Cyberthreats to Hospitals: Panacea, a Toolkit for People-Centric Cybersecurity

Healthcare organizations are an attractive target for cyber-attacks, because the digitization of health processes is emerging as a necessity. Healthcare is a rich source of valuable data and its defences are weak. The particular weakness of this domain is due to the high complexity and dynamism of the healthcare technological environment and to the fact that healthcare working environment has many characteristics that make human behaviour a cybersecurity hazard. Cyberattacks may have significant effects on the provision of health services. Concrete measures strengthening a healthcare setting must take into account number and diversity of hospital basic components and existing security policies. The purpose of this work is to present a cybersecurity toolkit for connected devices and people. Panacea toolkit supports hospitals performing preparedness activities for example: assessment of the nature and severity of a threat, identification of mitigation measures and adoption of mitigation strategies

Phishing simulation exercise in a large hospital: A case study

Background: Phishing is a major threat to the data and infrastructure of healthcare organizations and many cyberattacks utilize this socially engineered pathway. Phishing simulation is used to identify weaknesses and risks in the human defences of organizations. There are many factors influencing the difficulty of detecting a phishing email including fatigue and the nature of the deceptive message. Method: A major Italian Hospital with over 6000 healthcare staff performed a phishing simulation as part of its annual training and risk assessment. Three campaigns were launched at approx. 4-month intervals, to compare staff reaction to a general phishing email and a customized one. Results: The results show that customization of phishing emails makes them much more likely to be acted on. In the first campaign, 64% of staff did not open the general phish, significantly more than the 38% that did not open the custom phish. A significant difference was also found for the click rate, with significantly more staff clicking on the custom phish. However, the campaigns could not be run as intended, due to issues raised within the organization. Conclusions: Phishing simulation is useful but not without its limitations. It requires contextual knowledge, skill and experience to ensure that it is effective. The exercise raised many issues within the Hospital. Successful, ethical phishing simulations require coordination across the organization, precise timing and lack of staff awareness. This can be complex to coordinate. Misleading messages containing false threats or promises can cause a backlash from staff and unions. The effectiveness of the message is dependent on the personalization of the message to current, local events. The lessons learned can be useful for other hospitals

The role of reward-based motivation in motor learning and performance

Il comportamento umano \ue8 fortemente influenzato dalla motivazione che consente il perseguimento degli obiettivi sostenendo un'ispezione efficiente dell'ambiente circostante e consentendo l'esecuzione delle azioni motorie pi\uf9 convenienti per interagire con esso. La motivazione pu\uf2 essere manipolata con successo semplicemente somministrando rinforzi o punizioni in cambio di prestazioni comportamentali. Lo scopo di questa ricerca \ue8 stato quello di studiare come l'apprendimento di un modello comportamentale visuo-motorio possa essere influenzato da diversi contesti motivazionali. A questo scopo, abbiamo sviluppato un protocollo di training computerizzato in grado di indurre l'apprendimento di schemi motori specifici ed abbiamo esaminato le prestazioni in questa nuova attivit\ue0 in quattro diversi gruppi con differenti gradi di coinvolgimento motivazionale. I quattro protocolli adottati nei diversi gruppi sono stati: 1) senza alcun tipo di ricompensa o di informazioni sulla prestazione (Esperimento 1), 2) con un errore di retroazione, segnalando le prove con scarso rendimento (Esperimento 2), 3) con un incentivo monetario indicante la disponibilit\ue0 di un premio variabile in funzione dell\u2019accuratezza della prestazione nella prova che sarebbe seguita (Esperimento 3), 4) con un feedback monetario, offrendo una ricompensa variabile immediatamente dopo le prove con una performance accurata (Esperimento 4). La nuova attivit\ue0 visivo-motoria da apprendere consisteva nel muovere il dito indice sopra un potenziometro al fine di mantenere un cursore entro i confini di un percorso curvilineo che scorreva sulla schermo del computer. Il protocollo \ue8 stato caratterizzato da: 9 sedute di allenamento in giorni consecutivi, 3 sedute di ritenzione e 2 sessioni di test in tempi diversi dall'ultimo giorno di allenamento. In ogni sessione i partecipanti dovevano completare 160 prove. Negli esperimenti 3 e 4 i segnali di ricompensa venivano consegnati sia nel corso delle sessioni di allenamento che durante le sessioni di ritenzione. Nessun premio \ue8 stato consegnato durante le sessioni di test. Una prima analisi completa dei dati \ue8 stata effettuata attraverso l\u2019analisi della varianza a misure ripetute (ANOVA) con Esperimento (da 1 a 4) come fattore tra soggetti e sessione come fattore entro soggetti. Nel complesso, il \u201cTempo In\u201d (il tempo trascorso dal cursore all'interno del percorso in movimento) \ue8 aumentato notevolmente tra le sessioni, raggiungendo un plateau solo dopo 7 giorni dall'inizio dell\u2019allenamento. Confrontando a livello globale la prestazione tra gli esperimenti, \ue8 stato chiaro che i punteggi pi\uf9 alti sono stati ottenuti dai partecipanti nell\u2019Esperimento 4 ed i punteggi pi\uf9 bassi sono stati ottenuti nell'Esperimento 1. I nostri dati hanno mostrato che, con un alto impegno motivazionale, l\u2019apprendimento motorio sviluppato in precedenza ed i suoi effetti sono stati pi\uf9 duraturi rispetto alla condizione in cui non era presente alcun feedback. In linea con la natura traslazionale di questo progetto, il passo successivo sar\ue0 quello di elaborare nuovi protocolli di allenamento visuo-motorio, con feedback gratificanti, al fine di 1) promuovere un pi\uf9 veloce ed efficiente recupero delle funzioni visuo-motorie nei pazienti con ictus cerebrale, 2) aumentare l'energia motoria e, in questo modo, facilitare l'applicazione e l'efficacia della maggior parte dei programmi di riabilitazione con pazienti con malattia di Parkinson.Human behaviour is crucially driven by motivation, which allows the pursuit of goals by supporting an efficient inspection of the surrounding environment and by enabling execution of the more convenient motor actions to interact with it. Motivation can be successfully manipulated by simply delivering rewarding (or punishing) consequences in return to behavioural performance. The aim of this research was to study how the learning of a visuo-motor behavioural pattern may be influenced by different motivational contexts. To this purpose, we developed a computerized training protocol able to induce learning of specific motor patterns and examined performance in this new task in four different groups with different degrees of motivational engagement. The four protocols adopted in the different groups were: 1) without any kind of reward or feedback information (Experiment 1); 2) with an error feedback, signaling trials with poor performance (Experiment 2); 3) with a monetary incentive signaling the availability of a variable prize in turn for accurate performance in the forthcoming trial (Experiment 3); 4) with a monetary feedback, delivering a variable reward immediately after trials with an accurate performance (Experiment 4). The new visuo-motor task to be learned, required to move the index finger over a potentiometer in order to keep a cursor within the boundaries of a curvilinear path sliding across the computer screen. The protocol was characterized by: 9 sessions of training in consecutive days, 3 retention sessions and 2 test sessions at different time lags from the last training day. On each session participants had to complete 160 trials. In Experiments 3 and 4 reward signals were delivered during both training and retention sessions. No reward was delivered during the test sessions. A first, comprehensive data analysis was carried out through a repeated measures analysis of variance (ANOVA) with Experiment (1 to 4) as the between-subjects factor and Session as the within-subjects factor. Overall, Time In performance (the time spent by the cursor inside the moving path) increased significantly across sessions, reaching a plateau only after 7 days from the beginning of training. By comparing the overall level of performance across experiments it was clear that the highest scores were obtained by participants in Experiment 4 and the lowest scores were obtained in Experiment 1. Our data showed that, under high motivational engagement, motor learning developed earlier, and its effects were longer lasting compared to the condition in which no feedback was present. In line with the translational nature of this project, the next step will be to devise new protocols of visuo-motor training grounded on these findings, pivoting on the delivery of rewarding feedbacks 1) to promote faster and more efficient recovery of visuo-motor functions in patients with cerebral stroke 2) to increase motor energy and, in this way, facilitate the application and improve the efficacy of most rehabilitation programs with patients with Parkinson\u2019s disease

Slow-oscillatory Transcranial Direct Current Stimulation Modulates Memory in Temporal Lobe Epilepsy by Altering Sleep Spindle Generators: A Possible Rehabilitation Tool.

BACKGROUND: Temporal lobe epilepsy (TLE) is often associated with memory deficits. Given the putative role for sleep spindles memory consolidation, spindle generators skewed toward the affected lobe in TLE subjects may be a neurophysiological marker of defective memory. Slow-oscillatory transcranial direct current stimulation (sotDCS) during slow waves sleep (SWS) has previously been shown to enhance sleep-dependent memory consolidation by increasing slow-wave sleep and modulating sleep spindles. OBJECTIVE/HYPOTHESIS: To test if anodal sotDCS over the affected TL prior to a nap affects sleep spindles and whether this improves memory consolidation. METHODS: Randomized controlled cross-over study. 12 people with TLE underwent sotDCS (0.75 Hz; 0-250 \u3bcV, 30 min) or sham before daytime nap. Declarative verbal and visuospatial learning were tested. Fast and slow spindle signals were recorded by 256-channel EEG during sleep. In both study arms, electrical source imaging (ESI) localized cortical generators. Neuropsychological data were analyzed with general linear model statistics or the Kruskal-Wallis test (P or Z < 0.05), and neurophysiological data tested with the Mann-Whitney t test and binomial distribution test (P or Z < 0.05). RESULTS: An improvement in declarative (P = 0.05) and visuospatial memory performance (P = 0.048) emerged after sotDCS. SotDCS increased slow spindle generators current density (Z = 0.001), with a shift to the anterior cortical areas. CONCLUSIONS: Anodal sotDCS over the affected temporal lobe improves declarative and visuospatial memory performance by modulating slow sleep spindles cortical source generators. SotDCS appears a promising tool for memory rehabilitation in people with TLE