Jorge Peña Queralta, Farhad Keramat, Salma Salimi, Lei Fu · 6 authors
Abstract Purpose of Review: Distributed ledger technologies (DLTs), particularly blockchain, are paving the way to securing and managing distributed and large-scale systems of autonomous agents. We look into how these technologies are moving out of the lab and into the real world within the robotics field. Recent Findings: Despite the scalability and real-world applicability concerns, new solutions have emerged that show resilience to intermittent connectivity, as well as scalable solutions for managed or permissioned networks. Summary: We present a review on the various use cases that different DLTs can support in multi-robot systems. We argue that the majority of the work to date on open and permissionless blockchains is only applicable to a subset of robotics use cases, with novel DLT architectures and permissioned blockchains driving adoption across industrial and more mature application scenarios.
The proposed study aims to identify the major challenges for blockchain adoption to manage reverse logistics activities of recyclable hospital waste in the Indian healthcare sector, in the COVID era. Fifteen challenges are identified through literature review and experts' views and are prioritized and analyzed for cause-and-effect relationships using a hybrid approach combining Best-Worst Method (BWM) and Decision-Making Trial and Evaluation Laboratory (DEMATEL). A sensitivity analysis is performed to evaluate the results' robustness. The results reveal that the Technological and Regulatory challenges category plays the most influential role consisting of Lack of Government Support and Policies, Lack of Strategic Planning, Lack of Knowledge and Qualified Expertise, Lack of Standards and Regulations, High Cost Involved, and Lack of Top Management Support are the most significant challenges affecting blockchain adoption. This study can support healthcare stakeholders, policymakers, government, and researchers in planning the strategic removal of the challenges to blockchain adoption in the Indian healthcare sector. The identification of the mutual interaction among the challenges will help healthcare decision makers address strategic questions of waste management from a holistic point of view. Since the work is achieved in the Indian healthcare context, generalization of the results must be carefully considered. The present study contributes significantly to discussing blockchain's potential in healthcare waste management. The study's findings can aid decision making process of managers, policymakers, and benefit researchers in this field. Supplementary Information: The online version contains supplementary material available at 10.1007/s12063-023-00413-9.
Due to the shortage of available kidney organs for transplants, handling every donor kidney with utmost care is crucial to preserve the organ's health, especially during the organ supply chain where kidneys are prone to deterioration during transportation. Therefore, this research proposes a blockchain platform to aid in managing kidneys in the supply chain. This framework establishes a secure system that meticulously tracks the organ's location and handling, safeguarding the health from donor to recipient. Additionally, a machine-learning algorithm is embedded to monitor organ health in real-time against various metrics for prompt detection of possible kidney damage.
Prasoon Soni, Alok Mathur, Dhruvil Patel, R. Manjula
Organ donation and organ trafficking are significant global health issues that pose ethical and legal challenges. There is a significant shortage of available organs for transplantation compared to the demand, resulting in the emergence of an illegal market for organs. This black market exploits and takes advan- tage of vulnerable individuals, who are coerced into selling their organs for transplant purposes. To address these issues, this research proposes using blockchain technology as a tool for improving transparency and traceabil- ity in the organ donation and transplantation process. The platform is built on top of the Polygon blockchain, using smart contracts to automate various aspects of the process, such as verifying donor and recipient identities, man- aging organ matching, and releasing organ donation records. Patient infor- mation is securely stored using MongoDB, while decentralized digital identi- ties ensure data security and privacy. An administrative dashboard provides a user-friendly interface for managing the system, and regular data analytics and monitoring track key metrics. The use of blockchain technology has the poten- tial to improve the safety and ethical integrity of the organ transplantation process, combat organ trafficking, and improve the availability of lifesaving organ transplants.
Robotics systems of all types are revolutionizing a wide variety of industriesâtransportation, manufacturing, and even healthcareâand yet, many essential ingredients for robotics systems in the real world are not technologically ready for deployment. Currently, robots lack the protocols and standards required to be safe and secure outside factories. In an attempt to close this gap, recent research has demonstrated the security benefits of combining robotics systems with blockchain-based and related technologies (e.g., smart contracts, zero-knowledge proofs, Merkle trees). In this perspective article, I argue that blockchain-based robotics is starting to provide innovative solutions (e.g., secure data sharing, consensus mechanisms, and new interaction methods) to urgent problems of robot security. I list the most important takeaways so far from this emerging field of research that I helped establish together with a growing community. I close the article by discussing the implications of the security challenges that the robotics research community is facing, and possible ways for us to move forward.
<p>Recent technological advancements have led to the development of new methods for managing organ donation systems, which aim to overcome the limitations of traditional centralized systems. To achieve increased transparency, security, and efficiency in the organ donation process, blockchain technology is being proposed as a replacement for these centralized systems. However, most previous works on organ donation systems have focused on using Ethereum-based blockchain solutions, which offer limited control, a fixed set of consensus protocols, and no support for concurrent executions. In contrast, our work has utilized the Hyperledger Fabric framework to develop a network model of the organ donation system. We have designed and deployed a prototype system with smart contracts using Amazon Managed Blockchain Service. Additionally, we have built a client application that uses the Fabric SDK to interact with the network and perform various actions. To evaluate the performance of our system, we conducted extensive testing using the Hyperledger Caliper benchmarking tool. In our test bench, the system achieved a peak actual send rate of 389.1 transactions per second (TPS) for creating new records and 508.4 TPS for reading records. At a send rate of 800 TPS, the system took an average of 12.16 seconds to serve a request for creating a record and an average of 3.71 seconds to serve a request for reading a record. Future work is required to extend the functionalities of the system and identify potential endorsers and managers for this type of controlled blockchain network.</p>
Alessandro Anselmo, Marco Materazzo, Nicola Di Lorenzo, Bruno Sensi · 10 authors
In the last few years, innovative technology and health care digitalization played a major role in all medical fields and a great effort worldwide to manage this large amount of data, in terms of security and digital privacy has been made by different national health systems. Blockchain technology, a peer-to-peer distributed database without centralized authority, initially applied to Bitcoin protocol, soon gained popularity, thanks to its distributed immutable nature in several non-medical fields. Therefore, the aim of the present review (PROSPERO N° CRD42022316661) is to establish a putative future role of blockchain and distribution ledger technology (DLT) in the organ transplantation field and its role to overcome inequalities. Preoperative assessment of the deceased donor, supranational crossover programs with the international waitlist databases, and reduction of black-market donations and counterfeit drugs are some of the possible applications of DLT, thanks to its distributed, efficient, secure, trackable, and immutable nature to reduce inequalities and discrimination.
Over the past decade, the blockchain technology has gained a significant traction with the introduction of the âbitcoinâ, the first cryptocurrency back in 2008. The rapid growth of âbitcoinâ as a currency and the Bitcoin as a protocol has served as a wake-up call to the IT community which began to realize the real potential of blockchain technology. Blockchain technology is capable of filling many gaps that traditional IT solutions struggle to address. In the other hand the increasing complexity of adjudicating health insurance claims is an urge to introduce more secure and efficient claims adjudication system. Blockchain technology has the potential to reshape the claims adjudication process not only due to its decentralized and tamper-proof features but to its consensus protocols and much more other characteristics. This article studies some of the most recent researches on blockchain solution for health insurance claim adjudication, evaluates the its feasibility and identifies areas where blockchain technology could be applied to improve efficiency and accuracy. This study will also examine the potential benefits and challenges of implementing a blockchain-based system, like reducing administrative costs and improving fraud detection.
The organ donation and transplantation methods in use today present a variety of requirements and barriers as well as technical, clinical, ethical, and legal limitations regards registration, matching of donors and recipients, organ procurement, delivery, and transplantation. In order to provide a fair and effective procedure, a complete framework for organ donation and transplantation is necessary as well as to enhance patient satisfaction and trust. In this paper, we describe a completely decentralised, secure, trackable, auditable, private, and trustworthy private Ethereum blockchain-based system for coordinating organ donation and transplantation. We create smart contracts and outline the development, testing, and verification of six algorithms. By performing research on privacy, security, and confidentiality and contrasting our solution with the available alternatives, we assess the effectiveness of the suggested solution.
Dounia Marbouh, Mecit Can Emre Simsekler, Khaled Salah, Raja Jayaraman · 5 authors
Medical errors are recognized as major threats to patient safety worldwide. Lack of streamlined communication and an inability to share and exchange data are among the contributory factors affecting patient safety. To address these challenges, blockchain can be utilized to ensure a secure, transparent and decentralized data exchange among stakeholders. In this study, we discuss six use cases that can benefit from blockchain to gain operational effectiveness and efficiency in the patient safety context. The role of stakeholders, system requirements, opportunities and challenges are discussed in each use case in detail. Connecting stakeholders and data in complex healthcare systems, blockchain has the potential to provide an accountable and collaborative milieu for the delivery of safe care. By reviewing the potential of blockchain in six use cases, we suggest that blockchain provides several benefits, such as an immutable and transparent structure and decentralized architecture, which may help transform health care and enhance patient safety. While blockchain offers remarkable opportunities, it also presents open challenges in the form of trust, privacy, scalability and governance. Future research may benefit from including additional use cases and developing smart contracts to present a more comprehensive view on potential contributions and challenges to explore the feasibility of blockchain-based solutions in the patient safety context.
Abstract This paper argues that the widespread belief that interactions between blockchains and their users are trustâfree is inaccurate and misleading, since this belief not only overlooks the vital role played by trust in the lack of knowledge and control but also conceals the moral and normative relevance of relying on blockchain applications. The paper reaches this argument by providing a close philosophical examination of the concept referred to as trust in blockchain technology, clarifying the trustor group, the structure, and the normatively loaded nature of this trust relation. The paper ends by critically reflecting on two of the most promising values (decentralization and transparency) that can invite usersâ trust in blockchain technology, arguing that there is a tension between the pressing values that are intended to be achieved by developers and the predicament situations caused by current blockchain implementations.
Lodovico Parmegiani, A. Arnone, Silvia Bernardi, Walter Ciampaglia · 7 authors
Abstract Study question To date, no publications exist describing Blockchain in IVF (Hickman, 2020). Can Blockchain technology be used for traceability and accountability in IVF laboratory procedures? Summary answer Blockchain is an easy-to-implement technology for incorruptible traceability of a âVirus-Freeâ vitrification/warming procedure. What is known already In healthcare, Blockchain can become a tool to address challenges regarding sensitive data-sharing and traceability of medical and laboratory procedures. During the Covid-19 pandemic, many authors warned about the role of LN2 as a potential vector for virus contamination, and vitrification and warming were identified as critical procedures for risk of contamination for environments, surfaces, operators and cells. In this study we describe the first application of Blockchain in IVF for incorruptible traceability of a âVirus-Freeâ vitrification/warming procedure based on the combined use of UVC-Sterilized Liquid Nitrogen (LN2) and CE Medical Devices (CE-MD). Study design, size, duration Report on 2346 Ethereum Blockchain data transactions for IVF laboratory procedures mined from 01/10/2019 to 31/12/2021. The procedures were oocyte/embryo vitrification, warming or handling in LN2 after cryopreservation. For each vitrification, warming and handling a UVC-sterilized batch of LN2 was associated with the code assigned to the vitrification/warming procedure and with the lot number of the single-use sterile vitrification box (N-Sleeve). The clinical results obtained from warmed oocytes/embryos were observed as completion of this process. Participants/materials, setting, methods A Blockchain trusted âVirus-Freeâ vitrification/warming programme was set up using a specifically designed CE-MD N-Bath-System (Nterilizer-Italy). Each procedure was traced by the CE-MDâs software and a dedicated web application. Finally, data were made incorruptible by Ethereum Blockchain transactions. Before oocyte/embryo warming, vitrification carrier washing with UVC-sterilized LN2 was performed in accordance with Parmegiani et al (2012) and recent international anti-Covid guidelines. Main results and the role of chance Of the 2346 Blockchain transactions 1268 regarded vitrification and cryopreserved specimen handling procedures; 1078 transactions were frozen cell warmings (308 oocytes and 770 embryos) performed on 799 patients. To date, 445 pregnancies have been obtained (pregnancy rate: 41% per cycle; 56% per patient) and 219 babies have been born. Limitations, reasons for caution Ethereum is a decentralized, open-source blockchain with smart contract functionality. Ether is the native cryptocurrency which is highly susceptible to cost changes. Other public or private Blockchains may be used in future in healthcare with more stable transaction costs. Wider implications of the findings This is the first evidence of the application of Blockchain in IVF and many others will probably follow. Blockchain immutable records of LN2 sterilization combined with procedure codes and disposable lots represent incorruptible traces for âVirus-Freeâ vitrification/warming. During this pandemic 219 babies were born from cryopreservation procedures powered by Blockchain. Trial registration number Not Applicable
Abstract Robot Operating System (ROS) has brought great potential for automation in all fields involved in production activities, which greatly improves productivity and simplifies operations that belonged to humans originally. However, ROS is highly dependent on communication but lacks secure data sharing mechanisms. Therefore, when it comes to multi-robots interaction scenarios, there are severe challenges in ensuring the safe and trustworthy exchange of specified confidential data among multi-robots. The reliability of data also needs to be considered carefully. This paper proposes a solution to this problem based on blockchain technology. We present a general secure and convenient authorization framework named AuthROS for ROS nodes with absolute security and high availability based on private Ethereum network and SM algorithms. This framework is capable of meeting the requirements for immutability and security of confidential data exchange in nodes of ROS of any size. An authority granting and identity identifying mechanism is proposed and integrated into the Ethereum smart contract to execute atomically to ensure the trustworthiness exchange of data and no third-party participation. At the same time, a key exchange based on SM2 and plaintext encryption mechanism based on SM4 is proposed to ensure the data transmission security. Furthermore, a data digest uploading scheme is adopted to improve the efficiency of querying and data uploading to the Ethereum network. Based on all of mechanisms mentioned above, AuthROS can play a role in the scenario where data transmitted among robots need to be recorded and maintain immobility. Experimental results demonstrated that AuthROS is equipped with excellent security, good time performance along with Nodes Forging resistance. We believe that AuthROS is the first secure data sharing framework for Robots loaded with ROS. We open sourced AuthROS at https://github.com/RobAI-Lab/ROS-Chain.
Jack Huang, Yuan Wei Qi, Muhammad Rizwan Asghar, Andrew Meads · 5 authors
Abstract In New Zealand, the demand for healthcare services has grown gradually in the last decade, and it is likely to increase further. This had led to issues such as increasing treatment costs and processing time for the patients. To address the growing pressure in the healthcare sector, and its fragmented IT landscape that compounds the problems further, the New Zealand Ministry of Health aims to establish a shared Electronic Health Record (EHR) system that integrates all the major healthcare organisations such as hospitals, medical centres, and specialists. Due to its characteristics, blockchain technology could be a potential platform for building such largeâscale health systems. Here, MedBloc, a blockchainâbased secure EHR system that enables patients and healthcare providers to access and share health records while providing usability, security, and privacy is presented. MedBloc captures a longitudinal view of the patientsâ health story and empowers the patients to regulate their own data by allowing them to give or withdraw consent for healthcare providers to access their records. To preserve the patientsâ privacy and protect their health data, MedBloc uses an encryption scheme to secure records and smart contracts to enforce access control to prevent unauthorised access.
Resource-based consensus is the backbone of permissionless distributed ledger systems. The security of such protocols relies fundamentally on the level of resources actively engaged in the system. The variety of different resources (and related proof protocols, some times referred to as PoX in the literature) raises the fundamental question whether it is possible to utilize many of them in tandem and build multi-resource consensus protocols. The challenge in combining different resources is to achieve fungibility between them, in the sense that security would hold as long as the cumulative adversarial power across all resources is bounded. In this work, we put forth Minotaur, a multi-resource blockchain consensus protocol that combines proof-of-work (PoW) and proof-of-stake (PoS), and we prove it optimally fungible. At the core of our design, Minotaur operates in epochs while continuously sampling the active computational power to provide a fair exchange between the two resources, work and stake. Further, we demonstrate the ability of Minotaur to handle a higher degree of work fluctuation as compared to the Bitcoin blockchain; we also generalize Minotaur to any number of resources. We demonstrate the simplicity of Minotaur via implementing a full stack client in Rust (available open source). We use the client to test the robustness of Minotaur to variable mining power and combined work/stake attacks and demonstrate concrete empirical evidence towards the suitability of Minotaur to serve as the consensus layer of a real-world blockchain.
Fidelia Cascini, Flavia Beccia, Francesco Andrea Causio, Andrea Gentili · 7 authors
The recent progress of genomics research is providing unprecedented insight into human genetic variance, susceptibility to disease and risk stratification. Current trends predict that a massive amount of genomic data will be produced in the upcoming years which, when coupled with the fast-paced development of the field, will create new social, ethical, and legal challenges. In the complex legislative environment of the European Union, genomic data sharing policies will have to weigh the benefits of scientific discovery against the ethical risks posed by the act of sharing sensitive data. In this complex, interconnected environment, blockchain provides a unique and novel solution to accountability, traceability, and transparency issues regarding genomic data sharing. Implementing a distributed ledger technology-based database could empower both patients and citizens to responsibly use genomic data pertaining to them because it allows for a higher degree of control over the recipients of their data and their uses. The blockchain technology will engage both data owners and policymakers to address the multiple issues of genomic data sharing and allow us to redefine the way we look at genomics.
Todayâs organ donation and transplantation systems pose different requirements and challenges in terms of registration, donor-recipient matching, organ removal, organ delivery, and transplantation with legal, clinical, ethical, and technical constraints. Therefore, an end to-end organ donation and transplantation system is required to guarantee a fair and efficient process to enhance patient experience and trust. We propose a private Ethereum blockchain based solution to enable organ donation and transplantation management in a manner that is fully secure, traceable, auditable, private, and trustworthy. We develop smart contracts that ensure the data provenance by recording events automatically. We present algorithms with their implementation, testing, and validation details. We evaluate the performance of the proposed solution by performing privacy, security, and confidentiality analyses as well as comparing our solution with the existing solutions. Key Words: organ, donation, private, confidentiality
BACKGROUND: In clinical genomics, sharing of rare genetic disease information between genetic databases and laboratories is essential to determine the pathogenic significance of variants to enable the diagnosis of rare genetic diseases. Significant concerns regarding data governance and security have reduced this sharing in practice. Blockchain could provide a secure method for sharing genomic data between involved parties and thus help overcome some of these issues. OBJECTIVE: This study aims to contribute to the growing knowledge of the potential role of blockchain technology in supporting the sharing of clinical genomic data by describing blockchain-based dynamic consent architecture to support clinical genomic data sharing and provide a proof-of-concept implementation, called ConsentChain, for the architecture to explore its performance. METHODS: The ConsentChain requirements were captured from a patient forum to identify security and consent concerns. The ConsentChain was developed on the Ethereum platform, in which smart contracts were used to model the actions of patients, who may provide or withdraw consent to share their data; the data creator, who collects and stores patient data; and the data requester, who needs to query and access the patient data. A detailed analysis was undertaken of the ConsentChain performance as a function of the number of transactions processed by the system. RESULTS: We describe ConsentChain, a blockchain-based system that provides a web portal interface to support clinical genomic sharing. ConsentChain allows patients to grant or withdraw data requester access and allows data requesters to query and submit access to data stored in a secure off-chain database. We also developed an ontology model to represent patient consent elements into machine-readable codes to automate the consent and data access processes. CONCLUSIONS: Blockchains and smart contracts can provide an efficient and scalable mechanism to support dynamic consent functionality and address some of the barriers that inhibit genomic data sharing. However, they are not a complete answer, and a number of issues still need to be addressed before such systems can be deployed in practice, particularly in relation to verifying user credentials.
Introduction and Structural Organization of Transplantation in Argentina Argentina is the eighth largest country in the world (surface area of 2,780,400 km2), and the third most populated country in South America (its estimated population is 44,494,502). It is divided into 24 autonomously governed provinces (1). The health care system in Argentina, which covers >22 million people, is decentralized, with multiple state-dependent funders consisting of social security, public, and private subsectors. There are 4.5 hospital beds per 1000 inhabitants and 3.49 physicians per 1000 inhabitants (overall there are 166,187 physicians in the country) (2,3). There is one nephrologist for every 40 patients, ranking third in Latin Ame rica in terms of the number of nephrologists per million inhabitants (4,5). The first kidney transplantation in Argentina was performed in Buenos Aires in 1957 by Lanari et al. (6). Over the next several decades, a series of laws were sequentially passed, aiming to streamline the national transplantation processes. These ultimately led to the creation of a single national, decentralized organization called the National Central Institute for the Coordination of Ablation and Implantation (INCUCAI), an entity under the National Ministry of Health. INCUCAI's mission is to promote, regulate, and coordinate activities related to the procurement and transplantation of organs, tissues, and cells at a national level, guaranteeing transparency, equity, and quality (7). In 2003, the INCUCAI created a database system called The National Procurement and Transplantation Information System of the Argentine Republic to track, assess, regulate, and manage all transplant activities in Argentina. It provides free online access to all essential information related to organ transplantation and the registry of patients on dialysis. This system is also used to help guide health policies and clinical research (8). The country is divided into five procurement regions, encompassing 157 transplantation centers. Of these centers, 61 perform kidney transplants, 35 liver, 16 kidney-pancreas, 28 heart, eight lung, five heart and lung, and four intestinal transplants. Historically, the vast majority of transplant surgeries were performed by a combination of vascular surgeons and urologists, but recently general surgeons specifically trained in multiorgan transplantation services have joined the services and established laparoscopic living donor nephrectomy techniques. Pre- and post-kidney transplant care is managed by transplant nephrologists as a fundamental part of a multidisciplinary team that also includes psychologists, social workers, specialized nurses, etc. The Argentine Society of Transplantation, which brings together all transplant professionals, was established in 1982 (3,4). Argentina supports the Declaration of Istanbul and participates actively through its scientific societies in the summit of the Pontifical Academy of Sciences to combat organ trafficking and transplant tourism (3,7). Kidney Transplantation in Argentina The characteristics of the kidney transplant population in Argentina are shown in Table 1. There have been 15,774 kidney transplants performed in Argentina since 1998 (1). Of these, 89% were performed in adult patients and 11% in pediatric ones. The majority of transplants originate from deceased donors with the predominant cause of death being stroke (52%) and traumatic brain injury (39%) (1,8). In 2005, a major initiative was made to increase organ donation by the passing of the Law of Presumed Consent. However, although this law established that all persons should be considered potential donors, donation still required confirmation from a family member. This law was updated in 2018 that established that all people are potential donors, unless they had previously declared themselves as nondonors to INCUCAI. Although family refusal to donate was already decreasing (from 45% in 2016 to 33% in 2018), the new law further reduced the rate of refusal to 13% in 2019. These changes have increased the donation rate from 11.8 per million population (PMP) in 2016, to 15.8 PMP in 2018, and 19.9 PMP in 2019. Indeed, barriers to donation are now more logistical in nature (e.g., limitations in the universal harvesting and transportation of organs throughout the country), rather than due to social or cultural grounds. Table 1. - Characteristics of kidney transplant recipients in Argentinaa General Characteristics of the Health Care in ESKD and Kidney Transplant in Argentine Population 44,938,712 Population on dialysis (HD+PD) 30,607 Population of ESKD on the waiting list 5221 (17%) Population with a functioning kidney transplant 11,486 Adult LDKTs (2019) 3998 (92%) Pediatric LDKTs (2019) 367 (8%) Number of KT centers 61 Cost of peritransplant module (20 days post-transplantation) US$4840 b Monthly cost of the post-transplantation module (average) US$212 b Comparison DDKT DDKT LDKT Total KT from 1998 to the present 15,740 5069 KT per year (2019) 1232 359 Source: DDKT versus LDKT, % 69 31 Age of the recipient, yr, mean±SD 45.5 (45.2â45.8) 36.3 (35.9â36.7) Male, % 57% 57% Cold ischemia time, mean±SD 19.37 (19.2â19.5) 1.5 (1.35â1.62) Time on dialysis until kidney transplantation, mean±SD 6.1 (5.97â6.22) 1.96 (1.89â2.05) Years on the waiting list, mean±SD 2.32 (2.35â2.40) 0 Causes of death post-transplant, % DDKT LDKT Infection 43 36 Cardio-cerebrovascular 24 19 Other 15 13 Neoplasm 7 19 Causes of graft loss, % DDKT LDKT Chronic allograft dysfunction 38 48 Others 30 32 Acute rejection 17 15 Primary nonfunction 7 1 Vascular complications 3 2 Urological complications 1 1 Infection 2 0 Noncompliance 1 0 Recurrent disease 1 1 HD, hemodialysis; PD, peritoneal dialysis; KT, kidney transplant; LDKT, living donor kidney transplant; DDKT, deceased donor kid ney transplant.aOfficial data from National Central Institute for the Coordination of Ablation and Implantation between January 1, 1998 and December 31, 2019.bUsing the unofficial exchange rate as of August 2021 (approximately 186 Argentine pesos per dollar). Despite these advances in donation, overall transplantation rates are insufficient to meet demand. The overall ESKD dialysis population in Argentina is 30,607 patients, of whom 5221 (17%) are on the waiting list (2). The average waiting time on the transplant list is >6 years. In 2019, there were 1674 kidney transplants, 69 simultaneous kidney-pancreas, 19 kidney-liver, and five kidney-heart transplants. Of the 1674 kidney transplants, 1325 (79%) were deceased donor kidney transplants (DDKT) and 349 (21%) were living donor kidney transplants (LKTD). This percentage of LKDT has hovered between 20% and 30% over the last 10 years. In total, 97% of LKDTs came from related donors, and 14% were performed preemptively. Although paired donation is allowed in the national exchange program, they are quite rare. The cost of renal transplantation is predominantly covered by governmental agencies including the National Institute of Social Security for Retirement and Pensions (47%), public insurance (35%), and provincial social security (12%); commercial insurance accounts for the remaining <10%. These insurances cover almost all transplant-related costs. In general, patients do not incur any out-of-pocket costs for any post-transplant care, other than for a few prophylactic medications. In 2021, the estimated cost for the kidney transplantation module (including kidney transplant surgery and all immunosuppression and general medication during first 20 days) was close to US$4840 (considering the unofficial exchange rate of approximately 186 Argentine pesos per dollar; however, there is an alternative market with values that differ greatly from the official ones because the Argentine government imposes very high taxes and strict restrictions for the purchase of foreign currency). It was US$212 per consult for the monthly post-transplantation module (monthly outpatient clinic visit) (4). Outcomes and most Common Complications of Kidney Transplantation in Argentina As expected, adults that receive an LDKT have better patient and graft survival rates than adults receiving DDKT (5,8). Patient survival rates for LDKT versus DDKT were 98% versus 90%, 95% versus 80%, and 90% versus 68%, at 1, 5, and 10 years, respectively. However, graft survival rates were 97% versus 83%, 87% versus 66%, and 71% versus 46%, for these same time points (Figure 1, A and B) (5,8). The main causes of graft loss in DDKT were chronic allograft dysfunction (38%) followed by acute rejection (17%), primary nonfunction (7%), infections (2%), vascular complication (3%), urological complication (1%), noncompliance (1%), recurrent disease (1%), and others (30%) (5,8). Of note, in Argentina, infection constitutes a main cause of death in patients with functioning grafts close to 43% for DDKT, similar to that reported by the Latin America Dialysis and Transplant Registry (9).Figure 1.: Patient and graft survival in deceased donor kidney transplant versus living donor kidney transplant in Argentina from 1998 to 2019. LDKT, living donor kidney transplant; DDKT, deceased donor kidney transplant.Effect of Delayed Graft Function A major challenge for optimizing transplant outcomes in Argentina, as in most of Latin America, is the high incidence of delayed graft function (DGF) after DDKT (approximately 60%). The causes of DGF in Argentina are multifactorial, but predominantly related to suboptimal organ maintenance due to prolonged cold ischemia time and limited access to extracorporeal perfusion machines (9,10). Because DGF results increased length of stay, need for dialysis, infection rates, acute rejection (with the associated decrease in graft and patient survival), and costs, it has had an increasingly detrimental effect on the advancement of kidney transplantation in Argentina. Other barriers negatively affecting organ donation in the country include: (1) sociocultural problems related to fear and myths about donation, (2) lack of educational campaigns in schools, (3) lack of early identification of potential donors in the health care facilities, and (4) suboptimal education regarding transplantation to health care personnel (3,9). Future Perspectives and New Challenges The kidney transplant program in Argentina has made much progress since its inception. Some of the major advances include (1) a legal framework and structured governmental organizations that oversee organ donation and transplantation, these have improved access to transplants; (2) the development of a network of highly skilled personnel, which has improved outcomes due to better transplant and post-transplant care; and (3) an online registry system for traceability of donation-transplantation process (5). However, there are still several challenges to overcome. First, we must further educate our health care administrators and funders so they recognize that kidney transplantation is the most cost-effective treatment for advanced CKD, because it not only restores the patient's quality of life, but also significantly improves survival (compared with patients that remain on dialysis), and lowers public health costs. That is, it needs to be recognized as the treatment of choice. Second, we must increase the donor pool by increasing the use of expanded criteria deceased donors and strongly encourage the growth of LDKT programs. Finally, we must improve organ preservation by incorporating the routine use extracorporeal perfusion machines, reduce cold-ischemia times, and develop donor procurement protocols for organ harvesting post-circulatory death. We believe these measures would further improve the national transplant program. Disclosures R.A. Maldonado reports receiving speaker honoraria from AstraZeneca, Novartis, and Sandoz; reports being a scientific advisor or member as the Coordinator of Transplant Work Group of the Argentine Society of Nephrology, and Member of Kidney Transplant Committee of Argentine Society of Transplantation; and reports other interests/relationships as President of the CĂłrdoba Society of Nephrology. The remaining author has nothing to disclose. Funding None.
Pedro Elkind Velmovitsky, Frederico M. Bublitz, Laura Fadrique, Plinio Pelegrini Morita
BACKGROUND: Although big data and smart technologies allow for the development of precision medicine and predictive models in health care, there are still several challenges that need to be addressed before the full potential of these data can be realized (eg, data sharing and interoperability issues, lack of massive genomic data sets, data ownership, and security and privacy of health data). Health companies are exploring the use of blockchain, a tamperproof and distributed digital ledger, to address some of these challenges. OBJECTIVE: In this viewpoint, we aim to obtain an overview of blockchain solutions that aim to solve challenges in health care from an industry perspective, focusing on solutions developed by health and technology companies. METHODS: We conducted a literature review following the protocol defined by Levac et al to analyze the findings in a systematic manner. In addition to traditional databases such as IEEE and PubMed, we included search and news outlets such as CoinDesk, CoinTelegraph, and Medium. RESULTS: Health care companies are using blockchain to improve challenges in five key areas. For electronic health records, blockchain can help to mitigate interoperability and data sharing in the industry by creating an overarching mechanism to link disparate personal records and can stimulate data sharing by connecting owners and buyers directly. For the drug (and food) supply chain, blockchain can provide an auditable log of a product's provenance and transportation (including information on the conditions in which the product was transported), increasing transparency and eliminating counterfeit products in the supply chain. For health insurance, blockchain can facilitate the claims management process and help users to calculate medical and pharmaceutical benefits. For genomics, by connecting data buyers and owners directly, blockchain can offer a secure and auditable way of sharing genomic data, increasing their availability. For consent management, as all participants in a blockchain network view an immutable version of the truth, blockchain can provide an immutable and timestamped log of consent, increasing transparency in the consent management process. CONCLUSIONS: Blockchain technology can improve several challenges faced by the health care industry. However, companies must evaluate how the features of blockchain can affect their systems (eg, the append-only nature of blockchain limits the deletion of data stored in the network, and distributed systems, although more secure, are less efficient). Although these trade-offs need to be considered when viewing blockchain solutions, the technology has the potential to optimize processes, minimize inefficiencies, and increase trust in all contexts covered in this viewpoint.
Vicent Cholvi, Antonio Fernåndez Anta, Chryssis Georgiou, Nicolas Nicolaou · 6 authors
In order to formalize Distributed Ledger Technologies and their interconnections, recent research has introduced the concept of a Distributed Ledger Object (denoted $$\mathcal {O}^L$$ ), a concurrent abstraction that maintains a totally ordered sequence of records, capturing the essence of blockchains and distributed ledgers. In this work, we introduce the Distributed Grow-only Set object (denoted $$\mathcal {O}^{GS}$$ ), a novel abstraction that, unlike the $$\mathcal {O}^L$$ , maintains an immutable set of records by supporting only Add and Get operations. This object is inspired by the Grow-only Set (G-Set) a well-known Conflict-free Replicated Data Type (CRDT). We formally define the $$\mathcal {O}^{GS}$$ and present a Byzantine-tolerant, consensus-free implementation (denoted as $$\mathcal {O}^{GS}_B$$ ) that ensures eventual consistency. Building on this implementation, we propose consensus-free algorithmic solutions to two fundamental problems: the Atomic Appends problem, which concerns atomically appending multiple records to distinct ledgers, and the Atomic Adds problem, its counterpart in the context of G-Sets. Additionally, we show how the $$\mathcal {O}^{GS}_B$$ can be leveraged to construct a consensus-free, Single-Writer Byzantine-tolerant $$\mathcal {O}^L$$ . We argue that the applicability of the $$\mathcal {O}^{GS}_B$$ extends well beyond these specific use cases, offering a lightweight and efficient foundation for a variety of distributed applications.
Vicent Cholvi, Antonio Fernåndez Anta, Chryssis Georgiou, Nicolas Nicolaou · 6 authors
In order to formalize Distributed Ledger Technologies and their\ninterconnections, a recent line of research work has formulated the notion of\nDistributed Ledger Object (DLO), which is a concurrent object that maintains a\ntotally ordered sequence of records, abstracting blockchains and distributed\nledgers. Through DLO, the Atomic Appends problem, intended as the need of a\nprimitive able to append multiple records to distinct ledgers in an atomic way,\nis studied as a basic interconnection problem among ledgers.\n In this work, we propose the Distributed Grow-only Set object (DSO), which\ninstead of maintaining a sequence of records, as in a DLO, maintains a set of\nrecords in an immutable way: only Add and Get operations are provided. This\nobject is inspired by the Grow-only Set (G-Set) data type which is part of the\nConflict-free Replicated Data Types. We formally specify the object and we\nprovide a consensus-free Byzantine-tolerant implementation that guarantees\neventual consistency. We then use our Byzantine-tolerant DSO (BDSO)\nimplementation to provide consensus-free algorithmic solutions to the Atomic\nAppends and Atomic Adds (the analogous problem of atomic appends applied on\nG-Sets) problems, as well as to construct consensus-free Single-Writer BDLOs.\nWe believe that the BDSO has applications beyond the above-mentioned problems.\n
In this paper, we develop a foundation for a constellation of Low Earth Orbit (LEO) satellite IoT by constructing a Blockchain-based framework for continual knowledge sharing and learning collaboratively. This approach is directly applicable for a swarm of Unmanned Aerial Vehicles (UAVs). We ablate Federated Learning (FL) successful features as a basis to ensure high precision of learning inferences at timescales relevant to the underlying time-varying space network and channel dynamics. In such a dynamic setting, there is always a likelihood that miners may be compromised or fail to propagate information in time because of some intrinsic factors such as channel impairments, satellite handovers and attacks. Such transmission failures often lead to undesirable forking events in the Blockchain. Consequently, maintaining a low energy consumption and smallish delay in such an erratic network is highly nontrivial and challenging. To quantify the impacts of the forking and minimize the occurrence of such unwanted events and their adverse effects, we develop a procedure to estimate the expected energy consumption for a given set of miners, block transmissions, and LEOsâ or UAVsâ mobility. Besides, we shed light on deep learning-based resource allocation for mobile mining and demonstrate the synergic gain of FL with Blockchain.
Abstract This paper proposes a novel way to understand trust in blockchain technology by analogy with trust placed in institutions. In support of the analysis, a detailed investigation of institutional trust is provided, which is then used as the basis for understanding the nature and ethical limits of blockchain trust. Two interrelated arguments are presented. First, given blockchainsâ capacity for being institution-like entities by inviting expectations similar to those invited by traditional institutions, blockchain trust is argued to be best conceptualized as a specialized form of trust in institutions. Keeping only the core functionality and certain normative ideas of institutions, this technology broadens our understanding of trust by removing the need for third parties while retaining the value of trust for the trustor. Second, the paper argues that blockchainsâ decentralized nature and the implications and effects of this decentralization on trust issues are double-edged. With the erasure of central points, the systems simultaneously crowd out the pivotal role played by traditional institutions and a cadre of representatives in meeting their assigned obligations and securing the functional systemsâ trustworthy performances. As such, blockchain is positioned as a technology containing both disruptive features that can be embedded with meaningful normative values and inherent ethical limits that pose a direct challenge to the actual trustworthiness of blockchain implementations. Such limits are proposed to be ameliorated by facilitating a shift of responsibility to the groups of people directly associated with the engendering of trust in the blockchain context.