SAFECAR: A Brain–Computer Interface and intelligent framework to detect drivers’ distractions

As recently reported by the World Health Organization (WHO), the high use of intelligent devices such as smartphones, multimedia systems, or billboards causes an increase in distraction and, consequently, fatal accidents while driving. The use of EEG-based Brain–Computer Interfaces (BCIs) has been proposed as a promising way to detect distractions. However, existing solutions are not well suited for driving scenarios. They do not consider complementary data sources, such as contextual data, nor guarantee realistic scenarios with real-time communications between components. This work proposes an automatic framework for detecting distractions using BCIs and a realistic driving simulator. The framework employs different supervised Machine Learning (ML)-based models on classifying the different types of distractions using Electroencephalography (EEG) and contextual driving data collected by car sensors, such as line crossings or objects detection. This framework has been evaluated using a driving scenario without distractions and a similar one where visual and cognitive distractions are generated for ten subjects. The proposed framework achieved 83.9% -score with a binary model and 73% with a multiclass model using EEG, improving 7% in binary classification and 8% in multi-class classification by incorporating contextual driving into the training dataset. Finally, the results were confirmed by a neurophysiological study, which revealed significantly higher voltage in selective attention and multitasking

Mitigating Communications Threats in Decentralized Federated Learning through Moving Target Defense

The rise of Decentralized Federated Learning (DFL) has enabled the training of machine learning models across federated participants, fostering decentralized model aggregation and reducing dependence on a server. However, this approach introduces unique communication security challenges that have yet to be thoroughly addressed in the literature. These challenges primarily originate from the decentralized nature of the aggregation process, the varied roles and responsibilities of the participants, and the absence of a central authority to oversee and mitigate threats. Addressing these challenges, this paper first delineates a comprehensive threat model, highlighting the potential risks of DFL communications. In response to these identified risks, this work introduces a security module designed for DFL platforms to counter communication-based attacks. The module combines security techniques such as symmetric and asymmetric encryption with Moving Target Defense (MTD) techniques, including random neighbor selection and IP/port switching. The security module is implemented in a DFL platform called Fedstellar, allowing the deployment and monitoring of the federation. A DFL scenario has been deployed, involving eight physical devices implementing three security configurations: (i) a baseline with no security, (ii) an encrypted configuration, and (iii) a configuration integrating both encryption and MTD techniques. The effectiveness of the security module is validated through experiments with the MNIST dataset and eclipse attacks. The results indicated an average F1 score of 95%, with moderate increases in CPU usage (up to 63.2% +-3.5%) and network traffic (230 MB +-15 MB) under the most secure configuration, mitigating the risks posed by eavesdropping or eclipse attacks

Decentralized Federated Learning: Fundamentals, State-of-the-art, Frameworks, Trends, and Challenges

In the last decade, Federated Learning (FL) has gained relevance in training collaborative models without sharing sensitive data. Since its birth, Centralized FL (CFL) has been the most common approach in the literature, where a central entity creates a global model. However, a centralized approach leads to increased latency due to bottlenecks, heightened vulnerability to system failures, and trustworthiness concerns affecting the entity responsible for the global model creation. Decentralized Federated Learning (DFL) emerged to address these concerns by promoting decentralized model aggregation and minimizing reliance on centralized architectures. However, despite the work done in DFL, the literature has not (i) studied the main aspects differentiating DFL and CFL; (ii) analyzed DFL frameworks to create and evaluate new solutions; and (iii) reviewed application scenarios using DFL. Thus, this article identifies and analyzes the main fundamentals of DFL in terms of federation architectures, topologies, communication mechanisms, security approaches, and key performance indicators. Additionally, the paper at hand explores existing mechanisms to optimize critical DFL fundamentals. Then, the most relevant features of the current DFL frameworks are reviewed and compared. After that, it analyzes the most used DFL application scenarios, identifying solutions based on the fundamentals and frameworks previously defined. Finally, the evolution of existing DFL solutions is studied to provide a list of trends, lessons learned, and open challenges

Noise-based cyberattacks generating fake P300 waves in brain–computer interfaces

Most of the current Brain–Computer Interfaces (BCIs) application scenarios use electroencephalographic signals (EEG) containing the subject’s information. It means that if EEG were maliciously manipulated, the proper functioning of BCI frameworks could be at risk. Unfortunately, it happens in frameworks sensitive to noise-based cyberattacks, and more efforts are needed to measure the impact of these attacks. This work presents and analyzes the impact of four noise-based cyberattacks attempting to generate fake P300 waves in two different phases of a BCI framework. A set of experiments show that the greater the attacker’s knowledge regarding the P300 waves, processes, and data of the BCI framework, the higher the attack impact. In this sense, the attacker with less knowledge impacts 1% in the acquisition phase and 4% in the processing phase, while the attacker with the most knowledge impacts 22% and 74%, respectively

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research