VOIP for Telerehabilitation: A Risk Analysis for Privacy, Security, and HIPAA Compliance

Voice over the Internet Protocol (VoIP) systems such as Adobe ConnectNow, Skype, ooVoo, etc. may include the use of software applications for telerehabilitation (TR) therapy that can provide voice and video teleconferencing between patients and therapists.  Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by information technologists, providers of care, and other health care entities. This paper develops a privacy and security checklist that can be used within a VoIP system to determine if it meets privacy and security procedures and whether it is HIPAA compliant. Based on this analysis, specific HIPAA criteria that therapists and health care facilities should follow are outlined and discussed, and therapists must weigh the risks and benefits when deciding to use VoIP software for TR. 

VOIP for Telerehabilitation: A Risk Analysis for Privacy, Security and HIPAA Compliance: Part II

In a previous publication the authors developed a privacy and security checklist to evaluate Voice over the Internet Protocol (VoIP) videoconferencing software used between patients and therapists to provide telerehabilitation (TR) therapy.  In this paper, the privacy and security checklist that was previously developed is used to perform a risk analysis of the top ten VoIP videoconferencing software to determine if their policies provide answers to the privacy and security checklist. Sixty percent of the companies claimed they do not listen into video-therapy calls unless maintenance is needed. Only 50% of the companies assessed use some form of encryption, and some did not specify what type of encryption was used. Seventy percent of the companies assessed did not specify any form of auditing on their servers. Statistically significant differences across company websites were found for sharing information outside of the country (p=0.010), encryption (p=0.006), and security evaluation (p=0.005). Healthcare providers considering use of VoIP software for TR services may consider using this privacy and security checklist before deciding to incorporate a VoIP software system for TR.  Other videoconferencing software that is specific for TR with strong encryption, good access controls, and hardware that meets privacy and security standards should be considered for use with TR.Keywords: Voice over the Internet Protocol (VOIP), telerehabilitation, HIPAA, privacy, security, evaluatio

Global analysis of community-associated methicillin-resistant Staphylococcus aureus exoproteins reveals molecules produced in vitro and during infection

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a threat to human health worldwide. Although progress has been made, mechanisms of CA-MRSA pathogenesis are poorly understood and a comprehensive analysis of CA-MRSA exoproteins has not been conducted. To address that deficiency, we used proteomics to identify exoproteins made by MW2 (USA400) and LAC (USA300) during growth in vitro. Two hundred and fifty unique exoproteins were identified by 2-dimensional gel electrophoresis coupled with automated direct infusion-tandem mass spectrometry (ADI-MS/MS) analysis. Eleven known virulence-related exoproteins differed in abundance between the strains, including alpha-haemolysin (Hla), collagen adhesin (Cna), staphylokinase (Sak), coagulase (Coa), lipase (Lip), enterotoxin C3 (Sec3), enterotoxin Q (Seq), V8 protease (SspA) and cysteine protease (SspB). Mice infected with MW2 or LAC produced antibodies specific for known or putative virulence factors, such as autolysin (Atl), Cna, Ear, ferritin (Ftn), Lip, 1-phosphatidylinositol phosphodiesterase (Plc), Sak, Sec3 and SspB, indicating the exoproteins are made during infection in vivo. We used confocal microscopy to demonstrate aureolysin (Aur), Hla, SspA and SspB are produced following phagocytosis by human neutrophils, thereby linking exoprotein production in vitro with that during host–pathogen interaction. We conclude that the exoproteins identified herein likely account in part for the success of CA-MRSA as a human pathogen

Upfront intensive chemo-immunotherapy with autograft in 199 adult mantle cell lymphoma patients : prolonged survival and cure potentiality at long term

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SGLT2 inhibition reprograms systemic metabolism via FGF21-dependent and -independent mechanisms

Pharmacologic inhibition of the renal sodium/glucose cotransporter-2 induces glycosuria and reduces glycemia. Given that SGLT2 inhibitors (SGLT2i) reduce mortality and cardiovascular risk in type 2 diabetes, improved understanding of molecular mechanisms mediating these metabolic effects is required. Treatment of obese but nondiabetic mice with the SGLT2i canagliflozin (CANA) reduces adiposity, improves glucose tolerance despite reduced plasma insulin, increases plasma ketones, and improves plasma lipid profiles. Utilizing an integrated transcriptomic-metabolomics approach, we demonstrate that CANA modulates key nutrient-sensing pathways, with activation of 5\u2032 AMP-activated protein kinase (AMPK) and inhibition of mechanistic target of rapamycin (mTOR), independent of insulin or glucagon sensitivity or signaling. Moreover, CANA induces transcriptional reprogramming to activate catabolic pathways, increase fatty acid oxidation, reduce hepatic steatosis and diacylglycerol content, and increase hepatic and plasma levels of FGF21. Given that these phenotypes mirror the effects of FGF21 to promote lipid oxidation, ketogenesis, and reduction in adiposity, we hypothesized that FGF21 is required for CANA action. Using FGF21-null mice, we demonstrate that FGF21 is not required for SGLT2i-mediated induction of lipid oxidation and ketogenesis but is required for reduction in fat mass and activation of lipolysis. Taken together, these data demonstrate that SGLT2 inhibition triggers a fasting-like transcriptional and metabolic paradigm but requires FGF21 for reduction in adiposity

MSCRAMM-targeted vaccines and immunotheraphy for staphylococcal infection.

Hospital-acquired infections are associated with prolonged hospitalization and an increase in both healthcare costs and resources. Advances in sophisticated medical procedures, an increase in the number of immunocompromised patients, and the continued emergence of resistance to conventional antibiotic therapy has created a need for alternative strategies to prevent and treat infectious bacterial diseases. Immunoprevention and immunotherapy targeting microbial surface components recognizing adhesive matrix molecule (MSCRAMM) proteins are viable approaches to potentially impede bacterial adherence, eliminate colonization, and minimize hematogenous dissemination, thereby halting the inception and progression of infection. This review summarizes several investigative efforts where staphylococcal MSCRAMM proteins are being utilized in the design of subunit vaccines and in the development of innovative therapeutic strategies that could be implemented following the onset of infection to manage severe and life-threatening disease