA1c levels in the age group > 50 years was significantly higher than before that age (P < 0.001). Thus, HbA1c increased by 1.118% in age > 50 years group compared to age ≤ 50 years, and this increase in HbA1c was significantly higher in women compared to men (B = 0.495, P < 0.001). Conclusion: HbA1c levels are lower in women before the estimated menopausal age, which should be taken into consideration when using HbA1c for screening, diagnosis, and monitoring of diabetes in Saudi adult women. The short lifespan of red blood cells, due to loss of blood through menstruation, in women before menopause age, is a possible reason for these variations.

Background/Aims: Ledipasvir/sofosbuvir (LDV/SOF) combination is administered for 12 to 24 weeks to treat hepatitis C virus (HCV); guidelines recommend 8 weeks treatment duration for HCV genotype (GT) 1 infection based on the patient's baseline characteristics. Data on treating HCV GT4 with LDV/SOF are limited. In this prospective cohort study, the efficacy and safety of 8 weeks treatment duration with LDV/SOF was evaluated in HCV GT4 patients in Saudi Arabia. Patients and Methods: Treatment-naïve, non-cirrhotic HCV GT4 patients received LDV/SOF for 8 weeks. HCV RNA levels and laboratory evaluations were recorded at baseline and at Weeks 4, 8, and 20. The primary endpoint was sustained virologic response 12 weeks after the end of the treatment (SVR12). Safety data were also recorded. Results: Forty-five patients with a mean age of 43.9 ± 17.2 years participated, of whom 57.8% were male. Mean log10 HCV RNA was 6.26 ± 6.32 IU/mL and most (91.1%) had baseline HCV RNA levels

Summary Limited clinical trial data has shown high efficacy of co-formulated ledipasvir/sofosbuvir (LDV/SOF) in the treatment of hepatitis C virus (HCV) genotype (GT)-4 infected cirrhotic patients. We assessed real-world safety and efficacy of LDV/SOF with or without ribavirin (RBV) in GT4-infected patients with compensated and decompensated cirrhosis. Patients & Methods This observational cohort (n = 213) included GT4 treatment-naive (59.6%) and -experienced (40.4%) patients with advanced fibrosis (F3, Metavir; n = 30), compensated (F4, n = 135) and decompensated cirrhosis (n = 48) treated for 12 (n = 202) or 24 weeks (n = 11) with LDV/SOF. RBV was dosed by physician discretion between 600–1200 mg daily. Patients with prior DAA failure were excluded from the analysis. The primary efficacy endpoint was sustained virologic response 12 weeks after treatment (SVR12) on an intention-to-treat analysis, and occurrence of serious adverse events (SAEs). Results The mean age of the overall cohort was 59.6 ± 12.1 years and 125 (58.7) were female. Overall, 197 (92.5%) of the patients achieved SVR12, including 93.3% of F3 fibrosis, 93.3% of compensated cirrhotics and 89.6% of the decompensated cirrhotics ( P = 0.686). Addition of RBV (68.5%) did not enhance efficacy (91.8% vs. 94.0% without RBV, P = 0.563), including in F3 fibrosis, compensated and decompensated cirrhosis ( P > 0.05, for all). There was no difference in SVR12 rates with 24 and 12 weeks therapy (90.9% and 92.6%, respectively; P = 0.586). Treatment failure (n = 16) was mostly related to relapse (n = 11), while on-treatment death (n = 3) and breakthrough (n = 2) comprised a minority. SAEs occurred in 9 (4.2%) patients requiring early treatment discontinuation in 4 (3 on-treatment deaths and 1 pregnancy). Conclusion LDV/SOF therapy yielded high SVR12 rates in both compensated and decompensated cirrhotic GT4 patients. The addition of RBV to this regimen did not improve efficacy. The safety profile of this regimen was comparable with that reported for other HCV genotypes.

BACKGROUND & AIMS Limited data have shown high efficacy of co-formulated ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) in the treatment of hepatitis C virus (HCV) genotype (GT)-4, and combined with dasabuvir (DSV) in GT1 patients, with chronic kidney disease (CKD) stages 4-5 (

Autophagy is a key metabolic process where cells can recycle its proteins and organelles to regenerate its own cellular building blocks. Chemotherapy is indispensable for cancer treatment but associated with various side-effects, including organ damage. Stem cell-based therapy is a promising approach for reducing chemotherapeutic side effects, however, one of its main culprits is the poor survival of transplanted stem cells in damaged tissues. Here, we aimed to test the effects of activating autophagy in adipose-derived mesenchymal stem/stromal cells (ADSCs) on the survival of ADSCs, and their therapeutic value in cisplatin-induced liver injury model. Autophagy was activated in ADSCs by rapamycin (50 nM/L) for two hours before transplantation and were compared to non-preconditioned ADSCs. Rapamycin preconditioning resulted in activated autophagy and improved survival of ADSCs achieved by increased autophagosomes, upregulated autophagy-specific LC3-II gene, decreased protein degradation/ubiquitination by downregulated p62 gene, downregulated mTOR gene, and finally, upregulated antiapoptotic BCL-2 gene. In addition, autophagic ADSCs transplantation in the cisplatin liver injury model, liver biochemical parameters (AST, ALT and albumin), lipid peroxidation (MDA), antioxidant profile (SOD and GPX) and histopathological picture were improved, approaching near-normal conditions. These promising autophagic ADSCs effects were achieved by modulation of components in TGF-β1/Smad and PI3K-AKT signaling pathways, besides reducing NF-κB gene expression (marker for inflammation), reducing TGF-β1 levels (marker for fibrosis) and increasing SDF-1 levels (liver regeneration marker) in liver. Therefore, current results highlight the importance of autophagy in augmenting the therapeutic potential of stem cell therapy in alleviating cisplatin-associated liver damage and opens the path for improved cell-based therapies, in general, and with chemotherapeutics, in particular.

Background Despite the prevalence of overweight and obesity and increases in associated diseases such as diabetes and heart disease in the Saudi population, no studies have addressed the spread of obesity among Saudi police officers. Therefore, the present study aimed to assess the prevalence of overweight and obesity and associations with biochemical parameters among the police in Riyadh. Method The study involved a cross-sectional survey of 160 police officers in Riyadh, Saudi Arabia. Anthropometric measurements, blood pressure, lipid profiles and fasting blood sugar levels were measured for all individuals. Results According to the results, the average body mass index (BMI) was 27.5 ± 5.1, indicating an increase in overweight in this population and 66.9% were overweight or obese. Moreover, the mean systolic and diastolic blood pressure values were 119.5 and 79.4 mmHg, respectively, within normal limits. The mean total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride (TG) levels were 187.5, 43.9, 119.5 and 124.5 mg/100 ml, respectively. Discussion These BMI and biochemical findings suggest a high proportion of overweight and obese individuals in the sample population, as well as an increase in the proportion of individuals with high levels of biochemical indicators who are therefore susceptible to heart disease and diabetes. Conclusion The study recommends using preventive programs to combat obesity and overweight and related diseases and conducting further studies using measures other than BMI.

Ambient temperature is predicted to rise in Saudi Arabia, and how this will impact the health of its population has not been investigated. Saudi Arabia is one of the top ten countries with the highest prevalence of diabetes. The current study investigates the correlation between ambient temperature and HbA1c levels in a group of Saudis in Riyadh. Age, gender, and HbA1c data for six years were obtained from patients’ records. The maximum daily temperature of Riyadh city for the same period were obtained. A total of 168,614 patient records were obtained. There was a statistically significant positive correlation between ambient temperature and HbA1c levels, where for each 1°C increase in average weekly temperature HbA1c increased by 0.007%. Patients were at high risk of having HbA1c ≥ 7% in high and moderate temperature than in low temperature (P < 0.001, odds ratio (OR): 1.134, and P < 0.001, odds ratio (OR): 1.034; respectively). The mean of HbA1c in females (7.27 ± 1.96) was significantly lower than in males (7.40 ± 1.86), and the probability of males having HbA1c ≥ 7% was about 17.4% higher than females. However, the HbA1c levels in females were significantly more affected by rising temperature compared to males (B = 0.003, P = 0.008). Overall, rise in ambient temperature is associated with worsening HbA1c, which could be harmful to the health of Saudis suffering from diabetes. Possible reasons for the increase in HbA1c could include reduced physical activity, reduced sunlight exposure, and dehydration during hot weather. More research on the relationship between climate change and public health in Saudi Arabia is needed. Funding Statement: This study is a part of the PhD research project of Abdullah S. Alghamdi who is supported and funded by the General Directorate of Medical Services of the Interior Ministry in Saudi Arabia. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approvals were obtained from De Montfort University (Faculty of Health and Life Sciences Research Ethics Committee) and Security Forces Hospital (Riyadh, Saudi Arabia). All obtained data were performed in accordance with relevant guidelines and regulations.

Background The aim of this study was to evaluate the surface treatment of dentin with phototherapy (ER-CR-YSGG laser) in the presence of different bonding systems on their shear bond strength and microleakage. Materials and methods Eighty intact human third molars were divided into two groups. Forty teeth were treated with conventional flat wheel diamond bur and the remaining forty were treated with Er Cr YSGG laser (phototherapy). The two groups i.e. treated with laser (l) and group treated with abrasive bur (NL) were further divided into two subgroups of twenty samples each. Subgroup 1 was surface treated with etch and rinse (ER) and other 20 remaining samples were treated with self- etch (SE) bonding regime. Specimens from all the groups were assessed for shear bond strength and microleakage scores. Ten samples from all groups were immersed in 2% methylene blue for 24 h and assessed under a digital microscope for microleakage. Data was assessed using analysis of variance and tukey multiple comparisons test. Results The lowest bond strength was achieved in laser prepared phototherapy group bonded with self-etch (LSE-11.87 ± 1.21). The maximum bond strength score was observed in non-laser-etch and rinse group (NLER-23.66 ± 2.56). The highest mean microleakage was observed among laser bonded with self-etch (LSE) specimens (1.0 ± 0.13). The lowest microleakage scores were seen in group treated with non-phototherapy etch and rinse (NLER-0.4 ± 0.11) regime. Conclusion Use of etch and rinse dentin bonding regime in combination with ER-CR-YSGG phototherapy dentin treatment has the potential for clinical application in comparison to conventional conditioning technique.

Background/Aims: Around 101,000 individuals are estimated to be viremic for chronic hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA) in 2014; however, only about 20% have been diagnosed. We aim to assess baseline epidemiology, disease burden, and evaluate strategies to eliminate HCV in KSA. Materials and Methods: The infected population and disease progression were modeled using age- and gender-defined cohorts to track HCV incidence, prevalence, hepatic complications, and mortality. Baseline assumptions and transition probabilities were extracted from the literature. The impacts of two scenarios on HCV-related disease burden were considered through increases in treatment efficacy alone or treatment and diagnosis. Results: In 2030, it is estimated by the base scenario that viremic prevalence will increase to 103,000 cases, hepatocellular carcinoma (HCC) to 470, decompensated and compensated cirrhosis cases to 1,300 and 15,400, respectively, and liver-related mortality to 670 deaths. Using high efficacy treatment alone resulted in 2030 projection of 80,700 viremic cases, 350 HCC cases, 480 liver-related deaths, and 850 and 11,500 decompensated and compensated cirrhosis cases, respectively. With an aggressive treatment strategy, in 2030 there will be about 1,700 viremic cases, 1 HCC case, about 20 liver-related deaths, and 5 and 130 cases of decompensated and compensated cirrhosis, respectively. Delaying this strategy by one year would result in 360 additional deaths by 2030. Conclusions: HCV in KSA remains constant, and cases of advanced liver disease and mortality continue to rise. Considered increases in treatment efficacy and number treated would have a significantly greater impact than increased treatment efficacy alone. The projected impact will facilitate disease forecasting, resource planning, and strategies for HCV management. Increased screening and diagnosis would likely be required as part of a national strategy.

Quality of service (QoS)-adaptive service configuration is crucial for seamless access to video services in cloud-assisted video surveillance systems. To maintain seamless access to video on a user's preferred device, suitable video transcoding services are needed. It is a challenging task to choose and configure these services for various devices to ensure QoS-adaptive user experiences. To configure these services for the desired user devices, a suitable configuration algorithm is needed. Therefore, this paper describes a QoS-adaptive service configuration approach to choose the optimal configuration for the preferred user devices in varied contexts so that the user can access the services ubiquitously. We implemented a cloud-assisted video surveillance prototype to show how the proposed method can handle ubiquitous access to target video for possible QoS-adaptive and video processing requirements in terms of bandwidth, delay, and frame rates. The results show that the proposed configuration method outperforms the other comparable approaches.

Annotation facility on slides from both students and educators are explored.Live broadcast of a lecture to multi-class is realized by real time mixture.Students are highly in favor of annotation facility.High internet speed is required for live broadcast using real time mixture. The availability of 3G and 4G technologies coupled with tablet PCs and smart phones makes the communication and learning system easier. In engineering education, these sophisticated technologies can bring immense advantages to the methods of delivering and acquiring knowledge. In this paper, we focus on facilities of a smart class environment for engineering education that can improve the co-learning procedure. We particularly emphasize the use of 3G and 4G technology in a smart class.

Optimal doses of Ribavirin (RBV) for hepatitis C virus (HCV) treatment are not known. To assess the safety and efficacy of PegIFNalfa-2a in combination with an adjusted (ADJ) RBV dose based on early pharmacokinetics versus a fixed standard (STD) dose of RBV in chronic HCV genotype (GT) 4-naive patients in a randomized trial. One hundred eighty-one patients were randomized. The baseline variables were similar in both arms and females were 50.3% of the patients, 76.5% had minimal-moderate fibrosis (F0-2). Sustained virologic response (SVR) was achieved in 99 (54.7%) subjects. SVR was seen in 50/90 (55.6%) of ADJ dose of RBV and 49/91 (53.9%) of STD dose subjects. Prematurely withdrawal or discontinuation of treatment prematurely in the ADJ RBV arm occurred in 11/90 patients (12.2%) compared with 6/91 subjects (6.6%) in the STD arm (P = 0.214). Similarly, virologic relapse was seen in 14/90 (15.6%) patients of the ADJ arm and 12/91 (13.2%) of the STD arm. Anemia grade 3-4 was seen in 36.7% in ADJ versus 17.6% in STD arm (P = 0.003). Occurrence of rapid virologic response and absences of F4 fibrosis predicted SVR in a univariate analysis. However, age, gender, weight, presence of diabetes, baseline alanine aminotransferase, and vitamin D levels were not significantly different in patients achieving SVR. ADJ higher doses of RBV based on its early pharmacokinetics-based RBV do not improve SVR rates in HCV GT4 treated in combination with peg-IFN alpha-2-a versus STD therapy. Patients on ADJ higher doses of RBV experienced higher rates of anemia and require more erythropoietin without increasing SVR.

INTRODUCTION The combination of sofosbuvir (SOF) with simeprevir (SMV) or daclatasvir (DCV) is very effective in treating hepatitis C virus (HCV) infection, particularly genotype (GT) 1. However, the data on GT4 are very limited. We aimed to determine the efficacy and safety of SOF in combination with either SMV or DCV in GT4-infected patients. PATIENTS AND METHODS In this real life, prospective, observational study, HCV (GT4) patients (n=96) were evaluated in 2 groups on the basis of the 12-week treatment regimen they received. Group 1 (n=56) patients were treated with SOF and SMV±ribavirin (RBV), whereas group 2 patients were treated with SOF and DCV±RBV (n=40). The primary efficacy endpoint was sustained virologic response 12, whereas the primary safety endpoint was drug discontinuation or occurrence of grade 3/4 adverse events. RESULTS The mean age was 49±14.6 years (59.4% men). Cirrhosis was present in 53.6% and 35.0% of groups 1 and 2, respectively, whereas 27 patients (48.2%) in group 1 and 21 patients (52.5%) in group 2 had failed prior interferon-based treatment. The median pretreatment HCV-RNA log10 was 6.1 (3.6 to 7.0) and 6.0 (3.6 to 7.2) IU/mL in groups 1 and 2, respectively. RBV was given to 17 patients (30.4%) in group 1 and 2 patients (5%) in group 2. All patients achieved sustained virologic response 12 (100%). Adverse events occurred in 32% of patients (grade 1 and 2), but none discontinued treatment. One patient died in the SMV group (not related to treatment). CONCLUSIONS SMV/SOF or DCV/SOF combinations are safe and highly effective in HCV-GT4 treatment. Cirrhosis and failure of prior interferon-based treatment did not influence treatment response.

Background/Aims: Hepatitis D virus (HDV) is a defective RNA virus that is dependent on hepatitis B surface antigen (HBsAg) for transmission and replication. HDV significance arises from the possibility of poor prognosis of hepatitis B virus (HBV) infection. In Saudi Arabia, HDV prevalence varied from 8 to 32% before the HBV vaccination program and ranged from 0 to 14.7% after the vaccination program was started. The last study, performed in 2004, showed a prevalence of 8.6% in hospital-based HBV cases and 3.3% in healthy donors. The aim of this study was to investigate the prevalence and molecular characterization of HDV in chronic hepatitis B (CHB) patients at the King Abdulaziz University Hospital in Jeddah, Saudi Arabia by molecular and serological techniques. To the best of our knowledge, this is the first study to detect HDV at the molecular level in Saudi Arabia. Patients and Methods: The study included samples from 182 CHB patients from Jeddah; 13 samples with HBsAg negative were excluded. Samples were tested for HDV-Ab, viral RNA by reverse transcriptase–polymerase chain reaction (RT-PCR) in the HDV L-Ag region and sequence analysis. Results: The mean age of the participants was 44.36 years; 75.1% of the participants were Saudi nationals, 58% were males. Nine samples were positive for HDV-Ab and four were borderline; all were subjected to RT-PCR amplification. Three of the positive HDV-Ab cases and 1 borderline case were positive by RT-PCR. All the positive cases had HBV genotype D, and the positive RT-PCR cases were positive for HBV DNA. One of the HDV viremic samples was of genotype 1 by sequencing. The prevalence of HDV in the study was 7.7%, which was lower in Saudis (6.3%) than in non-Saudis (11.9%). Conclusion: HDV coinfection does not seem to have an effect on the clinical status of the recruited CHB cases in this study. More studies are needed to investigate the genetic diversity in other areas such as the southern parts of the Kingdom.

WOS: 000426979400014, PubMed ID: 28404132, Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1.0% (95% uncertainty interval 0.8-1.1) in 2015, corresponding to 71.1 million (62.5-79.4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections., John C Martin Foundation, John C Martin Foundation.

Today digital video is used extensively in many applications. Sometimes a video could be treated as a top secret for an organization, for example military secrets, surveillance footage and corporate product designs, and may need to be shared among a group of people in a secure manner. Traditional data security methods such as encryption techniques are prone to single-point attack, i.e. the secret can be revealed by obtaining the decryption key from any single person. Alternatively, the secret sharing scheme provides collective control over the secrecy of information and is considered information theoretically secure. In this paper, we propose to adopt a secret sharing based approach to provide collective control over a given sensitive video. We present three methods that utilize the spatial and temporal redundancy in videos in different ways. We analyze the security of these methods and compare them for efficiency in terms of computation time and space using extensive experimentation.

Intrusion detection is very serious issue in these days because the prevention of intrusions depends on detection. Therefore, accurate detection of intrusion is very essential to secure information in computer and network systems of any organization such as private, public, and government. Several intrusion detection approaches are available but the main problem is their performance, which can be enhanced by increasing the detection rates and reducing false positives. This issue of the existing techniques is the focus of research in this paper. The poor performance of such techniques is due to raw dataset which confuse the classifier and results inaccurate detection due to redundant features. The recent approaches used principal component analysis (PCA) for feature subset selection which is based on highest eigenvalues, but the features corresponding to the highest eigenvalues may not have the optimal sensitivity for the classifier due to ignoring many sensitive features. Instead of using traditional approach of selecting features with the highest eigenvalues such as PCA, this research applied a genetic algorithm to search the genetic principal components that offers a subset of features with optimal sensitivity and the highest discriminatory power. The support vector machine (SVM) is used for classification purpose. This research work used the knowledge discovery and data mining cup dataset for experimentation. The performance of this approach was analyzed and compared with existing approaches. The results show that proposed method enhances SVM performance in intrusion detection that outperforms the existing approaches and has the capability to minimize the number of features and maximize the detection rates.

Ambient-aware environments are technologically augmented with myriad sensors, devices and other emerging services in order to support users. However, users find it complex in interacting with such environments due to the presence of numerous devices and services. In this situation, providing context-aware implicit or automatic interaction support may help reducing the cognitive load of the users and facilitate easy access of the available devices and services. However, due to the imprecision in context information, implicit interactions performed by the environment often leads to mis-automation. The result of such impaired implicitness causes distrust and dissatisfaction to the user. In order to address this issue, we propose a system that considers quality of information to dynamically adjust the level of implicit interaction and allows a system to operate in different modes such as full-automation, action suggestion, simple notification, or null action. We conduct experiment in a smart home scenario in order to elicit users' acceptance and trust regarding the proposed system. Our experiment shows that dynamic and alternative mode of interaction not only increases the satisfaction of users but also helps to avoid distrust in automated actions carried out by the environment under varying contexts.

Most of current intrusion detection systems are based on machine learning methods but very few till now use clustering algorithms as a preprocessing layer to reduce the high dimensionality of data, which is difficult to analyze. In this paper we introduce Modular Neural Network for intrusion detection, which apply Principal Component Analysis (PCA) as preprocessing layer for reducing huge information quantity presented in knowledge discovery and data mining (KDD99) data set. PCA significantly reduce the high dimensionality of data set without loss of information. Then this preprocess data in the form of principal component is presented to Batch Backpropagation Neural Network for efficient intrusion detection. We rely on some experiments to calculate Root Mean Square Error (RMSE) using Modular Neural Network on KDD 99 data set. Our experimental results show improvement in the learning time due to the reduction of high dimensions of data. Also we have obtained low RMSE during training, which is below the acceptance range of 0.1. Proposed Modular Neural Network has capability to efficiently and accurately classify data into attack and normal.

Intrusions are serious questions in network systems. Numerous intrusion detection techniques are present to tackle these problems but the dilemma is performance. To raise performance, it is momentous to raise the detection rates and decrease false alarm rates. The contemporary methods use Principal Component Analysis (PCA) to project features space to principal feature space and choose features corresponding to the highest eigenvalues, but the features corresponding to the highest eigenvalues may not have the best possible sensitivity for the classifier due to ignoring several sensitive features. Therefore, we applied a Genetic Algorithm (GA) to search the principal feature space for a subset of features with optimal sensitivity. So, in this research, a method for optimal features subset selection is proposed to overcome performance issues using PCA, GA and Multilayer Perceptron (MLP). The KDD-cup dataset is used. This method is capable to minimize amount of features and maximize the detection rates.

Intrusion detection is an important technique in computer and network security. A variety of intrusion detection approaches be present to resolve this severe issue but the main problem is performance. It is important to increase the detection rates and reduce false alarm rates in the area of intrusion detection. Therefore, in this research, an optimized intrusion detection mechanism using soft computing techniques is proposed to overcome performance issues. The KDD-cup dataset is used that is a benchmark for evaluating the security detection mechanisms. The Principal Component Analysis (PCA) is applied to transform the input samples into a new feature space. The selecting of an appropriate number of principal components is a critical problem. So, Genetic Algorithm (GA) is used in the optimum selection of principal components instead of using traditional method. The Support Vector Machine (SVM) is used for classification purpose. The performance of this approach is addresses. Further, a comparative analysis is made with existing approaches. Consequently, this method provides optimal intrusion detection mechanism which is capable to minimize amount of features and maximize the detection rates.

Background/Aims: Middle Eastern countries, including Saudi Arabia to some extent, are endemic for chronic hepatitis B (CHB) infection which could be associated with high mortality and comorbidities risk. However, limited data characterizing this CHB population exists. Our aim was to characterize and compare CHB patients in 2015 with those in 2010 and 2012 in Saudi Arabia. Patients and Methods: We conducted and compared three cross-sectional analyses of adult patients with CHB defined as either positive hepatitis B surface antigen or documented CHB history in 2010, 2012, and 2015. Data were accessed from the multicenter Systematic Observatory Liver Disease Registry (SOLID). Results: A total of 765 CHB patients were identified in 2010 (n = 274), 2012 (n = 256), and 2015 (n = 235). Median age was significantly higher in 2015 (47 years) compared to 2010 and 2012 (42 years;P < 0.05). The proportions of patients with hepatocellular carcinoma (range 1–12%) and cirrhosis (range 5–23%) were significantly higher in 2015 compared to 2010 and 2012 (P < 0.05). Compared to 2010, patients in 2015 had significantly (P < 0.05) higher prevalence of coronary artery disease (10% vs. 4%) and hyperbilirubinemia (18% vs. 9%). Although not significant, there was a numerical increase in 2015 in chronic kidney disease (9% vs. 7% in 2010;P= 0.559) and hepatic steatosis (32% vs. 25% in 2010;P= 0.074). Significantly more patients in 2015 (P < 0.05) were treatment experienced (23% vs. 5% in 2010/2012) and switched treatment (17% vs. 1–2% in 2010/2012). Conclusions: Between 2010 and 2015, the CHB population in Saudi Arabia had significantly aged and was more likely to develop liver disease sequelae and other comorbidities.

This paper elaborates on the evaluation stage of an empirical process whose purpose is to evaluate and select a best-of-breed AWEM, Automated Web Engineering Methodology environment. The process is basically comprised of four major stages, namely: characteristics identification, screening of available AWEM environments, evaluation, and selection.During the evaluation stage, an “evaluation scheme”, which serves specific web application domains reflecting the organization's perspective towards the AWEM environment, is created. The idea is to make the evaluation process more user-centric. The actual evaluation is then conducted based on the results gained through the development of real pilot projects.The paper contributes to the current research in web engineering area by proposing an evaluation mechanism through the introduction of a so-called “evaluation scheme”, a sub-set of predefined essential criteria. Another major contribution is the introduction of an evaluation algorithm for weighing and rating various characteristics and alternatives that will eventually assist in making a final decision. Both, the process and the algorithm, were fully automated and evaluated on real world cases using the AWEM-ESS, which is an evaluation and selection system built specifically for this purpose.

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15 countries in Europe, the Middle East and Asia, and the relative impact of two scenarios was considered: increased treatment efficacy while holding the annual number of treated patients constant and increased treatment efficacy and an increased annual number of treated patients. Increasing levels of diagnosis and treatment, in combination with improved treatment efficacy, were critical for achieving substantial reductions in disease burden. A 90% reduction in total HCV infections within 15 years is feasible in most countries studied, but it required a coordinated effort to introduce harm reduction programmes to reduce new infections, screening to identify those already infected and treatment with high cure rate therapies. This suggests that increased capacity for screening and treatment will be critical in many countries. Birth cohort screening is a helpful tool for maximizing resources. Among European countries, the majority of patients were born between 1940 and 1985. A wider range of birth cohorts was seen in the Middle East and Asia (between 1925 and 1995).

C4I (Command, Control, Communication, Computer and Intelligence) systems became the core of the command and control operations in military, emergency response, disaster management etc. The data sets used by these systems are large and complex to analyze and analysis process take long time. In today’s scenario the quantity of information or data that is traveling over the internet is not only huge in size but intricate as well. Big Data are now speedily growing in all domains of science and engineering due to fast expansion of data storage, networking and data collection capacity. Since Big Data is an emerging technology in the market which can bring huge benefits to the companies and organizations, it becomes a need of time to understand this technology. C4I systems can also be benefitted from Big Data. In this paper some important goals, applications, challenges and tools of Big Data are highlighted in context of C4I systems that will be helpful for both academia and industry to further strengthen the basis of Big Data usage in C4I systems.

This paper presents an energy efficient cognitive radio multichannel medium access control (MAC) protocol called ECR-MAC for battlefield communications. ECR-MAC requires only a single half-duplex radio transceiver on each node that integrates the spectrum sensing at physical (PHY) layer and the packet scheduling at MAC layer. In addition to explicit frequency negotiation which is adopted by conventional multichannel MAC protocols, ECR-MAC introduces lightweight explicit time negotiation. This two-dimensional negotiation enables ECR-MAC to exploit the advantage of both multiple channels and TDMA, and achieves aggressive power savings by allowing nodes that are not involved in communication to go into doze mode. The proposed energy efficient ECR-MAC protocol allows secondary users (SUs) to identify and use the unused frequency spectrum in a way that constrains the level of interference to the primary users (PUs). Extensive simulation results show that our proposed ECR-MAC protocol successfully exploits multiple channels and significantly improves network performance by using the licensed spectrum band opportunistically and protects QoS provisioning over cognitive radio ad hoc networks.

Cognitive radio (CR) networks are becoming an increasingly important part of the wireless networking landscape due to the ever-increasing scarcity of spectrum resources throughout the world. Nowadays CR media is becoming popular wireless communication media for disaster recovery communication network. Although the operational aspects of CR are being explored vigorously, its security aspects have gained less attention to the research community. The existing research on CR network mainly focuses on the spectrum sensing and allocation, energy efficiency, high throughput, end-to-end delay and other aspect of the network technology. But, very few focuses on the security aspect and almost none focus on the secure anonymous communication in CR networks (CRNs). In this research article we would focus on secure anonymous communication in CR ad hoc networks (CRANs). We would propose a secure anonymous routing for CRANs based on pairing based cryptography which would provide source node, destination node and the location anonymity. Furthermore, the proposed research would protect different attacks those are feasible on CRANs.

Browsing web through smartphone browsers is gaining popularity due to the convenience and availability of infrastructure at almost all places. On the other hand the capabilities of smartphone browsers are also improved to a great extent and many browsers are available to users. One can perform almost all of his information seeking and web related tasks through smartphone browser. Many web sites are customized for the smartphone browsers. This research work is deemed to identify the frequently used smartphone browser features. Mixed methods of research are employed in this study. Qualitative method i.e. interview is used to collect the data from the smartphone users to lay down the basis for quantitative phase i.e. survey. Features are categorized into different categories and two groups i.e. basic, and advanced features. Results show that features related to tabs, view and download are the frequently used by users. The results are equally help for practitioners and researchers to work on the improvement of browser's usability.

Command, control, communication, computer and intelligence (C4I) systems provide situational awareness, which contributes to the decision making process in complex operational environment. The C4I systems need real time seamless information exchange amongst its elements over a distributed network. Cognitive radio (CR) is an emerging wireless technology that can use spectrum in an entirely new and more efficient manner and offer efficient, secure, and reliable communications. In CR ad hoc networks, spectrum efficiency and energy efficiency are vitally important because spectrum availability is opportunistic in nature and mobile CR nodes usually have limited energy. Aiming to improve network throughput along with improving spectrum and energy efficiencies, this paper proposes a resource reservation scheme for C4I systems, called channel-slot aggregation diversity based slot reservation (CADSR), by which each CR node can utilize multiple slots in different channels simultaneously and efficiently utilize the power control mechanism. The proposed scheme dynamically assigns channel-slots to CR nodes using the diversity technique. A dynamic frame length expansion and shrinking scheme has also been introduced that improves the slot utilization. Simulation results show that the proposed CADSR mechanism achieves significant performance improvement as compared to the state-of-the-art approaches.

C4I (command, control, communication, computer and intelligence) are complex information systems designed to achieve mission objectives through better situational awareness and information superiority. C4I systems are system of systems (SOS), SOS comprised of independent constituent systems that interoperate with other systems to achieve specific mission objectives. In this paper we propose a framework for the interoperability of C4I Systems that covers key issues and challenges related to interoperability of heterogeneous C4I systems such as complexity, criticality and Information Exchanges Requirements (IER). The frameworks make use of department of defense architecture framework (DOAF) to describe data exchange requirements, source adapters, message translation, routing and destination adapters.

C4I (Command, Control, Communication, Computer and Intelligence) systems are critical systems of systems. These systems are used in military, emergency response, and in disaster management etc. Due to the sensitive nature of domains and applications of these systems, quality could never be compromised. C4I systems are resource demanding system, their expansion or up gradation for the sake of improvement require additional computational resources. Cloud computing provides a solution for the convenient access and scaling of resources. Recently, it is envisioned by the researchers to deploy C4I systems using cloud computing resources. However, there are many issues in such deployment and security being at the top, is focus of many researchers. In this research, security requirements and concerns of cloud based C4I systems are highlighted. Different aspects of cloud computing and C4I systems are discussed from the security point of view. This research will be helpful for both academia and industry to further strengthen the basis of cloud based C4I systems.

In cognitive radio (CR) ad hoc networks, spectrum efficiency and energy efficiency are vitally important because spectrum availability is opportunistic in nature and mobile CR nodes usually have limited energy. Aiming to improve network throughput along with improving spectrum and energy efficiencies, this paper proposes a channel-slot aggregation diversity based slot reservation (CADSR) scheme by which each CR node can utilize multiple slots in different channels simultaneously and efficiently utilize the power control mechanism with only a single CR transceiver. The proposed scheme dynamically assigns channel-slots to CR nodes using the diversity technique according to the topology density of the network and the bandwidth requirement, allowing CR nodes to join and leave the network at any time in a distributed way. A dynamic frame length expansion and shrinking scheme has also been introduced that improves the slot utilization. Extensive simulation results show that the proposed mechanism achieves significant performance improvement in network throughput, energy efficiency, and end-to-end delay.

Gilead Sciences The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. in addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing. Ctr Dis Anal, Louisville, CO 80027 USA Natl Liver Inst, Menoufia, Egypt JW Goethe Univ Hosp, Frankfurt, Germany Univ Calgary, Liver Unit, Div Gastroenterol & Hepatol, Calgary, AB, Canada Ankara Univ, Dept Gastroenterol, Sch Med, TR-06100 Ankara, Turkey Hosp Santo Antonio Capuchos, Dept Gastroenterol, Ctr Hosp Lisboa Cent, Lisbon, Portugal Med Univ Innsbruck, A-6020 Innsbruck, Austria Univ São Paulo, Sch Med, São Paulo, Brazil Hop Henri Mondor, Serv Hepatogastroenterol, F-94010 Creteil, France Adv Tech Hlth Serv Res TAISS, Madrid, Spain Ege Univ, Izmir, Turkey Karolinska Inst, Dept Med Huddinge, Stockholm, Sweden Karolinska Univ Hosp, Dept Gastroenterol & Hepatol Infect Dis, Stockholm, Sweden Ankara Univ, TR-06100 Ankara, Turkey Univ Leipzig, D-04109 Leipzig, Germany Osped Cantonale, Dept Gastroenterol, Bellinzona, Switzerland Univ Montreal, Dept Med, Liver Unit, Montreal, PQ H3C 3J7, Canada Fed Univ State Rio de Janeiro, Dept Gastroenterol, Rio de Janeiro, Brazil Arud Ctr Addict Med, Zurich, Switzerland Hosp Valle de Hebron, CIBERehd, Barcelona, Spain Hosp Puerta Hierro, Madrid, Spain Univ Fed Rio Grande do Sul, Hosp Clin, Porto Alegre, RS, Brazil Odense Univ Hosp, Dept Infect Dis, DK-5000 Odense, Denmark Reg Hosp Hovedstaden, Copenhagen, Denmark Univ Fed Rio de Janeiro, Dept Clin Med, Rio de Janeiro, Brazil Univ Plymouth, Peninsula Sch Med & Dent, Plymouth PL4 8AA, Devon, England Univ New S Wales, Kirby Inst, Sydney, NSW, Australia Cairo Univ, Cairo, Egypt Orebro Univ Hosp, Dept Infect Dis, Orebro, Sweden Univ Orebro, Sch Hlth & Med Sci, SE-70182 Orebro, Sweden Ain Shams Univ, Cairo, Egypt Dokuz Eylul Univ, Izmir, Turkey Karolinska Inst, Karolinska Univ Hosp, Dept Med Huddinge, Infect Dis Unit, Stockholm, Sweden Exigo Consultores, Alhos Vedros, Portugal Universidade Federal de São Paulo, Div Gastroenterol, São Paulo, Brazil Universidade Federal de São Paulo, Div Infect Dis, São Paulo, Brazil Inst Clin & Expt Med, Dept Hepatogastroenterol, Prague, Czech Republic Hosp Carlos III, CIBERehd, Madrid, Spain Univ Copenhagen, Copenhagen, Denmark Direccao Geral Saude, Lisbon, Portugal Univ Estadual Campinas, Disciplina Doencas Infecciosas, Dept Clin Med, Grp Estudo Hepatites,Fac Ciencias Med,UNICAMP, São Paulo, Brazil Wilhelminenspital Stadt Wien, Dept Internal Med 4, Vienna, Austria Univ São Paulo, Sch Med, Div Gastroenterol & Hepatol, São Paulo, Brazil Med Univ Vienna, Div Gastroenterol & Hepatol, Dept Internal Med 3, Vienna, Austria Masaryk Univ, Univ Hosp Brno, Clin Infect Dis, Brno, Czech Republic Univ Manitoba, Dept Internal Med, Sect Hepatol, Winnipeg, MB, Canada Hlth Sci Ctr, Viral Hepatitis Invest Unit, Winnipeg, MB, Canada European Liver Patients Assoc, St Truiden, Belgium Istanbul Univ, Istanbul, Turkey Univ British Columbia, British Columbia Ctr Dis Control, Vancouver, BC V5Z 1M9, Canada Aalborg Univ Hosp, Dept Med Gastroenterol, Aalborg, Denmark Aalborg Univ Hosp, Sect Mol Diagnost, Aalborg, Denmark Katholieke Univ Leuven, Univ Hosp Leuven, Louvain, Belgium Hosp Santa Maria, Dept Gastroenterol, Ctr Hosp Lisboa Norte, Lisbon, Portugal Univ Western Ontario, Div Gastroenterol, London, ON, Canada Univ Dusseldorf, Dusseldorf, Germany Univ Libre Brussels, Erasme Univ Hosp, Brussels, Belgium Univ Hosp, Div Gastroenterol & Hepatol, Geneva, Switzerland Univ Hosp, Div Clin Pathol, Geneva, Switzerland Natl Inst Publ Hlth, Natl Reference Lab Hepatitis, Prague, Czech Republic Univ Southhampton, Southampton, England Dalhousie Univ & Hepatol Serv, Capital Dist Hlth Author, Queen Elizabeth II Hlth Sci Ctr, Dept Med, Halifax, NS, Canada Dalhousie Univ & Hepatol Serv, Capital Dist Hlth Author, Queen Elizabeth II Hlth Sci Ctr, Dept Surg, Halifax, NS, Canada Univ British Columbia, Dept Gastroenterol, Vancouver, BC V5Z 1M9, Canada Assembleia Republ, Lisbon, Portugal Alfred Hosp, Melbourne, Vic, Australia Monash Univ, Melbourne, Vic 3004, Australia UCL, Div Med, UCL Inst Liver & Digest Hlth, London, England Hop Henri Mondor, Dept Sante Publ, F-94010 Creteil, France Nottingham Univ Hosp NHS Trust, Nottingham, England Biomed Res Unit, Nottingham, England Ctr Hosp Porto, Dept Infect Dis, Oporto, Portugal Cantonal Hosp St Gallen, Div Gastroenterol & Hepatol, St Gallen, Switzerland Univ Toronto, Toronto Gen Hosp, Univ Hlth Network, Toronto, ON M5G 1L7, Canada Egyptian Liver Res Inst & Hosp, Dakahliah, Egypt Monash Hlth, Melbourne, Vic, Australia Catholic Univ Louvain, Clin Univ St Luc, Brussels, Belgium Med Univ Graz, Div Gastroenterol & Hepatol, Dept Internal Med, Graz, Austria St Vincents Hosp, Dept Gastroenterol, Melbourne, Vic, Australia Univ Melbourne, Melbourne, Vic, Australia Charles Univ Prague, Dept Internal Med, Fac Med 1, Prague, Czech Republic Cent Mil Hosp, Prague, Czech Republic Univ Antwerp, B-2020 Antwerp, Belgium Deutsch Leberhilfe eV, Cologne, Germany Ghent Univ Hosp, Ghent, Belgium Univ Ghent, Belgium Hasselt Univ, Dept Hlth Econ & Patient Safety, Diepenbeek, Belgium Hannover Med Sch, Dept Gastroenterol Hepatol & Endocrinol, Hannover, Germany Copenhagen Univ Hosp, Hvidovre, Denmark Univ New S Wales, St George Hosp Clin Sch Med, Sydney, NSW, Australia Univ New S Wales, Sch Med Sci, Sydney, NSW, Australia Univ Zurich Hosp, Swiss HPB Hepatopancreatobiliary Ctr, CH-8091 Zurich, Switzerland Univ Zurich Hosp, Dept Gastroenterol & Hepatol, CH-8091 Zurich, Switzerland Universidade Federal de São Paulo, Div Gastroenterol, São Paulo, Brazil Universidade Federal de São Paulo, Div Infect Dis, São Paulo, Brazil Web of Science

The Telecare Medical Information System (TMIS) provides a set of different medical services to the patient and medical practitioner. The patients and medical practitioners can easily connect to the services remotely from their own premises. There are several studies carried out to enhance and authenticate smartcard-based remote user authentication protocols for TMIS system. In this article, we propose a set of enhanced and authentic Three Factor (3FA) remote user authentication protocols utilizing a smartphone capability over a dynamic Cloud Computing (CC) environment. A user can access the TMIS services presented in the form of CC services using his smart device e.g. smartphone. Our framework transforms a smartphone to act as a unique and only identity required to access the TMIS system remotely. Methods, Protocols and Authentication techniques are proposed followed by security analysis and a performance analysis with the two recent authentication protocols proposed for the healthcare TMIS system.

Resource allocation play an important role in service composition for cloud-based video surveillance platform. In this platform, the utilization of computational resources is managed through accessing various services from Virtual Machine (VM) resources. A single service accessed from VMs running inside such a cloud platform may not cater the application demands of all surveillance users. Services require to be modeled as a value added composite service. In order to provide such a composite service to the customer, VM resources need to be utilized optimally so that QoS requirements is fulfilled. In order to optimize the VM resource allocation, we have used linear programming approach as well as heuristics. The simulation results show that our approach outperforms the existing VM allocation schemes in a cloud-based video surveillance environment, in terms of cost and response time.

Smart surveillance systems have dramatically evolved over the recent years due to the availability of affordable sensing technologies, media processing discoveries and advanced networking capabilities. In third generation of surveillance systems, the distribution of surveillance capabilities over different sites has extremely boosted the complexity of such systems. As a result, managing alerts and responses that serve as a building block for collaboration among different parties has become very challenging in distributed surveillance system setting. The aim of this research is to propose an effective mechanism for establishing a strong collaboration among distributed smart surveillance systems regardless of the heterogeneity of their platforms. The proposed mechanism is demonstrated in the form of a generic Enterprise Architecture that utilizes DoDAF 2.0 to represent the development of Architectural Descriptions for supporting an accurate and complete integration and interaction among distributed smart surveillance systems. The development of Architectural Descriptions proposed in this research will facilitate an appropriate management of alerts and responses for improved situation awareness.

Road accidents and traffic jams are common problems being the target of a lot of research works to be resolved in current traffic system. Vehicular Ad hoc Network (VANET) is commonly part of Intelligent Transport System (ITS) which is directly involved in handling these problems and aims to make journey on road comfortable. In this paper, vehicular SMS system (VSS) is proposed based on cellular network to provide VANET services to users through SMS system. It has the potential of being more cost effective solution as compared to VANET but needs further research to resolve its trust and privacy issues.