Assessing the impact of autonomous motivation and psychological need satisfaction in explaining adherence to an exercise referral scheme.

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Eynon, Michael John; O'Donnell, Christopher; Williams, Lynn

2017-10-01

Given the mixed findings concerning self-determination theory in explaining adherence to exercise referral schemes (ERS), the present study attempted to examine whether autonomous motivation and psychological need satisfaction could predict ERS adherence. Participants referred to an 8-week ERS completed self-report measures grounded in self-determination theory and basic needs theory at baseline (N = 124), mid-scheme (N = 58), and at the end of the scheme (N = 40). Logistic regressions were used to analyse the data. Autonomous motivation measured at mid-scheme explained between 12 and 16% of the variance in ERS adherence. Autonomy, relatedness and competence measured at mid-scheme explained between 18 and 26% of the variance in ERS adherence. This model also explained between 18 and 25% when measured at the end of the scheme. The study found limited evidence for the role of autonomous motivation in explaining ERS adherence. Stronger support was found for the satisfaction of the three needs for autonomy, relatedness and competence in predicting ERS adherence. Future research should tap into the satisfaction of all three needs collectively to help foster ERS adherence.

A systematic review and economic evaluation of exercise referral schemes in primary care: a short report.

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Campbell, Fiona; Holmes, Mike; Everson-Hock, Emma; Davis, Sarah; Buckley Woods, Helen; Anokye, Nana; Tappenden, Paul; Kaltenthaler, Eva

2015-07-01

It is estimated that only 39% of men and 29% of women in England achieve the levels of physical activity that are recommended to protect health and prevent disease. One approach to addressing this problem has been the development of exercise referral schemes (ERSs), in which health professionals refer patients to external exercise providers. These schemes have been widely rolled out across the UK despite concerns that they may not produce sustained changes in levels of physical activity and, therefore, may not be cost-effective interventions. The evidence to determine clinical effectiveness and cost-effectiveness was evaluated in 2009. This review seeks to update this earlier work by incorporating new evidence and re-examining the cost-effectiveness. To assess the clinical effectiveness and cost-effectiveness of ERSs compared with usual care. Exhaustive searches of relevant electronic databases and journals were undertaken to identify new studies evaluating ERSs using a randomised controlled trial (RCT) design. RCTs that incorporated a qualitative evaluation of the intervention were identified in order to explore the barriers and facilitators to the uptake of and adherence to ERSs. Data were extracted using a previously designed tool and study quality assessed for potential bias. Where data could be pooled, meta-analyses were carried out. Qualitative analysis was also undertaken using a thematic approach. The cost-effectiveness was evaluated using a Markov structure which estimated the likelihood of becoming physically active and the subsequent risk reduction on coronary heart disease (CHD), stroke and type 2 diabetes mellitus. The model adopts a lifetime horizon, and a NHS and Personal Social Services perspective was taken with discounting at 1.5% for both costs and benefits. The search identified one new RCT and one new qualitative study. The new data were pooled with existing data from the 2011 review by Pavey et al. [Pavey TG, Anokye N, Taylor AH, Trueman P

Improving the Authentication Scheme and Access Control Protocol for VANETs

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Wei-Chen Wu

2014-11-01

Full Text Available Privacy and security are very important in vehicular ad hoc networks (VANETs. VANETs are negatively affected by any malicious user’s behaviors, such as bogus information and replay attacks on the disseminated messages. Among various security threats, privacy preservation is one of the new challenges of protecting users’ private information. Existing authentication protocols to secure VANETs raise challenges, such as certificate distribution and reduction of the strong reliance on tamper-proof devices. In 2011, Yeh et al. proposed a PAACP: a portable privacy-preserving authentication and access control protocol in vehicular ad hoc networks. However, PAACP in the authorization phase is breakable and cannot maintain privacy in VANETs. In this paper, we present a cryptanalysis of an attachable blind signature and demonstrate that the PAACP’s authorized credential (AC is not secure and private, even if the AC is secretly stored in a tamper-proof device. An eavesdropper can construct an AC from an intercepted blind document. Any eavesdropper can determine who has which access privileges to access which service. For this reason, this paper copes with these challenges and proposes an efficient scheme. We conclude that an improving authentication scheme and access control protocol for VANETs not only resolves the problems that have appeared, but also is more secure and efficient.

Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

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Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

2017-12-01

Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for

A Novel Load Balancing Scheme for Multipath Routing Protocol in MANET

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Kokilamani Mounagurusamy

2016-09-01

Full Text Available The recent advancements in information and communication technology create a great demand for multipath routing protocols. In MANET, nodes can be arbitrarily located and can move freely at any given time. The topology of MANET can change rapidly and unpredictably. Because wireless link capacities are usually limited, congestion is possible in MANETs. Hence, balancing the load in a MANET is important since nodes with high load will deplete their batteries quickly, thereby increasing the probability of disconnecting or partitioning the network. To overcome these, the multipath protocol should be aware of load at route discovery phase. The main objective of the proposed article is to balance the load on a node and to extend the lifetime of the node due to the congestion, energy depletion and link failures. This article describes a novel load and congestion aware scheme called Path Efficient Ad-hoc On-demand Multipath Distance Vector (PE-AOMDV protocol to increase the performance of routing process in MANET in terms of congestion, end-to-end delay and load balancing. A new threshold value and a counter variable are introduced to limit the number of communication paths passing over a node in route discovery phase. For every new request the counter variable is incremented by one and the threshold value is compared to see whether the maximum number of connections has been reached or not. The proposed method is network simulator ns-2 and it is found that there is a significant improvement in the proposed scheme. It reduces the energy consumption, average end-to-end delay and normalized routing overhead. Also the proposed scheme increases packet delivery ratio, throughput and minimizes routing overheads.

Evaluation of specialist referrals at a rural health care clinic.

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Biggerstaff, Mary Ellen; Short, Nancy

2017-07-01

Transition to a value-based care system involves reducing costs improving population health and enhancing the patient experience. Many rural hospitals must rely on specialist referrals because of a lack of an internal system of specialists on staff. This evaluation of the existing specialist referrals from primary care was conducted to better understand and improve the referral process and address costs, population health, and the patient experience. A 6-month retrospective chart review was conducted to evaluate quality and outcomes of specialty referrals submitted by 10 primary care providers. During a 6-month period in 2015, there was a total of 13,601 primary care patient visits and 3814 referrals, a referral rate of approximately 27%. The most striking result of this review was that nearly 50% of referred patients were not making the prescribed specialist appointment. Rather than finding a large number of unnecessary referrals, we found overall referral rates higher than expected, and a large percentage of our patients were not completing their referrals. The data and patterns emerging from this investigation would guide the development of referral protocols for a newly formed accountable care organization and lead to further quality improvement projects: a LEAN effort, dissemination of results to clinical and executive staff, protocols for orthopedic and neurosurgical referrals, and recommendations for future process improvements. ©2017 American Association of Nurse Practitioners.

Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009-14: predictors of dropout and barriers to adherence.

Science.gov (United States)

Kelly, Michael C; Rae, Glen C; Walker, Diane; Partington, Sarah; Dodd-Reynolds, Caroline J; Caplan, Nick

2017-12-01

Exercise Referral Schemes (ERS) are a prevalent method of increasing physical activity levels. However, they suffer from participant dropout and research predicting dropout or barriers to adherence are limited. This study aimed to focus upon the effect of referral characteristics on dropout, dropout predictors and whether self-reported barriers to exercise predict dropout. ERS data from 2009 to 2014 were retrieved for analysis. Chi-squared and t-tests were used to investigate differences between referral characteristics, and logistic regression used to investigate dropout predictors. Of 6894 participants, 37.8% (n = 2608) dropped out within 6 weeks and 50.03% (n = 3449) by the final 12th week. More males adhered (P dropouts being significantly younger (P Dropout predictors were smoking (OR = 1.58, 95% CI: 1.29-1.93) or being a Tier 3 referral (OR = 1.47, 95% CI: 1.25-1.73). Increasing age (OR = 0.98, 95% CI: 0.98-0.99), drinking alcohol (OR = 0.82, 95% CI: 0.71-0.95), secondary care referrals (OR = 0.68, 95% CI: 0.52-0.90), having a lack of motivation (OR = 0.81, 95% CI: 0.69-0.95) or a lack of childcare (OR = 0.69, 95% CI: 0.50-0.95) decreased the likelihood of dropout. ERS dropout continues to be problematic. Smoking and having moderate-high comorbidities predicted dropout. Increasing age and patient-reported barriers of a lack of time or childcare decreased dropout risk. The reasons for dropout require further investigation. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A General Scheme for Information Interception in the Ping-Pong Protocol

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Piotr Zawadzki

2016-01-01

Full Text Available The existence of undetectable eavesdropping of dense coded information has been already demonstrated by Pavičić for the quantum direct communication based on the ping-pong paradigm. However, (a the explicit scheme of the circuit is only given and no design rules are provided; (b the existence of losses is implicitly assumed; (c the attack has been formulated against qubit based protocol only and it is not clear whether it can be adapted to higher dimensional systems. These deficiencies are removed in the presented contribution. A new generic eavesdropping scheme built on a firm theoretical background is proposed. In contrast to the previous approach, it does not refer to the properties of the vacuum state, so it is fully consistent with the absence of losses assumption. Moreover, the scheme applies to the communication paradigm based on signal particles of any dimensionality. It is also shown that some well known attacks are special cases of the proposed scheme.

Cambridge community Optometry Glaucoma Scheme.

Science.gov (United States)

Keenan, Jonathan; Shahid, Humma; Bourne, Rupert R; White, Andrew J; Martin, Keith R

2015-04-01

With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. 1733 patients were evaluated by this scheme between 2010 and 2013. Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. The number of false positive referrals from initial referral into the scheme. Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system. © 2014 Royal Australian and New Zealand College of Ophthalmologists.

The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol

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Ford Daniel E

2010-11-01

Full Text Available Abstract Background Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group. Methods The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates and patient participation (proportion referred who go to the website. We will then compare the effectiveness of the standard and augmented patient websites. Discussion Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login and patient outcomes (six-month smoking cessation. Trial Registration Web-delivered Provider Intervention for

Early signaling, referral, and treatment of adolescent chronic pain: a study protocol

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Voerman Jessica S

2012-06-01

Full Text Available Abstract Background Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study. Methods and design The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition. Discussion If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based. Trial registration Dutch Trial Register NTR1926

Prediction Schemes to Enhance the Routing Process in Geographical GPSR Ad Hoc Protocol

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Raed Saqour

2007-01-01

Full Text Available Geographical routing protocols have received a serious attention due to more advantages they have in comparison to the conventional routing protocols. They require information about the physical position of nodes needed to be available. Commonly, each node determines its own position through the use of Global Positioning System (GPS or some other type of positioning service. Greedy Perimeter Stateless Routing (GPSR protocol, which is one of geographical routing protocols, limits the forwarding decision of the packet based on the node's own position, the destination's position and the position of the forwarding node's neighbors. Location information has some inaccuracy depending on the localization system and the environment exists in. This paper aims to study the impact of mobility metrics (beacon interval, and node speed on introducing location information error in GPSR protocol using different mobility models. The effect of these metrics is identified in GPSR as Neighbor Break Link (NBL problem. Based on simulation analysis, mobility prediction schemes are proposed to migrate the observed problem.

An effective implementation scheme of just-in-time protocol for optical burst switching networks

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Wu, Guiling; Li, Xinwan; Chen, Jian-Ping; Wang, Hui

2005-02-01

Optical burst switching (OBS) has been emerging as a promising technology that can effectively support the next generation IP-oriented transportation networks. JIT signaling protocol for OBS is relatively simple and easy to be implemented by hardware. This paper presented an effective scheme to implement the JIT protocol, which not only can effectively implement reservation and release of optical channels based on JIT, but also can process the failure of channel reservation and release due to loss of burst control packets. The scheme includes: (1) a BHP (burst head packet) path table is designed and built at each OBS node. It is used to guarantee the corresponding burst control packet, i.e. BHP, BEP (burst end packet) and BEP_ACK (BEP acknowledgement), to be transmitted in the same path. (2) The timed retransmission of BEP and the reversed deletion of the item in BHP path tables triggered by the corresponding BEP_ACK are combined to solve the problems caused by the loss of the signaling messages in channel reservation and release process. (3) Burst head packets and BEP_ACK are transmitted using "best-effort" method. Related signaling messages and their formats for the proposed scheme are also given.

[Evaluation of a thyroid disease referral protocal in a health area of Madrid].

Science.gov (United States)

López, A; Rollán, M T; Bedoya, M J; García, C

The collaboration between healthcare levels is essential for our patients. The aim of this study is to determine the suitability of a referral protocol between the different healthcare levels. A collaboration study was carried out between general practitioners, endocrinologists, and the Department of Biochemistry. After creating the protocol together and implementing it, the suitability was evaluated. A total of 284 referral sheets were evaluated, 65% were adequately sent, and 51% were referred due to laboratory abnormalities, 42% for morphological alterations, and 7% for both reasons. Just under three-quarters (72%) were referred in the normal way (adequacy 90.6%). The clinical information in the referral sheet was considered adequate in 59%, and the request for ultrasound was adequate in 78%. A significant number (16%) of patients should have been returned to Primary Care. It is considered that creating protocols is part of our task. The compliance with the protocol can be improved in Primary Care and specialised care. Publicado por Elsevier España, S.L.U.

Verification in Referral-Based Crowdsourcing

Science.gov (United States)

Naroditskiy, Victor; Rahwan, Iyad; Cebrian, Manuel; Jennings, Nicholas R.

2012-01-01

Online social networks offer unprecedented potential for rallying a large number of people to accomplish a given task. Here we focus on information gathering tasks where rare information is sought through “referral-based crowdsourcing”: the information request is propagated recursively through invitations among members of a social network. Whereas previous work analyzed incentives for the referral process in a setting with only correct reports, misreporting is known to be both pervasive in crowdsourcing applications, and difficult/costly to filter out. A motivating example for our work is the DARPA Red Balloon Challenge where the level of misreporting was very high. In order to undertake a formal study of verification, we introduce a model where agents can exert costly effort to perform verification and false reports can be penalized. This is the first model of verification and it provides many directions for future research, which we point out. Our main theoretical result is the compensation scheme that minimizes the cost of retrieving the correct answer. Notably, this optimal compensation scheme coincides with the winning strategy of the Red Balloon Challenge. PMID:23071530

Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators.

Science.gov (United States)

Morgan, Fiona; Battersby, Alysia; Weightman, Alison L; Searchfield, Lydia; Turley, Ruth; Morgan, Helen; Jagroo, James; Ellis, Simon

2016-03-05

Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS) continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE) on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were 'inactive' (i.e. they are not currently meeting UK physical activity guidelines). Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement). Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and 'making exercise a habit' post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a dislike of the music and TV and a lack of confidence in operating

A general scheme for information interception in the ping pong protocol

OpenAIRE

Zawadzki, Piotr; Miszczak, Jarosław Adam

2016-01-01

The existence of an undetectable eavesdropping of dense coded information has been already demonstrated by Pavi\\v{c}i\\'c for the quantum direct communication based on the ping-pong paradigm. However, a) the explicit scheme of the circuit is only given and no design rules are provided, b) the existence of losses is implicitly assumed, c) the attack has been formulated against qubit based protocol only and it is not clear whether it can be adapted to higher dimensional systems. These deficienci...

Packet reversed packet combining scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2006-07-01

The packet combining scheme is a well defined simple error correction scheme with erroneous copies at the receiver. It offers higher throughput combined with ARQ protocols in networks than that of basic ARQ protocols. But packet combining scheme fails to correct errors when the errors occur in the same bit locations of two erroneous copies. In the present work, we propose a scheme that will correct error if the errors occur at the same bit location of the erroneous copies. The proposed scheme when combined with ARQ protocol will offer higher throughput. (author)

REFERQUAL: a pilot study of a new service quality assessment instrument in the GP exercise referral scheme setting

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Cock, Don; Adams, Iain C; Ibbetson, Adrian B; Baugh, Phil

2006-01-01

Background The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out. Methods A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients. Results Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items. Conclusion REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure. PMID:16725021

A preliminary evaluation of optometric management and referral protocols for pa-tients with diabetic retinopathy

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M. Mehta

2005-12-01

Full Text Available Aim: The purpose of this pilot study was to investigate  the  assessment,  management  and referral practices of South African optometrists in  the  care  of  patients  with  diabetic  retinop-athy  (DR  and  to  recommend  strategies  to improve  and  standardize  patient  management as required.  Methods:  The  study  design  incorporated quantitative,  qualitative  and  clinical  measures that were administered to fourteen experienced optometrists from the Durban area. The quan-titative measure, the questionnaire in appendix I, evaluated the optometrists’ management pro-tocols of patients with diabetes mellitus (DM.  These  included  the  optometrists’  referral  and co-management practices, their awareness and usage  of  appropriate  guidelines  in  the  man-agement  and  referral  of  these  patients,  their perceived levels of competence and confidence in their education, levels of service offered to the patients and finally the role of Continuous Professional  Development  (CPD.  This  self-report information was supplemented by a set of clinical measures where the study sample grad-ed levels of DR, chose appropriate management options  and  indicated  prognosis  for  disease progression based on a set of slides presented to  them.  Finally  the  fourteen  optometrists,  as well as two ophthalmologists, were interviewed using tailored, semi-structured interview sched-ules. These interviews were used to elaborate and corroborate information obtained from the other two research approaches.  Results:  Descriptive  analysis  was  used  to analyse  the  data  from  the  quantitative  and clinical  measures,  whilst  the  interviews  were analysed  thematically.  Although  86%  of  the sample routinely screened for ocular manifesta-tions of DM, there was no standardization in the criteria used by the fourteen optometrists

Automatic referral to cardiac rehabilitation.

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Fischer, Jane P

2008-01-01

The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

The impact of glaucoma referral refinement criteria on referral to, and first-visit discharge rates from, the hospital eye service: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project.

Science.gov (United States)

Ratnarajan, Gokulan; Newsom, Wendy; French, Karen; Kean, Jane; Chang, Lydia; Parker, Mike; Garway-Heath, David F; Bourne, Rupert R A

2013-03-01

To assess the impact of referral refinement criteria on the number of patients referred to, and first-visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance. All low-risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra-ocular pressure (IOP) (22-28 mmHg) or IOP asymmetry (>5 mmHg) and high-risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low-risk referrals were seen by Optometrists with a specialist interest in glaucoma and high-risk referrals were referred directly to the HES. Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first-visit discharge rates were for referrals based on IOP alone (45% for IOP 22-28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first-visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65-80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22-28 mmHg would have satisfied the JCG criteria for non-referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of £16 258 (13%). The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low-risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals. Ophthalmic & Physiological Optics © 2013 The College

QoS Support Polling Scheme for Multimedia Traffic in Wireless LAN MAC Protocol

Institute of Scientific and Technical Information of China (English)

YANG Zhijun; ZHAO Dongfeng

2008-01-01

Quality of service (QoS) support is a key attribute for multimedia traffic including video, voice, and data in wireless local area networks (LANs) but is limited in 802.11-based wireless LANs. A polling-based scheme called the point coordination function (PCF) was developed for 802.11 LANs to support the trans-mission of multimedia traffic. However, the PCF is not able to meet the desired practical traffic differentiation requirements for real-time data. This paper describes a QoS support polling scheme based on the IEEE 802.11 medium access control (MAC) protocol. The scheme uses a two-level polling mechanism with the QoS classes differentiated by two different access policies. Stations with higher priority traffic such as key or real-time data form the first level and can access the common channel through an exhaustive access policy. Other stations with lower priority traffic form the second level and can access the channel through a gated access policy. A system model based on imbedded Markov chain theory and a generation function were setup to explicitly analyze the mean information packet waiting time of the two-level polling scheme. Theo-retical and simulation results show that the new scheme efficiently differentiates services to guarantee better QoS and system stability.

Adherence to exercise referral schemes by participants – what do providers and commissioners need to know? A systematic review of barriers and facilitators

Directory of Open Access Journals (Sweden)

Fiona Morgan

2016-03-01

Full Text Available Abstract Background Physical inactivity levels are rising worldwide with major implications for the health of the population and the prevalence of non-communicable diseases. Exercise referral schemes (ERS continue to be a popular intervention utilised by healthcare practitioners to increase physical activity. We undertook a systematic review of views studies in order to inform guidance from the UK National Institute of Health and Care Excellence (NICE on exercise referral schemes to promote physical activity. This paper reports on the participant views identified, to inform those seeking to refine schemes to increase attendance and adherence. Methods Fifteen databases and a wide range of websites and grey literature sources were searched systematically for publications from 1995 to June 2013. In addition, a range of supplementary methods including, a call for evidence by NICE, contacting authors, reference list checking and citation tracking were utilised to identify additional research. Studies were included where they detailed schemes for adults aged 19 years or older who were ‘inactive’ (i.e. they are not currently meeting UK physical activity guidelines. Study selection was conducted independently in duplicate. Quality assessment was undertaken by one reviewer and checked by a second, with 20 % of papers being considered independently in duplicate. Papers were coded in qualitative data analysis software Atlas.ti. This review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results Evidence from 33 UK-relevant studies identified that support from providers, other attendees and family was an important facilitator of adherence and ‘making exercise a habit’ post programme, as was the variety and personalised nature of sessions offered. Barriers to attendance included the inconvenient timing of sessions, their cost and location. An intimidating gym atmosphere, a

Three-pass protocol scheme for bitmap image security by using vernam cipher algorithm

Science.gov (United States)

Rachmawati, D.; Budiman, M. A.; Aulya, L.

2018-02-01

Confidentiality, integrity, and efficiency are the crucial aspects of data security. Among the other digital data, image data is too prone to abuse of operation like duplication, modification, etc. There are some data security techniques, one of them is cryptography. The security of Vernam Cipher cryptography algorithm is very dependent on the key exchange process. If the key is leaked, security of this algorithm will collapse. Therefore, a method that minimizes key leakage during the exchange of messages is required. The method which is used, is known as Three-Pass Protocol. This protocol enables message delivery process without the key exchange. Therefore, the sending messages process can reach the receiver safely without fear of key leakage. The system is built by using Java programming language. The materials which are used for system testing are image in size 200×200 pixel, 300×300 pixel, 500×500 pixel, 800×800 pixel and 1000×1000 pixel. The result of experiments showed that Vernam Cipher algorithm in Three-Pass Protocol scheme could restore the original image.

Wireless Broadband Access and Accounting Schemes

Institute of Scientific and Technical Information of China (English)

无

2003-01-01

In this paper, we propose two wireless broadband access and accounting schemes. In both schemes, the accounting system adopts RADIUS protocol, but the access system adopts SSH and SSL protocols respectively.

Correct mutual information, quantum bit error rate and secure transmission efficiency in Wojcik's eavesdropping scheme on ping-pong protocol

OpenAIRE

Zhang, Zhanjun

2004-01-01

Comment: The wrong mutual information, quantum bit error rate and secure transmission efficiency in Wojcik's eavesdropping scheme [PRL90(03)157901]on ping-pong protocol have been pointed out and corrected

FPGA implementation cost and performance evaluation of IEEE 802.11 protocol encryption security schemes

Science.gov (United States)

Sklavos, N.; Selimis, G.; Koufopavlou, O.

2005-01-01

The explosive growth of internet and consumer demand for mobility has fuelled the exponential growth of wireless communications and networks. Mobile users want access to services and information, from both internet and personal devices, from a range of locations without the use of a cable medium. IEEE 802.11 is one of the most widely used wireless standards of our days. The amount of access and mobility into wireless networks requires a security infrastructure that protects communication within that network. The security of this protocol is based on the wired equivalent privacy (WEP) scheme. Currently, all the IEEE 802.11 market products support WEP. But recently, the 802.11i working group introduced the advanced encryption standard (AES), as the security scheme for the future IEEE 802.11 applications. In this paper, the hardware integrations of WEP and AES are studied. A field programmable gate array (FPGA) device has been used as the hardware implementation platform, for a fair comparison between the two security schemes. Measurements for the FPGA implementation cost, operating frequency, power consumption and performance are given.

FPGA implementation cost and performance evaluation of IEEE 802.11 protocol encryption security schemes

International Nuclear Information System (INIS)

Sklavos, N; Selimis, G; Koufopavlou, O

2005-01-01

The explosive growth of internet and consumer demand for mobility has fuelled the exponential growth of wireless communications and networks. Mobile users want access to services and information, from both internet and personal devices, from a range of locations without the use of a cable medium. IEEE 802.11 is one of the most widely used wireless standards of our days. The amount of access and mobility into wireless networks requires a security infrastructure that protects communication within that network. The security of this protocol is based on the wired equivalent privacy (WEP) scheme. Currently, all the IEEE 802.11 market products support WEP. But recently, the 802.11i working group introduced the advanced encryption standard (AES), as the security scheme for the future IEEE 802.11 applications. In this paper, the hardware integrations of WEP and AES are studied. A field programmable gate array (FPGA) device has been used as the hardware implementation platform, for a fair comparison between the two security schemes. Measurements for the FPGA implementation cost, operating frequency, power consumption and performance are given

Exact analysis of Packet Reversed Packet Combining Scheme and Modified Packet Combining Scheme; and a combined scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2007-07-01

Packet combining scheme is a well defined simple error correction scheme for the detection and correction of errors at the receiver. Although it permits a higher throughput when compared to other basic ARQ protocols, packet combining (PC) scheme fails to correct errors when errors occur in the same bit locations of copies. In a previous work, a scheme known as Packet Reversed Packet Combining (PRPC) Scheme that will correct errors which occur at the same bit location of erroneous copies, was studied however PRPC does not handle a situation where a packet has more than 1 error bit. The Modified Packet Combining (MPC) Scheme that can correct double or higher bit errors was studied elsewhere. Both PRPC and MPC schemes are believed to offer higher throughput in previous studies, however neither adequate investigation nor exact analysis was done to substantiate this claim of higher throughput. In this work, an exact analysis of both PRPC and MPC is carried out and the results reported. A combined protocol (PRPC and MPC) is proposed and the analysis shows that it is capable of offering even higher throughput and better error correction capability at high bit error rate (BER) and larger packet size. (author)

Towards successful coordination of electronic health record based-referrals: a qualitative analysis.

Science.gov (United States)

Hysong, Sylvia J; Esquivel, Adol; Sittig, Dean F; Paul, Lindsey A; Espadas, Donna; Singh, Simran; Singh, Hardeep

2011-07-27

breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

Science.gov (United States)

Kotecha, A; Brookes, J; Foster, P J

2017-06-01

PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.

An evaluation of a collaborative bibliotherapy scheme delivered via a library service.

Science.gov (United States)

Macdonald, J; Vallance, D; McGrath, M

2013-12-01

This paper reports on the evaluation of a bibliotherapy scheme delivered via a local library service, in conjunction with General Practice (GP) practices, local social welfare agencies and through self-referral. The Read Yourself Well (RYW) scheme was based on principles established from other similar schemes and as a way of delivering support for adults experiencing mild to moderate mental health problems for whom clinical treatments are not appropriate. The intervention consisted of initial referral and evaluation by the scheme bibliotherapist, a one-hour session at the beginning and end of the intervention where a purpose-designed questionnaire and two mental health assessments were carried out (the General Health Questionnaire and the Clinical Outcomes in Routine Evaluation questionnaire). Contact and support from the bibliotherapist was provided during the intervention period. One hundred and fifty-seven participants were recruited to the evaluation of whom 114 provided full data. Statistical analyses of the mental health scores showed significant improvements post treatment, for, both male and female participants, for all three referral routes, and for participants who were previously library users, and those who joined the library service to participate in the RYW scheme. The results of this large sample evaluation support the proposal that library-based bibliotherapy can be effective in the treatment of mental health problems. © 2012 John Wiley & Sons Ltd.

Assistance protocol for venous ulcers patients: validation of contents

Directory of Open Access Journals (Sweden)

Daniele Vieira Dantas

2013-07-01

Full Text Available Venous ulcers require complex treatment and are responsible for significant morbidity and mortality rates. This study aims at identifying aspects validated by the jury for the preparation of an assistance protocol for venous ulcer sufferers. It is a descriptive and quantitative research, with 39 professionals (30 nurses, 7 doctors and two physiotherapists, held at the Onofre Lopes University Hospital, between April and July/2010. Data collection began through a questionnaire checklist. Analysis was performed through Statistical Package for Social Science 15.0, assessing compliance with guidelines. Results were the compositional aspects of the protocol: assessment of patient and lesion history/documentation, wound care/perilesional skin, dressing suggestion, use of antibiotics and pain treatment, surgical treatment/medication, improving venous return and relapse prevention, patient referral, professional training and referral/counter-referral. It was concluded that to compose the protocol, aspects related to diagnosis, treatment and injury prevention must be considered.

Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

Science.gov (United States)

Ball, Sarah L; Greenhalgh, Joanne; Roland, Martin

2016-03-24

The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives brought in to curtail this rise, but there is currently limited evidence for their effectiveness, and little is known about their mechanisms of action. This study aimed to gain a better understanding of how RMCs operate and the factors contributing to the achievement of their goals. Drawing on the principles of realist evaluation, we sought to elicit programme theories (the ideas and assumptions about how a programme works) and to identify the key issues to be considered when establishing or evaluating such schemes. Qualitative study with a purposive sample of health professionals and managers involved in the commissioning, set-up and running of four referral management centres in England and with GPs referring through these centres. Semi-structured interviews were conducted with 18 participants. Interviews were audio-recorded and transcribed. Data were analysed thematically. Interview data highlighted the diverse aims and functions of RMCs, reflecting a range of underlying programme theories. These included the overarching theory that RMCs work by ensuring the best use of limited resources and three sub-theories, relating to how this could be achieved, namely, improving the quality of referrals and patient care, reducing referrals, and increasing efficiency in the referral process. The aims of the schemes, however, varied between sites and between stakeholders, and evolved significantly over time. Three themes were identified relating to the context in which RMCs were implemented and managed: the impact of practical and administrative difficulties; the importance and challenge of stakeholder buy-in; and the dependence of perceived effectiveness on the aims and priorities of the scheme. Many RMCs were described as successful by those involved, despite limited

Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol

Directory of Open Access Journals (Sweden)

Esther Buregyeya

2016-11-01

Full Text Available Abstract Background Uganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics. Methods/Design A cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A sample of study clusters will implement the intervention. The intervention will consist of three components: i raising awareness in the community: village health teams will discuss the importance of referral and encourage households to save money, ii training and supervision of providers in the private sector to diagnose, treat and refer sick children, iii regular meetings between the public and private providers (convened by the district health team to discuss the referral system. Twenty clusters will be included in the study, randomized in the ratio of 1:1. A minimum of 319 sick children per cluster and the total number of sick children to be recruited from all clusters will be 8910; adjusting for a 10 % loss to follow up and possible withdrawal of private outlets. Discussion The immediate sustainable impact will be appropriate treatment of sick children. The intervention is likely to impact on private sector practices since the scope of the services they provide will have expanded. The proposed study is also likely to have an impact on families as; i they may appreciate the importance of timely referral on child illness management, ii the cost savings related to reduced morbidity will be used by household to access other social services. The linkage between the private and public sectors will create a potential avenue for delivery of other public health interventions and improved working relations in the two sectors. Further, improved quality of

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

Directory of Open Access Journals (Sweden)

Paul Lindsey A

2011-07-01

subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.

The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial.

Science.gov (United States)

Giné-Garriga, Maria; Coll-Planas, Laura; Guerra, Míriam; Domingo, Àlex; Roqué, Marta; Caserotti, Paolo; Denkinger, Michael; Rothenbacher, Dietrich; Tully, Mark A; Kee, Frank; McIntosh, Emma; Martín-Borràs, Carme; Oviedo, Guillermo R; Jerez-Roig, Javier; Santiago, Marta; Sansano, Oriol; Varela, Guillermo; Skjødt, Mathias; Wirth, Katharina; Dallmeier, Dhayana; Klenk, Jochen; Wilson, Jason J; Blackburn, Nicole E; Deidda, Manuela; Lefebvre, Guillaume; González, Denise; Salvà, Antoni

2017-05-18

Older adults are the fastest growing segment of the world's population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45-60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics' related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. The findings of this

Quantum signature scheme based on a quantum search algorithm

International Nuclear Information System (INIS)

Yoon, Chun Seok; Kang, Min Sung; Lim, Jong In; Yang, Hyung Jin

2015-01-01

We present a quantum signature scheme based on a two-qubit quantum search algorithm. For secure transmission of signatures, we use a quantum search algorithm that has not been used in previous quantum signature schemes. A two-step protocol secures the quantum channel, and a trusted center guarantees non-repudiation that is similar to other quantum signature schemes. We discuss the security of our protocol. (paper)

Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system.

Science.gov (United States)

Byrnes, Joshua M; Comans, Tracy A

2015-02-01

Abstract To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist. A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists. Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government ofup to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings. The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.

Verifiable Secret Redistribution for Threshold Sharing Schemes

National Research Council Canada - National Science Library

Wong, Theodore M; Wang, Chenxi; Wing, Jeannette M

2002-01-01

.... Our protocol guards against dynamic adversaries. We observe that existing protocols either cannot be readily extended to allow redistribution between different threshold schemes, or have vulnerabilities that allow faulty old shareholders...

A full quantum network scheme

International Nuclear Information System (INIS)

Ma Hai-Qiang; Wei Ke-Jin; Yang Jian-Hui; Li Rui-Xue; Zhu Wu

2014-01-01

We present a full quantum network scheme using a modified BB84 protocol. Unlike other quantum network schemes, it allows quantum keys to be distributed between two arbitrary users with the help of an intermediary detecting user. Moreover, it has good expansibility and prevents all potential attacks using loopholes in a detector, so it is more practical to apply. Because the fiber birefringence effects are automatically compensated, the scheme is distinctly stable in principle and in experiment. The simple components for every user make our scheme easier for many applications. The experimental results demonstrate the stability and feasibility of this scheme. (general)

Modeling and Simulation of Handover Scheme in Integrated EPON-WiMAX Networks

DEFF Research Database (Denmark)

Yan, Ying; Dittmann, Lars

2011-01-01

In this paper, we tackle the seamless handover problem in integrated optical wireless networks. Our model applies for the convergence network of EPON and WiMAX and a mobilityaware signaling protocol is proposed. The proposed handover scheme, Integrated Mobility Management Scheme (IMMS), is assisted...... by enhancing the traditional MPCP signaling protocol, which cooperatively collects mobility information from the front-end wireless network and makes centralized bandwidth allocation decisions in the backhaul optical network. The integrated network architecture and the joint handover scheme are simulated using...... OPNET modeler. Results show validation of the protocol, i.e., integrated handover scheme gains better network performances....

A security analysis of the 802.11s wireless mesh network routing protocol and its secure routing protocols.

Science.gov (United States)

Tan, Whye Kit; Lee, Sang-Gon; Lam, Jun Huy; Yoo, Seong-Moo

2013-09-02

Wireless mesh networks (WMNs) can act as a scalable backbone by connecting separate sensor networks and even by connecting WMNs to a wired network. The Hybrid Wireless Mesh Protocol (HWMP) is the default routing protocol for the 802.11s WMN. The routing protocol is one of the most important parts of the network, and it requires protection, especially in the wireless environment. The existing security protocols, such as the Broadcast Integrity Protocol (BIP), Counter with cipher block chaining message authentication code protocol (CCMP), Secure Hybrid Wireless Mesh Protocol (SHWMP), Identity Based Cryptography HWMP (IBC-HWMP), Elliptic Curve Digital Signature Algorithm HWMP (ECDSA-HWMP), and Watchdog-HWMP aim to protect the HWMP frames. In this paper, we have analyzed the vulnerabilities of the HWMP and developed security requirements to protect these identified vulnerabilities. We applied the security requirements to analyze the existing secure schemes for HWMP. The results of our analysis indicate that none of these protocols is able to satisfy all of the security requirements. We also present a quantitative complexity comparison among the protocols and an example of a security scheme for HWMP to demonstrate how the result of our research can be utilized. Our research results thus provide a tool for designing secure schemes for the HWMP.

Primary care physician referral patterns in Ontario, Canada: a descriptive analysis of self-reported referral data.

Science.gov (United States)

Liddy, Clare; Arbab-Tafti, Sadaf; Moroz, Isabella; Keely, Erin

2017-08-22

In many countries, the referral-consultation process faces a number of challenges from inefficiencies and rising demand, resulting in excessive wait times for many specialties. We collected referral data from a sample of family doctors across the province of Ontario, Canada as part of a larger program of research. The purpose of this study is to describe referral patterns from primary care to specialist and allied health services from the primary care perspective. We conducted a prospective study of patient referral data submitted by primary care providers (PCP) from 20 clinics across Ontario between June 2014 and January 2016. Monthly referral volumes expressed as a total number of referrals to all medical and allied health professionals per month. For each referral, we also collected data on the specialty type, reason for referral, and whether the referral was for a procedure. PCPs submitted a median of 26 referrals per month (interquartile range 11.5 to 31.8). Of 9509 referrals eligible for analysis, 97.8% were directed to medical professionals and 2.2% to allied health professionals. 55% of medical referrals were directed to non-surgical specialties and 44.8% to surgical specialties. Medical referrals were for procedures in 30.8% of cases and non-procedural in 40.9%. Gastroenterology received the largest share (11.2%) of medical referrals, of which 62.3% were for colonoscopies. Psychology received the largest share (28.3%) of referrals to allied health professionals. We described patterns of patient referral from primary care to specialist and allied health services for 30 PCPs in 20 clinics across Ontario. Gastroenterology received the largest share of referrals, nearly two-thirds of which were for colonoscopies. Future studies should explore the use of virtual care to help manage non-procedural referrals and examine the impact that procedural referrals have on wait times for gastroenterology.

Four-state discrimination scheme beyond the heterodyne limit

DEFF Research Database (Denmark)

Muller, C. R.; Castaneda, Mario A. Usuga; Wittmann, C.

2012-01-01

We propose and experimentally demonstrate a hybrid discrimination scheme for the quadrature phase shift keying protocol, which outperforms heterodyne detection for any signal power. The discrimination is composed of a quadrature measurement, feed forward and photon detection.......We propose and experimentally demonstrate a hybrid discrimination scheme for the quadrature phase shift keying protocol, which outperforms heterodyne detection for any signal power. The discrimination is composed of a quadrature measurement, feed forward and photon detection....

Global Imaging referral guidelines

International Nuclear Information System (INIS)

Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.

2010-01-01

The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement

In the beginning: role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme.

Science.gov (United States)

Rouse, Peter C; Ntoumanis, Nikos; Duda, Joan L; Jolly, Kate; Williams, Geoffrey C

2011-06-01

Self-determination theory (Deci & Ryan, 2000, Intrinsic motivation and self-determination in human behaviour. New York: Plenum Publishing) highlights the impact autonomy supportive environments can have on exercise motivation and positive health outcomes. Yet little is known about whether differential effects occur as a function of which significant other is providing this support. Further, no research has examined the relationship between motivation and the social environment with participants' mental health and intentions to be physically active before entering an exercise intervention. Study participants were 347 British adults who were about to start an exercise referral scheme. Regression analyses revealed that the effects of autonomy support on mental health and physical activity intentions differed as a function of who provided the support (offspring, partner or physician), with the offspring having the weakest effects. A structural model was supported, indicating that autonomy support and more autonomous regulations led to more positive mental health outcomes and stronger intentions to be physically active. Knowledge of the social environmental and personal motivation of those about to commence an exercise programme can provide important insights for professionals supporting such efforts. © 2011 Taylor & Francis

Improvement of One Quantum Encryption Scheme

Science.gov (United States)

Cao, Zhengjun; Liu, Lihua

2012-01-01

Zhou et al. proposed a quantum encryption scheme based on quantum computation in 2006 [N. Zhou et al., Physica A362 (2006) 305]. Each qubit of the ciphertext is constrained to two pairs of conjugate states. So, its implementation is feasible with the existing technology. But it is inefficient since it entails six key bits to encrypt one message bit, and the resulting ciphertext for one message bit consists of three qubits. In addition, its security cannot be directly reduced to the well-known BB84 protocol. In this paper, we improve it using the technique developed in BB84 protocol. The new scheme entails only two key bits to encrypt one message bit. The resulting ciphertext is just composed of two qubits. It saves about a half cost without the loss of security. Moreover, the new scheme is probabilistic instead of deterministic.

An Energy-aware Routing Scheme in Delay Tolerant Mobile Sensor Networking

Directory of Open Access Journals (Sweden)

Zhe Chen

2014-08-01

Full Text Available In Delay Tolerant Mobile Sensor Networking (DTMSN, mobile sensor nodes are usually limited to their energy capacity, one important concern in routing design of DTMSN is energy consumption. This paper presents a number of variations of the Epidemic Routing Protocol (ERP to extend the DTMSN lifetime. It introduces the analytical model for ERP, after introducing the concepts behind the Target Delivery Probability and Minimum Delivery Probability, it defines the network lifetime. In this paper, it firstly studies many variations of the Epidemic Routing Protocol to extend the lifetime of the DTMSN. Secondly, based on the Epidemic Routing Protocol, three schemes are introduced. Those schemes rely on the limiting the times of message allowed for propagation (LT scheme, directly controlling the number of the copies (LC scheme, split the copies to the residual energies of the nodes (LE scheme. Finally, with the experiment and the validation of the simulation, the LE scheme can significantly maximize the lifetime of DTMSN, because it minimizes the number of copies and that shifts the generation of the copies to the nodes with larger residual energy.

Quantum multi-signature protocol based on teleportation

International Nuclear Information System (INIS)

Wen Xiao-jun; Liu Yun; Sun Yu

2007-01-01

In this paper, a protocol which can be used in multi-user quantum signature is proposed. The scheme of signature and verification is based on the correlation of Greenberger-Horne-Zeilinger (GHZ) states and the controlled quantum teleportation. Different from the digital signatures, which are based on computational complexity, the proposed protocol has perfect security in the noiseless quantum channels. Compared to previous quantum signature schemes, this protocol can verify the signature independent of an arbitrator as well as realize multi-user signature together. (orig.)

Distributed public key schemes secure against continual leakage

DEFF Research Database (Denmark)

Akavia, Adi; Goldwasser, Shafi; Hazay, Carmit

2012-01-01

-secure against continual memory leakage. Our DPKE scheme also implies a secure storage system on leaky devices, where a value s can be secretely stored on devices that continually leak information about their internal state to an external attacker. The devices go through a periodic refresh protocol......In this work we study distributed public key schemes secure against continual memory leakage. The secret key will be shared among two computing devices communicating over a public channel, and the decryption operation will be computed by a simple 2-party protocol between the devices. Similarly...... against continual memory leakage, under the Bilinear Decisional Diffie-Hellman and $2$-linear assumptions. Our schemes have the following properties: 1. Our DPKE and DIBE schemes tolerate leakage at all times, including during refresh. During refresh the tolerated leakage is a (1/2-o (1),1)-fraction...

Radiologists' responses to inadequate referrals

International Nuclear Information System (INIS)

Lysdahl, Kristin Bakke; Hofmann, Bjoern Morten; Espeland, Ansgar

2010-01-01

To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

Cryptanalysis and improvement of a biometrics-based authentication and key agreement scheme for multi-server environments.

Science.gov (United States)

Yang, Li; Zheng, Zhiming

2018-01-01

According to advancements in the wireless technologies, study of biometrics-based multi-server authenticated key agreement schemes has acquired a lot of momentum. Recently, Wang et al. presented a three-factor authentication protocol with key agreement and claimed that their scheme was resistant to several prominent attacks. Unfortunately, this paper indicates that their protocol is still vulnerable to the user impersonation attack, privileged insider attack and server spoofing attack. Furthermore, their protocol cannot provide the perfect forward secrecy. As a remedy of these aforementioned problems, we propose a biometrics-based authentication and key agreement scheme for multi-server environments. Compared with various related schemes, our protocol achieves the stronger security and provides more functionality properties. Besides, the proposed protocol shows the satisfactory performances in respect of storage requirement, communication overhead and computational cost. Thus, our protocol is suitable for expert systems and other multi-server architectures. Consequently, the proposed protocol is more appropriate in the distributed networks.

Cryptanalysis and improvement of a biometrics-based authentication and key agreement scheme for multi-server environments

Science.gov (United States)

Zheng, Zhiming

2018-01-01

According to advancements in the wireless technologies, study of biometrics-based multi-server authenticated key agreement schemes has acquired a lot of momentum. Recently, Wang et al. presented a three-factor authentication protocol with key agreement and claimed that their scheme was resistant to several prominent attacks. Unfortunately, this paper indicates that their protocol is still vulnerable to the user impersonation attack, privileged insider attack and server spoofing attack. Furthermore, their protocol cannot provide the perfect forward secrecy. As a remedy of these aforementioned problems, we propose a biometrics-based authentication and key agreement scheme for multi-server environments. Compared with various related schemes, our protocol achieves the stronger security and provides more functionality properties. Besides, the proposed protocol shows the satisfactory performances in respect of storage requirement, communication overhead and computational cost. Thus, our protocol is suitable for expert systems and other multi-server architectures. Consequently, the proposed protocol is more appropriate in the distributed networks. PMID:29534085

Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

Directory of Open Access Journals (Sweden)

Kyle Richard G

2013-01-01

Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

BSEA: A Blind Sealed-Bid E-Auction Scheme for E-Commerce Applications

Directory of Open Access Journals (Sweden)

Rohit Kumar Das

2016-12-01

Full Text Available Due to an increase in the number of internet users, electronic commerce has grown significantly during the last decade. Electronic auction (e-auction is one of the famous e-commerce applications. Even so, security and robustness of e-auction schemes still remain a challenge. Requirements like anonymity and privacy of the b i d value are under threat from the attackers. Any auction protocol must not leak the anonymity and the privacy of the b i d value of an honest Bidder. Keeping these requirements in mind, we have firstly proposed a controlled traceable blind signature scheme (CTBSS because e-auction schemes should be able to trace the Bidders. Using CTBSS, a blind sealed-bid electronic auction scheme is proposed (BSEA. We have incorporated the notion of blind signature to e-auction schemes. Moreover, both the schemes are based upon elliptic curve cryptography (ECC, which provides a similar level of security with a comparatively smaller key size than the discrete logarithm problem (DLP based e-auction protocols. The analysis shows that BSEA fulfills all the requirements of e-auction protocol, and the total computation overhead is lower than the existing schemes.

Modified Aggressive Packet Combining Scheme

International Nuclear Information System (INIS)

Bhunia, C.T.

2010-06-01

In this letter, a few schemes are presented to improve the performance of aggressive packet combining scheme (APC). To combat error in computer/data communication networks, ARQ (Automatic Repeat Request) techniques are used. Several modifications to improve the performance of ARQ are suggested by recent research and are found in literature. The important modifications are majority packet combining scheme (MjPC proposed by Wicker), packet combining scheme (PC proposed by Chakraborty), modified packet combining scheme (MPC proposed by Bhunia), and packet reversed packet combining (PRPC proposed by Bhunia) scheme. These modifications are appropriate for improving throughput of conventional ARQ protocols. Leung proposed an idea of APC for error control in wireless networks with the basic objective of error control in uplink wireless data network. We suggest a few modifications of APC to improve its performance in terms of higher throughput, lower delay and higher error correction capability. (author)

Controlled Delegation Protocol in Mobile RFID Networks

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Yang MingHour

2010-01-01

Full Text Available To achieve off-line delegation for mobile readers, we propose a delegation protocol for mobile RFID allowing its readers access to specific tags through back-end server. That is to say, reader-tag mutual authentication can be performed without readers being connected to back-end server. Readers are also allowed off-line access to tags' data. Compared with other delegation protocols, our scheme uniquely enables back-end server to limit each reader's reading times during delegation. Even in a multireader situation, our protocol can limit reading times and reading time periods for each of them and therefore makes back-end server's delegation more flexible. Besides, our protocol can prevent authorized readers from transferring their authority to the unauthorized, declining invalid access to tags. Our scheme is proved viable and secure with GNY logic; it is against certain security threats, such as replay attacks, denial of service (DoS attacks, Man-in-the-Middle attacks, counterfeit tags, and breaches of location and data privacy. Also, the performance analysis of our protocol proves that current tags can afford the computation load required in this scheme.

Privacy-Preserving Meter Report Protocol of Isolated Smart Grid Devices

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Zhiwei Wang

2017-01-01

Full Text Available Smart grid aims to improve the reliability, efficiency, and security of the traditional grid, which allows two-way transmission and efficiency-driven response. However, a main concern of this new technique is that the fine-grained metering data may leak the personal privacy information of the customers. Thus, the data aggregation mechanism for privacy protection is required for the meter report protocol in smart grid. In this paper, we propose an efficient privacy-preserving meter report protocol for the isolated smart grid devices. Our protocol consists of an encryption scheme with additively homomorphic property and a linearly homomorphic signature scheme, where the linearly homomorphic signature scheme is suitable for privacy-preserving data aggregation. We also provide security analysis of our protocol in the context of some typical attacks in smart grid. The implementation of our protocol on the Intel Edison platform shows that our protocol is efficient enough for the physical constrained devices, like smart meters.

A Scenario-Based Protocol Checker for Public-Key Authentication Scheme

Science.gov (United States)

Saito, Takamichi

Security protocol provides communication security for the internet. One of the important features of it is authentication with key exchange. Its correctness is a requirement of the whole of the communication security. In this paper, we introduce three attack models realized as their attack scenarios, and provide an authentication-protocol checker for applying three attack-scenarios based on the models. We also utilize it to check two popular security protocols: Secure SHell (SSH) and Secure Socket Layer/Transport Layer Security (SSL/TLS).

Referrals and relationships: in-practice referrals meetings in a general practice.

Science.gov (United States)

Rowlands, G; Willis, S; Singleton, A

2001-08-01

GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted

The referral backfire effect: The identity threatening nature of referral failure

NARCIS (Netherlands)

Claus, B.; Geyskens, K.; Millet, K.; Dewitte, S.

2012-01-01

The present paper shows that when a person has the experience of giving advice but that advice is not acted upon, there is a reduced openness to external information. We call this the "referral backfire effect". We argue that this referral backfire effect is due to the identity threatening nature of

Towards Symbolic Encryption Schemes

DEFF Research Database (Denmark)

Ahmed, Naveed; Jensen, Christian D.; Zenner, Erik

2012-01-01

, namely an authenticated encryption scheme that is secure under chosen ciphertext attack. Therefore, many reasonable encryption schemes, such as AES in the CBC or CFB mode, are not among the implementation options. In this paper, we report new attacks on CBC and CFB based implementations of the well......Symbolic encryption, in the style of Dolev-Yao models, is ubiquitous in formal security models. In its common use, encryption on a whole message is specified as a single monolithic block. From a cryptographic perspective, however, this may require a resource-intensive cryptographic algorithm......-known Needham-Schroeder and Denning-Sacco protocols. To avoid such problems, we advocate the use of refined notions of symbolic encryption that have natural correspondence to standard cryptographic encryption schemes....

Matroids and quantum-secret-sharing schemes

International Nuclear Information System (INIS)

Sarvepalli, Pradeep; Raussendorf, Robert

2010-01-01

A secret-sharing scheme is a cryptographic protocol to distribute a secret state in an encoded form among a group of players such that only authorized subsets of the players can reconstruct the secret. Classically, efficient secret-sharing schemes have been shown to be induced by matroids. Furthermore, access structures of such schemes can be characterized by an excluded minor relation. No such relations are known for quantum secret-sharing schemes. In this paper we take the first steps toward a matroidal characterization of quantum-secret-sharing schemes. In addition to providing a new perspective on quantum-secret-sharing schemes, this characterization has important benefits. While previous work has shown how to construct quantum-secret-sharing schemes for general access structures, these schemes are not claimed to be efficient. In this context the present results prove to be useful; they enable us to construct efficient quantum-secret-sharing schemes for many general access structures. More precisely, we show that an identically self-dual matroid that is representable over a finite field induces a pure-state quantum-secret-sharing scheme with information rate 1.

Radiologists' responses to inadequate referrals

Energy Technology Data Exchange (ETDEWEB)

Lysdahl, Kristin Bakke [Oslo University College, Faculty of Health Sciences, Oslo (Norway); University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Hofmann, Bjoern Morten [University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Gjoevik University College, Faculty of Health Care and Nursing, Gjoevik (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway)

2010-05-15

To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease

Directory of Open Access Journals (Sweden)

Aloudat Sarah

2008-02-01

Full Text Available Abstract Background To identify patient and health system characteristics associated with late referral of patients with chronic kidney disease to nephrologists. Methods MEDLINE, CENTRAL, and CINAHL were searched using the appropriate MESH terms in March 2007. Two reviewers individually and in duplicate reviewed the abstracts of 256 articles and selected 18 observational studies for inclusion. The reasons for late referral were categorized into patient or health system characteristics. Data extraction and content appraisal were done using a prespecified protocol. Results Older age, the existence of multiple comorbidities, race other than Caucasian, lack of insurance, lower socioeconomic status and educational levels were patient characteristics associated with late referral of patients with chronic kidney disease. Lack of referring physician knowledge about the appropriate timing of referral, absence of communication between referring physicians and nephrologists, and dialysis care delivered at tertiary medical centers were health system characteristics associated with late referral of patients with chronic kidney disease. Most studies identified multiple factors associated with late referral, although the relative importance and the combined effect of these factors were not systematically evaluated. Conclusion A combination of patient and health system characteristics is associated with late referral of patients with chronic kidney disease. Overall, being older, belonging to a minority group, being less educated, being uninsured, suffering from multiple comorbidities, and the lack of communication between primary care physicians and nephrologists contribute to late referral of patients with chronic kidney disease. Both primary care physicians and nephrologists need to engage in multisectoral collaborative efforts that ensure patient education and enhance physician awareness to improve the care of patients with chronic kidney disease.

Semi-quantum communication: protocols for key agreement, controlled secure direct communication and dialogue

Science.gov (United States)

Shukla, Chitra; Thapliyal, Kishore; Pathak, Anirban

2017-12-01

Semi-quantum protocols that allow some of the users to remain classical are proposed for a large class of problems associated with secure communication and secure multiparty computation. Specifically, first-time semi-quantum protocols are proposed for key agreement, controlled deterministic secure communication and dialogue, and it is shown that the semi-quantum protocols for controlled deterministic secure communication and dialogue can be reduced to semi-quantum protocols for e-commerce and private comparison (socialist millionaire problem), respectively. Complementing with the earlier proposed semi-quantum schemes for key distribution, secret sharing and deterministic secure communication, set of schemes proposed here and subsequent discussions have established that almost every secure communication and computation tasks that can be performed using fully quantum protocols can also be performed in semi-quantum manner. Some of the proposed schemes are completely orthogonal-state-based, and thus, fundamentally different from the existing semi-quantum schemes that are conjugate coding-based. Security, efficiency and applicability of the proposed schemes have been discussed with appropriate importance.

Enhanced Security and Pairing-free Handover Authentication Scheme for Mobile Wireless Networks

Science.gov (United States)

Chen, Rui; Shu, Guangqiang; Chen, Peng; Zhang, Lijun

2017-10-01

With the widely deployment of mobile wireless networks, we aim to propose a secure and seamless handover authentication scheme that allows users to roam freely in wireless networks without worrying about security and privacy issues. Given the open characteristic of wireless networks, safety and efficiency should be considered seriously. Several previous protocols are designed based on a bilinear pairing mapping, which is time-consuming and inefficient work, as well as unsuitable for practical situations. To address these issues, we designed a new pairing-free handover authentication scheme for mobile wireless networks. This scheme is an effective improvement of the protocol by Xu et al., which is suffer from the mobile node impersonation attack. Security analysis and simulation experiment indicate that the proposed protocol has many excellent security properties when compared with other recent similar handover schemes, such as mutual authentication and resistance to known network threats, as well as requiring lower computation and communication cost.

Improving Wojcik's eavesdropping attack on the ping-pong protocol

International Nuclear Information System (INIS)

Zhang Zhanjun; Man Zhongxiao; Li Yong

2004-01-01

The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme only induces half of the eavesdropping-induced channel loss in Wojcik's scheme, therefore, in a larger domain of the quantum channel transmission efficiency η, i.e., [0,75%], the eavesdropper Eve can attack all the transmitted bits. The improvement of the ping-pong protocol security produced by Wojcik's is also suitable for our eavesdropping attack

A Survey of Authentication Schemes in Telecare Medicine Information Systems.

Science.gov (United States)

Aslam, Muhammad Umair; Derhab, Abdelouahid; Saleem, Kashif; Abbas, Haider; Orgun, Mehmet; Iqbal, Waseem; Aslam, Baber

2017-01-01

E-Healthcare is an emerging field that provides mobility to its users. The protected health information of the users are stored at a remote server (Telecare Medical Information System) and can be accessed by the users at anytime. Many authentication protocols have been proposed to ensure the secure authenticated access to the Telecare Medical Information System. These protocols are designed to provide certain properties such as: anonymity, untraceability, unlinkability, privacy, confidentiality, availability and integrity. They also aim to build a key exchange mechanism, which provides security against some attacks such as: identity theft, password guessing, denial of service, impersonation and insider attacks. This paper reviews these proposed authentication protocols and discusses their strengths and weaknesses in terms of ensured security and privacy properties, and computation cost. The schemes are divided in three broad categories of one-factor, two-factor and three-factor authentication schemes. Inter-category and intra-category comparison has been performed for these schemes and based on the derived results we propose future directions and recommendations that can be very helpful to the researchers who work on the design and implementation of authentication protocols.

The Political Economy of International Emissions Trading Scheme Choice

DEFF Research Database (Denmark)

Boom, Jan-Tjeerd; Svendsen, Jan Tinggard

2000-01-01

The Kyoto Protocol allows emission trade between the Annex B countries. We consider three schemes of emissions trading: government trading, permit trading and credit trading. The schemes are compared in a public choice setting focusing on group size and rent-seeking from interest groups. We find ...

A lightweight and secure two factor anonymous authentication protocol for Global Mobility Networks

Science.gov (United States)

2018-01-01

Global Mobility Networks(GLOMONETs) in wireless communication permits the global roaming services that enable a user to leverage the mobile services in any foreign country. Technological growth in wireless communication is also accompanied by new security threats and challenges. A threat-proof authentication protocol in wireless communication may overcome the security flaws by allowing only legitimate users to access a particular service. Recently, Lee et al. found Mun et al. scheme vulnerable to different attacks and proposed an advanced secure scheme to overcome the security flaws. However, this article points out that Lee et al. scheme lacks user anonymity, inefficient user authentication, vulnerable to replay and DoS attacks and Lack of local password verification. Furthermore, this article presents a more robust anonymous authentication scheme to handle the threats and challenges found in Lee et al.’s protocol. The proposed protocol is formally verified with an automated tool(ProVerif). The proposed protocol has superior efficiency in comparison to the existing protocols. PMID:29702675

Eavesdropping on the two-way quantum communication protocols with invisible photons

Energy Technology Data Exchange (ETDEWEB)

Cai Qingyu [State Key Laboratory of Magnetics Resonance and Atomic and Molecular Physics, Wuhan Institution of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China)]. E-mail: qycai@wipm.ac.cn

2006-02-20

The crucial issue of quantum communication protocol is its security. In this Letter, we show that all the deterministic and direct two-way quantum communication protocols, sometimes called ping-pong (PP) protocols, are insecure when an eavesdropper uses the invisible photon to eavesdrop on the communication. With our invisible photon eavesdropping (IPE) scheme, the eavesdropper can obtain full information of the communication with zero risk of being detected. We show that this IPE scheme can be implemented experimentally with current technology. Finally, a possible improvement of PP communication protocols security is proposed00.

Eavesdropping on the two-way quantum communication protocols with invisible photons

International Nuclear Information System (INIS)

Cai Qingyu

2006-01-01

The crucial issue of quantum communication protocol is its security. In this Letter, we show that all the deterministic and direct two-way quantum communication protocols, sometimes called ping-pong (PP) protocols, are insecure when an eavesdropper uses the invisible photon to eavesdrop on the communication. With our invisible photon eavesdropping (IPE) scheme, the eavesdropper can obtain full information of the communication with zero risk of being detected. We show that this IPE scheme can be implemented experimentally with current technology. Finally, a possible improvement of PP communication protocols security is proposed

MULTIMEDIA DATA TRANSMISSION THROUGH TCP/IP USING HASH BASED FEC WITH AUTO-XOR SCHEME

Directory of Open Access Journals (Sweden)

R. Shalin

2012-09-01

Full Text Available The most preferred mode for communication of multimedia data is through the TCP/IP protocol. But on the other hand the TCP/IP protocol produces huge packet loss unavoidable due to network traffic and congestion. In order to provide a efficient communication it is necessary to recover the loss of packets. The proposed scheme implements Hash based FEC with auto XOR scheme for this purpose. The scheme is implemented through Forward error correction, MD5 and XOR for providing efficient transmission of multimedia data. The proposed scheme provides transmission high accuracy, throughput and low latency and loss.

MULTIMEDIA DATA TRANSMISSION THROUGH TCP/IP USING HASH BASED FEC WITH AUTO-XOR SCHEME

OpenAIRE

R. Shalin; D. Kesavaraja

2012-01-01

The most preferred mode for communication of multimedia data is through the TCP/IP protocol. But on the other hand the TCP/IP protocol produces huge packet loss unavoidable due to network traffic and congestion. In order to provide a efficient communication it is necessary to recover the loss of packets. The proposed scheme implements Hash based FEC with auto XOR scheme for this purpose. The scheme is implemented through Forward error correction, MD5 and XOR for providing efficient transmissi...

Group covariant protocols for quantum string commitment

International Nuclear Information System (INIS)

Tsurumaru, Toyohiro

2006-01-01

We study the security of quantum string commitment (QSC) protocols with group covariant encoding scheme. First we consider a class of QSC protocol, which is general enough to incorporate all the QSC protocols given in the preceding literatures. Then among those protocols, we consider group covariant protocols and show that the exact upperbound on the binding condition can be calculated. Next using this result, we prove that for every irreducible representation of a finite group, there always exists a corresponding nontrivial QSC protocol which reaches a level of security impossible to achieve classically

User satisfaction with referrals at a collaborative virtual reference service Virtual reference services, Reference services, Referrals, User satisfaction

Directory of Open Access Journals (Sweden)

Nahyun Kwon

2006-01-01

Full Text Available Introduction. This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference service. Method. The data analysed for this study were 420 chat reference transaction transcripts along with corresponding online survey questionnaires submitted by the service users. Both sets of data were collected from an electronic archive of a southeastern state public library system that has participated in 24/7 Reference of the Metropolitan Cooperative Library System (MCLS. Results. Referrals in the collaborative chat reference service comprised approximately 30% of the total transactions. Circulation-related questions were the most often referred among all question types, possibly because of the inability of 'outside' librarians to access patron accounts. Most importantly, user satisfaction with referrals was found to be significantly lower than that of completed answers. Conclusion. The findings of this study addressed the importance of distinguishing two types of referrals: the expert research referrals conducive to collaborative virtual reference services; and the re-directional local referrals that increase unnecessary question traffic, thereby being detrimental to effective use of collaborative reference. Continuing efforts to conceptualize referrals in multiple dimensions are anticipated to fully grasp complex phenomena underlying referrals.

Factors influencing adherence to referral advice following pre-referral treatment with artesunate suppositories in children in rural Tanzania.

Science.gov (United States)

Simba, Daudi O; Warsame, Marian; Kimbute, Omari; Kakoko, Deodatus; Petzold, Max; Tomson, Goran; Premji, Zul; Gomes, Melba

2009-07-01

WHO recommends artemisinin suppository formulations as pre-referral treatment for children who are unable to take oral medication and cannot rapidly reach a facility for parenteral treatment. We investigated factors influencing caretakers' adherence to referral advice following pre-referral treatment of their children with rectal artesunate suppositories. The study was nested within an intervention study that involved pre-referral treatment of all children who came to a community dispenser for treatment because they were unable to take oral medications because of repeated vomiting, lethargy, convulsions or altered consciousness. All patients who did not comply with referral advice were stratified by actions taken post-referral: taking their children to a drug shop, a traditional healer, or not seeking further treatment, and added to a random selection of patients who complied with referral advice. Caretakers of the children were interviewed about their socio-economic status (SES), knowledge about malaria, referral advice given and actions they took following pre-referral treatment. Interview data for 587 caretakers were matched with symptoms of the children, the time of treatment, arrival at a health facility or other actions taken post-pre-referral treatment. The majority (93.5%) of caretakers reported being given referral advice by the community drug dispenser. The odds of adherence with this advice were three times greater for children with altered consciousness and/or convulsions than for children with other symptoms [odds ratio (OR) 3.47, 95% confidence interval (CI) 2.32-5.17, P < 0.001]. When questioned, caretakers who remembered when (OR 2.19, 95% CI 1.48-3.23, P < 0.001) and why (OR 1.77, 95% CI 1.07-2.95, P = 0.026) they were advised to proceed to health facility - were more likely to follow referral advice. Cost did not influence adherence except within a catchment area of facilities that charged for services. In these areas, costs deterred adherence by

Employee Referrals and Efficiency Wages

OpenAIRE

Kugler, Adriana D.

2002-01-01

Many workers believe that personal contacts are crucial for obtaining jobs in high-wage sectors. On the other hand, firms in high-wage sectors report using employee referrals because they help provide screening and monitoring of new employees. This Paper develops a matching model that can explain the link between inter-industry wage differentials and the use of employee referrals. Referrals lower monitoring costs because high-effort referees can exert peer pressure on co-workers, allowing fir...

Arbitrated quantum signature scheme based on χ-type entangled states

International Nuclear Information System (INIS)

Zuo, Huijuan; Huang, Wei; Qin, Sujuan

2013-01-01

An arbitrated quantum signature scheme, which is mainly applied in electronic-payment systems, is proposed and investigated. The χ-type entangled states are used for quantum key distribution and quantum signature in this protocol. Compared with previous quantum signature schemes which also utilize χ-type entangled states, the proposed scheme provides higher efficiency. Finally, we also analyze its security under various kinds of attacks. (paper)

A no-key-exchange secure image sharing scheme based on Shamir's three-pass cryptography protocol and the multiple-parameter fractional Fourier transform.

Science.gov (United States)

Lang, Jun

2012-01-30

In this paper, we propose a novel secure image sharing scheme based on Shamir's three-pass protocol and the multiple-parameter fractional Fourier transform (MPFRFT), which can safely exchange information with no advance distribution of either secret keys or public keys between users. The image is encrypted directly by the MPFRFT spectrum without the use of phase keys, and information can be shared by transmitting the encrypted image (or message) three times between users. Numerical simulation results are given to verify the performance of the proposed algorithm.

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

Directory of Open Access Journals (Sweden)

Jolly Kate

2009-06-01

Full Text Available Abstract Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT-based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7 or to the SDT-based intervention (n = 6. Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833.

Novel Scheme for Packet Forwarding without Header Modifications in Optical Networks

DEFF Research Database (Denmark)

Wessing, Henrik; Christiansen, Henrik Lehrmann; Fjelde, Tina

2002-01-01

We present a novel scheme for packet forwarding in optical packet-switched networks and we further demonstrate its good scalability through simulations. The scheme requires neither header modification nor any label distribution protocol, thus reducing component cost while simplifying network...

Profile of respiratory problems in patients presenting to a referral pulmonary clinic

Directory of Open Access Journals (Sweden)

Dasgupta Angira

2008-01-01

Full Text Available Analysis of OPD data of 2012 patients in a referral pulmonary clinic at Kolkata was done following a protocol-based approach. Obstructive airway diseases (COPD and asthma were the most common (43% problem followed by infective lung diseases (15% including tuberculosis, bronchogenic carcinoma (8%, ILD (4%, haemopty-sis of undiagnosed etiology (4.5%, chronic cough of undiagnosed etiology (6.5% and pleural diseases (4.6%. Other diseases like obstructive sleep apnoea, sarcoid-osis, systemic diseases with lung involvements etc., and non respiratory problems formed the rest (14.4%.

Establishing rational networking using the DL04 quantum secure direct communication protocol

Science.gov (United States)

Qin, Huawang; Tang, Wallace K. S.; Tso, Raylin

2018-06-01

The first rational quantum secure direct communication scheme is proposed, in which we use the game theory with incomplete information to model the rational behavior of the participant, and give the strategy space and utility function. The rational participant can get his maximal utility when he performs the protocol faithfully, and then the Nash equilibrium of the protocol can be achieved. Compared to the traditional schemes, our scheme will be more practical in the presence of rational participant.

Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral.

Science.gov (United States)

Hogben, M; St Lawrence, J S; Montaño, D E; Kasprzyk, D; Leichliter, J S; Phillips, W R

2004-02-01

The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.

Electronic referrals: what matters to the users.

Science.gov (United States)

Warren, Jim; Gu, Yulong; Day, Karen; White, Sue; Pollock, Malcolm

2012-01-01

Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand. Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records. The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In

Referral bias in ALS epidemiological studies.

Science.gov (United States)

Logroscino, Giancarlo; Marin, Benoit; Piccininni, Marco; Arcuti, Simona; Chiò, Adriano; Hardiman, Orla; Rooney, James; Zoccolella, Stefano; Couratier, Philippe; Preux, Pierre-Marie; Beghi, Ettore

2018-01-01

Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias. Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas. Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area. A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.

Improving Wojcik's eavesdropping attack on the ping-pong protocol

Energy Technology Data Exchange (ETDEWEB)

Zhang Zhanjun [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China) and School of Physics and Material Science, Anhui University, Hefei 230039 (China)]. E-mail: zhangzj@wipm.ac.cn; Man Zhongxiao [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China); Li Yong [Department of Physics, Central China Normal University, Wuhan 430079 (China)

2004-11-29

The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme only induces half of the eavesdropping-induced channel loss in Wojcik's scheme, therefore, in a larger domain of the quantum channel transmission efficiency {eta}, i.e., [0,75%], the eavesdropper Eve can attack all the transmitted bits. The improvement of the ping-pong protocol security produced by Wojcik's is also suitable for our eavesdropping attack.

Performance Analysis of an Enhanced PRMA-HS Protocol for LEO Satellite Communication

Institute of Scientific and Technical Information of China (English)

ZHUO Yong-ning; YAN Shao-hu; WU Shi-qi

2005-01-01

The packet reservation multiple access with hindering state (PRMA-HS) is a protocol suitable for LEO satellite mobile communication. Although working well with light system payload (amount of user terminals), the protocol imposes high channel congestion on system with heavy payload, thus degrades the system's quality of service. To controlling the channel congestion, a scheme of enhanced PRMA-HS protocol is proposed, which aims to reduce the collision of voice packets by adopting a mechanism of access control. Through theoretic analysis, the system's mathematic model is presented and the packet drop probability of the scheme is deduced. To testify the performance of the scheme, a simulation is performed and the results support our analysis.

Open-access ultrasound referrals from general practice.

LENUS (Irish Health Repository)

Hughes, P

2015-03-01

Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

Attitudes regarding specialist referrals in periodontics.

Science.gov (United States)

Sharpe, G; Durham, J A; Preshaw, P M

2007-02-24

To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England. Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently. Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted. Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.

OPM Scheme Editor 2: A graphical editor for specifying object-protocol structures

Energy Technology Data Exchange (ETDEWEB)

Chen, I-Min A.; Markowitz, V.M.; Pang, F.; Ben-Shachar, O.

1993-07-01

This document describes an X-window based Schema Editor for the Object-Protocol Model (OPM). OPM is a data model that supports the specification of complex object and protocol classes. objects and protocols are qualified in OPM by attributes that are defined over (associated with) value classes. Connections of object and protocol classes are expressed in OPM via attributes. OPM supports the specification (expansion) of protocols in terms of alternative and sequences of component (sub) protocols. The OPM Schema Editor allows specifying, displaying, modifying, and browsing through OPM schemas. The OPM Schema Editor generates an output file that can be used as input to an OPM schema translation tool that maps OPM schemas into definitions for relational database management systems. The OPM Schema Editor was implemented using C++ and the X11 based Motif toolkit, on Sun SPARCstation under Sun Unix OS 4.1. This document consists of the following parts: (1) A tutorial consisting of seven introductory lessons for the OPM Schema Editor. (2) A reference manual describing all the windows and functions of the OPM Schema Editor. (3) An appendix with an overview of OPM.

Managing Consumer Referrals in a Chain Network

OpenAIRE

Maria Arbatskaya; Hideo Konishi

2014-01-01

We consider the optimal pricing and referral strategy of a monopoly that uses a simple consumer communication network (a chain) to spread product information. The first-best policy with fully discriminatory position-based referral fees involves standard monopoly pricing and referral fees that provide consumers with strictly positive referral incentives. Effective price discrimination among consumers based on their positions in the chain occurs in both the first-best solution and the second-be...

A protocol improves GP recording of long-term sickness absence risk factors.

Science.gov (United States)

van Dijk, Paul; Hogervorst, Wouter; ter Riet, Gerben; van Dijk, Frank

2008-06-01

If general practitioners (GPs) were better informed about patients' risks of long-term sickness absence (LTSA), they could incorporate these risk assessments into their patient management plans and cooperate more with occupational physicians to prevent LTSA. To evaluate the effectiveness of a protocol helping GPs in recording risks of LTSA and in co-operating with occupational physicians (OPs). Twenty-six GPs (co-operating in four groups) in Amsterdam, The Netherlands, participated in a controlled intervention study. Fourteen GPs were the protocol-supported intervention group and twelve GPs were the reference group. Outcome measures were consultations containing work-related information, information about two risk factors for LTSA, referrals to OPs and contacts of OPs with GPs and patients. Outcomes were identified through an electronic search in the GPs' information systems. Entries containing information were independently scored by two investigators. The proportions of patients with consultations documenting LTSA-pertinent items were compared between the groups, accounting for differences at baseline. There was no increase in consultations containing work-related information. Recording of risk factor information increased in the intervention group; the difference was 4.5% [95% CI 1.5-7.6] and 1.8% (95% CI -0.8 to 4.4) for the two risk factors. The referral rate to the OP increased by 2.9% (95% CI 1.2-4.5). There was no effect on contacts of OPs with GPs or with patients. Protocol-supported consultations may lead to a modest increase in information regarding two risk factors for LTSA in GPs' electronic records and to more referrals to OPs.

Efficient Anonymous Authenticated Key Agreement Scheme for Wireless Body Area Networks

Directory of Open Access Journals (Sweden)

Tong Li

2017-01-01

Full Text Available Wireless body area networks (WBANs are widely used in telemedicine, which can be utilized for real-time patients monitoring and home health-care. The sensor nodes in WBANs collect the client’s physiological data and transmit it to the medical center. However, the clients’ personal information is sensitive and there are many security threats in the extra-body communication. Therefore, the security and privacy of client’s physiological data need to be ensured. Many authentication protocols for WBANs have been proposed in recent years. However, the existing protocols fail to consider the key update phase. In this paper, we propose an efficient authenticated key agreement scheme for WBANs and add the key update phase to enhance the security of the proposed scheme. In addition, session keys are generated during the registration phase and kept secretly, thus reducing computation cost in the authentication phase. The performance analysis demonstrates that our scheme is more efficient than the currently popular related schemes.

Referral Criteria from Community Clinics to Pediatric Emergency Departments

Directory of Open Access Journals (Sweden)

Jacob Urkin

2008-01-01

Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

A data seamless interaction scheme between electric power secondary business systems

Science.gov (United States)

Ai, Wenkai; Qian, Feng

2018-03-01

At present, the data interaction of electric power secondary business systems is very high, and it is not universal to develop programs when data interaction is carried out by different manufacturers' electric power secondary business systems. There are different interaction schemes for electric power secondary business systems with different manufacturers, which lead to high development cost, low reusability and high maintenance difficulty. This paper introduces a new data seamless interaction scheme between electric power secondary business systems. The scheme adopts the international common Java message service protocol as the transmission protocol, adopts the common JavaScript object symbol format as the data interactive format, unified electric power secondary business systems data interactive way, improve reusability, reduce complexity, monitor the operation of the electric power secondary business systems construction has laid a solid foundation.

Characteristics Of Referrals To An Oral And Maxillofacial Surgery ...

African Journals Online (AJOL)

... Practitioners (GMPS) sent the most referrals (507 or 74.0%), specialist medical practitioners (SMPs) sent 86(12.6%) and general dental practitioners (GDPs) sent 59(8.6%) referrals. The medical specialty with most referrals was paediatrics (29.0 % of the SMPs referrals). 44.5% of the referrals had no provisional diagnosis, ...

Privacy-Preserving Data Aggregation Protocol for Fog Computing-Assisted Vehicle-to-Infrastructure Scenario

Directory of Open Access Journals (Sweden)

Yanan Chen

2018-01-01

Full Text Available Vehicle-to-infrastructure (V2I communication enables moving vehicles to upload real-time data about road surface situation to the Internet via fixed roadside units (RSU. Thanks to the resource restriction of mobile vehicles, fog computation-enhanced V2I communication scenario has received increasing attention recently. However, how to aggregate the sensed data from vehicles securely and efficiently still remains open to the V2I communication scenario. In this paper, a light-weight and anonymous aggregation protocol is proposed for the fog computing-based V2I communication scenario. With the proposed protocol, the data collected by the vehicles can be efficiently obtained by the RSU in a privacy-preserving manner. Particularly, we first suggest a certificateless aggregate signcryption (CL-A-SC scheme and prove its security in the random oracle model. The suggested CL-A-SC scheme, which is of independent interest, can achieve the merits of certificateless cryptography and signcryption scheme simultaneously. Then we put forward the anonymous aggregation protocol for V2I communication scenario as one extension of the suggested CL-A-SC scheme. Security analysis demonstrates that the proposed aggregation protocol achieves desirable security properties. The performance comparison shows that the proposed protocol significantly reduces the computation and communication overhead compared with the up-to-date protocols in this field.

An Enhanced Secure Identity-Based Certificateless Public Key Authentication Scheme for Vehicular Sensor Networks.

Science.gov (United States)

Li, Congcong; Zhang, Xi; Wang, Haiping; Li, Dongfeng

2018-01-11

Vehicular sensor networks have been widely applied in intelligent traffic systems in recent years. Because of the specificity of vehicular sensor networks, they require an enhanced, secure and efficient authentication scheme. Existing authentication protocols are vulnerable to some problems, such as a high computational overhead with certificate distribution and revocation, strong reliance on tamper-proof devices, limited scalability when building many secure channels, and an inability to detect hardware tampering attacks. In this paper, an improved authentication scheme using certificateless public key cryptography is proposed to address these problems. A security analysis of our scheme shows that our protocol provides an enhanced secure anonymous authentication, which is resilient against major security threats. Furthermore, the proposed scheme reduces the incidence of node compromise and replication attacks. The scheme also provides a malicious-node detection and warning mechanism, which can quickly identify compromised static nodes and immediately alert the administrative department. With performance evaluations, the scheme can obtain better trade-offs between security and efficiency than the well-known available schemes.

An Enhanced Secure Identity-Based Certificateless Public Key Authentication Scheme for Vehicular Sensor Networks

Science.gov (United States)

Li, Congcong; Zhang, Xi; Wang, Haiping; Li, Dongfeng

2018-01-01

Vehicular sensor networks have been widely applied in intelligent traffic systems in recent years. Because of the specificity of vehicular sensor networks, they require an enhanced, secure and efficient authentication scheme. Existing authentication protocols are vulnerable to some problems, such as a high computational overhead with certificate distribution and revocation, strong reliance on tamper-proof devices, limited scalability when building many secure channels, and an inability to detect hardware tampering attacks. In this paper, an improved authentication scheme using certificateless public key cryptography is proposed to address these problems. A security analysis of our scheme shows that our protocol provides an enhanced secure anonymous authentication, which is resilient against major security threats. Furthermore, the proposed scheme reduces the incidence of node compromise and replication attacks. The scheme also provides a malicious-node detection and warning mechanism, which can quickly identify compromised static nodes and immediately alert the administrative department. With performance evaluations, the scheme can obtain better trade-offs between security and efficiency than the well-known available schemes. PMID:29324719

Evaluation and Referral of Diabetic Eye Disease in the Endocrinology and Primary Care Office Settings.

Science.gov (United States)

Silva, Fabiana Q; Adhi, Mehreen; Wai, Karen M; Olansky, Leann; Lansang, M Cecilia; Singh, Rishi P

2016-10-01

The purpose of this study was to identify whether endocrinologists and primary care physicians (PCP) adequately screen for ophthalmic symptoms/signs within office visits and provide timely ophthalmology referrals in patients with diabetes. Patients between the ages of 18 years and 80 years with diabetes who underwent an office visit with an endocrinologist or a PCP between January 1, 2014, and December 31, 2014, were identified. Demographics, ophthalmic assessments, and referral information were collected. A total of 1,250 patient records were reviewed. Providers asked about ophthalmic symptoms/signs in 95.5% and 71% of endocrinology and primary care office encounters, respectively (P endocrinology and PCP visits, respectively (P < .0001). Ophthalmic complications from diabetes are not adequately screened, especially within the primary care setting, and further quality improvement measures may improve adherence to recommended screening protocols. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:930-934.]. Copyright 2016, SLACK Incorporated.

Multi-area layered multicast scheme for MPLS networks

Science.gov (United States)

Ma, Yajie; Yang, Zongkai; Wang, Yuming; Chen, Jingwen

2005-02-01

Multi-protocol label switching (MPLS) is multiprotocols both at layer 2 and layer 3. It is suggested to overcome the shortcomings of performing complex longest prefix matching in layer 3 routing by using short, fixed length labels. The MPLS community has put more effort into the label switching of unicast IP traffic, but less in the MPLS multicast mechanism. The reasons are the higher label consumption, the dynamical mapping of L3 multicast tree to L2 LSPs and the 20-bit shim header which is much fewer than the IPv4 IP header. On the other hand, heterogeneity of node capability degrades total performance of a multicast group. In order to achieve the scalability as well as the heterogeneity in MPLS networks, a novel scheme of MPLS-based Multi-area Layered Multicast Scheme (MALM) is proposed. Unlike the existing schemes which focus on aggregating the multicast stream, we construct the multicast tree based on the virtual topology aggregation. The MPLS area is divided into different sub-areas to form the hierarchical virtual topology and the multicast group is reconstructed into multiple layers according to the node capability. At the same time, the label stack is used to save the label space. For stability of the MALM protocol, a multi-layer protection scheme is also discussed. The experiment results show that the proposed scheme saves label space and decrease the Multicast Forwarding Table in much degree.

Analysing Password Protocol Security Against Off-line Dictionary Attacks

NARCIS (Netherlands)

Corin, R.J.; Doumen, J.M.; Etalle, Sandro; Busi, Nadia; Gorrieri, Roberto; Martinelli, Fabio

We study the security of password protocols against off-line dictionary attacks. In addition to the standard adversary abilities, we also consider further cryptographic advantages given to the adversary when considering the password protocol being instantiated with particular encryption schemes. We

Development of a quarterly referral productivity report.

Science.gov (United States)

Wu, Cai; Sandoval, Alex; Hicks, Katrina N; Edwards, Tim J; Green, Lyle D

2007-10-11

The Office of Physician Relations at The University of Texas M. D. Anderson Cancer Center (MDACC) has developed a dynamic referral productivity reporting tool for its Multidisciplinary Care Centers (MCC). The tool leverages information within the institution's Enterprise Information Warehouse (EIW) using business intelligent software Hyperion Intelligent Explorer Suite 8.3. the referral productivity reports are intended to provide each MCC with detailed referral and registration data outlining how, and from where, patients arrive here for treatment. The reports supports operational and strategic initiatives aimed at improving referral processes and market related program development.

Dynamic Channel Slot Allocation Scheme and Performance Analysis of Cyclic Quorum Multichannel MAC Protocol

Directory of Open Access Journals (Sweden)

Xing Hu

2017-01-01

Full Text Available In high diversity node situation, multichannel MAC protocol can improve the frequency efficiency, owing to fewer collisions compared with single-channel MAC protocol. And the performance of cyclic quorum-based multichannel (CQM MAC protocol is outstanding. Based on cyclic quorum system and channel slot allocation, it can avoid the bottleneck that others suffered from and can be easily realized with only one transceiver. To obtain the accurate performance of CQM MAC protocol, a Markov chain model, which combines the channel-hopping strategy of CQM protocol and IEEE 802.11 distributed coordination function (DCF, is proposed. The results of numerical analysis show that the optimal performance of CQM protocol can be obtained in saturation bound situation. And then we obtain the saturation bound of CQM system by bird swarm algorithm. In addition, to improve the performance of CQM protocol in unsaturation situation, a dynamic channel slot allocation of CQM (DCQM protocol is proposed, based on wavelet neural network. Finally, the performance of CQM protocol and DCQM protocol is simulated by Qualnet platform. And the simulation results show that the analytic and simulation results match very well; the DCQM performs better in unsaturation situation.

An Enhanced Reservation-Based MAC Protocol for IEEE 802.15.4 Networks

Science.gov (United States)

Afonso, José A.; Silva, Helder D.; Macedo, Pedro; Rocha, Luis A.

2011-01-01

The IEEE 802.15.4 Medium Access Control (MAC) protocol is an enabling standard for wireless sensor networks. In order to support applications requiring dedicated bandwidth or bounded delay, it provides a reservation-based scheme named Guaranteed Time Slot (GTS). However, the GTS scheme presents some drawbacks, such as inefficient bandwidth utilization and support to a maximum of only seven devices. This paper presents eLPRT (enhanced Low Power Real Time), a new reservation-based MAC protocol that introduces several performance enhancing features in comparison to the GTS scheme. This MAC protocol builds on top of LPRT (Low Power Real Time) and includes various mechanisms designed to increase data transmission reliability against channel errors, improve bandwidth utilization and increase the number of supported devices. A motion capture system based on inertial and magnetic sensors has been used to validate the protocol. The effectiveness of the performance enhancements introduced by each of the new features is demonstrated through the provision of both simulation and experimental results. PMID:22163826

A fully distributed geo-routing scheme for wireless sensor networks

KAUST Repository

Bader, Ahmed

2013-12-01

When marrying randomized distributed space-time coding (RDSTC) to beaconless geo-routing, new performance horizons can be created. In order to reach those horizons, however, beaconless geo-routing protocols must evolve to operate in a fully distributed fashion. In this letter, we expose a technique to construct a fully distributed geo-routing scheme in conjunction with RDSTC. We then demonstrate the performance gains of this novel scheme by comparing it to one of the prominent classical schemes. © 2013 IEEE.

A fully distributed geo-routing scheme for wireless sensor networks

KAUST Repository

Bader, Ahmed; Abed-Meraim, Karim; Alouini, Mohamed-Slim

2013-01-01

When marrying randomized distributed space-time coding (RDSTC) to beaconless geo-routing, new performance horizons can be created. In order to reach those horizons, however, beaconless geo-routing protocols must evolve to operate in a fully distributed fashion. In this letter, we expose a technique to construct a fully distributed geo-routing scheme in conjunction with RDSTC. We then demonstrate the performance gains of this novel scheme by comparing it to one of the prominent classical schemes. © 2013 IEEE.

Quality of oral surgery referrals and how to improve them

Directory of Open Access Journals (Sweden)

Bjorkeborn M

2017-11-01

Full Text Available Mikael Björkeborn,1 Henrik Nilsson,2 Jonas Anderud1 1Department of Oral and Maxillofacial Surgery, Halmstad Hospital, Halmstad, Sweden; 2Department of Oral and Maxillofacial Surgery, Växjö Hospital, Växjö, Sweden Aim: To assess the quality of routine oral surgery referrals received at Halmstad Hospital and Växjö Hospital and to emphasize areas for improvement. Method: A retrospective study was performed on all routine oral surgery referrals received between 2014 and 2015 at both Halmstad Hospital and Växjö Hospital. A total of 1,891 referral letters were assessed for their quality against a predetermined checklist of basic requirements of a satisfactory referral. The referrals were also categorized according to if it was sent by a male, female, private dental service, or the Swedish Public Dental Health service. Results: A diagnosis was missing in 30% of all referrals. Radiographs and information about previous radiographic examinations were not included in 10% of the referrals. Of those referrals that included radiographs, only around half were deemed adequate for diagnostic purposes. The presenting complaint was missing in 40% of all referrals. Current medical history was absent in 40% and current medication was omitted in 60% of the referrals. Information about tobacco use was only included in 10% of all referrals. Overall, female referrers performed better than male colleagues. Private referrals more regularly included information about diagnosis, previous treatment, and current medication. On the other hand, referrals from the public dental health service more frequently included radiographs, tobacco use, and current medical history. Conclusion: There is plenty of room for improving the standards of oral surgery referrals. We suggest that future electronic referral systems should only allow for submission once all of the essential information has been considered. Keywords: clinical audit, referral quality, oral surgery referrals

Generalized routing protocols for multihop relay networks

KAUST Repository

Khan, Fahd Ahmed

2011-07-01

Performance of multihop cooperative networks depends on the routing protocols employed. In this paper we propose the last-n-hop selection protocol, the dual path protocol, the forward-backward last-n-hop selection protocol and the forward-backward dual path protocol for the routing of data through multihop relay networks. The average symbol error probability performance of the schemes is analysed by simulations. It is shown that close to optimal performance can be achieved by using the last-n-hop selection protocol and its forward-backward variant. Furthermore we also compute the complexity of the protocols in terms of number of channel state information required and the number of comparisons required for routing the signal through the network. © 2011 IEEE.

A robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care.

Science.gov (United States)

Wen, Fengtong

2013-12-01

User authentication plays an important role to protect resources or services from being accessed by unauthorized users. In a recent paper, Das et al. proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. This scheme uses three factors, e.g. biometrics, password, and smart card, to protect the security. It protects user privacy and is believed to have many abilities to resist a range of network attacks, even if the secret information stored in the smart card is compromised. In this paper, we analyze the security of Das et al.'s scheme, and show that the scheme is in fact insecure against the replay attack, user impersonation attacks and off-line guessing attacks. Then, we also propose a robust uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. Compared with the existing schemes, our protocol uses a different user authentication mechanism to resist replay attack. We show that our proposed scheme can provide stronger security than previous protocols. Furthermore, we demonstrate the validity of the proposed scheme through the BAN (Burrows, Abadi, and Needham) logic.

Families of quantum fingerprinting protocols

Science.gov (United States)

Lovitz, Benjamin; Lütkenhaus, Norbert

2018-03-01

We introduce several families of quantum fingerprinting protocols to evaluate the equality function on two n -bit strings in the simultaneous message passing model. The original quantum fingerprinting protocol uses a tensor product of a small number of O (logn ) -qubit high-dimensional signals [H. Buhrman et al., Phys. Rev. Lett. 87, 167902 (2001), 10.1103/PhysRevLett.87.167902], whereas a recently proposed optical protocol uses a tensor product of O (n ) single-qubit signals, while maintaining the O (logn ) information leakage of the original protocol [J. M. Arazola and N. Lütkenhaus, Phys. Rev. A 89, 062305 (2014), 10.1103/PhysRevA.89.062305]. We find a family of protocols which interpolate between the original and optical protocols while maintaining the O (logn ) information leakage, thus demonstrating a tradeoff between the number of signals sent and the dimension of each signal. There has been interest in experimental realization of the recently proposed optical protocol using coherent states [F. Xu et al., Nat. Commun. 6, 8735 (2015), 10.1038/ncomms9735; J.-Y. Guan et al., Phys. Rev. Lett. 116, 240502 (2016), 10.1103/PhysRevLett.116.240502], but as the required number of laser pulses grows linearly with the input size n , eventual challenges for the long-time stability of experimental setups arise. We find a coherent state protocol which reduces the number of signals by a factor 1/2 while also reducing the information leakage. Our reduction makes use of a simple modulation scheme in optical phase space, and we find that more complex modulation schemes are not advantageous. Using a similar technique, we improve a recently proposed coherent state protocol for evaluating the Euclidean distance between two real unit vectors [N. Kumar et al., Phys. Rev. A 95, 032337 (2017), 10.1103/PhysRevA.95.032337] by reducing the number of signals by a factor 1/2 and also reducing the information leakage.

Improving the psychological evaluation of exercise referral: Psychometric properties of the Exercise Referral Quality of Life Scale

Directory of Open Access Journals (Sweden)

Charlotte Hilton

2015-07-01

Full Text Available There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.

Interventions targeted at primary care practitioners to improve the identification and referral of patients with co-morbid obesity: a realist review protocol.

Science.gov (United States)

Blane, David N; Macdonald, Sara; Morrison, David; O'Donnell, Catherine A

2015-05-01

Obesity is one of the most significant public health challenges in the developed world. Recent policy has suggested that more can be done in primary care to support adults with obesity. In particular, general practitioners (GPs) and practice nurses (PNs) could improve the identification and referral of adults with obesity to appropriate weight management services. Previous interventions targeted at primary care practitioners in this area have had mixed results, suggesting a more complex interplay between patients, practitioners, and systems. The objectives of this review are (i) to identify the underlying 'programme theory' of interventions targeted at primary care practitioners to improve the identification and referral of adults with obesity and (ii) to explore how and why GPs and PNs identify and refer individuals with obesity, particularly in the context of weight-related co-morbidity. This protocol will explain the rationale for using a realist review approach and outline the key steps in this process. Realist review is a theory-led approach to knowledge synthesis that provides an explanatory analysis aimed at discerning what works, for whom, in what circumstances, how, and why. In this review, scoping interviews with key stakeholders involved in the planning and delivery of adult weight management services in Scotland helped to inform the identification of formal theories - from psychology, sociology, and implementation science - that will be tested as the review progresses. A comprehensive search strategy is described, including scope for iterative searching. Data analysis is outlined in three stages (describing context-mechanism-outcome configurations, exploring patterns in these configurations, and developing and testing middle-range theories, informed by the formal theories previously identified), culminating in the production of explanatory programme theory that considers individual, interpersonal, and institutional/systems-level components. This is the

GAME ANALYSIS OF KYOTO AND POST-KYOTO SCHEMES

Energy Technology Data Exchange (ETDEWEB)

Haruo Imai [Kyoto Institute of Economic Research, Kyoto University, Sakyo, Kyoto (Japan)

2008-09-30

Kyoto protocol, put in force in Feb. 2005, is criticized from both sides, those demanding a stricter target for GHG (green house gas) emission reduction on the one side, and those claiming for more flexible and comprehensive controls of the emission on the other side, for its modest target and narrow coverage. Even though its value could be that of a mere precedent and experimentation, Kyoto protocol includes very special experimentation to assist the world wide cooperation for a mitigation of climate change, i.e. the introduction of three mechanisms, emissions trading, joint implementation, and clean development mechanism (CDM). Together, they are called Kyoto mechanisms. Evaluation of mechanisms is one important role of microeconomics and the game theory is a major tool for it. We shall scrutinize these mechanisms from such viewpoint. A special attention is placed on CDM, as it is the novel mechanism introduced by Kyoto protocol, and gives a unique link between Annex I nations (mostly developed countries) and non-Annex I nations (mostly developing countries). Next, we examine some of the currently proposed schemes after 2013, the post Kyoto schemes. One of the chief issues is the possibility of making a comprehensive agreement including both the USA and large developing countries with rapidly increasing emission levels of GHG like China and India. Adding to these, not only the proposed schemes themselves, but the process of negotiation itself inspired several researches in cooperative game theory and in particular, coalition formation theory. We shall touch upon this issue separately, and examine how successfully they predicted the outcome leading to Kyoto, retrospectively. Finally, we end our discussion with a brief consideration over the underlining normative argument concerning these schemes.

Re-examining the security of blind quantum signature protocols

International Nuclear Information System (INIS)

Wang Mingming; Chen Xiubo; Niu Xinxin; Yang Yixian

2012-01-01

Recently, blind quantum signature (BQS) protocols have been proposed with the help of a third-party verifier. However, our research shows that some of the BQS protocols are unable to complete the blind signature task fairly if the verifier is dishonest. Indeed, these protocols can be viewed as variants of the classical digital signature scheme of symmetric-key cryptography. If nobody is trusted in such protocols, digital signature cannot be implemented since disagreements cannot be solved fairly.

PREMEDICATION PROTOCOLS IN DENTAL PRACTICE IN ALLERGIC PATIENTS.

OpenAIRE

Angelina Kisselova; Adriana Krasteva; Assya Krasteva

2011-01-01

The problem with choosing a suitable pre-medication protocols before local anesthesia in dentistry in allergic patients is always discussed, as in the dental practice different schemes are already proven (3,5). The propose of this communication is to share the experience on those pre-medication schemes in allergic patients during and outside pollen season.

Comparison of referral and non-referral hypertensive disorders during pregnancy: an analysis of 271 consecutive cases at a tertiary hospital.

Science.gov (United States)

Liu, Ching-Ming; Chang, Shuenn-Dyh; Cheng, Po-Jen

2005-05-01

This retrospective cohort study analyzed the clinical manifestations in patients with preeclampsia and eclampsia, assessed the risk factors compared to the severity of hypertensive disorders on maternal and perinatal morbidity, and mortality between the referral and non-referral patients. 271 pregnant women with preeclampsia and eclampsia were assessed (1993 to 1997). Chi-square analysis was used for the comparison of categorical variables, and the comparison of the two independent variables of proportions in estimation of confidence intervals and calculated odds ratio of the referral and non-referral groups. Multivariate logistic regression was used for adjusting potential confounding risk factors. Of the 271 patients included in this study, 71 (26.2%) patients were referrals from other hospitals. Most of the 62 (87.3%) referral patients were transferred during the period 21 and 37 weeks of gestation. Univariate analysis revealed that referral patients with hypertensive disorder were significantly associated with SBP > or =180, DBP > or =105, severe preclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP), emergency C/S, maternal complications, and low birth weight babies, as well as poor Apgar score. Multivariate logistic regression analyses revealed that the risk factors identified to be significantly associated with increased risk of referral patients included: diastolic blood pressure above 105 mmHg (adjusted odds ratio, 2.09; 95 percent confidence interval, 1.06 to 4.13; P = 0.034), severe preeclampsia (adjusted odds ratio, 3.46; 95 percent confidence interval, 1.76 to 6.81; P < 0.001), eclampsia (adjusted odds ratio, 2.77; 95 percent confidence interval, 0.92 to 8.35; P = 0.071), HELLP syndrome (adjusted odds ratio, 18.81; 95 percent confidence interval, 2.14 to 164.99; P = 0.008). The significant factors associated with the referral patients with hypertensive disorders were severe preeclampsia, HELLP, and eclampsia. Lack of prenatal care was

Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre.

Science.gov (United States)

Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H

2015-07-01

Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial

Science.gov (United States)

2014-01-01

Background The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. Methods An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres. Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise. Blood pressure and weight were assessed at baseline and 6 months. Results Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Conclusions Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

Science.gov (United States)

Duda, Joan L; Williams, Geoffrey C; Ntoumanis, Nikos; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Rouse, Peter C; Lodhia, Rekha; Blamey, Ruth V; Jolly, Kate

2014-01-29

The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise

Referral for Outpatients Urological Services: Poor Conformity and ...

African Journals Online (AJOL)

Background: This study was aimed at establishing the degree of conformity with the referral system, level of pre-referral investigative evaluations and degree of diagnosis concordance between the referring centres and the referral hospital in Western region of Kenya. Methods: This was a hospital based descriptive, ...

Short Stature Diagnosis and Referral

Directory of Open Access Journals (Sweden)

Mohamad Maghnie

2018-01-01

Full Text Available The “360° GH in Europe” meeting, which examined various aspects of GH diseases, was held in Lisbon, Portugal, in June 2016. The Merck KGaA (Germany funded meeting comprised three sessions entitled “Short Stature Diagnosis and Referral,” “Optimizing Patient Management,” and “Managing Transition.” Each session had three speaker presentations, followed by a discussion period, and is reported as a manuscript, authored by the speakers. The first session examined current processes of diagnosis and referral by endocrine specialists for pediatric patients with short stature. Requirements for referral vary widely, by country and by patient characteristics such as age. A balance must be made to ensure eligible patients get referred while healthcare systems are not over-burdened by excessive referrals. Late referral and diagnosis of non-GH deficiency conditions can result in increased morbidity and mortality. The consequent delays in making a diagnosis may compromise the effectiveness of GH treatment. Algorithms for growth monitoring and evaluation of skeletal disproportions can improve identification of non-GH deficiency conditions. Performance and validation of guidelines for diagnosis of GH deficiency have not been sufficiently tested. Provocative tests for investigation of GH deficiency remain equivocal, with insufficient information on variations due to patient characteristics, and cutoff values for definition differ not only by country but also by the assay used. When referring and diagnosing causes of short stature in pediatric patients, clinicians need to rely on many factors, but the most essential is clinical experience.

Design and Analysis of an Enhanced Patient-Server Mutual Authentication Protocol for Telecare Medical Information System.

Science.gov (United States)

Amin, Ruhul; Islam, S K Hafizul; Biswas, G P; Khan, Muhammad Khurram; Obaidat, Mohammad S

2015-11-01

In order to access remote medical server, generally the patients utilize smart card to login to the server. It has been observed that most of the user (patient) authentication protocols suffer from smart card stolen attack that means the attacker can mount several common attacks after extracting smart card information. Recently, Lu et al.'s proposes a session key agreement protocol between the patient and remote medical server and claims that the same protocol is secure against relevant security attacks. However, this paper presents several security attacks on Lu et al.'s protocol such as identity trace attack, new smart card issue attack, patient impersonation attack and medical server impersonation attack. In order to fix the mentioned security pitfalls including smart card stolen attack, this paper proposes an efficient remote mutual authentication protocol using smart card. We have then simulated the proposed protocol using widely-accepted AVISPA simulation tool whose results make certain that the same protocol is secure against active and passive attacks including replay and man-in-the-middle attacks. Moreover, the rigorous security analysis proves that the proposed protocol provides strong security protection on the relevant security attacks including smart card stolen attack. We compare the proposed scheme with several related schemes in terms of computation cost and communication cost as well as security functionalities. It has been observed that the proposed scheme is comparatively better than related existing schemes.

Deflection routing scheme for GMPLS-based OBS networks

DEFF Research Database (Denmark)

Eid, Arafat; Mahmood, Waqar; Alomar, Anwar

2010-01-01

Integrating the Generalized Multi-Protocol Label Switching (GMPLS) framework into an Optical Burst Switching (OBS) Control Plane is a promising solution to alleviating most of OBS performance and design issues. However, implementing the already proposed OBS deflection routing schemes is not appli...

Reading Intervention and Special Education Referrals

Science.gov (United States)

Polcyn, Dawn M.; Levine-Donnerstein, Deborah; Perfect, Michelle M.; Obrzut, John E.

2014-01-01

This study examined whether consistently implementing reading fluency interventions prior to referring students for a special education evaluation led to fewer overall special education referrals, as well as more accurate special education referrals. Results indicated that the implementation of a peer-mediated reading fluency intervention…

An improved biometrics-based authentication scheme for telecare medical information systems.

Science.gov (United States)

Guo, Dianli; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping

2015-03-01

Telecare medical information system (TMIS) offers healthcare delivery services and patients can acquire their desired medical services conveniently through public networks. The protection of patients' privacy and data confidentiality are significant. Very recently, Mishra et al. proposed a biometrics-based authentication scheme for telecare medical information system. Their scheme can protect user privacy and is believed to resist a range of network attacks. In this paper, we analyze Mishra et al.'s scheme and identify that their scheme is insecure to against known session key attack and impersonation attack. Thereby, we present a modified biometrics-based authentication scheme for TMIS to eliminate the aforementioned faults. Besides, we demonstrate the completeness of the proposed scheme through BAN-logic. Compared to the related schemes, our protocol can provide stronger security and it is more practical.

Analyzing the effect of routing protocols on media access control protocols in radio networks

Energy Technology Data Exchange (ETDEWEB)

Barrett, C. L. (Christopher L.); Drozda, M. (Martin); Marathe, A. (Achla); Marathe, M. V. (Madhav V.)

2002-01-01

We study the effect of routing protocols on the performance of media access control (MAC) protocols in wireless radio networks. Three well known MAC protocols: 802.11, CSMA, and MACA are considered. Similarly three recently proposed routing protocols: AODV, DSR and LAR scheme 1 are considered. The experimental analysis was carried out using GloMoSim: a tool for simulating wireless networks. The main focus of our experiments was to study how the routing protocols affect the performance of the MAC protocols when the underlying network and traffic parameters are varied. The performance of the protocols was measured w.r.t. five important parameters: (i) number of received packets, (ii) average latency of each packet, (iii) throughput (iv) long term fairness and (v) number of control packets at the MAC layer level. Our results show that combinations of routing and MAC protocols yield varying performance under varying network topology and traffic situations. The result has an important implication; no combination of routing protocol and MAC protocol is the best over all situations. Also, the performance analysis of protocols at a given level in the protocol stack needs to be studied not locally in isolation but as a part of the complete protocol stack. A novel aspect of our work is the use of statistical technique, ANOVA (Analysis of Variance) to characterize the effect of routing protocols on MAC protocols. This technique is of independent interest and can be utilized in several other simulation and empirical studies.

The Singapore protocol [for quantum cryptography

International Nuclear Information System (INIS)

Englert, B.

2005-01-01

The qubit protocol for quantum key distribution presented in this talk is fully tomographic and more efficient than other tomographic protocols. Under ideal circumstances the efficiency is log 2 (4/3) = 0.415 key bits per qubit sent, which is 25% more than the efficiency of 1/3 = 0.333 for the standard 6-state protocol. One can extract 0.4 key bits per qubit by a simple two-way communication scheme, and can so get close to the information-theoretical limit. The noise thresholds for secure key bit generation in the presence of unbiased noise will be reported and discussed. (author)

Caregivers' compliance with referral advice

DEFF Research Database (Denmark)

Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

2018-01-01

BACKGROUND: Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance...... in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers' referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. RESULTS: CHW saw 18......,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings

Evaluation of cardiovascular risk-lowering health benefits accruing from laboratory-based, community-based and exercise-referral exercise programmes.

Science.gov (United States)

Webb, R; Thompson, J E S; Ruffino, J-S; Davies, N A; Watkeys, L; Hooper, S; Jones, P M; Walters, G; Clayton, D; Thomas, A W; Morris, K; Llewellyn, D H; Ward, M; Wyatt-Williams, J; McDonnell, B J

2016-01-01

To evaluate the ability of community-based exercise programmes to facilitate public participation in exercise and hence improved cardiovascular health, we assessed the respective impacts of: a continuously monitored exercise programme based within our university (study 1); a Valleys Regional Park-facilitated community-based outdoor exercise programme (study 2); a Wales National Exercise Referral Scheme-delivered exercise-referral programme (study 3). Biomolecular (monocytic PPARγ target gene expression), vascular haemodynamic (central/peripheral blood pressure, arterial stiffness), clinical (insulin sensitivity, blood lipids) and anthropometric (body mass index, waist circumference, heart rate) parameters were investigated using RT-PCR, applanation tonometry, chemical analysis and standard anthropometric techniques. In studies 1-3, 22/28, 32/65 and 11/14 participants adhered to their respective exercise programmes, and underwent significant increases in physical activity levels. Importantly, beneficial effects similar to those seen in our previous studies (eg, modulations in expression of monocytic PPARγ target genes, decreases in blood pressure/arterial stiffness, improvements in blood lipids/insulin sensitivity) were observed (albeit to slightly differing extents) only in participants who adhered to their respective exercise programmes. While study 1 achieved more intense exercise and more pronounced beneficial effects, significant cardiovascular risk-lowering health benefits related to biomolecular markers, blood pressure, arterial stiffness and blood lipids were achieved via community/referral-based delivery modes in studies 2 and 3. Because cardiovascular health benefits were observed in all 3 studies, we conclude that the majority of benefits previously reported in laboratory-based studies can also be achieved in community-based/exercise-referral settings. These findings may be of use in guiding policymakers with regard to introduction and/or continued

Exact Throughput Analyses of Energy-Harvesting Cooperation Scheme with Best Relay Selections Under I/Q Imbalance

Directory of Open Access Journals (Sweden)

Tan Phuoc Huynh

2017-01-01

Full Text Available In this paper, we propose an energy-harvesting cooperation scheme in which relays suffer in-phase and quadrature-phase imbalances (IQI and harvest energy from a wireless transmit source. A best relay is selected based on end-to-end signal-to-interference-plus-noise ratios (SINRs in both Amplify-and-Forward (called an EHAF protocol and Decode-and-Forward (called an EHDF protocol cooperation methods. We analyze and evaluate the system performance in terms of exact closed-form throughputs over Rayleigh fading channels. Simulation and analysis results discover contributions as follows. Firstly, the throughput performance of the proposed protocols EHAF and EHDF is improved when comparing with that of a non-selection cooperation scheme. Secondly, the EHDF protocol is more efficient than the EHAF protocol. Finally, the theoretical analyses are validated by performing Monte Carlo simulations.

ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

Directory of Open Access Journals (Sweden)

Johnston Steven

2011-06-01

Full Text Available Abstract Background In Australia approximately 25% of Emergency Department (ED attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit. Methods/Design A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted. Discussion If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding. Trial Registration Australian and New Zealand Clinical Trials Registry Number 12610001064099

8 CFR 235.6 - Referral to immigration judge.

Science.gov (United States)

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 235.6 Section 235.6 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 235.6 Referral to immigration judge. (a) Notice—(1) Referral by Form I...

Fuzzy Extractor and Elliptic Curve Based Efficient User Authentication Protocol for Wireless Sensor Networks and Internet of Things

Directory of Open Access Journals (Sweden)

Anup Kumar Maurya

2017-10-01

Full Text Available To improve the quality of service and reduce the possibility of security attacks, a secure and efficient user authentication mechanism is required for Wireless Sensor Networks (WSNs and the Internet of Things (IoT. Session key establishment between the sensor node and the user is also required for secure communication. In this paper, we perform the security analysis of A.K.Das’s user authentication scheme (given in 2015, Choi et al.’s scheme (given in 2016, and Park et al.’s scheme (given in 2016. The security analysis shows that their schemes are vulnerable to various attacks like user impersonation attack, sensor node impersonation attack and attacks based on legitimate users. Based on the cryptanalysis of these existing protocols, we propose a secure and efficient authenticated session key establishment protocol which ensures various security features and overcomes the drawbacks of existing protocols. The formal and informal security analysis indicates that the proposed protocol withstands the various security vulnerabilities involved in WSNs. The automated validation using AVISPA and Scyther tool ensures the absence of security attacks in our scheme. The logical verification using the Burrows-Abadi-Needham (BAN logic confirms the correctness of the proposed protocol. Finally, the comparative analysis based on computational overhead and security features of other existing protocol indicate that the proposed user authentication system is secure and efficient. In future, we intend to implement the proposed protocol in real-world applications of WSNs and IoT.

A slotted access control protocol for metropolitan WDM ring networks

Science.gov (United States)

Baziana, P. A.; Pountourakis, I. E.

2009-03-01

In this study we focus on the serious scalability problems that many access protocols for WDM ring networks introduce due to the use of a dedicated wavelength per access node for either transmission or reception. We propose an efficient slotted MAC protocol suitable for WDM ring metropolitan area networks. The proposed network architecture employs a separate wavelength for control information exchange prior to the data packet transmission. Each access node is equipped with a pair of tunable transceivers for data communication and a pair of fixed tuned transceivers for control information exchange. Also, each access node includes a set of fixed delay lines for synchronization reasons; to keep the data packets, while the control information is processed. An efficient access algorithm is applied to avoid both the data wavelengths and the receiver collisions. In our protocol, each access node is capable of transmitting and receiving over any of the data wavelengths, facing the scalability issues. Two different slot reuse schemes are assumed: the source and the destination stripping schemes. For both schemes, performance measures evaluation is provided via an analytic model. The analytical results are validated by a discrete event simulation model that uses Poisson traffic sources. Simulation results show that the proposed protocol manages efficient bandwidth utilization, especially under high load. Also, comparative simulation results prove that our protocol achieves significant performance improvement as compared with other WDMA protocols which restrict transmission over a dedicated data wavelength. Finally, performance measures evaluation is explored for diverse numbers of buffer size, access nodes and data wavelengths.

Asymptotic adaptive bipartite entanglement-distillation protocol

International Nuclear Information System (INIS)

Hostens, Erik; Dehaene, Jeroen; De Moor, Bart

2006-01-01

We present an asymptotic bipartite entanglement-distillation protocol that outperforms all existing asymptotic schemes. This protocol is based on the breeding protocol with the incorporation of two-way classical communication. Like breeding, the protocol starts with an infinite number of copies of a Bell-diagonal mixed state. Breeding can be carried out as successive stages of partial information extraction, yielding the same result: one bit of information is gained at the cost (measurement) of one pure Bell state pair (ebit). The basic principle of our protocol is at every stage to replace measurements on ebits by measurements on a finite number of copies, whenever there are two equiprobable outcomes. In that case, the entropy of the global state is reduced by more than one bit. Therefore, every such replacement results in an improvement of the protocol. We explain how our protocol is organized as to have as many replacements as possible. The yield is then calculated for Werner states

Novel Quantum Secret Sharing and Controlled Communication Schemes Based on Einstein–Podolsky–Rosen Correlations

International Nuclear Information System (INIS)

Yuan, Li; Gui-Hua, Zeng

2009-01-01

Employing quantum registers, we first proposed a novel (2, 3) quantum threshold scheme based on Einstein–Podolsky–Rosen (EPR) correlations in this letter. Motivated by the present threshold scheme, we also propose a controlled communication scheme to transmit the secret message with a controller. In the communication protocol, the encoded quantum message carried by particles sequence, is transmitted by legitimate communicators

Secure Protocol for “Host — NFC Reader” Communication

Directory of Open Access Journals (Sweden)

A. O. Menshenin

2012-06-01

Full Text Available The paper presents a secure protocol for communication between host and NFC reader. The protocol protection scheme uses symmetric cipher with cyclic session key generation and provides confidentiality, integrity, end parties authentication and resistance to replay attacks. Deployment scenario in a typical electronic payment system is also presented.

Lightweight SIP/SDP compression scheme (LSSCS)

Science.gov (United States)

Wu, Jian J.; Demetrescu, Cristian

2001-10-01

In UMTS new IP based services with tight delay constraints will be deployed over the W-CDMA air interface such as IP multimedia and interactive services. To integrate the wireline and wireless IP services, 3GPP standard forum adopted the Session Initiation Protocol (SIP) as the call control protocol for the UMTS Release 5, which will implement next generation, all IP networks for real-time QoS services. In the current form the SIP protocol is not suitable for wireless transmission due to its large message size which will need either a big radio pipe for transmission or it will take far much longer to transmit than the current GSM Call Control (CC) message sequence. In this paper we present a novel compression algorithm called Lightweight SIP/SDP Compression Scheme (LSSCS), which acts at the SIP application layer and therefore removes the information redundancy before it is sent to the network and transport layer. A binary octet-aligned header is added to the compressed SIP/SDP message before sending it to the network layer. The receiver uses this binary header as well as the pre-cached information to regenerate the original SIP/SDP message. The key features of the LSSCS compression scheme are presented in this paper along with implementation examples. It is shown that this compression algorithm makes SIP transmission efficient over the radio interface without losing the SIP generality and flexibility.

Correlates of oncologist-issued referrals for psycho-oncology services: what we learned from the electronic voluntary screening and referral system for depression (eVSRS-D).

Science.gov (United States)

Lee, Joo-Young; Jung, Dooyoung; Kim, Won-Hyoung; Lee, Hyuk-Joon; Noh, Dong-Young; Hahm, Bong-Jin

2016-02-01

Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS). The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups. Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions. The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals. Copyright © 2015 John Wiley & Sons, Ltd.

Efficient authentication scheme based on near-ring root extraction problem

Science.gov (United States)

Muthukumaran, V.; Ezhilmaran, D.

2017-11-01

An authentication protocolis the type of computer communication protocol or cryptography protocol specifically designed for transfer of authentication data between two entities. We have planned a two new entity authentication scheme on the basis of root extraction problem near-ring in this article. We suggest that this problem is suitably difficult to serve as a cryptographic assumption over the platform of near-ring N. The security issues also discussed.

Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention.

Science.gov (United States)

Dahhan, Ali; Maddox, William R; Krothapalli, Siva; Farmer, Matthew; Shah, Amit; Ford, Benjamin; Rhodes, Marc; Matthews, Laurie; Barnes, Vernon A; Sharma, Gyanendra K

2015-08-01

Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR). Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined. Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, pEducation of providers and implementation of a formal referral system can improve RR and PR. Published by Elsevier B.V.

A Source Anonymity-Based Lightweight Secure AODV Protocol for Fog-Based MANET.

Science.gov (United States)

Fang, Weidong; Zhang, Wuxiong; Xiao, Jinchao; Yang, Yang; Chen, Wei

2017-06-17

Fog-based MANET (Mobile Ad hoc networks) is a novel paradigm of a mobile ad hoc network with the advantages of both mobility and fog computing. Meanwhile, as traditional routing protocol, ad hoc on-demand distance vector (AODV) routing protocol has been applied widely in fog-based MANET. Currently, how to improve the transmission performance and enhance security are the two major aspects in AODV's research field. However, the researches on joint energy efficiency and security seem to be seldom considered. In this paper, we propose a source anonymity-based lightweight secure AODV (SAL-SAODV) routing protocol to meet the above requirements. In SAL-SAODV protocol, source anonymous and secure transmitting schemes are proposed and applied. The scheme involves the following three parts: the source anonymity algorithm is employed to achieve the source node, without being tracked and located; the improved secure scheme based on the polynomial of CRC-4 is applied to substitute the RSA digital signature of SAODV and guarantee the data integrity, in addition to reducing the computation and energy consumption; the random delayed transmitting scheme (RDTM) is implemented to separate the check code and transmitted data, and achieve tamper-proof results. The simulation results show that the comprehensive performance of the proposed SAL-SAODV is a trade-off of the transmission performance, energy efficiency, and security, and better than AODV and SAODV.

Physician Referral Patterns

Data.gov (United States)

U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

40 CFR 13.33 - Referrals to the Department of Justice.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Referrals to the Department of Justice... COLLECTION STANDARDS Referrals § 13.33 Referrals to the Department of Justice. (a) Prompt referral. The... Justice, Washington, DC 20530. (2) Unless otherwise provided by DOJ regulations or procedures, EPA refers...

Protocol for fermionic positive-operator-valued measures

Science.gov (United States)

Arvidsson-Shukur, D. R. M.; Lepage, H. V.; Owen, E. T.; Ferrus, T.; Barnes, C. H. W.

2017-11-01

In this paper we present a protocol for the implementation of a positive-operator-valued measure (POVM) on massive fermionic qubits. We present methods for implementing nondispersive qubit transport, spin rotations, and spin polarizing beam-splitter operations. Our scheme attains linear opticslike control of the spatial extent of the qubits by considering ground-state electrons trapped in the minima of surface acoustic waves in semiconductor heterostructures. Furthermore, we numerically simulate a high-fidelity POVM that carries out Procrustean entanglement distillation in the framework of our scheme, using experimentally realistic potentials. Our protocol can be applied not only to pure ensembles with particle pairs of known identical entanglement, but also to realistic ensembles of particle pairs with a distribution of entanglement entropies. This paper provides an experimentally realizable design for future quantum technologies.

A secure effective dynamic group password-based authenticated key agreement scheme for the integrated EPR information system

Directory of Open Access Journals (Sweden)

Vanga Odelu

2016-01-01

Full Text Available With the rapid growth of the Internet, a lot of electronic patient records (EPRs have been developed for e-medicine systems. The security and privacy issues of EPRs are important for the patients in order to understand how the hospitals control the use of their personal information, such as name, address, e-mail, medical records, etc. of a particular patient. Recently, Lee et al. proposed a simple group password-based authenticated key agreement protocol for the integrated EPR information system (SGPAKE. However, in this paper, we show that Lee et al.’s protocol is vulnerable to the off-line weak password guessing attack and as a result, their scheme does not provide users’ privacy. To withstand this security weakness found in Lee et al.’s scheme, we aim to propose an effective dynamic group password-based authenticated key exchange scheme for the integrated EPR information system, which retains the original merits of Lee et al.’s scheme. Through the informal and formal security analysis, we show that our scheme provides users’ privacy, perfect forward security and known-key security, and also protects online and offline password guessing attacks. Furthermore, our scheme efficiently supports the dynamic group password-based authenticated key agreement for the integrated EPR information system. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications tool and show that our scheme is secure against passive and active attacks.

A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

Science.gov (United States)

Islam, Shayla; Abdalla, Aisha H.; Habaebi, Mohamed H.; Latif, Suhaimi A.; Hassan, Wan H.; Hasan, Mohammad K.; Ramli, H. A. M.; Khalifa, Othman O.

2013-12-01

NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, "Signaling Storm" occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6.

A comparative signaling cost analysis of Macro Mobility scheme in NEMO (MM-NEMO) with mobility management protocol

International Nuclear Information System (INIS)

Islam, Shayla; Abdalla, Aisha H; Habaebi, Mohamed H; Latif, Suhaimi A; Hassan, Wan H; Hasan, Mohammad K; Ramli, H A M; Khalifa, Othman O

2013-01-01

NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it's Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, ''Signaling Storm'' occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6

Factors affecting cardiac rehabilitation referral by physician specialty.

Science.gov (United States)

Grace, Sherry L; Grewal, Keerat; Stewart, Donna E

2008-01-01

Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

Network-topology-adaptive quantum conference protocols

International Nuclear Information System (INIS)

Zhang Sheng; Wang Jian; Tang Chao-Jing; Zhang Quan

2011-01-01

As an important application of the quantum network communication, quantum multiparty conference has made multiparty secret communication possible. Previous quantum multiparty conference schemes based on quantum data encryption are insensitive to network topology. However, the topology of the quantum network significantly affects the communication efficiency, e.g., parallel transmission in a channel with limited bandwidth. We have proposed two distinctive protocols, which work in two basic network topologies with efficiency higher than the existing ones. We first present a protocol which works in the reticulate network using Greeberger—Horne—Zeilinger states and entanglement swapping. Another protocol, based on quantum multicasting with quantum data compression, which can improve the efficiency of the network, works in the star-like network. The security of our protocols is guaranteed by quantum key distribution and one-time-pad encryption. In general, the two protocols can be applied to any quantum network where the topology can be equivalently transformed to one of the two structures we propose in our protocols. (general)

Qualitative study on maternal referrals in rural Tanzania: Decision ...

African Journals Online (AJOL)

Administrator

The process in deciding to seek referral care is envisaged within community .... The three phases of delays model in accessing .... as dangerous at home and immediate care is required, the ... referral or is unable to pay the costs of referral, the ...

Neurology referrals to a liaison psychiatry service.

LENUS (Irish Health Repository)

Fitzgerald, P

2012-02-03

The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.

The role of referrals in financing technology-based ventures

NARCIS (Netherlands)

Heuven, J.M.J.

2009-01-01

Many referral mechanisms can be found in the context of entrepreneurship. Networks and third party referrals play a prominent role in spotting entrepreneurial opportunities and in acquiring the resources necessary for growth. In this dissertation, the focus is on the role of referrals in acquiring

Password Authenticated Key Exchange and Protected Password Change Protocols

Directory of Open Access Journals (Sweden)

Ting-Yi Chang

2017-07-01

Full Text Available In this paper, we propose new password authenticated key exchange (PAKE and protected password change (PPC protocols without any symmetric or public-key cryptosystems. The security of the proposed protocols is based on the computational Diffie-Hellman assumption in the random oracle model. The proposed scheme can resist both forgery server and denial of service attacks.

Researches on the Security of Cluster-based Communication Protocol for Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Yanhong Sun

2014-08-01

Full Text Available Along with the in-depth application of sensor networks, the security issues have gradually become the bottleneck of wireless sensor applications. To provide a solution for security scheme is a common concern not only of researchers but also of providers, integrators and users of wireless sensor networks. Based on this demand, this paper focuses on the research of strengthening the security of cluster-based wireless sensor networks. Based on the systematic analysis of the clustering protocol and its security enhancement scheme, the paper introduces the broadcast authentication scheme, and proposes an SA-LEACH network security enhancement protocol. The performance analysis and simulation experiments prove that the protocol consumes less energy with the same security requirements, and when the base station is comparatively far from the network deployment area, it is more advantageous in terms of energy consumption and t more suitable for wireless sensor networks.

Improved two-way six-state protocol for quantum key distribution

International Nuclear Information System (INIS)

Shaari, J.S.; Bahari, Asma' Ahmad

2012-01-01

A generalized version for a qubit based two-way quantum key distribution scheme was first proposed in the paper [Phys. Lett. A 358 (2006) 85] capitalizing on the six quantum states derived from three mutually unbiased bases. While boasting of a higher level of security, the protocol was not designed for ease of practical implementation. In this work, we propose modifications to the protocol, resulting not only in improved security but also in a more efficient and practical setup. We provide comparisons for calculated secure key rates for the protocols in noisy and lossy channels. -- Highlights: ► Modification for efficient generalized two-way QKD is proposed. ► Calculations include secure key rates in noisy and lossy channels for selected attack scenario. ► Resulting proposal provides for higher secure key rate in selected attack scheme.

Improved two-way six-state protocol for quantum key distribution

Energy Technology Data Exchange (ETDEWEB)

Shaari, J.S., E-mail: jesni_shamsul@yahoo.com [Faculty of Science, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang (Malaysia); Bahari, Asma' Ahmad [Faculty of Science, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang (Malaysia)

2012-10-01

A generalized version for a qubit based two-way quantum key distribution scheme was first proposed in the paper [Phys. Lett. A 358 (2006) 85] capitalizing on the six quantum states derived from three mutually unbiased bases. While boasting of a higher level of security, the protocol was not designed for ease of practical implementation. In this work, we propose modifications to the protocol, resulting not only in improved security but also in a more efficient and practical setup. We provide comparisons for calculated secure key rates for the protocols in noisy and lossy channels. -- Highlights: ► Modification for efficient generalized two-way QKD is proposed. ► Calculations include secure key rates in noisy and lossy channels for selected attack scenario. ► Resulting proposal provides for higher secure key rate in selected attack scheme.

Using the emergency department as a screening site for high blood pressure. A method for improving hypertension detection and appropriate referral.

Science.gov (United States)

Mamon, J; Green, L; Levine, D M; Gibson, G; Gurley, H T

1987-08-01

This study describes the development and testing of a high blood pressure protocol for use in emergency departments (ED) to enhance detection of those patients appropriate for subsequent referral. The protocol involves two serial blood pressure measurements and a patient interview to determine: 1) previous history of high blood pressure (HBP), 2) treatment in past year for HBP, and 3) usual source of medical care. The accuracy of patient reporting was validated by comparison with the patients' hospital record (reflecting outpatient and inpatient visits). Results indicate that these self-reports have high levels of sensitivity (range 90-100%) and specificity (range 79-96%). Use of the additional patient information increased the sensitivity of the screening protocol in identifying when and where a patient should be referred. Use of this methodology indicates that the protocol is a simple and effective method for HBP screening. The findings also suggest that the ED is an ideal site for screening the "hard-to-reach" hypertensive population.

Physician self-referral and physician-owned specialty facilities.

Science.gov (United States)

Casalino, Lawrence P

2008-06-01

Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

DRO: domain-based route optimization scheme for nested mobile networks

Directory of Open Access Journals (Sweden)

Chuang Ming-Chin

2011-01-01

Full Text Available Abstract The network mobility (NEMO basic support protocol is designed to support NEMO management, and to ensure communication continuity between nodes in mobile networks. However, in nested mobile networks, NEMO suffers from the pinball routing problem, which results in long packet transmission delays. To solve the problem, we propose a domain-based route optimization (DRO scheme that incorporates a domain-based network architecture and ad hoc routing protocols for route optimization. DRO also improves the intra-domain handoff performance, reduces the convergence time during route optimization, and avoids the out-of-sequence packet problem. A detailed performance analysis and simulations were conducted to evaluate the scheme. The results demonstrate that DRO outperforms existing mechanisms in terms of packet transmission delay (i.e., better route-optimization, intra-domain handoff latency, convergence time, and packet tunneling overhead.

Referral recommendations for osteoarthritis of the knee incorporating patients' preferences

Science.gov (United States)

Musila, Nyokabi; Underwood, Martin; McCaskie, Andrew W; Black, Nick; Clarke, Aileen; van der Meulen, Jan H

2011-01-01

Background. GPs have to respond to conflicting policy developments. As gatekeeper they are supposed to manage the growing demand for specialist services and as patient advocate they should be responsive to patients' preferences. We used an innovative approach to develop a referral guideline for patients with chronic knee pain that explicitly incorporates patients' preferences. Methods. A guideline development group of 12 members including patients, GPs, orthopaedic surgeons and other health care professionals used formal consensus development informed by systematic evidence reviews. They rated the appropriateness of referral for 108 case scenarios describing patients according to symptom severity, age, body mass, co-morbidity and referral preference. Appropriateness was expressed on scale from 1 (‘strongly disagree’) to 9 (‘strongly agree’). Results. Ratings of referral appropriateness were strongly influenced by symptom severity and patients' referral preferences. The influence of other patient characteristics was small. There was consensus that patients with severe knee symptoms who want to be referred should be referred and that patient with moderate or mild symptoms and strong preference against referral should not be referred. Referral preference had a greater impact on the ratings of referral appropriateness when symptoms were moderate or severe than when symptoms were mild. Conclusions. Referral decisions for patients with osteoarthritis of the knee should only be guided by symptom severity and patients' referral preferences. The guideline development group seemed to have given priority to avoiding inefficient resource use in patients with mild symptoms and to respecting patient autonomy in patients with severe symptoms. PMID:20817791

An Authentication Protocol for Future Sensor Networks.

Science.gov (United States)

Bilal, Muhammad; Kang, Shin-Gak

2017-04-28

Authentication is one of the essential security services in Wireless Sensor Networks (WSNs) for ensuring secure data sessions. Sensor node authentication ensures the confidentiality and validity of data collected by the sensor node, whereas user authentication guarantees that only legitimate users can access the sensor data. In a mobile WSN, sensor and user nodes move across the network and exchange data with multiple nodes, thus experiencing the authentication process multiple times. The integration of WSNs with Internet of Things (IoT) brings forth a new kind of WSN architecture along with stricter security requirements; for instance, a sensor node or a user node may need to establish multiple concurrent secure data sessions. With concurrent data sessions, the frequency of the re-authentication process increases in proportion to the number of concurrent connections. Moreover, to establish multiple data sessions, it is essential that a protocol participant have the capability of running multiple instances of the protocol run, which makes the security issue even more challenging. The currently available authentication protocols were designed for the autonomous WSN and do not account for the above requirements. Hence, ensuring a lightweight and efficient authentication protocol has become more crucial. In this paper, we present a novel, lightweight and efficient key exchange and authentication protocol suite called the Secure Mobile Sensor Network (SMSN) Authentication Protocol. In the SMSN a mobile node goes through an initial authentication procedure and receives a re-authentication ticket from the base station. Later a mobile node can use this re-authentication ticket when establishing multiple data exchange sessions and/or when moving across the network. This scheme reduces the communication and computational complexity of the authentication process. We proved the strength of our protocol with rigorous security analysis (including formal analysis using the BAN

Characteristics of Successful and Unsuccessful Mental Health Referrals of Refugees

Science.gov (United States)

Shannon, Patricia J.; Vinson, Gregory A.; Cook, Tonya; Lennon, Evelyn

2018-01-01

In this community based participatory research study, we explored key characteristics of mental health referrals of refugees using stories of providers collected through an on-line survey. Ten coders sorted 60 stories of successful referrals and 34 stories of unsuccessful referrals into domains using the critical incident technique. Principal Components Analysis yielded categories of successful referrals that included: active care coordination, proactive resolution of barriers, establishment of trust, and culturally responsive care. Unsuccessful referrals were characterized by cultural barriers, lack of care coordination, language barriers, system barriers, providers being unwilling to see refugees. Recommendations for training and policy are discussed. PMID:25735618

Referral pattern of hemodialysis patients to nephrologists

International Nuclear Information System (INIS)

Anees, M.; Mumtaz, A.; Nazir, M.; Ibrahim, M.; Kausar, T.

2007-01-01

To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and

A Two-Layered Mobility Architecture Using Fast Mobile IPv6 and Session Initiation Protocol

Directory of Open Access Journals (Sweden)

Nursimloo DeeyaS

2008-01-01

Full Text Available Abstract This paper proposes an integrated mobility scheme that combines the procedures of fast handover for Mobile IPv6 (FMIPv6 and session initiation protocol (SIP mobility for realtime communications. This integrated approach is based on the context of the applications utilized. Furthermore, to reduce system redundancies and signaling loads, several functionalities of FMIPv6 and SIP have been integrated to optimize the integrated mobility scheme. The proposed scheme aims at reducing the handover latency and packet loss for an ongoing realtime traffic. Using ns-2 simulation, we analyze the performance of the proposed integrated scheme and compare it with the existing protocols for a VoIP and for a video stream traffic. This mobility architecture achieves lower handover delay and less packet loss than using either FMIPv6 or SIP and hence presents a powerful handover mobility scheme for next generation IP-based wireless systems.

A Two-Layered Mobility Architecture Using Fast Mobile IPv6 and Session Initiation Protocol

Directory of Open Access Journals (Sweden)

Deeya S. Nursimloo

2007-12-01

Full Text Available This paper proposes an integrated mobility scheme that combines the procedures of fast handover for Mobile IPv6 (FMIPv6 and session initiation protocol (SIP mobility for realtime communications. This integrated approach is based on the context of the applications utilized. Furthermore, to reduce system redundancies and signaling loads, several functionalities of FMIPv6 and SIP have been integrated to optimize the integrated mobility scheme. The proposed scheme aims at reducing the handover latency and packet loss for an ongoing realtime traffic. Using ns-2 simulation, we analyze the performance of the proposed integrated scheme and compare it with the existing protocols for a VoIP and for a video stream traffic. This mobility architecture achieves lower handover delay and less packet loss than using either FMIPv6 or SIP and hence presents a powerful handover mobility scheme for next generation IP-based wireless systems.

24 CFR 17.9 - Referral to Department of Justice.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to Department of Justice... Procedures § 17.9 Referral to Department of Justice. When Department of Justice approval or consultation is required under § 17.8, the referral or request shall be transmitted to the Department of Justice by the...

CAD for CT colonography: toward a preparation-independent scheme

International Nuclear Information System (INIS)

Naeppi, J.

2007-01-01

Computer-aided detection (CAD) systems can be used to automatically detect and display the locations of polyps and masses in computed tomographic colonography (CTC) data for assisting radiologists' image interpretation. Rapid technical advancements over the last few years have established a fundamental CAD scheme for CTC that includes the steps of colon extraction, polyp detection, and false-positive (FP) reduction. Several CAD prototype systems have demonstrated clinically acceptable high polyp detection sensitivity with relatively few FP detections in cathartic CTC, and observer studies have demonstrated the potential benefit of such systems in improving the accuracy and consistency of radiologists' detection performance. Some CAD prototype systems have also demonstrated promising performance in reduced cathartic and non-cathartic CTC. Recent advancements suggest that CAD systems can soon be expected to provide a preparation-independent scheme that can yield consistently high detection sensitivity with moderately low FP rate not only with cathartic CTC protocols but over a wide range of cathartic, reduced cathartic, and non-cathartic CTC protocols. (orig.)

Eavesdropping on the Bostroem-Filbinger Communication Protocol in Noisy Quantum Channel

OpenAIRE

Cai, Qing-yu

2004-01-01

We show an eavesdropping scheme on Bostr\\UNICODE{0xf6}m-Felbinger communication protocol (called ping-pong protocol) [Phys. Rev. Lett. 89, 187902 (2002)] in an ideal quantum channel. A measurement attack can be perfectly used to eavesdrop Alice's information instead of a most general quantum operation attack. In a noisy quantum channel, the direct communication is forbidden. We present a quantum key distribution protocol based on the ping-pong protocol, which can be used in a low noisy quantu...

Autonomous Power Control MAC Protocol for Mobile Ad Hoc Networks

Directory of Open Access Journals (Sweden)

2006-01-01

Full Text Available Battery energy limitation has become a performance bottleneck for mobile ad hoc networks. IEEE 802.11 has been adopted as the current standard MAC protocol for ad hoc networks. However, it was developed without considering energy efficiency. To solve this problem, many modifications on IEEE 802.11 to incorporate power control have been proposed in the literature. The main idea of these power control schemes is to use a maximum possible power level for transmitting RTS/CTS and the lowest acceptable power for sending DATA/ACK. However, these schemes may degrade network throughput and reduce the overall energy efficiency of the network. This paper proposes autonomous power control MAC protocol (APCMP, which allows mobile nodes dynamically adjusting power level for transmitting DATA/ACK according to the distances between the transmitter and its neighbors. In addition, the power level for transmitting RTS/CTS is also adjustable according to the power level for DATA/ACK packets. In this paper, the performance of APCMP protocol is evaluated by simulation and is compared with that of other protocols.

A Novel Basis Splitting Eavesdropping Scheme in Quantum Cryptography Based on the BB84 Protocol

International Nuclear Information System (INIS)

Zhao Nan; Zhu Chang-Hua; Quan Dong-Xiao

2015-01-01

We propose a novel strategy named basis-splitting scheme to split the intercepted quanta into several portions based on different bases, for eavesdropping in the process of quantum cryptography. Compared with intercept-resend strategy, our simulation results of the basis-splitting scheme under the non-ideal condition show a greater performance, especially with the increase of the length of shifted bits. Consequently our scheme can aid eavesdropper to gather much more useful information. (paper)

10 CFR 1014.7 - Referral to Department of Justice.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Referral to Department of Justice. 1014.7 Section 1014.7... § 1014.7 Referral to Department of Justice. (a) When Department of Justice approval or consultation is required under § 1014.6, the referral or request shall be transmitted to the Department of Justice by the...

Efficient quantum secret sharing scheme with two-particle entangled states

International Nuclear Information System (INIS)

Zhu Zhen-Chao; Fu An-Min; Zhang Yu-Qing

2011-01-01

This paper proposes a protocol for multi-party quantum secret sharing utilizing four non-orthogonal two-particle entangled states following some ideas in the schemes proposed by Liu et al. (2006 Chin. Phys. Lett. 23 3148) and Zhang et al. (2009 Chin. Phys. B 18 2149) respectively. The theoretical efficiency for qubits of the new protocol is improved from 50% to approaching 100%. All the entangled states can be used for generating the private key except those used for the eavesdropping check. The validity of a probable attack called opaque cheat attack to this kind of protocols is considered in the paper for the first time. (general)

Epidemiology of infective endocarditis in a large Belgian non-referral hospital.

Science.gov (United States)

Poesen, K; Pottel, H; Colaert, J; De Niel, C

2014-06-01

Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk). The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included. Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality. The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.

Eavesdropping on the "ping-pong" quantum communication protocol

OpenAIRE

Wojcik, Antoni

2002-01-01

The proposed eavesdropping scheme reveals that the quantum communication protocol recently presented by Bostrom and Felbinger [Phys. Rev. Lett. 89, 187902 (2002)] is not secure as far as quantum channel losses are taken into account.

Dynamic Contention Window Control Scheme in IEEE 802.11e EDCA-Based Wireless LANs

Science.gov (United States)

Abeysekera, B. A. Hirantha Sithira; Matsuda, Takahiro; Takine, Tetsuya

In the IEEE 802.11 MAC protocol, access points (APs) are given the same priority as wireless terminals in terms of acquiring the wireless link, even though they aggregate several downlink flows. This feature leads to a serious throughput degradation of downlink flows, compared with uplink flows. In this paper, we propose a dynamic contention window control scheme for the IEEE 802.11e EDCA-based wireless LANs, in order to achieve fairness between uplink and downlink TCP flows while guaranteeing QoS requirements for real-time traffic. The proposed scheme first determines the minimum contention window size in the best-effort access category at APs, based on the number of TCP flows. It then determines the minimum and maximum contention window sizes in higher priority access categories, such as voice and video, so as to guarantee QoS requirements for these real-time traffic. Note that the proposed scheme does not require any modification to the MAC protocol at wireless terminals. Through simulation experiments, we show the effectiveness of the proposed scheme.

An Overview and Analysis of Mobile Internet Protocols in Cellular Environments.

Science.gov (United States)

Chao, Han-Chieh

2001-01-01

Notes that cellular is the inevitable future architecture for the personal communication service system. Discusses the current cellular support based on Mobile Internet Protocol version 6 (Ipv6) and points out the shortfalls of using Mobile IP. Highlights protocols especially for mobile management schemes which can optimize a high-speed mobile…

RSRP: A Robust Secure Routing Protocol in MANET

Directory of Open Access Journals (Sweden)

Sinha Ditipriya

2014-05-01

Full Text Available In this paper, we propose a novel algorithm RSRP to build a robust secure routing protocol in mobile ad-hoc networks (MANETs. This algorithm is based on some basic schemes such as RSA_CRT for encryption and decryption of messages; CRT for safety key generation, Shamir’s secret sharing principle for generation of secure routes. Those routes which are free from any malicious node and which belong to the set of disjoint routes between a source-destination pair are considered as probable routes. Shamir’s secret sharing principle is applied on those probable routes to obtain secure routes. Finally, most trustworthy and stable route is selected among those secure routes. Selection of the final route depends on some criteria of the nodes present in a route e.g.: battery power, mobility and trust value. In addition, complexity of key generation is reduced to a large extent by using RSA-CRT instead of RSA. In turn, the routing becomes less expensive and most secure and robust one. Performance of this routing protocol is then compared with non-secure routing protocols (AODV and DSR, secure routing scheme using secret sharing, security routing protocol using ZRP and SEAD depending on basic characteristics of these protocols. All such comparisons show that RSRP shows better performance in terms of computational cost, end-to-end delay and packet dropping in presence of malicious nodes in the MANET, keeping the overhead in terms of control packets same as other secure routing protocols.

An energy-efficient transmission scheme for real-time data in wireless sensor networks.

Science.gov (United States)

Kim, Jin-Woo; Barrado, José Ramón Ramos; Jeon, Dong-Keun

2015-05-20

The Internet of things (IoT) is a novel paradigm where all things or objects in daily life can communicate with other devices and provide services over the Internet. Things or objects need identifying, sensing, networking and processing capabilities to make the IoT paradigm a reality. The IEEE 802.15.4 standard is one of the main communication protocols proposed for the IoT. The IEEE 802.15.4 standard provides the guaranteed time slot (GTS) mechanism that supports the quality of service (QoS) for the real-time data transmission. In spite of some QoS features in IEEE 802.15.4 standard, the problem of end-to-end delay still remains. In order to solve this problem, we propose a cooperative medium access scheme (MAC) protocol for real-time data transmission. We also evaluate the performance of the proposed scheme through simulation. The simulation results demonstrate that the proposed scheme can improve the network performance.

Neonatal hearing screening of high-risk infants using automated auditory brainstem response: a retrospective analysis of referral rates.

LENUS (Irish Health Repository)

McGurgan, I J

2013-10-07

The past decade has seen the widespread introduction of universal neonatal hearing screening (UNHS) programmes worldwide. Regrettably, such a programme is only now in the process of nationwide implementation in the Republic of Ireland and has been largely restricted to one screening modality for initial testing; namely transient evoked otoacoustic emissions (TEOAE). The aim of this study is to analyse the effects of employing a different screening protocol which utilises an alternative initial test, automated auditory brainstem response (AABR), on referral rates to specialist audiology services.

Linking project-based mechanisms with domestic greenhouse gas emissions trading schemes

International Nuclear Information System (INIS)

Bygrave, S.; Bosi, M.

2004-01-01

Although there are a number of possible links between emission trading and project-based mechanisms, the focus of this paper is on linking domestic GHG emission trading schemes with: (1) domestic; and, (2) international (JI and CDM) GHG reduction project activities. The objective is to examine some of the challenges in linking DETs and project-based mechanisms, as well as some possible solutions to address these challenges. The link between JI / CDM and intergovernmental international emissions trading (i.e. Article 17 of the Kyoto Protocol) is defined by the Kyoto Protocol, and therefore is not covered in this paper. The paper is written in the context of: (a) countries adhering to the Kyoto Protocol and elaborating their strategies to meet their GHG emission commitments, including through the use of the emissions trading and project-based mechanisms. For example, the European Union (EU) will be commencing a GHG Emissions Trading Scheme in January 2005, and recently, the Council of ministers and the European Parliament agreed on a text for an EU Linking Directive allowing the use of JI and CDM emission units in the EU Emission Trading Scheme (EU-ETS); and (b) all countries (and/or regions within countries) with GHG emission obligations that may choose to use domestic emissions trading and project-based mechanisms to meet their GHG commitments. The paper includes the following elements: (1) an overview of the different flexibility mechanisms (i.e. GHG emissions trading and PBMs), including a brief description and comparisons between the mechanisms (Section 3); (2) an exploration of the issues that emerge when project-based mechanisms link with domestic emissions trading schemes, as well as possible solutions to address some of the challenges raised (Section 4); (3) a case study examining the EU-ETS and the EU Linking Directive on project-based mechanisms, in particular on how the EU is addressing in a practical context relevant linking issues (Section 5); (4) a

Do poison center triage guidelines affect healthcare facility referrals?

Science.gov (United States)

Benson, B E; Smith, C A; McKinney, P E; Litovitz, T L; Tandberg, W D

2001-01-01

The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

Manet key management via Mobile Ficlke Key protocol (MFK ...

African Journals Online (AJOL)

Manet key management via Mobile Ficlke Key protocol (MFK) ... Journal of Fundamental and Applied Sciences. Journal Home · ABOUT THIS JOURNAL ... No Abstract. Keywords: MANET; key management scheme; simulation environment ...

Appropriate diagnostic imaging - Assessment of the quality of referrals from general practice

DEFF Research Database (Denmark)

Andersen, Merethe Kirstine Kousgaard; Torfing, Trine; Ulrichsen, Walther

and MRI regarding musculoskeletal issues. The reviews were conducted according to a preformed registration schema. Themes for the survey were: Relevance of referral, relevance of chosen modality, exhaustiveness of referral information, relevance of information and eventual suggestions for a more relevant......-scanning was the most relevant (87%). Overall, referral information was relevant in 80% of the cases, and most relevant in referrals to x-ray (87%). In 9.5% of referrals the chosen modality was not the optimal, which was most pronounced for ultrasound referrals (13%). Referral information was most insufficient...... regarding MRI, where 56.4% of information was described as less insufficient/insufficient. It was a frequent notation, that there was too much irrelevant information, which was ascribed to copy-paste from the general practitioners’ records. Conclusion A majority of referrals from general practice...

Barriers to palliative radiotherapy referral: A Canadian perspective

International Nuclear Information System (INIS)

Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

2007-01-01

Radiotherapy is an effective but underutilized treatment modality for cancer patients. We decided to investigate the factors influencing radiotherapy referral among family physicians in our region. A 30-item survey was developed to determine palliative radiotherapy knowledge and factors influencing referral. It was sent to 400 physicians in eastern Ontario (Canada) and the completed surveys were evaluated. The overall response rate was 50% with almost all physicians seeing cancer patients recently (97%) and the majority (80%) providing palliative care. Approximately 56% had referred patients for radiotherapy previously and 59% were aware of the regional community oncology program. Factors influencing radiotherapy referral included the following: waiting times for radiotherapy consultation and treatment, uncertainty about the benefits of radiotherapy, patient age, and perceived patient inconvenience. Physicians who referred patients for radiotherapy were more than likely to provide palliative care, work outside of urban centres, have hospital privileges and had sought advice from a radiation oncologist in the past. A variety of factors influence the referral of cancer patients for radiotherapy by family physicians and addressing issues such as long waiting times, lack of palliative radiotherapy knowledge and awareness of Cancer Centre services could increase the rate of appropriate radiotherapy patient referral

Development of a Single Locus Sequence Typing (SLST) Scheme for Typing Bacterial Species Directly from Complex Communities.

Science.gov (United States)

Scholz, Christian F P; Jensen, Anders

2017-01-01

The protocol describes a computational method to develop a Single Locus Sequence Typing (SLST) scheme for typing bacterial species. The resulting scheme can be used to type bacterial isolates as well as bacterial species directly from complex communities using next-generation sequencing technologies.

A virtual network computer's optical storage virtualization scheme

Science.gov (United States)

Wang, Jianzong; Hu, Huaixiang; Wan, Jiguang; Wang, Peng

2008-12-01

In this paper, we present the architecture and implementation of a virtual network computers' (VNC) optical storage virtualization scheme called VOSV. Its task is to manage the mapping of virtual optical storage to physical optical storage, a technique known as optical storage virtualization. The design of VOSV aims at the optical storage resources of different clients and servers that have high read-sharing patterns. VOSV uses several schemes such as a two-level Cache mechanism, a VNC server embedded module and the iSCSI protocols to improve the performance. The results measured on the prototype are encouraging, and indicating that VOSV provides the high I/O performance.

Applications of Multi-Channel Safety Authentication Protocols in Wireless Networks.

Science.gov (United States)

Chen, Young-Long; Liau, Ren-Hau; Chang, Liang-Yu

2016-01-01

People can use their web browser or mobile devices to access web services and applications which are built into these servers. Users have to input their identity and password to login the server. The identity and password may be appropriated by hackers when the network environment is not safe. The multiple secure authentication protocol can improve the security of the network environment. Mobile devices can be used to pass the authentication messages through Wi-Fi or 3G networks to serve as a second communication channel. The content of the message number is not considered in a multiple secure authentication protocol. The more excessive transmission of messages would be easier to collect and decode by hackers. In this paper, we propose two schemes which allow the server to validate the user and reduce the number of messages using the XOR operation. Our schemes can improve the security of the authentication protocol. The experimental results show that our proposed authentication protocols are more secure and effective. In regard to applications of second authentication communication channels for a smart access control system, identity identification and E-wallet, our proposed authentication protocols can ensure the safety of person and property, and achieve more effective security management mechanisms.

Referral for assisted reproductive technology: Indications and ...

African Journals Online (AJOL)

Ramakantb

Over an 8-year period, 23 consenting infertile patients/ couples were given referral for assisted conception. The median age was 36 years and mean duration of infertility was 43 months. Indications for referral as shown in Table 1 were male factor in five (21.7%) patients, female factor in seven (30.4%) patients, and both ...

Introduction of electronic referral from community associated with more timely review by secondary services.

Science.gov (United States)

Warren, J; White, S; Day, K J; Gu, Y; Pollock, M

2011-01-01

Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007. To measure the extent of uptake of eReferral and its association with changes in referral processing. Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders. eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (psystem usability issues. With eReferrals, a referral's status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems. We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.

The effect of the 2-week wait referral system on the detection of and mortality from colorectal cancer: protocol of a systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Ella Mozdiak

2016-10-01

Full Text Available Abstract Background Colorectal cancer represents the fourth most common cancer in England and Wales; survival is high for early stage disease but declines sharply with advanced stage. UK figures suggest that cancer survival rates are lower than those of other Western European countries. Current 5-year survival is around 50 %. A rapid access strategy was introduced through the Department of Health in 2000. This 2-week wait (TWW referral pathway was devised to streamline referral for suspected cancer, allow diagnosis at an earlier stage, reduce cancer survival inequality and reduce cancer-related mortality. However, only around half of patients with colorectal cancer have symptoms that fit the TWW criteria plus there is a fourfold difference in referral rates across England and Wales. High-quality evidence of TWW outcome measures for colorectal cancer is lacking. This systematic review will collate and evaluate the latest evidence on colorectal cancer detection rate, stage at diagnosis and mortality. Methods English-language publications from 2000 reporting outcomes on the TWW referral system for suspected colorectal cancer will be eligible for inclusion. Cochrane, EMBASE, MEDLINE via PubMed, NHS Evidence, Trip and the British Library Catalogue databases will be searched. Two paired reviewers will independently screen all titles/abstracts and full text for eligibility, then extract data and assess for bias using standardised formats. They will hand review reference lists of eligible articles. Disagreement will be resolved via third party adjudication. Summary effect measures for post-referral diagnosis and mortality rates will be calculated and expressed as relative risk, hazard rate ratio or risk difference with corresponding 95 % confidence intervals. Where possible summary effect measures will be pooled, heterogeneity and its extent for pooled estimates will be assessed via visual inspection of forest plots and explored via sub-group analysis

Improved Wojcik's eavesdropping attack on ping-pong protocol without eavesdropping-induced channel loss

International Nuclear Information System (INIS)

Zhang Zhanjun; Li Yong; Man Zhongxiao

2005-01-01

The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme has a zero eavesdropping-induced channel loss and produces perfect anticorrelation. Therefore, the eavesdropper Eve can safely attack all the transmitted bits and the eavesdropping information gain can always exceed the legitimate user's information gain in the whole domain of the quantum channel transmission efficiency η, i.e., [0,100%]. This means that the ping-pong protocol can be completely eavesdropped in its original version. But the improvement of the ping-pong protocol security produced by Wojcik is also suitable for our eavesdropping attack

Compliance with referral of sick children: a survey in five districts of Afghanistan

Directory of Open Access Journals (Sweden)

Newbrander William

2012-04-01

Full Text Available Abstract Background Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers’ compliance with referral of sick children to higher-level health facilities in Afghanistan. Methods The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI, or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. Results The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs, especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies. Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28, most families (63% who went to the referral site walked and hence paid nothing. Most caretakers (75% complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers’ compliance with referral. Conclusions Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.

Compliance with referral of sick children: a survey in five districts of Afghanistan.

Science.gov (United States)

Newbrander, William; Ickx, Paul; Werner, Robert; Mujadidi, Farooq

2012-04-27

Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential. This paper examines referral patterns for sick children, and factors that influence caretakers' compliance with referral of sick children to higher-level health facilities in Afghanistan. The study was conducted in 5 rural districts of 5 Afghan provinces using interviews with parents or caretakers in 492 randomly selected households with a child from 0 to 2 years old who had been sick within the previous 2 weeks with diarrhea, acute respiratory infection (ARI), or fever. Data collectors from local nongovernmental organizations used a questionnaire to assess compliance with a referral recommendation and identify barriers to compliance. The number of referrals, 99 out of 492 cases, was reasonable. We found a high number of referrals by community health workers (CHWs), especially for ARI. Caretakers were more likely to comply with referral recommendations from community members (relative, friend, CHW, traditional healer) than with recommendations from health workers (at public clinics and hospitals or private clinics and pharmacies). Distance and transportation costs did not create barriers for most families of referred sick children. Although the average cost of transportation in a subsample of 75 cases was relatively high (US$11.28), most families (63%) who went to the referral site walked and hence paid nothing. Most caretakers (75%) complied with referral advice. Use of referral slips by health care providers was higher for urgent referrals, and receiving a referral slip significantly increased caretakers' compliance with referral. Use of referral slips is important to increase compliance with referral recommendations in rural Afghanistan.

Consultation and referral between physicians in new medical practice environments.

Science.gov (United States)

Schaffer, W A; Holloman, F C

1985-10-01

The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. Institutional programs now pursue patient referrals as part of a marketing strategy to attract new patients who then become attached to the institution, rather than to a physician. Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.

Innovation in managing the referral process at a Canadian pediatric hospital.

Science.gov (United States)

MacGregor, Daune; Parker, Sandra; MacMillan, Sharon; Blais, Irene; Wong, Eugene; Robertson, Chris J; Bruce-Barrett, Cindy

2009-01-01

The provision of timely and optimal patient care is a priority in pediatric academic health science centres. Timely access to care is optimized when there is an efficient and consistent referral system in place. In order to improve the patient referral process and, therefore, access to care, an innovative web-based system was developed and implemented. The Ambulatory Referral Management System enables the electronic routing for submission, review, triage and management of all outpatient referrals. The implementation of this system has provided significant metrics that have informed how processes can be improved to increase access to care. Use of the system has improved efficiency in the referral process and has reduced the work associated with the previous paper-based referral system. It has also enhanced communication between the healthcare provider and the patient and family and has improved the security and confidentiality of patient information management. Referral guidelines embedded within the system have helped to ensure that referrals are more complete and that the patient being referred meets the criteria for assessment and treatment in an ambulatory setting. The system calculates and reports on wait times, as well as other measures.

An improved authenticated key agreement protocol for telecare medicine information system.

Science.gov (United States)

Liu, Wenhao; Xie, Qi; Wang, Shengbao; Hu, Bin

2016-01-01

In telecare medicine information systems (TMIS), identity authentication of patients plays an important role and has been widely studied in the research field. Generally, it is realized by an authenticated key agreement protocol, and many such protocols were proposed in the literature. Recently, Zhang et al. pointed out that Islam et al.'s protocol suffers from the following security weaknesses: (1) Any legal but malicious patient can reveal other user's identity; (2) An attacker can launch off-line password guessing attack and the impersonation attack if the patient's identity is compromised. Zhang et al. also proposed an improved authenticated key agreement scheme with privacy protection for TMIS. However, in this paper, we point out that Zhang et al.'s scheme cannot resist off-line password guessing attack, and it fails to provide the revocation of lost/stolen smartcard. In order to overcome these weaknesses, we propose an improved protocol, the security and authentication of which can be proven using applied pi calculus based formal verification tool ProVerif.

Green-Frag: Energy-Efficient Frame Fragmentation Scheme for Wireless Sensor Networks

KAUST Repository

Daghistani, Anas H.

2013-01-01

that is optimized to be energy efficient, which is originated from the chosen frame fragmentation scheme. This new energy-efficient frame fragmentation protocol is called (Green-Frag). Green-Frag uses an algorithm that gives sensor nodes the ability to transmit data

HIV+ deceased donor referrals: A national survey of organ procurement organizations.

Science.gov (United States)

Cash, Ayla; Luo, Xun; Chow, Eric K H; Bowring, Mary Grace; Shaffer, Ashton A; Doby, Brianna; Wickliffe, Corey E; Alexander, Charles; McRann, Deborah; Tobian, Aaron A R; Segev, Dorry L; Durand, Christine M

2018-02-01

HIV-infected (HIV+) donor organs can be transplanted into HIV+ recipients under the HIV Organ Policy Equity (HOPE) Act. Quantifying HIV+ donor referrals received by organ procurement organizations (OPOs) is critical for HOPE Act implementation. We surveyed the 58 USA OPOs regarding HIV+ referral records and newly discovered HIV+ donors. Using data from OPOs that provided exact records and CDC HIV prevalence data, we projected a national estimate of HIV+ referrals. Fifty-five (95%) OPOs reported HIV+ referrals ranging from 0 to 276 and newly discovered HIV+ cases ranging from 0 to 10 annually. Six OPOs in areas of high HIV prevalence reported more than 100 HIV+ donor referrals. Twenty-seven (47%) OPOs provided exact HIV+ referral records and 28 (51%) OPOs provided exact records of discovered HIV+ cases, totaling 1450 HIV+ referrals and 39 discovered HIV+ donors in the prior year. These OPOs represented 67% and 59% of prevalent HIV cases in the USA; thus, we estimated 2164 HIV+ referrals and 66 discovered HIV+ cases nationally per year. OPOs reported a high volume of HIV+ referrals annually, of which a subset will be medically eligible for donation. Particularly in areas of high HIV prevalence, OPOs require ongoing support to implement the HOPE Act. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Review Of Referral Patterns For Sagittal Synostosis In Ireland: 2008-2013

LENUS (Irish Health Repository)

Berney, M J

2018-01-01

Sagittal synostosis (SS) is the commonest form of craniosynostosis. Children with sagittal synostosis in Ireland are treated in the National Paediatric Craniofacial Centre (NPCC) in Temple Street Children’s University Hospital. This retrospective study analysed the correlation between referral patterns to the unit and age at operation. The notes of 81 patients referred over a 5 year period (April 2008 – April 2013) to the NPCC with non-syndromic SS were reviewed and demographics and referral information were recorded. Of 81 patients reviewed, 60 (74%) were referred before 6 months of age, while 21 (26%) had late referrals. Neonatologists referred 100% of infants before 6 months, paediatricians referred 71%, and GPs 64%. Later referral was associated with a more complex referral pathway, including multiple-steps of referral and unnecessary investigations. Improved clinician knowledge and emphasis on the importance of early referral may lead to a reduction in late referrals.

Detecting child abuse based on parental characteristics: Does The Hague Protocol cause parents to avoid the Emergency Department?

NARCIS (Netherlands)

Diderich, H.M.; Fekkes, M.; Dechesne, M.; Buitendijk, S.E.; Oudesluys-Murphy, A.M.

2015-01-01

Objectives: The Hague Protocol is used by professionals at the adult Emergency Departments (ED) in The Netherlands to detect child abuse based on three parental characteristics: (1) domestic violence, (2) substance abuse or (3) suicide attempt or self-harm. After detection, a referral is made to the

Channel-aware multi-user uplink transmission scheme for SIMO-OFDM systems

Institute of Scientific and Technical Information of China (English)

PAN ChengKang; CAI YueMing; XU YouYun

2009-01-01

The problem of medium access control (MAC) in wireless single-Input multiple-output-orthogonal frequency division multiplexing (SIMO-OFOM) systems is addressed.Traditional random access protocols have low overheads and inferior performance.Centralized methods have superior performance and high overheads.To achieve the tradeoff between overhead and performance,we propose a channelaware uplink transmission (CaUT) scheme for SIMO-OFDM systems.In CaUT,users transmit requestto-send (RTS) at some subcarriers whose channel gains are above a predetermined threshold.Using the channel state information provided by RTS,access point performs user selection with receive beamforming to decide which users can access and then broadcasts the selection results via clear-to-send (CTS) to users.We present a distributed power control scheme by using a simple fixed modulation mode.We optimize the modulation order and channel gain thresholds to maximize the separable packets subject to the bit-error-rate (BER) and temporal fairness requirements and the Individual average transmit power constraints.The performance of CaUT scheme is analyzed analytically and evaluated by simulations.Simulation results show that CaUT can achieve more significant throughput performance than traditional random access protocols.

An Effective Collaborative Mobile Weighted Clustering Schemes for Energy Balancing in Wireless Sensor Networks.

Science.gov (United States)

Tang, Chengpei; Shokla, Sanesy Kumcr; Modhawar, George; Wang, Qiang

2016-02-19

Collaborative strategies for mobile sensor nodes ensure the efficiency and the robustness of data processing, while limiting the required communication bandwidth. In order to solve the problem of pipeline inspection and oil leakage monitoring, a collaborative weighted mobile sensing scheme is proposed. By adopting a weighted mobile sensing scheme, the adaptive collaborative clustering protocol can realize an even distribution of energy load among the mobile sensor nodes in each round, and make the best use of battery energy. A detailed theoretical analysis and experimental results revealed that the proposed protocol is an energy efficient collaborative strategy such that the sensor nodes can communicate with a fusion center and produce high power gain.

Implicit Block ACK Scheme for IEEE 802.11 WLANs

Science.gov (United States)

Sthapit, Pranesh; Pyun, Jae-Young

2016-01-01

The throughput of IEEE 802.11 standard is significantly bounded by the associated Medium Access Control (MAC) overhead. Because of the overhead, an upper limit exists for throughput, which is bounded, including situations where data rates are extremely high. Therefore, an overhead reduction is necessary to achieve higher throughput. The IEEE 802.11e amendment introduced the block ACK mechanism, to reduce the number of control messages in MAC. Although the block ACK scheme greatly reduces overhead, further improvements are possible. In this letter, we propose an implicit block ACK method that further reduces the overhead associated with IEEE 802.11e’s block ACK scheme. The mathematical analysis results are presented for both the original protocol and the proposed scheme. A performance improvement of greater than 10% was achieved with the proposed implementation.

The Political Economy of International Emission Trading Scheme Choice: Empirical Evidence

DEFF Research Database (Denmark)

Boom, J.T.; Svendsen, Gert Tinggaard

2000-01-01

The Kyoto Protocol allows emissions trading. It does however not specify how this is to take place and the discussion on the design of an emissions trading scheme is ongoing. In this paper, we give some empirical evidence on the preference of industry and environmental organizations for internati...... for international emissions trading scheme. Since they may have an influence on decision makers, their opinion is important. Our conclusion is that both industry and environmental organizations prefer credit trading, although for widely different reasons....

The QKD network: model and routing scheme

Science.gov (United States)

Yang, Chao; Zhang, Hongqi; Su, Jinhai

2017-11-01

Quantum key distribution (QKD) technology can establish unconditional secure keys between two communicating parties. Although this technology has some inherent constraints, such as the distance and point-to-point mode limits, building a QKD network with multiple point-to-point QKD devices can overcome these constraints. Considering the development level of current technology, the trust relaying QKD network is the first choice to build a practical QKD network. However, the previous research didn't address a routing method on the trust relaying QKD network in detail. This paper focuses on the routing issues, builds a model of the trust relaying QKD network for easily analysing and understanding this network, and proposes a dynamical routing scheme for this network. From the viewpoint of designing a dynamical routing scheme in classical network, the proposed scheme consists of three components: a Hello protocol helping share the network topology information, a routing algorithm to select a set of suitable paths and establish the routing table and a link state update mechanism helping keep the routing table newly. Experiments and evaluation demonstrates the validity and effectiveness of the proposed routing scheme.

6 CFR 11.13 - Referrals to the Department of Justice.

Science.gov (United States)

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Referrals to the Department of Justice. 11.13 Section 11.13 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.13 Referrals to the Department of Justice. Referrals of debts to the Department of Justice for collection will...

Butterfly Encryption Scheme for Resource-Constrained Wireless Networks

Directory of Open Access Journals (Sweden)

Raghav V. Sampangi

2015-09-01

Full Text Available Resource-constrained wireless networks are emerging networks such as Radio Frequency Identification (RFID and Wireless Body Area Networks (WBAN that might have restrictions on the available resources and the computations that can be performed. These emerging technologies are increasing in popularity, particularly in defence, anti-counterfeiting, logistics and medical applications, and in consumer applications with growing popularity of the Internet of Things. With communication over wireless channels, it is essential to focus attention on securing data. In this paper, we present an encryption scheme called Butterfly encryption scheme. We first discuss a seed update mechanism for pseudorandom number generators (PRNG, and employ this technique to generate keys and authentication parameters for resource-constrained wireless networks. Our scheme is lightweight, as in it requires less resource when implemented and offers high security through increased unpredictability, owing to continuously changing parameters. Our work focuses on accomplishing high security through simplicity and reuse. We evaluate our encryption scheme using simulation, key similarity assessment, key sequence randomness assessment, protocol analysis and security analysis.

Butterfly Encryption Scheme for Resource-Constrained Wireless Networks.

Science.gov (United States)

Sampangi, Raghav V; Sampalli, Srinivas

2015-09-15

Resource-constrained wireless networks are emerging networks such as Radio Frequency Identification (RFID) and Wireless Body Area Networks (WBAN) that might have restrictions on the available resources and the computations that can be performed. These emerging technologies are increasing in popularity, particularly in defence, anti-counterfeiting, logistics and medical applications, and in consumer applications with growing popularity of the Internet of Things. With communication over wireless channels, it is essential to focus attention on securing data. In this paper, we present an encryption scheme called Butterfly encryption scheme. We first discuss a seed update mechanism for pseudorandom number generators (PRNG), and employ this technique to generate keys and authentication parameters for resource-constrained wireless networks. Our scheme is lightweight, as in it requires less resource when implemented and offers high security through increased unpredictability, owing to continuously changing parameters. Our work focuses on accomplishing high security through simplicity and reuse. We evaluate our encryption scheme using simulation, key similarity assessment, key sequence randomness assessment, protocol analysis and security analysis.

Identification and Referral of Patients at Risk for Post-traumatic Stress Disorder: A Literature Review and Retrospective Analysis.

Science.gov (United States)

Bolduc, Aaron; Hwang, Brice; Hogan, Christopher; Bhalla, Varun K; Nesmith, Elizabeth; Medeiros, Regina; Alexander, Cassie; Holsten, Steven B

2015-09-01

Post-traumatic stress disorder (PTSD) is a well-established psychological disorder after severe traumatic injury but remains poorly recognized. Recent changes in the "Resources for Optimal Care of the Injured Trauma Patient 2014" stress the need for comprehensive screening and referral for PTSD and depression after injury. Our purpose was to review the current PTSD literature and perform a retrospective chart review to evaluate screening at our institution. We hypothesized a lack of documentation and thus referral of these patients to mental health professionals. We performed a literature review of 43 publications of risk factors for PTSD in the civilian adult population followed by a retrospective review. Records were analyzed for basic demographics, risk factors found in the literature, and referrals to mental health providers. Risk factors included amputation, dissociative symptoms, female gender, history of mental health disorder, and peri-traumatic emotionality. Traumatic amputation status and gender were recorded in all patients. History of mental health disorder was present in 11.5 per cent patients, absent in 80.75 per cent, and not recorded in 7.75 per cent with an overall documentation of 91.75 per cent. Dissociative symptoms and peri-traumatic emotionality were recorded in 0.5 per cent and 1.0 per cent of patients, respectively. Only 13 patients of 400 (3.25%) were referred to mental health professionals. Despite extensive evidence and literature supporting risk factors for the development of PTSD, identification and treatment at our level 1 trauma center is lacking. There is a need for consistent screening among trauma centers to identify PTSD risk factors and protocols for risk reduction and referrals for patients at risk.

22 CFR 304.9 - Referral to the Department of Justice.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Referral to the Department of Justice. 304.9... Procedures § 304.9 Referral to the Department of Justice. When Department of Justice approval or consultation is required under § 304.8, the referral or request shall be transmitted to the Department of Justice...

10 CFR 15.67 - Referral to the Department of Justice.

Science.gov (United States)

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Referral to the Department of Justice. 15.67 Section 15.67 Energy NUCLEAR REGULATORY COMMISSION DEBT COLLECTION PROCEDURES Referral of a Claim § 15.67 Referral to the Department of Justice. (a) Unless excepted by DOJ, the NRC shall complete the CCLR accompanied by...

HIV Viral Load Trends in Six Eastern Caribbean Countries Utilizing a Regional Laboratory Referral Service: Implications for Treatment as Prevention.

Science.gov (United States)

Landis, R Clive; Carmichael-Simmons, Kelly; Hambleton, Ian R; Best, Anton

2015-01-01

Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS), Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL) offered by The Ladymeade Reference Unit (LRU) Laboratory, Barbados. The objective of this study was to evaluate 5 year VL trends in the six larger OECS countries participating in this regional referral service. Blood samples were collected in source countries and transported to Barbados as frozen plasma according to a standardized protocol. Plasma specimens were amplified by RT PCR on a Roche TaqMan 48 analyser (Roche Diagnostics, Panama City, Panama). VL was considered optimally suppressed below a threshold level of < 200 HIV-1 copies/mL of blood. The same threshold was used as a binary indicator in an analysis of the secular change in VL suppression. Montserrat was excluded due to insufficient number of samples. A steady rise in VL referrals from OECS countries was recorded, rising from 312 samples in 2009 to 1,060 samples in 2013. A total of 3,543 samples were tested, with a sample rejection rate (9.2%) mostly due to breaks in the cold chain. Aggregate VL data showed the odds of VL suppression in the Eastern Caribbean improved by 66% for each additional year after 2009 (Odds Ratio 1.66 [95% CI 1.46 to 1.88]; p<0.001). We demonstrate the feasibility of establishing a regional laboratory referral service for HIV VL monitoring in the Eastern Caribbean. Aggregate VL trends showed a significant year-on-year improvement in VL suppression, implying public health benefits through treatment as prevention in the OECS. VL provides a powerful monitoring & evaluation tool for strengthening HIV programs at country level among the small island states participating in this regional referral network.

HIV Viral Load Trends in Six Eastern Caribbean Countries Utilizing a Regional Laboratory Referral Service: Implications for Treatment as Prevention.

Directory of Open Access Journals (Sweden)

R Clive Landis

Full Text Available Since 2009, seven countries in the Organization of Eastern Caribbean States (OECS, Antigua & Barbuda, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia, and St. Vincent & the Grenadines, have been utilizing a laboratory referral service for HIV-1 viral load (VL offered by The Ladymeade Reference Unit (LRU Laboratory, Barbados. The objective of this study was to evaluate 5 year VL trends in the six larger OECS countries participating in this regional referral service.Blood samples were collected in source countries and transported to Barbados as frozen plasma according to a standardized protocol. Plasma specimens were amplified by RT PCR on a Roche TaqMan 48 analyser (Roche Diagnostics, Panama City, Panama. VL was considered optimally suppressed below a threshold level of < 200 HIV-1 copies/mL of blood. The same threshold was used as a binary indicator in an analysis of the secular change in VL suppression. Montserrat was excluded due to insufficient number of samples.A steady rise in VL referrals from OECS countries was recorded, rising from 312 samples in 2009 to 1,060 samples in 2013. A total of 3,543 samples were tested, with a sample rejection rate (9.2% mostly due to breaks in the cold chain. Aggregate VL data showed the odds of VL suppression in the Eastern Caribbean improved by 66% for each additional year after 2009 (Odds Ratio 1.66 [95% CI 1.46 to 1.88]; p<0.001.We demonstrate the feasibility of establishing a regional laboratory referral service for HIV VL monitoring in the Eastern Caribbean. Aggregate VL trends showed a significant year-on-year improvement in VL suppression, implying public health benefits through treatment as prevention in the OECS. VL provides a powerful monitoring & evaluation tool for strengthening HIV programs at country level among the small island states participating in this regional referral network.

8 CFR 1235.6 - Referral to immigration judge.

Science.gov (United States)

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Referral to immigration judge. 1235.6 Section 1235.6 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS INSPECTION OF PERSONS APPLYING FOR ADMISSION § 1235.6 Referral to immigration judge...

Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

Energy Technology Data Exchange (ETDEWEB)

Vandervelde, C. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom)], E-mail: clivevandervelde@gmail.com; Connor, S E.J. [Department of Radiology, Guy' s and St Thomas' NHS Foundation Trust (United Kingdom); Department of Neuroradiology, King' s College Hospital NHS Foundation Trust, London (United Kingdom)

2009-02-15

Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome.

Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management

International Nuclear Information System (INIS)

Vandervelde, C.; Connor, S.E.J.

2009-01-01

Aim: To investigate the diagnostic yield of T2-weighted magnetic resonance imaging (MRI) screening for vestibular schwannoma and other relevant conditions in the setting of audiovestibular symptoms, given the more liberal contemporary referral criteria. To determine whether presenting clinical symptoms correlate with imaging outcome in order to guide future protocols for MRI referral. Materials and methods: Eight hundred and eighty-one consecutive MRI examinations performed in patients with audiovestibular dysfunction were reviewed. Clinical indications and findings were recorded. Case notes were reviewed in patients with positive imaging findings. Two-way, cross-tabulation, Chi-square analysis was performed to assess the relationship between presenting symptoms and imaging outcome. Results: Twelve of the 881 (1.4%) were positive for vestibular schwannoma. A further four of 881 (0.4%) revealed other relevant conditions. Incidental conditions, felt to be irrelevant to the presenting symptoms, were noted in 12 of the 881 (1.4%). In all 12 cases that were positive for vestibular schwannoma, either tinnitus or hearing loss was present. Conclusion: The yield for T2-weighted MRI to diagnose vestibular schwannoma and other relevant retrocochlear conditions was lower than for previous studies, which is likely to reflect trends in referral criteria. No single audiovestibular symptom or combination of symptoms is a statistically significant predictor of imaging outcome

Practices and attitudes of doctors and patients to downward referral in Shanghai, China.

Science.gov (United States)

Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu

2017-04-03

In China, the rate of downward referral is relatively low, as most people are unwilling to be referred from hospitals to community health systems (CHSs). The aim of this study was to explore the effect of doctors' and patients' practices and attitudes on their willingness for downward referral and the relationship between downward referral and sociodemographic characteristics. Doctors and patients of 13 tertiary hospitals in Shanghai were stratified through random sampling. The questionnaire surveyed their sociodemographic characteristics, attitudes towards CHSs and hospitals, understanding of downward referral, recognition of the community first treatment system, and downward referral practices and willingness. Descriptive statistics, χ 2 test and stepwise logistic regression analysis were employed for statistical analysis. Only 20.8% (161/773) of doctors were willing to accept downward referrals, although this proportion was higher among patients (37.6%, 326/866). Doctors' willingness was influenced by education, understanding of downward referral, and perception of health resources in hospitals. Patients' willingness was influenced by marital status, economic factors and recognition of the community first treatment system. Well-educated doctors who do not consider downward referral would increase their workloads and those with a more comprehensive understanding of hospitals and downward referral process were more likely to make a downward referral decision. Single-injury patients fully recognising the community first treatment system were more willing to accept downward referral. Patients' willingness was significantly increased if downward referral was cost-saving. A better medical insurance system was another key factor for patients to accept downward referral decisions, especially for the floating population. To increase the rate of downward referral, the Chinese government should optimise the current referral system and conduct universal publicity for

An Improved and Secure Anonymous Biometric-Based User Authentication with Key Agreement Scheme for the Integrated EPR Information System.

Science.gov (United States)

Jung, Jaewook; Kang, Dongwoo; Lee, Donghoon; Won, Dongho

2017-01-01

Nowadays, many hospitals and medical institutes employ an authentication protocol within electronic patient records (EPR) services in order to provide protected electronic transactions in e-medicine systems. In order to establish efficient and robust health care services, numerous studies have been carried out on authentication protocols. Recently, Li et al. proposed a user authenticated key agreement scheme according to EPR information systems, arguing that their scheme is able to resist various types of attacks and preserve diverse security properties. However, this scheme possesses critical vulnerabilities. First, the scheme cannot prevent off-line password guessing attacks and server spoofing attack, and cannot preserve user identity. Second, there is no password verification process with the failure to identify the correct password at the beginning of the login phase. Third, the mechanism of password change is incompetent, in that it induces inefficient communication in communicating with the server to change a user password. Therefore, we suggest an upgraded version of the user authenticated key agreement scheme that provides enhanced security. Our security and performance analysis shows that compared to other related schemes, our scheme not only improves the security level, but also ensures efficiency.

An Improved and Secure Anonymous Biometric-Based User Authentication with Key Agreement Scheme for the Integrated EPR Information System.

Directory of Open Access Journals (Sweden)

Jaewook Jung

Full Text Available Nowadays, many hospitals and medical institutes employ an authentication protocol within electronic patient records (EPR services in order to provide protected electronic transactions in e-medicine systems. In order to establish efficient and robust health care services, numerous studies have been carried out on authentication protocols. Recently, Li et al. proposed a user authenticated key agreement scheme according to EPR information systems, arguing that their scheme is able to resist various types of attacks and preserve diverse security properties. However, this scheme possesses critical vulnerabilities. First, the scheme cannot prevent off-line password guessing attacks and server spoofing attack, and cannot preserve user identity. Second, there is no password verification process with the failure to identify the correct password at the beginning of the login phase. Third, the mechanism of password change is incompetent, in that it induces inefficient communication in communicating with the server to change a user password. Therefore, we suggest an upgraded version of the user authenticated key agreement scheme that provides enhanced security. Our security and performance analysis shows that compared to other related schemes, our scheme not only improves the security level, but also ensures efficiency.

An Improved and Secure Anonymous Biometric-Based User Authentication with Key Agreement Scheme for the Integrated EPR Information System

Science.gov (United States)

Kang, Dongwoo; Lee, Donghoon; Won, Dongho

2017-01-01

Nowadays, many hospitals and medical institutes employ an authentication protocol within electronic patient records (EPR) services in order to provide protected electronic transactions in e-medicine systems. In order to establish efficient and robust health care services, numerous studies have been carried out on authentication protocols. Recently, Li et al. proposed a user authenticated key agreement scheme according to EPR information systems, arguing that their scheme is able to resist various types of attacks and preserve diverse security properties. However, this scheme possesses critical vulnerabilities. First, the scheme cannot prevent off-line password guessing attacks and server spoofing attack, and cannot preserve user identity. Second, there is no password verification process with the failure to identify the correct password at the beginning of the login phase. Third, the mechanism of password change is incompetent, in that it induces inefficient communication in communicating with the server to change a user password. Therefore, we suggest an upgraded version of the user authenticated key agreement scheme that provides enhanced security. Our security and performance analysis shows that compared to other related schemes, our scheme not only improves the security level, but also ensures efficiency. PMID:28046075

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review.

Science.gov (United States)

Naseriasl, Mansour; Adham, Davoud; Janati, Ali

2015-06-01

around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.

Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda.

Science.gov (United States)

Nanyonjo, Agnes; Bagorogoza, Benson; Kasteng, Frida; Ayebale, Godfrey; Makumbi, Fredrick; Tomson, Göran; Källander, Karin

2015-08-28

Integrated community case management (iCCM) relies on community health workers (CHWs) managing children with malaria, pneumonia, diarrhoea, and referring children when management is not possible. This study sought to establish the cost per sick child referred to seek care from a higher-level health facility by a CHW and to estimate caregivers' willingness to pay (WTP) for referral. Caregivers of 203 randomly selected children referred to higher-level health facilities by CHWs were interviewed in four Midwestern Uganda districts. Questionnaires and document reviews were used to capture direct, indirect and opportunity costs incurred by caregivers, CHWs and health facilities managing referred children. WTP for referral was assessed through the 'bidding game' approach followed by an open-ended question on maximum WTP. Descriptive analysis was conducted for factors associated with referral completion and WTP using logistic and linear regression methods, respectively. The cost per case referred to higher-level health facilities was computed from a societal perspective. Reasons for referral included having fever with a negative malaria test (46.8%), danger signs (29.6%) and drug shortage (37.4%). Among the referred, less than half completed referral (45.8%). Referral completion was 2.8 times higher among children with danger signs (p = 0.004) relative to those without danger signs, and 0.27 times lower among children who received pre-referral treatment (p average cost per case referred was US$ 4.89 and US$7.35 per case completing referral. For each unit cost per case referred, caregiver out of pocket expenditure contributed 33.7%, caregivers' and CHWs' opportunity costs contributed 29.2% and 5.1% respectively and health facility costs contributed 39.6%. The mean (SD) out of pocket expenditure was US$1.65 (3.25). The mean WTP for referral was US$8.25 (14.70) and was positively associated with having received pre-referral treatment, completing referral and increasing

A Sleep-Awake Scheme Based on CoAP for Energy-Efficiency in Internet of Things

Directory of Open Access Journals (Sweden)

Wenquan Jin

2017-11-01

Full Text Available Internet Engineering Task Force (IETF have developed Constrained Application Protocol (CoAP to enable communication between sensor or actuator nodes in constrained environments, such as small amount of memory, and low power. IETF CoAP and HTTP are used to monitor or control environments in Internet of Things (IoT and Machine-to-Machine (M2M. In this paper, we present a sleep-awake scheme based on CoAP for energy efficiency in Internet of Things. This scheme supports to increase energy efficiency of IoT nodes using CoAP protocol. We have slightly modified the IoT middleware to improve CoAP protocol to conserve energy in the IoT nodes. Also, the IoT middleware includes some functionality of the CoRE Resource Directory (RD and the Message Queue (MQ broker with IoT nodes to synchronize sleepy status.

Data exchange technology based on handshake protocol for industrial automation system

Science.gov (United States)

Astafiev, A. V.; Shardin, T. O.

2018-05-01

In the article, questions of data exchange technology based on the handshake protocol for industrial automation system are considered. The methods of organizing the technology in client-server applications are analyzed. In the process of work, the main threats of client-server applications that arise during the information interaction of users are indicated. Also, a comparative analysis of analogue systems was carried out, as a result of which the most suitable option was chosen for further use. The basic schemes for the operation of the handshake protocol are shown, as well as the general scheme of the implemented application, which describes the entire process of interaction between the client and the server.

45 CFR 1619.3 - Referral to the Corporation.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Referral to the Corporation. 1619.3 Section 1619.3 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION DISCLOSURE OF INFORMATION § 1619.3 Referral to the Corporation. If a person requests information, not required...

Distributed protocols for digital signatures and public key encryption.

OpenAIRE

Kuchta, Veronika

2016-01-01

Distributed protocols allow a cryptographic scheme to distribute its operation among a group of participants (servers). This new concept of cryptosystems was introduced by Desmedt [56]. We consider two different flavours of distributed protocols. One of them considers a distributed model with n parties where all of these parties are honest. The other allows up to t − 1 parties to be faulty. Such cryptosystems are called threshold cryptosystems. The distribution of cryptographic process is ...

A Weak Value Based QKD Protocol Robust Against Detector Attacks

Science.gov (United States)

Troupe, James

2015-03-01

We propose a variation of the BB84 quantum key distribution protocol that utilizes the properties of weak values to insure the validity of the quantum bit error rate estimates used to detect an eavesdropper. The protocol is shown theoretically to be secure against recently demonstrated attacks utilizing detector blinding and control and should also be robust against all detector based hacking. Importantly, the new protocol promises to achieve this additional security without negatively impacting the secure key generation rate as compared to that originally promised by the standard BB84 scheme. Implementation of the weak measurements needed by the protocol should be very feasible using standard quantum optical techniques.

determinants of referral practices of clients by traditional birth

African Journals Online (AJOL)

GBENGY

referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010 ... proportion of pregnant women are attended at childbirth ... tility; management of threatened abortion; ... refuse referral and whatever is the outcome.

PHACK: An Efficient Scheme for Selective Forwarding Attack Detection in WSNs

Directory of Open Access Journals (Sweden)

Anfeng Liu

2015-12-01

Full Text Available In this paper, a Per-Hop Acknowledgement (PHACK-based scheme is proposed for each packet transmission to detect selective forwarding attacks. In our scheme, the sink and each node along the forwarding path generate an acknowledgement (ACK message for each received packet to confirm the normal packet transmission. The scheme, in which each ACK is returned to the source node along a different routing path, can significantly increase the resilience against attacks because it prevents an attacker from compromising nodes in the return routing path, which can otherwise interrupt the return of nodes’ ACK packets. For this case, the PHACK scheme also has better potential to detect abnormal packet loss and identify suspect nodes as well as better resilience against attacks. Another pivotal issue is the network lifetime of the PHACK scheme, as it generates more acknowledgements than previous ACK-based schemes. We demonstrate that the network lifetime of the PHACK scheme is not lower than that of other ACK-based schemes because the scheme just increases the energy consumption in non-hotspot areas and does not increase the energy consumption in hotspot areas. Moreover, the PHACK scheme greatly simplifies the protocol and is easy to implement. Both theoretical and simulation results are given to demonstrate the effectiveness of the proposed scheme in terms of high detection probability and the ability to identify suspect nodes.

Structured printed referral letter (form letter; saves time and improves communication

Directory of Open Access Journals (Sweden)

R.P.J.C. Ramanayake

2013-01-01

Full Text Available Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. Patients are referred to specialists when investigation or therapeutic options are exhausted in primary care or when opinion or advice is needed from them. Referral has considerable implications for patients, health care system and health care costs. Good communication between primary and secondary care is essential for the smooth running of any health care system. Referral and reply letters are the sole means of communication between doctors most of the time and breakdown in communication could lead to poor continuity of care, delayed diagnoses, polypharmacy, increased litigation risk and unnecessary testing. A referral letter also helps to avoid patient dissatisfaction and loss of confidence in family physician. Studies of referral letters have reported that specialists are dissatisfied with their quality and content. Inclusion of letter writing skills in the medical curriculum, peer assessment and feedback have shown to improve the quality of referral letters. . Form letters have shown to enhance information content and communication in referral process. In Sri Lanka referral letters are usually hand written and frequent complaints are that these letters do not contain adequate information and retrieval of information is a problem due to poor legibility and clarity. Sometimes Primary care doctors refer patients to hospitals and specialists with only verbal instructions. To address these short comings this form letter was introduced. Based on the guidelines and systematic review of published articles, items of information to be included were decided. Printed forms of the letter are kept in the practice and the doctor has to just fill up relevant information under each heading. The objectives of introducing this structured referral letter was to improve the quality and standard of referral letters and save time for both general

Referral of children seeking care at private health facilities in Uganda.

Science.gov (United States)

Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

2017-02-14

In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.

A Dynamic Reallocation Based Window Access Scheme for Enhancing QoS of Vehicular Ad-hoc Networks (VANETs

Directory of Open Access Journals (Sweden)

Md. Amirul Islam

2018-01-01

Full Text Available This article proposes a new MAC scheme for Vehicle-to-Infrastructure (V2I communications that dynamically reallocates unused TDMA slots. By maintaining a balanced waiting time, the proposed TDMA based scheduling scheme allocates TDMA slots in a rational way to minimize merging and one-hop neighboring collision. The proposed scheme ensures dynamic reallocation of unused slots by using “time slot reassignment” mechanism. The scheme has been simulated in VEINS framework of OMNET++ network simulator and its performance has been compared with other conventional protocols. Experimental results show that our scheme performs better than existing schemes in terms of successfully transmitted data packets.

An Authenticated Key Agreement Scheme Based on Cyclic Automorphism Subgroups of Random Orders

Directory of Open Access Journals (Sweden)

Yang Jun

2017-01-01

Full Text Available Group-based cryptography is viewed as a modern cryptographic candidate solution to blocking quantum computer attacks, and key exchange protocols on the Internet are one of the primitives to ensure the security of communication. In 2016 Habeeb et al proposed a “textbook” key exchange protocol based on the semidirect product of two groups, which is insecure for use in real-world applications. In this paper, after discarding the unnecessary disguising notion of semidirect product in the protocol, we establish a simplified yet enhanced authenticated key agreement scheme based on cyclic automorphism subgroups of random orders by making hybrid use of certificates and symmetric-key encryption as challenge-and-responses in the public-key setting. Its passive security is formally analyzed, which is relative to the cryptographic hardness assumption of a computational number-theoretic problem. Cryptanalysis of this scheme shows that it is secure against the intruder-in-the-middle attack even in the worst case of compromising the signatures, and provides explicit key confirmation to both parties.

Green-Frag: Energy-Efficient Frame Fragmentation Scheme for Wireless Sensor Networks

KAUST Repository

Daghistani, Anas H.

2013-05-15

Power management is an active area of research in wireless sensor networks (WSNs). Efficient power management is necessary because WSNs are battery-operated devices that can be deployed in mission-critical applications. From the communications perspective, one main approach to reduce energy is to maximize throughput so the data can be transmitted in a short amount of time. Frame fragmentation techniques aim to achieve higher throughput by reducing retransmissions. Using experiments on a WSN testbed, we show that frame fragmentation helps to reduce energy consumption. We then study and compare recent frame fragmentation schemes to find the most energy-efficient scheme. Our main contribution is to propose a new frame fragmentation scheme that is optimized to be energy efficient, which is originated from the chosen frame fragmentation scheme. This new energy-efficient frame fragmentation protocol is called (Green-Frag). Green-Frag uses an algorithm that gives sensor nodes the ability to transmit data with optimal transmit power and optimal frame structure based on environmental conditions. Green-Frag takes into consideration the channel conditions, interference patterns and level, as well as the distance between sender and receiver. The thesis discusses various design and implementation considerations for Green-Frag. Also, it shows empirical results of comparing Green-Frag with other frame fragmentation protocols in terms of energy efficiency. Green-Frag performance results shows that it is capable of choosing the best transmit according to the channel conditions. Subsequently, Green-Frag achieves the least energy consumption in all environmental conditions.

Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.

Science.gov (United States)

Armañanzas, Laura; Arroyo, Antonio; Ruiz-Tovar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

2015-01-01

Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH.

Science.gov (United States)

Oh, Sukho; Hwang, DongYeop; Kim, Ki-Hyung; Kim, Kangseok

2018-04-16

Time Slotted Channel Hopping (TSCH) is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

Energy-Efficient Cluster Based Routing Protocol in Mobile Ad Hoc Networks Using Network Coding

Directory of Open Access Journals (Sweden)

Srinivas Kanakala

2014-01-01

Full Text Available In mobile ad hoc networks, all nodes are energy constrained. In such situations, it is important to reduce energy consumption. In this paper, we consider the issues of energy efficient communication in MANETs using network coding. Network coding is an effective method to improve the performance of wireless networks. COPE protocol implements network coding concept to reduce number of transmissions by mixing the packets at intermediate nodes. We incorporate COPE into cluster based routing protocol to further reduce the energy consumption. The proposed energy-efficient coding-aware cluster based routing protocol (ECCRP scheme applies network coding at cluster heads to reduce number of transmissions. We also modify the queue management procedure of COPE protocol to further improve coding opportunities. We also use an energy efficient scheme while selecting the cluster head. It helps to increase the life time of the network. We evaluate the performance of proposed energy efficient cluster based protocol using simulation. Simulation results show that the proposed ECCRP algorithm reduces energy consumption and increases life time of the network.

Sleep/wake scheduling scheme for minimizing end-to-end delay in multi-hop wireless sensor networks

Directory of Open Access Journals (Sweden)

Madani Sajjad

2011-01-01

Full Text Available Abstract We present a sleep/wake schedule protocol for minimizing end-to-end delay for event driven multi-hop wireless sensor networks. In contrast to generic sleep/wake scheduling schemes, our proposed algorithm performs scheduling that is dependent on traffic loads. Nodes adapt their sleep/wake schedule based on traffic loads in response to three important factors, (a the distance of the node from the sink node, (b the importance of the node's location from connectivity's perspective, and (c if the node is in the proximity where an event occurs. Using these heuristics, the proposed scheme reduces end-to-end delay and maximizes the throughput by minimizing the congestion at nodes having heavy traffic load. Simulations are carried out to evaluate the performance of the proposed protocol, by comparing its performance with S-MAC and Anycast protocols. Simulation results demonstrate that the proposed protocol has significantly reduced the end-to-end delay, as well as has improved the other QoS parameters, like average energy per packet, average delay, packet loss ratio, throughput, and coverage lifetime.

Audit of Referrals to an Ophthalmic Outpatient Clinic of a Tertiary ...

African Journals Online (AJOL)

Objectives: To determine the referral pattern and assess the quality and accuracy of referral letters to the ophthalmic outpatient clinic of University of Nigeria Teaching Hospital, Enugu. Methods: This study is a prospective cross-sectional survey of all new ophthalmic referrals to the ophthalmic outpatient clinic at University of ...

Cost-Effectiveness of HIV Testing Referral Strategies among Tuberculosis Patients in India

Science.gov (United States)

Uhler, Lauren M.; Kumarasamy, Nagalingeswaran; Mayer, Kenneth H.; Saxena, Anjali; Losina, Elena; Muniyandi, Malaisamy; Stoler, Adam W.; Lu, Zhigang; Walensky, Rochelle P.; Flanigan, Timothy P.; Bender, Melissa A.; Freedberg, Kenneth A.; Swaminathan, Soumya

2010-01-01

Background Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and cost-effectiveness of alternative HIV testing referral strategies among TB patients in India. Methods and Findings We utilized a computer model of HIV and TB disease to project outcomes for patients with active TB in India. We compared life expectancy, cost, and cost-effectiveness for three HIV testing referral strategies: 1) selective referral for HIV testing of those with increased HIV risk, 2) routine referral of patients in the nine highest HIV prevalence states with selective referral elsewhere (current standard), and 3) routine referral of all patients for HIV testing. TB-related data were from the World Health Organization. HIV prevalence among TB patients was 9.0% in the highest prevalence states, 2.9% in the other states, and 4.9% overall. The selective referral strategy, beginning from age 33.50 years, had a projected discounted life expectancy of 16.88 years and a mean lifetime HIV/TB treatment cost of US$100. The current standard increased mean life expectancy to 16.90 years with additional per-person cost of US$10; the incremental cost-effectiveness ratio was US$650/year of life saved (YLS) compared to selective referral. Routine referral of all patients for HIV testing increased life expectancy to 16.91 years, with an incremental cost-effectiveness ratio of US$730/YLS compared to the current standard. For HIV-infected patients cured of TB, receiving antiretroviral therapy increased survival from 4.71 to 13.87 years. Results were most sensitive to the HIV prevalence and the cost of second-line antiretroviral therapy. Conclusions Referral of all patients with active TB in India for HIV testing will be both effective and cost-effective. While effective implementation of this strategy would require investment, routine

Energy-efficient cooperative protocols for full-duplex relay channels

KAUST Repository

Khafagy, Mohammad Galal

2013-12-01

In this work, energy-efficient cooperative protocols are studied for full-duplex relaying (FDR) with loopback interference. In these protocols, relay assistance is only sought under certain conditions on the different link outages to ensure effective cooperation. Recently, an energy-efficient selective decode-And-forward protocol was proposed for FDR, and was shown to outperform existing schemes in terms of outage. Here, we propose an incremental selective decode-And-forward protocol that offers additional power savings, while keeping the same outage performance. We compare the performance of the two protocols in terms of the end-to-end signal-to-noise ratio cumulative distribution function via closed-form expressions. Finally, we corroborate our theoretical results with simulation, and show the relative relay power savings in comparison to non-selective cooperation in which the relay cooperates regardless of channel conditions. © 2013 IEEE.

Energy-efficient cooperative protocols for full-duplex relay channels

KAUST Repository

Khafagy, Mohammad Galal; Ismail, Amr; Alouini, Mohamed-Slim; Aï ssa, Sonia

2013-01-01

In this work, energy-efficient cooperative protocols are studied for full-duplex relaying (FDR) with loopback interference. In these protocols, relay assistance is only sought under certain conditions on the different link outages to ensure effective cooperation. Recently, an energy-efficient selective decode-And-forward protocol was proposed for FDR, and was shown to outperform existing schemes in terms of outage. Here, we propose an incremental selective decode-And-forward protocol that offers additional power savings, while keeping the same outage performance. We compare the performance of the two protocols in terms of the end-to-end signal-to-noise ratio cumulative distribution function via closed-form expressions. Finally, we corroborate our theoretical results with simulation, and show the relative relay power savings in comparison to non-selective cooperation in which the relay cooperates regardless of channel conditions. © 2013 IEEE.

Improved Wojcik's eavesdropping attack on ping-pong protocol without eavesdropping-induced channel loss

Energy Technology Data Exchange (ETDEWEB)

Zhang Zhanjun [School of Physics and Material Science, Anhui University, Hefei 230039 (China) and Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China)]. E-mail: zhangzj@wipm.ac.cn; Li Yong [Department of Physics, Huazhong Normal University, Wuhan 430079 (China); Man Zhongxiao [Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071 (China)

2005-06-27

The eavesdropping scheme proposed by Wojcik [Phys. Rev. Lett. 90 (2003) 157901] on the ping-pong protocol [Phys. Rev. Lett. 89 (2002) 187902] is improved by constituting a new set of attack operations. The improved scheme has a zero eavesdropping-induced channel loss and produces perfect anticorrelation. Therefore, the eavesdropper Eve can safely attack all the transmitted bits and the eavesdropping information gain can always exceed the legitimate user's information gain in the whole domain of the quantum channel transmission efficiency {eta}, i.e., [0,100%]. This means that the ping-pong protocol can be completely eavesdropped in its original version. But the improvement of the ping-pong protocol security produced by Wojcik is also suitable for our eavesdropping attack.

Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

Science.gov (United States)

Marshall, C; Ramaswamy, P; Bergin, F G; Rosenberg, I L; Leaper, D J

1999-01-01

The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

A novel authentication scheme using self-certified public keys for telecare medical information systems.

Science.gov (United States)

Guo, Dianli; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping

2015-06-01

Telecare medical information systems (TMIS), with the explosive growth of communication technology and physiological monitoring devices, are applied increasingly to enable and support healthcare delivery services. In order to safeguard patients' privacy and tackle the illegal access, authentication schemes for TMIS have been investigated and designed by many researchers. Many of them are promising for adoption in practice, nevertheless, they still have security flaws. In this paper, we propose a novel remote authentication scheme for TMIS using self-certified public keys, which is formally secure in the ID-mBJM model. Besides, the proposed scheme has better computational efficiency. Compared to the related schemes, our protocol is more practical for telemedicine system.

Quality of psychiatric referrals to secondary-level care | Struwig ...

African Journals Online (AJOL)

Less than 20% of the referral letters included information on previous psychiatric consultations, current psychotropic medication, the outcome of physical examinations, and results of special investigations. Only 17 (6%) referral letters indicated a preliminary diagnosis according to an officially recognised classification system ...

A Tree Based Broadcast Scheme for (m, k)-firm Real-Time Stream in Wireless Sensor Networks.

Science.gov (United States)

Park, HoSung; Kim, Beom-Su; Kim, Kyong Hoon; Shah, Babar; Kim, Ki-Il

2017-11-09

Recently, various unicast routing protocols have been proposed to deliver measured data from the sensor node to the sink node within the predetermined deadline in wireless sensor networks. In parallel with their approaches, some applications demand the specific service, which is based on broadcast to all nodes within the deadline, the feasible real-time traffic model and improvements in energy efficiency. However, current protocols based on either flooding or one-to-one unicast cannot meet the above requirements entirely. Moreover, as far as the authors know, there is no study for the real-time broadcast protocol to support the application-specific traffic model in WSN yet. Based on the above analysis, in this paper, we propose a new ( m , k )-firm-based Real-time Broadcast Protocol (FRBP) by constructing a broadcast tree to satisfy the ( m , k )-firm, which is applicable to the real-time model in resource-constrained WSNs. The broadcast tree in FRBP is constructed by the distance-based priority scheme, whereas energy efficiency is improved by selecting as few as nodes on a tree possible. To overcome the unstable network environment, the recovery scheme invokes rapid partial tree reconstruction in order to designate another node as the parent on a tree according to the measured ( m , k )-firm real-time condition and local states monitoring. Finally, simulation results are given to demonstrate the superiority of FRBP compared to the existing schemes in terms of average deadline missing ratio, average throughput and energy consumption.

WDM Network and Multicasting Protocol Strategies

Directory of Open Access Journals (Sweden)

Pinar Kirci

2014-01-01

Full Text Available Optical technology gains extensive attention and ever increasing improvement because of the huge amount of network traffic caused by the growing number of internet users and their rising demands. However, with wavelength division multiplexing (WDM, it is easier to take the advantage of optical networks and optical burst switching (OBS and to construct WDM networks with low delay rates and better data transparency these technologies are the best choices. Furthermore, multicasting in WDM is an urgent solution for bandwidth-intensive applications. In the paper, a new multicasting protocol with OBS is proposed. The protocol depends on a leaf initiated structure. The network is composed of source, ingress switches, intermediate switches, edge switches, and client nodes. The performance of the protocol is examined with Just Enough Time (JET and Just In Time (JIT reservation protocols. Also, the paper involves most of the recent advances about WDM multicasting in optical networks. WDM multicasting in optical networks is given as three common subtitles: Broadcast and-select networks, wavelength-routed networks, and OBS networks. Also, in the paper, multicast routing protocols are briefly summarized and optical burst switched WDM networks are investigated with the proposed multicast schemes.

Referral patterns of children with poor growth in primary health care

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van Buuren Stef

2007-05-01

Full Text Available Abstract Background To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO. Methods Three sets of referral rules were tested on the growth data of a random sample (n = 400 of all children born between 01-01-1985 and 31-12-1988, attending school doctors between 1998 and 2000 in Leiden and Alphen aan den Rijn (the Netherlands: the screening criteria mentioned in the Dutch Consensus Guideline (DCG, those of the UK Consensus Guideline (UKCG and the cut-off values mentioned in the WHO Global Database on Child growth and Malnutrition. Results Application of the DCG would lead to the referral of too many children (almost 80%. The largest part of the referrals is due to the deflection of height, followed by distance to target height and takes primarily place during the first 3 years. The deflection away from the parental height would also lead to too many referrals. In contrast, the UKCG only leads to 0.3% referrals and the WHO-criteria to approximately 10%. Conclusion The current Dutch consensus guideline leads to too many referrals, mainly due to the deflection of length during the first 3 years of life. The UKCG leads to far less referrals, but may be relatively insensitive to detect clinically relevant growth disorders like Turner syndrome. New guidelines for growth monitoring are needed, which combine a low percentage of false positive results with a good sensitivity.

Information-theoretic security proof for quantum-key-distribution protocols

International Nuclear Information System (INIS)

Renner, Renato; Gisin, Nicolas; Kraus, Barbara

2005-01-01

We present a technique for proving the security of quantum-key-distribution (QKD) protocols. It is based on direct information-theoretic arguments and thus also applies if no equivalent entanglement purification scheme can be found. Using this technique, we investigate a general class of QKD protocols with one-way classical post-processing. We show that, in order to analyze the full security of these protocols, it suffices to consider collective attacks. Indeed, we give new lower and upper bounds on the secret-key rate which only involve entropies of two-qubit density operators and which are thus easy to compute. As an illustration of our results, we analyze the Bennett-Brassard 1984, the six-state, and the Bennett 1992 protocols with one-way error correction and privacy amplification. Surprisingly, the performance of these protocols is increased if one of the parties adds noise to the measurement data before the error correction. In particular, this additional noise makes the protocols more robust against noise in the quantum channel

Information-theoretic security proof for quantum-key-distribution protocols

Science.gov (United States)

Renner, Renato; Gisin, Nicolas; Kraus, Barbara

2005-07-01

We present a technique for proving the security of quantum-key-distribution (QKD) protocols. It is based on direct information-theoretic arguments and thus also applies if no equivalent entanglement purification scheme can be found. Using this technique, we investigate a general class of QKD protocols with one-way classical post-processing. We show that, in order to analyze the full security of these protocols, it suffices to consider collective attacks. Indeed, we give new lower and upper bounds on the secret-key rate which only involve entropies of two-qubit density operators and which are thus easy to compute. As an illustration of our results, we analyze the Bennett-Brassard 1984, the six-state, and the Bennett 1992 protocols with one-way error correction and privacy amplification. Surprisingly, the performance of these protocols is increased if one of the parties adds noise to the measurement data before the error correction. In particular, this additional noise makes the protocols more robust against noise in the quantum channel.

A project investigating music therapy referral trends within palliative care: an Australian perspective.

Science.gov (United States)

Horne-Thompson, Anne; Daveson, Barbara; Hogan, Bridgit

2007-01-01

The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.

Childhood intussusception at the Moi teaching and referral hospital ...

African Journals Online (AJOL)

Objective: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. Design: A retrospective descriptive study covering the period January 2000 to December 2003. Setting: Moi Teaching and Referral Hospital, ...

Study protocol for a cluster randomized controlled trial to evaluate a referral strategy for axial spondyloarthritis in young primary care patients with chronic low back pain; an impact study.

Science.gov (United States)

van Hoeven, Lonneke; Vergouwe, Yvonne; Koes, Bart W; Hazes, Johanna M W; Weel, Angelique E A M

2016-07-12

Axial spondyloarthritis (axSpA) is a disabling inflammatory joint disease with chronic low back pain (CLBP) as leading symptom. Recognizing axSpA in the large amount of CLBP patients is difficult for general practioners (GP). This evaluation aims to assess the effect of a referral strategy for axSpA in young primary care patients with CLBP by comparing the use of the strategy with usual care. The effect is measured at three different levels; by patient reported outcomes (the clinical effect), process and costs evaluation. This study design is a cluster randomized controlled trial with GP as clusters. GPs throughout the Netherlands are invited to participate and randomized to either the intervention or the control group. Patients from participating GPs are invited to participate if they have ever been registered with low back pain, without radiation (ICPC L03) and aged 18-45 years. To be included in the study, patients need to have current low back pain and chronic low back pain (>12 weeks). In the intervention arm a referral strategy for axSpA will be applied in CLBP patients, in the control arm care as usual will be provided for CLBP patients. The referral strategy consists of four easy to use variables. All are questions about the back pain complaints of the patients. Data is prospectively collected in an online database at baseline (T0), 4 months (T1), 12 months (T2) and 24 months (T3). After time point T1 (4 months) patients from the control group will also receive the intervention i.e. the application of a referral strategy for axSpA. The effect of the referral strategy is measured at three different levels, by patient outcomes (e.g. pain scores, quality of life), process measures (e.g. number of axSpA diagnoses by rheumatologists) and by costs (work productivity and health care resources use). Our primary outcome is the Roland Morris Disability Questionnaire after 4 months, secondary outcomes are pain and quality of life. Costs will be assessed before

Selective Route Based on SNR with Cross-Layer Scheme in Wireless Ad Hoc Network

Directory of Open Access Journals (Sweden)

Istikmal

2017-01-01

Full Text Available In this study, we developed network and throughput formulation models and proposed new method of the routing protocol algorithm with a cross-layer scheme based on signal-to-noise ratio (SNR. This method is an enhancement of routing protocol ad hoc on-demand distance vector (AODV. This proposed scheme uses selective route based on the SNR threshold in the reverse route mechanism. We developed AODV SNR-selective route (AODV SNR-SR for a mechanism better than AODV SNR, that is, the routing protocol that used average or sum of path SNR, and also better than AODV which is hop-count-based. We also used selective reverse route based on SNR mechanism, replacing the earlier method to avoid routing overhead. The simulation results show that AODV SNR-SR outperforms AODV SNR and AODV in terms of throughput, end-to-end delay, and routing overhead. This proposed method is expected to support Device-to-Device (D2D communications that are concerned with the quality of the channel awareness in the development of the future Fifth Generation (5G.

How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

Science.gov (United States)

Cubbin, S; Llewellyn-Jones, S; Donnelly, P

2000-01-01

It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

Critical care outreach referrals: a mixed-method investigative study of outcomes and experiences.

Science.gov (United States)

Pattison, Natalie; Eastham, Elizabeth

2012-01-01

To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT). A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles. A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients. Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care

Assessment of the feasibility and coverage of a modified universal hearing screening protocol for use with newborn babies of migrant workers in Beijing.

Science.gov (United States)

Qi, Beier; Cheng, Xiaohua; En, Hui; Liu, Bo; Peng, Shichun; Zhen, Yong; Cai, Zhenghua; Huang, Lihui; Zhang, Luo; Han, Demin

2013-08-08

Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents. We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population. A total of 10,983 healthy babies born to migrant mothers between January 2007 and December 2009 at a Beijing public hospital were investigated for hearing abnormalities according to a modified UNHS protocol. This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24-48 hours and 2 months after birth. Infants not passing a screening test were referred to the next test, until any hearing loss was confirmed by the auditory brainstem response (ABR) test. A total of 98.91% (10983/11104) of all newborn children underwent the initial OAE test, of which 27.22% (2990/10983) failed the test. 1712 of the failed babies underwent the second inpatient OAE test, with739 failing again; thus significantly decreasing the overall positive rate for abnormal hearing from 27.22% to 18.36% ([2990-973 /10983)]; p = 0). Overall, 1147(56.87%) babies underwent the outpatient OAE test again after1-month, of whom 228 failed and were referred for the second outpatient OAE test (i.e. 2.08% (228/10983) referral rate at 1month of age). 141 of these infants underwent the referral test, of whom 103 (73.05%) tested positive again and were referred for a final ABR test for hearing loss (i.e. final referral rate of 1.73% ([228-38/10983] at 2 months of age). Only 54 infants attended the ABR test and 35 (0.32% of the original cohort tested) were diagnosed with abnormal hearing. Our study shows that it is feasible and practical to achieve high coverage rates for screening hearing loss and decrease the referral rates in

Referral letters to the psychiatrist in Nigeria: is communication ...

African Journals Online (AJOL)

history, may not be elements that non-psychiatrist phy- sicians routinely collect during their examinations and, therefore, one would not expect such information to be available to be included in referral letters. Conclusion. Deficits in communication or information transfer through referral letters to the psychiatrist are common.

Referral letters to the psychiatrist in Nigeria: is communication ...

African Journals Online (AJOL)

Result: A majority (>80%) of the referral letters had no information on the current medication list, relevant psychosocial history, outline of management to date, results of investigations to date, and known allergies. Conclusion: Deficits in communication or information transfer through referral letters to the psychiatrist are ...

A User Authentication Scheme Based on Elliptic Curves Cryptography for Wireless Ad Hoc Networks.

Science.gov (United States)

Chen, Huifang; Ge, Linlin; Xie, Lei

2015-07-14

The feature of non-infrastructure support in a wireless ad hoc network (WANET) makes it suffer from various attacks. Moreover, user authentication is the first safety barrier in a network. A mutual trust is achieved by a protocol which enables communicating parties to authenticate each other at the same time and to exchange session keys. For the resource-constrained WANET, an efficient and lightweight user authentication scheme is necessary. In this paper, we propose a user authentication scheme based on the self-certified public key system and elliptic curves cryptography for a WANET. Using the proposed scheme, an efficient two-way user authentication and secure session key agreement can be achieved. Security analysis shows that our proposed scheme is resilient to common known attacks. In addition, the performance analysis shows that our proposed scheme performs similar or better compared with some existing user authentication schemes.

First quality score for referral letters in gastroenterology—a validation study

Science.gov (United States)

Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

2016-01-01

Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107

Computerised sepsis protocol management. Description of an early warning system.

Science.gov (United States)

de Dios, Begoña; Borges, Marcio; Smith, Timothy D; Del Castillo, Alberto; Socias, Antonia; Gutiérrez, Leticia; Nicolás, Jordi; Lladó, Bartolomé; Roche, Jose A; Díaz, Maria P; Lladó, Yolanda

2018-02-01

New strategies need to be developed for the early recognition and rapid response for the management of sepsis. To achieve this purpose, the Multidisciplinary Sepsis Team (MST) developed the Computerised Sepsis Protocol Management (PIMIS). The aim of this study was to evaluate the convenience of using PIMIS, as well as the activity of the MST. An analysis was performed on the data collected from solicited MST consultations (direct activation of PIMIS by attending physician or telephone request) and unsolicited ones (by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software [SIDCV]), as well as the hospital department, source of infection, treatment recommendation, and acceptance of this. Of the 1,581 first consultations, 65.1% were solicited consultations (84.1% activation of PIMIS and 15.9% by telephone). The majority of unsolicited consultations were generated by the microbiology laboratory (95.2%), and 4.8% from the SIDCV. Referral from solicited consultations were generated sooner (5.63days vs 8.47days; P<.001) and came from clinical specialties rather than from the surgical ward (73.0% vs 39.1%; P<.001). A recommendation was made for antimicrobial prescription change in 32% of first consultations. The treating physician accepted 78.1% of recommendations. The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource, and that PIMIS software is perceived to be useful and convenient to use, as it is the main source of referral. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Optimization of burn referrals

DEFF Research Database (Denmark)

Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne

2014-01-01

INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...

A lightweight privacy preserving authenticated key agreement protocol for SIP-based VoIP

OpenAIRE

Zhang, Liping; Tang, Shanyu; Zhu, Shaohui

2016-01-01

Session Initiation Protocol (SIP) is an essential part of most Voice over Internet Protocol (VoIP) architecture. Although SIP provides attractive features, it is exposed to various security threats, and so an efficient and secure authentication scheme is sought to enhance the security of SIP. Several attempts have been made to address the tradeoff problem between security and efficiency, but designing a successful authenticated key agreement protocol for SIP is still a challenging task from t...

Analyses of resource reservation schemes for optical burst switching networks

Science.gov (United States)

Solanska, Michaela; Scholtz, Lubomir; Ladanyi, Libor; Mullerova, Jarmila

2017-12-01

With growing demands of Internet Protocol services for transmission capacity and speed, the Optical Burst Switching presents the solution for future high-speed optical networks. Optical Burst Switching is a technology for transmitting large amounts of data bursts through a transparent optical switching network. To successfully transmit bursts over OBS network and reach the destination node, resource reservation schemes have to be implemented to allocate resources and configure optical switches for that burst at each node. The one-way resource reservation schemes and the performance evaluation of reservation schemes are presented. The OBS network model is performed using OMNeT++ simulation environment. During the reservation of network resources, the optical cross-connect based on semiconductor optical amplifier is used as the core node. Optical switches based on semiconductor optical amplifiers are a promising technology for high-speed optical communication networks.

44 CFR 11.17 - Referral to Department of Justice.

Science.gov (United States)

2010-10-01

... Justice. 11.17 Section 11.17 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... Referral to Department of Justice. When Department of Justice approval or consultation is required under § 11.16, the referral or request shall be transmitted to the Department of Justice by the Chief Counsel...

A reliable transmission protocol for ZigBee-based wireless patient monitoring.

Science.gov (United States)

Chen, Shyr-Kuen; Kao, Tsair; Chan, Chia-Tai; Huang, Chih-Ning; Chiang, Chih-Yen; Lai, Chin-Yu; Tung, Tse-Hua; Wang, Pi-Chung

2012-01-01

Patient monitoring systems are gaining their importance as the fast-growing global elderly population increases demands for caretaking. These systems use wireless technologies to transmit vital signs for medical evaluation. In a multihop ZigBee network, the existing systems usually use broadcast or multicast schemes to increase the reliability of signals transmission; however, both the schemes lead to significantly higher network traffic and end-to-end transmission delay. In this paper, we present a reliable transmission protocol based on anycast routing for wireless patient monitoring. Our scheme automatically selects the closest data receiver in an anycast group as a destination to reduce the transmission latency as well as the control overhead. The new protocol also shortens the latency of path recovery by initiating route recovery from the intermediate routers of the original path. On the basis of a reliable transmission scheme, we implement a ZigBee device for fall monitoring, which integrates fall detection, indoor positioning, and ECG monitoring. When the triaxial accelerometer of the device detects a fall, the current position of the patient is transmitted to an emergency center through a ZigBee network. In order to clarify the situation of the fallen patient, 4-s ECG signals are also transmitted. Our transmission scheme ensures the successful transmission of these critical messages. The experimental results show that our scheme is fast and reliable. We also demonstrate that our devices can seamlessly integrate with the next generation technology of wireless wide area network, worldwide interoperability for microwave access, to achieve real-time patient monitoring.

A secure quantum group signature scheme based on Bell states

International Nuclear Information System (INIS)

Zhang Kejia; Song Tingting; Zuo Huijuan; Zhang Weiwei

2013-01-01

In this paper, we propose a new secure quantum group signature with Bell states, which may have applications in e-payment system, e-government, e-business, etc. Compared with the recent quantum group signature protocols, our scheme is focused on the most general situation in practice, i.e. only the arbitrator is trusted and no intermediate information needs to be stored in the signing phase to ensure the security. Furthermore, our scheme has achieved all the characteristics of group signature—anonymity, verifiability, traceability, unforgetability and undeniability, by using some current developed quantum and classical technologies. Finally, a feasible security analysis model for quantum group signature is presented. (paper)

[Self-referrals at Emergency Care Access Points and triage by General Practitioner Cooperatives].

Science.gov (United States)

Smits, M; Rutten, M; Schepers, L; Giesen, P

2017-01-01

There is a trend for General Practitioner Cooperatives (GPCs) to co-locate with emergency departments (EDs) of hospitals at Emergency Care Access Points (ECAPs), where the GPCs generally conduct triage and treat a large part of self-referrals who would have gone to the ED by themselves in the past. We have examined patient and care characteristics of self-referrals at ECAPs where triage was conducted by GPCs, also to determine the percentage of self-referrals being referred to the ED. Retrospective cross-sectional observational study. Descriptive analyses of routine registration data from self-referrals of five ECAPs (n = 20.451). Patient age, gender, arrival time, urgency, diagnosis and referral were analysed. Of the self-referrals, 57.9% was male and the mean age was 32.7 years. The number of self-referrals per hour was highest during weekends, particularly between 11 a.m. and 5 p.m. On weekdays, there was a peak between 5 and 9 p.m. Self-referrals were mostly assigned a low-urgency grade (35.7% - U4 or U5) or a mid-urgency grade (49% - U3). Almost half of the self-referrals had trauma of the locomotor system (28%) or the skin (27.3%). In total, 23% of the patients was referred to the ED. Self-referred patients at GPCs are typically young, male and have low- to mid-urgency trauma-related problems. Many self-referrals present themselves on weekend days or early weekday evenings. Over three quarters of these patients can be treated by the GPCs, without referral to the ED. This reduces the workload at the ED.

An Efficient and Secure Certificateless Authentication Protocol for Healthcare System on Wireless Medical Sensor Networks

Science.gov (United States)

Guo, Rui; Wen, Qiaoyan; Jin, Zhengping; Zhang, Hua

2013-01-01

Sensor networks have opened up new opportunities in healthcare systems, which can transmit patient's condition to health professional's hand-held devices in time. The patient's physiological signals are very sensitive and the networks are extremely vulnerable to many attacks. It must be ensured that patient's privacy is not exposed to unauthorized entities. Therefore, the control of access to healthcare systems has become a crucial challenge. An efficient and secure authentication protocol will thus be needed in wireless medical sensor networks. In this paper, we propose a certificateless authentication scheme without bilinear pairing while providing patient anonymity. Compared with other related protocols, the proposed scheme needs less computation and communication cost and preserves stronger security. Our performance evaluations show that this protocol is more practical for healthcare system in wireless medical sensor networks. PMID:23710147

Escalator: An Autonomous Scheduling Scheme for Convergecast in TSCH

Directory of Open Access Journals (Sweden)

Sukho Oh

2018-04-01

Full Text Available Time Slotted Channel Hopping (TSCH is widely used in the industrial wireless sensor networks due to its high reliability and energy efficiency. Various timeslot and channel scheduling schemes have been proposed for achieving high reliability and energy efficiency for TSCH networks. Recently proposed autonomous scheduling schemes provide flexible timeslot scheduling based on the routing topology, but do not take into account the network traffic and packet forwarding delays. In this paper, we propose an autonomous scheduling scheme for convergecast in TSCH networks with RPL as a routing protocol, named Escalator. Escalator generates a consecutive timeslot schedule along the packet forwarding path to minimize the packet transmission delay. The schedule is generated autonomously by utilizing only the local routing topology information without any additional signaling with other nodes. The generated schedule is guaranteed to be conflict-free, in that all nodes in the network could transmit packets to the sink in every slotframe cycle. We implement Escalator and evaluate its performance with existing autonomous scheduling schemes through a testbed and simulation. Experimental results show that the proposed Escalator has lower end-to-end delay and higher packet delivery ratio compared to the existing schemes regardless of the network topology.

Evaluation of frame aggregation schemes for the p-persistent based next generation WLANS

Science.gov (United States)

Ahmad, Ashar; Anna, Kiran; Bassiouni, Mostafa A.

2010-04-01

The next Generation IEEE 802.11n is designed to improve the throughput of the existing standard 802.11. It aims to achieve this by increasing the data rate from 54 Mbps to 600 Mbps with the help of physical layer enhancements. Therefore, the Medium Access Layer (MAC) requires improvements to fully utilize the capabilities of the enhanced 802.11n physical layer. In this paper, we present the performance evaluation results of two frame aggregation schemes viz., MAC Protocol Data Unit Aggregation (A-MPDU) and MAC Service Data Unit Aggregation (A-MSDU) and study their performance impact when the two schemes are incorporated in a p-persistent based 802.11n. The simulation results have shown that the two schemes achieve consistent performance improvement over the standard non-aggregation scheme.

A distance-aware replica adaptive data gathering protocol for Delay Tolerant Mobile Sensor Networks.

Science.gov (United States)

Feng, Yong; Gong, Haigang; Fan, Mingyu; Liu, Ming; Wang, Xiaomin

2011-01-01

In Delay Tolerant Mobile Sensor Networks (DTMSNs) that have the inherent features of intermitted connectivity and frequently changing network topology it is reasonable to utilize multi-replica schemes to improve the data gathering performance. However, most existing multi-replica approaches inject a large amount of message copies into the network to increase the probability of message delivery, which may drain each mobile node's limited battery supply faster and result in too much contention for the restricted resources of the DTMSN, so a proper data gathering scheme needs a trade off between the number of replica messages and network performance. In this paper, we propose a new data gathering protocol called DRADG (for Distance-aware Replica Adaptive Data Gathering protocol), which economizes network resource consumption through making use of a self-adapting algorithm to cut down the number of redundant replicas of messages, and achieves a good network performance by leveraging the delivery probabilities of the mobile sensors as main routing metrics. Simulation results have shown that the proposed DRADG protocol achieves comparable or higher message delivery ratios at the cost of the much lower transmission overhead than several current DTMSN data gathering schemes.

Clinical neurophysiology referral patterns to a tertiary hospital--a prospective audit.

LENUS (Irish Health Repository)

Renganathan, R

2012-02-03

BACKGROUND: Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. AIM: To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. METHODS: We did a prospective audit of the referral patterns to the neurophysiology department over a 12 -week period. RESULTS: Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. CONCLUSIONS: Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.

On the security of two remote user authentication schemes for telecare medical information systems.

Science.gov (United States)

Kim, Kee-Won; Lee, Jae-Dong

2014-05-01

The telecare medical information systems (TMISs) support convenient and rapid health-care services. A secure and efficient authentication scheme for TMIS provides safeguarding patients' electronic patient records (EPRs) and helps health care workers and medical personnel to rapidly making correct clinical decisions. Recently, Kumari et al. proposed a password based user authentication scheme using smart cards for TMIS, and claimed that the proposed scheme could resist various malicious attacks. However, we point out that their scheme is still vulnerable to lost smart card and cannot provide forward secrecy. Subsequently, Das and Goswami proposed a secure and efficient uniqueness-and-anonymity-preserving remote user authentication scheme for connected health care. They simulated their scheme for the formal security verification using the widely-accepted automated validation of Internet security protocols and applications (AVISPA) tool to ensure that their scheme is secure against passive and active attacks. However, we show that their scheme is still vulnerable to smart card loss attacks and cannot provide forward secrecy property. The proposed cryptanalysis discourages any use of the two schemes under investigation in practice and reveals some subtleties and challenges in designing this type of schemes.

5 CFR 177.108 - Referral to Department of Justice.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Referral to Department of Justice. 177... ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.108 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...

24 CFR 107.65 - Referral to the Attorney General.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Referral to the Attorney General... Referral to the Attorney General. If the results of a complaint investigation or a compliance review... appropriate cases shall recommend that the General Counsel refer the case to the Attorney General of the...

Multipath Activity Based Routing Protocol for Mobile ‎Cognitive Radio Ad Hoc Networks

Directory of Open Access Journals (Sweden)

Shereen Omar

2017-01-01

Full Text Available Cognitive radio networks improve spectrum utilization by ‎sharing licensed spectrum with cognitive radio devices. In ‎cognitive radio ad hoc networks the routing protocol is one ‎of the most challenging tasks due to the changes in ‎frequency spectrum and the interrupted connectivity ‎caused by the primary user activity. In this paper, a multi‎path activity based routing protocol for cognitive radio ‎network (MACNRP is proposed. The protocol utilizes ‎channel availability and creates multiple node-disjoint ‎routes between the source and destination nodes. The ‎proposed protocol is compared with D2CARP and FTCRP ‎protocols. The performance evaluation is conducted ‎through mathematical analysis and using OPNET ‎simulation. The performance of the proposed protocol ‎achieves an increase in network throughput; besides it ‎decreases the probability of route failure due to node ‎mobility and primary user activity. We have found that the ‎MACNRP scheme results in 50% to 75% reduction in ‎blocking probability and 33% to 78% improvement in ‎network throughput, with a reasonable additional routing ‎overhead and average packet delay. Due to the successful ‎reduction of collision between primary users and ‎cognitive users, the MACNRP scheme results in decreasing ‎the path failure rate by 50% to 87%.‎

Provably Secure Heterogeneous Access Control Scheme for Wireless Body Area Network.

Science.gov (United States)

Omala, Anyembe Andrew; Mbandu, Angolo Shem; Mutiria, Kamenyi Domenic; Jin, Chunhua; Li, Fagen

2018-04-28

Wireless body area network (WBAN) provides a medium through which physiological information could be harvested and transmitted to application provider (AP) in real time. Integrating WBAN in a heterogeneous Internet of Things (IoT) ecosystem would enable an AP to monitor patients from anywhere and at anytime. However, the IoT roadmap of interconnected 'Things' is still faced with many challenges. One of the challenges in healthcare is security and privacy of streamed medical data from heterogeneously networked devices. In this paper, we first propose a heterogeneous signcryption scheme where a sender is in a certificateless cryptographic (CLC) environment while a receiver is in identity-based cryptographic (IBC) environment. We then use this scheme to design a heterogeneous access control protocol. Formal security proof for indistinguishability against adaptive chosen ciphertext attack and unforgeability against adaptive chosen message attack in random oracle model is presented. In comparison with some of the existing access control schemes, our scheme has lower computation and communication cost.

The Time Division Multi-Channel Communication Model and the Correlative Protocol Based on Quantum Time Division Multi-Channel Communication

International Nuclear Information System (INIS)

Liu Xiao-Hui; Pei Chang-Xing; Nie Min

2010-01-01

Based on the classical time division multi-channel communication theory, we present a scheme of quantum time-division multi-channel communication (QTDMC). Moreover, the model of quantum time division switch (QTDS) and correlative protocol of QTDMC are proposed. The quantum bit error rate (QBER) is analyzed and the QBER simulation test is performed. The scheme shows that the QTDS can carry out multi-user communication through quantum channel, the QBER can also reach the reliability requirement of communication, and the protocol of QTDMC has high practicability and transplantable. The scheme of QTDS may play an important role in the establishment of quantum communication in a large scale in the future. (general)

Design and Research of a New secure Authentication Protocol in GSM networks

Directory of Open Access Journals (Sweden)

Qi Ai-qin

2016-01-01

Full Text Available As the first line of defense in the security application system, Authentication is an important security service. Its typical scheme is challenge/response mechanism and this scheme which is simple-structured and easy to realize has been used worldwide. But these protocols have many following problems In the GSM networks such as the leakage of user indentity privacy, no security protection between home registers and foreign registers and the vicious intruders’ information stealing and so on. This paper presents an authentication protocol in GSM networks based on maths operation and modular square root technique . The analysis of the security and performance has also been done. The results show that it is more robust and secure compared to the previous agreements.

BAVP: Blockchain-Based Access Verification Protocol in LEO Constellation Using IBE Keys

OpenAIRE

Wei, Songjie; Li, Shuai; Liu, Peilong; Liu, Meilin

2018-01-01

LEO constellation has received intensive research attention in the field of satellite communication. The existing centralized authentication protocols traditionally used for MEO/GEO satellite networks cannot accommodate LEO satellites with frequent user connection switching. This paper proposes a fast and efficient access verification protocol named BAVP by combining identity-based encryption and blockchain technology. Two different key management schemes with IBE and blockchain, respectively...

First quality score for referral letters in gastroenterology-a validation study.

Science.gov (United States)

Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

2016-10-08

To create and validate an objective and reliable score to assess referral quality in gastroenterology. An observational multicentre study. 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Correlation between the TPS and a visual analogue scale (VAS) for referral quality. The 327 referrals had an average TPS of 13.2 (range 1-25) and an average VAS of 4.7 (range 0.2-9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Referral Regions for Time-Sensitive Acute Care Conditions in the United States.

Science.gov (United States)

Wallace, David J; Mohan, Deepika; Angus, Derek C; Driessen, Julia R; Seymour, Christopher M; Yealy, Donald M; Roberts, Mark M; Kurland, Kristen S; Kahn, Jeremy M

2018-03-24

Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Referrral Systems Development and Survey of Perioperative and Critical Care Referral to Anesthetists.

Science.gov (United States)

Narendra, P L; Hegde, Harihar V; Khan, Maroof Ahmad; Talikoti, Dayanand G; Nallamilli, Samson

2017-01-01

Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. The response rate was 43.8%. Sixty percent (55.3-64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42-72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16-8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92-29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) ( P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) ( P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) ( P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) ( P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.

7 CFR 3.21 - Referrals of Debts to Justice.

Science.gov (United States)

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Referrals of Debts to Justice. 3.21 Section 3.21... and Compromise of Claims § 3.21 Referrals of Debts to Justice. An agency shall promptly refer to Justice for litigation debts on which aggressive collection activity has been taken in accordance with...

40 CFR 1620.8 - Referral to Department of Justice.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Referral to Department of Justice... ADMINISTRATIVE CLAIMS ARISING UNDER THE FEDERAL TORT CLAIMS ACT § 1620.8 Referral to Department of Justice. When Department of Justice approval or consultation is required, or the advice of the Department of Justice is...

Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain

Directory of Open Access Journals (Sweden)

Villa Guillermo

2012-08-01

Full Text Available Abstract Background A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. Methods A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Results Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY. When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %. Conclusions Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both

Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain.

Science.gov (United States)

Villa, Guillermo; Sánchez-Álvarez, Emilio; Cuervo, Jesús; Fernández-Ortiz, Lucía; Rebollo, Pablo; Ortega, Francisco

2012-08-16

A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred. A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained. Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %). Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients' survival rates and health-related quality of life at an

A Secure and Robust User Authenticated Key Agreement Scheme for Hierarchical Multi-medical Server Environment in TMIS.

Science.gov (United States)

Das, Ashok Kumar; Odelu, Vanga; Goswami, Adrijit

2015-09-01

The telecare medicine information system (TMIS) helps the patients to gain the health monitoring facility at home and access medical services over the Internet of mobile networks. Recently, Amin and Biswas presented a smart card based user authentication and key agreement security protocol usable for TMIS system using the cryptographic one-way hash function and biohashing function, and claimed that their scheme is secure against all possible attacks. Though their scheme is efficient due to usage of one-way hash function, we show that their scheme has several security pitfalls and design flaws, such as (1) it fails to protect privileged-insider attack, (2) it fails to protect strong replay attack, (3) it fails to protect strong man-in-the-middle attack, (4) it has design flaw in user registration phase, (5) it has design flaw in login phase, (6) it has design flaw in password change phase, (7) it lacks of supporting biometric update phase, and (8) it has flaws in formal security analysis. In order to withstand these security pitfalls and design flaws, we aim to propose a secure and robust user authenticated key agreement scheme for the hierarchical multi-server environment suitable in TMIS using the cryptographic one-way hash function and fuzzy extractor. Through the rigorous security analysis including the formal security analysis using the widely-accepted Burrows-Abadi-Needham (BAN) logic, the formal security analysis under the random oracle model and the informal security analysis, we show that our scheme is secure against possible known attacks. Furthermore, we simulate our scheme using the most-widely accepted and used Automated Validation of Internet Security Protocols and Applications (AVISPA) tool. The simulation results show that our scheme is also secure. Our scheme is more efficient in computation and communication as compared to Amin-Biswas's scheme and other related schemes. In addition, our scheme supports extra functionality features as compared to

Acceptance of referral for partners by clients testing positive for human immunodeficiency virus

Directory of Open Access Journals (Sweden)

Netsanet F

2013-01-01

Full Text Available Fetene Netsanet,1 Ayalew Dessie21IMA World Health SuddHealth Multi Donor Trust Fund-Basic Package of Health Services Project, Juba, South Sudan; 2United States Agency for International Development, Private Health Sector Program, Abt Associates Inc, Addis Ababa, EthiopiaBackground: Human immunodeficiency virus (HIV-positive individuals who do not disclose their HIV status to their partners are more likely to present late for HIV and acquired immune deficiency syndrome (AIDS care than those who have disclosed their HIV status to their partners. A major area of challenge with regards to HIV counseling for clients is disclosure of their HIV status to their partners. The main methods of partner notification are patient referral, provider referral, contract referral, and outreach assistance. The emphasis on a plausible and comprehensive partner referral strategy for widespread positive case detection in resource-limited countries needs to be thought out and developed.Methods: A qualitative study was conducted among newly HIV-positive clients to identify partners for notification and acceptance of referral by their partners. Health service providers working in HIV testing and counseling clinics were also provided with semistructured questionnaires in order to assess their view towards partner notification strategies for clients testing positive for HIV.Results: Fifteen newly diagnosed HIV-positive clients were counseled to provide referral slips to their partners. All clients agreed and took the referral card. However, only eight were willing and actually provided the card to their partners. Five of the eight partners of clients who tested HIV-positive and who were provided with referral cards responded to the referral and were tested for HIV. Three were positive and two were negative. Nine of 11 counselors did not agree to requesting partner locator information from HIV-positive clients for contractual referral and/or outreach assistance. The findings

[Primary lymphoma of the central nervous system: 20 years' experience in a referral hospital].

Science.gov (United States)

Calderón-Garcidueñas, A L; Pacheco-Calleros, J; Castelán-Maldonado, E; Nocedal-Rustrián, F C

Primary central nervous system lymphomas (PCNSL) are rare neoplasms. AIM. To study the clinical aspects and the immuno-phenotype of all cases of PCNSL in a 20 years lapse in a referral hospital in Northeastern Mexico. From January 1986 to December 2005 all PCNSL histologically confirmed were studied. The primary lymphomas were 1% of malignant central nervous system neoplasms. 21 cases were studied (ages from 9-70 years) with male predominance (2:1). 24% patients had immuno-suppression. The more frequent clinical data were: papilledema (71%), headache (62%), paresis (48%) and seizures (33%). 33% of patients died during the first six months after diagnosis. The T lymphomas were 19% of cases and corresponded to small cell type. PCNSL are still a diagnostic challenge. Multicenter studies are required in order to determine the best treatment protocol.

A Tree Based Broadcast Scheme for (m, k-firm Real-Time Stream in Wireless Sensor Networks

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HoSung Park

2017-11-01

Full Text Available Recently, various unicast routing protocols have been proposed to deliver measured data from the sensor node to the sink node within the predetermined deadline in wireless sensor networks. In parallel with their approaches, some applications demand the specific service, which is based on broadcast to all nodes within the deadline, the feasible real-time traffic model and improvements in energy efficiency. However, current protocols based on either flooding or one-to-one unicast cannot meet the above requirements entirely. Moreover, as far as the authors know, there is no study for the real-time broadcast protocol to support the application-specific traffic model in WSN yet. Based on the above analysis, in this paper, we propose a new (m, k-firm-based Real-time Broadcast Protocol (FRBP by constructing a broadcast tree to satisfy the (m, k-firm, which is applicable to the real-time model in resource-constrained WSNs. The broadcast tree in FRBP is constructed by the distance-based priority scheme, whereas energy efficiency is improved by selecting as few as nodes on a tree possible. To overcome the unstable network environment, the recovery scheme invokes rapid partial tree reconstruction in order to designate another node as the parent on a tree according to the measured (m, k-firm real-time condition and local states monitoring. Finally, simulation results are given to demonstrate the superiority of FRBP compared to the existing schemes in terms of average deadline missing ratio, average throughput and energy consumption.

Referral patterns of community health workers diagnosing and treating malaria

DEFF Research Database (Denmark)

Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal

2016-01-01

Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria...... rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy...... (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral inpatient registers...

BVS: A Lightweight Forward and Backward Secure Scheme for PMU Communications in Smart Grid

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Wei Ren

2011-01-01

Full Text Available In smart grid, phaser measurement units (PMUs can upload readings to utility centers via supervisory control and data acquisition (SCADA or energy management system (EMS to enable intelligent controlling and scheduling. It is critical to maintain the secrecy of readings so as to protect customers' privacy, together with integrity and source authentication for the reliability and stability of power scheduling. In particular, appealing security scheme needs to perform well in PMUs that usually have computational resource constraints, thus designed security protocols have to remain lightweight in terms of computation and storage. In this paper, we propose a family of schemes to solve this problem. They are public key based scheme (PKS, password based scheme (PWS and billed value-based scheme (BVS. BVS can achieve forward and backward security and only relies on hash functions. Security analysis justifies that the proposed schemes, especially BVS, can attain the security goals with low computation and storage cost.

CRITICAL ANALYSIS OF REFERRALS TO ELECTRODIAGNOSTIC EXAMINATION OF THE PERIPHERAL NERVOUS SYSTEM

Directory of Open Access Journals (Sweden)

Simon Podnar

2003-04-01

Full Text Available Background. Clinical neurophysiologists observe a large number of examinees referred to a electromyographic (EMG laboratory without clinical symptoms or signs of the peripheral nervous system lesion. Such referrals do not improve management of patients, but only unnecessarily burden examinees and laboratory personnel. The aim of the present study was to check appropriateness of referrals to electrodiagnostic examination, look for reasons for problems and suggest possible improvements.Methods. From the database of the Institute of Clinical Neurophysiology in Ljubljana all examinees evaluated by the author in a »general« EMG laboratory in the first 4 months of 2002 were included. From data about examinees, referral doctors, referral diagnoses, clinical symptoms and signs and electrophysiological findings, predictive values for neurological referral diagnoses and electrodiagnostic abnormalities were calculated using descriptive and multivariate statistical analyses.Results. Three hundred examinees (42% men were included. Neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees (carpal tunnel syndrome 50%, radiculopathy 25%, other mononeuropathies 15%, polineuropathy 9%. In 9% of examinees only clinical, and in 47% neither clinical nor electrodiagnostic abnormalities were demonstrated. Using a multivariate analysis positive effect of referral with neurological diagnosis, of paraesthesiae and findings of weakness and sensory loss, and negative effect of pain and referral diagnosis cervicobrachialgia or lumboischialgia on pathological electrodiagnostic findings were found. Isolated pain and paraesthesiae (with carpal tunnel syndrome excluded were particularly poor predictors of abnormal electrodiagnostic findings (9% and 16%, respectively. With exception of 20 patients with carpal tunnel syndrome, none with normal clinical neurological examination had abnormal electrodiagnostic findings

evaluative study of medical doctors' mode of referral for physiother

African Journals Online (AJOL)

Olwafemi Odebiyi

physicians' mode of referral of patients for physiotherapy in Nigeria. A total of 1192 physicians .... The Influence of Medical School of Graduation. Table 1 shows the .... This must have also been responsible for the high rate of referral observed.

29 CFR 1601.29 - Referral to the Attorney General.

Science.gov (United States)

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Referral to the Attorney General. 1601.29 Section 1601.29... of Civil Actions § 1601.29 Referral to the Attorney General. If the Commission is unable to obtain... shall inform the Attorney General of the appropriate facts in the case with recommendations for the...

10 CFR 430.54 - Referral to the Attorney General.

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2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Referral to the Attorney General. 430.54 Section 430.54... Business Exemptions § 430.54 Referral to the Attorney General. Notice of the application for exemption under this subpart shall be transmitted to the Attorney General by the Secretary and shall contain (a) a...

An efficient deterministic secure quantum communication scheme based on cluster states and identity authentication

International Nuclear Information System (INIS)

Wen-Jie, Liu; Han-Wu, Chen; Zhi-Qiang, Li; Zhi-Hao, Liu; Wen-Bo, Hu; Ting-Huai, Ma

2009-01-01

A novel efficient deterministic secure quantum communication scheme based on four-qubit cluster states and single-photon identity authentication is proposed. In this scheme, the two authenticated users can transmit two bits of classical information per cluster state, and its efficiency of the quantum communication is 1/3, which is approximately 1.67 times that of the previous protocol presented by Wang et al [Chin. Phys. Lett. 23 (2006) 2658]. Security analysis shows the present scheme is secure against intercept-resend attack and the impersonator's attack. Furthermore, it is more economic with present-day techniques and easily processed by a one-way quantum computer. (general)

Lightweight ECC based RFID authentication integrated with an ID verifier transfer protocol.

Science.gov (United States)

He, Debiao; Kumar, Neeraj; Chilamkurti, Naveen; Lee, Jong-Hyouk

2014-10-01

The radio frequency identification (RFID) technology has been widely adopted and being deployed as a dominant identification technology in a health care domain such as medical information authentication, patient tracking, blood transfusion medicine, etc. With more and more stringent security and privacy requirements to RFID based authentication schemes, elliptic curve cryptography (ECC) based RFID authentication schemes have been proposed to meet the requirements. However, many recently published ECC based RFID authentication schemes have serious security weaknesses. In this paper, we propose a new ECC based RFID authentication integrated with an ID verifier transfer protocol that overcomes the weaknesses of the existing schemes. A comprehensive security analysis has been conducted to show strong security properties that are provided from the proposed authentication scheme. Moreover, the performance of the proposed authentication scheme is analyzed in terms of computational cost, communicational cost, and storage requirement.

A service evaluation of self-referral to military mental health teams

Science.gov (United States)

Kennedy, I.; Jones, N.; Sharpley, J.; Greenberg, N.

2016-01-01

Background The UK military runs a comprehensive mental health service ordinarily accessed via primary care referrals. Aims To evaluate the feasibility of self-referral to mental health services within a military environment. Methods Three pilot sites were identified; one from each service (Royal Navy, Army, Air Force). Socio-demographic information included age, rank, service and career duration. Clinical data included prior contact with general practitioner (GP), provisional diagnosis and assessment outcome. Results Of the 57 self-referrals, 69% (n = 39) had not previously accessed primary care for their current difficulties. After their mental health assessment, 47 (82%) were found to have a formal mental health problem and 41 (72%) were offered a further mental health clinician appointment. The data compared favourably with a large military mental health department that reported 87% of primary care referrals had a formal mental health condition. Conclusions The majority of self-referrals had formal mental health conditions for which they had not previously sought help from primary care; most were offered further clinical input. This supports the view that self-referral may be a useful option to encourage military personnel to seek professional care over and above the usual route of accessing care through their GP. PMID:27121634

Additive operator-difference schemes splitting schemes

CERN Document Server

Vabishchevich, Petr N

2013-01-01

Applied mathematical modeling isconcerned with solving unsteady problems. This bookshows how toconstruct additive difference schemes to solve approximately unsteady multi-dimensional problems for PDEs. Two classes of schemes are highlighted: methods of splitting with respect to spatial variables (alternating direction methods) and schemes of splitting into physical processes. Also regionally additive schemes (domain decomposition methods)and unconditionally stable additive schemes of multi-component splitting are considered for evolutionary equations of first and second order as well as for sy

Secure anonymity-preserving password-based user authentication and session key agreement scheme for telecare medicine information systems.

Science.gov (United States)

Sutrala, Anil Kumar; Das, Ashok Kumar; Odelu, Vanga; Wazid, Mohammad; Kumari, Saru

2016-10-01

Information and communication and technology (ICT) has changed the entire paradigm of society. ICT facilitates people to use medical services over the Internet, thereby reducing the travel cost, hospitalization cost and time to a greater extent. Recent advancements in Telecare Medicine Information System (TMIS) facilitate users/patients to access medical services over the Internet by gaining health monitoring facilities at home. Amin and Biswas recently proposed a RSA-based user authentication and session key agreement protocol usable for TMIS, which is an improvement over Giri et al.'s RSA-based user authentication scheme for TMIS. In this paper, we show that though Amin-Biswas's scheme considerably improves the security drawbacks of Giri et al.'s scheme, their scheme has security weaknesses as it suffers from attacks such as privileged insider attack, user impersonation attack, replay attack and also offline password guessing attack. A new RSA-based user authentication scheme for TMIS is proposed, which overcomes the security pitfalls of Amin-Biswas's scheme and also preserves user anonymity property. The careful formal security analysis using the two widely accepted Burrows-Abadi-Needham (BAN) logic and the random oracle models is done. Moreover, the informal security analysis of the scheme is also done. These security analyses show the robustness of our new scheme against the various known attacks as well as attacks found in Amin-Biswas's scheme. The simulation of the proposed scheme using the widely accepted Automated Validation of Internet Security Protocols and Applications (AVISPA) tool is also done. We present a new user authentication and session key agreement scheme for TMIS, which fixes the mentioned security pitfalls found in Amin-Biswas's scheme, and we also show that the proposed scheme provides better security than other existing schemes through the rigorous security analysis and verification tool. Furthermore, we present the formal security

A robust anonymous biometric-based remote user authentication scheme using smart cards

Directory of Open Access Journals (Sweden)

Ashok Kumar Das

2015-04-01

Full Text Available Several biometric-based remote user authentication schemes using smart cards have been proposed in the literature in order to improve the security weaknesses in user authentication system. In 2012, An proposed an enhanced biometric-based remote user authentication scheme using smart cards. It was claimed that the proposed scheme is secure against the user impersonation attack, the server masquerading attack, the password guessing attack, and the insider attack and provides mutual authentication between the user and the server. In this paper, we first analyze the security of An’s scheme and we show that this scheme has three serious security flaws in the design of the scheme: (i flaw in user’s biometric verification during the login phase, (ii flaw in user’s password verification during the login and authentication phases, and (iii flaw in user’s password change locally at any time by the user. Due to these security flaws, An’s scheme cannot support mutual authentication between the user and the server. Further, we show that An’s scheme cannot prevent insider attack. In order to remedy the security weaknesses found in An’s scheme, we propose a new robust and secure anonymous biometric-based remote user authentication scheme using smart cards. Through the informal and formal security analysis, we show that our scheme is secure against all possible known attacks including the attacks found in An’s scheme. The simulation results of our scheme using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications tool ensure that our scheme is secure against passive and active attacks. In addition, our scheme is also comparable in terms of the communication and computational overheads with An’s scheme and other related existing schemes. As a result, our scheme is more appropriate for practical applications compared to other approaches.

10 CFR 820.72 - Referral to the Attorney General.

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2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Referral to the Attorney General. 820.72 Section 820.72... Referral to the Attorney General. If there is reason to believe a criminal violation of the Act or the DOE Nuclear Safety Requirements has occurred, DOE may refer the matter to the Attorney General of the United...

A Transactional Asynchronous Replication Scheme for Mobile Database Systems

Institute of Scientific and Technical Information of China (English)

丁治明; 孟小峰; 王珊

2002-01-01

In mobile database systems, mobility of users has a significant impact on data replication. As a result, the various replica control protocols that exist today in traditional distributed and multidatabase environments are no longer suitable. To solve this problem, a new mobile database replication scheme, the Transaction-Level Result-Set Propagation (TLRSP)model, is put forward in this paper. The conflict detection and resolution strategy based on TLRSP is discussed in detail, and the implementation algorithm is proposed. In order to compare the performance of the TLRSP model with that of other mobile replication schemes, we have developed a detailed simulation model. Experimental results show that the TLRSP model provides an efficient support for replicated mobile database systems by reducing reprocessing overhead and maintaining database consistency.

DS-ARP: a new detection scheme for ARP spoofing attacks based on routing trace for ubiquitous environments.

Science.gov (United States)

Song, Min Su; Lee, Jae Dong; Jeong, Young-Sik; Jeong, Hwa-Young; Park, Jong Hyuk

2014-01-01

Despite the convenience, ubiquitous computing suffers from many threats and security risks. Security considerations in the ubiquitous network are required to create enriched and more secure ubiquitous environments. The address resolution protocol (ARP) is a protocol used to identify the IP address and the physical address of the associated network card. ARP is designed to work without problems in general environments. However, since it does not include security measures against malicious attacks, in its design, an attacker can impersonate another host using ARP spoofing or access important information. In this paper, we propose a new detection scheme for ARP spoofing attacks using a routing trace, which can be used to protect the internal network. Tracing routing can find the change of network movement path. The proposed scheme provides high constancy and compatibility because it does not alter the ARP protocol. In addition, it is simple and stable, as it does not use a complex algorithm or impose extra load on the computer system.

Referral Practices Among U.S. Publicly Funded Health Centers That Offer Family Planning Services.

Science.gov (United States)

Carter, Marion W; Robbins, Cheryl L; Gavin, Loretta; Moskosky, Susan

2018-01-29

Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.

ESS-FH: Enhanced Security Scheme for Fast Handover in Hierarchical Mobile IPv6

Science.gov (United States)

You, Ilsun; Lee, Jong-Hyouk; Sakurai, Kouichi; Hori, Yoshiaki

Fast Handover for Hierarchical Mobile IPv6 (F-HMIPv6) that combines advantages of Fast Handover for Mobile IPv6 (FMIPv6) and Hierarchical Mobile IPv6 (HMIPv6) achieves the superior performance in terms of handover latency and signaling overhead compared with previously developed mobility protocols. However, without being secured, F-HMIPv6 is vulnerable to various security threats. In 2007, Kang and Park proposed a security scheme, which is seamlessly integrated into F-HMIPv6. In this paper, we reveal that Kang-Park's scheme cannot defend against the Denial of Service (DoS) and redirect attacks while largely relying on the group key. Then, we propose an Enhanced Security Scheme for F-HMIPv6 (ESS-FH) that achieves the strong key exchange and the key independence as well as addresses the weaknesses of Kang-Park's scheme. More importantly, it enables fast handover between different MAP domains. The proposed scheme is formally verified based on BAN-logic, and its handover latency is analyzed and compared with that of Kang-Park's scheme.

Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform.

Science.gov (United States)

Matloob, Samir A; Hyam, Jonathan A; Thorne, Lewis; Bradford, Robert

2016-01-01

Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them. During a 14-day period, number of bleeps, missed bleeps, calls discussing new referrals and previously processed referrals were recorded. Whether new referrals were appropriately documented and referrers received a written response was also recorded. A commercially provided secure cloud-based data archiving telecommunications and database platform for referrals was subsequently introduced within the Trust and the questionnaire repeated during another 14-day period 1 year after implementation. Missed bleeps per day reduced from 16% (SD ± 6.4%) to 9% (SD ± 4.8%; df = 13, paired t-tests p = 0.007) and mean calls per day clarifying previous referrals reduced from 10 (SD ± 4) to 5 (SD ± 3.5; df = 13, p = 0.003). Documentation of new referrals increased from 43% (74/174) to 85% (181/210), and responses to referrals increased from 74% to 98%. The use of a secure cloud-based data archiving telecommunications and database platform significantly increased the documentation of new referrals. This led to fewer missed bleeps and fewer calls about old referrals for the on call registrar. This system of documenting referrals results in improved continuity of care for neurosurgical patients, a significant reduction in risk for Trusts and a more efficient use of Registrar time.

Police referrals at the psychiatric emergency service in Taiwan.

Science.gov (United States)

Wang, Jen-Pang; Wu, Chia-Yi; Chiu, Chih-Chiang; Yang, Tsu-Hui; Liu, Tzong-Hsien; Chou, Pesus

2015-12-01

The police are the frontline workers in crisis situations involving patients with severe mental illness and act as a primary referral source for psychiatric emergency services (PES) in the community. The aims of this study were to investigate the distribution and characteristics of police referral among psychiatric patients in Taiwan. The study cohort consisted of patients who visited the PES of Taipei City Psychiatric Center from January 2009 to December 2010. The associations between the factors of demographics, clinical characteristics, and psychiatric service utilization and police referral were evaluated. Among the 7656 psychiatric emergency visits, 3029 (39.6%) were referred by the police. These patients referred by police were more likely to be male and aged between 30 to 49 years. Clinical factors related to police referrals including a higher triage assessment level, chief problems included violence, disturbance, substance use, less anxiety, and a diagnosis of unspecified psychosis. The triage assessment level and chief problems assessed by nurses were major predictors. These patients tended to be referred from the catchment area and during the nighttime shift, were discharged during the daytime shift, and stayed longer in the PES. Disposition arrangements such as discharge against medical advice and involuntary admission were also associated with police referrals. Patients referred by the police to the PES were those with more severe psychiatric problems and illnesses assessed by psychiatric nurses and psychiatrists. They tended to have more complex service utilization at the PES. © 2015 Wiley Publishing Asia Pty Ltd.

Remote upgrade and control system of NAT crossing based on mail protocol

Directory of Open Access Journals (Sweden)

Chen Lei

2017-02-01

Full Text Available This paper proposes a new scheme which uses transmits information such as related IP address and port by the mail server POP3 and SMTP protocol to realize net address turning (NAT crossing.The UDP connection between client and device node is realized by using "burrow" technology.Compared to the scheme that uses procedure server to realize NAT crossing schemes by the "burrow" technology,our scheme has advantages of saving operating costs,improving the stability of the system and enhancing the transferability of the system.With multiple equipment node,and a variety of network environment,we introduces the firmware update module,designs and realizes the remote upgrade and the control system of an intelligent device of Internet of Things based on the proposed scheme,and discusses the robustness of the system.

A Forward-secure Grouping-proof Protocol for Multiple RFID Tags

Directory of Open Access Journals (Sweden)

Liu Ya-li

2012-09-01

Full Text Available Designing secure and robust grouping-proof protocols based on RFID characteristics becomes a hotspot in the research of security in Internet of Things (IOT. The proposed grouping-proof protocols recently have security and/or privacy omission and these schemes afford order-dependence by relaying message among tags through an RFID reader. In consequence, aiming at enhancing the robustness, improving scalability, reducing the computation costs on resource-constrained devices, and meanwhile combing Computational Intelligence (CI with Secure Multi-party Communication (SMC, a Forward-Secure Grouping-Proof Protocol (FSGP for multiple RFID tags based on Shamir's (, secret sharing is proposed. In comparison with the previous grouping-proof protocols, FSGP has the characteristics of forward-security and order-independence addressing the scalability issue by avoiding relaying message. Our protocol provides security enhancement, performance improvement, and meanwhile controls the computation cost, which equilibrates both security and low cost requirements for RFID tags.

May the Kyoto protocol produce results?

International Nuclear Information System (INIS)

Jaureguy-Naudin, M.

2009-01-01

A not well managed drastic reduction of greenhouse emissions might result in significant decrease of living standards, but without such reduction efforts, climate change might have five to twenty times higher costs. Thus, while indicating estimated consequences or evolutions of greenhouse emissions and temperature, the author stresses the need of emission reduction. She discusses the role of economic instruments which can be used in policies aimed at the struggle against climate change. She recalls the emission reduction commitments specified in the Kyoto protocol, discusses the present status, operation and results of the international emission trading scheme, the lessons learned after the first years of operation, comments the involvement of emerging countries in relationship with another mechanism defined in the protocol: the Clean Development Mechanism

A Secure Routing Protocol for Wireless Sensor Networks Considering Secure Data Aggregation

Directory of Open Access Journals (Sweden)

Triana Mugia Rahayu

2015-06-01

Full Text Available The commonly unattended and hostile deployments of WSNs and their resource-constrained sensor devices have led to an increasing demand for secure energy-efficient protocols. Routing and data aggregation receive the most attention since they are among the daily network routines. With the awareness of such demand, we found that so far there has been no work that lays out a secure routing protocol as the foundation for a secure data aggregation protocol. We argue that the secure routing role would be rendered useless if the data aggregation scheme built on it is not secure. Conversely, the secure data aggregation protocol needs a secure underlying routing protocol as its foundation in order to be effectively optimal. As an attempt for the solution, we devise an energy-aware protocol based on LEACH and ESPDA that combines secure routing protocol and secure data aggregation protocol. We then evaluate its security effectiveness and its energy-efficiency aspects, knowing that there are always trade-off between both.

Improving an Anonymous and Provably Secure Authentication Protocol for a Mobile User

Directory of Open Access Journals (Sweden)

Jongho Moon

2017-01-01

Full Text Available Recently many authentication protocols using an extended chaotic map were suggested for a mobile user. Many researchers demonstrated that authentication protocol needs to provide key agreement, mutual authentication, and user anonymity between mobile user and server and resilience to many possible attacks. In this paper, we cautiously analyzed chaotic-map-based authentication scheme and proved that it is still insecure to off-line identity guessing, user and server impersonation, and on-line identity guessing attacks. To address these vulnerabilities, we proposed an improved protocol based on an extended chaotic map and a fuzzy extractor. We proved the security of the proposed protocol using a random oracle and AVISPA (Automated Validation of Internet Security Protocols and Applications tool. Furthermore, we present an informal security analysis to make sure that the improved protocol is invulnerable to possible attacks. The proposed protocol is also computationally efficient when compared to other previous protocols.

Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?

Science.gov (United States)

Bottino, Clement J; Rhodes, Erinn T; Kreatsoulas, Catherine; Cox, Joanne E; Fleegler, Eric W

2017-07-01

To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Security and Correctness Analysis on Privacy-Preserving k-Means Clustering Schemes

Science.gov (United States)

Su, Chunhua; Bao, Feng; Zhou, Jianying; Takagi, Tsuyoshi; Sakurai, Kouichi

Due to the fast development of Internet and the related IT technologies, it becomes more and more easier to access a large amount of data. k-means clustering is a powerful and frequently used technique in data mining. Many research papers about privacy-preserving k-means clustering were published. In this paper, we analyze the existing privacy-preserving k-means clustering schemes based on the cryptographic techniques. We show those schemes will cause the privacy breach and cannot output the correct results due to the faults in the protocol construction. Furthermore, we analyze our proposal as an option to improve such problems but with intermediate information breach during the computation.

Energy efficient routing protocols for wireless sensor networks: comparison and future directions

Directory of Open Access Journals (Sweden)

Loganathan Murukesan

2017-01-01

Full Text Available Wireless sensor network consists of nodes with limited resources. Hence, it is important to design protocols or algorithms which increases energy efficiency in order to improve the network lifetime. In this paper, techniques used in the network layer (routing of the internet protocol stack to achieve energy efficiency are reviewed. Usually, the routing protocols are classified into four main schemes: (1 Network Structure, (2 Communication Model, (3 Topology Based, and (4 Reliable Routing. In this work, only network structure based routing protocols are reviewed due to the page constraint. Besides, this type of protocols are much popular among the researchers since they are fairly simple to implement and produce good results as presented in this paper. Also, the pros and cons of each protocols are presented. Finally, the paper concludes with possible further research directions.

Trends in referral to a single encopresis clinic over 20 years.

Science.gov (United States)

Fishman, Laurie; Rappaport, Leonard; Schonwald, Alison; Nurko, Samuel

2003-05-01

To compare the characteristics of children with encopresis referred to a single encopresis clinic over the course of 20 years, including symptoms, previous diagnostic and therapeutic interventions, and parental attitudes. A retrospective study was conducted of an encopresis clinic at a tertiary care pediatric hospital. Questionnaires at initial evaluation elicited information about bowel habits, soiling, previous evaluations, previous treatments, and parental attitudes. In 503 children with encopresis, the average age of referral dropped from 115 months during the earliest 5 years to 77 months during the most recent 5 years. Children who had soiling for >3 years before referral decreased from 63% to 12%. The use of barium enema before referral decreased from 14% to 5%, as did psychological evaluation, from 25% to 14%. Previous therapy with enemas decreased from 45% to 27%. Mineral oil use remained at approximately 50%, and 20% of children had no previous treatment. Symptoms at referral and parental attitudes did not change across the years. Children are now referred at an earlier age to our tertiary encopresis clinic. The number of invasive and psychological evaluations has decreased before referral. However, treatment by many primary care providers before the referral has not changed. These data may suggest that pediatricians have increased awareness of encopresis and greater appreciation of its primarily physical rather than psychological nature. Additional studies will be needed to determine how these factors affect outcome.

A service evaluation of self-referral to military mental health teams.

Science.gov (United States)

Kennedy, I; Whybrow, D; Jones, N; Sharpley, J; Greenberg, N

2016-07-01

The UK military runs a comprehensive mental health service ordinarily accessed via primary care referrals. To evaluate the feasibility of self-referral to mental health services within a military environment. Three pilot sites were identified; one from each service (Royal Navy, Army, Air Force). Socio-demographic information included age, rank, service and career duration. Clinical data included prior contact with general practitioner (GP), provisional diagnosis and assessment outcome. Of the 57 self-referrals, 69% (n = 39) had not previously accessed primary care for their current difficulties. After their mental health assessment, 47 (82%) were found to have a formal mental health problem and 41 (72%) were offered a further mental health clinician appointment. The data compared favourably with a large military mental health department that reported 87% of primary care referrals had a formal mental health condition. The majority of self-referrals had formal mental health conditions for which they had not previously sought help from primary care; most were offered further clinical input. This supports the view that self-referral may be a useful option to encourage military personnel to seek professional care over and above the usual route of accessing care through their GP. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Referral criteria for school-based hearing screening in South Africa ...

African Journals Online (AJOL)

Referral criteria for school-based hearing screening in South Africa: Considerations for resource-limited contexts. ... Diagnostic audiometry confirmed that almost half (47%) of the referred children had a hearing loss. Conclusion: A screening intensity of 25 dB HL andimmediate rescreen reduces the referral rate significantly ...

Outcome of referrals for deceased organ donation to the government organ procurement organization.

Science.gov (United States)

Suguitan, G A; Cabanayan-Casasola, C B; Danguilan, R A; Jaro, J M A

2014-05-01

The Human Organ Preservation Effort is a government organ procurement organization that pioneered the Deceased Organ Donation Program in the Philippines. Deceased organ donation comprises only 20% of kidney transplantation in the Philippines in the last 3 years. Various measures were implemented to improve deceased organ donor referrals and organ retrieval. To compare outcome of deceased organ donor referrals from 2002 to 2008 and 2009 to 2012 in the Philippines. This retrospective study reviewed the deceased organ donor referrals from 2002 to 2008 and 2009 to 2012. There were 437 referrals for potential deceased organ donors from 2009 to 2012, compared to 434 referrals from 2002 to 2008. Referrals were mainly trauma victims (76%) followed by those with cerebrovascular accidents (12%). In the recent cohort, 81% were approached and 60% consented for donation, but only 23% were retrieved and transplanted. Among those not retrieved, the majority (19%) were medically unsuitable and 6% retracted their consent. Although there was an increasing trend of organ donation referrals in the last 4 years, only 25% were procured. The reasons for nonprocurement should be addressed. Copyright © 2014 Elsevier Inc. All rights reserved.

Dynamic Group Management Scheme for Sustainable and Secure Information Sensing in IoT

Directory of Open Access Journals (Sweden)

Hyungjoo Kim

2016-10-01

Full Text Available The services provided to users in the environment associated with the Internet of Things (hereinafter referred to as IoT begin with the information collected from sensors. It is imperative to transmit high-quality sensor data for providing better services. It is also required to collect data only from those authenticated sensors. Moreover, it is imperative to collect high-quality data on a sustainable and continuous basis in order to provide services anytime and anywhere in the IoT environment. Therefore, high-quality, authenticated sensor networks should be constructed. The most prominent routing protocol to enhance the energy consumption efficiency for the sustainable data collection in a sensor network is the LEACH routing protocol. The LEACH routing protocol transmits sensor data by measuring the energy of sensors and allocating sensor groups dynamically. However, these sensor networks have vulnerabilities such as key leakage, eavesdropping, replay attack and relay attack, given the nature of wireless network communication. A large number of security techniques have been studied in order to solve these vulnerabilities. Nonetheless, these studies still cannot support the dynamic sensor group allocation of the LEACH routing protocol. Furthermore, they are not suitable for the sensor nodes whose hardware computing ability and energy resources are limited. Therefore, this paper proposed a group sensor communication protocol that utilizes only the four fundamental arithmetic operations and logical operation for the sensor node authentication and secure data transmission. Through the security analysis, this paper verified that the proposed scheme was secure to the vulnerabilities resulting from the nature of wireless network communication. Moreover, this paper verified through the performance analysis that the proposed scheme could be utilized efficiently.

Interface Assignment-Based AODV Routing Protocol to Improve Reliability in Multi-Interface Multichannel Wireless Mesh Networks

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Won-Suk Kim

2015-01-01

Full Text Available The utilization of wireless mesh networks (WMNs has greatly increased, and the multi-interface multichannel (MIMC technic has been widely used for the backbone network. Unfortunately, the ad hoc on-demand distance vector (AODV routing protocol defined in the IEEE 802.11s standard was designed for WMNs using the single-interface single-channel technic. So, we define a problem that happens when the legacy AODV is used in MIMC WMNs and propose an interface assignment-based AODV (IA-AODV in order to resolve that problem. IA-AODV, which is based on multitarget path request, consists of the PREQ prediction scheme, the PREQ loss recovery scheme, and the PREQ sender assignment scheme. A detailed operation according to various network conditions and services is introduced, and the routing efficiency and network reliability of a network using IA-AODV are analyzed over the presented system model. Finally, after a real-world test-bed for MIMC WMNs using the IA-AODV routing protocol is implemented, the various indicators of the network are evaluated through experiments. When the proposed routing protocol is compared with the existing AODV routing protocol, it performs the path update using only 14.33% of the management frames, completely removes the routing malfunction, and reduces the UDP packet loss ratio by 0.0012%.

Harmonisation between National and International Tradeable Permit Schemes. CATEP Synthesis Paper

International Nuclear Information System (INIS)

Haites, E.

2003-01-01

It is technically possible to link national emissions trading schemes with widely divergent designs. Where design differences create potential problems, technical solutions are available. The greater the similarity of their designs, the easier schemes are to link. During the 2005 - 2007 period the EU Directive, if it is adopted, will lead to the establishment of at least 25 national emissions trading schemes. The Directive specifies many of the design features of these schemes, but leaves the allocation of allowances, rules for banking allowances into the commitment period, use of the opt-out provision, and a few other design features to Member States. The resulting differences among Member State schemes are unlikely to undermine the links between the schemes established by the Directive. The Community may enter into agreements with non-members for mutual recognition of allowances between their emissions trading schemes, but few, if any, links of this type are expected prior to 2008 for practical reasons. Beginning in 2008, Article 17 of the Kyoto Protocol establishes an international emissions trading scheme that can link the national trading schemes of Annex I Parties. It imposes no requirements for harmonisation on the national emissions trading schemes linked. Some design differences could create technical problems, although solutions are available and at least one of the governments involved has an incentive to solve the problem. Adverse competitiveness impacts due to differences in the distribution of allowances across national schemes may need to be addressed through institutions such as the WTO. Most of the national trading schemes will also be subject to the EU Directive and be subject to greater harmonisation after 2008. The result is likely to be a progressive expansion and integration of greenhouse gas allowance markets over the next decade

Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India

Directory of Open Access Journals (Sweden)

Shashi Kant

2018-01-01

Full Text Available Background: The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care. Objective: This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH. Methods: An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed. Results: The referral rate was found to be 31.7%. Preterm labor (30.6%, pregnancy-induced hypertension (17%, and fetal distress (10.6% were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank. Conclusions: The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.

An Anonymous Access Authentication Scheme Based on Proxy Ring Signature for CPS-WMNs

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Tianhan Gao

2017-01-01

Full Text Available Access security and privacy have become a bottleneck for the popularization of future Cyber-Physical System (CPS networks. Furthermore, users’ need for privacy-preserved access during movement procedure is more urgent. To address the anonymous access authentication issue for CPS Wireless Mesh Network (CPS-WMN, a novel anonymous access authentication scheme based on proxy ring signature is proposed. A hierarchical authentication architecture is presented first. The scheme is then achieved from the aspect of intergroup and intragroup anonymous mutual authentication through proxy ring signature mechanism and certificateless signature mechanism, respectively. We present a formal security proof of the proposed protocol with SVO logic. The simulation and performance analysis demonstrate that the proposed scheme owns higher efficiency and adaptability than the typical one.

Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care.

Science.gov (United States)

Taft, Angela J; Small, Rhonda; Humphreys, Cathy; Hegarty, Kelsey; Walter, Ruby; Adams, Catina; Agius, Paul

2012-09-20

Intimate partner violence (IPV) can result in significant harm to women and families and is especially prevalent when women are pregnant or recent mothers. Maternal and child health nurses (MCHN) in Victoria, Australia are community-based nurse/midwives who see over 95% of all mothers with newborns. MCHN are in an ideal position to identify and support women experiencing IPV, or refer them to specialist family violence services. Evidence for IPV screening in primary health care is inconclusive to date. The Victorian government recently required nurses to screen all mothers when babies are four weeks old, offering an opportunity to examine the effectiveness of MCHN IPV screening practices. This protocol describes the development and design of MOVE, a study to examine IPV screening effectiveness and the sustainability of screening practice. MOVE is a cluster randomised trial of a good practice model of MCHN IPV screening involving eight maternal and child health nurse teams in Melbourne, Victoria. Normalisation Process Theory (NPT) was incorporated into the design, implementation and evaluation of the MOVE trial to enhance and evaluate sustainability. Using NPT, the development stage combined participatory action research with intervention nurse teams and a systematic review of nurse IPV studies to develop an intervention model incorporating consensus guidelines, clinical pathway and strategies for individual nurses, their teams and family violence services. Following twelve months' implementation, primary outcomes assessed include IPV inquiry, IPV disclosure by women and referral using data from MCHN routine data collection and a survey to all women giving birth in the previous eight months. IPV will be measured using the Composite Abuse Scale. Process and impact evaluation data (online surveys and key stakeholders interviews) will highlight NPT concepts to enhance sustainability of IPV identification and referral. Data will be collected again in two years. MOVE

An On-Demand Emergency Packet Transmission Scheme for Wireless Body Area Networks.

Science.gov (United States)

Al Ameen, Moshaddique; Hong, Choong Seon

2015-12-04

The rapid developments of sensor devices that can actively monitor human activities have given rise to a new field called wireless body area network (BAN). A BAN can manage devices in, on and around the human body. Major requirements of such a network are energy efficiency, long lifetime, low delay, security, etc. Traffic in a BAN can be scheduled (normal) or event-driven (emergency). Traditional media access control (MAC) protocols use duty cycling to improve performance. A sleep-wake up cycle is employed to save energy. However, this mechanism lacks features to handle emergency traffic in a prompt and immediate manner. To deliver an emergency packet, a node has to wait until the receiver is awake. It also suffers from overheads, such as idle listening, overhearing and control packet handshakes. An external radio-triggered wake up mechanism is proposed to handle prompt communication. It can reduce the overheads and improve the performance through an on-demand scheme. In this work, we present a simple-to-implement on-demand packet transmission scheme by taking into considerations the requirements of a BAN. The major concern is handling the event-based emergency traffic. The performance analysis of the proposed scheme is presented. The results showed significant improvements in the overall performance of a BAN compared to state-of-the-art protocols in terms of energy consumption, delay and lifetime.

An On-Demand Emergency Packet Transmission Scheme for Wireless Body Area Networks

Directory of Open Access Journals (Sweden)

Moshaddique Al Ameen

2015-12-01

Full Text Available The rapid developments of sensor devices that can actively monitor human activities have given rise to a new field called wireless body area network (BAN. A BAN can manage devices in, on and around the human body. Major requirements of such a network are energy efficiency, long lifetime, low delay, security, etc. Traffic in a BAN can be scheduled (normal or event-driven (emergency. Traditional media access control (MAC protocols use duty cycling to improve performance. A sleep-wake up cycle is employed to save energy. However, this mechanism lacks features to handle emergency traffic in a prompt and immediate manner. To deliver an emergency packet, a node has to wait until the receiver is awake. It also suffers from overheads, such as idle listening, overhearing and control packet handshakes. An external radio-triggered wake up mechanism is proposed to handle prompt communication. It can reduce the overheads and improve the performance through an on-demand scheme. In this work, we present a simple-to-implement on-demand packet transmission scheme by taking into considerations the requirements of a BAN. The major concern is handling the event-based emergency traffic. The performance analysis of the proposed scheme is presented. The results showed significant improvements in the overall performance of a BAN compared to state-of-the-art protocols in terms of energy consumption, delay and lifetime.

38 CFR 1.953 - Minimum amount of referrals to the Department of Justice.

Science.gov (United States)

2010-07-01

... referrals to the Department of Justice. 1.953 Section 1.953 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS GENERAL PROVISIONS Referrals to Gao, Department of Justice, Or Irs § 1.953 Minimum amount of referrals to the Department of Justice. (a) Except as otherwise provided in paragraphs...

Comparison of patient referral processes between rural and urban health facilities in Liberia

Directory of Open Access Journals (Sweden)

J. Kim*

2013-12-01

Conclusions: Patient referral systems in Liberia are relatively unsystematic. While formal and informal mechanisms for referrals exist at both rural and urban health facilities, establishing guidelines for referral care practices and transportation strategies tailored to each of these settings will help to strengthen the healthcare system as a whole.

A Smart Collaborative Routing Protocol for Reliable Data Diffusion in IoT Scenarios.

Science.gov (United States)

Ai, Zheng-Yang; Zhou, Yu-Tong; Song, Fei

2018-06-13

It is knotty for current routing protocols to meet the needs of reliable data diffusion during the Internet of Things (IoT) deployments. Due to the random placement, limited resources and unattended features of existing sensor nodes, the wireless transmissions are easily exposed to unauthorized users, which becomes a vulnerable area for various malicious attacks, such as wormhole and Sybil attacks. However, the scheme based on geographic location is a suitable candidate to defend against them. This paper is inspired to propose a smart collaborative routing protocol, Geographic energy aware routing and Inspecting Node (GIN), for guaranteeing the reliability of data exchanging. The proposed protocol integrates the directed diffusion routing, Greedy Perimeter Stateless Routing (GPSR), and the inspecting node mechanism. We first discuss current wireless routing protocols from three diverse perspectives (improving transmission rate, shortening transmission range and reducing transmission consumption). Then, the details of GIN, including the model establishment and implementation processes, are presented by means of the theoretical analysis. Through leveraging the game theory, the inspecting node is elected to monitor the network behaviors. Thirdly, we evaluate the network performances, in terms of transmission delay, packet loss ratio, and throughput, between GIN and three traditional schemes (i.e., Flooding, GPSR, and GEAR). The simulation results illustrate that the proposed protocol is able to outperform the others.

Cluster chain based energy efficient routing protocol for moblie WSN

Directory of Open Access Journals (Sweden)

WU Ziyu

2016-04-01

Full Text Available With the ubiquitous smart devices acting as mobile sensor nodes in the wireless sensor networks(WSNs to sense and transmit physical information,routing protocols should be designed to accommodate the mobility issues,in addition to conventional considerations on energy efficiency.However,due to frequent topology change,traditional routing schemes cannot perform well.Moreover,existence of mobile nodes poses new challenges on energy dissipation and packet loss.In this paper,a novel routing scheme called cluster chain based routing protocol(CCBRP is proposed,which employs a combination of cluster and chain structure to accomplish data collection and transmission and thereafter selects qualified cluster heads as chain leaders to transmit data to the sink.Furthermore,node mobility is handled based on periodical membership update of mobile nodes.Simulation results demonstrate that CCBRP has a good performance in terms of network lifetime and packet delivery,also strikes a better balance between successful packet reception and energy consumption.

A Hierarchical Energy Efficient Reliable Transport Protocol for Wireless Sensor Networks

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Prabhudutta Mohanty

2014-12-01

Full Text Available The two important requirements for many Wireless Senor Networks (WSNs are prolonged network lifetime and end-to-end reliability. The sensor nodes consume more energy during data transmission than the data sensing. In WSN, the redundant data increase the energy consumption, latency and reduce reliability during data transmission. Therefore, it is important to support energy efficient reliable data transport in WSNs. In this paper, we present a Hierarchical Energy Efficient Reliable Transport Protocol (HEERTP for the data transmission within the WSN. This protocol maximises the network lifetime by controlling the redundant data transmission with the co-ordination of Base Station (BS. The proposed protocol also achieves end-to-end reliability using a hop-by-hop acknowledgement scheme. We evaluate the performance of the proposed protocol through simulation. The simulation results reveal that our proposed protocol achieves better performance in terms of energy efficiency, latency and reliability than the existing protocols.

22 CFR 213.37 - Referrals to the Department of Justice.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Referrals to the Department of Justice. 213.37... Department of Justice § 213.37 Referrals to the Department of Justice. (a) The CFO, through the FMS cross... of Justice's Nationwide Central Intake Facility as required by the Claims Collection Litigation...

Why Doctors Do Not Answer Referral Letters | Smith | South African ...

African Journals Online (AJOL)

Background: Healthcare workers at primary healthcare (PHC) clinics are frustrated by the fact that they do not receive replies to their referral letters to doctors. Referral letters act as permission slips to allow patients easy access to treatment by specialists at secondary and tertiary service levels and communicate reasons for ...

20 CFR 658.414 - Referral of non-JS-related complaints.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of non-JS-related complaints. 658... ADMINISTRATIVE PROVISIONS GOVERNING THE JOB SERVICE SYSTEM Job Service Complaint System State Agency Js Complaint System § 658.414 Referral of non-JS-related complaints. (a) To facilitate the operation of the...

User Satisfaction with Referrals at a Collaborative Virtual Reference Service

Science.gov (United States)

Kwon, Nahyun

2006-01-01

Introduction: This study investigated unmonitored referrals in a nationwide, collaborative chat reference service. Specifically, it examined the extent to which questions are referred, the types of questions that are more likely to be referred than others, and the level of user satisfaction with the referrals in the collaborative chat reference…

Can adding web-based support to UK primary care exercise referral schemes improve patients’ physical activity levels? Findings from an internal pilot study.

Directory of Open Access Journals (Sweden)

Adrian Taylor

2015-10-01

Full Text Available Background: Promoting physical activity (PA via primary care exercise referral schemes (ERS is common but there is no rigorous evidence for long term changes in PA (Pavey et al, 2011 among those with chronic conditions. From July 2015, for 15 months, the e-coachER trial began to recruit 1400 patients (in SW England, Birmingham and Glasgow with one or more chronic conditions including diabetes, obesity, hypertension, osteoarthritis, or depression, who are eligible and about to attend an ERS. The two-arm parallel RCT is powered to determine if the addition of a web-based, interactive, theory-driven and evidence-based support system called e-coachER (hosted on the ‘LifeGuide’ platform will result in at least 10% more patients who do 150 mins or more per week of accelerometer assessed moderate or vigorous physical activity (MVPA at 12 months. Recruitment into the trial is within primary care, using both mail-merged patient invitations and opportunistic GP invitations (and exercise referrals. Within the trial, after participants are screened, provide consent and complete baseline assessments, they are randomised to receive usual ERS at each site or usual ERS plus a mailed Welcome Pack with registration details to access e-coachER on-line. Inclusion criteria for entering the trial are: (1 Aged 16-74 years; (2 with one or more of the following: obesity (BMI 30-35, hypertension (SBP 140-179 or DBP 90-109, type 2 diabetes, lower limb osteoarthritis, recent history of treatment for depression; (3 Participants who are in the two lowest (of four groups using the GP Physical Activity Questionnaire; (4 have an e-mail address and access to the internet; (5 Eligible for an ERS. The intervention rationale, design and content are reported in another presentation. Aims: This presentation will provide initial findings from a 3 month internal pilot phase with a focus on trial recruitment and initial intervention engagement. We will present data on the

An Enhanced Three-Factor User Authentication Scheme Using Elliptic Curve Cryptosystem for Wireless Sensor Networks

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Chenyu Wang

2017-12-01

Full Text Available As an essential part of Internet of Things (IoT, wireless sensor networks (WSNs have touched every aspect of our lives, such as health monitoring, environmental monitoring and traffic monitoring. However, due to its openness, wireless sensor networks are vulnerable to various security threats. User authentication, as the first fundamental step to protect systems from various attacks, has attracted much attention. Numerous user authentication protocols armed with formal proof are springing up. Recently, two biometric-based schemes were proposed with confidence to be resistant to the known attacks including offline dictionary attack, impersonation attack and so on. However, after a scrutinization of these two schemes, we found them not secure enough as claimed, and then demonstrated that these schemes suffer from various attacks, such as offline dictionary attack, impersonation attack, no user anonymity, no forward secrecy, etc. Furthermore, we proposed an enhanced scheme to overcome the identified weaknesses, and proved its security via Burrows–Abadi–Needham (BAN logic and the heuristic analysis. Finally, we compared our scheme with other related schemes, and the results showed the superiority of our scheme.

An Enhanced Three-Factor User Authentication Scheme Using Elliptic Curve Cryptosystem for Wireless Sensor Networks.

Science.gov (United States)

Wang, Chenyu; Xu, Guoai; Sun, Jing

2017-12-19

As an essential part of Internet of Things (IoT), wireless sensor networks (WSNs) have touched every aspect of our lives, such as health monitoring, environmental monitoring and traffic monitoring. However, due to its openness, wireless sensor networks are vulnerable to various security threats. User authentication, as the first fundamental step to protect systems from various attacks, has attracted much attention. Numerous user authentication protocols armed with formal proof are springing up. Recently, two biometric-based schemes were proposed with confidence to be resistant to the known attacks including offline dictionary attack, impersonation attack and so on. However, after a scrutinization of these two schemes, we found them not secure enough as claimed, and then demonstrated that these schemes suffer from various attacks, such as offline dictionary attack, impersonation attack, no user anonymity, no forward secrecy, etc. Furthermore, we proposed an enhanced scheme to overcome the identified weaknesses, and proved its security via Burrows-Abadi-Needham (BAN) logic and the heuristic analysis. Finally, we compared our scheme with other related schemes, and the results showed the superiority of our scheme.

Design and analysis of communication protocols for quantum repeater networks

International Nuclear Information System (INIS)

Jones, Cody; Kim, Danny; Rakher, Matthew T; Ladd, Thaddeus D; Kwiat, Paul G

2016-01-01

We analyze how the performance of a quantum-repeater network depends on the protocol employed to distribute entanglement, and we find that the choice of repeater-to-repeater link protocol has a profound impact on entanglement-distribution rate as a function of hardware parameters. We develop numerical simulations of quantum networks using different protocols, where the repeater hardware is modeled in terms of key performance parameters, such as photon generation rate and collection efficiency. These parameters are motivated by recent experimental demonstrations in quantum dots, trapped ions, and nitrogen-vacancy centers in diamond. We find that a quantum-dot repeater with the newest protocol (‘MidpointSource’) delivers the highest entanglement-distribution rate for typical cases where there is low probability of establishing entanglement per transmission, and in some cases the rate is orders of magnitude higher than other schemes. Our simulation tools can be used to evaluate communication protocols as part of designing a large-scale quantum network. (paper)

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral.

Science.gov (United States)

Rahman, Rachel Jane; Thogersen-Ntoumani, Cecilie; Thatcher, Joanne; Doust, Jonathan

2011-11-01

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N = 293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.

A novel and efficient user access control scheme for wireless body area sensor networks

Directory of Open Access Journals (Sweden)

Santanu Chatterjee

2014-07-01

Full Text Available Wireless body area networks (WBANs can be applied to provide healthcare and patient monitoring. However, patient privacy can be vulnerable in a WBAN unless security is considered. Access to authorized users for the correct information and resources for different services can be provided with the help of efficient user access control mechanisms. This paper proposes a new user access control scheme for a WBAN. The proposed scheme makes use of a group-based user access ID, an access privilege mask, and a password. An elliptic curve cryptography-based public key cryptosystem is used to ensure that a particular legitimate user can only access the information for which he/she is authorized. We show that our scheme performs better than previously existing user access control schemes. Through a security analysis, we show that our scheme is secure against possible known attacks. Furthermore, through a formal security verification using the AVISPA (Automated Validation of Internet Security Protocols and Applications tool, we show that our scheme is also secure against passive and active attacks.

Justification of doctors' referral for radiological imaging among some Nigerian doctors

Directory of Open Access Journals (Sweden)

Emmanuel Osaigbovo Ighodaro

2017-01-01

Full Text Available Introduction: The demand for radiological examination has increased tremendously despite paucity of referring clinicians' knowledge on radiation protection. Reasons to justify these referrals vary. Consequently, the aim of this study is to evaluate the relationship between clinicians' knowledge of radiological imaging dosage to their referral justification and guideline. Materials and Methods: Structured questionnaires were developed with four sections (Section 1, sociodemographic data; Section 2, justification for imaging referral; Section 3, knowledge of radiation dose to patients; Section 4, effect of irradiation. The questionnaires were administered at a previous Nigerian Medical Association National Conference, which took place at Lagos in 2013. Sections 3 and 4 were scored and rated. Results: The respondents gave plausible reasons to refer patients for radiological evaluation despite the observation that majority of them were unaware of the existence of referral guidelines and had poor knowledge on radiation. Only 16 (12.2% of the respondents had a fair score on knowledge about radiation dose to patients while 110 (84.0% had poor score. Five (3.8% of the respondents had good score. Similarly, on identifying effect of radiation, 10 (7.6% had good score, 4 (3.1% fair score, and 117 (89.3% poor score. Conclusion: Most of the referrals of patients for radiological evaluation by the respondents were not based on the standard guidelines. Therefore, it is pertinent that referral guidelines should be developed and implemented and clinicians should be educated and trained on radiation protection.

Energy Efficient Clustering Protocol to Enhance Performance of Heterogeneous Wireless Sensor Network: EECPEP-HWSN

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Santosh V. Purkar

2018-01-01

Full Text Available Heterogeneous wireless sensor network (HWSN fulfills the requirements of researchers in the design of real life application to resolve the issues of unattended problem. But, the main constraint faced by researchers is the energy source available with sensor nodes. To prolong the life of sensor nodes and thus HWSN, it is necessary to design energy efficient operational schemes. One of the most suitable approaches to enhance energy efficiency is the clustering scheme, which enhances the performance parameters of WSN. A novel solution proposed in this article is to design an energy efficient clustering protocol for HWSN, to enhance performance parameters by EECPEP-HWSN. The proposed protocol is designed with three level nodes namely normal, advanced, and super, respectively. In the clustering process, for selection of cluster head we consider different parameters available with sensor nodes at run time that is, initial energy, hop count, and residual energy. This protocol enhances the energy efficiency of HWSN and hence improves energy remaining in the network, stability, lifetime, and hence throughput. It has been found that the proposed protocol outperforms than existing well-known LEACH, DEEC, and SEP with about 188, 150, and 141 percent respectively.

Improving efficiency and saving money in an otolaryngology urgent referral clinic.

Science.gov (United States)

Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

2015-06-16

A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.

On the security of a novel key agreement protocol based on chaotic maps

International Nuclear Information System (INIS)

Xiang Tao; Wong, K.-W.; Liao Xiaofeng

2009-01-01

Recently, Xiao et al. proposed a novel key agreement protocol based on Chebyshev chaotic map. In this paper, the security of the protocol is analyzed, and two attack methods can be found in different scenarios. The essential principle of Xiao et al.'s scheme is summarized. It is also pointed out with proof that any attempt along this line to improve the security of Chebyshev map is redundant.

Pulmonary hypertension: Real-world data from a Portuguese expert referral centre.

Science.gov (United States)

Gomes, A; Cruz, C; Rocha, J; Ricardo, M; Vicente, M; Melo, A; Santos, M; Carvalho, L; Gonçalves, F; Reis, A

2018-04-16

Pulmonary hypertension (PH) is a heterogeneous, debilitating condition with highly relevant impact on functional capacity, quality of life, and life-expectancy. This study aims to provide long-term data on the Portuguese PH population, by characterising the clinical presentation, evolution, and outcomes of PH patients in a specialised referral centre. Retrospective analysis of a cohort of 101 patients with pre-capillary PH (pcPH) referenced to an expert tertiary care referral centre in northern Portugal from 2002 to 2013. Diagnosis was confirmed by right heart catheterisation (RHC). PH classification followed consensus criteria from the 5th World Symposium in Nice, 2013. The most frequent causes of pcPH were Group 1 PH - pulmonary arterial hypertension (PAH) (54.4%) and Group 4 PH - Chronic thromboembolic pulmonary hypertension (CTEPH) (25.7%); importantly, 17.8% of patients presented PH associated with multiple aetiologies. Targeted therapy was used in 91.1% of patients (48.5% combination therapy). 1-, 3-, and 5-year survival was estimated at 86.6%, 76.7%, and 64.1%, respectively. Survival was significantly better for those ≤40 years old (10.5 vs. 6.4 years; P=0.003) and for women with I/HPAH (9.3 vs. 4.5 years; P=0.039). This study provides long-term, real-world data for the management of PAH and CTEPH in Portugal and demonstrates the importance of dedicated electronic medical records and well defined clinical management protocols for better patient outcomes. Patients presented mostly with intermediate or high risk of mortality, which suggests delayed diagnosis and highlights the need to increase awareness among clinicians. Copyright © 2018 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Modeling and Performance Analysis of Route-Over and Mesh-Under Routing Schemes in 6LoWPAN under Error-Prone Channel Condition

Directory of Open Access Journals (Sweden)

Tsung-Han Lee

2013-01-01

Full Text Available 6LoWPAN technology has attracted extensive attention recently. It is because 6LoWPAN is one of Internet of Things standard and it adapts to IPv6 protocol stack over low-rate wireless personal area network, such as IEEE 802.15.4. One view is that IP architecture is not suitable for low-rate wireless personal area network. It is a challenge to implement the IPv6 protocol stack into IEEE 802.15.4 devices due to that the size of IPv6 packet is much larger than the maximum packet size of IEEE 802.15.4 in data link layer. In order to solve this problem, 6LoWPAN provides header compression to reduce the transmission overhead for IP packets. In addition, two selected routing schemes, mesh-under and route-over routing schemes, are also proposed in 6LoWPAN to forward IP fragmentations under IEEE 802.15.4 radio link. The distinction is based on which layer of the 6LoWPAN protocol stack is in charge of routing decisions. In route-over routing scheme, the routing distinction is taken at the network layer and, in mesh-under, is taken by the adaptation layer. Thus, the goal of this research is to understand the performance of two routing schemes in 6LoWPAN under error-prone channel condition.

Community referral in home management of malaria in western Uganda: A case series study

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Nsungwa-Sabiiti Jesca

2006-03-01

Full Text Available Abstract Background Home Based Management of fever (HBM was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children Methods A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral. Results Overall referral rate was 8% (117/1454. Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93% "urgent referrals" accessed referral care but 8 (31% delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50% were urgently referred; most delayed ≥ 2 days before accessing referral care. Conclusion The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.

The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

DEFF Research Database (Denmark)

Lewinter, Christian; Bland, John M; Crouch, Simon

2014-01-01

BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI......% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion...... (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003. CONCLUSIONS: CR referral was associated with improved survival in 2003...

An XML-Based Protocol for Distributed Event Services

Science.gov (United States)

Smith, Warren; Gunter, Dan; Quesnel, Darcy; Biegel, Bryan (Technical Monitor)

2001-01-01

This viewgraph presentation provides information on the application of an XML (extensible mark-up language)-based protocol to the developing field of distributed processing by way of a computational grid which resembles an electric power grid. XML tags would be used to transmit events between the participants of a transaction, namely, the consumer and the producer of the grid scheme.

Referral determinants in Swiss primary care with a special focus on managed care.

Directory of Open Access Journals (Sweden)

Ryan Tandjung

Full Text Available Studies have shown large variation of referral probabilities in different countries, and many influencing factors have been described. This variation is most likely explained by different healthcare systems, particularly to which extent primary care physicians (PCPs act as gatekeepers. In Switzerland no mandatory gatekeeping system exists, however insurance companies offer voluntary managed care plans with reduced insurance premiums. We aimed at investigating the role of managed care plans as a potential referral determinant in a non-gatekeeping healthcare system. We conducted a cross-sectional study with 90 PCPs collecting data on consultations and referrals in 2012/2013. During each consultation up to six reasons for encounters (RFE were documented. For each RFE PCPs indicated whether a referral was initiated. Determinants for referrals were analyzed by hierarchical logistic regression, taking the potential cluster effect of the PCP into account. To further investigate the independent association of the managed care plan with the referral probability, a hierarchical multivariate logistic regression model was applied, taking into account all available data potentially affecting the referring decision. PCPs collected data on 24'774 patients with 42'890 RFE, of which 2427 led to a referral. 37.5% of patients were insured in managed health care plans. Univariate analysis showed significant higher referral rates of patients with managed care plans (10.7% vs. 8.5%. The difference in referral probability remained significant after controlling for other confounders in the hierarchical multivariate regression model (OR 1.355. Patients in managed care plans were more likely to be referred than patients without such a model. These data contradict the argument that patients in managed care plans have limited healthcare access, but underline the central role of PCPs as coordinator of care.

Characteristics of patients with diabetes who accept referrals for care management services

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Bree Holtz

2016-01-01

Full Text Available Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75% accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities.

10 CFR 1015.505 - Minimum amount of referrals to the Department of Justice.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Minimum amount of referrals to the Department of Justice... THE UNITED STATES Referrals to the Department of Justice § 1015.505 Minimum amount of referrals to the Department of Justice. (a) DOE shall not refer for litigation claims of less than $2,500, exclusive of...

32 CFR 701.9 - Referrals.

Science.gov (United States)

2010-07-01

... referral, a point of contact by name, a telephone number (commercial and DSN), and an e-mail address (if... record any FOIA request for investigative, intelligence, or any other type of records that are on loan to.... However, if for investigative or intelligence purposes, the outside agency desires anonymity, a DON...

Development, appraisal, validation and implementation of a consensus protocol for the assessment of cerebral amyloid angiopathy in post-mortem brain tissue

Science.gov (United States)

Love, Seth; Chalmers, Katy; Ince, Paul; Esiri, Margaret; Attems, Johannes; Jellinger, Kurt; Yamada, Masahito; McCarron, Mark; Minett, Thais; Matthews, Fiona; Greenberg, Steven; Mann, David; Kehoe, Patrick Gavin

2014-01-01

In a collaboration involving 11 groups with research interests in cerebral amyloid angiopathy (CAA), we used a two-stage process to develop and in turn validate a new consensus protocol and scoring scheme for the assessment of CAA and associated vasculopathic abnormalities in post-mortem brain tissue. Stage one used an iterative Delphi-style survey to develop the consensus protocol. The resultant scoring scheme was tested on a series of digital images and paraffin sections that were circulated blind to a number of scorers. The scoring scheme and choice of staining methods were refined by open-forum discussion. The agreed protocol scored parenchymal and meningeal CAA on a 0-3 scale, capillary CAA as present/absent and vasculopathy on 0-2 scale, in the 4 cortical lobes that were scored separately. A further assessment involving three centres was then undertaken. Neuropathologists in three centres (Bristol, Oxford and Sheffield) independently scored sections from 75 cases (25 from each centre) and high inter-rater reliability was demonstrated. Stage two used the results of the three-centre assessment to validate the protocol by investigating previously described associations between APOE genotype (previously determined), and both CAA and vasculopathy. Association of capillary CAA with or without arteriolar CAA with APOE ε4 was confirmed. However APOE ε2 was also found to be a strong risk factor for the development of CAA, not only in AD but also in elderly non-demented controls. Further validation of this protocol and scoring scheme is encouraged, to aid its wider adoption to facilitate collaborative and replication studies of CAA. PMID:24754000

Connection Setup Signaling Scheme with Flooding-Based Path Searching for Diverse-Metric Network

Science.gov (United States)

Kikuta, Ko; Ishii, Daisuke; Okamoto, Satoru; Oki, Eiji; Yamanaka, Naoaki

Connection setup on various computer networks is now achieved by GMPLS. This technology is based on the source-routing approach, which requires the source node to store metric information of the entire network prior to computing a route. Thus all metric information must be distributed to all network nodes and kept up-to-date. However, as metric information become more diverse and generalized, it is hard to update all information due to the huge update overhead. Emerging network services and applications require the network to support diverse metrics for achieving various communication qualities. Increasing the number of metrics supported by the network causes excessive processing of metric update messages. To reduce the number of metric update messages, another scheme is required. This paper proposes a connection setup scheme that uses flooding-based signaling rather than the distribution of metric information. The proposed scheme requires only flooding of signaling messages with requested metric information, no routing protocol is required. Evaluations confirm that the proposed scheme achieves connection establishment without excessive overhead. Our analysis shows that the proposed scheme greatly reduces the number of control messages compared to the conventional scheme, while their blocking probabilities are comparable.

49 CFR 1018.72 - Referral to the Department of Justice.

Science.gov (United States)

2010-10-01

... 49 Transportation 8 2010-10-01 2010-10-01 false Referral to the Department of Justice. 1018.72... Claim § 1018.72 Referral to the Department of Justice. (a) Claims for which the gross original amount is... Justice, Washington, DC 20530. Claims for which the gross original amount is $500,000 or less must be...

Locally decodable codes and private information retrieval schemes

CERN Document Server

Yekhanin, Sergey

2010-01-01

Locally decodable codes (LDCs) are codes that simultaneously provide efficient random access retrieval and high noise resilience by allowing reliable reconstruction of an arbitrary bit of a message by looking at only a small number of randomly chosen codeword bits. Local decodability comes with a certain loss in terms of efficiency - specifically, locally decodable codes require longer codeword lengths than their classical counterparts. Private information retrieval (PIR) schemes are cryptographic protocols designed to safeguard the privacy of database users. They allow clients to retrieve rec

An enhanced biometric authentication scheme for telecare medicine information systems with nonce using chaotic hash function.

Science.gov (United States)

Das, Ashok Kumar; Goswami, Adrijit

2014-06-01

Recently, Awasthi and Srivastava proposed a novel biometric remote user authentication scheme for the telecare medicine information system (TMIS) with nonce. Their scheme is very efficient as it is based on efficient chaotic one-way hash function and bitwise XOR operations. In this paper, we first analyze Awasthi-Srivastava's scheme and then show that their scheme has several drawbacks: (1) incorrect password change phase, (2) fails to preserve user anonymity property, (3) fails to establish a secret session key beween a legal user and the server, (4) fails to protect strong replay attack, and (5) lacks rigorous formal security analysis. We then a propose a novel and secure biometric-based remote user authentication scheme in order to withstand the security flaw found in Awasthi-Srivastava's scheme and enhance the features required for an idle user authentication scheme. Through the rigorous informal and formal security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool and show that our scheme is secure against passive and active attacks, including the replay and man-in-the-middle attacks. Our scheme is also efficient as compared to Awasthi-Srivastava's scheme.

Security bound of two-basis quantum-key-distribution protocols using qudits

International Nuclear Information System (INIS)

Nikolopoulos, Georgios M.; Alber, Gernot

2005-01-01

We investigate the security bounds of quantum-cryptographic protocols using d-level systems. In particular, we focus on schemes that use two mutually unbiased bases, thus extending the Bennett-Brassard 1984 quantum-key-distribution scheme to higher dimensions. Under the assumption of general coherent attacks, we derive an analytic expression for the ultimate upper security bound of such quantum-cryptography schemes. This bound is well below the predictions of optimal cloning machines. The possibility of extraction of a secret key beyond entanglement distillation is discussed. In the case of qutrits we argue that any eavesdropping strategy is equivalent to a symmetric one. For higher dimensions such an equivalence is generally no longer valid

Specialist Physicians' Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors.

Science.gov (United States)

Dossett, Lesly A; Kauffmann, Rondi M; Lee, Jay S; Singh, Harkamal; Lee, M Catherine; Morris, Arden M; Jagsi, Reshma; Quinn, Gwendolyn P; Dimick, Justin B

2018-06-01

Our objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors. Physicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral. We conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure. Participants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships. Specialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.

Asthma referrals: a key component of asthma management that needs to be addressed

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Price D

2017-07-01

Full Text Available David Price,1,2 Leif Bjermer,3 David A Bergin,4 Rafael Martinez5 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK; 2Observational and Pragmatic Research Institute, Singapore; 3Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden; 4Novartis Ireland Limited, Dublin, Ireland; 5Novartis Pharma AG, Basel, Switzerland Abstract: Heterogeneity of asthma and difficulty in achieving optimal control are the major challenges in the management of asthma. To help attain the best possible clinical outcomes in patients with asthma, several guidelines provide recommendations for patients who will require a referral to a specialist. Such referrals can help in clearing the uncertainty from the initial diagnosis, provide tailored treatment options to patients with persistent symptoms and offer the patients access to health care providers with expertise in the management of the asthma; thus, specialist referrals have a substantial impact on disease prognosis and the patient’s health status. Hurdles in implementing these recommendations include lack of their dissemination among health care providers and nonadherence to these guidelines; these hurdles considerably limit the implementation of specialist referrals, eventually affecting the rate of referrals. In this review, recommendations for specialist referrals from several key international and national asthma guidelines and other relevant published literature are evaluated. Furthermore, we highlight why referrals are not happening, how this can be improved, and ultimately, what should be done in the specialist setting, based on existing evidence in published literature. Keywords: asthma, disease management, specialization, primary care physicians, referral

Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners.

Science.gov (United States)

Lohr, Robert H; West, Colin P; Beliveau, Margaret; Daniels, Paul R; Nyman, Mark A; Mundell, William C; Schwenk, Nina M; Mandrekar, Jayawant N; Naessens, James M; Beckman, Thomas J

2013-11-01

To compare the quality of referrals of patients with complex medical problems from nurse practitioners (NPs), physician assistants (PAs), and physicians to general internists. We conducted a retrospective comparison study involving regional referrals to an academic medical center from January 1, 2009, through December 31, 2010. All 160 patients referred by NPs and PAs combined and a random sample of 160 patients referred by physicians were studied. Five experienced physicians blinded to the source of referral used a 7-item instrument to assess the quality of referrals. Internal consistency, interrater reliability, and dimensionality of item scores were determined. Differences between item scores for patients referred by physicians and those for patients referred by NPs and PAs combined were analyzed by using multivariate ordinal logistical regression adjusted for patient age, sex, distance of the referral source from Mayo Clinic, and Charlson Index. Factor analysis revealed a 1-dimensional measure of the quality of patient referrals. Interrater reliability (intraclass correlation coefficient for individual items: range, 0.77-0.93; overall, 0.92) and internal consistency for items combined (Cronbach α=0.75) were excellent. Referrals from physicians were scored higher (percentage of agree/strongly agree responses) than were referrals from NPs and PAs for each of the following items: referral question clearly articulated (86.3% vs 76.0%; P=.0007), clinical information provided (72.6% vs 54.1%; P=.003), documented understanding of the patient's pathophysiology (51.0% vs 30.3%; P<.0001), appropriate evaluation performed locally (60.3% vs 39.0%; P<.0001), appropriate management performed locally (53.5% vs 24.1%; P<.0001), and confidence returning patient to referring health care professional (67.8% vs 41.4%; P<.0001). Referrals from physicians were also less likely to be evaluated as having been unnecessary (30.1% vs 56.2%; P<.0001). The quality of referrals to an

29 CFR 6.41 - Referral to Chief Administrative Law Judge.

Science.gov (United States)

2010-07-01

... Administrative Law Judge to conduct such hearings as may be necessary to decide the disputed matters. A copy of... 29 Labor 1 2010-07-01 2010-07-01 true Referral to Chief Administrative Law Judge. 6.41 Section 6... Substantial Interest Proceedings § 6.41 Referral to Chief Administrative Law Judge. (a) Upon timely receipt of...

Rationing of hip and knee referrals in the public hospital: the true unmet need.

Science.gov (United States)

Inglis, Tom; Armour, Paul; Inglis, Grahame; Hooper, Gary

2017-03-24

The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.

Obstetrical referrals by traditional birth attendants.

Science.gov (United States)

Mustafa, Rozina; Hashmi, Haleema; Mustafa, Rubina

2012-01-01

In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable to diagnose the complications and are often unable to take decisions on timely referral. The objective of this study was to determine the prevalence, nature and outcome of life threatening obstetrical conditions in referrals by Traditional Birth Attendants (TBAs). This Observational, Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima Hospital, Baqai Medical University, a tertiary care community based hospital. The study included patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%) patients admitted with life threatening obstetric conditions. The near-miss morbidities and mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1 (1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is (66.6%) almost double of postpartum haemorrhage (37.5%). Mortality to near miss morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were responsible for near-miss morbidities and mortalities.

Superposition Attacks on Cryptographic Protocols

DEFF Research Database (Denmark)

Damgård, Ivan Bjerre; Funder, Jakob Løvstad; Nielsen, Jesper Buus

2011-01-01

of information. In this paper, we introduce a fundamentally new model of quantum attacks on classical cryptographic protocols, where the adversary is allowed to ask several classical queries in quantum superposition. This is a strictly stronger attack than the standard one, and we consider the security......Attacks on classical cryptographic protocols are usually modeled by allowing an adversary to ask queries from an oracle. Security is then defined by requiring that as long as the queries satisfy some constraint, there is some problem the adversary cannot solve, such as compute a certain piece...... of several primitives in this model. We show that a secret-sharing scheme that is secure with threshold $t$ in the standard model is secure against superposition attacks if and only if the threshold is lowered to $t/2$. We use this result to give zero-knowledge proofs for all of NP in the common reference...

Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries.

Science.gov (United States)

Hughes, Danny R; Sunshine, Jonathan H; Bhargavan, Mythreyi; Forman, Howard

2011-09-01

As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. Self-referral in imaging was significantly (P nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

Enhanced Key Management Protocols for Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Baojiang Cui

2015-01-01

Full Text Available With rapid development and extensive use of wireless sensor networks (WSNs, it is urgent to enhance the security for WSNs, in which key management is an effective way to protect WSNs from various attacks. However, different types of messages exchanged in WSNs typically have different security requirements which cannot be satisfied by a single keying mechanism. In this study, a basic key management protocol is described for WSNs based on four kinds of keys, which can be derived from an initial master key, and an enhanced protocol is proposed based on Diffie-Hellman algorithm. The proposed scheme restricts the adverse security impact of a captured node to the rest of WSNs and meets the requirement of energy efficiency by supporting in-network processing. The master key protection, key revocation mechanism, and the authentication mechanism based on one-way hash function are, respectively, discussed. Finally, the performance of the proposed scheme is analyzed from the aspects of computational efficiency, storage requirement and communication cost, and its antiattack capability in protecting WSNs is discussed under various attack models. In this paper, promising research directions are also discussed.

Impaired Job Performance and Critical Incidents: Factors Influencing Supervisory EAP Referrals.

Science.gov (United States)

Harley, David A.

Relatively little empirical research has been done on the supervisory referral of employees to employee assistance programs (EAPs). Inclusion of constructive confrontation (supervisory referral) into program standards and its continued promotion as a "central strategy" of program theory and operation calls for critical investigation of…

A reliable, delay bounded and less complex communication protocol for multicluster FANETs

Directory of Open Access Journals (Sweden)

Wajiya Zafar

2017-02-01

Full Text Available Recently, Flying Ad-hoc Networks (FANETs, enabling ad-hoc networking between Unmanned Aerial Vehicles (UAVs is gaining importance in several military and civilian applications. The sensitivity of the applications requires adaptive; efficient; delay bounded and scalable communication network among UAVs for data transmission. Due to communication protocol complexity; rigidity; cost of commercial-off-the-shelf (COT components; limited radio bandwidth; high mobility and computational resources; maintaining the desired level of Quality of Service (QoS becomes a daunting task. For the first time in this research we propose multicluster FANETs for efficient network management; the proposed scheme considerably reduces communication cost and optimizes network performance as well as exploit low power; less complex and low cost IEEE 802.15.4 (MAC protocol for intercluster and intracluster communication. In this research both beacon enabled mode and beaconless modes have been investigated with Guaranteed Time Slots (GTS and virtual Time Division Multiple Access (TDMA respectively. The methodology plays a key role towards reserving bandwidth for latency critical applications; eliminate collisions and medium access delays. Moreover analysis ad-hoc routing protocols including two proactive (OLSR, DSDV and one reactive (AODV is also presented. The results shows that the proposed scheme guarantees high packet delivery ratios while maintaining acceptable levels of latency requirements comparable with more complex and dedicatedly designed protocols in literature.

Referrals to a regional allergy clinic - an eleven year audit

Directory of Open Access Journals (Sweden)

Hewson Paul

2010-12-01

Full Text Available Abstract Background Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i differences over time and by demographics, (ii types of allergy, (iii co-occurrence, and (iv spatial distributions. Methods Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Results Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65% than males. Airborne allergies were the most frequent (623, and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410 patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142 had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg. There were age differences by types of allergy; people referred with food allergies were

High risk pregnancy referrals adequacy in the Basic Health Services of Sobral, Ceará, Brazil

Directory of Open Access Journals (Sweden)

José Juvenal Linhares

2009-03-01

Full Text Available Objective: To describe the appropriateness of referrals of high-risk pregnancies in the basic healthcare network of Sobral, in Ceará, Brazil. Methods: A descriptive quantitative study. The medical files of 173 pregnant patients referred to the high-risk outpatient clinic of Centro de Especialidades Médicas of Sobral, during the period from July 2006 to April 2007, were analyzed. Variables analyzed were correctness of the referrals, professionals who made them, causes and origins of the referrals, and age bracket of the patients referred. The referrals were divided into “appropriate” and “inappropriate”, according to the classification of risk established by the technical manual of the Ministry of Health. Rresults: Of the 173 cases, 102 (59% were considered appropriate/correct, and 71 (41% referrals were considered inappropriate/incorrect. The referrals were divided according to the professional class of the referring individuals: physicians or nurses. Of the 173 referrals, 49 (28.3% were made by physicians, and 124 (71.7% by nurses. Of the 49 patients referred by physicians, 39 (79.6% were considered correct. Of the 124 referrals made by nurses, 63 (50.8% were considered incorrect, revealing a significant difference between the groups (p < 0.00001. The most common causes of referrals of pregnant patients were hypertensive syndromes (23.6%, physiological modifications of pregnancy (22.6%, prolonged pregnancy (15.1%, and diabetes (12.3%. Cconclusions: There was a low rate of appropriate/correct referrals. There is a need for training in the basic healthcare network for quality prenatal care, with special emphasis on referring nurses.

Mac protocols for wireless sensor network (wsn): a comparative study

International Nuclear Information System (INIS)

Arshad, J.; Akram, Q.; Saleem, Y.

2014-01-01

Data communication between nodes is carried out under Medium Access Control (MAC) protocol which is defined at data link layer. The MAC protocols are responsible to communicate and coordinate between nodes according to the defined standards in WSN (Wireless Sensor Networks). The design of a MAC protocol should also address the issues of energy efficiency and transmission efficiency. There are number of MAC protocols that exist in the literature proposed for WSN. In this paper, nine MAC protocols which includes S-MAC, T-MAC, Wise-MAC, Mu-MAC, Z-MAC, A-MAC, D-MAC, B-MAC and B-MAC+ for WSN have been explored, studied and analyzed. These nine protocols are classified in contention based and hybrid (combination of contention and schedule based) MAC protocols. The goal of this comparative study is to provide a basis for MAC protocols and to highlight different mechanisms used with respect to parameters for the evaluation of energy and transmission efficiency in WSN. This study also aims to give reader a better understanding of the concepts, processes and flow of information used in these MAC protocols for WSN. A comparison with respect to energy reservation scheme, idle listening avoidance, latency, fairness, data synchronization, and throughput maximization has been presented. It was analyzed that contention based MAC protocols are less energy efficient as compared to hybrid MAC protocols. From the analysis of contention based MAC protocols in term of energy consumption, it was being observed that protocols based on preamble sampling consume lesser energy than protocols based on static or dynamic sleep schedule. (author)

An improved and effective secure password-based authentication and key agreement scheme using smart cards for the telecare medicine information system.

Science.gov (United States)

Das, Ashok Kumar; Bruhadeshwar, Bezawada

2013-10-01

Recently Lee and Liu proposed an efficient password based authentication and key agreement scheme using smart card for the telecare medicine information system [J. Med. Syst. (2013) 37:9933]. In this paper, we show that though their scheme is efficient, their scheme still has two security weaknesses such as (1) it has design flaws in authentication phase and (2) it has design flaws in password change phase. In order to withstand these flaws found in Lee-Liu's scheme, we propose an improvement of their scheme. Our improved scheme keeps also the original merits of Lee-Liu's scheme. We show that our scheme is efficient as compared to Lee-Liu's scheme. Further, through the security analysis, we show that our scheme is secure against possible known attacks. In addition, we simulate our scheme for the formal security verification using the widely-accepted AVISPA (Automated Validation of Internet Security Protocols and Applications) tool to show that our scheme is secure against passive and active attacks.

Intellectual Disabilities, Challenging Behaviour and Referral Texts: A Critical Discourse Analysis

Science.gov (United States)

Nunkoosing, Karl; Haydon-Laurelut, Mark

2011-01-01

The texts of referrals written by workers in residential services for people with learning difficulties constitute sites where contemporary discourses of intellectual disabilities are being constructed. This paper uses Critical Discourse Analysis to examine referrals made to a Community Learning Disability Team (CLDT). The study finds referral…

Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

Science.gov (United States)

Larsson, Laura S; Kuster, Emilie

2013-01-01

The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

An Energy Efficient Mutual Authentication and Key Agreement Scheme Preserving Anonymity for Wireless Sensor Networks

Science.gov (United States)

Lu, Yanrong; Li, Lixiang; Peng, Haipeng; Yang, Yixian

2016-01-01

WSNs (Wireless sensor networks) are nowadays viewed as a vital portion of the IoTs (Internet of Things). Security is a significant issue in WSNs, especially in resource-constrained environments. AKA (Authentication and key agreement) enhances the security of WSNs against adversaries attempting to get sensitive sensor data. Various AKA schemes have been developed for verifying the legitimate users of a WSN. Firstly, we scrutinize Amin-Biswas’s currently scheme and demonstrate the major security loopholes in their works. Next, we propose a lightweight AKA scheme, using symmetric key cryptography based on smart card, which is resilient against all well known security attacks. Furthermore, we prove the scheme accomplishes mutual handshake and session key agreement property securely between the participates involved under BAN (Burrows, Abadi and Needham) logic. Moreover, formal security analysis and simulations are also conducted using AVISPA(Automated Validation of Internet Security Protocols and Applications) to show that our scheme is secure against active and passive attacks. Additionally, performance analysis shows that our proposed scheme is secure and efficient to apply for resource-constrained WSNs. PMID:27338382

An Energy Efficient Mutual Authentication and Key Agreement Scheme Preserving Anonymity for Wireless Sensor Networks.

Science.gov (United States)

Lu, Yanrong; Li, Lixiang; Peng, Haipeng; Yang, Yixian

2016-06-08

WSNs (Wireless sensor networks) are nowadays viewed as a vital portion of the IoTs (Internet of Things). Security is a significant issue in WSNs, especially in resource-constrained environments. AKA (Authentication and key agreement) enhances the security of WSNs against adversaries attempting to get sensitive sensor data. Various AKA schemes have been developed for verifying the legitimate users of a WSN. Firstly, we scrutinize Amin-Biswas's currently scheme and demonstrate the major security loopholes in their works. Next, we propose a lightweight AKA scheme, using symmetric key cryptography based on smart card, which is resilient against all well known security attacks. Furthermore, we prove the scheme accomplishes mutual handshake and session key agreement property securely between the participates involved under BAN (Burrows, Abadi and Needham) logic. Moreover, formal security analysis and simulations are also conducted using AVISPA(Automated Validation of Internet Security Protocols and Applications) to show that our scheme is secure against active and passive attacks. Additionally, performance analysis shows that our proposed scheme is secure and efficient to apply for resource-constrained WSNs.

An Energy Efficient Mutual Authentication and Key Agreement Scheme Preserving Anonymity for Wireless Sensor Networks

Directory of Open Access Journals (Sweden)

Yanrong Lu

2016-06-01

Full Text Available WSNs (Wireless sensor networks are nowadays viewed as a vital portion of the IoTs (Internet of Things. Security is a significant issue in WSNs, especially in resource-constrained environments. AKA (Authentication and key agreement enhances the security of WSNs against adversaries attempting to get sensitive sensor data. Various AKA schemes have been developed for verifying the legitimate users of a WSN. Firstly, we scrutinize Amin-Biswas’s currently scheme and demonstrate the major security loopholes in their works. Next, we propose a lightweight AKA scheme, using symmetric key cryptography based on smart card, which is resilient against all well known security attacks. Furthermore, we prove the scheme accomplishes mutual handshake and session key agreement property securely between the participates involved under BAN (Burrows, Abadi and Needham logic. Moreover, formal security analysis and simulations are also conducted using AVISPA(Automated Validation of Internet Security Protocols and Applications to show that our scheme is secure against active and passive attacks. Additionally, performance analysis shows that our proposed scheme is secure and efficient to apply for resource-constrained WSNs.

A Third-Party E-Payment Protocol Based on Quantum Group Blind Signature

Science.gov (United States)

Zhang, Jian-Zhong; Yang, Yuan-Yuan; Xie, Shu-Cui

2017-09-01

A third-party E-payment protocol based on quantum group blind signature is proposed in this paper. Our E-payment protocol could protect user's anonymity as the traditional E-payment systems do, and also have unconditional security which the classical E-payment systems can not provide. To achieve that, quantum key distribution, one-time pad and quantum group blind signature are adopted in our scheme. Furthermore, if there were a dispute, the manager Trent can identify who tells a lie.

DOW-PR DOlphin and Whale Pods Routing Protocol for Underwater Wireless Sensor Networks (UWSNs).

Science.gov (United States)

Wadud, Zahid; Ullah, Khadem; Hussain, Sajjad; Yang, Xiaodong; Qazi, Abdul Baseer

2018-05-12

Underwater Wireless Sensor Networks (UWSNs) have intrinsic challenges that include long propagation delays, high mobility of sensor nodes due to water currents, Doppler spread, delay variance, multipath, attenuation and geometric spreading. The existing Weighting Depth and Forwarding Area Division Depth Based Routing (WDFAD-DBR) protocol considers the weighting depth of the two hops in order to select the next Potential Forwarding Node (PFN). To improve the performance of WDFAD-DBR, we propose DOlphin and Whale Pod Routing protocol (DOW-PR). In this scheme, we divide the transmission range into a number of transmission power levels and at the same time select the next PFNs from forwarding and suppressed zones. In contrast to WDFAD-DBR, our scheme not only considers the packet upward advancement, but also takes into account the number of suppressed nodes and number of PFNs at the first and second hops. Consequently, reasonable energy reduction is observed while receiving and transmitting packets. Moreover, our scheme also considers the hops count of the PFNs from the sink. In the absence of PFNs, the proposed scheme will select the node from the suppressed region for broadcasting and thus ensures minimum loss of data. Besides this, we also propose another routing scheme (whale pod) in which multiple sinks are placed at water surface, but one sink is embedded inside the water and is physically connected with the surface sink through high bandwidth connection. Simulation results show that the proposed scheme has high Packet Delivery Ratio (PDR), low energy tax, reduced Accumulated Propagation Distance (APD) and increased the network lifetime.

Impact of Ages and Stages Questionnaire Scores on Pediatrician Referral Patterns

Science.gov (United States)

Roane, Brandy Michelle; Valleley, Rachel J.; Allen, Keith D.

2012-01-01

The American Academy of Pediatrics has recommended an algorithm for identifying children with potential developmental delays. It includes a recommendation that positive screening should result in referral for additional evaluation or intervention. Yet, it is not known whether positive screens do, in fact, influence physician referrals. The primary…

Referral patterns of children with poor growth in primary health care

NARCIS (Netherlands)

Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dekker, F.W.; Dommelen, P. van; Buuren, S. van; Lodder-van der Kooij, A.M.; Verkerk, P.H.; Wit, J.M.

2007-01-01

Background. To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these

A Secure and Anonymous Two-Factor Authentication Protocol in Multiserver Environment

Directory of Open Access Journals (Sweden)

Chenyu Wang

2018-01-01

Full Text Available With the great development of network technology, the multiserver system gets widely used in providing various of services. And the two-factor authentication protocols in multiserver system attract more and more attention. Recently, there are two new schemes for multiserver environment which claimed to be secure against the known attacks. However, after a scrutinization of these two schemes, we found that (1 their description of the adversary’s abilities is inaccurate; (2 their schemes suffer from many attacks. Thus, firstly, we corrected their description on the adversary capacities to introduce a widely accepted adversary model and then summarized fourteen security requirements of multiserver based on the works of pioneer contributors. Secondly, we revealed that one of the two schemes fails to preserve forward secrecy and user anonymity and cannot resist stolen-verifier attack and off-line dictionary attack and so forth and also demonstrated that another scheme fails to preserve forward secrecy and user anonymity and is not secure to insider attack and off-line dictionary attack, and so forth. Finally, we designed an enhanced scheme to overcome these identified weaknesses, proved its security via BAN logic and heuristic analysis, and then compared it with other relevant schemes. The comparison results showed the superiority of our scheme.

Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

Science.gov (United States)

Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K

2018-01-01

We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

Appropriateness of Referrals for Upper Gastrointestinal Endoscopy ...

African Journals Online (AJOL)

Appropriateness of Referrals for Upper Gastrointestinal Endoscopy. ... Accra between January and December, 2008 were interviewed and evaluated for this study. ... Presentations with bleeding and suspicion of malignancy showed statistical ...

Audit of the Health Service Executive orthodontic referral pathway between 2009 and 2011 in the Dublin Mid-Leinster region.

LENUS (Irish Health Repository)

Wolstencroft, Simon

2014-03-21

An audit was undertaken in 2009 to determine the success of the new national orthodontic referral protocol introduced to the Health Service Executive (HSE) in 2007 and operated in the Dublin Mid-Leinster HSE region. It was repeated in 2011 to determine if the HSE austerity measures have had a bearing on the orthodontic service performance in the Dublin Mid-Leinster HSE region. The audit also measured the success of referring practitioners in identifying the correct Index of Orthodontic Treatment Need (IOTN) classification of the patient. In the 2011 audit, the figures were broken down to identify the occlusal variables that caused dental practitioners most difficulties in identification. The audit demonstrates a good referral to assessment timeframe in 2009 (85-80% compliance for IOTN 5 and 4 within three to six months, respectively), which deteriorates significantly in 2011 (26-4% for IOTN 5 and 4 within three to six months, respectively). The ability of dentists to identify the correct IOTN classification was better in 2009 (60% correct) compared to 2011 (51% correct), but both figures fell below the audit standard of 75% of referrals with correct IOTN classifications. The IOTN occlusal dental health components most readily identified by referring practitioners and meeting audit standards were 5a (overjet >9mm), 5i (impacted teeth) and 5h (extensive hypodontia). The remaining occlusal dental health components in the HSE IOTN fell below the audit standard. The audit clearly identifies a requirement for a continued educational effort to maintain the HSE IOTN skill base in primary care, and a need for additional resources to manage the demand for orthodontic assessments.

Differential referral of women and men to employee assistance programs: the role of supervisory attitudes.

Science.gov (United States)

Young, D W; Reichman, W R; Levy, M F

1987-01-01

Potential factors underlying sex differences in the referral of problem-drinking subordinates to employee assistance programs (EAPs) were explored in interviews with 120 supervisors in four organizations. Analyses of data obtained in these interviews assessed the relative ability of eight variables to predict supervisor's actual identification and referral of female and male problem drinkers. In addition to numbers of employees supervised, the supervisors' judgment of the EAP's effectiveness was the best predictor of referral and identification, regardless of the sex of the referred subordinate. Knowledge and training in the EAP was a secondary contributor to referral of men, but played no role in female referrals. When controlling for all other variables, the extent to which supervisors held an egalitarian attitude toward women's rights and roles was found to be marginally positively related to identification of female drinkers. Similarly, a less stigmatized, stereotyped view of women's use and abuse of alcohol was marginally associated with a greater likelihood of referral of a female drinker to the EAP. Neither of these attitudinal variables was related to identification or referral of male problem drinkers.

Think Stoma Nurse: a tool to trigger referral to specialist care.

Science.gov (United States)

Hanley, Judy; Adams, Jane

This article describes the initial development and subsequent evolution of a simple referral assessment tool for stoma care. The first author's personal experience identified that there was widespread inconsistency in perceptions of local multidisciplinary teams as to when it was appropriate to refer to specific specialist nursing teams. This resulted in both inappropriate and delayed referrals. A 'Think Specialist Nurse' initiative was developed across the author's trust, building on the traffic light template from the 'ThinkGlucose' tool, to facilitate referrals to clinical nurse specialists. The stoma-care specific tool, 'Think Stoma Nurse', has subsequently evolved beyond its initial audience, and has been adapted into materials aimed at patients and carers.

Quantum dual signature scheme based on coherent states with entanglement swapping

International Nuclear Information System (INIS)

Liu Jia-Li; Shi Rong-Hua; Shi Jin-Jing; Lv Ge-Li; Guo Ying

2016-01-01

A novel quantum dual signature scheme, which combines two signed messages expected to be sent to two diverse receivers Bob and Charlie, is designed by applying entanglement swapping with coherent states. The signatory Alice signs two different messages with unitary operations (corresponding to the secret keys) and applies entanglement swapping to generate a quantum dual signature. The dual signature is firstly sent to the verifier Bob who extracts and verifies the signature of one message and transmits the rest of the dual signature to the verifier Charlie who verifies the signature of the other message. The transmission of the dual signature is realized with quantum teleportation of coherent states. The analysis shows that the security of secret keys and the security criteria of the signature protocol can be greatly guaranteed. An extensional multi-party quantum dual signature scheme which considers the case with more than three participants is also proposed in this paper and this scheme can remain secure. The proposed schemes are completely suited for the quantum communication network including multiple participants and can be applied to the e-commerce system which requires a secure payment among the customer, business and bank. (paper)

Implementation of medical retina virtual clinics in a tertiary eye care referral centre.

Science.gov (United States)

Kortuem, Karsten; Fasler, Katrin; Charnley, Amanda; Khambati, Hussain; Fasolo, Sandro; Katz, Menachem; Balaskas, Konstantinos; Rajendram, Ranjan; Hamilton, Robin; Keane, Pearse A; Sim, Dawn A

2018-01-06

The increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashion METHODS: First attendances in the VMRC (September 2016-May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed. A total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%). VMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Performance analysis for a QoS-aware hybrid token-CDMA MAC protocol

CSIR Research Space (South Africa)

Liu, YS

2007-09-01

Full Text Available ) 20000 Bad state duration ( i badτ ) 3.2 ms Bad state ibadPEP 1.0 Good state igoodPEP Holtzman’s approximation WTRP Channel bit rate 1.28 Mbps Signal to Noise Rato (SNR) 8 dB .... INTRODUCTION d hoc and wireless mesh networks (WMNs) [1] are commonly known to implement IEEE 802.11 related schemes as their medium access control (MAC) protocols. It is known from [2,3] that with the 802.11 based scheme; the performance is degraded...

7 CFR 1403.17 - Referral of debts to Department of Justice.

Science.gov (United States)

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 1403.17... PROCEDURES § 1403.17 Referral of debts to Department of Justice. Debts which cannot be collected in accordance with these regulations may be referred to the Department of Justice for collection action. ...

Study of Herpes Zoster in a Self-Referral Out-Patient Clinic ...

African Journals Online (AJOL)

Aim: To study the presentation of herpes zoster (shingles) in self-referral urban primary care setting. Patients and method: During nearly 20 years, patients of Igbo ethnic group presented with herpes zoster, on a self-referral basis, to my urban, week day evening, out patient clinic. The recorded epidemiological parameters ...

Adoption of the 2006 Field Triage Decision Scheme for Injured Patients

Directory of Open Access Journals (Sweden)

Sasser, Scott

2011-07-01

Full Text Available Background: When emergency medical services (EMS providers respond to the scene of an injury, they must decide where to transport the injured patients for further evaluation and treatment. This is done through a process known as “field triage”, whereby a patient’s injuries are matched to the most appropriate hospital. In 2005-2006 the National Expert Panel on Field Triage, convened by the Centers for Disease Control and Prevention and the National Highway Traffic Safety Administration, revised the 1999 American College of Surgeons Committee on Trauma Field Triage Decision Scheme. This revision, the 2006 Field Triage Decision Scheme, was published in 2006.Methods: State Public Health departments’ and EMS’ external websites were evaluated to ascertain the current status of implementation of the 2006 Field Triage Decision Scheme.Results: Information regarding field triage was located for 41 states. In nine states no information regarding field triage was available on their websites. Of the 41 states where information was located, seven were classified as “full adopters” of the 2006 Field Triage Decision Scheme; nine were considered “partial adopters”; 17 states were found to be using a full version or modification of the 1999 Field Triage Decision Scheme; and eight states were considered to be using a different protocol or scheme for field triage.Conclusion: Many states have adopted the 2006 Decision Scheme (full or partial. Further investigation is needed to determine the reasons why some states do not adopt the guidelines. [West J Emerg Med. 2011;12(3:275-283.

Performance analysis of signaling protocols on OBS switches

Science.gov (United States)

Kirci, Pinar; Zaim, A. Halim

2005-10-01

In this paper, Just-In-Time (JIT), Just-Enough-Time (JET) and Horizon signalling schemes for Optical Burst Switched Networks (OBS) are presented. These signaling schemes run over a core dWDM network and a network architecture based on Optical Burst Switches (OBS) is proposed to support IP, ATM and Burst traffic. In IP and ATM traffic several packets are assembled in a single packet called burst and the burst contention is handled by burst dropping. The burst length distribution in IP traffic is arbitrary between 0 and 1, and is fixed in ATM traffic at 0,5. Burst traffic on the other hand is arbitrary between 1 and 5. The Setup and Setup ack length distributions are arbitrary. We apply the Poisson model with rate λ and Self-Similar model with pareto distribution rate α to identify inter-arrival times in these protocols. We consider a communication between a source client node and a destination client node over an ingress and one or more multiple intermediate switches.We use buffering only in the ingress node. The communication is based on single burst connections in which, the connection is set up just before sending a burst and then closed as soon as the burst is sent. Our analysis accounts for several important parameters, including the burst setup, burst setup ack, keepalive messages and the optical switching protocol. We compare the performance of the three signalling schemes on the network under as burst dropping probability under a range of network scenarios.

Referral pathways for patients with TIA avoiding hospital admission: a scoping review.

Science.gov (United States)

Evans, Bridie Angela; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne C; Snooks, Helen; Whitman, Shirley; Rees, Nigel

2017-02-14

To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Scoping review. PubMed, CINAHL Web of Science, Scopus. Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. ISRCTN85516498. Stage: pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Obstetric referrals from a rural clinic to a community hospital in Honduras.

Science.gov (United States)

Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D

2015-11-01

referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparative Study on Various Authentication Protocols in Wireless Sensor Networks.

Science.gov (United States)

Rajeswari, S Raja; Seenivasagam, V

2016-01-01

Wireless sensor networks (WSNs) consist of lightweight devices with low cost, low power, and short-ranged wireless communication. The sensors can communicate with each other to form a network. In WSNs, broadcast transmission is widely used along with the maximum usage of wireless networks and their applications. Hence, it has become crucial to authenticate broadcast messages. Key management is also an active research topic in WSNs. Several key management schemes have been introduced, and their benefits are not recognized in a specific WSN application. Security services are vital for ensuring the integrity, authenticity, and confidentiality of the critical information. Therefore, the authentication mechanisms are required to support these security services and to be resilient to distinct attacks. Various authentication protocols such as key management protocols, lightweight authentication protocols, and broadcast authentication protocols are compared and analyzed for all secure transmission applications. The major goal of this survey is to compare and find out the appropriate protocol for further research. Moreover, the comparisons between various authentication techniques are also illustrated.

Comparative Study on Various Authentication Protocols in Wireless Sensor Networks

Science.gov (United States)

Rajeswari, S. Raja; Seenivasagam, V.

2016-01-01

Wireless sensor networks (WSNs) consist of lightweight devices with low cost, low power, and short-ranged wireless communication. The sensors can communicate with each other to form a network. In WSNs, broadcast transmission is widely used along with the maximum usage of wireless networks and their applications. Hence, it has become crucial to authenticate broadcast messages. Key management is also an active research topic in WSNs. Several key management schemes have been introduced, and their benefits are not recognized in a specific WSN application. Security services are vital for ensuring the integrity, authenticity, and confidentiality of the critical information. Therefore, the authentication mechanisms are required to support these security services and to be resilient to distinct attacks. Various authentication protocols such as key management protocols, lightweight authentication protocols, and broadcast authentication protocols are compared and analyzed for all secure transmission applications. The major goal of this survey is to compare and find out the appropriate protocol for further research. Moreover, the comparisons between various authentication techniques are also illustrated. PMID:26881272

EU Action against Climate Change. EU emissions trading. An open scheme promoting global innovation

International Nuclear Information System (INIS)

2005-01-01

The European Union is committed to global efforts to reduce the greenhouse gas emissions from human activities that threaten to cause serious disruption to the world's climate. Building on the innovative mechanisms set up under the Kyoto Protocol to the 1992 United Nations Framework Convention on Climate Change (UNFCCC) - joint implementation, the clean development mechanism and international emissions trading - the EU has developed the largest company-level scheme for trading in emissions of carbon dioxide (CO2), making it the world leader in this emerging market. The emissions trading scheme started in the 25 EU Member States on 1 January 2005

Why Do At-Risk Mothers Fail To Reach Referral Level? Barriers ...

African Journals Online (AJOL)

In southern Tanzania, few high-risk pregnancies are channeled through antenatal care to the referral level. We studied the influences that make pregnant women heed or reject referral advice. Semi-structured interviews with sixty mothers-to-be, twenty-six health workers and six key-informants to identify barriers to use of ...

A Collaborative Process Model for Promoting Successful Referrals in College Counseling

Science.gov (United States)

Iarussi, Melanie M.; Shaw, Brian M.

2016-01-01

The need to refer students to off-campus mental health providers is common in college counseling. Such referrals can be challenging for college counselors who strive to meet students' counseling needs while adhering to ethical and center policy guidelines. In this article, the authors explore the nature and challenges of referral in college…

An efficient three-party password-based key agreement protocol using extended chaotic maps

International Nuclear Information System (INIS)

Shu Jian

2015-01-01

Three-party password-based key agreement protocols allow two users to authenticate each other via a public channel and establish a session key with the aid of a trusted server. Recently, Farash et al. [Farash M S, Attari M A 2014 “An efficient and provably secure three-party password-based authenticated key exchange protocol based on Chebyshev chaotic maps”, Nonlinear Dynamics 77(7): 399–411] proposed a three-party key agreement protocol by using the extended chaotic maps. They claimed that their protocol could achieve strong security. In the present paper, we analyze Farash et al.’s protocol and point out that this protocol is vulnerable to off-line password guessing attack and suffers communication burden. To handle the issue, we propose an efficient three-party password-based key agreement protocol using extended chaotic maps, which uses neither symmetric cryptosystems nor the server’s public key. Compared with the relevant schemes, our protocol provides better performance in terms of computation and communication. Therefore, it is suitable for practical applications. (paper)