Prior authorization is a process requiring health care providers to obtain advance approval from a payer before a patient undergoes a procedure for the study to be covered. Prior authorization was ...introduced to decrease overutilization of ultrasound procedures. However, it has led to unanticipated consequences such as impeding access to obstetric imaging, increased administrative overhead without reimbursement, and contribution to physician frustration and burnout. Payers often use intermediary radiology benefit management companies without providing specialty-specific review in a timely manner as is requisite when practicing high-risk obstetrics. This article proposes a number of potential solutions to this problem: (1) consider alternative means to monitor overutilization; (2) create and evaluate data regarding providers in the highest utilization; (3) continue to support and grow the educational efforts of speciality societies to publish clinical guidelines; and (4) emphasize the importance of practicing evidence-based medicine. Understanding that not all health plans may be willing or able to collaborate with health care providers, we encourage physicians to advocate for policies and legislation to limit the implementation of prior authorization within their own states.
Advances in 5G and the Internet of Things (IoT) have to cater to the diverse and varying needs of different stakeholders, devices, sensors, applications, networks, and access technologies that come ...together for a dedicated IoT network for a synergistic purpose. Therefore, there is a need for a solution that can assimilate the various requirements and policies to dynamically and intelligently orchestrate them in the dedicated IoT network. Thus we identify and describe a representative industry-relevant use case for such a smart and adaptive environment through interviews with experts from a leading telecommunication vendor. We further propose and evaluate candidate architectures to achieve dynamic and intelligent orchestration in such a smart environment using a systematic approach for architecture design and by engaging six senior domain and IoT experts. The candidate architecture with an adaptive and intelligent element ("Smart AAA agent") was found superior for modifiability, scalability, and performance in the assessments. This architecture also explores the enhanced role of authentication, authorization, and accounting (AAA) and makes the base for complete orchestration. The results indicate that the proposed architecture can meet the requirements for a dedicated IoT network, which may be used in further research or as a reference for industry solutions.
The U.S. COVID-19 vaccination program, which commenced in December 2020, has been instrumental in preventing morbidity and mortality from COVID-19 disease. Safety monitoring has been an essential ...component of the program. The federal government undertook a comprehensive and coordinated approach to implement complementary safety monitoring systems and to communicate findings in a timely and transparent way to healthcare providers, policymakers, and the public. Monitoring involved both well-established and newly developed systems that relied on both spontaneous (passive) and active surveillance methods. Clinical consultation for individual cases of adverse events following vaccination was performed, and monitoring of special populations, such as pregnant persons, was conducted. This report describes the U.S. government’s COVID-19 vaccine safety monitoring systems and programs used by the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service. Using the adverse event of myocarditis following mRNA COVID-19 vaccination as a model, we demonstrate how the multiple, complementary monitoring systems worked to rapidly detect, assess, and verify a vaccine safety signal. In addition, longer-term follow-up was conducted to evaluate the recovery status of myocarditis cases following vaccination. Finally, the process for timely and transparent communication and dissemination of COVID-19 vaccine safety data is described, highlighting the responsiveness and robustness of the U.S. vaccine safety monitoring infrastructure during the national COVID-19 vaccination program.
During the COVID-19 pandemic, candidate COVID-19 vaccines were being developed for potential use in the United States on an unprecedented, accelerated schedule. It was anticipated that once ...available, under U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) or FDA approval, COVID-19 vaccines would be broadly used and potentially administered to millions of individuals in a short period of time. Intensive monitoring in the post-EUA/licensure period would be necessary for timely detection and assessment of potential safety concerns. To address this, the Centers for Disease Control and Prevention (CDC) convened an Advisory Committee on Immunization Practices (ACIP) work group focused solely on COVID-19 vaccine safety, consisting of independent vaccine safety experts and representatives from federal agencies – the ACIP COVID-19 Vaccine Safety Technical Work Group (VaST).
This report provides an overview of the organization and activities of VaST, summarizes data reviewed as part of the comprehensive effort to monitor vaccine safety during the COVID-19 pandemic, and highlights selected actions taken by CDC, ACIP, and FDA in response to accumulating post-authorization safety data. VaST convened regular meetings over the course of 29 months, from November 2020 through April 2023; through March 2023 FDA issued EUAs for six COVID-19 vaccines from four different manufacturers and subsequently licensed two of these COVID-19 vaccines. The independent vaccine safety experts collaborated with federal agencies to ensure timely assessment of vaccine safety data during this time. VaST worked closely with the ACIP COVID-19 Vaccines Work Group; that work group used safety data and VaST’s assessments for benefit-risk assessments and guidance for COVID-19 vaccination policy. Safety topics reviewed by VaST included those identified in safety monitoring systems and other topics of scientific or public interest.
VaST provided guidance to CDC’s COVID-19 vaccine safety monitoring efforts, provided a forum for review of data from several U.S. government vaccine safety systems, and assured that a diverse group of scientists and clinicians, external to the federal government, promptly reviewed vaccine safety data. In the event of a future pandemic or other biological public health emergency, the VaST model could be used to strengthen vaccine safety monitoring, enhance public confidence, and increase transparency through incorporation of independent, non-government safety experts into the monitoring process, and through strong collaboration among federal and other partners.
Search over encrypted data is a critically important enabling technique in cloud computing, where encryption-before-outsourcing is a fundamental solution to protecting user data privacy in the ...untrusted cloud server environment. Many secure search schemes have been focusing on the single-contributor scenario, where the outsourced dataset or the secure searchable index of the dataset are encrypted and managed by a single owner, typically based on symmetric cryptography. In this paper, we focus on a different yet more challenging scenario where the outsourced dataset can be contributed from multiple owners and are searchable by multiple users, i.e., multi-user multi-contributor case. Inspired by attribute-based encryption (ABE), we present the first attribute-based keyword search scheme with efficient user revocation (ABKS-UR) that enables scalable fine-grained (i.e., file-level) search authorization. Our scheme allows multiple owners to encrypt and outsource their data to the cloud server independently. Users can generate their own search capabilities without relying on an always online trusted authority. Fine-grained search authorization is also implemented by the owner-enforced access policy on the index of each file. Further, by incorporating proxy re-encryption and lazy re-encryption techniques, we are able to delegate heavy system update workload during user revocation to the resourceful semi-trusted cloud server. We formalize the security definition and prove the proposed ABKS-UR scheme selectively secure against chosen-keyword attack. To build confidence of data user in the proposed secure search system, we also design a search result verification scheme. Finally, performance evaluation shows the efficiency of our scheme.
Background
Prior authorization of prescription medications is a policy tool that can potentially impact care quality and patient safety.
Objective
To examine the effectiveness of a mandatory ...peer‐review program in reducing antipsychotic prescriptions among Medicaid‐insured children, accounting for secular trends that affected antipsychotic prescribing nationally.
Data Source
Medicaid Analytical eXtracts (MAX) with administrative claims for health services provided between January 2006 and December 2011.
Study Design
This retrospective, observational study examined prescription claims records from Washington State (Washington) and compared them to a synthetic control drawing from 20 potential donor states that had not implemented any antipsychotic prior authorization program or mandatory peer review for Medicaid‐insured children during the study period. This method provided a means to control for secular trends by simulating the antipsychotic use trajectory that the program state would have been expected to experience in the absence of the policy implementation.
Principal Findings
Before the policy implementation, antipsychotic use prevalence closely tracked those of the synthetic control (6.17 per 1000 in Washington vs. 6.21 in the synthetic control group). Within two years after the policy was implemented, prevalence decreased to 4.04 in Washington and remained stable in the synthetic control group (6.47), corresponding to an approximately 38% decline.
Conclusion
Prior authorization program designs and implementations vary widely. This mandatory peer‐review program, with an authorization window and two‐stage rollout, was effective in moving population level statistics toward safe and judicious use of antipsychotic medications in children.
With the development of deep learning processors and accelerators, deep learning models have been widely deployed on edge devices as part of the Internet of Things. Edge device models are generally ...considered as valuable intellectual properties that are worth for careful protection. Unfortunately, these models have a great risk of being stolen or illegally copied. The existing model protections using encryption algorithms are suffered from high computation overhead which is not practical due to the limited computing capacity on edge devices. In this work, we propose a light-weight, practical, and general Edge device model Protection method at neuron level, denoted as EdgePro. Specifically, we select several neurons as authorization neurons and set their activation values to locking values and scale the neuron outputs during training, where the authorization neurons, locking value, and scale factor together form the "passwords". Then, we design lock training to implement model property protection through alternately locking and releasing, which correspond to model performance preservation and encryption, respectively. EdgePro protects the model by ensuring it can only work correctly when the "passwords" are met, at the cost of encrypting and storing the information of the "passwords" instead of the whole model. Extensive experimental results indicate that EdgePro can work well on the task of protecting models on different datasets. The inference time increase of EdgePro is only 60% of state-of-the-art methods, and the accuracy loss is less than 1%. Additionally, EdgePro is robust against adaptive attacks including fine-tuning, reverse engineering, and pruning, which makes it more practical in real-world applications. EdgePro is also open sourced to facilitate future research: https://github.com/Leon022/EdgePro .
Sustainable agriculture aims to meet the food needs of the growing world population while ensuring minimal impact on the environment and humans as well as productivity. Although pesticides represent ...the backbone of the agri-food sector in its endeavor to secure food production their application is perceived by many as an obstacle towards the achievement of sustainability; the main concerns are linked with their adverse effects on human health and the environment. Τhis review aims to present the status of chemical plant protection and provide insights into the use of pesticides within the context of sustainable agriculture. It mainly focuses on the strengthened legislation frameworks, which especially in the European Union and the United States of America ensure the placement in the market of pesticides with acceptable toxicological and environmental profiles without compromising crop production. Furthermore, the implementation of Integrated Pest Management principles plays a key role in the sustainable use of pesticides. The stringent regulatory requirements have resulted in the dramatic increase of the associated effort and costs in pesticide research and development (R&D) of improved products. Nevertheless, the investment of leading agrochemical companies in the R&D of new pesticides remains high. All the above set the ground for the sustainable use of pesticides in crop production while their successful application remains a challenge.
Display omitted
•Sustainable use of pesticides is one way concerning anthroposphere and biosphere.•Pesticide authorization verifies an acceptable risk to humans and environment.•Management of pesticides can corroborate sustainability in agriculture.•The investment in pesticide R&D remains high.•Co-operation of all stakeholders is essential for the sustainable food production.
This study aims to provide an integrated model that examines the determinants of customer intention to use facial recognition systems (FRS) in quick-service restaurants (QSRs). An extended model ...built based on the unified theory of acceptance and use of technology (UTAUT) was tested via structural equation modeling (SEM) using data collected from a sample of 558 QSR customers. The results showed that perceived performance expectancy, social influence, and trust in the system significantly and positively affect customer intention to use FRS to access loyalty and payment accounts. Furthermore, customer hedonic motivation had a positive effect on the intention to use FRS for authorization to their loyalty accounts, but no effect on the intention to use this technology for payment account authorization. The developed model would be helpful to managers for making a decision of utilizing FRS in QSRs and promoting the technology among customers.
•The study examines adoption intentions of facial recognition systems (FRS) by customers of quick-service restaurants (QSRs).•This research differentiates between customer intentions to adopt FRS for loyalty account and payment account authorization.•Performance expectancy, social influence, and trust affect customer intentions to use FRS for both types of authorization.•Hedonic motivations positively influence customer intention to use FRS in QSRs for loyalty account authorization only.•Perceived security has a strong positive impact on trust in FRS in QSRs.
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