A Novel Deep Learning Strategy for Classifying Different Attack Patterns for Deep Brain Implants

Deep brain stimulators (DBSs), a widely used and comprehensively acknowledged restorative methodology, are a type of implantable medical device which uses electrical stimulation to treat neurological disorders. These devices are widely used to treat diseases such as Parkinson, movement disorder, epilepsy, and psychiatric disorders. Security in such devices plays a vital role since it can directly affect the mental, emotional, and physical state of human bodies. In worst-case situations, it can even lead to the patient's death. An adversary in such devices, for instance, can inhibit the normal functionality of the brain by introducing fake stimulation inside the human brain. Nonetheless, the adversary can impair the motor functions, alter impulse control, induce pain, or even modify the emotional pattern of the patient by giving fake stimulations through DBSs. This paper presents a deep learning methodology to predict different attack stimulations in DBSs. The proposed work uses long short-term memory, a type of recurrent network for forecasting and predicting rest tremor velocity. (A type of characteristic observed to evaluate the intensity of the neurological diseases) The prediction helps in diagnosing fake versus genuine stimulations. The effect of deep brain stimulation was tested on Parkinson tremor patients. The proposed methodology was able to detect different types of emulated attack patterns efficiently and thereby notifying the patient about the possible attack. - 2013 IEEE.This work was supported by the Qatar National Research Fund (a member of Qatar Foundation) through NPRP under Grant 8-408-2-172.Scopu

Cybersecurity of multi-cloud healthcare systems: A hierarchical deep learning approach

With the increase in sophistication and connectedness of the healthcare networks, their attack surfaces and vulnerabilities increase significantly. Malicious agents threaten patients’ health and life by stealing or altering data as it flows among the multiple domains of healthcare networks. The problem is likely to exacerbate with the increasing use of IoT devices, edge, and core clouds in the next generation healthcare networks. Presented in this paper is MUSE, a system of deep hierarchical stacked neural networks for timely and accurate detection of malicious activity that leads to alteration of meta-information or payload of the dataflow between the IoT gateway, edge and core clouds. Smaller models at the edge clouds take substantially less time to train as compared to the large models in the core cloud. To improve the speed of training and accuracy of detection of large core cloud models, the MUSE system uses a novel method of merging and aggregating layers of trained edge cloud models to construct a partly pre-trained core cloud model. As a result, the model in the core cloud takes substantially smaller number of epochs (6 to 8) and, consequently, less time, compared to those in the edge clouds, training of which take 35 to 40 epochs to converge. With the help of extensive evaluations, it is shown that with the MUSE system, large, merged models can be trained in significantly less time than the unmerged models that are created independently in the core cloud. Through several runs it is seen that the merged models give on an average 26.2% reduction in training times. From the experimental evaluation we demonstrate that along with fast training speeds the merged MUSE model gives high training and test accuracies, ranging from 95% to 100%, in detection of unknown attacks on dataflows. The merged model thus generalizes very well on the test data. This is a marked improvement when compared with the accuracy given by un-merged model as well as accuracy reported by other researchers with newer datasets

Engineering students' readiness to transition to emergency online learning in response to COVID-19: Case of Qatar

This study examined engineering students' initial readiness to transition to emergency online learning in response to COVID-19 in Qatar. A theoretical framework is proposed for understanding the factors influencing students' readiness for change. Sequential explanatory mixed-method research was conducted, with 140 participants completing an online survey, of which 68 also contributed written reflections and 8 participated in semi-structured interviews. Exploratory factor analysis displayed a four-factor structure, including initial preparedness and motivation for online learning, self-efficacy beliefs about online learning, self-directed learning online, and support. The qualitative outcomes supported the four factors and provided further insight into their varied and nuanced manifestation. In accounting for the perceived impact of the factors on readiness, significant differences were identified regarding pedagogical mode, with students enrolled in PBL courses reporting higher readiness than those from non-PBL courses. The practical implications for preparing students for future emergency online learning are discussed. 2020 by the authors.Scopu

Demystifying Smoker's Paradox: A Propensity Score-Weighted Analysis in Patients Hospitalized With Acute Heart Failure.

Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in-hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52-0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31-0.70) covariate adjustment. With the propensity score-derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36-1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.Gulf CARE (Gulf Acute Heart Failure Registry) is an investigator- initiated study conducted under the auspices of the Gulf Heart Association and funded by Servier, Paris, France; and (for centers in Saudi Arabia), by the Saudi Heart Association (The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia [research group number: RG -1436- 013]). This does not alter our adherence to policies on sharing data and materials; and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The publication of this article was funded by the Qatar National Library

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

Aims: Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results: From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions: A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.Gulf CARE is an investigator-initiated study conducted under the auspices of the Gulf Heart Association and funded by Servier, Paris, France, and (for centres in Saudi Arabia) by the Saudi Heart Association [The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research Group Number RG-1436-013)]. This does not alter our adherence to policies on sharing data and materials, and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The UN Convention on the Rights of Persons with Disabilities from a Qatari Human Rights Perspective

For a long time disability was considered a question of social development, outside the responsibilities of official human rights institutions. Over the last three decades this approach has evolved, and disability is now viewed in terms of human rights, a change that has received important support from the United Nations and its Convention on the Rights of Persons with Disabilities (CRPD) of 2006. Qatar ratified the CRPD in 2008. The main purposes of the CRPD are "to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity". The CRPD embodies the philosophy of the social model of disability; that is, the idea that an individual's disability is largely the product of a social order in which someone who is different does not fit in. This is clear in the Convention's definition of disability and in its guiding principles of non-discrimination, universal accessibility and legal capacity, inclusion and diversity. In its journey towards implementing the CRPD, Qatar will likely face challenges common to all signatory countries: the philosophical questioning of the Convention's theoretical framework, as well as objections from traditional legal theorists to the Convention's doctrine. The challenges to the theoretical basis of the Convention will likely converge around philosophical doubts regarding adopting the social model of disability as a new paradigm and concerns that such a model is impossible to implement. The doctrinal legal objections are most often linked to the relative difficulty of applying international mandates to domestic laws. In addition, the rights of persons with disabilities are often considered economic, social and cultural rights, which are provided for depending on the resources actually available; those rights are often not viewed as individual, civil and political rights under the human rights statute, independent of the fact that they need an action or an abstention from the state. Finally, traditional legal doctrine holds that individual legal capacity requires full mental competence as a pre-requisite. The CRPD, instead, advances a model of assisted capacity; this means that a degree of legal capacity is recognized in each individual according to his or her condition. The individual receives assistance in making decisions, while in the classical doctrine the individual is substituted altogether by a guardian. Other challenges to full CRPD implementation are more specific to Qatar. Qatar has traditionally conceived disability as a medical problem of the individual, who is given support and rehabilitation. The legal framework approaches disability from that perspective, and the medical model seems to be deeply rooted in Qatar. Disability is presented as a problem of individuals with special needs that must be corrected, rectified or tempered by providing as much support as possible. This is not the model of the Convention, and Qatari legislation must be brought into the fold of the social and human rights model in order to be compliant with the CRPD's mandate.qscienc

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries