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Routing protocols for underwater wireless sensor networks (UWSN) and underwater Internet of Things (IoT_UWSN) networks have expanded significantly. DBR routing protocol is one of the most critical routing protocols in UWSNs. In this routing protocol, the energy consumption of the nodes, the rate of loss of sent packets, and the rate of drop of routing packets due to node shutdown have created significant challenges. For this purpose, in a new scenario called FB-DBR, clustering is performed, and fuzzy logic and bloom filter are used in each cluster's new routing protocol in underwater wireless sensor networks. Due to the fuzzy nature of the parameters used in DBR, better results are obtained and bloom filters are used in routing tables to compensate for the deceleration. as the average number of accesses to routing table entries, dead nodes, Number of Packets Sent to Base Station (BS), Number of Packets Received at BS, Packet Dropped, and Remaining Energy has improved significantly., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto. Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH ; (2) Assessment for Safety During the HB-TMH Initial Visit ; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

Abstract: Medical data sharing, anti-tampering, and leakage prevention have always been severe problems that plagued the pharmaceutical industry. When a patient is referred, he often cannot provide information about previous visits because the medical information of each hospital cannot be shared in most cases, but only through Medical records, test sheets, and other easily lost paper information are used to share some medical information. At the same time, patient medical information is easily leaked, and the medical information provided in the event of a medical dispute cannot guarantee authenticity and impartiality. This article designs a consortium medical blockchain system based on a Possible Byzantine Fault Tolerance algorithm. This system is a medical system that is maintained and shared by multiple nodes and can prevent medical data from being tampered with or leaked. It can be used to solve these medical problems. Compared with the existing medical blockchain system, this system has certain advantages and better applicability., Competing Interests: The author has no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Cloud computing has evolved the big data technologies to a consolidated paradigm with SPaaS (Streaming processing-as-a-service). With a number of enterprises offering cloud-based solutions to end-users and other small enterprises, there has been a boom in the volume of data, creating interest of both industry and academia in big data analytics, streaming applications, and social networking applications. With the companies shifting to cloud-based solutions as a service paradigm, the competition grows in the market. Good quality of service (QoS) is a must for the enterprises, as they strive to survive in a competitive environment. However, achieving reasonable QoS goals to meet SLA agreement cost-effectively is challenging due to variation in workload over time. This problem can be solved if the system has the ability to predict the workload for the near future. In this paper, we present a novel topology-refining scheme based on a workload prediction mechanism. Predictions are made through a model based on a combination of SVR, autoregressive, and moving average model with a feedback mechanism. Our streaming system is designed to increase the overall performance by making the topology refining robust to the incoming workload on the fly, while still being able to achieve QoS goals of SLA constraints. Apache Flink distributed processing engine is used as a testbed in the paper. The result shows that the prediction scheme works well for both workloads, i.e., synthetic as well as real traces of data., Competing Interests: The authors have declared that no competing interests exist.

Methods: The aim of the paper is twofold. First, we present Starviewer, a DICOM viewer developed in C++ with a core component built on top of open-source libraries. The viewer supports extensions that implement functionalities and front-ends for specific use cases. Second, we propose an adaptable evaluation framework based on a set of criteria weighted according to user needs. The framework can consider different user profiles and allow criteria to be decomposed in subcriteria and grouped in more general categories making a multi-level hierarchical structure that can be analysed at different levels of detail to make scores interpretation more comprehensible., Results: Different examples to illustrate Starviewer functionalities and its extensions are presented. In addition, the proposed evaluation framework is used to compare Starviewer with four open-source viewers regarding their functionalities for daily clinical practice. In a range from 0 to 10, the final scores are: Horos (7.7), Starviewer (6.2), Weasis (6.0), Ginkgo CADx (4.1), and medInria (3.8)., Conclusions: Starviewer provides basic and advanced features for daily image diagnosis needs as well as a modular design that enables the development of custom extensions. The evaluation framework is useful to understand and prioritize new development goals, and can be easily adapted to express different needs by altering the weights. Moreover, it can be used as a complement to maturity models., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The US Food and Drug Administration (FDA) Sentinel System uses a distributed data network, a common data model, curated real-world data, and distributed analytic tools to generate evidence for FDA decision-making. Sentinel system needs include analytic flexibility, transparency, and reproducibility while protecting patient privacy. Based on over a decade of experience, a critical system limitation is the inability to identify enough medical conditions of interest in observational data to a satisfactory level of accuracy. Improving the system's ability to use computable phenotypes will require an "all of the above" approach that improves use of electronic health data while incorporating the growing array of complementary electronic health record data sources. FDA recently funded a Sentinel System Innovation Center and a Community Building and Outreach Center that will provide a platform for collaboration across disciplines to promote better use of real-world data for decision-making., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner., Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema., Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5)., Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness., Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge., (©Anna Janssen, Candice Donnelly, Judy Kay, Peter Thiem, Aldo Saavedra, Nirmala Pathmanathan, Elisabeth Elder, Phuong Dinh, Masrura Kabir, Kirsten Jackson, Paul Harnett, Tim Shaw. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.04.2020.)

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

Objective: The study sought to design, pilot, and evaluate a federated data completeness tracking system (CTX) for assessing completeness in research data extracted from electronic health record data across the Accessible Research Commons for Health (ARCH) Clinical Data Research Network., Materials and Methods: The CTX applies a systems-based approach to design workflow and technology for assessing completeness across distributed electronic health record data repositories participating in a queryable, federated network. The CTX invokes 2 positive feedback loops that utilize open source tools (DQe-c and Vue) to integrate technology and human actors in a system geared for increasing capacity and taking action. A pilot implementation of the system involved 6 ARCH partner sites between January 2017 and May 2018., Results: The ARCH CTX has enabled the network to monitor and, if needed, adjust its data management processes to maintain complete datasets for secondary use. The system allows the network and its partner sites to profile data completeness both at the network and partner site levels. Interactive visualizations presenting the current state of completeness in the context of the entire network as well as changes in completeness across time were valued among the CTX user base., Discussion: Distributed clinical data networks are complex systems. Top-down approaches that solely rely on technology to report data completeness may be necessary but not sufficient for improving completeness (and quality) of data in large-scale clinical data networks. Improving and maintaining complete (high-quality) data in such complex environments entails sociotechnical systems that exploit technology and empower human actors to engage in the process of high-quality data curating., Conclusions: The CTX has increased the network's capacity to rapidly identify data completeness issues and empowered ARCH partner sites to get involved in improving the completeness of respective data in their repositories., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background: Distributed ledger technology (DLT) holds great potential to improve health information exchange. However, the immutable and transparent character of this technology may conflict with data privacy regulations and data processing best practices., Objective: The aim of this paper is to develop a proof-of-concept system for immutable, interoperable, and General Data Protection Regulation (GDPR)-compliant exchange of blood glucose data., Methods: Given that there is no ideal design for a DLT-based patient-provider data exchange solution, we proposed two different variations for our proof-of-concept system. One design was based purely on the public IOTA distributed ledger (a directed acyclic graph-based DLT) and the second used the same public IOTA ledger in combination with a private InterPlanetary File System (IPFS) cluster. Both designs were assessed according to (1) data reversal risk, (2) data linkability risks, (3) processing time, (4) file size compatibility, and (5) overall system complexity., Results: The public IOTA design slightly increased the risk of personal data linkability, had an overall low processing time (requiring mean 6.1, SD 1.9 seconds to upload one blood glucose data sample into the DLT), and was relatively simple to implement. The combination of the public IOTA with a private IPFS cluster minimized both reversal and linkability risks, allowed for the exchange of large files (3 months of blood glucose data were uploaded into the DLT in mean 38.1, SD 13.4 seconds), but involved a relatively higher setup complexity., Conclusions: For the specific use case of blood glucose explored in this study, both designs presented a suitable performance in enabling the interoperable exchange of data between patients and providers. Additionally, both systems were designed considering the latest guidelines on personal data processing, thereby maximizing the alignment with recent GDPR requirements. For future works, these results suggest that the conflict between DLT and data privacy regulations can be addressed if careful considerations are made regarding the use case and the design of the data exchange system., (©David Hawig, Chao Zhou, Sebastian Fuhrhop, Andre S Fialho, Navin Ramachandran. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.06.2019.)

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

The accuracy and diversity of recommendation algorithms have always been the research hotspot of recommender systems. A good recommender system should not only have high accuracy and diversity, but also have adequate robustness against spammer attacks. However, the issue of recommendation robustness has received relatively little attention in the literature. In this paper, we systematically study the influences of different spammer behaviors on the recommendation results in various recommendation algorithms. We further propose an improved algorithm by incorporating the inner-similarity of user's purchased items in the classic KNN approach. The new algorithm effectively enhances the robustness against spammer attacks and thus outperforms traditional algorithms in recommendation accuracy and diversity when spammers exist in the online commercial systems., Competing Interests: Authors Zhang C, Han T and Ge X are paid employees of ShuKun BeiJing Network Technology Co., Limited. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Recently telecom fraud has become a serious problem especially in developing countries such as China. At present, it can be very difficult to coordinate different agencies to prevent fraud completely. In this paper we study how to detect large transfers that are sent from victims deceived by fraudsters at the receiving bank. We propose a new generative adversarial network (GAN) based model to calculate for each large transfer a probability that it is fraudulent, such that the bank can take appropriate measures to prevent potential fraudsters to take the money if the probability exceeds a threshold. The inference model uses a deep denoising autoencoder to effectively learn the complex probabilistic relationship among the input features, and employs adversarial training that establishes a minimax game between a discriminator and a generator to accurately discriminate between positive samples and negative samples in the data distribution. We show that the model outperforms a set of well-known classification methods in experiments, and its applications in two commercial banks have reduced losses of about 10 million RMB in twelve weeks and significantly improved their business reputation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The new IEEE 11073 service-oriented device connectivity (SDC) standard proposals for networked point-of-care and surgical devices constitutes the basis for improved interoperability due to its independence of vendors. To accelerate the distribution of the standard a reference implementation is indispensable. However, the implementation of such a framework has to overcome several non-trivial challenges. First, the high level of complexity of the underlying standard must be reflected in the software design. An efficient implementation has to consider the limited resources of the underlying hardware. Moreover, the frameworks purpose of realizing a distributed system demands a high degree of reliability of the framework itself and its internal mechanisms. Additionally, a framework must provide an easy-to-use and fail-safe application programming interface (API). In this work, we address these challenges by discussing suitable software engineering principles and practical coding guidelines. A descriptive model is developed that identifies key strategies. General feasibility is shown by outlining environments in which our implementation has been utilized.

Modern surgical departments are characterized by a high degree of automation supporting complex procedures. It recently became apparent that integrated operating rooms can improve the quality of care, simplify clinical workflows, and mitigate equipment-related incidents and human errors. Particularly using computer assistance based on data from integrated surgical devices is a promising opportunity. However, the lack of manufacturer-independent interoperability often prevents the deployment of collaborative assistive systems. The German flagship project OR.NET has therefore developed, implemented, validated, and standardized concepts for open medical device interoperability. This paper describes the universal OR.NET interoperability concept enabling a safe and dynamic manufacturer-independent interconnection of point-of-care (PoC) medical devices in the operating room and the whole clinic. It is based on a protocol specifically addressing the requirements of device-to-device communication, yet also provides solutions for connecting the clinical information technology (IT) infrastructure. We present the concept of a service-oriented medical device architecture (SOMDA) as well as an introduction to the technical specification implementing the SOMDA paradigm, currently being standardized within the IEEE 11073 service-oriented device connectivity (SDC) series. In addition, the Session concept is introduced as a key enabler for safe device interconnection in highly dynamic ensembles of networked medical devices; and finally, some security aspects of a SOMDA are discussed.

The new medical device communication protocol known as IEEE 11073 SDC is well-suited for the integration of (surgical) point-of-care devices, so are the established Health Level Seven (HL7) V2 and Digital Imaging and Communications in Medicine (DICOM) standards for the communication of systems in the clinical IT infrastructure (CITI). An integrated operating room (OR) and other integrated clinical environments, however, need interoperability between both domains to fully unfold their potential for improving the quality of care as well as clinical workflows. This work thus presents concepts for the propagation of clinical and administrative data to medical devices, physiologic measurements and device parameters to clinical IT systems, as well as image and multimedia content in both directions. Prototypical implementations of the derived components have proven to integrate well with systems of networked medical devices and with the CITI, effectively connecting these heterogeneous domains. Our qualitative evaluation indicates that the interoperability concepts are suitable to be integrated into clinical workflows and are expected to benefit patients and clinicians alike. The upcoming HL7 Fast Healthcare Interoperability Resources (FHIR) communication standard will likely change the domain of clinical IT significantly. A straightforward mapping to its resource model thus ensures the tenability of these concepts despite a foreseeable change in demand and requirements.

As the number of elderly persons with chronic illnesses increases, a new public infrastructure for their care is becoming increasingly necessary. In particular, technologies that can monitoring bio-signals in real-time have been receiving significant attention. Currently, most healthcare monitoring services are implemented by wireless carrier through centralized servers. These services are vulnerable to data concentration because all data are sent to a remote server. To solve these problems, we propose self-organizing P2P middleware for healthcare monitoring that enables a real-time multi bio-signal streaming without any central server by connecting the caregiver and care recipient. To verify the performance of the proposed middleware, we evaluated the monitoring service matching time based on a monitoring request. We also confirmed that it is possible to provide an effective monitoring service by evaluating the connectivity between Peer-to-Peer and average jitter., Competing Interests: The authors declare no conflict of interest.

Marriage and family therapists (MFTs) use ethical codes and state licensure laws/rules as guidelines for best clinical practice. It is important that professional codes reflect the potential exponential use of technology in therapy. However, current standards regarding technology use lack clarity. To explore this gap, a summative content analysis was conducted on state licensure laws/rules and professional ethical codes to find themes and subthemes among the many aspects of therapy in which technology can be utilized. Findings from the content analysis indicated that while there have been efforts by both state and professional organizations to incorporate guidance for technology use in therapy, a clear and comprehensive "roadmap" is still missing. Future scholarship is needed that develops clearer guidelines for therapists., (© 2017 American Association for Marriage and Family Therapy.)

Objective: Electrical source localization (ESL) deriving from scalp EEG and, in recent years, from intracranial EEG (iEEG), is an established method in epilepsy surgery workup. We aimed to validate the distributed ESL derived from scalp EEG and iEEG, particularly regarding the spatial extent of the source, using a realistic epileptic spike activity simulator., Approach: ESL was applied to the averaged scalp EEG and iEEG spikes of two patients with drug-resistant structural epilepsy. The ESL results for both patients were used to outline the location and extent of epileptic cortical patches, which served as the basis for designing a spatiotemporal source model. EEG signals for both modalities were then generated for different anatomic locations and spatial extents. ESL was subsequently performed on simulated signals with sLORETA, a commonly used distributed algorithm. ESL accuracy was quantitatively assessed for iEEG and scalp EEG., Main Results: The source volume was overestimated by sLORETA at both EEG scales, with the error increasing with source size, particularly for iEEG. For larger sources, ESL accuracy drastically decreased, and reconstruction volumes shifted to the center of the head for iEEG, while remaining stable for scalp EEG. Overall, the mislocalization of the reconstructed source was more pronounced for iEEG., Significance: We present a novel multiscale framework for the evaluation of distributed ESL, based on realistic multiscale EEG simulations. Our findings support that reconstruction results for scalp EEG are often more accurate than for iEEG, owing to the superior 3D coverage of the head. Particularly the iEEG-derived reconstruction results for larger, widespread generators should be treated with caution.

In the existing centralized location services system structure, the server is easily attracted and be the communication bottleneck. It caused the disclosure of users' location. For this, we presented a new distributed collaborative recommendation strategy that is based on the distributed system. In this strategy, each node establishes profiles of their own location information. When requests for location services appear, the user can obtain the corresponding location services according to the recommendation of the neighboring users' location information profiles. If no suitable recommended location service results are obtained, then the user can send a service request to the server according to the construction of a k-anonymous data set with a centroid position of the neighbors. In this strategy, we designed a new model of distributed collaborative recommendation location service based on the users' location information profiles and used generalization and encryption to ensure the safety of the user's location information privacy. Finally, we used the real location data set to make theoretical and experimental analysis. And the results show that the strategy proposed in this paper is capable of reducing the frequency of access to the location server, providing better location services and protecting better the user's location privacy., Competing Interests: The authors have declared that no competing interests exist.

Background: The benefits of intravenous tissue-type plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) are time dependent. Because emergency rooms quickly initiate a stroke alert with more severe symptoms, we hypothesized that patients with lower National Institutes of Health Stroke Scale (NIHSS) scores, indicating a less severe stroke, would have longer door-to-needle (DTN) times compared to patients with higher NIHSS scores., Methods: Data obtained from the 19-hospital Providence Stroke Registry were used to identify AIS patients who received IV-tPA within 4.5 hours of last-known-well. NIHSS scores were obtained prior to tPA administration at the time of emergency department presentation and categorized as low-NIHSS (score = 0-5) or high-NIHSS (score = 6-42) strokes. Median DTN times were collected for both groups as the primary outcome variable. Linear mixed-effects regression models were used to assess the effect of NIHSS scores on DTN and its 2 components: door-to-CT (DCT) and CT-to-needle (CTN) times., Results: We identified 692 AIS patients who received IV-tPA within 4.5 hours of last-known-well, with 198 patients presenting with low-NIHSS strokes and 494 patients with high-NIHSS strokes. In multivariable analysis, median DTN time was estimated to be 18% higher for low-NIHSS strokes than high-NIHSS strokes after adjusting for covariates (P < .001). Median DCT times were also higher for low-NIHSS (19 minutes) compared to high-NIHSS (11 minutes) strokes after adjusting for covariates (P < .001), whereas CTN times were unchanged (P = .055)., Conclusion: In AIS patients receiving IV-tPA in a telestroke network, lower NIHSS scores were associated with longer DTN and DCT times., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Due to the continuous advancements in wireless communication in terms of quality of communication and affordability of the technology, the application area of Mobile Adhoc Networks (MANETs) significantly growing particularly in military and disaster management. Considering the sensitivity of the application areas, security in terms of detection of Denial of Service (DoS) and intrusion has become prime concern in research and development in the area. The security systems suggested in the past has state recognition problem where the system is not able to accurately identify the actual state of the network nodes due to the absence of clear definition of states of the nodes. In this context, this paper proposes a framework based on Finite State Machine (FSM) for denial of service and intrusion detection in MANETs. In particular, an Interruption Detection system for Adhoc On-demand Distance Vector (ID-AODV) protocol is presented based on finite state machine. The packet dropping and sequence number attacks are closely investigated and detection systems for both types of attacks are designed. The major functional modules of ID-AODV includes network monitoring system, finite state machine and attack detection model. Simulations are carried out in network simulator NS-2 to evaluate the performance of the proposed framework. A comparative evaluation of the performance is also performed with the state-of-the-art techniques: RIDAN and AODV. The performance evaluations attest the benefits of proposed framework in terms of providing better security for denial of service and intrusion detection attacks.

As one of the most popular statistical and machine learning models, logistic regression with regularization has found wide adoption in biomedicine, social sciences, information technology, and so on. These domains often involve data of human subjects that are contingent upon strict privacy regulations. Concerns over data privacy make it increasingly difficult to coordinate and conduct large-scale collaborative studies, which typically rely on cross-institution data sharing and joint analysis. Our work here focuses on safeguarding regularized logistic regression, a widely-used statistical model while at the same time has not been investigated from a data security and privacy perspective. We consider a common use scenario of multi-institution collaborative studies, such as in the form of research consortia or networks as widely seen in genetics, epidemiology, social sciences, etc. To make our privacy-enhancing solution practical, we demonstrate a non-conventional and computationally efficient method leveraging distributing computing and strong cryptography to provide comprehensive protection over individual-level and summary data. Extensive empirical evaluations on several studies validate the privacy guarantee, efficiency and scalability of our proposal. We also discuss the practical implications of our solution for large-scale studies and applications from various disciplines, including genetic and biomedical studies, smart grid, network analysis, etc.

Software methods that enable navigation of radiology cases on various digital platforms differ between handheld devices and desktop computers. This has resulted in poor compatibility of online radiology teaching files across mobile smartphones, tablets, and desktop computers. A standardized, platform-independent, or "agnostic" approach for presenting online radiology content was produced in this work by leveraging modern hypertext markup language (HTML) and JavaScript web software technology. We describe the design and evaluation of this software, demonstrate its use across multiple viewing platforms, and make it publicly available as a model for future development efforts.

Objective: To introduce and evaluate a method that uses electronic medical record (EMR) data to measure the effects of computer system downtime on clinical processes associated with pathology testing and results reporting., Materials and Methods: A matched case-control design was used to examine the effects of five downtime events over 11-months, ranging from 5 to 300min. Four indicator tests representing different laboratory workflows were selected to measure delays and errors: potassium, haemoglobon, troponin and activated partial thromboplastin time. Tests exposed to a downtime were matched to tests during unaffected control periods by test type, time of day and day of week. Measures included clinician read time (CRT), laboratory turnaround time (LTAT), and rates of missed reads, futile searches, duplicate orders, and missing test results., Results: The effects of downtime varied with the type of IT problem. When clinicians could not logon to a results reporting system for 17-min, the CRT for potassium and haemoglobon tests was five (10.3 vs. 2.0days) and six times (13.4 vs. 2.1days) longer than control (p=0.01-0.04; p=0.0001-0.003). Clinician follow-up of tests was also delayed by another downtime involving a power outage with a small effect. In contrast, laboratory processing of troponin tests was unaffected by network services and routing problems. Errors including missed reads, futile searches, duplicate orders and missing test results could not be examined because the sample size of affected tests was not sufficient for statistical testing., Conclusion: This study demonstrates the feasibility of using routinely collected EMR data with a matched case-control design to measure the effects of downtime on clinical processes. Even brief system downtimes may impact patient care. The methodology has potential to be applied to other clinical processes with established workflows where tasks are pre-defined such as medications management., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Today, security is a prominent issue when any type of communication is being undertaken. Like traditional networks, supervisory control and data acquisition (SCADA) systems suffer from a number of vulnerabilities. Numerous end-to-end security mechanisms have been proposed for the resolution of SCADA-system security issues, but due to insecure real-time protocol use and the reliance upon open protocols during Internet-based communication, these SCADA systems can still be compromised by security challenges. This study reviews the security challenges and issues that are commonly raised during SCADA/protocol transmissions and proposes a secure distributed-network protocol version 3 (DNP3) design, and the implementation of the security solution using a cryptography mechanism. Due to the insecurities found within SCADA protocols, the new development consists of a DNP3 protocol that has been designed as a part of the SCADA system, and the cryptographically derived security is deployed within the application layer as a part of the DNP3 stack.

Surgical procedures become more and more complex and the number of medical devices in an operating room (OR) increases continuously. Today's vendor-dependent solutions for integrated ORs are not able to handle this complexity. They can only form isolated solutions. Furthermore, high costs are a result of vendor-dependent approaches. Thus we present a service-oriented device communication for distributed medical systems that enables the integration and interconnection between medical devices among each other and to (medical) information systems, including plug-and-play functionality. This system will improve patient's safety by making technical complexity of a comprehensive integration manageable. It will be available as open standards that are part of the IEEE 11073 family of standards. The solution consists of a service-oriented communication technology, the so called Medical Devices Profile for Web Services (MDPWS), a Domain Information & Service Model, and a binding between the first two mechanisms. A proof of this concept has been done with demonstrators of real world OR devices.

Background: The universal qPCR data exchange file format RDML is today well accepted by the scientific community, part of the MIQE guidelines and implemented in many qPCR instruments. With the increased use of RDML new challenges emerge. The flexibility of the RDML format resulted in some implementations that did not meet the expectations of the consortium in the level of support or the use of elements., Results: In the current RDML version 1.2 the description of the elements was sharpened. The open source editor RDML-Ninja was released (http://sourceforge.net/projects/qpcr-ninja/). RDML-Ninja allows to visualize, edit and validate RDML files and thus clarifies the use of RDML elements. Furthermore RDML-Ninja serves as reference implementation for RDML and enables migration between RDML versions independent of the instrument software. The database RDMLdb will serve as an online repository for RDML files and facilitate the exchange of RDML data (http://www.rdmldb.org). Authors can upload their RDML files and reference them in publications by the unique identifier provided by RDMLdb. The MIQE guidelines propose a rich set of information required to document each qPCR run. RDML provides the vehicle to store and maintain this information and current development aims at further integration of MIQE requirements into the RDML format., Conclusions: The editor RDML-Ninja and the database RDMLdb enable scientists to evaluate and exchange qPCR data in the instrument-independent RDML format. We are confident that this infrastructure will build the foundation for standardized qPCR data exchange among scientists, research groups, and during publication.

This paper presents a wireless biosignal acquisition system-on-a-chip (WBSA-SoC) specialized for electrocardiogram (ECG) monitoring. The proposed system consists of three subsystems, namely, 1) the ECG acquisition node, 2) the protocol for standard IEEE 802.15.4 ZigBee system, and 3) the RF transmitter circuits. The ZigBee protocol is adopted for wireless communication to achieve high integration, applicability, and portability. A fully integrated CMOS RF front end containing a quadrature voltage-controlled oscillator and a 2.4-GHz low-IF (i.e., zero-IF) transmitter is employed to transmit ECG signals through wireless communication. The low-power WBSA-SoC is implemented by the TSMC 0.18-μm standard CMOS process. An ARM-based displayer with FPGA demodulation and an RF receiver with analog-to-digital mixed-mode circuits are constructed as verification platform to demonstrate the wireless ECG acquisition system. Measurement results on the human body show that the proposed SoC can effectively acquire ECG signals.

Today, connecting medical devices to the hospital network becomes a priority for many hospitals. User and operator requirements for communication must be considered in order to develop an adequate interoperable integration approach. This paper conducts a requirement study using questionnaires and working groups investigating 16 clinical communication requirements for connecting medical devices with each other and with clinical IT systems. Six German Hospitals order the communication requirements by their clinical relevance and categorize those into four main clusters. Communication requirements regarding accurate data transfer and processing for patients and devices have top priority, while communication requirements regarding remote manipulation of medical devices have low rank. Connecting medical devices to clinical IT systems improves clinical documentation and with it patient care processes.

Services composition is fundamental to software development in multi-service wireless sensor networks (WSNs). The quality of service (QoS) of services composition applications (SCAs) are confronted with severe challenges due to the open, dynamic, and complex natures of WSNs. Most previous research separated various QoS indices into different fields and studied them individually due to the computational complexity. This approach ignores the mutual influence between these QoS indices, and leads to a non-comprehensive and inaccurate analysis result. The universal generating function (UGF) shows the speediness and precision in QoS analysis. However, only one QoS index at a time can be analyzed by the classic UGF. In order to efficiently analyze the comprehensive QoS of SCAs, this paper proposes an improved UGF technique-vector universal generating function (VUGF)-which considers the relationship between multiple QoS indices, including security, and can simultaneously analyze multiple QoS indices. The numerical examples demonstrate that it can be used for the evaluation of the comprehensive QoS of SCAs subjected to the security constraint in WSNs. Therefore, it can be effectively applied to the optimal design of multi-service WSNs.

Objective: This paper describes Health Level 7 (HL7) V.3 Care Transfer, Care Record Query, and Care Record messages. This is the core of the Care Provision Domain in the HL7 standard which became normative at the end of 2012 and is an American National Standards Institute (ANSI)-approved HL7 standard., Background and Significance: Using a message is somewhat different from the approach offered in the current HL7 Clinical Document Architecture (CDA). The overall advantage is human-to-human communication and system-to-system processing of structured data through electronic messages, supporting continuity of care and interactive structured data exchange through querying., Materials and Methods: The Care Provision Domain Model in HL7 was developed based on use cases from several projects internationally. Use case and information analysis, model building, HL7 consensus methods (eg, working group meetings), conference calls, balloting, a draft standard for trial use, pilot implementations, and subsequent evaluation were applied., Results: The membership and pilot implementers gave feedback to improve the draft standard. After the formal ballot process, HL7 membership accepted it as a normative standard and it is now ANSI approved. The Care Provision Domain Model defines the structure (data exchanged) and dynamics (workflow and communications) of the Care Record, Care Record Query, and Care Transfer., Discussion and Conclusions: The HL7 V3 Care Provision Domain differs from the HL7 CDA regarding support of the dynamics of care (eg, for continuity of care) as provided through a series of interactions and queries, but is similar with respect to the data and their organization., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Nowadays, quality of service (QoS) is very popular in various research areas like distributed systems, multimedia real-time applications and networking. The requirements of these systems are to satisfy reliability, uptime, security constraints and throughput as well as application specific requirements. The real-time multimedia applications are commonly distributed over the network and meet various time constraints across networks without creating any intervention over control flows. In particular, video compressors make variable bit-rate streams that mismatch the constant-bit-rate channels typically provided by classical real-time protocols, severely reducing the efficiency of network utilization. Thus, it is necessary to enlarge the communication bandwidth to transfer the compressed multimedia streams using Flexible Time Triggered- Enhanced Switched Ethernet (FTT-ESE) protocol. FTT-ESE provides automation to calculate the compression level and change the bandwidth of the stream. This paper focuses on low-latency multimedia transmission over Ethernet with dynamic quality-of-service (QoS) management. This proposed framework deals with a dynamic QoS for multimedia transmission over Ethernet with FTT-ESE protocol. This paper also presents distinct QoS metrics based both on the image quality and network features. Some experiments with recorded and live video streams show the advantages of the proposed framework. To validate the solution we have designed and implemented a simulator based on the Matlab/Simulink, which is a tool to evaluate different network architecture using Simulink blocks.

Providing patients and clinicians with self-contained PACS viewer on CD format is a common and necessary tool to share vital imaging data. However, to be useful, this tool should be reliable, robust, and convenient. Numerous PACS viewer options are available, often without empirical data to guide in choosing one for routine use. To assist in making a standardized choice for our institution, we chose four common viewers, benchmarked on four different workstations reflecting the variety of environments used by non-radiologist clinicians who would receive a CD. Four CD-based DICOM viewers from eFilm, Philips, Pacsgear Gearview, and iSite were examed on two radiology PACS workstations, a standard desktop computer, and a laptop using a test case consisting of a multi-series CTA with 13 series and 3,035 total images. Multiple objective measures, subjective measures, and presence of key features were evaluated including program time to load, image time to load, cine/movie mode, ability to adequately window and level, pan and zoom functionality, basic measurement tools, and perceived lag when scrolling through a multi-image series. Substantial differences in speed of operation and behavior on multiple systems were documented, which could potentially add several minutes to the time required to open and view a patient's imaging data. The eFilm and iSite viewers operated consistently and reliably across all tested computer environments. The iSite viewer, having among the quickest load times in the group tested and consistently low subjective scroll lag during series viewing, and also beneficially allowing partial viewing while images load in the background, was found to generate the best overall user experience. Because of these significant differences, we have recommended that our institution standardize all patient imaging CD creation using the iSite viewer.

Information technology (IT) is pushing ahead with drastic reforms of modern life for improvement of human welfare. Objects constitute "Information Networks" through smart, self-regulated information gathering that also recognizes and controls current information states in Wireless Sensor Networks (WSNs). Information observed from sensor networks in real-time is used to increase quality of life (QoL) in various industries and daily life. One of the key challenges of the WSNs is how to achieve lossless data transmission. Although nowadays sensor nodes have enhanced capacities, it is hard to assure lossless and reliable end-to-end data transmission in WSNs due to the unstable wireless links and low hard ware resources to satisfy high quality of service (QoS) requirements. We propose a node and path traffic prediction model to predict and minimize the congestion. This solution includes prediction of packet generation due to network congestion from both periodic and event data generation. Simulation using NS-2 and Matlab is used to demonstrate the effectiveness of the proposed solution.