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Mathematical Biosciences and... Sep 2023In conventional message communication systems, the practice of multi-message multi-receiver signcryption communication encounters several challenges, including the...
In conventional message communication systems, the practice of multi-message multi-receiver signcryption communication encounters several challenges, including the vulnerability to Key Generation Center (KGC) attacks, privacy breaches and excessive communication data volume. The KGC necessitates a secure channel to transmit partial private keys, thereby rendering the security of these partial private keys reliant on the integrity of the interaction channel. This dependence introduces concerns regarding the confidentiality of the private keys. Our proposal advocates for the substitution of the KGC in traditional certificateless schemes with blockchain and smart contract technology. Parameters are publicly disclosed on the blockchain, leveraging its tamper-proof property to ensure security. Furthermore, this scheme introduces conventional encryption techniques to achieve user identity privacy in the absence of a secure channel, effectively resolving the issue of user identity disclosure inherent in blockchain-based schemes and enhancing communication privacy. Moreover, users utilize smart contract algorithms to generate a portion of the encrypted private key, thereby minimizing the possibility of third-party attacks. In this paper, the scheme exhibits resilience against various attacks, including KGC leakage attacks, internal privilege attacks, replay attacks, distributed denial of service attacks and Man-in-the-Middle (MITM) attacks. Additionally, it possesses desirable security attributes such as key escrow security and non-repudiation. The proposed scheme has been theoretically and experimentally analyzed under the random oracle model, based on the computational Diffie-Hellman problem and the discrete logarithm problem. It has been proven to possess confidentiality and unforgeability. Compared with similar schemes, our scheme has lower computational cost and shorter ciphertext length. It has obvious advantages in communication and time overhead.
PubMed: 38052552
DOI: 10.3934/mbe.2023806 -
Social Science & Medicine (1982) Nov 2023To respond to the COVID-19 pandemic, governments frequently resorted to declaring the state of emergency, fuelling contestations over the abuse of public powers and...
To respond to the COVID-19 pandemic, governments frequently resorted to declaring the state of emergency, fuelling contestations over the abuse of public powers and effectiveness of the measures to induce compliance. This article examines how the denial of the political nature of emergency governance known as depoliticisation undermines government credibility and may suit anti-democratic actors. We contribute to understanding the relationship between depoliticisation and democracy by showing how Slovak coalition parties during key parliamentary debates on the state of emergency during the COVID-19 pandemic insisted on depoliticising the pandemic while parliamentary opposition parties with anti-democratic leanings successfully opted for its repoliticisation. Repoliticising a key decision on managing the public health emergency granted credibility to illiberal political actors at the expense of the government, cautioning against depoliticisation strategies to be invoked by democrats in fragile democracies. Instead, accepting that such decisions are political may prevent the loss of credibility due to unsuccessful rhetorical practices of depoliticisation.
Topics: Humans; COVID-19; Pandemics; Politics; Government; Public Health
PubMed: 37832315
DOI: 10.1016/j.socscimed.2023.116297 -
JAMA Network Open Oct 2023Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for...
IMPORTANCE
Prior authorization (PA) requires clinicians and patients to navigate a complex approval pathway. Resultant delays and denials can be particularly problematic for patients with cancer, who often need urgent treatment or symptom management.
OBJECTIVE
To investigate the patient perspective of PA for cancer-related care, including perceptions about the process, outcomes (including delays and denials), and patient administrative burden.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, anonymous survey used a convenience sample of patients with PA experience. Participants were recruited using social media and email lists of US-based cancer advocacy organizations from July 1 to October 6, 2022.
EXPOSURE
Prior authorization for any cancer-related service.
MAIN OUTCOMES AND MEASURES
Delays to care, outcome of PA, communication, and changes in anxiety (measured on a scale of 0-100, with 0 indicating no anxiety and higher scores indicating higher levels of anxiety) and trust.
RESULTS
Of 178 respondents (158 women [88%], 151 non-Hispanic White respondents [84%], 164 respondents [92%] <65 years), 112 (63%) reported that their cancer care was approved and given as recommended, and 39 (22%) did not receive recommended care due to delays or denials. Most respondents (123 [69%]) reported a PA-related delay in care; of those with delayed care, 90 (73%) reported a delay of 2 or more weeks. Most respondents (119 [67%]) had to personally become involved in the PA process; 35 (20%) spent 11 or more hours dealing with PA issues. Overall, the PA experience was rated as bad (70 [40%]) or horrible (55 of 174 [32%]); ratings were associated with the length of delay (ρ = 0.36; P < .001) and the time spent on PA (ρ = 0.42; P < .001). Self-reported PA-related anxiety was higher than usual anxiety (mean [SD] score, 74.7 [20.2] vs 37.5 [22.6]; P < .001) and was correlated with delay length (ρ = 0.16; P = .04), time spent on PA (ρ = 0.27; P < .001), and overall PA experience (ρ = 0.34; P < .001). After PA, 159 respondents (89%) trusted their insurance company less, and 148 respondents (83%) trusted the health care system less. Patient involvement in the PA process was associated with increased odds of distrusting their insurance company (β = 6.0; 95% CI, 1.9-19.2) and the health care system (β = 3.3; 95% CI, 1.4-8.1) and of having a negative experience (β = 6.6; 95% CI, 3.1-14.3).
CONCLUSIONS AND RELEVANCE
This survey-based cross-sectional study of the patient experience with PA highlights an adverse outcome of PA: 22% of patients did not receive the care recommended by their treatment team because of PA. Most respondents experienced a delay in recommended oncology care, and delays were associated with increased anxiety, a negative perception of the PA process, and patient administrative burden.
Topics: Humans; Female; Prior Authorization; Cross-Sectional Studies; Surveys and Questionnaires; Neoplasms; Patient Outcome Assessment
PubMed: 37851442
DOI: 10.1001/jamanetworkopen.2023.38182 -
Journal of the American Board of Family... Jan 2024The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office...
The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare & Medicaid Services to monitor "disenrollment of MA beneficiaries in the last year of life, validate MA-provided encounter data, and strengthen audits used to identify and recover improper payments to MA plans." The House Subcommittee on Oversight and Investigations of the Committee on Energy & Commerce, dedicated a hearing to "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans." In addition, a recently conducted audit of the Office of the Inspector General of the Department of Health and Human Services raised concerns over "denials of prior authorization requests" and "beneficiary access to medically necessary care." In this article we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.
Topics: Aged; Humans; United States; Medicare Part C
PubMed: 37857442
DOI: 10.3122/jabfm.2023.230111R1 -
Palliative & Supportive Care Oct 2023The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their...
OBJECTIVES
The study aims to describe inadequate, disrespectful, and abusive palliative and hospice care received by lesbian, gay, and bisexual (LGB) patients and their spouses/partners due to their sexual orientation or gender identity.
METHODS
A national sample of 865 healthcare professionals recruited from palliative and hospice care professional organizations completed an online survey. Respondents were asked to describe their observations of inadequate, disrespectful, or abusive care to LGB patients and their spouses/partners.
RESULTS
There were 15.6% who reported observing disrespectful care to LGB patients, 7.3% observed inadequate care, and 1.6% observed abusive care; 43% reported discriminatory care toward the spouses/partners. Disrespectful care to LGB patients included insensitive and judgmental attitudes and behaviors, gossip and ridicule, and disrespect of the spouse/partner. Inadequate care included denial of care; care that was delayed incomplete, or rushed; dismissive or antagonistic treatment; privacy and confidentiality violations; and dismissive treatment of the spouse/partner.
SIGNIFICANCE OF RESULTS
These findings provide evidence of discrimination faced by LGB patients and partners while receiving care for serious illness. Hospice and palliative care programs should promote respectful, inclusive, and affirming care for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, including policies and practices that are welcoming and supportive to both employees and patients. Staff at all levels should be trained to create safe and respectful environments for LGBTQ patients and their families.
Topics: Humans; Female; Male; Palliative Care; Gender Identity; Sexual Behavior; Sexual and Gender Minorities; Attitude of Health Personnel
PubMed: 37435654
DOI: 10.1017/S1478951523001037 -
Critical Care Explorations Sep 2023Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2,...
Competing definitions of sepsis have significant clinical implications and impact both medical coding and hospital payment. Although clinicians may prefer Sepsis-2, payer use of Sepsis-3 to validate clinical diagnoses may result in denial of payment or requests to recoup previously paid funds from healthcare providers. The Sepsis-2.5 project was a cooperative effort between a hospital system and a private payer to develop a community-based, literature-supported consensus definition for sepsis characterized by the presence of clinical illness, a source of infection, and evidence of organ dysfunction. This new definition ("Sepsis-2.5") has been instrumental in resolving provider-payer conflicts in defining clinical sepsis and reimbursing care.
PubMed: 37644973
DOI: 10.1097/CCE.0000000000000970 -
HealthcarePapers Jul 2023Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare...
Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare systems in Europe. We use the Netherlands as a case study to explore some of these mechanisms. Here, we discuss how a focus on cultural deficiency and the denial of racism allows the bearers of inequality and inequity to be blamed for their own disenfranchisement. Nonetheless, scholars in the Netherlands continue to show how everyday racism is negatively impacting marginalized people's lives and their access to the social determinants of health and well-being in society.
Topics: Humans; Racism; Antiracism; Delivery of Health Care
PubMed: 37887166
DOI: 10.12927/hcpap.2023.27195 -
JAMA Oncology Mar 2024
Topics: Humans; Prior Authorization; Medicaid
PubMed: 38175626
DOI: 10.1001/jamaoncol.2023.5801 -
Sensors (Basel, Switzerland) Oct 2023Current vehicles include electronic features that provide ease and convenience to drivers. These electronic features or nodes rely on in-vehicle communication protocols...
Current vehicles include electronic features that provide ease and convenience to drivers. These electronic features or nodes rely on in-vehicle communication protocols to ensure functionality. One of the most-widely adopted in-vehicle protocols on the market today is the Controller Area Network, popularly referred to as the CAN bus. The CAN bus is utilized in various modern, sophisticated vehicles. However, as the sophistication levels of vehicles continue to increase, we now see a high rise in attacks against them. These attacks range from simple to more-complex variants, which could have detrimental effects when carried out successfully. Therefore, there is a need to carry out an assessment of the security vulnerabilities that could be exploited within the CAN bus. In this research, we conducted a security vulnerability analysis on the CAN bus protocol by proposing an attack scenario on a CAN bus simulation that exploits the arbitration feature extensively. This feature determines which message is sent via the bus in the event that two or more nodes attempt to send a message at the same time. It achieves this by prioritizing messages with lower identifiers. Our analysis revealed that an attacker can spoof a message ID to gain high priority, continuously injecting messages with the spoofed ID. As a result, this prevents the transmission of legitimate messages, impacting the vehicle's operations. We identified significant risks in the CAN protocol, including spoofing, injection, and Denial of Service. Furthermore, we examined the latency of the CAN-enabled system under attack, finding that the compromised node (the attacker's device) consistently achieved the lowest latency due to message arbitration. This demonstrates the potential for an attacker to take control of the bus, injecting messages without contention, thereby disrupting the normal operations of the vehicle, which could potentially compromise safety.
PubMed: 37837053
DOI: 10.3390/s23198223 -
Frontiers in Psychiatry 2024There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic... (Review)
Review
BACKGROUND
There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic illness in which patients have the delusion that they are not pregnant. The authors provide a literature review regarding psychotic pregnancy denial, present an unpublished case and its questions and dilemmas, and offer recommendations for resolving the ethical challenges these cases raise.
CASE
A 26-year-old, single, unemployed woman of no fixed residence was admitted for suicidal ideation. She had a history of psychosis, had multiple ER visits and at least one previous hospitalization, had minimal contact with psychiatric outpatient clinics, and had been poorly compliant with treatment recommendations. She was discovered to be about 31 weeks pregnant in the emergency room. Ultrasound exams revealed no fetal anomalies. This was the patient's second pregnancy; her previous pregnancy resulted in an abortion. Her sole psychotic symptom was the delusional belief that she was not pregnant. On the rare occasions when the patient acknowledged being pregnant, she requested termination of pregnancy. Despite intensive pharmacological treatment of her psychosis, the patient continued believing that she was not pregnant and repeatedly said she would not participate in the labor and delivery process. She disagreed with the induction of labor or a cesarean section if needed. The patient developed gestational hypertension, an obstetric indication for delivery. Induction of labor was offered to avoid potentially disastrous outcomes for the pregnant woman and the fetus.
CONCLUSION
Psychotic pregnancy denial is potentially life-threatening. Delivery of the fetus requires carefully weighing risks and benefits and thoroughly considering the ethical framework.
TEACHING POINTS
Treatment of birthing people with psychotic denial of pregnancy is complex; it requires special clinical and ethical skills to determine the patient's level of decision-making impairment and to find a middle ground between the pregnant person's right to autonomy and the physicians' beneficence-based duties. Using a well-coordinated, interdisciplinary approach and a solid ethical framework, the decision to deliver the fetus while engaging the pregnant person, to the extent possible, in the decision-making process is essential.
PubMed: 38370555
DOI: 10.3389/fpsyt.2024.1337988