Search Results (389)

The Internet of Medical Things (IoMT) is becoming a vital part of modern healthcare, enabling ongoing patient monitoring and remote diagnosis. However, as more devices connect to the internet, healthcare systems become more vulnerable to serious security issues such as unauthorized access, patient data manipulation, and Man-in-the-Middle attacks. Conventional Intrusion Detection Systems (IDSs) often struggle with the unclear and uncertain characteristics of IoMT traffic, which leads to reduced detection accuracy and increased false alarms. To address these challenges, this paper proposes ML-FSID-FIS, a multi-level feature selection-based Intrusion Detection System that employs a fuzzy inference system (FIS) for classification in IoMT networks. The model combines multiple feature selection techniques into a three-stage multi-level feature selection strategy to improve detection efficiency and strengthen the security of IoMT networks. In the first stage, four feature selection techniques—Random Forest, XGBoost, ReliefF, and Mutual Information—are applied to identify the most relevant features. In the second stage, a frequency-based consensus strategy is utilized to extract consistently selected features from the four top-ranked sets. In the third stage, an ensemble refinement using bagging-based ranking is employed to rank the remaining features, resulting in the selection of the top five features. From these, three candidate 3-feature groups are formed and evaluated, and the best-performing group is selected as the final input set for the fuzzy logic classifier. The FIS produces a continuous risk score that is mapped to a binary decision using a validation-selected threshold. When the proposed method was tested on the WUSTL-EHMS-2020 dataset and compared with other recent work using the same dataset, it showed strong detection performance while maintaining a very low false positive rate of 0.3%. This study is distinguished by its integrated design, which combines a three-stage multi-level feature selection strategy with fuzzy logic-based intrusion classification to improve feature efficiency and support interpretable intrusion detection in IoMT. Full article

Concurrent with the rising consumption of ultra-processed, high-calorie diets and the decline in physical activity, obesity and related cardiovascular conditions among young adults have continued to increase, becoming an important global public health concern. This study integrates non-invasive Internet of Things (IoT) sensing devices, including the TERUMO ES-P2000 blood pressure monitor (Terumo Corp., Tokyo, Japan) and the PhysioFlow PF07 Enduro cardiac hemodynamic analyzer (Manatec Biomedical, Poissy, France), with an artificial neural network (ANN) for cardiac index (CI) prediction. Through appropriate data preprocessing and model training strategies, the generalization ability and stability of the proposed CI prediction model were significantly enhanced. Experimental results demonstrate that, when using three physiological parameters as input, the ANN achieved a classification accuracy of 97.78%, substantially outperforming traditional approaches. Even under two-parameter input conditions, the model maintained strong predictive performance. These findings confirm the effectiveness and practical potential of the proposed framework for real-time, non-invasive CI assessment. Moreover, this research has received rigorous assessment and approval from the Institutional Review Board (IRB) under application number 202501987B0. Full article

Morocco, facing a growing prevalence of chronic diseases such as diabetes, hypertension, and cardiovascular diseases, must overcome significant challenges to modernize its healthcare system. In this context, the integration of digital technologies, including telemedicine, the Internet of Medical Things (IoMT), Artificial Intelligence (AI), and healthcare system interoperability, represents a promising solution to improve the management of chronic diseases. This article examines how these technologies can be utilized to transform the Moroccan healthcare system into a more accessible, efficient, and patient-focused model of care. The paper reviews recent pilot projects and initiatives, focusing on infrastructure development, remote monitoring, AI and IoMT integration, public health campaigns, and national health programs aimed at improving access to treatment. Building on these observations, the paper explores the potential of an integrated digital health system for managing chronic diseases and proposes a national integrated care architecture that connects Morocco’s public and private healthcare providers. These insights highlight the significance of digital health in Morocco and provide a framework for improved, more patient-centered, and more efficient advanced healthcare. Future perspectives focus on developing an adapted digital transformation approach to further enhance chronic disease management. Full article

The Internet of Medical Things (IoMT) has become a core component of modern healthcare infrastructures, enabling continuous patient monitoring, remote diagnostics, and data-driven clinical decision-making. Despite these advances, authentication in IoMT environments remains a critical security challenge, intensified by strict resource constraints of medical devices and the emerging threat posed by quantum computing to classical cryptographic techniques. This systematic review investigates authentication mechanisms in IoMT from both post-quantum and system-level perspectives. A structured literature review was conducted using a PRISMA-informed methodology across major scientific databases, including IEEE Xplore, ACM Digital Library, SpringerLink, ScienceDirect, and MDPI. From an initial set of 95 records, 63 studies were selected for qualitative synthesis following screening and eligibility assessment. To organise existing research, this study introduces a multi-dimensional classification framework that categorises authentication solutions according to cryptographic paradigm (classical, hybrid, and post-quantum), deployment architecture, system objectives, and clinical operational constraints. The comparative synthesis demonstrates important trade-offs between security strength, latency, computational overhead, and energy consumption that are frequently underexplored in the existing literature. Furthermore, the analysis identifies key research gaps related to scalability in heterogeneous medical environments, trust establishment across administrative and clinical domains, usability under strict timing constraints, and resilience against quantum-capable adversaries. Based on these findings, future research directions are outlined toward adaptive, lightweight, and context-aware post-quantum authentication frameworks designed for real-world IoMT deployments. Limitations of this review include restriction to English-language publications and selected databases. This study received no external funding, and the review protocol was not formally registered. Full article

Long-term home-based sleep monitoring requires wearable sensing devices that strictly balance signal precision with power constraints. This study presents the design and implementation of a low-noise, low-power wearable single-channel electroencephalography (EEG) system for automatic sleep staging. The hardware architecture integrates a TI ADS1298 analog front-end with an STM32F4 microcontroller, utilizing differential sampling and hardware-based filtering to effectively suppress power-line interference and baseline drift. System-level testing demonstrates an average power consumption of approximately 150.85 mW, enabling over 24.6 h of continuous operation on a 1000 mAh battery, which meets the requirements for overnight monitoring. To achieve accurate staging without draining the wearable’s battery, we adopted and deployed a lightweight deep learning model, SleePyCo, on the cloud backend. This architecture was specifically optimized for our edge–cloud collaborative execution, which combines contrastive representation learning with temporal dependency modeling. Validation on the ISRUC dataset yielded an overall accuracy of 79.3% ± 3.0%, with a notable F1-score of 88.3% for Deep Sleep (N3). Furthermore, practical field trials involving 10 healthy subjects verified the system’s engineering stability, achieving a valid data rate exceeding 97% and a Bluetooth packet loss rate of only 0.8%. These results confirm that the proposed hardware–software co-designed system provides a robust, energy-efficient IoMT sensing solution for daily sleep health management. Full article

The rapid growth of Internet of Medical Things (IoMT) devices has revolutionized diagnostics and patient care within smart healthcare networks. However, this progress has also expanded the attack surface due to the heterogeneity and interconnectivity of medical devices. To overcome the limitations of traditional batch-trained security models, this study proposes an adaptive online intrusion detection framework designed for real-time operation in dynamic healthcare environments. The system combines Leveraging Bagging with Hoeffding Tree classifiers for incremental learning while integrating the Page–Hinkley test to detect and adapt to concept drift in evolving attack patterns. A modular and scalable network architecture supports centralized monitoring and ensures seamless interoperability across various IoMT protocols. Implemented within a low-latency, high-throughput stream-processing pipeline, the framework meets the stringent clinical requirements for responsiveness and reliability. To simulate streaming conditions, we evaluated the model using the CICIoMT2024 dataset, presenting one instance at a time in random order to reflect dynamic, real-time traffic in IoMT networks. Experimental results demonstrate exceptional performance, achieving accuracies of 0.9963 for binary classification, 0.9949 for six-class detection, and 0.9860 for nineteen-class categorization. These results underscore the framework’s practical efficacy in protecting modern healthcare infrastructures from evolving cyber threats. Full article

The Internet of Medical Things (IoMT) transforms healthcare through interconnected medical devices but faces significant cybersecurity threats, particularly intrusion and exfiltration attacks. Centralized intrusion detection systems (IDSs) require data aggregation, presenting privacy and scalability risks. This paper proposes FedEnsemble-DP, a privacy-aware Federated Learning (FL) framework for decentralized intrusion detection in IoMT networks. The framework integrates three data balancing scenarios (Raw Imbalanced, Local SMOTE, Centralized SMOTE) with Differential Privacy (DP) and Secure Aggregation mechanisms. Extensive experiments on WUSTL-EHMS-2020 and CIC-IoMT-2024 datasets under non-IID settings (Dirichlet $\alpha$ = 0.3) demonstrate that models with strong privacy guarantees ($\epsilon$ = 3.0) frequently match or exceed non-private baselines. Key findings show Local SMOTE with $\epsilon$ = 3.0 achieved 94.60% accuracy and 0.9598 AUC, while Raw Imbalanced with $\epsilon$ = 3.0 attained 94.50% accuracy and 0.9494 AUC. Even with strict privacy ($\epsilon$ = 3.0), these results surpassed the non-private baseline (93.20% accuracy) in the raw scenario. Centralized SMOTE showed effectiveness but introduced training instability. These results indicate that local data balancing combined with calibrated DP noise can yield high detection performance while preserving privacy, effectively bridging security-performance and data confidentiality requirements in distributed healthcare networks. Full article

Many existing healthcare facilities still rely on the legacy Wi-Fi 5 (IEEE 802.11ac) standard, which is based on Orthogonal Frequency-Division Multiplexing (OFDM). OFDM supports single-user-per-channel access, leading to increased contention, higher latency, jitter, and packet loss under dense device deployments commonly found in clinical environments. This study presents a quantitative performance evaluation of Wi-Fi 5 and Wi-Fi 6/7 by comparing the effectiveness of OFDM with Orthogonal Frequency-Division Multiple Access (OFDMA) and Target Wake Time (TWT) in a simulated dense IoMT environment. Simulations were conducted using Network Simulator 3 (NS-3), and relevant Quality of Service (QoS) metrics. The results demonstrated that OFDMA reduces average network delay by up to approximately 37%, improves throughput by approximately 20%, and reduces packet loss ratio by up to 85% compared to OFDM under high-density operations, while exhibiting marginally improved jitter performance (approximately 2%). In addition, the use of TWT achieved substantial reductions in device power consumption of up to approximately 90%, at the cost of reduced aggregate throughput of up to approximately 75% under high station densities. These results demonstrated that Wi-Fi 6/7 technologies can offer significant advantages in terms of QoS and energy efficiency over legacy Wi-Fi 5 for dense IoMT environments. Full article

The growing adoption of wearable devices creates a critical need for robust and secure Internet of Things solutions to manage biometric data streams. Current architectures often lack emphasis on seamless data capture, secure cloud storage and integrated dashboard visualization. This research addresses these gaps by investigating and evaluating an IoT framework leveraging lightweight communication and real-time visualization for improved healthcare monitoring. Drawing primarily on recent peer-reviewed journals and reputable conference proceedings, we evaluate an IoT architecture that securely integrates wearable biometric data into a cloud-based dashboard. The system utilizes encrypted advertising packets (e.g., AES-128-CCM) to broadcast biometric signals, eliminating the need for permanent device pairing and minimizing energy consumption. These packets are captured by our prototype ESP32-based (Espressif Systems, Shanghai, China) gateway node, decrypted and forwarded to a secure cloud environment that ensures persistent storage and accessibility. The cloud-based dashboard provides medical staff and end-users with real-time insights and long-term data tracking. Emphasis was placed on evaluating the system’s low latency performance, energy efficiency and data confidentiality. System evaluation demonstrates that encrypted advertising packets can securely transmit biometric signals, while drastically reducing energy consumption and latency. System evaluation demonstrates that encrypted BLE advertising serves as a superior alternative to traditional pairing-based methods for long-term medical monitoring. By implementing a dual-optimization strategy that balances data confidentiality with power efficiency, the proposed system achieved a 33-fold increase in operational autonomy compared with standard permanent BLE connections. These results represent a significant advancement in battery longevity for the IoMT ecosystem, providing a scalable solution for continuous, secure biometric signal transmission with minimal energy overhead. Full article

The rapid digital transformation of healthcare has improved clinical efficiency, patient engagement, and data accessibility, but it has also introduced significant cyber security and data privacy challenges. Healthcare IT systems increasingly rely on interconnected networks, electronic health records (EHRs), tele-medicine platforms, cloud infrastructures, and Internet of Medical Things (IoMT) devices, which collectively expand the attack surface for cyber threats. This scoping review maps and synthesizes recent evidence on cyber security risks in healthcare, including ransomware, data breaches, insider threats, and vulnerabilities in legacy systems, and examines key data privacy concerns related to patient confidentiality, regulatory compliance, and secure data governance. We also review contemporary security strategies, including encryption, multi-factor authentication, zero-trust architecture, blockchain-based approaches, AI-enabled threat detection, and compliance frameworks such as HIPAA and GDPR. Persistent challenges include integrating robust security with clinical usability, protecting resource-limited hospital environments, and managing human factors such as staff awareness and policy adherence. Overall, the findings suggest that effective healthcare cyber security requires a multi-layered defense combining technical controls, continuous monitoring, governance and regulatory alignment, and sustained organizational commitment to security culture. Future research should prioritize adaptive security models, improved standardization, and privacy-preserving analytics to protect patient data in increasingly complex healthcare ecosystems. Full article

Healthcare 5.0 and the Internet of Medical Things (IoMT) is emerging as a scalable model for the delivery of customised healthcare and chronic disease management, through Remote Patient Monitoring (RPM) in patient smart home environments. Large-scale RPM initiatives are being rolled out by healthcare providers (HCPs); however, the constrained nature of IoMT devices and proximity to poorly administered smart home technologies create a cyber risk for highly personalised patient data. The recent Network and Information Systems (NIS 2) directive requires HCPs to improve their cyber risk management approaches, mandating heavy penalties for non-compliance. Current research into cyber risk management in smart home-based RPM does not address scalability. This research examines scalability through the lens of the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework and develops a novel Scalability Index (SI), informed by a PRISMA guided systematic literature review. Our search strategy identified 57 studies across major databases including ACM, IEEE, MDPI, Elsevier, and Springer, authored between January 2016 and March 2025 (final search 21 March 2025), which focussed on cyber security risk management in the RPM context. Studies focussing solely on healthcare institutional settings were excluded. To mitigate bias, a sample of the papers (30/57) were assessed by two other raters; the resulting Cohen’s Kappa inter-rater agreement statistic (0.8) indicating strong agreement on study selection. The results, presented in graphical and tabular format, provide evidence that most cyber risk approaches do not consider scalability from the HCP perspective. Applying the SI to the 57 studies in our review resulted in a low to medium scalability potential of most cyber risk management proposals, indicating that they would not support the requirements of NIS 2 in the RPM context. A limitation of our work is that it was not tested in a live large-scale setting. However, future research could validate the proposed SI, providing guidance for researchers and practitioners in enhancing cyber risk management of large-scale RPM initiatives. Full article

This paper proposes an efficient and automated smart healthcare communication framework that integrates a two-level filtering scheme with a multi-objective Genetic Algorithm (GA) to enhance the reliability, timeliness, and energy efficiency of Internet of Medical Things (IoMT) systems. In the first stage, physiological signals collected from heterogeneous sensors (e.g., blood pressure, glucose level, ECG, patient movement, and ambient temperature) were pre-processed using an adaptive least-mean-square (LMS) filter to suppress noise and motion artifacts, thereby improving signal quality prior to analysis. In the second stage, a GA-based optimization engine selects optimal routing paths and transmission parameters by jointly considering end-to-end delay, Signal-to-Noise Ratio (SNR), energy consumption, and packet loss ratio (PLR). The two-level filtering strategy, i.e., LMS, ensures that only denoised and high-priority records are forwarded for more processing, enabling timely delivery for supporting the downstream clinical network by optimizing the communication. The proposed mechanism is evaluated via extensive simulations involving 30–100 devices and multiple generations and is benchmarked against two existing smart healthcare schemes. The results demonstrate that the integrated GA and filtering approach significantly reduces end-to-end delay by 10%, as well as communication latency and energy consumption, while improving the packet delivery ratio by approximately 15%, as well as throughput, SNR, and overall Quality of Service (QoS) by up to 98%. These findings indicate that the proposed framework provides a scalable and intelligent communication backbone for early disease detection, continuous monitoring, and timely intervention in smart healthcare environments. Full article

Modern healthcare systems increasingly depend on wearable Internet of Medical Things (IoMT) devices for the continuous monitoring of patients’ physiological parameters. It remains challenging to differentiate between genuine physiological anomalies, sensor faults, and malicious cyber interference. In this work, we propose a hybrid fusion framework designed to attribute the most plausible source of an anomaly, thereby supporting more reliable clinical decisions. The proposed framework is developed and evaluated using two complementary datasets: CICIoMT2024 for modelling security threats and a large-scale intensive care cohort from MIMIC-IV for analysing key vital signs and bedside interventions. The core of the system combines a supervised XGBoost classifier for attack detection with an unsupervised LSTM autoencoder for identifying physiological and technical deviations. To improve clinical realism and avoid artefacts introduced by quantised or placeholder measurements, the physiological module incorporates quality-aware preprocessing and missingness indicators. The fusion decision policy is calibrated under prudent, safety-oriented constraints to limit false escalation. Rather than relying on fixed fusion weights, we train a lightweight fusion classifier that combines complementary evidence from the security and clinical modules, and we select class-specific probability thresholds on a dedicated calibration split. The security module achieves high cross-validated performance, while the clinical model captures abnormal physiological patterns at scale, including deviations consistent with both acute deterioration and data-quality faults. Explainability is provided through SHAP analysis for the security module and reconstruction-error attribution for physiological anomalies. The integrated fusion framework achieves a final accuracy of 99.76% under prudent calibration and a Matthews Correlation Coefficient (MCC) of 0.995, with an average end-to-end inference latency of 84.69 ms (p95 upper bound of 107.30 ms), supporting near real-time execution in edge-oriented settings. While performance is strong, clinical severity labels are operationalised through rule-based proxies, and cross-domain fusion relies on harmonised alignment assumptions. These aspects should be further evaluated using realistic fault traces and prospective IoMT data. Despite these limitations, the proposed framework offers a practical and explainable approach for IoMT-based patient monitoring. Full article

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique that utilizes magnetic fields to induce cortical electric currents, enabling both the measurement and modulation of neuronal activity. Initially developed as a diagnostic tool, TMS now serves dual roles in clinical neurology, offering insight into neurophysiological dysfunctions and the therapeutic modulation of abnormal cortical excitability. This review examines key TMS outcome measures, including motor thresholds (MT), input–output (I/O) curves, cortical silent periods (CSP), and paired-pulse paradigms such as short-interval intracortical inhibition (SICI), short-interval intracortical facilitation (SICF), intracortical facilitation (ICF), long interval cortical inhibition (LICI), interhemispheric inhibition (IHI), and short-latency afferent inhibition (SAI). These biomarkers reflect underlying neurotransmitter systems and can aid in differentiating neurological conditions. Diagnostic applications of TMS are explored in Parkinson’s disease (PD), dystonia, essential tremor (ET), Alzheimer’s disease (AD), and mild cognitive impairment (MCI). Each condition displays characteristic neurophysiological profiles, highlighting the potential for TMS-derived biomarkers in early or differential diagnosis. Therapeutically, repetitive TMS (rTMS) has shown promise in modulating cortical circuits and improving motor and cognitive symptoms. High- and low-frequency stimulation protocols have demonstrated efficacy in PD, dystonia, ET, AD, and MCI, targeting the specific cortical regions implicated in each disorder. Moreover, the successful application of TMS in differentiating and treating AD and MCI underscores its clinical utility and translational potential across all neurodegenerative conditions. As research advances, increased attention and investment in TMS could facilitate similar diagnostic and therapeutic breakthroughs for other neurological disorders that currently lack robust tools for early detection and effective intervention. Moreover, this review also aims to underscore the importance of maintaining standardized TMS protocols. By highlighting inconsistencies and variability in outcomes across studies, we emphasize that careful methodological design is critical for ensuring the reproducibility, comparability, and reliable interpretation of TMS findings. In summary, this review emphasizes the value of TMS as a distinctive, non-invasive approach to probing brain function and highlights its considerable promise as both a diagnostic and therapeutic modality in neurology—roles that are often considered separately. Full article

The Internet of Military Things (IoMT) relies on Long-Range Wide Area Networks (LoRaWAN) for low-power, long-range communication in critical applications like border security and soldier health monitoring. However, conventional priority-based flow control mechanisms, which rely on static classification thresholds, lack the adaptability to handle the nuanced, continuous nature of physiological data and dynamic network states. To overcome this rigidity, this paper introduces a novel, domain-adaptive Fuzzy Logic Flow Control (FFC) protocol specifically tailored for LoRaWAN-based IoMT. While employing established Mamdani inference, the FFC system innovatively fuses multi-parameter physiological data (body temperature, blood pressure, oxygen saturation, and heart rate) into a continuous Health Score, which is then mapped via a context-optimised sigmoid function to dynamic transmission intervals. This represents a novel application-layer semantic integration with LoRaWAN’s constrained MAC and PHY layers, enabling cross-layer flow optimisation without protocol modification. Simulation results confirm that FFC significantly enhances reliability and energy efficiency while reducing latency relative to traditional static priority architectures. Seamlessly integrated into the NS-3 LoRaWAN simulation framework, the FFC protocol demonstrates superior performance in IoMT communications. Simulation results confirm that FFC significantly enhances reliability and energy efficiency while reducing latency compared with traditional static priority-based architectures. It achieves this by prioritising high-priority health telemetry, proactively mitigating network congestion, and optimising energy utilisation, thereby offering a robust solution for emergent, health-critical scenarios in resource-constrained environments. Full article