Towards an evaluation framework for medical device-integrated electronic medical record

INTRODUCTION

Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control mechanisms. We reviewed the related literature, including existing EMR and MD risk assessment approaches, to identify MDI-EMR comprehensive evaluation dimensions and measures.

AREAS COVERED

We searched multiple databases, including PubMed, Web of Knowledge, Scopus, ACM, Embase, IEEE and Ingenta. We explored various evaluation aspects of MD and EMR to gain a better understanding of their complex integration. We reviewed numerous risk management and assessment frameworks related to MD and EMR security aspects and mitigation controls and then identified their common evaluation aspects. Our review indicated that previous evaluation frameworks assessed MD and EMR independently. To address this gap, we proposed an evaluation framework based on the sociotechnical dimensions of health information systems and risk assessment approaches for MDs to evaluate MDI-EMR integratively.

EXPERT OPINION

The emergence of MDI-EMR cyber threats requires appropriate evaluation tools to ensure the safe development and application of MDI-EMR. Consequently, our proposed framework will continue to evolve through subsequent validations and refinements. This process aims to establish its applicability in informing stakeholders of the safety level and assessing its effectiveness in mitigating risks for future improvements.

Spatio-temporal patterns and control mechanism of the ecosystem carbon use efficiency across the Mongolian Plateau

Carbon use efficiency (CUE) is a crucial parameter that reflects the carbon storage within ecosystems, providing insight into the potential for carbon sequestration at the ecosystem scale and its feedback on climate change. The Mongolian Plateau exemplifies an arid and semi-arid region with a delicate ecological environment that displays heightened sensitivity to global climate change. Understanding the variation and control of CUE is critical for assessing regional carbon. However, few studies have focused on the interaction of factors influencing CUE; furthermore, how CUE responds to climate change and anthropogenic activities remains unclear. Here, we aimed to investigate spatiotemporal patterns and their control mechanisms by generating CUE data based on multi-source remote sensing data. CUE demonstrated a slow downward trend from 2000 to 2018, with higher values in relatively dry-cool regions and lower values in relatively humid-warm regions. Furthermore, CUE values were ranked by biome as follows: grassland > sandy vegetation > cropland > shrubs > forest, driven by climate characteristics, vegetation coverage, water stress, stand age, and management practices. Additionally, climatic factors affected CUE more than the soil variables, except for alpine meadows. The climate factors of precipitation (PPT), index of water availability (IWA) (QPPT = 0.487, QIWA = 0.444), and soil factors, e.g., pH and soil organic content (SOC) (QPH = 0.397, QSOC = 0.372), had the greatest influence on CUE. Finally, most two explanatory factors interacted to effectively enhance the explanation of CUE; the synergy of the IWA and PPT contributed the most to CUE (QIWA∩PPT = 0.604). Moreover, the joint effect of climate change and anthropogenic activities was identified as the major contributor (68 %) to the decline in CUE within this region. This study presents compelling evidence highlighting the importance of considering climate change and anthropogenic disturbances in ecosystem management and conservation efforts in arid and semi-arid regions.

Spectral analysis of blood flow oscillations to assess the plantar skin blood flow regulation in response to preconditioning local vibrations

BACKGROUND

Local vibration has shown promise in improving skin blood flow and wound healing. However, the underlying mechanism of local vibration as a preconditioning intervention to alter plantar skin blood flow after walking is unclear.

OBJECTIVE

The objective was to use wavelet analysis of skin blood flow oscillations to investigate the effect of preconditioning local vibration on plantar tissues after walking.

METHODS

A double-blind, repeated measures design was tested in 10 healthy participants. The protocol included 10-min baseline, 10-min local vibrations (100 Hz or sham), 10-min walking, and 10-min recovery periods. Skin blood flow was measured over the first metatarsal head of the right foot during the baseline and recovery periods. Wavelet amplitudes after walking were expressed as the ratio of the wavelet amplitude before walking.

RESULTS

The results showed the significant difference in the metabolic (vibration 10.06 ± 1.97, sham 5.78 ± 1.53, p < 0.01) and neurogenic (vibration 7.45 ± 1.54, sham 4.78 ± 1.22, p < 0.01) controls. There were no significant differences in the myogenic, respiratory and cardiac controls between the preconditioning local vibration and sham conditions.

CONCLUSIONS

Our results showed that preconditioning local vibration altered the normalization rates of plantar skin blood flow after walking by stimulating the metabolic and neurogenic controls.

Membrane fouling potential of the denitrification filter effluent and the control mechanism by ozonation in the process of wastewater reclamation

A process of denitrification filter (DNF) coupled with ultrafiltration (UF) and ozonation (DNF-UF-O₃) has been widely applied to advanced nitrogen removal for wastewater reclamation. Despite of the effective removal of nitrogen by DNF, the influence of DNF stage on the operation of UF was still unclear. In this study, a laboratory filtration system was used to investigate the membrane fouling potential of DNF effluent and the fouling control of ozonation. The membrane fouling potential was proved to be increased significantly after DNF stage and alleviated with ozonation treatment. With the help of UV-vis, fluorescence spectroscopy, scanning electron microscopy (SEM) and molecular weight (MW) analysis, the change of DOM component characteristics was proved to be in accordance with the change of fouling potential. The water samples were further fractionated into six hydrophobic/hydrophilic acidic/basic/neutral fractions, among which hydrophobic acids (HOA) and hydrophobic neutrals (HON) dominated the membrane fouling potential of DNF effluent. Detailed study of each fraction revealed that higher MW components in HOA and HON played a crucial role in the fouling of UF membrane. The dominant component of membrane fouling could be degraded and removed by ozonation, and therefore significant fouling alleviation was achieved. These results indicated that in the process of wastewater reclamation, besides conventional water quality indexes, more detailed water features should also be taken into consideration to optimize the whole process. Moreover, the control effects by ozonation could be monitored simply according to the change of specific UV absorbance (SUVA) and fluorescence intensity as surrogates in engineering applications. According to these results, a modified DNF-O₃-UF process with O₃ dosage of 3 mg/L was proposed simply by reversing the sequence of UF and O₃ with no more infrastructure. This modified DNF-O₃-UF process was expected to enlarge the produce capacity of reclaimed water with much lower electricity costs and chemical consumption.

Transmission Dynamics and Control Mechanisms of Vector-Borne Diseases with Active and Passive Movements Between Urban and Satellite Cities

A metapopulation model which explicitly integrates vector-borne and sexual transmission of an epidemic disease with passive and active movements between an urban city and a satellite city is formulated and analysed. The basic reproduction number of the disease is explicitly determined as a combination of sexual and vector-borne transmission parameters. The sensitivity analysis reveals that the disease is primarily transmitted via the vector-borne mode, rather than via sexual transmission, and that sexual transmission by itself may not initiate or sustain an outbreak. Also, increasing the population movements from one city to the other leads to an increase in the basic reproduction number of the later city but a decrease in the basic reproduction number of the former city. The influence of other significant parameters is also investigated via the analysis of suitable partial rank correlation coefficients. After gauging the effects of mobility, we explore the potential effects of optimal control strategies relying upon several distinct restrictions on population movement.