Access Protocol Research Articles

HM-ORAM: A Lightweight Crash-consistent ORAM Framework on Hybrid Memory System

Byte-addressable non-volatile memory (NVM) is a promising alternative technology for main memory, allowing the processor to access persistent data in the main memory directly. Systems with emerging NVM as the main memory still suffer from information leakage, performance, and endurance challenges. Fortunately, Oblivious RAM (ORAM) provides provable secure address obfuscation and encryption and can be used to build a secure memory system. However, it is challenging to support crash consistency with the increasing use of NVM as persistent memory. Current state-of-the-art PS-ORAM systems are designed based on pure NVM memory systems, which suffer from low performance. Different from the previous PS-ORAM system, in this work, we consider a hybrid memory system (both NVM and DRAM) and aim to build a crash-consistent ORAM framework with low overhead. We propose the HM-ORAM framework, which includes a novel ORAM tree-level partition scheme, a lightweight data persistency architecture, and a secure access protocol. It makes full advantage of both hybrid memory technologies to achieve the design requirements to support crash consistency and persistence of ORAM systems with minimal write overhead. Without compromising security, HM-ORAM can outperform an NVM-based ORAM (i.e., NVM-ORAM) system by 1.23 × and 1.39 × in non-recursive and recursive implementations.

Fishers and First Responders: Oil Spill Safety Workshop Design and Evaluation

ABSTRACT Objectives This paper describes the design and evaluation of a workshop created to develop safer disaster response strategies for fishing communities, using the 2019 Northeast Brazil Oil Spill as a starting point for community-engaged education. Methods The 3-day pilot workshop included presentations, structured discussions, and interactive activities with small-scale fishers (SSFs), university researchers, and representatives of local government agencies. The workshop was evaluated through a mixed-method approach that considered qualitative data from discussion groups, collectively built products, and content retention. Evaluation methods were designed to contribute to participant learning while collecting information to improve the workshop’s design. Results The workshop succeeded in identifying harm reduction strategies for SSFs in the face of chemical spills, as well as in connecting them with government agencies that can provide support. Feedback from facilitators and participants was largely positive, emphasizing the accessibility of the event, participant enthusiasm, and the importance of the content for SSFs’ safety. In evaluating content retention, nearly all content was understood and could be explained effectively by the SSF participants. Products of the workshop that the community can refer to in the future include community-produced videos about safety in encounters with petrochemicals and two flowcharts that outline disaster response strategies Conclusion Community education and participatory frameworks support rich learning experiences around community health, with benefits for researchers and SSF participants. This workshop built on experiences from the 2019 oil spill to develop safer chemical spill response strategies that consider resource availability in the target community. Future events could build from this base to prepare for other kinds of disasters, like floods and storms. This event aims to reduce harm to SSFs, but government and professional first responder support remains essential to ensure safe disaster response due to a lack of safe, accessible protocols for such events.

Implantable Cardioverter-Defibrillators and Cardiovascular Resynchronization Therapy with Left Ventricular Assist Devices: A MOMENTUM 3 Trial Analysis.

The benefit of implantable cardioverter-defibrillators (ICD) and cardiovascular resynchronization therapy (CRT-D) in patients supported with a HeartMate 3 left ventricular assist device (LVAD) remains uncertain. An analysis of the MOMENTUM 3 randomized clinical trial and the first 1000 patients in the Continued Access Protocol trial. Patients were divided into three groups based on the presence of ICD and/or CRT-D: No device (n=153, 11%), ICD only (n=699, 50.4%), CRT-D (n=535, 38.6%). We assessed the association of ICD or CRT-D with overall mortality, ventricular arrhythmias (VA), rehospitalization rates, quality of life and six-minute walk test distance at 2-years of follow-up. Patients with ICD or CRT-D had similar survival to those without (HR 1.3, 95% CI 0.8-2.1, p=0.36) with no differences in rehospitalizations, quality-of-life or six-minute walk test distance. VA occurred more frequently in patients with ICD or CRT-D (HR 2.4, 95% CI 1.3-4.3, p=0.006). Compared to ICD alone, patients with CRT-D demonstrated similar survival (HR 1.1, 95% CI 0.9-1.5, p=0.36), however, had increased rates of VA (HR 1.3, 95% CI 1.0-1.7, p=0.03). There were no differences in rate of rehospitalization between those with ICD or CRT-D and those without (p=0.19) or between those with ICD and those with CRT-D (p=0.32). A propensity-matched sensitivity analysis confirmed these findings. In this post-hoc analysis of the MOMENTUM 3 trial, the presence of ICD or CRT-D at the time of HM3 LVAD implantation was associated with an increased incidence of VA but was not associated with survival, quality of life or functional capacity. Momentum 3 portfolio, NCT02224755 (Pivotal) and NCT02892955 (CAP).

"We can't change that while they're in the hospital": Unveiling the manifestations of infrastructural violence and wound care for people who inject drugs.

Healthcare avoidance or delays for wounds and related skin- and soft-tissue infections are often attributed to negative interactions with medical providers. An infrastructural violence framework posits that healthcare infrastructure serves as a material channel for structural violence, maintaining inequities in healthcare experiences and outcomes. Infrastructural violence ensues when infrastructure is designed for some members or groups within a society while perpetuating violence among others. This study draws on the concept to understand how healthcare infrastructure creates and perpetuates inequities within the healthcare system for people who inject drugs for their wound care-related needs. Between January and September 2023, semi-structured interviews were conducted with 12 medical providers in Maryland. An abductive thematic analysis approach was followed. Healthcare infrastructure mediated the relationship between structural factors, such as policies on prescribing privileges of medications for opioid use disorder and subsequent individual health experiences. Medical providers also described how their access to training, protocols, and other resources was insufficient to meet the needs of people who inject drugs presenting to healthcare settings for wound care. A new conceptual grounding provides recommendations on extending beyond medical provider behavior change interventions in healthcare settings to create supportive infrastructure, which includes readily available and accessible policies, protocols, and resources to care for this patient population.

Ultrasound-guided peripheral intravenous access in adults: A randomized crossover controlled trial.

Peripheral intravenous access is a common invasive clinical procedure, and difficult peripheral intravenous access is a common problem in the care of emergency and critically ill patients. The timeliness of immediate treatment is affected by the difficulty of intravenous access in clinical practice, which endangers patient safety. Repeated injections increase the pressure on nursing staff, consume more nursing hours, and incur higher medical costs. This study aimed to develop an evidence-based ultrasound-guided peripheral intravenous access protocol and evaluate the effectiveness of ultrasound guidance on difficult peripheral intravenous access. This was a randomized crossover study. This study enrolled 36 adult volunteers with difficult peripheral intravenous access at a medical center in southern Taiwan via convenience sampling. A randomized block design was used to generate random sequences. Each participant underwent ultrasound-guided and traditionally blind peripheral intravenous access. Ultrasound-guided peripheral intravenous access was performed using a high-frequency 12-MHz-ultrasound probe, and a two-person, dynamic, longitudinal, and transverse scanning method was adopted to help locate the position, direction, and depth of the peripheral veins. In this study, the chi-square test, Fisher's exact test, and independent t-test were used to compare post-test differences between the two groups. Ultrasound guidance significantly improved the first attempt success rate (odds ratio=10.97, p<0.0001) and overall success rate (odds ratio=49.67, p<0.0001) and reduced the number of attempts (mean difference=-0.50 attempts, p<0.0001) in difficult peripheral intravenous access. The ultrasound-guided peripheral intravenous access protocol developed in this study can significantly improve injection effectiveness in adults for whom intravenous access is difficult. A two-person, dynamic, longitudinal, and transverse scanning method is recommended in clinical practice to perform intravenous cannulation through rigorous ultrasound operation training to resolve the clinical problem of difficult intravenous access, reduce pressure on nursing staff, and improve the quality of clinical care. ISRCTN18025891.

Organising digital twin in the built environment: a systematic review and research directions on the missing links of use and user perspectives of digital twin in Architecture, Engineering and Construction (AEC) sector

There has been growing interest in the adoption of advanced digital technologies in the Architecture, Engineering and Construction (AEC) sector, as shown by the increasing number of review studies on the adoption of Digital Twin (DT) in the sector. While previous reviews on DT in the AEC sector have emphasised the technical opportunities and challenges, reviews that take a specific organisational and management focus on the use of DT are lacking. In this systematic review, we close this gap by analysing 102 papers from three main scientific databases (Google Scholar, Scopus and Web of Science), which emphasise organisational and management aspects of using DT in the AEC sector across the project and asset lifecycle phases. The findings indicate that, whereas there is still a stronger focus on finding optimisations for various performance concerns (e.g. project efficiency, health and safety and maintenance performance), there is increasing awareness and interest in using DT to encourage collaboration and (end-)user participation. Despite this recognition, our review also identified a number of critical knowledge gaps on the use and user perspectives of DT, which includes how powerful computational tools can be developed into user-friendly interfaces to reduce complexity and increase accessibility to all stakeholders in the decision-making process, and how participatory design frameworks can be combined with structured feedback systems and standardised data access protocols in order to stimulate communication, continuous improvement, and data-driven decision making.

Simple and Fail-safe Method to Transform Miniprep Escherichia coli Strain K12 Plasmid DNA Into Viable Agrobacterium tumefaciens EHA105 Cells for Plant Genetic Transformation.

Agrobacterium-mediated gene transformation method is a vital molecular biology technique employed to develop transgenic plants. Plants are genetically engineered to develop disease-free varieties, knock out unsettling traits for crop improvement, or incorporate an antigenic protein to make the plant a green factory for edible vaccines. The method's robustness was validated through successful transformations, demonstrating its effectiveness as a standard approach for researchers working in plant biotechnology. It enables the introduction of foreign DNA into plant genomes. Conventionally, plant genetic transformation has relied on time-consuming, costly, and technically demanding procedures, such as electroporation and chimeric viruses or biolistic methods, which usually yield variable transformation efficiencies. This study presents a simple and fail-safe protocol that involves a modified freeze-thaw and heat-shock concoction method. This approach involves a streamlined plasmid miniprep procedure to isolate high-quality plasmid DNA from Escherichia coli K12 strain, followed by a target-specific transfer into A. tumefaciens EHA105 strain. The optimized method minimizes DNA degradation and maximizes uptake by Agrobacterium cells, making it a reproducible and accessible protocol for various genetic engineering applications. The transformation efficiency is consistently high, enhancing plasmid uptake while maintaining cell viability, requiring minimal specialized equipment and reagents. The proposed protocol offers significant advantages, including simplicity, reliability, and cost-effectiveness, positioning it as a valuable alternative to traditional techniques in the field of plant biotechnology. Key features • Uses liquid nitrogen as a proxy for freezing. • Plasmid DNA from competent bacterial cells is extracted using a user-friendly high-copy isolation kit. • A maximum of five consecutive days is sufficient to complete the procedures.

Impact of China’s Accession Protocol on its Participation in the Dispute Settlement Mechanism (DSM): An Analysis of Eleven Protocol-related Cases

It has been twenty-three years since China acceded to the WTO. Since then, China has participated in high-profile disputes through the WTO’s DSM. During this period, China has evolved from being a silent observer to a sophisticated participant in the DSM. This has provided a valuable opportunity to observe China’s participation in the DSM and to analyse the factors affecting China’s performance. This article examines China’s engagement in the DSM relating to cases concerning China’s Accession Protocol in which China was involved as a respondent. Based on an in-depth analysis of eleven Protocol-related cases settled among all cases pertaining to China's Accession Protocol, I conclude that both the Accession Protocol itself and the interpretive approach adopted by the DSB have made it challenging for China to defend against allegations of violating its obligations under China’s Accession Protocol and the associated commitments outlined in China's Working Party Report. WTO Members can consequently without difficulty resort to certain provisions under the Accession Protocol to bring cases against China.

Simple and versatile electrochemical synthesis of highly substituted 2,1-benzisoxazoles.

A sustainable, general and scalable electrochemical protocol for direct access to 3-(acylamidoalkyl)-2,1-benzisoxazoles by cathodic reduction of widely accessible nitro arenes is established. The method is characterised by a simple undivided set-up under constant current conditions, inexpensive and reusable carbon-based electrodes, and environmentally benign reaction conditions. The versatility of the developed protocol is demonstrated on 39 highly diverse examples with up to 81% yield. A 50-fold scale-up electrolysis highlights its relevance for preparative applications.

High-Yield Generation of Glucose-Responsive Pseudoislets From Murine Insulinoma Cells for In Vitro Studies and Longitudinal Monitoring of Graft Survival In Vivo

Compared to primary pancreatic islets, insulinoma cell-derived 3D pseudoislets offer a more accessible, consistent, renewable, and widely applicable model system for optimization and mechanistic studies in type 1 diabetes (T1D). Here, we report a simple and efficient method for generating 3D pseudoislets from MIN6 and NIT-1 murine insulinoma cells. These pseudoislets are homogeneous in size and morphology (~150 µm), exhibit functional glucose-stimulated insulin secretion (GSIS) up to 18 days (NIT-1) enabling long-term studies, are produced in high yield [>35,000 Islet Equivalence from 30 ml culture], and are suitable for both in vitro and in vivo studies, including for encapsulation studies. To enable non-invasive longitudinal monitoring of graft survival in vivo, we transduced NIT-1 cells with green fluorescent protein-luciferase and confirmed comparable morphology, viability, and GSIS to untransduced cells in vitro. After subcutaneous implantation, we show capability to monitor graft survival in immunodeficient mice, recurrence of autoimmunity in non-obese diabetic mice, and allorejection in C57BL/6 mice. Overall, this platform provides an accessible protocol for generating high yields of 3D pseudoislets and non-invasive longitudinal monitoring of graft survival in different models offer advantages over primary islets for optimization and mechanistic studies of β cell biology, drug discovery, T1D pathogenesis and prevention, and β cell transplantation.

Implementing zero-knowledge proof authentication on Hyperledger fabric to enhance patient privacy and access control

In recent years, the healthcare sector has encountered significant challenges in authenticating identities for online medical services. A predominant reliance on centralized identity management systems (IDMs) has presented obstacles to the seamless exchange of patient identities among various healthcare institutions, often resulting in data isolation within individual silos. Of paramount concern are the potential privacy breaches associated with centralized IDMs, which may compromise patient confidentiality. In response to these challenges, we propose a novel approach to securely sharing patient details across multiple hospitals utilizing the zero-knowledge access protocol (MediCrypt-ZKAP) within the Hyperledger Fabric blockchain framework. By adopting MediCrypt-ZKAP, hospitals can effectively verify the identities of requesting entities without disclosing sensitive patient information, thereby ensuring the highest levels of confidentiality and privacy protection. The proposed system represents a proactive step towards addressing the critical need for secure and interoperable patient data exchange within the healthcare sector. Through the integration of MediCrypt-ZKAP into existing blockchain infrastructure, our solution aims to enhance data security and privacy while promoting seamless collaboration among healthcare institutions.

Enhanced Identity and Access Management with Artificial Intelligence: A Strategic Overview

The article aims to impart an overview of integrating artificial intelligence (AI) with identity and access management (IAM) systems and their strategic view regarding evolution, benefits, and challenges. Solid IAM systems are bulwarks of defense that shield sensitive information from sophisticated digital threats. The evolution of IAM during these last three decades - from modules such as Lightweight Directory Access Protocol (LDAP) to developed systems - has made inroads into handling the contemporary complexities of modern security protocols. It is AI that boosts IAM to real-time threat detection, automated user provisioning, and compliance with regulations through which provisioning is done using machine learning to analyze vast amounts of data for the detection of access patterns that are not usual and from those to predict the breaches, followed by the implementation of solid authentications and controls, including biometric and adaptive verification. Apart from providing benefits, there are challenges to be taken care of in a scenario where the integration of AI will call for advanced hardware, standardized software, and intensive training of users. General AI-driven platforms and tools, like IBM Security Identity Governance and Microsoft Azure Active Directory, add to the strength of IAM by ensuring the automatic detection of potential threats and facilitating proactive actions against them. Moreover, the article elaborates on a few AI-driven IAM applications in the finance and healthcare sectors, which considerably impact data security and fraud reduction. In this regard, addressing the current challenges and developing standardized frameworks is going to be imperative for the extraction of the full potential of AI into IAM.

An RF-powered multi-device diamond relay IoT network using A-NOMA for WBAN

ABSTRACT This article presents an energy-efficient multi-device (MD) diamond relay network (DRN) using radio frequency (RF) energy harvesting (EH) using an improved adaptive non-orthogonal multiple access (A-NOMA) protocol for wireless body area network (WBAN) scenario. To understand the practical application of A-NOMA in WBAN, a realistic virtual environment has been modelled in Netsim v13.1, and subsequently the simulated values are processed in Matlab to compare the achievable sum rate (ASR) with OMA and NOMA. Next, theoretical derivations of ASR and energy efficiency (EE) are carried out and validated through extensive simulations. Moreover, the bit error rate (BER) analysis has been performed and compared with the baseline models. Additionally, an in-depth evaluation of EE with respect to ASR has been performed. Results show that our proposed approach is more effective than the existing benchmarks and reveal an intriguing trade-off between ASR and EE.

Public perspectives on COVID-19 triage protocols for access to critical care in extreme pandemic context.

COVID-19 triage protocols are resource allocation processes to deal with the potential lack of resources in Intensive Care Units (ICU). They have given rise to numerous ethical issues and controversies. Among them is the fear that people will be denied access to ICU on the basis of judgments about their quality of life, social value, frailty or age. This online Democratic Deliberation (DD) with members of the public aimed to discover the necessary considerations and conditions that make triage protocols more acceptable to guide future decisions in terms of the values and criteria that must underpin triage protocols. We simultaneously conducted the online DD in Quebec and Ontario on May 28th and June 4th, 2022, among adults who do not work in the healthcare sector, recruited randomly among the members of the public registered on Leger Opinion poll website to favor sociodemographic diversity. Data was analyzed using thematic analysis. Among the participants who took part in the study, 27 participants were from Ontario and 20 from Quebec. Three main themes emerged: 1) Acceptance of the protocol and values, 2) Considerations to be integrated in triage protocols, 3) Conditions which may favor a greater public acceptance of these protocols. Participants supported the idea of prioritizing patients with the best prognosis of survival under extreme conditions. The maximization of benefits was the most predominant approach. Participants considered that triage protocols are necessary to reduce arbitrariness in decision making and to facilitate these tragic decisions by health professionals.

Sum computation rate maximization for wireless powered OFDMA-based mobile edge computing network

The wireless power transfer (WPT) and mobile edge computing (MEC) technologies have been advocated as the prospective effective solution for future wireless networks. This paper introduces a multi-user WPT-MEC system, where a sum computation rate (SCR) maximization design by jointly optimizing the WPT duration, the allocation of the subcarrier selection indicator of each user, each user’s transmit power, and the parameters related to different offload modes at each user is considered. In such a system, the hybrid access point (AP) broadcasts radio frequency (RF) energy intended for users to harvest, subsequently enabling users to transmit their computation tasks to the MEC server via the orthogonal frequency division multiple access (OFDMA) protocol. To address this non-convexity SCR maximization problem, a decomposition optimization is proposed. In the top-problem, the DRL-based deep neural network (DNN) model is applied to realize the computation selection indicator and subcarrier selection indicator among each user. In the sub-problem, for the binary offloading mode, an efficient two-stage algorithm with golden section search and intrinsic properties is utilized to determine the optimal values of remaining parameters. For the partial offloading mode, the problem is reformulated by introducing new variables and then the convex optimization techniques are utilized to efficiently obtain the corresponding solutions. Simulation results demonstrate the proposed approach outperforms the benchmark methods considered in both binary and partial offloading modes.

Variability of Prehospital Pain Management Protocols: A Review of Prehospital Care Protocols in the United States.

We describe emergency medical services (EMS) protocols for pain management in the United States to elucidate systemic variability in protocols. We describe types of pain medications included in protocols, routes of administration, indications for use, standing orders for dosing, and use in pediatric patients. We performed a review of all publicly accessible EMS protocols from the website http://www.emsprotocols.org, supplemented with internet searches. Data were abstracted into a data collection form from June 2021 to January 2022. We developed categories of responses to summarize the data, using frequencies and proportions to describe outcome measures. We reviewed 104 EMS protocols, spanning 43 states. The most common pain management medications include fentanyl (94.2%), morphine (70.2%), ketamine (61.5%), ketorolac (40.4%), oral acetaminophen (36.5%), oral ibuprofen (22.1%), and nitrous oxide (19.2%). The most common route of administration across all protocols and medications is intravenous. Severe pain, without a specified level, is the most common indication for fentanyl (65.3%), morphine (61.6%), ketorolac (50.0%), and nitrous oxide (40.0%). Musculoskeletal injuries and burns are the most common indications for morphine, 15.1% and 19.2% of protocols, respectively. The majority of protocols dictate the weight-based dosing of fentanyl (74.5%), morphine (64.4%), ketamine (87.3%), oral acetaminophen (56.8%), and oral ibuprofen (59.1%). However, 97.6% and 100.0% of protocols dictate a fixed dose of ketorolac and nitrous oxide, respectively. Fentanyl, morphine, oral acetaminophen, and oral ibuprofen can be administered to pediatric patients based on standing orders among >90.0% of protocols. However, only 46.2% and 75.0% of protocols allow the use of ketorolac and nitrous oxide in pediatric patients, respectively. We found variability in EMS pain management protocols including the types of allowed medications, routes of administration, dosing, and indications for use. Further studies may assess whether standardized protocols across EMS systems could improve patient safety and quality of care.

HPR191 Utilization of a Managed Access Protocol to Enable Reimbursement of Liraglutide (Saxenda®) for Weight Management for Patients in Ireland

HPR191 Utilization of a Managed Access Protocol to Enable Reimbursement of Liraglutide (Saxenda®) for Weight Management for Patients in Ireland

Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device.

Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation. In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship. The authors analyzed the presence of LVEDD<55mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years. Adverse events included hemocompatibility-related (stroke, bleeding, and pump thrombosis) and non-hemocompatibility-related (right heart failure, infection) outcomes. Those with a smaller LVEDD (<55mm) (n=108) were older (age 63 ± 11 years vs 60 ± 12 years; P = 0.005), were more often female (31% vs 20%; P = 0.096), and had more ischemic cardiomyopathy (60.2% vs 42.6%; P = 0.0004) compared with the LVEDD≥55mm group (n=1,813). Death during implant hospitalization was higher (14.8 vs 5.7%; P=0.0007) and survival at 2 years was lower (63.3% vs 81.8%; HR: 1.97 [95%CI: 1.39-2.79]; P = 0.0002) in the LVEDD<55mm group. The LVEDD<55mm group experienced more deaths due to hemocompatibility-related adverse events (2.8% vs 0.6%; HR: 4.61 [95%CI: 1.29-16.45]; P = 0.018) and right heart failure, both early (0-30days; 7.4% vs 2.0%; HR: 3.70 [95%CI: 1.73-7.91]; P = 0.001) and late (>30days; 12.0 vs 4.8%; HR: 2.58 [95%CI: 1.37-4.84]; P = 0.003). Low-flow alarms rehospitalizations were higher in the LVEDD<55mm cohort (17.4 vs 8.3%; HR: 2.39 [95%CI: 1.59-3.59]; P< 0.001). Although infrequent in occurrence, smaller LVEDD (<55mm) is associated with increased risk for early and late mortality, a consequence of hemocompatibility-related and right heart failure-related deaths. Rehospitalizations due to low-flow alarms are also more frequent. (MOMENTUM 3 IDE Clinical Study Protocol [HM3™]; NCT02224755; MOMENTUM 3 Continued Access Protocol [MOMENTUM 3 CAP]; NCT02892955).

HPR245 Baseline Characteristics of Patients Approved for Reimbursement of Liraglutide (Saxenda®) for Weight Management Under a Managed Access Protocol in Ireland

HPR245 Baseline Characteristics of Patients Approved for Reimbursement of Liraglutide (Saxenda®) for Weight Management Under a Managed Access Protocol in Ireland

HPR59 Managed Access Protocols As an Innovative Approach to Enabling Access to High-Cost Orphan Medicines: The Irish Experience

HPR59 Managed Access Protocols As an Innovative Approach to Enabling Access to High-Cost Orphan Medicines: The Irish Experience