Big Data in the Assessment of Pediatric Medication Safety.

Big data (BD) in pediatric medication safety research provides many opportunities to improve the safety and health of children. The number of pediatric medication and device trials has increased in part because of the past 20 years of US legislation requiring and incentivizing study of the effects of medical products in children (Food and Drug Administration Modernization Act of 1997, Pediatric Rule in 1998, Best Pharmaceuticals for Children Act of 2002, and Pediatric Research Equity Act of 2003). There are some limitations of traditional approaches to studying medication safety in children. Randomized clinical trials within the regulatory context may not enroll patients who are representative of the general pediatric population, provide the power to detect rare safety signals, or provide long-term safety data. BD sources may have these capabilities. In recent years, medical records have become digitized, and cell phones and personal devices have proliferated. In this process, the field of biomedical science has progressively used BD from those records coupled with other data sources, both digital and traditional. Additionally, large distributed databases that include pediatric-specific outcome variables are available. A workshop entitled "Advancing the Development of Pediatric Therapeutics: Application of 'Big Data' to Pediatric Safety Studies" held September 18 to 19, 2017, in Silver Spring, Maryland, formed the basis of many of the ideas outlined in this article, which are intended to identify key examples, critical issues, and future directions in this early phase of an anticipated dramatic change in the availability and use of BD.

The Times they Are a-Changin' - Healthcare 4.0 Is Coming!

The Industrial Revolution brought new economics and new epidemic patterns to the people, which formed the healthcare 1.0 that focused on public health solutions. The emergence of large production concept and technology brought healthcare to 2.0. Bigger hospitals and better medical education were established, and doctors were trained for specialty for better treatment quality. The size of computer shrunk. This allowed fast development of computer-based devices and information technology, leading the healthcare to 3.0. The initiation of smart medicine nowadays announces the arrival of healthcare 4.0 with new brain and new hands. It is an era of big revision of previous technologies, one of which is artificial intelligence which will lead humans to a new world that emphasizes more on advanced and continuous learnings.

'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Tele-Emergency Services in the Himalayas.

Introduction:Nonavailability of emergency healthcare services in mountainous, isolated, and sparsely populated regions is a universal problem. In a first of its kind initiative, Tele-emergency services (TES) was provided in Keylong and Kaza in Himachal Pradesh in Northern India, at an altitude of 3,353 meters with temperatures of -30°C during winter months.Methods:Existing rooms in regional hospital (Keylong) and community health center (Kaza) were converted into tele-emergency centers by connecting them, to a state-of-the-art emergency department at the Joint Commission International-accredited Apollo Main Hospital at Chennai, 2,925 km away. Training was carried out at both ends. Average turnaround time for an emergency teleconsult was less than 12 minutes. Tele-ECG, Spirometry, and Point-of-Care Diagnostics for blood biochemistry were made available.Results:In the first 35 months, 753 teleconsults were given in the 24/7 TES, out of a total of 10,213 teleconsults constituting 7.4%. Out of a total of 6,442 telelaboratory tests, 431 tests were done in an emergency setting constituting 6.7%. Of the 16 cases of myocardial infarction remotely diagnosed, 4 were thrombolysed through telementoring. Of seven patients with Supra Ventricular Tachycardia, six patients were stabilized through electrical cardioversion and one through chemical cardioversion through telementoring. Ten deaths were documented, of which one occurred at the site. One hundred ninety-six were stabilized and transferred to higher centers. Thirteen required helicopter evacuations. Detailed analysis revealed that the total average cost for a single emergency teleconsult during this period was US$208.Conclusions:Preliminary analysis confirms that delivering TES in inhospitable terrains in a Public Private Partnership mode is doable and is welcomed by the community.

Participatory Technology Development to Enhance Community Resilience.

Objective: To assess the feasibility of a novel, partnered technology development process to co-create mobile health applications (apps) addressing community health priorities, using psychoeducation of cognitive behavioral therapy (CBT) principles for enhancing resilience as an example. Design: Stakeholder engagement, workgroups, pilot feasibility study using mixed methods during October 2013 through January 2016 over three phases: 1) defining the vision of the project and increasing technical capacity, 2) co-development and pilot testing of the app, and 3) planning for sustainability. Setting: An academic-community partnership in South Los Angeles, California. Participants: Eight stakeholders; 30 pilot participants from the community. Main Outcome Measures: Qualitative analysis of audio-recordings of the app development process and stakeholder interviews, surveys of stakeholders' perception of the development process, app use data, and feedback from pilot participants. Results: The participatory technology development process resulted in creation and pilot-testing of a resiliency-focused text messaging app. Of the 1,107 messages sent, 23 out of 30 (77%) app users responded to explore interactive content. Stakeholders reported increased perceived competency in creating mobile apps and that the process fostered a culture of co-leadership. There was also sustained engagement in mobile app development by stakeholders beyond the initial project period. Conclusions: This is the first study, to our knowledge, to demonstrate the feasibility of participatory technology development, an approach involving direct participation in the development, tailoring and maintenance of a mobile app by a broad set of stakeholders with high representation from racial/ethnic minorities from an under-resourced community. Participatory technology development is a promising approach for creating sustainable, relevant and engaging health technologies across different technological, clinical and community settings.

A New Approach to Predict user Mobility Using Semantic Analysis and Machine Learning.

Mobility prediction is a technique in which the future location of a user is identified in a given network. Mobility prediction provides solutions to many day-to-day life problems. It helps in seamless handovers in wireless networks to provide better location based services and to recalculate paths in Mobile Ad hoc Networks (MANET). In the present study, a framework is presented which predicts user mobility in presence and absence of mobility history. Naïve Bayesian classification algorithm and Markov Model are used to predict user future location when user mobility history is available. An attempt is made to predict user future location by using Short Message Service (SMS) and instantaneous Geological coordinates in the absence of mobility patterns. The proposed technique compares the performance metrics with commonly used Markov Chain model. From the experimental results it is evident that the techniques used in this work gives better results when considering both spatial and temporal information. The proposed method predicts user's future location in the absence of mobility history quite fairly. The proposed work is applied to predict the mobility of medical rescue vehicles and social security systems.

How to formulate research questions and design studies for telehealth assessment and evaluation.

Planning a research strategy and formulating the right research questions at various stages of developing a telehealth intervention are essential for producing scientific evidence. The aim of research at each stage should correspond to the maturity of the intervention and will require a variety of study designs. Although there are several published evaluation frameworks for telemedicine or telehealth as a subset of broader eHealth domain, there is currently no simple model to guide research planning. In this paper we propose a five-stage model as a framework for planning a comprehensive telehealth research program for a new intervention or service system. The stages are: (1) Concept development, (2) Service design, (3) Pre-implementation, (4) Implementation, (5) Post-implementation, and at each stage a number of studies are considered. Robust evaluation is important for the widespread acceptance and implementation of telehealth. We hope this framework enables researchers, service administrators and clinicians to conceptualise, undertake and appraise telehealth research from the point of view of being able to assess how applicable and valid the research is for their particular circumstances.

Using agility to combat cyber attacks.

Some incident response practitioners feel that they have been locked in a battle with cyber criminals since the popular adoption of the internet. Initially, organisations made great inroads in preventing and containing cyber attacks. In the last few years, however, cyber criminals have become adept at eluding defence security technologies and rapidly modifying their exploit strategies for financial or political gains. Similar to changes in military combat tactics, cyber criminals utilise distributed attack cells, real-time communications, and rapidly mutating exploits to minimise the potential for detection. Cyber criminals have changed their attack paradigm. This paper describes a new incident response paradigm aimed at combating the new model of cyber attacks with an emphasis on agility to increase the organisation's ability to respond rapidly to these new challenges.

A Secure Region-Based Geographic Routing Protocol (SRBGR) for Wireless Sensor Networks.

Due to the lack of dependency for routing initiation and an inadequate allocated sextant on responding messages, the secure geographic routing protocols for Wireless Sensor Networks (WSNs) have attracted considerable attention. However, the existing protocols are more likely to drop packets when legitimate nodes fail to respond to the routing initiation messages while attackers in the allocated sextant manage to respond. Furthermore, these protocols are designed with inefficient collection window and inadequate verification criteria which may lead to a high number of attacker selections. To prevent the failure to find an appropriate relay node and undesirable packet retransmission, this paper presents Secure Region-Based Geographic Routing Protocol (SRBGR) to increase the probability of selecting the appropriate relay node. By extending the allocated sextant and applying different message contention priorities more legitimate nodes can be admitted in the routing process. Moreover, the paper also proposed the bound collection window for a sufficient collection time and verification cost for both attacker identification and isolation. Extensive simulation experiments have been performed to evaluate the performance of the proposed protocol in comparison with other existing protocols. The results demonstrate that SRBGR increases network performance in terms of the packet delivery ratio and isolates attacks such as Sybil and Black hole.

#IHMayDay: tweeting for empowerment and social and emotional wellbeing.

OBJECTIVE: This paper examines the themes of #IHMayDay, a day-long Twitter discussion about Indigenous health led by Aboriginal and Torres Strait Islander peoples on 1 May 2014. METHOD: The Symplur analytics tool was used to identify the Twitter activity associated with #IHMayDay. This paper reviews the content of 423 tweets that were tweeted and retweeted by 346 individuals and 108 organisations. RESULTS: Issues related to social and emotional wellbeing were dominant, and the analysis highlights the empowering nature of the strengths-based discourse. CONCLUSIONS: Twitter-based events such as #IHMayDay and initiatives such as the rotated, curated account @IndigenousX are powerful platforms for learning, exchange, advocacy and dialogue about the social and emotional wellbeing and mental health of Aboriginal and Torres Strait Islander peoples.