Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education

Background Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient’s TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Methods Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO’s standard for information security risk management. Results A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Conclusions Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.publishedVersio

Immunohistochemical expression of epithelial and stromal immunomodulatory signalling molecules is a prognostic indicator in breast cancer

<p>Abstract</p> <p>Background</p> <p>The immune system has paradoxical roles during cancer development and the prognostic significance of immune modulating factors is controversial. The aim of this study was to determine the expression of cyclooxygenase 2 (COX-2), transforming growth factor-beta (TGF- beta), interleukin-10 (IL-10) and their prognostic significance in breast cancers. Ki67 was included as a measure of growth fraction of tumor cells.</p> <p>Methods</p> <p>On immunohistochemical stained slides from 38 breast cancer patients, we performed digital video analysis of tumor cell areas and adjacent tumor stromal areas from the primary tumors and their corresponding lymph node metastases. COX-2 was recorded as graded staining intensity.</p> <p>Results</p> <p>The expression of TGF-beta, IL-10 and Ki67 were recorded in tumor cell areas and adjacent tumor stromal areas. In both primary tumors and metastases, the expression of COX-2 was higher in the tumor stromal areas than in the tumor cell areas (both <it>P </it>< 0.001). High stromal staining intensity in the primary tumors was associated with a 3.9 (95% CI 1.1-14.2) times higher risk of death compared to the low staining group (<it>P </it>= 0.036). The expression of TGF-beta was highest in the tumor cell areas of both primary tumors and metastases (both <it>P </it>< 0.001). High stromal expression of TGF-beta was associated with increased mortality. For IL-10, the stromal expression was highest in the primary tumors (<it>P </it>< 0.001), whereas in the metastases the expression was highest in tumor cell areas (<it>P </it>< 0.001). High IL-10 expression in tumor- and stromal cell areas of primary tumors predicted mortality. Ki67 was higher expressed in tumor stromal areas of the metastases, and in tumor cell areas of the primary tumors (<it>P </it>< 0.001). Ki67 expression in tumor cell areas and stromal areas of the metastases was independently associated with breast cancer mortality.</p> <p>Conclusions</p> <p>Stromal expression of COX-2, TGF-beta and Ki67 may facilitate tumor progression in breast cancer.</p

Three-dimensional Ultrasound Volume Measurements in an Aortic Aneurysm Model

Measuring the aneurysm sac’s size is vital in postoperative surveillance following endovascular treatment of aortic aneurysms.  A three-dimensional ultrasound technique may enable accurate volume measurements.  However, there is no validation of any commercially   available electro-mechanical 3D ultrasound equipment or of the software used when measuring the volume of the aortic aneurysm sac. This investigation used a phantom model to study a three-dimensional ultrasound technique on aortic aneurysm sac volume measurements.  High volume measurement accuracy indicates that this method may be useful for postoperative surveillance following endovascular aortic aneurysm operations.  These results must be confirmed in clinical studies

Early ontogeny of the lesser sandeel (Ammodytes marinus)

Background Lesser sandeel (Ammodytes marinus) is widely distributed in North Sea ecosystems. Sandeel acts as a critical trophic link between zooplankton and top predators (fish, mammals, sea birds). Because they live buried in the sand, sandeel may be directly affected by the rapid expansion of anthropogenic activities linked to their habitat on the sea bottom (e.g., hydrocarbon extraction, offshore renewable energy, and subsea mining). It is, therefore, important to understand the impact of cumulative environmental and anthropogenic stressors on this species. A detailed description of the ontogenetic timeline and developmental staging for this species is lacking limiting the possibilities for comparative developmental studies assessing, e.g., the impact of various environmental stressors. Results A detailed description of the morphological development of lesser sandeel and their developmental trajectory, obtained through visual observations and microscopic techniques, is presented. Methods for gamete stripping and intensive culture of the early life stages are also provided. Conclusion This work provides a basis for future research to understand the effect of cumulative environmental and anthropogenic stressors on development in the early life stages of lesser sandeel.publishedVersio

Low bone mineral density is a significant risk factor for low-energy distal radius fractures in middle-aged and elderly men: A case-control study

Peer reviewe

Kunnskapsstatus for havsil i norsk sone av Nordsjøen

Tobis eller havsil er en nøkkelart i økosystemet i Nordsjøen, og viktige gyte- og leveområder for havsil er identifisert som særlig verdifulle og sårbare områder (SVO) i Nordsjøen. Rapporten oppsummerer eksisterende kunnskap og kunnskapshull om havsil (Ammodytes marinus) som er den dominerende silarten (tobisarten) i norsk sone av Nordsjøen og langs kysten av Norge. Havsilen har en viktig nøkkelrolle i disse økosystemene som mat til mange fiskearter, sjøpattedyr og sjøfugl. Etter en dramatisk nedgang i bestanden i norsk sone av Nordsjøen i begynnelsen av 2000-tallet har bestanden blitt stadig større de siste fem årene, og fremgangen sees i sammenheng med fornuftig høstingsstrategi, områdebasert norsk tobisforvaltning og bedre rekrutteringsforhold. Bestandssituasjonen langs norskekysten er i stor grad ukjent, men rapporten viser til en generell kraftig nedgang sammenlignet med 1950-1960 tallet. I 2019 var rekrutteringen igjen svært god langs Vestlandskysten. Havsilen, som andre silarter, har et eiendommelig levesett og tilbringer store deler av livet nedgravd i sanden der oksygenforholdene er gode. I larvefasen spres larvene seg over større områder, men de slår seg ned i samme type habitat som foreldrene. Den sterke tilknyttingen til egnet habitattype medfører at havsilen etter bunnslåing er relativt stasjonær og er sårbar for habitatforringelse, klimaendringer og høyt lokalt fisketrykk.publishedVersio

Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study

<p>Abstract</p> <p>Background</p> <p>This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine.</p> <p>Methods</p> <p>We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time.</p> <p>Results</p> <p>All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions.</p> <p>Conclusions</p> <p>As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine may potentially facilitate a communication-based follow-up and improve safety within the home setting, making it easier to choose and live with home dialysis.</p

In situ recordings of large gelatinous spheres from NE Atlantic, and the first genetic confirmation of egg mass of Illex coindetii (Vérany, 1839) (Cephalopoda, Mollusca)

In total, 90 gelatinous spheres, averaging one meter in diameter, have been recorded from ~ 1985 to 2019 from the NE Atlantic Ocean, including the Mediterranean Sea, using citizen science. More than 50% had a dark streak through center. They were recorded from the surface to ~ 60–70 m depth, mainly neutrally buoyant, in temperatures between 8 and 24°C. Lack of tissue samples has until now, prohibited confirmation of species. However, in 2019 scuba divers secured four tissue samples from the Norwegian coast. In the present study, DNA analysis using COI confirms species identity as the ommastrephid broadtail shortfin squid Illex coindetii (Vérany, 1839); these are the first confirmed records from the wild. Squid embryos at different stages were found in different egg masses: (1) recently fertilized eggs (stage ~ 3), (2) organogenesis (stages ~ 17–19 and ~ 23), and (3) developed embryo (stage ~ 30). Without tissue samples from each and every record for DNA corroboration we cannot be certain that all spherical egg masses are conspecific, or that the remaining 86 observed spheres belong to Illex coindetii. However, due to similar morphology and size of these spheres, relative to the four spheres with DNA analysis, we suspect that many of them were made by I. coindetii.publishedVersio