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At least 613 records · Page 34

Clinicians’ and Pharmacists’ Reported Implementation of Vaccination Practices for Adults

Introduction: Despite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians’ and pharmacists’ self-reported implementation of the Standards for Adult Immunization Practice (“the Standards”; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems). Methods: Two Internet panel surveys (one among clinicians and one among pharmacists) were conducted during February–March 2017 and asked respondents about their practice’s implementation of the Standards. T-tests assessed associations between clinician medical specialty, vaccine type, and each component of the Standards (March–August 2017). Results: Implementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines. Conclusions: This report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.

60 APPLIED LIFE SCIENCES↗

An algorithm for optimal management of aggregated HVAC power demand using smart thermostats

Here, this paper presents an algorithm for optimal management of aggregated power demand of a group of heating, ventilating and air-conditioning (HVAC) units. The algorithm provides an advanced direct load control mechanism for HVACs that leverages the availability of smart thermostats, which are remotely programmable and controllable. The paper provides a theoretical basis and an optimal solution to the problem of cycling a large number of HVAC units while respecting customer-chosen temperature limits for the purpose of maximum load reduction. The problem is presented in a new light by transforming it into a job scheduling problem and is solved using a combination of a novel greedy algorithm and a binary search algorithm. By leveraging widespread availability of smart internet-based (also referred to as IoT-based) thermostats in today’s environment, the proposed approach can be readily applied to residential buildings without additional electrical/IT infrastructure changes.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

A critical review of cyber-physical security for building automation systems

Modern Building Automation Systems (BASs), as the brain that enable the smartness of a smart building, often require increased connectivity both among system components as well as with outside entities, such as the cloud, to enable low-cost remote management, optimized automation via outsourced cloud analytics, and increased building-grid integrations. As smart buildings move towards open communication technologies, providing access to BASs through the building's intranet, or even remotely through the Internet, has become a common practice. However, increased connectivity and accessibility come with increased cyber security threats. BASs were historically developed as closed environments with limited cyber-security considerations. As a result, BASs in many buildings are vulnerable to cyber-attacks that may cause adverse consequences, such as occupant discomfort, excessive energy usage, and unexpected equipment downtime. Therefore, there is a strong need to advance the state-of-the-art in cyber-physical security for BASs and provide practical solutions for attack mitigation in buildings. However, an inclusive and systematic review of BAS vulnerabilities, potential cyber-attacks with impact assessment, detection & defense approaches, and cyber resilient control strategies is currently lacking in the literature. This review paper fills the gap by providing a comprehensive up-to-date review of cyber-physical security for BASs at three levels in commercial buildings: management level, automation level, and field level. The general BASs vulnerabilities and protocol-specific vulnerabilities for the four dominant BAS protocols (i.e., BACnet, KNX, LonWorks, and Modbus) are reviewed, followed by a discussion on four attack targets and seven potential attack scenarios. Furthermore, the impact of cyber-attacks on BASs is summarized as signal corruption, signal delaying, and signal blocking. The typical cyber-attack detection and defense approaches are identified at the three levels. Cyber resilient control strategies for BASs under attack are categorized into passive and active resilient control schemes. Open challenges and future opportunities are finally discussed.

97 MATHEMATICS AND COMPUTING↗

Inkless, dry printing nanographene via in-Situ Coordinated laser ablation and sintering processes

Printing carbon, such as graphene and other carbon structures, for flexible and printed electronics currently relies on either ink-based printing, laser-induced forward transfer (LIFT), or laser-induced graphitization (LIG) to convert carbon-rich precursor materials, such as polymers, to graphene-like carbon structures. Liquid inks contain toxic solvents, surfactants, and stabilizing additives that degrade electrical conductivity and require high-temperature post-processing. On the other hand, LIG is limited by the substrate. Here, this study introduces an additive manufacturing method for dry-printing carbon nanomaterials, ranging from amorphous carbon to crystalline graphene-like structures, on various substrates. The system utilizes laser ablation of a solid graphite target to create pure carbon nanoparticles in situ and on demand. An inert gas carries the nanoparticles onto the substrate, where they can be deposited either as amorphous structures or laser-sintered in real time to form various graphitic structures. The study of laser processing parameters, specifically fluence and pulse repetition frequency, revealed three unique regimes of nanostructure evolution that influence the morphological and electrical properties of these printed structures. Raman spectroscopy confirmed graphitization with a resistivity slightly higher than that of the bulk graphite target. The conductivity/resistivity could be tuned as a function of sintering laser power. Scanning transmission electron microscopy (STEM) revealed that turbostratic nanographene formed with an interlayer spacing of 0.40 nm. Despite ink-based printing methods, such as screen printing, inkjet printing (IJP), and aerosol jet printing (AJP), this eco-friendly and green manufacturing technique could eliminate toxic chemicals, reduce environmental impact, and enable single-step fabrication of carbon-based devices for applications in wearable sensors, energy storage, flexible electronics, and Internet of Things (IoT) devices.

Additive nanomanufacturing↗

RED-BL: Evaluating dynamic workload relocation for data center networks

In this study, we present RED-BL (Relocate Energy Demand to Better Locations), a framework to minimize the electricity cost for operating data center networks over consecutive intervals of fixed duration. Within each interval, RED-BL provides a mapping of workload to a set of geographically distributed data centers. To this end, RED-BL uses the geographical and temporal variations in electricity prices as exhibited by electrical energy markets. In addition, we incorporate the transition costs associated with a change in workload mapping from one interval to the next, over a planning window comprising multiple such intervals. This results in a sequence of workload mappings that is optimal over the entire planning window, even though the workload mapping in a given interval may not be locally optimal. Our evaluation of RED-BL uses electricity prices from the US markets and workload traces from live Internet applications with millions of users. We find that RED-BL can reduce the electric bill by as much as 45% compared to the case when the workload is uniformly distributed. When compared to existing workload relocation solutions, for a wide range of data center deployment sizes, RED-BL achieves electricity cost savings that are 8.28% higher, on average. This seemingly modest reduction can save millions of dollars for the operators. The cost of this saving is an inexpensive computation at the start of each planning window.

97 MATHEMATICS AND COMPUTING↗

Hybrid Modeling in the Era of Smart Manufacturing

Smart manufacturing (SM) is a new paradigm that allows manufacturing to enter its fourth revolution by exploiting state-of-the art sensing, communication and computation as the Industrial Internet of Things (IioT). Via the use of high-performance computing and advanced modeling, SM aims to improve the flexibility and adaptability of manufacturing. This paper addresses this trend by reviewing the combined use of data-driven and knowledge-enabled hybrid models (HM), and discusses how such techniques seamlessly fit in the SM platform. Furthermore, a discussion of the new paradigms of HM enabled by the SM platform is given, highlighting their importance in future large-scale applications of the SM platform.

42 ENGINEERING↗

Testing SOAR tools in use

Investigations within Security Operation Centers (SOCs) are tedious as they rely on manual efforts to query diverse data sources, overlay related logs, correlate the data into information, and then document results in a ticketing system. Security Orchestration, Automation, and Response (SOAR) tools are a relatively new technology that promise, with appropriate configuration, to collect, filter, and display needed diverse information; automate many of the common tasks that unnecessarily require SOC analysts’ time; facilitate SOC collaboration; and, in doing so, improve both efficiency and consistency of SOCs. There has been no prior research to test SOAR tools in practice; hence, understanding and evaluation of their effect is nascent and needed. Here, in this paper, we design and administer the first hands-on user study of SOAR tools, involving 24 participants and six commercial SOAR tools. Our contributions include the experimental design, itemizing six characteristics of SOAR tools, and a methodology for testing them. We describe configuration of a cyber range test environment, including network, user, and threat emulation; a full SOC tool suite; and creation of artifacts allowing multiple representative investigation scenarios to permit testing. We present the first research results on SOAR tools. Concisely, our findings are that: per-SOC SOAR configuration is extremely important; SOAR tools increase efficiency and reduce context switching, although with potentially decreased ticketing accuracy/completeness; user preference is slightly negatively correlated with their performance with the tool; internet dependence varies widely among SOAR tools; and balance of automation with assisting decision making is preferred by senior participants. We deliver a public user- and tool-anonymized and -obfuscated version of the data.

97 MATHEMATICS AND COMPUTING↗

Multi-channel low-cost light spectrum measurement using a multilayer perceptron

Light is one of the most important elements for residential and work spaces, which affects visual performance, comfort, productivity and well-being. The measures that quantify the characteristics of a light source are derived directly from the spectral power distribution (SPD). In addition the SPD is an important factor influencing the quality of a light source. However, measuring light source spectrum with traditional spectrometers is expensive, difficult to adapt to normal spaces, and hard to integrate with other systems. To address these challenges, a low-cost spectrometer was developed using an artificial neural network, with a resolution of 5 nm in the visible spectrum. The reconstructed SPD has an error lower than 2% and allows the derivation of measurements to characterize the colour quality of light sources. Additionally, the device has wireless communication (Bluetooth and Wi-Fi) in real-time, which allows integration into lighting control applications and other Internet of things (IoT) applications.

Botero-Valencia, Juan Sebastián↗

IoT-based retrofit information diffusion in future smart communities

Community-scale building retrofits are not merely scaled-up versions of single-building retrofits. They involve complex challenges, such as reconciling individual interests with collective goals and managing the dynamic interplay between buildings through mechanisms like power grids and social connections. Internet of Things (IoT) connectivity holds the potential to leverage these interplays to balance individual and collective interests effectively in smart communities. One critical aspect of this interplay is information diffusion, which shapes how retrofit decisions spread among neighbors, influencing individual choices and ultimately impacting community-level retrofit outcomes. In other words, IoT-based smart devices automatically push tailored retrofit notifications to homeowners, which completely changes the format of information diffusion in the future. To investigate this influence by such information diffusion, the study used CityBES to simulate energy performance for different retrofits and applied an information diffusion model to analyze how decisions spread in a networked community of 192 buildings. The diffusion process was modeled on a weighted, directed network, capturing the dynamics of information flow and decision-making across 16 scenarios. Individual retrofit benefits were evaluated through payback years, while community-level retrofit outcomes were assessed using greenhouse gas (GHG) emission reductions. The results demonstrate that easier information diffusion among neighbors encourages households to prioritize retrofit measures that align with the majority’s optimal choices, even at the expense of individual financial benefits. In this case, such collective prioritization enhanced community-level retrofit performance, increasing GHG emission reductions by up to 29.4 %. However, this improvement came with trade-offs, as the average payback period for households extended by approximately 1.74 years. These findings highlight the potential of IoT-based information diffusion in future smart communities to coordinate individual interests with collective goals, ultimately accelerating community-level building retrofits.

Shu, Lei↗

This letter corrects factual errors and omissions in Ellen K. Silbergeld's commentary on ''Managing hazards in place: The risks of residual risk''

Highlights: • The Bunker Hill Superfund Site has a long history of managing lead wastes on site. • We rely on comprehensive Institutional Controls Program to:• educate and train the community to limit their exposure. • monitor and maintain infrastructure and physical barriers to exposure. • monitor pediatric blood lead levels. • monitor interior house dust lead levels. • We share information widely via the:• internet • scientific journals • books • newsletters • reports • facebook • youtube.

54 ENVIRONMENTAL SCIENCES↗

Building complex event processing capability for intelligent environmental monitoring

Rapid evolution of Internet-of-Things is driving the increased deployment of smart sensors in environmental applications, contributing to many big data characteristics of environmental monitoring. Most of the current environmental monitoring systems are not designed to handle real-time datastreams, and the best practices for datastream processing and predictive analytics are yet to be established. This work presents a complex event processing (CEP) engine for detecting anomalies in real time, and demonstrates it using a series of real monitoring data from the geological carbon sequestration domain. We show that the service-based CEP engine is instrumental for enabling environmental intelligent monitoring systems to ingest heterogeneous datastreams with scalable performance. Our CEP framework requires minimal coding from the user and can be easily extended to other similar environmental monitoring applications.

54 ENVIRONMENTAL SCIENCES↗

Tikiri—Towards a lightweight blockchain for IoT

Internet of Things (IoT) platforms have been deployed in several domains to enhance efficiency of business process and improve productivity. Most IoT platforms comprise of heterogeneous software and hardware components which can potentially introduce security and privacy challenges. Blockchain technology has been proposed as one of the solutions to realize IoT security by leveraging the (a) Immutable ledger, (b) Decentralized architecture and (c) Strong cryptography primitives. However, integrating blockchain platforms with IoT based applications presents several challenges due to lack of (a) acceptable performance on resource-constrained devices, (b) high transaction throughput, (c) keyword-based search and retrieve, (d) transaction back pressure operations, and (e) real-time response. In this paper, we propose a lightweight blockchain platform, “Tikiri”, for resource-constrained IoT devices. Tikiri uses Apache Kafka for the consensus and proposes new blockchain architecture to handle real-time transaction execution on the blockchain. Tikiri is characterized by functional programming and actor-based smart contract platform that realizes concurrent execution of transactions in the blockchain. Tikiri realizes a lightweight and scalable blockchain that can provides performance on the resource-constrained IoT devices.

97 MATHEMATICS AND COMPUTING↗

Wireless infrastructure protection using low-cost radio frequency fingerprinting receivers

We report that low-data-rate wireless networks incorporated in critical infrastructure applications can be protected through 128-bit encryption keys and address-based access control lists. However, these bit-level credentials are vulnerable to interception, extraction and spoofing using software tools available free of charge on the Internet. Recent research has demonstrated that wireless physical layer device fingerprinting can be used to defend against replay and spoofing attacks. However, radio frequency (RF) fingerprinting typically uses expensive signal collection systems; this is because fingerprinting wireless devices with low-cost receivers has been reported to have inconsistent accuracy. In conclusion, this paper demonstrates a robust radio frequency fingerprinting process that is consistently accurate with both high-end and low-cost receivers. Indeed, the results demonstrate that low-cost software-defined radios can be used to perform accurate radio frequency fingerprinting and to identify spoofing attacks in critical IEEE 802.154-based infrastructure networks such as ZigBee.

97 MATHEMATICS AND COMPUTING↗

A National Radiation Oncology Medical Student Clerkship Survey: Didactic Curricular Components Increase Confidence in Clinical Competency

Purpose: Students applying to radiation oncology residency programs complete 1 or more radiation oncology clerkships. This study assesses student experiences and perspectives during radiation oncology clerkships. The impact of didactic components and number of clerkship experiences in relation to confidence in clinical competency and preparation to function as a first-year radiation oncology resident are evaluated. Methods and Materials: An anonymous, Internet-based survey was sent via direct e-mail to all applicants to a single radiation oncology residency program during the 2012-2013 academic year. The survey was composed of 3 main sections including questions regarding baseline demographic information and prior radiation oncology experience, rotation experiences, and ideal clerkship curriculum content. Results: The survey response rate was 37% (70 of 188). Respondents reported 191 unique clerkship experiences. Of the respondents, 27% (19 of 70) completed at least 1 clerkship with a didactic component geared towards their level of training. Completing a clerkship with a didactic component was significantly associated with a respondent's confidence to function as a first-year radiation oncology resident (Wilcoxon rank–sum P=.03). However, the total number of clerkships completed did not correlate with confidence to pursue radiation oncology as a specialty (Spearman ρ P=.48) or confidence to function as a first year resident (Spearman ρ P=.43). Conclusions: Based on responses to this survey, rotating students perceive that the majority of radiation oncology clerkships do not have formal didactic curricula. Survey respondents who completed a clerkship with a didactic curriculum reported feeling more prepared to function as a radiation oncology resident. However, completing an increasing number of clerkships does not appear to improve confidence in the decision to pursue radiation oncology as a career or to function as a radiation oncology resident. These results support further development of structured didactic curricula for the radiation oncology clerkship.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our nomogram for situations when the potential of relapse may guide the decision for initial intervention.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations

Purpose: Physicians encourage patients to be informed about their health care options, but much of the online health care–related resources can be beneficial only if patients are capable of comprehending it. This study's aim was to assess the readability level of online patient education resources for radiation oncology to conclude whether they meet the general public's health literacy needs as determined by the guidelines of the United States National Institutes of Health (NIH) and the American Medical Association (AMA). Methods: Radiation oncology–related internet-based patient education materials were downloaded from 5 major professional websites (American Society for Radiation Oncology, American Association of Physicists in Medicine, American Brachytherapy Society, (RadiologyInfo.org), and Radiation Therapy Oncology Group). Additional patient education documents were downloaded by searching for key radiation oncology phrases using Google. A total of 135 articles were downloaded and assessed for their readability level using 10 quantitative readability scales that are widely accepted in the medical literature. Results: When all 10 assessment tools for readability were taken into account, the 135 online patient education articles were written at an average grade level of 13.7 ± 2.0. One hundred nine of the 135 articles (80.7%) required a high school graduate's comprehension level (12th-grade level or higher). Only 1 of the 135 articles (0.74%) met the AMA and NIH recommendations for patient education resources to be written between the third-grade and seventh-grade levels. Conclusion: Radiation oncology websites have patient education material written at an educational level above the NIH and AMA recommendations; as a result, average American patients may not be able to fully understand them. Rewriting radiation oncology patient education resources would likely contribute to the patients' understanding of their health and treatment options, making each physician-patient interaction more productive and efficient.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Feasibility of Patient Reporting of Symptomatic Adverse Events via the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) in a Chemoradiotherapy Cooperative Group Multicenter Clinical Trial

Purpose: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Methods and Materials: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. Results: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling “too sick.” Conclusions: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Anomaly analysis and visualization for dynamic networks through spatiotemporal graph segmentations

With recent technology advance in Internet of Things (IoT) that involves human, sensors, and mobile devices, networks are not only growing much larger but more complex and dynamic in nature. The spatiotemporal dynamics of networks are represented by both topological changes and temporal shifts of attribute information associated with network components. Understanding the pattern and trend of dynamic networks is increasingly important. While data mining approaches are generally useful in analyzing the statistical properties of networks, there has been recent trend to consider bringing human into the loop, and to examine how feedback from visualizations of large-scale dynamic networks can further improve data mining and machine learning. Traditional visualization methods based on animation and sequences of snapshot graphs are also limited by human cognitive capability. Here, we present a dynamic network analysis and visualization (DNAV) tool which explores the spatiotemporal dimensions of graph components. In particular, nodes and edges are augmented with spatiotemporal segmentation based on both topological and attribute dynamics (e.g., time and locations of connectivity). To further facilitate analysis of large dynamic networks, DNAV includes statistical dynamic overviews alongside graph views, as well as data filtering modules for scalable analysis. Using case studies on public datasets, we demonstrate the effectiveness of DNAV in understanding and analyzing anomalies in dynamic networks such as computer communication networks.

97 MATHEMATICS AND COMPUTING↗