Securing the Internet of Healthcare

Cybersecurity, which includes the security of information technology (IT), is critical to ensuring that society trusts, and therefore can benefit from, modern technology. Problematically, though, rarely a day goes by without a news story related to how critical data has been exposed, exfiltrated, or otherwise inappropriately used or accessed as a result of supply chain vulnerabilities. From the Russian government’s campaign to influence the 2016 U.S. presidential election to the September 2017 Equifax breach of more than 140 million Americans’ credit reports, cyber risk has become a topic of conversation in boardrooms and the White House, on Wall Street and main street. But these discussions often miss the problems replete in the expansive supply chains on which many of these products and services we depend on are built; this is particularly true in the medical device context. The problem recently made national news with the voluntary recall of more than 400,000 pacemakers that were found to be vulnerable to hackers, necessitating a firmware update. This Article explores the myriad vulnerabilities in the supply chain for medical devices, investigates existing FDA cybersecurity and privacy regulations to identify any potential governance gaps, and suggests a path forward to boost cybersecurity due diligence for manufacturers by making use of new approaches and technologies, including blockchain

Advanced pressurization systems for cryogenic propellants Final report, 20 Nov. 1963 - 25 Jun. 1965

Optimized pressurization system for Apollo-type service module using cryogenic propellant

Substantial and sustained improvements in blood pressure, weight and lipid profiles from a carbohydrate restricted diet: an observational study of insulin resistant patients in primary care

Hypertension is the second biggest known global risk factor for disease after poor diet; perhaps lifestyle interventions are underutilized? In a previous small pilot study, it was found that a low carbohydrate diet was associated with significant improvements in blood pressure, weight, ‘deprescribing’ of medications and lipid profiles. We were interested to investigate if these results would be replicated in a larger study based in ‘real world’ GP practice. 154 patients with type 2 diabetes or impaired glucose tolerance were recruited into an observational cohort study in primary care. The effects of a low carbohydrate diet sustained for an average of two years (interquartile range 10–32 months) on cardiovascular risk factors were examined. Results demonstrate significant and substantial reductions in blood pressure (mean reduction of systolic BP 10.9 mmHg (interquartile range 0–22 mmHg) (p < 0.0001), mean reduction in diastolic BP 6.3 mmHg (interquartile range 0–12.8 mmHg) (p < 0.0001) and mean weight reduction of 9.5 Kg (interquartile range 5–13 Kg) (p < 0.0001) together with marked improvement in lipid profiles. This occurred despite a 20% reduction in anti-hypertensive medications. This novel and potentially highly effective dietary modification, done very cheaply alongside routine care, offers hope that should be tested in a large prospective trial

Commissioning and co‐production in health and care services in the United Kingdom and Ireland: An exploratory literature review

© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Introduction: This exploratory literature review seeks to examine the literature around commissioning processes in the co‐production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co‐production in service design and delivery? What are the contextual factors that influence these processes? Method: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008–2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty‐seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. Results: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co‐production; navigating relationships and the collective voice. Conclusion: Commissioning processes were commonly a barrier to the co‐production of health and care services. Though co‐production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer‐term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. Patient and Public Contribution: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement.Peer reviewe

The central density of a neutron star is unaffected by a binary companion at linear order in μ/R\mu/R

Recent numerical work by Wilson, Mathews, and Marronetti [J. R. Wilson, G. J. Mathews and P. Marronetti, Phys. Rev. D 54, 1317 (1996)] on the coalescence of massive binary neutron stars shows a striking instability as the stars come close together: Each star's central density increases by an amount proportional to 1/(orbital radius). This overwhelms any stabilizing effects of tidal coupling [which are proportional to 1/(orbital radius)^6] and causes the stars to collapse before they merge. Since the claimed increase of density scales with the stars' mass, it should also show up in a perturbation limit where a point particle of mass $\mu$ orbits a neutron star. We prove analytically that this does not happen; the neutron star's central density is unaffected by the companion's presence to linear order in $\mu/R$. We show, further, that the density increase observed by Wilson et. al. could arise as a consequence of not faithfully maintaining boundary conditions.Comment: 3 pages, REVTeX, no figures, submitted to Phys Rev D as a Rapid Communicatio

Securing the Internet of Healthcare

Cybersecurity, including the security of information technology (IT), is a critical requirement in ensuring society trusts, and therefore can benefit from, modern technology. Problematically, though, rarely a day goes by without a news story related to how critical data has been exposed, exfiltrated, or otherwise inappropriately used or accessed as a result of supply chain vulnerabilities. From the Russian government\u27s campaign to influence the 2016 U.S. presidential election to the September 2017 Equifax breach of more than 140-million Americans\u27 credit reports, mitigating cyber risk has become a topic of conversation in boardrooms and the White House, on Wall Street and Main Street. But oftentimes these discussions miss the problems replete in the often-expansive supply chains on which many of these products and services we depend on are built; this is particularly true in the medical device context. The problem recently made national news with the FDA-mandated recall of more than 400,000 pacemakers that were found to be vulnerable to hackers necessitating a firmware update. This Article explores the myriad vulnerabilities in the supply chain for medical devices, investigates existing FDA cybersecurity and privacy regulations to identify any potential governance gaps, and suggests a path forward to boost cybersecurity due diligence for manufacturers by making use of new approaches and technologies, including blockchain

Optimizing high-flow nasal cannula flow settings in adult hypoxemic patients based on peak inspiratory flow during tidal breathing

Cànula nasal d'alt flux; Hipoxèmia; Flux inspiratori màximCánula nasal de alto flujo; Hipoxemia; Flujo inspiratorio máximoHigh-flow nasal cannula; Hypoxemia; Peak inspiratory flowBackground Optimal flow settings during high-flow nasal cannula (HFNC) therapy are unknown. We investigated the optimal flow settings during HFNC therapy based on breathing pattern and tidal inspiratory flows in patients with acute hypoxemic respiratory failure (AHRF). Methods We conducted a prospective clinical study in adult hypoxemic patients treated by HFNC with a fraction of inspired oxygen (FIO2) ≥ 0.4. Patient’s peak tidal inspiratory flow (PTIF) was measured and HFNC flows were set to match individual PTIF and then increased by 10 L/min every 5–10 min up to 60 L/min. FIO2 was titrated to maintain pulse oximetry (SpO2) of 90–97%. SpO2/FIO2, respiratory rate (RR), ROX index [(SpO2/FIO2)/RR], and patient comfort were recorded after 5–10 min on each setting. We also conducted an in vitro study to explore the relationship between the HFNC flows and the tracheal FIO2, peak inspiratory and expiratory pressures. Results Forty-nine patients aged 58.0 (SD 14.1) years were enrolled. At enrollment, HFNC flow was set at 45 (38, 50) L/min, with an FIO2 at 0.62 (0.16) to obtain an SpO2/FIO2 of 160 (40). Mean PTIF was 34 (9) L/min. An increase in HFNC flows up to two times of the individual patient’s PTIF, incrementally improved oxygenation but the ROX index plateaued with HFNC flows of 1.34–1.67 times the individual PTIF. In the in vitro study, when the HFNC flow was set higher than PTIF, tracheal peak inspiratory and expiratory pressures increased as HFNC flow increased but the FIO2 did not change. Conclusion Mean PTIF values in most patients with AHRF were between 30 and 40 L/min. We observed improvement in oxygenation with HFNC flows set above patient PTIF. Thus, a pragmatic approach to set optimal flows in patients with AHRF would be to initiate HFNC flow at 40 L/min and titrate the flow based on improvement in ROX index and patient tolerance.This study does not have funding/support

Analysis of Chlamydia pneumoniae and AD-like Pathology in the Brains of BALB/c Mice Following Direct Intra-cranial Infection

Alzheimer’s disease (AD) is an age-related progressive neurodegenerative disorder and the most common form of dementia. The pathology in the central nervous system (CNS) impairs memory and cognition, hindering the capabilities and the quality of life of the individual. This project continues studying the role of infection and Alzheimer’s disease, as previous studies in this laboratory have done, and contributes to the overall understanding of the possible causes of this disease. In this study, BALB/c mice were infected, via direct intracranial injection, with a respiratory isolate (AR-39) of Chlamydia pneumoniae. Their brains were analyzed at 7 and 14 days post-infection, via immunohistochemistry, for the presence of C. pneumoniae, amyloid deposits and activated glial cells. The goal of this project was to measure the location and degree of C. pneumoniae burden, amyloid deposition and glial cell activation in the CNS following direct intracranial injection and to compare this data with results obtained from previous studies in this laboratory. We hypothesized that C. pneumoniae antigen and activated inflammatory cells will be observed in the infected mouse brains following direct intracranial injection and Aβ deposition will be observed in areas where inflammation occurs. C. pneumoniae, amyloid deposits and activated glial cells were detected in the brains following direct intracranial infection with C. pneumoniae. In infected mice there was an approximate 3.5-fold increase of C. pneumoniae antigen burden compared to uninfected mice at day 7 and there was an approximate 5.5-fold increase of C. pneumoniae antigen burden compared to uninfected mice at day 14. The burden of C. pneumoniae antigen, in the infected mice, increased 1.009-fold (no change) from day 7 to day 14 post-infection. The amyloid burden in infected mice increased approximately 3-fold compared to uninfected mice at day 7 and increased greater than10-fold compared to uninfected mice at day 14. The burden of amyloid, in the infected mice, increased 7-fold from day 7 to 14. From 7 to 14 days post-infection the C. pneumoniae and amyloid deposits located near the injection site spread distally from this location to other regions of the brain. Global activation of glia was observed in the CNS of infected mice at both 7 and 14 days post-infection. This data confirms that C. pneumoniae is capable of establishing an infection in the CNS. Although deposits were observed, the lack of a substantial amount of amyloid deposits suggested that the generation of deposits may require longer than 14 days following C. pneumoniae infection. As early as 7 days post-infection, inflammation is observed in response to the presence of C. pneumoniae and/or soluble amyloid in the CNS and the contribution of both infection with C. pneumoniae and the presence of soluble amyloid elicit the inflammatory response that presumably precedes and contributes to amyloid depositionhttps://digitalcommons.pcom.edu/posters/1003/thumbnail.jp