Anonymous Access Research Articles

A buffer container class hierarchy using Ada 2005

This paper describes the design of a set of multi-purpose containers that implement a buffer abstraction. These buffers feature a multi-layered approach where specialized higher level abstractions can statically select their low level implementation. The lower level implementations include bounded, unbounded, and persistent buffer types, whereas higher level abstractions provide support for various synchronization needs, streaming capabilities, and remote usage capabilities. The design and implementation incorporates some of the new Ada 2005 features including interfaces (limited, protected, and task), object prefix notation, extended returns, and new uses for anonymous access types. In addition, the design utilizes remote interface capabilities, which is the subject of an Ada 2005 AI work item for WG9, the ISO Working group responsible for maintaining the Ada language standard.

AMOEBA: Robust Location Privacy Scheme for VANET

Communication messages in vehicular ad hoc networks (VANET) can be used to locate and track vehicles. While tracking can be beneficial for vehicle navigation, it can also lead to threats on location privacy of vehicle user. In this paper, we address the problem of mitigating unauthorized tracking of vehicles based on their broadcast communications, to enhance the user location privacy in VANET. Compared to other mobile networks, VANET exhibits unique characteristics in terms of vehicular mobility constraints, application requirements such as a safety message broadcast period, and vehicular network connectivity. Based on the observed characteristics, we propose a scheme called AMOEBA, that provides location privacy by utilizing the <i xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">group navigation of vehicles</i> . By simulating vehicular mobility in freeways and streets, the performance of the proposed scheme is evaluated under VANET application constraints and two passive adversary models. We make use of vehicular groups for anonymous access to location based service applications in VANET, for user privacy protection. The robustness of the user privacy provided is considered under various attacks.

Factors Influencing Involvement in Research and Career Choice: A Survey of Graduating Physical Medicine and Rehabilitation Residents

Segal NA, Wilson Garvan C, Basford JR. Factors influencing involvement in research and career choice: a survey of graduating physical medicine and rehabilitation residents. Objective To assess the extent to which physical medicine and rehabilitation (PM&R) residents’ involvement in research and selection of postgraduate practice may be related to residency program research requirements and support for presentations. Design Internet-based survey. Setting Anonymous access to Web form. Participants PM&R residents graduating in June 2004 and 2005. Interventions Not applicable. Main Outcome Measures Involvement in research, postgraduate practice setting and planned research effort, residency research requirement, and support for scientific presentations. Results One hundred sixty (24%) of the 657 graduating residents, representing 25 states, the District of Columbia, and Puerto Rico, responded. Eighty-five percent indicated research involvement, with 74% reporting a research requirement and 85% residency program financial support for presentations. On average, respondents planned to devote 7% (95% confidence interval, 5%−9%) of their time to research once in practice. There was a statistically significant association between the existence of a research requirement and involvement in research ( P<.001). However, there was no evidence of a statistically significant association between either the existence of a research requirement or presentation support and the selection of an academic career. There were no significant regional disparities for the existence of a research requirement, travel support, or number of presentations. However, there was a statistically significant regional difference in the proportion of postgraduate practice time that the respondents planned to devote to research. Conclusions A requirement for PM&R residents to be involved in research may influence research activity during residency but may not be associated with selection of an academic or research-oriented practice.

TH‐E‐224C‐04: MMCTP, a Radiotherapy Research Environment for Monte Carlo and Patient‐Specific Treatment Planning

Purpose: To develop a flexible software package, on low cost hardware with the aim of integrating new patient specific treatment planning with Monte Carlo dose calculation suitable for large‐scale prospective and retrospective treatment planning studies.Programming Philosophy: The McGill Monte Carlo Treatment Planning system (MMCTP) is designed as a software environment for the research development of patient specific treatment planning. The design includes a workstation GUI for treatment planning tools, and anonymous access to standard low cost hardware for MC dose calculation. Results: Before using MMCTP, treatment plans are converted into the so‐called McGill RT format. This new file structure was designed for saving patient plans on the workstation. The current MMCTP features are: (a) DICOM and RTOG imports; (b) transverse/sagittal/coronal slice viewing for contours, CT scans, dose distributions; (c) contouring tools; (d) colour‐wash and isodose line display; (e) DVH analysis, and dose matrix comparison tools; (f) external beam editing; (g) thumbnail CT navigation tool; (h) EGS/Beam calculation and XVMC patient transport for photon and electron beams. MMCTP uses a two‐step process to generate MC dose distributions. The MC module controls egs/Beam and XVMC calculations. Input files, prepared from the beam geometry, are uploaded and run on the cluster using shell commands. Upon completion of XVMC, the GUI downloads individual dose files. Conclusion: The MMCTP GUI provides a flexible research platform for the development of patient specific MC treatment planning for photon and electron external beam radiation therapy. MMCTP uses an internal storage format that is flexible in that it allows for multi‐instance multi‐modality image information useful in the planning process. The visualization, dose matrix operation and DVH tools offer extensive possibility for plan analysis and comparison to plans imported from commercial treatment planning systems through well‐documented image storage protocols such as DICOM.

Current and future privacy enhancing technologies for the internet

This paper presents an overview of the current and next solutions for privacy protection on the Internet. We highlight five categories of Privacy Enhancing Technologies (Pets). First, we introduce the multiple virtual identities that can represent a person, and the way the person can manage them. Then, we focus on the untraceability problem, which has been a major field of research since the very first papers on privacy protection in the early eighties. Anonymous access to services will be the central point of the third category of pets we consider. To complete this overview, we describe the current and future authorization pets, and finish by a presentation of personal data management. For each of these categories we present some of the current technologies and the most promising ones under development.

A privacy‐enhanced access control

AbstractIt is sometimes necessary to access a server anonymously when the Internet or an electronic commerce application is used. In the present paper, for this need there is proposed a new system that uses an SPKI (Simple Public Key Infrastructure) framework in order to provide service with an emphasis on privacy. The proposed system does not require ID information and other personal information to be presented to the server. In short, only the information relating to the corresponding service is included in the certificate submitted to the server for utilization of the service, and not the ID information of the client. However, even though this is a system of anonymous access, it is not a framework that allows unlimited access, such as anonymous FTP (File Transfer Protocol). The SPKI framework itself only determines the format of the certificate, and does not provide a methodology for selecting or managing users. Therefore, in this paper, a new framework is proposed, and controlled anonymous access is shown to be obtainable by this framework. This paper will also discuss advantages of the proposed system, its anonymity, management, security, and the processing for certificate revocation. © 2006 Wiley Periodicals, Inc. Syst Comp Jpn, 37(5): 77–86, 2006; Published online in Wiley InterScience (www.interscience. wiley.com). DOI 10.1002/scj.10214

Anonymous attribute certificates based on traceable signatures

PurposeTo provide a cryptographic protocol for anonymously accessing services offered on the web. Such anonymous accesses can be disclosed or traced under certain conditions.Design/methodology/approachThe “traceable signature” scheme was used in conjunction with the “privilege management infrastructure”.FindingsThe cryptographic primitive provides a suitable tool for anonymous and unlinkable access to web resources based on the privileges that users hold. Moreover, the scheme allows for anonymity revocation and tracing of unlinkable accesses.Research limitations/implicationsThe power of the attribute authority should be divided into several entities, one of them being a trusted third party, to avoid illicit disclosing of information.Practical implicationsNew systems with support for anonymous access to web resources can be developed.Originality/valueThis paper adds the unlinkability property to anonymous accesses together with a tracing facility to existing proposals.

Off-label use of proton pump inhibitors and b-blockers in general practices: an analysis using the Disease Analyzer – mediplus patient database

The off-label use of medicines is a widespread phenomenon in medical practice but discussion on the legality of using drugs outside their licensed indications is still ongoing. Prescription recommendations and prescribing habits can differ greatly. We have used a database tool to analyze replies to a batch of questions which included the question "Is the off-label use of medications common?". The analysis was carried out using the Disease Analyzer--mediplus patient database, which is a database tool registered in Germany. It enabled the anonymous access to a representative panel of physicians and patients. More than 1,500 medical practices representing approximately 2.5 million patients were analyzed in a cross-sectional or longitudinal manner. The Disease Analyzer--mediplus database is unique in that it has direct links to individual diagnoses and the corresponding therapy. The findings demonstrated that proton pump inhibitors (PPI), which are licensed for the treatment of gastric ulcer and gastric reflux, are also used off-label in gastritis. The off-label use varies from 30 - 40% of prescriptions. The data indicate that the prescribing behavior has been influenced by the ending of the patent protection on omeprazole. A second instance which has been identified involves the beta-blocker carvedilol, which is licensed for the treatment of heart failure (24% of the total number of patients receiving the drug) but it was found that other beta-blockers are used off-label in this indication at a rate of more than 10% of prescriptions. The off-label use of drugs is high, especially in gastritis and heart failure. The investigation has also confirmed that the Disease Analyzer--mediplus database provides quantitative and qualitative analyses combining all relevant information concerning physicians, patients, diagnoses and therapy and that this information can be used to evaluate prescribing habits and trends with regard to the off-label use of drugs.

Revocable anonymous access to the Internet?

With the worldwide growth of open telecommunication networks and in particular the Internet, the privacy and security concerns of people using these networks have increased. On the one hand, users are concerned about their privacy, and desire to anonymously access the network. On the other hand, some organizations are concerned about how this anonymous access might be abused. This paper intends to bridge these conflicting interests, and proposes a solution for revocable anonymous access to the Internet. Moreover, the paper presents some legal background and motivation for such a solution. However, the paper also indicates some difficulties and disadvantages of the proposed solution, and suggests the need for further debate on the issue of online anonymity.

Doctors' prescription behaviour regarding dosage recommendations for preparations of kava extracts.

There are many publications on the use of kava extracts as a treatment alternative to tricyclic antidepressants and benzodiazepines, but little has been done to investigate the potential adverse effects that may be associated with prolonged or high-dose usage. To investigate the extent to which physicians comply with the recommended daily dose (RDD) of an antidepressant such as kava and the consequences of this behaviour with regard to the safety and efficacy of frequently prescribed kava extracts (Trade names: Antares, Laitan and Kavasporal forte). The analysis was carried out using the patient database MediPlus, which provides anonymous access to a representative and valid panel of physicians and patients in Germany. Prescriptions for Antares showed that the RDD of 1 tablet per day was exceeded in 58.2% of the cases, while those for Laitan showed that the RDD of 1 capsule per day was significantly exceeded in 75.6% of the cases; a one-off prescription was issued in 66% of the cases. As a result, the required effect diminished very quickly. Prescriptions for Kavasporal forte showed that the daily dosage of 2 capsules per day complied with the recommendations in only 49.1% of the cases; in 38.8% of the cases, the dosage dropped below the respective recommendation. As a consequence, the lower-dosed Kavasporal forte was prescribed for longer periods than the higher-dosed Antares and Laitan. In the case of a low-dosage recommendation, we saw a trend to over-dose in prescribing behaviour, which increases the risk of undesirable adverse reactions. On the other hand, we saw a trend to under-dose in the case of a higher dosage recommendation. This fact may explain the unexpected inefficacy of the therapy. These trends affected the duration of therapy, whereby a dosage lower than the RDD was prescribed for a longer period than a dosage higher than the RDD.

Lipid-lowering therapy: do hospitals influence the prescribing behavior of general practitioners?

This investigation addresses the question whether physicians in hospitals influence the prescribing behavior of general practitioners regarding patients who are discharged following hospitalization. Case studies for patients on lipid-lowering therapy were used as an example. All analyses described were carried out with mediplus, a longitudinal patient database with anonymous access to a representative and valid panel of physicians and patients in Germany. A total of more than 1,000 medical practices with over 6 million patients and over 100 million prescriptions can be analyzed using a cross- and/or longitudinal section of the database. The longest time period per patient exceeds 12 years commencing in 1989 and there are monthly updates. This allows not only cross-tabulation analysis but also time-dependent longitudinal analysis. The results of the study demonstrated that hospitals significantly influence the prescribing behavior of general practitioners. The sum of lipids lowering drugs prescribed in hospitals after admission increased by approximately 45% compared to the initial situation in practices. Physicians in hospitals play a significant role in causing a shift in treatment patterns of practice-based physicians with a reduction in use traditional fibrates in favor of cholesterin synthesizing enzyme inhibitors. The results of this investigation showed a significant increase in lipid-lowering therapy with a shift from fibrates to the more innovative CSE-inhibitors in the treatment pattern of patients following hospitalization. This study also demonstrates that the patient database used provides a useful insight into the extent of hospital physician influence on prescribing behavior of general practitioners and that this behavior can be quantified.

Treatment behavior of doctors regarding Helicobacter pylori infections.

Since the detection of the gastric acid resistant bacterium Helicobacter pylori in the year 1982 there has been a fundamental change regarding the therapy of ulcers. According to expert opinion these infections should be treated and eradicated, whereby the so-called triple-therapies are considered to be the most effective ones. Whether such recommendations to eradicate Helicobacter pylori can be put to use in daily practice is an important question that is frequently asked. All analyses described in the study here were done using mediplus, a longitudinal patient database with anonymous access to a representative and valid panel of physicians and patients within Germany. A total of more than 1,000 medical practices and over 75 million prescriptions can be analyzed in a cross- and/or longitudinal section. The longest time period per patient is more than 10 years starting in 1989 with monthly updates. With regard to existing recommendations, doctors overestimate their own compliance with the recommendations because only a fraction of traceable Helicobacter pylori infections are actually eradicated. Within the period of observation the therapy behavior has changed significantly in favor of the triple-therapies, but there are relevant differences between practitioners and internal specialists. Only a fraction of traceable Helicobacter pylori infections are adequately treated by doctors. The results show a very alarming situation due to the gap between "state of the art" and what is being achieved and carried out in daily practice. The potential for possible cost reductions and saving on resources is probably high. The results lead to the conclusion that in the treatment of Helicobacter pylori infections there is a potential for cost saving which is unused from the pharmacoeconomical point of view.

Use of the mediplus patient database in healthcare research.

Public health systems require fast and precise analyses of physicians' day-to-day diagnoses and therapy behavior regarding qualitative, safety or economical aspects. A partnership between physicians in practices and a database organization (IMS Health, Frankfurt, Germany) which has been in existence for more than 10 years has developed a procedure for documenting various types of studies with regard to diagnosis and therapy behavior. This endeavor has facilitated scientific progress by providing precise analytical information and guidelines. The database used has the name mediplus. It is a longitudinal patient database with anonymous access to a representative and valid panel of physicians and patients in Germany. A total of more than 1,000 medical practices and over 75 million prescriptions have been documented in a cross and/or longitudinal section. The longest time period per patient is more than 10 years starting in 1989, with monthly updates. Analyses have been obtained detailing prescription behavior of doctors regarding diabetes therapy and enable recommendations to be made regarding the therapy of migraine and the eradication of Helicobacter pylori infections. Information is also retrievable on drug safety studies in general and the extent to which hospitals influence the prescription behavior of doctors treating patients after discharge. The mediplus patient database combines all decision relevant information on physicians, patients, diagnoses and course of therapies and thus makes possible the investigation of the courses of diseases and therapy patterns. The monthly update enables trends to be identified at an early stage. The mediplus database is an ideal instrument for the enforcement of quantitative and qualitative analyses of patient histories because it directly links the individual diagnoses with the corresponding therapies. The database is currently undergoing extension with additional specialist groups such as pediatricians, neurologists, orthopedists, urologists, ENT specialists, surgeons and pulmonologists.

Déficience intellectuelle et environnement : contribution des courbes de croissance au diagnostic étiologique

Several derogatory clauses to parents' consent have been recently introduced in the French legislation concerning adolescents contraception and voluntary termination of pregnancy. Thus, from now on, adolescents may have free and anonymous access to contraception as well as detection and treatment of sexually transmitted diseases. Adolescents may also obtain emergency contraception without medical prescription. Parents' consent is no more necessary to authorize voluntary termination of pregnancy for an adolescent who wish to keep it secret.

The transfer of harm-reduction strategies into prisons: needle exchange programmes in two German prisons

In Autumn 1995, the Minister of Justice of Lower Saxony (a northern state of Germany) gave the green light for the implementation of a 2-year pilot project. This project provided for the distribution of sterile injection equipment and provision of communicative methods of prevention to drug addicted inmates in a women’s prison with 170 inmates (Vechta) and a men’s prison with 230 inmates (Lingen). The decision to go ahead with the project was based on positive experiences in Swiss prisons and the supporting recommendations of a panel of experts. The pilot project in Vechta started on 15 April 1996, using five dispensing machines which allow a needle exchange to guarantee an anonymous access. The project in the men’s prison started on 15 July 1996. Here the staff of the drug counselling service and of the health care unit hand out sterile syringes to inmates. The social scientific evaluation was carried out by the Carl von Ossietzky University in Oldenburg. The study focused on the aim of the project which is to assess the feasibility, usefulness and efficacy of the measures undertaken. Of special interest was whether and how changes occured in the prison system itself (i.e. acceptance of the measures by staff, medical service and management), and in the drug user’s behaviour and knowledge (i.e. development of needle sharing, change in drug use patterns). The study used a multi-methodological approach: documentation of the project practice, half standardized, longitudinal examination of inmates ( n=224) and staff ( n=153), qualitative examination of management, selected groups of prisoners, staff and external organisations (AIDS-Help-Groups; n=75) for at least two times. The evaluation intended to be dynamic, process accompanying, in order to communicate the empirical data and developments with the practice already during the pilot phase. Results of the final report of the study are presented here. Finally this paper discusses shortly what is known so far about the impact of needle exchange programmes in prisons in Germany and Switzerland.

The Consequences of Anonymous Access to the Financial Payments System

Rapid advances in technology have conferred vast benefits upon modern societies. Money can be transferred by wire in an instant. The internet has dispensed with the need to send faxes across telephone wires. The days when it was necessary to carry multiple currencies across the international borders have all but disappeared. The day is fast approaching when societies will be cashless and people will be able to carry so‐called smart cards that contain all of their funds in the form of electronic cash. Smart cards have the technical ability to facilitate transfers of electronic cash from one smart card to another. Electronic cash can be used to shop on the internet and even gamble there. The shares of a company can be bought and sold on multiple stock exchanges through electronic cash transactions. When a London stock exchange is closed, for example, a person in the UK might transmit electronic cash to New York and buy publicly traded shares because the stock exchanges in New York will be open. If a citizen of one country loses faith in the national currency, he might use an electronic cash transaction to convert his assets into the stronger currency of another country in a foreign bank account. The examples of how modern technology will continue to benefit us are numerous.

Review : Telephone triage: a panacea for child and family health care?

■ Telephone triage offers an exciting, although controversial means of extending the role of children's nurses ■ Convenient, anonymous and immediate access to advice and help could be very attractive to many families ■ Children who do not need face-to-face contact with health professionals can be 'filtered out' of that system ■ Telephone triage should result in more appropriate use of resources ■ Telephone communication skills need to be developed to ensure that the service is efficient and effective ■ Research needs to be undertaken to ensure that newly developing services are appropriately evaluated

Consumo y venta de tabaco en lugares públicos: evaluación del cumplimiento de la normativa vigente

To evaluate the compliance with current legislation on smoking and tobacco sale in public places in the city of Sabadell (Barcelona). A sample of 218 sites was randomly selected from a total of 1,224 affected by the legislation, after excluding those where direct, anonymous access was difficult. The existence of signs banning smoking, of areas reserved for smokers and the observation of an indication of smoking presence were analyzed, and also a simulation of the act of smoking was performed. An indication of smoking presence was observed in 61.5% of sites visited, 85.8% and 74.8% did not have a sign banning smoking at the entrance or in the interior, respectively, excluding restaurants and cafeterias. Only 4.1% of sites complied with all requirements established by the Law. Only one restaurant (1.7%) had a nonsmoking section. Our results show a low level of compliance with the legislation. The Administration should state a coherent and progressive strategy to achieve its complete application.