Recent years have seen the dramatic increase of wearable medical systems (WMS) that have demonstrated promise for improving health monitoring and overall well-being. Ensuring that the data collected are secure and trustworthy is crucial. This is especially true in the presence of adversaries who want to mount data manipulation attacks on WMS, which aim to manipulate the sensor measurements with fictitious data that is plausible but not accurate. Such attacks force clinicians or any decision support system AI analyzing the WMS data, to make incorrect diagnosis and treatment decisions about the user’s health. Given that there are different possible vulnerabilities found in WMS that can lead to data manipulation attacks, we take a different angle by developing an attack-agnostic approach, called Signal Interrelationship CApture for Physiological-process (SICAP), to detect data manipulation attacks on physiological sensor measurements in a WMS. SICAP approach leverages the idea that different physiological signals in the user’s body driven by the same underlying physiological process (e.g., cardiac process) are inherently related to each other. By capturing the interrelationship patterns between the related physiological signals, it can detect if any signal is maliciously altered. This is because the incorrect user data introduced by adversaries will have interrelationship patterns that are uncharacteris- tic of the individual’s physiological process and hence quite different from the ones SICAP expects. We demonstrate the efficacy of our approach in detecting data manipulation attacks by building different detection solutions for two commonly measured physiological sensor measurements in a WMS environment – electrocardiogram and arterial blood pressure. The advantage of using this approach is that it allows for detection of data manipulation attacks by taking advantage of different types of physiological sensors, which already exist in typical WMS, thus avoiding the need of redundant sensors of the same type. Furthermore, SICAP approach is not designed to be stand-alone but provides the last line of defense for WMS. It is complementary to, and coexist with, any existing or future security solutions that may be introduced to protect WMS against data manipulation attacks.

As our society heads into aging society, along with more double-career family, economic pressure for young couples, and the increase of women employment rate, it becomes inevitable for the government to import alien nursing workers to meet domestic needs. Nowadays, we see these workers cross the border and fly over the ocean to Taiwan ¡V their promised land. Indeed, how much do we know about them? The current research, instead of studying on how these workers influence our society as most of other related literature, focuses on the situations of these alien nursing workers in the hospital, treat them as individuals with emotions and selves not just economic values to Taiwanese. In this thesis, the role that the alien nursing workers play in the medical system and the ways that they interact with other people are discussed. As ¡§role" and "interaction" are both abstract and complicated facets of social life, the research adopts qualitative methods of in-depth interviews and field observation. Six alien nursing workers, three nursing workers, three nurses, a service user, and two government section members are interviewed.

Surface Electromyography (SEMG) systems are utilized throughout the medical industry to study abnormal electrical activity of the human muscle. Historically, SEMG systems employ surface (skin) mounted sensors that transmit electrical muscle data to a computer base via an umbilical cord. A typical SEMG analysis may exercise multiple sensors, each representing a unique data channel, positioned about the patient's body. Data transmission cables are linked between the surface mounted sensor nodes and a backpack worn by the patient. As the number of sensors increases, the patient's freedom of mobility decreases due to the lengthy data cables linked between the surface sensors and the backpack. An N-channel wireless SEMG system has been developed based on the ZigBee wireless standard. The system includes N-channels, each consisting of a wireless ZigBee transmitting modem, an 8-bit microcontroller, a low-pass filter and a pre-amplifier. All channels stream data to a central computer via a wireless receiving modem attached directly to the computer. The data is displayed to the user through graphical development software called LabView. The wireless surface electromyography(WSEMG) system successfully transmits reliable electrical muscle data fiom the patient to a computer base. The development of a WSEMG system offers an attractivealternative to implementing wired surface electromyography testing by facilitating thefreedom of patient mobility not bound by data transmission cables.

Advances in wireless technologies in the last ten years have created considerable opportunities as well as challenges for wireless body medical systems. The foremost challenge is how to build a reliable system connecting heterogeneous body sensors and actuators in an open system environment. In this dissertation, we present our work towards this goal. The system addresses four design issues: the underlying network architecture, the network scheduling disciplines, the location determination and tracking methods, and the embedded application execution architecture. We first present the design of an adaptive wireless protocol (MBStarPlus) to provide the basic wireless platform WBAN (Wireless Body Area Network). MBStarPlus is a real-time, secure, robust and flexible wireless network architecture. It is designed to utilize any low-power wireless radio as its physical layer. The TDMA mechanism is adopted for realtime data delivery. The time-slot length is adjustable for flexibility. Multiple technologies are utilized to provide reliability and security. We next investigate how to coordinate the body sensors/actuators that can optimally select from a range (maximum and minimum) of data rates. Two bandwidth scheduling algorithms are proposed. One is a greedy algorithm that works for sensors with limited computational capability. The other is the UMinMax scheduling algorithm that has better scalability and power-saving performance but is more computationally intensive. The third issue addressed in this proposal is how to achieve location determination and tracking by a mix of high-precision but expensive and lower-precision but cost-effective sensors. This is achieved by a novel collaborative location determination scheme ColLoc that can integrate different types of distance measurements into a location estimation algorithm by weighing them according to their precision levels. Through this, a localization service can be both cost-effective and sufficiently accurate. Fourth, in order to minimize the effects of long network latency when the body network scales up, we propose ControlInGateway, an architectural feature that allows a control application to be executed inside the network gateway without the host's involvement. With ControlInGateway, a wireless system could achieve the same control quality as a wired system. / text

This dissertation focuses on the modelling, identification and the parameter estimation for the co-infection of HIV-1 and M. tuberculosis. Many research papers in this field focus primarily on HIV, but multiple infections are explored here, as it is common in many individuals infected by HIV. Tuberculosis is also responsible for the highest number of casualties per year in the group of HIV-infected individuals. A model is proposed to indicate the populations of both pathogen as well as key information factors, such as the overall infected cell population and antigen-presenting cells. Simulations are made to indicate the growth and decline in cell-type numbers for a specific individual. Such simulations would provide a means for further, well-founded investigation into appropriate treatment strategies. One previous such model developed by Kirschner is used to obtain a nominal parameter set. Furthermore, the nominal set is then used in conjunction with real-world samples provided by the National Institute for Communicable Diseases in South Africa, to solidify the credibility of the model in the practical case. This is achieved via simulations and employs parameter estimation techniques, namely the Nelder-Mead cost-function method. An identifiability study of the model is also done. Conclusions drawn from this study include the result that the treatment of M. tuberculosis does not affect the course of HIV-1 progression in a notable way, and that the model can indeed be used in the process of better understanding the disease profile over time of infected individuals. / Dissertation (MEng)--University of Pretoria, 2008. / Electrical, Electronic and Computer Engineering / MEng / unrestricted

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

Este trabalho propõe uma estratégia para realizar uma avaliação de usabilidade situada de equipamentos médicos. A área da saúde tem feito cada vez mais uso da tecnologia da informação e a cada dia, o usuário de sistemas médicos se depara com mais equipamentos dotados de interfaces computacionais mais complexas. Avaliações de usabilidade tornam-se necessárias para garantir que o equipamento atenda as demandas das atividades dos profissionais da saúde e para minimizar a probabilidade de erros relacionados à interação com o sistema. Propõe-se, neste trabalho, uma estratégia para realizar a avaliação de usabilidade no ambiente de uso do equipamento. A estratégia proposta é avaliada em um estudo de caso com a avaliação de um monitor multiparamétrico dentro de uma UTI (Unidade de Terapia Intensiva), concluindo-se que ela se mostra útil ao processo de desenvolvimento, pois produz resultados de natureza diferente dos geralmente encontrados em laboratório. Adicionalmente, discutem-se os aspectos de ética envolvidos na avaliação situada de usabilidade. / This paper considers a strategy to perform a situated usability evaluation of medical equipments. The use of information technology in the health sector has increased, as a result, medical system users need to deal with a complex computer interface that becomes even more complex each day. Usability evaluation become useful to ensure that the equipment fullfills healthcare professionals demands and also minimize the probability of errors associated with computer-human interaction. In this study a strategy to do a usability evaluation on the equipments intended environment has been proposed. The proposed strategy is evaluated in a case study with a multiparameter monitor in an ICU (Intensive Care Unit), concluding that it is useful to the development process because it produces different kinds of results when compared to those found in laboratories. This study also discusses the issues of ethics involved in the usability situated evaluation .

Este trabalho propõe uma estratégia para realizar uma avaliação de usabilidade situada de equipamentos médicos. A área da saúde tem feito cada vez mais uso da tecnologia da informação e a cada dia, o usuário de sistemas médicos se depara com mais equipamentos dotados de interfaces computacionais mais complexas. Avaliações de usabilidade tornam-se necessárias para garantir que o equipamento atenda as demandas das atividades dos profissionais da saúde e para minimizar a probabilidade de erros relacionados à interação com o sistema. Propõe-se, neste trabalho, uma estratégia para realizar a avaliação de usabilidade no ambiente de uso do equipamento. A estratégia proposta é avaliada em um estudo de caso com a avaliação de um monitor multiparamétrico dentro de uma UTI (Unidade de Terapia Intensiva), concluindo-se que ela se mostra útil ao processo de desenvolvimento, pois produz resultados de natureza diferente dos geralmente encontrados em laboratório. Adicionalmente, discutem-se os aspectos de ética envolvidos na avaliação situada de usabilidade. / This paper considers a strategy to perform a situated usability evaluation of medical equipments. The use of information technology in the health sector has increased, as a result, medical system users need to deal with a complex computer interface that becomes even more complex each day. Usability evaluation become useful to ensure that the equipment fullfills healthcare professionals demands and also minimize the probability of errors associated with computer-human interaction. In this study a strategy to do a usability evaluation on the equipments intended environment has been proposed. The proposed strategy is evaluated in a case study with a multiparameter monitor in an ICU (Intensive Care Unit), concluding that it is useful to the development process because it produces different kinds of results when compared to those found in laboratories. This study also discusses the issues of ethics involved in the usability situated evaluation .

This diploma thesis deals with problematic of emergency medical service preparedness in the Czech Republic, in the place of disaster and during this situation especially in bus accident with large number of injuries and casualties. Bus accident can create high risk of forming mass disaster due to many people transported in small area with low safety components. High risk of many injuries and casualties with chaotic first call make hard decision to activate plans to solve this situation for emergency services. Theoretical part of diploma thesis maps transformation of Czech paramedic system organization from districts to regions and new legislations for emergency medical service that solve preparedness, organization and duties during large incidents. Due to this new legislations were formed offices for emergency preparedness which ensure this preparedness. Practical part of diploma thesis is analysis of Czech paramedic preparedness that solve bus accidents as disaster. For this analysis were used data from regional emergency medical service headquarters (EMS HQ) - bus accident reports, drills for staff and special material equipments. But only 3 EMS HQ provided acceptable data and 1 EMS HQ partly acceptable data. Aim of this study is assessment in preparedness change for disaster during examined time (2000 - 2011) and comparison of real event to training drills. This part of thesis is supplied by statistic data (transformed into graphs) of bus accidents with injuries and casualties from department of Transportation Police of the Czech republic and Fire Rescue Service Directorate. Whole practical part is made by analysis of primary (documents, EMS HQ personal visits) and secondary information (information servers, journals). Within this analysis was made evaluation of Czech emergency medical preparedness for bus accidents with large number of injuries and casualties. This analysis shows that in area of the Czech Republic is missing central directorate for Czech paramedic system. Which is shown in varying material, drill and whole preparedness for disaster situation. This problem is also made by new legislation that were not here before (law for emergency medical system and law notices). High variation of equipments and procedures in solving disasters can cause difficulties during accident intervention on the borders of paramedic regions. For comparison to other countries preparedness is in this thesis mentioned Poland - special training course for specialist in disaster management, USA - Medical Alert Center (MAC) and Israel - control system for disaster drills.

Philosophiae Doctor - PhD / Literature on post-operative pain indicates that post-operative pain is inadequately managed in many countries including Ghana. Little was also known about post-operative pain (POP) response and management in Ghana. This study sought to describe post-operative pain response and management among Ghanaian surgical nurses and post-operative patients within the medico-socio-cultural context. It also explored factors that influenced POP response and management and subsequently aimed to develop clinical guidelines within which post-operative pain could be managed in the medico-socio-cultural context. Research questions answered included: „what are the factors influencing post-operative pain responses among surgical patients and nurses; what clinical guidelines would be appropriate to guide post-operative pain management within the medico-socio-cultural context of Ghana?‟The study was designed as a multi-step focused ethnography which allowed the exploration of a specific sub-culture such as the surgical environment. The philosophical underpinnings of ethnography permit the investigator to use different data collection methods to fully understand the phenomenon investigated. Data collection during the ethnographic exploration phase involved individual interviews, clinical observations, and review of patients‟ clinical charts. At the stage of guideline development, data was collected through participant/expert review, systematic literature review, and consensus forum. Participants were sampled purposively and included 53 interview participants, 27 expert reviewers, and 29 consensus panel members. Also, there were 16 sections of clinical observation and review of 44 charts. The participants included nurses, patients and their relatives, the multidisciplinary team, key informants, experts, and stakeholders. The study was conducted at the Korle-Bu Teaching Hospital (KBTH) and Ridge Hospital, in Accra, Ghana. Appropriate ethical clearance was sought and individual informed consent was obtained.Concurrent analysis of data was done applying the principles of thematic content analysis and data was managed with NVivo 9. Themes that emerged from the patients‟ data were subjectivism which described pain dimensions and expressions and factors that influenced patients‟ pain experience were psycho-socio-cultural factors such as personal inclinations and socio-cultural background; and health system factors such as personnel attitude and health financing.The study also found that nurses perceived POP as an individual phenomenon and responded to pain by administering analgesics and by employing non-pharmacologic measures such as positioning and reassurance. Factors that influenced the nurses‟ pain response were individual factors such as commitment, discretion, and fear of addiction; and organizational factors such as organizational laxity and challenges of teamwork. Patients‟ relatives were also influenced by empathy, faith, and commitment to care for their post-operative patients. The multidisciplinary team and key informants were influenced by knowledge and experience in their respective specialty areas. Subsequently, the clinical guideline developed had four dimensions which highlighted patient and family education,effective teamwork, effective leadership and monitoring, and use of contemporary evidence for POP management.The study recommended that health professionals should be conscious of the subjectivenature of pain and they should educate and involve the patient on pain management decisions. Also, hospital leadership and the multidisciplinary team should be actively involved in pain management.