Trustworthy Wireless Personal Area Networks

In the Internet of Things (IoT), everyday objects are equipped with the ability to compute and communicate. These smart things have invaded the lives of everyday people, being constantly carried or worn on our bodies, and entering into our homes, our healthcare, and beyond. This has given rise to wireless networks of smart, connected, always-on, personal things that are constantly around us, and have unfettered access to our most personal data as well as all of the other devices that we own and encounter throughout our day. It should, therefore, come as no surprise that our personal devices and data are frequent targets of ever-present threats. Securing these devices and networks, however, is challenging. In this dissertation, we outline three critical problems in the context of Wireless Personal Area Networks (WPANs) and present our solutions to these problems. First, I present our Trusted I/O solution (BASTION-SGX) for protecting sensitive user data transferred between wirelessly connected (Bluetooth) devices. This work shows how in-transit data can be protected from privileged threats, such as a compromised OS, on commodity systems. I present insights into the Bluetooth architecture, Intel’s Software Guard Extensions (SGX), and how a Trusted I/O solution can be engineered on commodity devices equipped with SGX. Second, I present our work on AMULET and how we successfully built a wearable health hub that can run multiple health applications, provide strong security properties, and operate on a single charge for weeks or even months at a time. I present the design and evaluation of our highly efficient event-driven programming model, the design of our low-power operating system, and developer tools for profiling ultra-low-power applications at compile time. Third, I present a new approach (VIA) that helps devices at the center of WPANs (e.g., smartphones) to verify the authenticity of interactions with other devices. This work builds on past work in anomaly detection techniques and shows how these techniques can be applied to Bluetooth network traffic. Specifically, we show how to create normality models based on fine- and course-grained insights from network traffic, which can be used to verify the authenticity of future interactions

Internet of things in health: Requirements, issues, and gaps

Background and objectives: The Internet of Things (IoT) paradigm has been extensively applied to several sectors in the last years, ranging from industry to smart cities. In the health domain, IoT makes possible new scenarios of healthcare delivery as well as collecting and processing health data in real time from sensors in order to make informed decisions. However, this domain is complex and presents several tech- nological challenges. Despite the extensive literature about this topic, the application of IoT in healthcare scarcely covers requirements of this sector. Methods: A literature review from January 2010 to February 2021 was performed resulting in 12,108 articles. After filtering by title, abstract, and content, 86 were eligible and examined according to three requirement themes: data lifecycle; trust, security, and privacy; and human-related issues. Results: The analysis of the reviewed literature shows that most approaches consider IoT application in healthcare merely as in any other domain (industry, smart cities…), with no regard of the specific requirements of this domain. Conclusions: Future effort s in this matter should be aligned with the specific requirements and needs of the health domain, so that exploiting the capabilities of the IoT paradigm may represent a meaningful step forward in the application of this technology in healthcare.Consejería de Conocimiento, Investigación y Universidad, Junta de Andalucía P18-TPJ - 307

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Integrated Care Intervention Supported by a Mobile Health Tool for Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial

Background: Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective: This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods: A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results: Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions: The integrated care intervention supported by the mobile app did not improve patient self-management. However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care

Cloud Services Brokerage for Mobile Ubiquitous Computing

Recently, companies are adopting Mobile Cloud Computing (MCC) to efficiently deliver enterprise services to users (or consumers) on their personalized devices. MCC is the facilitation of mobile devices (e.g., smartphones, tablets, notebooks, and smart watches) to access virtualized services such as software applications, servers, storage, and network services over the Internet. With the advancement and diversity of the mobile landscape, there has been a growing trend in consumer attitude where a single user owns multiple mobile devices. This paradigm of supporting a single user or consumer to access multiple services from n-devices is referred to as the Ubiquitous Cloud Computing (UCC) or the Personal Cloud Computing. In the UCC era, consumers expect to have application and data consistency across their multiple devices and in real time. However, this expectation can be hindered by the intermittent loss of connectivity in wireless networks, user mobility, and peak load demands. Hence, this dissertation presents an architectural framework called, Cloud Services Brokerage for Mobile Ubiquitous Cloud Computing (CSB-UCC), which ensures soft real-time and reliable services consumption on multiple devices of users. The CSB-UCC acts as an application middleware broker that connects the n-devices of users to the multi-cloud services. The designed system determines the multi-cloud services based on the user's subscriptions and the n-devices are determined through device registration on the broker. The preliminary evaluations of the designed system shows that the following are achieved: 1) high scalability through the adoption of a distributed architecture of the brokerage service, 2) providing soft real-time application synchronization for consistent user experience through an enhanced mobile-to-cloud proximity-based access technique, 3) reliable error recovery from system failure through transactional services re-assignment to active nodes, and 4) transparent audit trail through access-level and context-centric provenance

Systematic review of smartphone-based passive sensing for health and wellbeing

OBJECTIVE: To review published empirical literature on the use of smartphone-based passive sensing for health and wellbeing. MATERIAL AND METHODS: A systematic review of the English language literature was performed following PRISMA guidelines. Papers indexed in computing, technology, and medical databases were included if they were empirical, focused on health and/or wellbeing, involved the collection of data via smartphones, and described the utilized technology as passive or requiring minimal user interaction. RESULTS: Thirty-five papers were included in the review. Studies were performed around the world, with samples of up to 171 (median n = 15) representing individuals with bipolar disorder, schizophrenia, depression, older adults, and the general population. The majority of studies used the Android operating system and an array of smartphone sensors, most frequently capturing accelerometry, location, audio, and usage data. Captured data were usually sent to a remote server for processing but were shared with participants in only 40% of studies. Reported benefits of passive sensing included accurately detecting changes in status, behavior change through feedback, and increased accountability in participants. Studies reported facing technical, methodological, and privacy challenges. DISCUSSION: Studies in the nascent area of smartphone-based passive sensing for health and wellbeing demonstrate promise and invite continued research and investment. Existing studies suffer from weaknesses in research design, lack of feedback and clinical integration, and inadequate attention to privacy issues. Key recommendations relate to developing passive sensing strategies matching the problem at hand, using personalized interventions, and addressing methodological and privacy challenges. CONCLUSION: As evolving passive sensing technology presents new possibilities for health and wellbeing, additional research must address methodological, clinical integration, and privacy issues. Doing so depends on interdisciplinary collaboration between informatics and clinical experts

Konzeption und Realisierung einer interaktiven und Feedback-orientierten Webplattform für Stresspatienten

Stress is a normal biological reaction to stressors. Stress is more and more present in our lives. Exposure to high stress levels for a long period of time can have negative effects on emotional and physical health. It is important to control and reduce stress and anxiety. Technology can help to measure, track and reduce the stress level. At University Ulm there exists several applications where patients suffering from stress can track their stress levels. The goal of this project is to develop an interactive and feedback-oriented web platform for patients that participate in the stress tracking program. The web platform should offer to users the opportunity to visualize their recorded stress data. Statistic related with their own data and in comparison with other participants should be presented. This web platform could help patients to become more conscious of their stressors or stressful situations, manage and maybe reduce their stress levels

Service-Oriented Framework for Developing Interoperable e-Health Systems in a Low-Income Country

e-Health solutions in low-income countries are fragmented, address institution-specific needs, and do little to address the strategic need for inter-institutional exchange of health data. Although various e-health interoperability frameworks exist, contextual factors often hinder their effective adoption in low-income countries. This underlines the need to investigate such factors and to use findings to adapt existing e-health interoperability models. Following a design science approach, this research involved conducting an exploratory survey among 90 medical and Information Technology personnel from 67 health facilities in Uganda. Findings were used to derive requirements for e-health interoperability, and to orchestrate elements of a service oriented framework for developing interoperable e-health systems in a low-income country (SOFIEH). A service-oriented approach yields reusable, flexible, robust, and interoperable services that support communication through well-defined interfaces. SOFIEH was evaluated using structured walkthroughs, and findings indicate that it scored well regarding applicability, usability, and understandability

Adaptive software architecture based on confident HCI for the deployment of sensitive services in smart homes

Smart spaces foster the development of natural and appropriate forms of human-computer interaction by taking advantage of home customization. The interaction potential of the Smart Home, which is a special type of smart space, is of particular interest in fields in which the acceptance of new technologies is limited and restrictive. The integration of smart home design patterns with sensitive solutions can increase user acceptance. In this paper, we present the main challenges that have been identified in the literature for the successful deployment of sensitive services (e.g., telemedicine and assistive services) in smart spaces and a software architecture that models the functionalities of a Smart Home platform that are required to maintain and support such sensitive services. This architecture emphasizes user interaction as a key concept to facilitate the acceptance of sensitive services by end-users and utilizes activity theory to support its innovative design. The application of activity theory to the architecture eases the handling of novel concepts, such as understanding of the system by patients at home or the affordability of assistive services. Finally, we provide a proof-of-concept implementation of the architecture and compare the results with other architectures from the literature