La regulación ética de aplicaciones digitales en salud frente a la pandemia por COVID-19 / La regulació ètica d'aplicacions digitals en salut enfront de la pandèmia per COVID-19 / Ethical regulation of digital health applications in the COVID-19 pandemic

Desde la pandemia por COVID-19, varios países han desarrollado aplicaciones digitales en salud para ayudar a las políticas de prevención y cuidado de la población. Pero utilizan datos personales y sensibles y pueden depender de una infraestructura inadecuada para el almacenamiento, el resguardo y la protección de los datos. Presentamos diez criterios que deben cumplir las aplicaciones digitales en salud para garantizar la protección del derecho a la intimidad, libertad, privacidad, igualdad y confidencialidad de todo ser humano. Deben establecerse formas adecuadas de gobernanza que impliquen a todas las partes interesadas en su uso para garantizar la transparencia y la responsabilidad en los procesos de generación y transferencia de conocimientos en el sector sanitario.(AU)

Des de la pandèmia per COVID-19, diversos països han desenvolupat aplicacions digitals en salut per a ajudar a les polítiques de prevenció i cura de la població. Però utilitzen dades personals i sensibles i poden dependre d'una infraestructura inadequada per a l'emmagatzematge, el resguard i la protecció de les dades. Presentem deu criteris que han de complir les aplicacions digitals en salut per a garantir la protecció del dret a la intimitat, llibertat, privacitat, igualtat i confidencialitat de tot ésser humà. Han d'establir-se formes adequades de governança que impliquin a totes les parts interessades en el seu ús per a garantir la transparència i la responsabilitat en els processos de generació i transferència de coneixementsen el sector sanitari.(AU)

Since the COVID-19 pandemic, several countries have developed digital health applications to assist prevention and population care policies. But they use personal and sensitive data and may rely on inadequate infrastructure for data storage, safeguarding and protection. We present ten criteria that digital health applications must meet toguarantee the protection of the right to privacy, freedom, equality and confidentiality of every human being. Appropriate forms of governance must be established that involve all stakeholders in their use to ensure transparency and accountability in the processes of knowledge generation and transfer in the health sector.(AU)

Aspectos bioéticos da utilização de sistemas de inteligência artificial no campo da saúde: um estudo exploratório / Aspectes bioètics de l'ús de sistemes d'intel·ligència artificial en el camp de la salut: un estudi exploratory / Aspectos bioéticos del uso de sistemas de inteligencia artificial en el campo de la salud: un estudio exploratorio / Bioethics issuesrelated to Artificial Intelligence in Health: an exploratory study

Objetivo: analisar a percepção de usuários de redes sociais a respeito da utilização de sistemas de IA no campo da saúde e osaspectos bioéticos associados a essa utilização. Método: Estudode método mistos, do tipo descritivo-exploratório. O percurso metodológico foi dividido em duas etapas: (1) levantamento de informação a respeito dos principais aspectos bioéticos envolvidos na utilizaçãode IA e (2) elaboração dos cenários de tomada de decisão. Os dados quantitativos foram analisados por meio de estatística descritiva a fim de caracterizar a amostra do ponto de vista sociodemográfico, bem como caracterizar o perfil de tomada de decisão da amostra comrelação às questões bioéticas associadas à utilização de sistemas de IA. A análise dos dados qualitativos foi realizada por meio da análise de conteúdo de Bardin. Resultados: com relação ao perfil sociodemográfico pode-se observar uma amostra de adultos, do sexo feminino, com curso superior completo. Com relação às preocupados éticas associadas aos cenários aplicados, as principais preocupações foram em primeiro lugar a privacidade e confidencialidade dos dados, seguido de preocupações relacionadas à responsabilidade associada a utilização destas tecnologias, bem como ao consentimento informado.(AU)

Objectiu: analitzar la percepció dels usuaris de les xarxes socials sobre l'ús de sistemes d'IA al camp de la salut i els aspectes bioètics associats a aquest ús. Mètode: Estudi de mètode mixt, del tipus descriptiu-exploratori. El camí metodològic es va dividir en dues etapes: (1) recopilació d'informació sobre els aspectes bioètics principals involucrats en l'ús de la IA i (2) elaboració d'escenarisper a la presa de decisions. Les dades quantitatives es van analitzar mitjançant estadística descriptiva per caracteritzar la mostra des del punt de vista sociodemogràfic, així com per caracteritzar el perfil de presa de decisions de la mostra pel que fa a qüestions bioètiques associades a l'ús de sistemes d'IA. L'anàlisi de dades qualitatives es va fer utilitzant l'anàlisi de contingut de Bardin. Resultats: quant al perfil sociodemogràfic, es pot observar una mostra de dones adultes amb títol universitari. Pel que fa a les preocupacionsètiques associades als escenaris aplicats, les principals preocupacions van ser en primer lloc la privadesa i confidencialitat de les dades, seguides de les preocupacions relacionades amb la responsabilitat associada a l'ús d'aquestes tecnologies, així com el consentiment informat.(AU)

Objetivo: analizar la percepción de los usuarios de las redes sociales sobre el uso de sistemas de IA en el campo de la salud y aspectos bioéticos asociados a este uso. Método: método mixto, del tipo descriptivo-exploratorio. El camino metodológico se dividió en dos etapas: (1) recopilación de información sobre los principales aspectos bioéticos involucrados en el uso de la IA y (2) elaboración de escenarios para la toma de decisiones. Los datos cuantitativos se analizaron mediante estadística descriptiva para caracterizar la muestra desde el punto de vista sociodemográfico, así como para caracterizar el perfil de toma de decisiones de la muestra con respecto a cuestiones bioéticas asociadas al uso de sistemas de IA. El análisis de datos cualitativos se realizó utilizando el análisis de contenido de Bardin. Resultados: en el perfil sociodemográfico se observa una muestra de mujeres adultas con título universitario. En cuanto a las preocupaciones éticas asociadas a los escenarios aplicados, las principales preocupaciones fueron en primer lugar la privacidad y confidencialidad de los datos, seguidas de las preocupaciones relacionadas con la responsabilidad asociada al uso de estas tecnologías, así como el consentimiento informado. (AU)

Objective: to analyze the perception of users of social networks regarding the use of AI systems in the field of health and the bioethical aspects associated with this use. Method: Mixed method study, of the descriptive-exploratory type. The methodological path was divided into twostages: (1) gathering information about the main bioethical aspects involved in the use of AI and (2) elaboration of decision-making scenarios. Quantitative data were analyzed using descriptive statistics in order to characterize the sample from a sociodemographic point of view, as well as to characterize the sample's decision-making profile regarding bioethical issues associated with the use of AI systems. Qualitative data analysis was performed using Bardin's content analysis. Results: with regard to thesociodemographic profile, a sample of female adults with a university degree can be observed. With regard to the ethical concerns associated with the applied scenarios, the main concerns were in the first place the privacy and confidentiality of the data,followed by concerns related to the responsibility associated with the use of these technologies, as well as informed consent.(AU)

Disparity between adolescents' health information needs and the information received in a middle-income country.

AIM: This study sought to identify adolescents' health information sources and determine the gap between what adolescents want to hear and what they actually hear from their healthcare providers (HCPs), a proxy for unmet health needs. METHODS: A cross-sectional study was conducted in four high schools conveniently selected in Jamaica to ensure adequate representation in rural and urban locales. Adolescents 11-19 years old with relevant assent/consent completed a paper-based self-administered questionnaire. Questions were adapted from the Young Adult Health Care Survey to determine proportion of adolescents receiving confidential care, the level of counselling offered and difference between location and unmet needs. RESULTS: Adolescents acknowledged multiple sources of information, with urban adolescents reporting television, radio and parents as sources more frequently than in rural setting (p < 0.05). They most commonly wanted to discuss weight management (n = 308, 64.2%), nutrition (n = 418, 87.1%), exercise (n = 361, 75.2%); and emotions they are experiencing (n = 246, 51.3%). Unmet needs differed by location; more rural than urban adolescents found that their desire to discuss school performance (p < 0.05) and sexual orientation (p < 0.05) was unmet, while more urban youth felt their need for discussions about STIs was unmet (p < 0.05), when compared to their rural counterparts. CONCLUSION: This study highlights that while there is some access to health information in Jamaica, especially via television, radio and internet, the needs of the adolescent population remain unmet. HCPs need to employ a patient-centred approach where confidentiality is established and screening is done for unmet needs in an effort to optimize health outcomes.

An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study.

BACKGROUND: The June 2022 US Supreme Court decision to ban abortion care in Dobbs v Jackson Women's Health Organization sparked ominous debate about the privacy and safety of women and families of childbearing age with digital footprints who actively engage in family planning, including abortion and miscarriage care. OBJECTIVE: To assess the perspectives of a subpopulation of research participants of childbearing age regarding the health-relatedness of their digital data, their concerns about the use and sharing of personal data online, and their concerns about donating data from various sources to researchers today or in the future. METHODS: An 18-item electronic survey was developed using Qualtrics and administered to adults (aged ≥18 years) registered in the ResearchMatch database in April 2021. Individuals were invited to participate in the survey regardless of health status, race, gender, or any other mutable or immutable characteristics. Descriptive statistical analyses were conducted using Microsoft Excel and manual queries (single layer, bottom-up topic modeling) and used to categorize illuminating quotes from free-text survey responses. RESULTS: A total of 470 participants initiated the survey and 402 completed and submitted the survey (for an 86% completion rate). Nearly half the participants (189/402, 47%) self-reported to be persons of childbearing age (18 to 50 years). Most participants of childbearing age agreed or strongly agreed that social media data, email data, text message data, Google search history data, online purchase history data, electronic medical record data, fitness tracker and wearable data, credit card statement data, and genetic data are health-related. Most participants disagreed or strongly disagreed that music streaming data, Yelp review and rating data, ride-sharing history data, tax records and other income history data, voting history data, and geolocation data are health-related. Most (164/189, 87%) participants were concerned about fraud or abuse based on their personal information, online companies and websites sharing information with other parties without consent, and online companies and websites using information for purposes that are not explicitly stated in their privacy policies. Free-text survey responses showed that participants were concerned about data use beyond scope of consent; exclusion from health care and insurance; government and corporate mistrust; and data confidentiality, security, and discretion. CONCLUSIONS: Our findings in light of Dobbs and other related events indicate there are opportunities to educate research participants about the health-relatedness of their digital data. Developing strategies and best privacy practices for discretion regarding digital-footprint data related to family planning should be a priority for companies, researchers, families, and other stakeholders.

Secured and Privacy-Preserving Multi-Authority Access Control System for Cloud-Based Healthcare Data Sharing.

With continuous advancements in Internet technology and the increased use of cryptographic techniques, the cloud has become the obvious choice for data sharing. Generally, the data are outsourced to cloud storage servers in encrypted form. Access control methods can be used on encrypted outsourced data to facilitate and regulate access. Multi-authority attribute-based encryption is a propitious technique to control who can access encrypted data in inter-domain applications such as sharing data between organizations, sharing data in healthcare, etc. The data owner may require the flexibility to share the data with known and unknown users. The known or closed-domain users may be internal employees of the organization, and unknown or open-domain users may be outside agencies, third-party users, etc. In the case of closed-domain users, the data owner becomes the key issuing authority, and in the case of open-domain users, various established attribute authorities perform the task of key issuance. Privacy preservation is also a crucial requirement in cloud-based data-sharing systems. This work proposes the SP-MAACS scheme, a secure and privacy-preserving multi-authority access control system for cloud-based healthcare data sharing. Both open and closed domain users are considered, and policy privacy is ensured by only disclosing the names of policy attributes. The values of the attributes are kept hidden. Characteristic comparison with similar existing schemes shows that our scheme simultaneously provides features such as multi-authority setting, expressive and flexible access policy structure, privacy preservation, and scalability. The performance analysis carried out by us shows that the decryption cost is reasonable enough. Furthermore, the scheme is demonstrated to be adaptively secure under the standard model.

Factors Affecting Disability Disclosure in Employment Setting for Individuals with Intellectual Disability.

This study aimed to increase the understanding of this disability disclosure of people with intellectual disability by examining the determinants of their disclosure at work. For this aim, six individuals with intellectual disability were interviewed, and consensual qualitative research (CQR) was used to identify factors related to their disability disclosure. As results, the factors that affect the disability disclosure were largely divided into personal variables and environmental variables, and various factors including confidence, disability severity, employment type, employers, co-workers, and organizational culture were mentioned. The results of this study can help people have better understanding about disability disclosure in employment settings. We also discuss how vocational education for individuals with intellectual disability should be offered.

Ensuring confidentiality and privacy of cloud data using a non-deterministic cryptographic scheme.

The amount of data generated by electronic systems through e-commerce, social networks, and data computation has risen. However, the security of data has always been a challenge. The problem is not with the quantity of data but how to secure the data by ensuring its confidentiality and privacy. Though there are several research on cloud data security, this study proposes a security scheme with the lowest execution time. The approach employs a non-linear time complexity to achieve data confidentiality and privacy. A symmetric algorithm dubbed the Non-Deterministic Cryptographic Scheme (NCS) is proposed to address the increased execution time of existing cryptographic schemes. NCS has linear time complexity with a low and unpredicted trend of execution times. It achieves confidentiality and privacy of data on the cloud by converting the plaintext into Ciphertext with a small number of iterations thereby decreasing the execution time but with high security. The algorithm is based on Good Prime Numbers, Linear Congruential Generator (LGC), Sliding Window Algorithm (SWA), and XOR gate. For the implementation in C#, thirty different execution times were performed and their average was taken. A comparative analysis of the NCS was performed against AES, DES, and RSA algorithms based on key sizes of 128kb, 256kb, and 512kb using the dataset from Kaggle. The results showed the proposed NCS execution times were lower in comparison to AES, which had better execution time than DES with RSA having the longest. Contrary, to existing knowledge that execution time is relative to data size, the results obtained from the experiment indicated otherwise for the proposed NCS algorithm. With data sizes of 128kb, 256kb, and 512kb, the execution times in milliseconds were 38, 711, and 378 respectively. This validates the NCS as a Non-Deterministic Cryptographic Algorithm. The study findings hence are in support of the argument that data size does not determine the execution time of a cryptographic algorithm but rather the size of the security key.

Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review.

BACKGROUND: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.

Providing Online Portal Access to Families of Adolescents and Young Adults with Diminished Capacity at an Academic Children's Hospital: A Case Report.

BACKGROUND: For caregivers of adolescents and young adults with severe cognitive deficits, or "diminished capacity," access to the medical record can be critical. However, this can be a challenge when utilizing the electronic health record (EHR) as information is often restricted in order to protect adolescent confidentiality. Having enhanced access for these proxies would be expected to improve engagement with the health system for the families of these medically complex adolescents and young adults. OBJECTIVES: To describe a process for granting full EHR access to proxies of adolescents with diminished capacity and young adults who are legally conserved while respecting regulations supporting adolescent confidentiality. METHODS: The first step in this initiative was to define the "diminished capacity" access class for both adolescents and young adults. Once defined, workflows utilizing best practice alerts were developed to support clinicians in providing the appropriate documentation. In addition, processes were developed to minimize the possibility of erroneously activating the diminished capacity access class for any given patient. To enhance activation, a support tool was developed to identify patients who might meet the criteria for diminished capacity proxy access. Finally, outreach and educations were developed for providers and clinics to make them aware of this initiative. RESULTS: Since activating this workflow, proxies of 138 adolescents and young adults have been granted the diminished capacity proxy access class. Approximately 54% are between 12 and 17 years with 46% 18 years and older. Proxies for both age groups have engaged with portal functionality at higher rates when compared to institutional rates of use by proxies of the general pediatric population. CONCLUSION: With this quality improvement initiative, we were able to enhance EHR access and engagement of families of some of the most complex adolescent and young adult patients without inadvertently compromising adolescent confidentiality.

Investigating the impact of stigma, accessibility and confidentiality on STI/STD/HIV self-testing among college students in the USA: protocol for a scoping review.

INTRODUCTION: In 2019, there were 2.5 million reported cases of chlamydia, gonorrhoea and syphilis. The Centers for Disease Control and Prevention reported in the USA, young people aged 15-24 made up 61% and 42% of chlamydia and gonorrhoea cases, respectively. Moreover, the highest rates of sexually transmitted infections (STIs) were reported among college-aged students. In this paper, we outline our protocol to systematically review the published literature on, the use of STI/HIV self-test kits, increasing STI/HIV testing uptake, and stigma, access and confidentiality issues, among young adult college students in the USA. METHODS AND ANALYSIS: This scoping review will be conducted and reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will search electronic databases, OVID Medline, OVID Embase, Web of Science, Cochrane Library, PubMed and CINAHL, for articles published in English from inception to the present. We will search other alternative sources such as ProQuest, Google Scholar and Google to identify grey literature. A two-step process will be used to identify eligible studies based on the defined inclusion criteria. First, the title and abstract of identified articles will be screened for possible inclusion. Second, full-text articles of relevant studies will be retrieved and screened for inclusion. Both screening steps will be done by two people independently. Finally, data will be extracted by two researchers working independently. Any arising disagreements will be resolved by consensus or by a third author. ETHICS AND DISSEMINATION: This study is a scoping review of the literature. Therefore, ethics approval is not required. Our plan for the dissemination of findings includes peer-reviewed manuscripts, conferences and webinars.

An Improved Lightweight User Authentication Scheme for the Internet of Medical Things.

The Internet of Medical Things (IoMT) is used in the medical ecosystem through medical IoT sensors, such as blood glucose, heart rate, temperature, and pulse sensors. To maintain a secure sensor network and a stable IoMT environment, it is important to protect the medical IoT sensors themselves and the patient medical data they collect from various security threats. Medical IoT sensors attached to the patient's body must be protected from security threats, such as being controlled by unauthorized persons or transmitting erroneous medical data. In IoMT authentication, it is necessary to be sensitive to the following attack techniques. (1) The offline password guessing attack easily predicts a healthcare administrator's password offline and allows for easy access to the healthcare worker's account. (2) Privileged-insider attacks executed through impersonation are an easy way for an attacker to gain access to a healthcare administrator's environment. Recently, previous research proposed a lightweight and anonymity preserving user authentication scheme for IoT-based healthcare. However, this scheme was vulnerable to offline password guessing, impersonation, and privileged insider attacks. These attacks expose not only the patients' medical data such as blood pressure, pulse, and body temperature but also the patients' registration number, phone number, and guardian. To overcome these weaknesses, in the present study we propose an improved lightweight user authentication scheme for the Internet of Medical Things (IoMT). In our scheme, the hash function and XOR operation are used for operation in low-spec healthcare IoT sensor. The automatic cryptographic protocol tool ProVerif confirmed the security of the proposed scheme. Finally, we show that the proposed scheme is more secure than other protocols and that it has 266.48% better performance than schemes that have been previously described in other studies.

Evaluating IoT-Based Services to Support Patient Empowerment in Digital Home Hospitalization Services.

Hospitals need to optimize patient care, as, among other factors, life expectancy has increased due to improvements in sanitation, nutrition, and medicines. Hospitalization-at-home (HaH) could increase admission efficiency, moderate costs, and reduce the demand for beds. This study aimed to provide data on the feasibility, acceptability, and effectiveness of the integration of IoT-based technology to support the remote monitoring and follow-up of patients admitted to HaH units, as well as the acceptability of IoT-based solutions in healthcare processes. The need for a reduction in the number of admission days, the percentage of admissions after discharge, and the actions of the emergency services during admission were the most relevant findings of this study. Furthermore, in terms of patient safety and trust perception, 98% of patients preferred this type of digitally-supported hospitalization model and up to 95% were very satisfied. On the professional side, the results showed a reduction in work overload and an increase in trust when the system was adopted.

Multi-party co-signature scheme based on SM2.

Two-party collaborative signature scheme is an important cryptographic technology for user authentication and data integrity protection when using mobile devices for financial and securities transactions. However, the two-party collaboration scheme has the following shortcomings: firstly, it is not flexible enough, and it requires the collaborating parties to be secure and trusted; secondly, the two-party collaboration security still needs to be improved. Once a hacker obtains the signature private key and collaborative identity of a mobile device, it can construct a legitimate two-party collaborative signature. Third, the application scenario of two-party co-signature is limited and cannot meet the application scenario of multi-device co-signature. For this reason, this paper designs a multi-party collaborative signature scheme based on SM2 digital signature algorithm in the standard "SM2 Elliptic Curve Public Key Cryptography" of GM/T003-2012. This scheme consists of multiple (more than 2) participants to jointly generate the signature group public key and valid signature in an interactive manner, while ensuring that each user cannot know the signature key other than their own during the signing process. We implement this scheme based on the GMP library. The experimental results show that this scheme is not only flexible but also more secure and trustworthy to meet the application scenario of multi-device collaborative signing. In addition, the time for multiple participants to construct signatures in this scheme is similar, and the time for signature verification is less different from that of the original SM2 signature.

Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review.

This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.

Provably Secure and Lightweight Patient Monitoring Protocol for Wireless Body Area Network in IoHT.

As one of the important applications of Internet of Health Things (IoHT) technology in the field of healthcare, wireless body area network (WBAN) has been widely used in medical therapy, and it can not only monitor and record physiological information but also transmit the data collected by sensor devices to the server in time. However, due to the unreliability and vulnerability of wireless network communication, as well as the limited storage and computing resources of sensor nodes in WBAN, a lot of authentication protocols for WBAN have been devised. In 2021, Alzahrani et al. designed an anonymous medical monitoring protocol, which uses lightweight cryptographic primitives for WBAN. However, we find that their protocol is defenseless to off-line identity guessing attacks, known-key attacks, and stolen-verifier attacks and has no perfect forward secrecy. Therefore, a patient monitoring protocol for WBAN in IoHT is proposed. We use security proof under the random oracle model (ROM) and automatic verification tool ProVerif to demonstrate that our protocol is secure. According to comparisons with related protocols, our protocol can achieve both high computational efficiency and security.

A fuzzy-set qualitative comparative analysis exploration of multiple paths to users' continuous use behavior of diabetes self-management apps.

BACKGROUND: Despite the obvious potential benefits of diabetes self-management apps, users' continuous use of diabetes self-management apps is still not widespread. Influential factors coexisted in information ecologies are likely to have a synthetic effect on users' continuous use behavior. However, it is less clear how factors in information ecologies combine to influence users' continuous use behavior. OBJECTIVE: The objectives of this study are to explore combinations of factors (perceived severity, information quality, service quality, system quality, and social influence) in information ecologies that lead to users' continuous use behavior of diabetes self-management apps and which combination is the most important. METHODS: Purpose sampling was used to recruit diabetes self-management app users from July 1, 2021 to January 31, 2022. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis. RESULTS: In total 280 diabetes self-management app users participated. The necessity analysis indicated that no single factor was necessary to cause users' continuous use behavior, and the sufficiency analysis identified five different combinations of factors that lead to users' continuous use behavior. Of these five, the combination of high information quality, high service quality, and high social influence was found to be the most important path. CONCLUSIONS: Users' continuous use behavior of diabetes self-management apps results from the synergistic effects of factors in information ecologies. The five paths that directly contribute to users' continuous use, as well as the four user types preliminarily identified in this study may provide a reference for healthcare providers and app developers.

Equivalence of care, confidentiality, and professional independence must underpin the hospital care of individuals experiencing incarceration.

We present the reflections of three clinical practitioners on ethical considerations when caring for individuals experiencing incarceration needing in-patient hospital services. We examine the challenges and critical importance of adhering to core principles of medical ethics in such settings. These principles encompass access to a physician, equivalence of care, patient's consent and confidentiality, preventive healthcare, humanitarian assistance, professional independence, and professional competence. We strongly believe that detained persons have a right to access healthcare services that are equivalent to those available in the general population, including in-patient services. All the other established standards to uphold the health and dignity of people experiencing incarceration should also apply to in-patient care, whether this takes place outside or inside the prison boundaries. Our reflection focuses on the principles of confidentiality, professional independence, and equivalence of care. We argue that the respect for these three principles, although they present specific implementation challenges, is foundational for implementing the other principles. Critically important are respect for the distinct roles and responsibilities of healthcare and security staff as well as transparent and non-hierarchical dialogue between them to ensure optimal health outcomes and functioning of hospital wards while balancing the ongoing tensions between care and control.

Increasing the security and traceability of biological samples in biobanks by blockchain technology.

BACKGROUND AND OBJECTIVE: One of the main tasks in a biobank consists in storing biological samples in a high-quality condition in order to future research. At moment, there exist many applications to manage a biobank. However, in general, these are web-based applications. In these web-based applications different tasks can be done. Among them, it is possible to remark the following: informed consent, confidentiality, non-profit, respect for quality and safety standards, including traceability of samples. In this paper, we describe a blockchain smart contract to ensure the traceability of the processes done in a biobank meaning a step forward to guarantee this traceability. METHODS: Use of blockchain technology to improve security, integrity and traceability of the processes carried out in a biobank. In particular IBM Hyperledger Fabric. RESULTS: As a result, a set of smart contracts have been developed describing the biobank processes. CONCLUSIONS: Improvement of the security, integrity, and traceability of samples in biobanks.

Can ChatGPT draft a research article? An example of population-level vaccine effectiveness analysis.

We reflect on our experiences of using Generative Pre-trained Transformer ChatGPT, a chatbot launched by OpenAI in November 2022, to draft a research article. We aim to demonstrate how ChatGPT could help researchers to accelerate drafting their papers. We created a simulated data set of 100 000 health care workers with varying ages, Body Mass Index (BMI), and risk profiles. Simulation data allow analysts to test statistical analysis techniques, such as machine-learning based approaches, without compromising patient privacy. Infections were simulated with a randomized probability of hospitalisation. A subset of these fictitious people was vaccinated with a fictional vaccine that reduced this probability of hospitalisation after infection. We then used ChatGPT to help us decide how to handle the simulated data in order to determine vaccine effectiveness and draft a related research paper. AI-based language models in data analysis and scientific writing are an area of growing interest, and this exemplar analysis aims to contribute to the understanding of how ChatGPT can be used to facilitate these tasks.

Privacy Preserving Image Encryption with Optimal Deep Transfer Learning Based Accident Severity Classification Model.

Effective accident management acts as a vital part of emergency and traffic control systems. In such systems, accident data can be collected from different sources (unmanned aerial vehicles, surveillance cameras, on-site people, etc.) and images are considered a major source. Accident site photos and measurements are the most important evidence. Attackers will steal data and breach personal privacy, causing untold costs. The massive number of images commonly employed poses a significant challenge to privacy preservation, and image encryption can be used to accomplish cloud storage and secure image transmission. Automated severity estimation using deep-learning (DL) models becomes essential for effective accident management. Therefore, this article presents a novel Privacy Preserving Image Encryption with Optimal Deep-Learning-based Accident Severity Classification (PPIE-ODLASC) method. The primary objective of the PPIE-ODLASC algorithm is to securely transmit the accident images and classify accident severity into different levels. In the presented PPIE-ODLASC technique, two major processes are involved, namely encryption and severity classification (i.e., high, medium, low, and normal). For accident image encryption, the multi-key homomorphic encryption (MKHE) technique with lion swarm optimization (LSO)-based optimal key generation procedure is involved. In addition, the PPIE-ODLASC approach involves YOLO-v5 object detector to identify the region of interest (ROI) in the accident images. Moreover, the accident severity classification module encompasses Xception feature extractor, bidirectional gated recurrent unit (BiGRU) classification, and Bayesian optimization (BO)-based hyperparameter tuning. The experimental validation of the proposed PPIE-ODLASC algorithm is tested utilizing accident images and the outcomes are examined in terms of many measures. The comparative examination revealed that the PPIE-ODLASC technique showed an enhanced performance of 57.68 dB over other existing models.