Assessing The Security Posture Of Openemr Using Capec Attack Patterns

Attack patterns describe the common methods of exploiting software. Good software engineering practices and principles alone are not enough to produce secure software. It is also important to know how software it attacked and to guard against it. Knowledge of attack patterns provides a good perspective of an attacker, thus enabling developers and testers to build secure software. CAPEC list is a taxonomy of attack patterns which we believe can enhance security testing. This research seeks to assess the security posture of OpenEMR 4.1.1, an open source Electronic Medical Record (EMR) system, based on CAPEC attack patterns. Five categories of CAPEC attack patterns were analyzed to find their relevance and applicability to OpenEMR. Whereas inapplicable attack patterns were not further considered, applicable attack patterns were further tested to assess OpenEMR vulnerability to them. Various security testing tools were used to carry out the tests. Attack patterns helped to focus black-box and white-box testing procedures on what and where to test. OpenEMR was found to be vulnerable to a number of vulnerabilities such as cross site scripting, authentication bypass, session sidejacking, among others. A number of exploitations were carried out based on the vulnerabilities discovered

Oesphageal Stenting for palliation of malignant mesothelioma

Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents

How does transit-oriented development affect a neighborhood?: A look into gentrification and displacement

Master of Regional and Community PlanningDepartment of Landscape Architecture/Regional and Community PlanningGregory NewmarkThe construction of light rail transit lines accompanied by transit-oriented developments improves neighborhoods and makes them attractive and desirable. These developments can also cause property values and rents to go up, making it difficult for low-income residents to stay, which can cause transit-oriented gentrification, as identified by some studies. Historically, low-income households have benefited from living close to station areas since they get cheap and easy accessibility to places. Hence, the vulnerable, including low-income households, adults with lower levels of education, and historically marginalized races, remain at risk of displacement when there is a socio-economic change to a more affluent group around these station areas. Previous studies have always sort to identify gentrification and displacement in low-income and dominated historically marginalized race neighborhoods. However, there have been a lot of challenges for researchers finding the right data and methods to measure gentrification and displacement. This study using simple local percentage share identifies gentrification and displacement in a moderate-to-high income white dominated neighborhood along the Southwest Light Rail Line in the Denver area. The study also tries to identify if the few vulnerable people in the neighborhood are displaced after a new transit development is introduced. The study adopts a pretest-posttest analysis to predict if the corridor undergoes gentrification before the construction of the LRT or after it is built. The study spans from 1990 to 2018 with analysis on changes in 1990-2000, 2000-2010, and 2010-2016. Two methods using simple quantitative analyses like percentage change, local percentage share, absolute figures, and location quotient are employed in this study. The first method uses the conventional method to identify gentrification, which scholars like Freeman (2005) and Chapple et al. (2017) have also used. The conventional method showed that the corridor was susceptible to gentrification through the study period but did not find the area to be gentrifying though there were signs of it. The flaw of the method ignoring the local shift from previous years influenced the adoption of the local share method. The local share method rather showed that the corridor gentrified in the 2010-2016 decennial period. The local share method identified gentrification by showing that the there is a five percentage point changes in the share of low-income households; share of adults with high school certificates or lower; the share of multi-family units; and the percentage increase of rent from the previous period. The study shows the share of adults with high school certificates or lower continuously reduced from 50% to 27% by the end of the study. Also, it was observed that before the construction of the LRT line in 2000, rents reduced to $785 but increased exponentially after the line was built to$1332. The study observed that, the share of new houses and multi-family units begun to increase after the opening of the line. The share of low-income households at the end of the study remained the same as the beginning, whiles the share of high-income households increased by 7 percentage points at the end of the study. No evidence of displacement was observed among non-white race and low-income households along the corridor. However, the reduction in the share of adults with high school certificates or lower and low-income households, whiles those with some college education and middle-income households remained the same, shows that there were some forms of displacement. This study also shows that in unique places like Denver, the conventional method of identifying gentrification and displacement does not show the true characteristics of transit induced gentrification as the local share method does. Also, the study shows that the construction of a new transit infrastructure may not be so hostile to historically marginalized races and sometimes bring about racial diversity as observed along the LRT corridor

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)—a study protocol

Introduction: Cardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a reduction in cardiac mortality and recurrent myocardial infarction. This trial assesses the feasibility of a home-based CR programme delivered using a mobile application (app).Methods: The Rehabilitation through Exercise prescription for Cardiac patients using an Artificial intelligence web-based Programme (RECAP) randomised controlled feasibility trial is a single-centre prospective study, in which patients will be allocated on a 1:1 ratio to a home-based CR programme delivered using a mobile app with accelerometers or standard hospital-based rehabilitation classes. The home-based CR programme will employ artificial intelligence to prescribe exercise goals to the participants on a weekly basis. The trial will recruit 70 patients in total. The primary objectives are to evaluate participant recruitment and dropout rates, assess the feasibility of randomisation, determine acceptability to participants and staff, assess the rates of potential outcome measures and determine hospital resource allocation to inform the design of a larger randomised controlled trial for clinical efficacy and health economic evaluation. Secondary objectives include evaluation of health-related quality of life and 6 minute walk distance.Ethics and dissemination: RECAP trial received a favourable outcome from the Berkshire research ethics committee in September 2022 (IRAS 315483)

A survey of minimally invasive cardiac surgery during the COVID-19 pandemic

BACKGROUND: Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. METHODS: An online questionnaire was designed through the ‘googleforms’ platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. RESULTS: There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). CONCLUSION: Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics

Feasibility study of early outpatient review and early cardiac rehabilitation after cardiac surgery: mixed-methods research design-a study protocol.

INTRODUCTION: Following cardiac surgery, patients currently attend an outpatient review 6 weeks after hospital discharge, where recovery is assessed and suitability to commence cardiac rehabilitation (CR) is determined. CR is then started from 8 weeks. Following a median sternotomy, cardiac surgery patients are required to refrain from upper body exercises, lifting of heavy objects and other strenuous activities for 12 weeks. A delay in starting CR can prolong the recovery process, increase dependence on family/carers and can cause frustration. However, current guidelines for activity and exercise after median sternotomy have been described as restrictive, anecdotal and increasingly at odds with modern clinical guidance for CR. This study aims to examine the feasibility of bringing forward outpatient review and starting CR earlier. METHODS AND ANALYSES: This is a multicentre, randomised controlled, open feasibility trial comparing postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control arm) versus, postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention arm). The study aims to recruit 100 eligible patients, aged 18-80 years who have undergone elective or urgent cardiac surgery involving a full median sternotomy, over a 7-month period across two centres. Feasibility will be measured by consent, recruitment, retention rates and attendance at appointments and CR sessions. Qualitative interviews with trial participants and staff will explore issues around study processes and acceptability of the intervention and the findings integrated with the feasibility trial outcomes to inform the design of a future full-scale randomised controlled trial. ETHICS AND DISSEMINATION: Ethics approval was granted by East Midlands-Derby Research Ethics Committee on 10 January 2019. The findings will be presented at relevant conferences disseminated via peer-reviewed research publications, and to relevant stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN80441309

Efficacy and safety of carbon dioxide insufflation for brain protection for patients undergoing planned left-sided open heart valve surgery:protocol for a multicentre, placebo-controlled, blinded, randomised controlled trial (the CO2 Study)

Introduction: Brain injury is common following open heart valve surgery. Carbon dioxide insufflation (CDI) has been proposed to reduce the incidence of brain injury by reducing the number of air microemboli entering the bloodstream in surgery. The CO2 Study will evaluate the efficacy and safety of CDI in patients undergoing planned left-sided open heart valve surgery. Methods and analysis: The CO2 Study is a multicentre, blinded, placebo-controlled, randomised controlled trial. Seven-hundred and four patients aged 50 years and over undergoing planned left-sided heart valve surgery will be recruited to the study, from at least eight UK National Health Service hospitals, and randomised in a 1:1 ratio to receive CDI or medical air insufflation (placebo) in addition to standard de-airing. Insufflation will be delivered at a flow rate of 5 L/min from before the initiation of cardiopulmonary bypass until 10 min after cardiopulmonary bypass weaning. Participants will be followed up until 3 months post-surgery. The primary outcome is acute ischaemic brain injury within 10 days post-surgery based on new brain lesions identified with diffusion-weighted MRI or clinical evidence of permanent brain injury according to the current definition of stroke. Ethics and dissemination: The study was approved by the East Midlands–Nottingham 2 Research Ethics Committee in June 2020 and the Medicines and Healthcare products Regulatory Agency in May 2020. All participants will provide written informed consent prior to undertaking any study assessments. Consent will be obtained by the principal investigator or a delegated member of the research team who has been trained in the study and undergone Good Clinical Practice training. Results will be disseminated through peer-reviewed publications and presentations at national and international meetings. Study participants will be informed of results through study notifications and patient organisations. Trial registration number: ISRCTN30671536