Security vulnerabilities in healthcare: an analysis of medical devices and software.

The integration of IoT in healthcare has introduced vulnerabilities in medical devices and software, posing risks to patient safety and system integrity. This study aims to bridge the research gap and provide valuable insights for addressing healthcare vulnerabilities and their mitigation mechanisms. Software vulnerabilities related to health systems from 2001 to 2022 were collected from the National Vulnerability Database (NVD) systematized by software developed by the researchers and assessed by a medical specialist for their impact on patient well-being. The analysis revealed electronic health records, wireless infusion pumps, endoscope cameras, and radiology information systems as the most vulnerable. In addition, critical vulnerabilities were identified, including poor credential management and hard-coded credentials. The investigation provides some insights into the consequences of vulnerabilities in health software products, projecting future security issues by 2025, offers mitigation suggestions, and highlights trends in attacks on life support and health systems are also provided. The healthcare industry needs significant improvements in protecting medical devices from cyberattacks. Securing communication channels and network schema and adopting secure software practices is necessary. In addition, collaboration, regulatory adherence, and continuous security monitoring are crucial. Industries, researchers, and stakeholders can utilize these findings to enhance security and safeguard patient safety.

Automated Workflow for Usability Audits in the PHR Realm.

Teleworking is an everyday reality in today's world. Many companies are opting for this way of working remotely, as it improves employers' satisfaction along with the work-life balance and it does not lead to any significant reduction in performance. In general, the comfortable use of software applications is a priority, and quality aspects such as usability are of vital importance. In this paper, a novel workflow is proposed. It consists of the following components: (1) a tool to manage usability evaluations based on expert reviews, called Usevalia; (2) a set of heuristics to be considered when performing the evaluations; (3) a catalogue of usability requirements to guide the evaluations; (4) a checklist related to the heuristics to verify that the evaluations have been performed correctly by all the auditors; and (5) a set of tasks to know in advance the functionality of the applications to be audited. Personal health records (PHRs) were taken as a case study. This methodology made it possible to involve a total of 31 working groups that evaluated the usability of four PHRs. Concerning the main results, the evaluators agreed that with Usevalia the usability evaluations could go a step further because they are coordinated and can work together remotely. In addition, analyses of usability scores provided insight into current proposals for improving usability of applications.

Taking the pulse of a classroom with a gamified audience response system.

BACKGROUND AND OBJECTIVE: This paper presents an empirical study of a gamified mobile-based assessment approach that can be used to engage students and improve their educational performance. METHOD: A gamified audience response system called G-SIDRA was employed. Three gamification elements were used to motivate students in classroom activities: badges for achievements to increase engagement, points to indicate progression and performance in the subject and ranking for promoting competitiveness. A total of 90 medical students in a General and Descriptive Anatomy of the Locomotor System course were taught using G-SIDRA in the academic year 2019/2020. Smart bracelets were configured to collect heart rate measurements from 30 students with the aim of evaluating the impact of the gamification elements. The control group consisted of a sample of 110 students enrolled on the same course in the academic year 2016/2017 using non-gamified SIDRA. RESULTS: Statistically significant differences were found between multiple choice questions (MCQ) scores obtained by using SIDRA and G-SIDRA in the four experiments (U = 1.621,50, p < 0,01 for Exp1; U = 1.950,00, p < 0,01 for Exp2; U = 955,00, p < 0,01 for Exp3; U = 2.335,00, p < 0,01 for Exp4). In the students' final exam grades, statistically significant differences between students that used G-SIDRA as opposed to SIDRA (T(157) = 3.992; p = 0.044) were obtained. Concerning gamification elements, statistically significantly differences were found in comparing the pulse increases after and before the badge event in the four experiments (U = 2.484,00, p = 0,038 for Exp1; U = 2.109,50, p = 0,046 for Exp2; U = 1.790,50, p = 0,025 for Exp3; U = 1.557,0, p = 0,048 for Exp4). However, there are not statistically significant differences between the pulse increases after and before the ranking event in the four experiments. In a 5-point Likert-type scale, the students expressed satisfaction with G-SIDRA (M = 4.552) and thought the system helped to better understand both theoretical and practical concepts (M = 4.092). Their global assessment of the G-SIDRA platform was 4.471. CONCLUSIONS: Of the three gamification elements used in the study, only badge has an effect on heart rate. Better student responses and academic performance were achieved when using G-SIDRA. Nevertheless, more research is required to evaluate the impact of the gamification elements on the motivation, engagement and performance of students. Physiological measures are promising approaches for gamification elements evaluation.

Effects of Gamification on the Benefits of Student Response Systems in Learning of Human Anatomy: Three Experimental Studies.

This paper presents three experiments to assess the impact of gamifying an audience response system on the perceptions and educational performance of students. An audience response system called SIDRA (Immediate Audience Response System in Spanish) and two audience response systems with gamification features, R-G-SIDRA (gamified SIDRA with ranking) and RB-G-SIDRA (gamified SIDRA with ranking and badges), were used in a General and Descriptive Human Anatomy course. Students participated in an empirical study. In the academic year 2019-2020, a total of 90 students used RB-G-SIDRA, 90 students employed R-G-SIDRA in the academic year 2018-2019, and 92 students used SIDRA in the academic year 2017-2018. Statistically significant differences were found between final exam grades obtained by using RB-G-SIDRA and SIDRA, U = 39.211 adjusted p = 0.001 and RB-G-SIDRA and R-G-SIDRA U = 31.157 adjusted p = 0.015, thus finding strong evidence with respect to the benefit of the badges used in RB-G-SIDRA. Moreover, in the students' SIDRA systems scores, statistically significant differences were found between RB-G-SIDRA and SIDRA, U = -90.521 adjusted p < 0.001, and between R-G-SIDRA and SIDRA, U = -87.998 adjusted p < 0.001. Significant correlations between individual and team scores were also found in all of the tests in RB-G-SIDRA and G-SIDRA. The students expressed satisfaction, engagement, and motivation with SIDRA, R-G-SIDRA, and RB-G-SIDRA, thus obtaining a final average assessment of 4.28, 4.61, and 4.47 out of 5, respectively. Students perform better academically with gamified versus non-gamified audience response systems. Findings can be used to build a gamified adaptive learning system.

Intracranial pressure analysis software: A mapping study and proposal.

Introduction Intracranial pressure (ICP) monitoring and analysis are techniques that are, each year, applied to millions of patients with pathologies with million of patients annually. The detection of the so called A and B-waves, and the analysis of subtle changes in C-waves, which are present in ICP waveform, may indicate decreased intracranial compliance, and may improve the clinical outcome. Despite the advances in the field of computerized data analysis, the visual screening of ICP continues to be the means principally employed to detect these waves. To the best of our knowledge, no review study has addressed automated ICP analysis in sufficient detail and a need to research the state of the art of ICP analysis has, therefore, been identified. Methodology This paper presents a systematic mapping study to provide answers to 7 research questions: publication time, venue and source trends, medical tasks undertaken, research methods used, computational systems developed, validation methodology, tools and systems employed for evaluation and research problems identified. An ICP software prototype is presented and evaluated as a consequence of the results. Results A total of 23 papers, published between 1990 and 2020, were selected from 6 online databases. After analyzing these papers, the following information was obtained: diagnosis and monitoring medical tasks were addressed to the same extent, and the main research method used was evaluation research. Several computational systems were identified in the papers, the main one being image classification, while the main analysis objective was single pulse analysis. Correlation with expert analysis was the most frequent validation method, and few of the papers stated the use of a published dataset. Few authors referred to the tools used to build or evaluate the proposed solutions. The most frequent research problem was the need for new analysis methods. These results have inspired us to propose a software prototype with which provide an automated solution that integrates ICP analysis and monitoring techniques. Conclusions The papers in this study were selected and classified with regard to ICP automated analysis methods. Several research gaps were identified, which the authors of this study have employed as a based on which to recommend future work. Furthermore, this study has identified the need for an empirical comparison between methods, which will require the use and development of certain standard metrics. An in-depth analysis conducted by means of systematic literature review is also required. The software prototype evaluation provided positive results, showing that the prototype may be a reliable system for A-wave detection.

Investigating the Impact of Usability on Energy Efficiency of Web-based Personal Health Records.

Usability plays an important role in eHealth applications for their widespread adoption. These software systems have been studied in depth in the literature from this perspective. However, the energy consumption of information systems in the eHealth domain lacks comprehensive research. In this paper, the relationship between the energy consumption of the main components of a PC and the usability evaluations of graphical user interfaces (GUI) were studied in client applications. For this purpose, personal health records (PHR) were used as a case study. A set of 4 web-based PHRs were evaluated with the performance of 20 common tasks in the aforementioned systems. The usability evaluations were carried out by 4 experts. A total of 8 heuristics particularly designed for electronic health record systems and based on the Nielsen usability heuristics were employed. The instantaneous energy values of the power supply and the monitor were collected with an energy consumption measuring equipment. As a result, the following significant correlations were found. In NoMoreClipboard between the Memory heuristic and the power supply (rs = 0.495, p = 0.044), and the Minimalist heuristic and the monitor (rs = - 0.513, p = 0.035). In PatientsLikeMe between the Minimalist heuristic and the power supply (rs = - 0.479, p = 0.083), as well as in the Error heuristic and the power supply (rs = - 0.638, p = 0.014). Finally, in Health Companion between the Match heuristic and the power supply (rs = - 0.481, p = 0.043), and the Error heuristic and the power supply again (rs = - 0.602, p = 0.008). Apart from that, the tasks were divided into those with excellent and fair usability. Those tasks with high usability scores were evaluated to detect whether they also had low energy consumption during task performance. Significant differences were found in PatientsLikeMe with respect to the Error heuristic and the power supply (212.39 ± 18.85W). Significant differences were also found in Health Companion with respect to the Match heuristic and the power supply (199.91 ± 7.19W). The results were discussed to reveal the fundamentals of how implementing usability can impact on energy costs when running client applications.

A Study on the Relationship between Usability of GUIs and Power Consumption of a PC: The Case of PHRs.

Usability is key to achieve quality in software products. The client applications with a high score in usability might impact on the power consumption when they are run in a PC. For this reason, energy savings turn to be critical in green software systems. In this paper the relationship between the usability evaluations of the GUIs and the power consumption measurements of the main components of a PC were analysed. A set of 5 web-based personal health records (PHRs) were selected as a case study. The usability assessment was performed by an expert, employing the 14 principles of design by Alan Dix as heuristics. They were scored on a Likert scale after performing a collection of common tasks in the PHRs. At the same time, an equipment to measure the energy consumption of hard disk drive, graphics card, processor, monitor and power supply was used. Spearman's index was studied for the correlations between the usability assessments and the power consumption measurements. As a results, some weak relationships were found. A total of 5 usability heuristics were observed to may influence energy consumption when they were considered in the implementation of the PHRs. These heuristics were the following ones: consistency, task migratability, observability, recoverability and responsiveness. Based on the results, the usability principles of design cannot always be related to lower energy consumption. Future research should focus on the tradeoffs between usability and power consumption of client applications when they are used in a computer.

Corrigendum to "Energy efficiency in software: A case study on sustainability in personal health records" [J. Clean. Prod. 282 (2021) 124262].

[This corrects the article DOI: 10.1016/j.jclepro.2020.124262.].

Energy efficiency in software: A case study on sustainability in personal health records.

A personal health record is an eHealth technology in which users can observe their progress over time for a given condition. A research gap was identified in the literature concerning the study of the amount of energy that these systems need for their operation, and the energy efficiency that may be attained depending on their design. After the selection of five representative personal health records, a total of 20 tasks commonly done, and based on previous work, were performed with regard to two proposed scenarios, namely patient use and health personnel usage. The power consumption of the main components of a host machine was measured during the performance of the proposed duties. To that end, a hardware tool called the Energy Efficiency Tester was employed. The data collected were analyzed statistically, and significant differences were found in the respective consumption of the display (χ2 (4) = 23.782, p = 0.000), the processor (χ2 (4) = 29.018, p = 0.000) and the whole PC (χ2 (4) = 28.582, p = 0.000). For all of these components, NoMoreClipBoard was the personal health record that required the least energy (57.699 W for the display, 3.162 W for the processor and 181.113 W for the whole PC). A total of two strong correlations were found in the energy consumption between the hard disk and the graphics card (r = 0.791, p < 0.001), and the processor and the PC (r = 0.950, p < 0.001). Some features generated special amounts of power consumption, such as the news wall found on PatientsLikeMe, or the use of load icons that had an impact on most PC components. In addition, an in-depth analysis of the user interfaces was performed. A discussion was carried out on the design of the user interfaces, also taking into account recommendations drawn from the literature, checking for their implementation in the personal health records selected. With the aim of promoting sustainability among software developers, a best practice guideline on sustainable software design was proposed. Basic sustainability recommendations were collected for professionals to consider when developing a software system in general, and a personal health record in particular.

Improving Accessibility for People with Disabilities: A Case Study on Inclusive Beach Tourism.

Disability is an important area in biomedical engineering. But research on disability should not only focus on the healthcare aspects, but also on the integration of people with disabilities in the cultural and social contexts, such as the existence of architectural elements that prevent the use of common public services. The present research aims to improve accessibility and enjoyment of people with physical and motor disabilities to the tourist resources of the area of interest. We present a case study focused on the beaches of the Region of Murcia, Spain. Both the architectural and technological aspects of accessibility are analyzed. From the architectural point of view, the method includes the definition of the parameters of accessibility, and the features required for the equipment according to the local and national regulations. From the technological point of view, the tools and requirements necessary to develop the system are presented.

Are the expected benefits of requirements reuse hampered by distance? An experiment.

BACKGROUND: Software development processes are often performed by distributed teams which may be separated by great distances. Global software development (GSD) has undergone a significant growth in recent years. The challenges concerning GSD are especially relevant to requirements engineering (RE). Stakeholders need to share a common ground, but there are many difficulties as regards the potentially variable interpretation of the requirements in different contexts. We posit that the application of requirements reuse techniques could alleviate this problem through the diminution of the number of requirements open to misinterpretation. RESULTS: This paper presents a reuse-based approach with which to address RE in GSD, with special emphasis on specification techniques, namely parameterised requirements and traceability relationships. An experiment was carried out with the participation of 29 university students enrolled on a Computer Science and Engineering course. Two main scenarios that represented co-localisation and distribution in software development were portrayed by participants from Spain and Morocco. The global teams achieved a slightly better performance than the co-located teams as regards effectiveness, which could be a result of the worse productivity of the global teams in comparison to the co-located teams. Subjective perceptions were generally more positive in the case of the distributed teams (difficulty, speed and understanding), with the exception of quality. CONCLUSIONS: A theoretical model has been proposed as an evaluation framework with which to analyse, from the point of view of the factor of distance, the effect of requirements specification techniques on a set of performance and perception-based variables. The experiment utilised a new internationalisation requirements catalogue. None of the differences found between co-located and distributed teams were significant according to the outcome of our statistical tests. The well-known benefits of requirements reuse in traditional co-located projects could, therefore, also be expected in GSD projects.

Calcification detection of abdominal aorta in CT images and 3D visualization in VR devices.

Automatic calcification detection in abdominal aorta consists of a set of computer vision techniques to quantify the amount of calcium that is found around this artery. Knowing that information, it is possible to perform statistical studies that relate vascular diseases with the presence of calcium in these structures. To facilitate the detection in CT images, a contrast is usually injected into the circulatory system of the patients to distinguish the aorta from other body tissues and organs. This contrast increases the absorption of X-rays by human blood, making it easier the measurement of calcifications. Based on this idea, a new system capable of detecting and tracking the aorta artery has been developed with an estimation of the calcium found surrounding the aorta. Besides, the system is complemented with a 3D visualization mode of the image set which is designed for the new generation of immersive VR devices.