A solution for strong authentication in sensor-based healthcare environments / Uma solução de autenticação forte para ambientes de saúde baseados em sensores

Medical devices equipped with network interfaces, classified as sensors, transmit sensitive information over the network. This information need to be secured applying security mechaninsms, in order to mitigate vulnerabilities.  Because  of the vulnerabilities, strong means of authentication have been investigated. However, existing strong authentication solutions require user interaction, not respecting their individuality. This paper proposes a strong authentication solution on sensor-based healthcare environments in order to support the authentication process of patients with special needs. The authentication was based on a combination of two methods acquired from sensors  of a healthcare environment: biometrics and location. In addition, standardizations provided by ISO/IEC 27799 and SBIS was followed for a safe development.

Optimizing C-RAN Backhaul Topologies: A Resilience-Oriented Approach Using Graph Invariants

ABSTRACT: At the verge of the launch of the first commercial fifth generation (5G) system, trends in wireless and optical networks are proceeding toward increasingly dense deployments, supporting resilient interconnection for applications that carry higher and higher capacity and tighter latency requirements. These developments put increasing pressure on network backhaul and drive the need for a re-examination of traditional backhaul topologies. Challenges of impending networks cannot be tackled by star and ring approaches due to their lack of intrinsic survivability and resilience properties, respectively. In support of this re-examination, we propose a backhaul topology design method that formulates the topology optimization as a graph optimization problem by capturing both the objective and constraints of optimization in graph invariants. Our graph theoretic approach leverages well studied mathematical techniques to provide a more systematic alternative to traditional approaches to backhaul design. Specifically, herein, we optimize over some known graph invariants, such as maximum node degree, topology diameter, average distance, and edge betweenness, as well as over a new invariant called node Wiener impact, to achieve baseline backhaul topologies that match the needs for resilient future wireless and optical networks

Hepatitis D double reflex testing of all hepatitis B carriers in low-HBV- and high-HBV/HDV-prevalence countries

Hepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus (HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV infections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Accurate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This requires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive individuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

A management by delegation smart object aware system for the internet of things

The smart objects (SObjs) are numerous and will communicate directly through the Internet of Things (IoT). Such huge number of SObjs may lead the IoT to face severe network conditions, in terms of network congestion and large delays. Thus, the management of SObjs is fundamental to avoid future IoT network problems. In such a management, network boxes, also called gateways, have been configured to manage SObjs with software updates or reconfiguration followed by a warm start. However, gateways configuration become soon outdated because SObjs join and leave the network quite frequently. Therefore, we propose an approach called MbDSAS to reconfigure gateways without the need of a software updating or patching to manage and detect SObjs and deal with the dynamicity of the IoT network. An evaluation of MbDSAS was performed through an airport modeled scenario. In addition, MbDSAS was experimentally tested to be qualified as a management solution to IoT scenarios and to determine the best performance combination of technologies to implement MbDSAS. The results shown that MbDSAS has its performance improved when developed with an architecture based on resources and through the use of a module textit Open Service Gateway Initiative (OSGi). Mb- DSAS when compared to a traditional management system shows superior in terms of memory consumption and processing, being classified as an important solution for the managing of SObjs from the IoT.Os objetos inteligentes (SObjs) são numerosos e irão comunicar-se diretamente através da Internet das Coisas (IoT). Esse grande número de SObjs, pode levar a IoT a enfrentar severas condições de rede, em termos de congestionamento na rede e atrasos na comunicação fim-a-fim. Assim, o gerenciamento de SObjs torna-se fundamental para evitar futuros problemas da IoT. Em tal gerenciamento, switches, network-boxes e roteadores, também chamados de gateways, são configurados para gerenciar SObjs através de reconfigurações e atualizações de software seguidas por reinicializações nos gateways. Entretanto, a dinamicidade da IoT, causa a necessidade de se reconfigurar os gateways frequentemente, i.e., a configuração vigente dos gateways torna-se rapidamente desatualizadas por lidar a todo momento com a entrada e saída de novos SObjs da rede. Assim, propõe-se uma abordagem chamada Management by Delegation Smart Object Aware System (MbDSAS), para reconfigurar gateways e gerenciar SObjs, sem a necessidade de uma atualização de software ou aplicação de patches, lidando com a dinamicidade da rede IoT. MbDSAS foi prototipado e uma avaliação foi realizada, através de um cenário, onde o fluxo de dispositivos existentes se assemelha com o de um aeroporto. Em adição, MbDSAS foi testado experimentalmente, em termos de desempenho, para avaliar sua qualificação como uma solução de gerenciamento para cenários da IoT e determinar a melhor combinação de tecnologias para implementar essa solução. Os resultados encontrados mostram que MbDSAS desempenha melhor quando desenvolvida com uma arquitetura de acesso baseada em recursos e através do uso de um módulo Open Service Gateway initiative (OSGi). MbDSAS quando comparada a um sistema de gerenciamento tradicional, se mostra superior em termos de consumo de memória e processamento, se classificando como uma importante solução para o gerenciamento de SObjs da IoT

Da rede para o espectro : um sistema de tomada de decisçao baseado em SDN para H-CRAN

As redes de acesso a rádio heterogêneas baseadas em conceito de nuvem (H-CRAN) incorporam conceitos de redes heterogêneas (HetNet) e redes de acesso de rádio em nuvem (C-RAN) para serem utilizadas nas redes de celulares da próxima geração. H-CRAN explora a heterogeneidade das macro e pequenas células das HetNets, permitindo que as redes de celulares alcancem uma maior eficiência espectral. Já, os conceitos de C-RAN envolvendo unidades de banda base e cabeças de rádio remotas permitem que a H-CRAN insira um ponto de processamento centralizado nas redes de celulares, reduzindo os gastos de capital e operacionais. Embora H-CRAN traga várias oportunidades para as redes de celulares, sua adoção não é livre de desafios. Entre os diferentes desafios existentes, destacamos os mais relevantes, (a) alta interferência intercelular; (b) restrições de latência críticas no processamento de sinal sem fio de longa distância; e (c) má alocação de recursos de processamento. Para enfrentar esses desafios, propomos um sistema de decisão baseado em software-determinado por rede (SDN) capaz de ser modificado para criar decisões que possam diminuir a interferência, atender às restrições de atraso e mitigar a subutilização de processamento para o funcionamento a longo prazo de uma H-CRAN. Ao adicionar conceitos de SDN e uma API orientada a recursos (ROA) simplificada, é possível centralizar logicamente o controle de H-CRAN considerando um conjunto de equipamentos distribuídos fisicamente. A metodologia empregada para mostrar a viabilidade da abordagem proposta baseia-se no desenvolvimento de um protótipo que suporte uma ampla gama de algoritmos de decisão. Este protótipo foi avaliado em três estudos de caso realizados em um ambiente simulado com base na especificação 3GPP para simuladores. No primeiro estudo de caso, avaliamos a sobrecarga de rede implícita ao adicionar um sistema de decisão baseado em SDN para H-CRAN. Posteriormente, um algoritmo de decisão é executado para explorar o compartilhamento de recursos, decidindo quais elementos de uma H-CRAN podem ser utilizados por duas operadoras de forma intercambiável para reduzir a interferência e aumentar a eficiência espectral. O terceiro estudo de caso mostra que a distância entre nuvem e cabeças de rádio remotas deve ser considerada nas decisões de alocação de processamento. Ao avaliar cada um dos estudos de caso, fica evidente a necessidade de um sistema de decisão baseado em SDN em H-CRAN para atacar os desafios inerentes dessas redes.Heterogeneous Cloud Radio Access Networks (H-CRAN) incorporate Heterogeneous Networks (HetNet) and Cloud Radio Access Networks (C-RAN) concepts for next-generation cellular networks. H-CRAN exploits the heterogeneity of macro and small cells from Het- Net, enabling cellular networks to achieve a higher spectral efficiency. Meanwhile, concepts from C-RAN involving baseband units and remote radio heads enable H-CRAN to insert a centralized point of processing for cellular networks, reducing capital and operational expenditures. Although H-CRAN brings several opportunities to cellular networks, it is not free from challenges. Among the different challenges existent, we highlight the most relevant ones, (a) high intercell interference; (b) critical latency constraints in long-distance wireless signal processing; and (c) poor allocation of processing resources. To address these challenges, we propose a Software-Defined Networking (SDN)-based decision-making system able to be programmatically changed to make decisions that can decrease interference, meet delay constraints, and mitigate processing underusage for long-term operation of an H-CRAN. By adding concepts of SDN with a simplified object-oriented API, it is possible to logically centralize the control of H-CRAN considering a pool of physically distributed equipment. The methodology employed to show the feasibility of the proposed approach is based on the development of a prototype that supports a wide range of decision algorithms. This prototype was evaluated in three case studies conducted on a simulated environment based on 3GPP specification for simulators. In the first case study, we evaluate the network overload implied by adding an SDNbased decision-making system to H-CRAN. Afterwards, a decision algorithm is executed to exploit resource sharing deciding which elements of an H-CRAN can be used by two operators interchangeably to reduce interference and increase spectrum efficiency at the spectrum level. The third case study shows that the distance between cloud and remote radio heads must be considered in processing power allocation decisions and also when assigning a virtual baseband unit to the cloud. Evaluating the case studies becomes clear the need of an SDN-based decision-making system in H-CRAN to address the inherent challenges of these networks

Software-defined handover decision engine for heterogeneous cloud radio access networks

The current telecommunication infrastructure is reaching its limits, no longer able to cope with the ever-growing number of connected devices and data traffic summed to the future QoS demand of 5G. To overcome such limitations, the Heterogeneous Cloud Radio Access Network (H-CRAN) has been considered as a promising architecture that includes very dense Radio Access Networks (RAN) and the centralization of signal processing at baseband pools. In scenarios with severe constraints and very dynamic network conditions, mobile users may face poor handover (HO) performance. Therefore, in this paper, we propose a novel combination between Software-Defined Wireless Networking (SDWN) and Software-Defined Handover Decision Engine (SDHDE) to approach optimal HO performance in H-CRAN. In particular, in the baseband pool, a wireless controller is used to receive HO information from the Southbound API communicating with the end-users at the RAN. The controllers publish this information to the SDHDE through the Northbound API, and SDHDE processes the HO decision for each user in an optimal manner. The reported simulation results demonstrate the improvements that our approach can achieve, mainly regarding smaller HO percentage failure and increased throughput

Submental Endotracheal Intubation: A Valuable Resource for the Management of Panfacial Fractures

Modern techniques for surgical treatment of midfacial and panfacial fractures in maxillofacial trauma lead to special problems for airway management. Usually, in perioperative management of panfacial fractures, the surgeon needs to control the dental occlusion and nasal pyramid assessment. For these reasons, oral and nasal endotracheal intubations are contraindicated for the management of panfacial fractures. Tracheotomy is considered by many as the preferred route for airway management in patients with severe maxillofacial fractures, but there are often perioperative and postoperative complications concerning this technique. The submental route for endotracheal intubation has been proposed as an alternative to tracheotomy in the surgical management of patients with panfacial fractures, besides it is accompanied by low morbidity. Thus, this paper aimed to describe the submental endotracheal intubation technique in a patient experiencing panfacial fracture. The subject was well treated using the submental endotracheal intubation to get good reconstruction of the fractures because the authors obtained free access of all facial fractures.2361851185