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House Speaker Kevin McCarthy (R-Calif.) pushed President Biden to agree to work requirements for millions of low-income Americans ahead of debt limit talks on May 16.

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.

This commentary discusses the current prior authorization (PA) process and the negative impacts it can have on patient care. According to the American Medical Association, 94% of patients experience delays in care and 78% abandon treatment altogether. These delays in care are often for lifesaving treatments and can result in adverse events. Additionally, PAs place an extensive administrative and financial burden on both patients and providers, often requiring several hours of seeking approval from insurance companies or requiring patients to try one or more other therapeutic avenues before an insurance company will approve the original course of treatment. This is all while insurance companies are making record profits each year. Frustrations with this system are leading to a rise in the number of physician practices switching to a cash-only business model, which increases autonomy, enables price transparency, and benefits both physicians and patients.

Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a \"better alternative\" to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. This study aims to examine HTP-related social media discourse around important policy events. We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a \"safer\" tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas.

Previous research shows that people commonly exaggerate the size of minority populations. Theories of intergroup threat predict that the larger people perceive minority groups to be, the less favorably they feel toward them. We investigate whether correcting Americans’ misperceptions about one such population—immigrants—affects related attitudes. We confirm that non-Hispanic Americans overestimate the percentage of the population that is foreign-born or in the United States without authorization. However, in seven separate survey experiments over 11 years, we find that providing accurate information does little to affect attitudes toward immigration, even though it does reduce the perceived size of the foreign-born population. This is true even when people’s misperceptions are explicitly corrected. These results call into question a potential cognitive mechanism that could underpin intergroup threat theory. Misperceptions about the size of minority groups may be a consequence, rather than a cause, of attitudes toward those groups.

To investigate stakeholder perspectives on how patient preference studies (PPS) should be designed and conducted to allow for inclusion of patient preferences in decision-making along the medical product life cycle (MPLC), and how patient preferences can be used in such decision-making. Two literature reviews and semi-structured interviews (n = 143) with healthcare stakeholders in Europe and the US were conducted; results of these informed the design of focus group guides. Eight focus groups were conducted with European patients, industry representatives and regulators, and with US regulators and European/Canadian health technology assessment (HTA) representatives. Focus groups were analyzed thematically using NVivo. Stakeholder perspectives on how PPS should be designed and conducted were as follows: 1) study design should be informed by the research questions and patient population; 2) preferred treatment attributes and levels, as well as trade-offs among attributes and levels should be investigated; 3) the patient sample and method should match the MPLC phase; 4) different stakeholders should collaborate; and 5) results from PPS should be shared with relevant stakeholders. The value of patient preferences in decision-making was found to increase with the level of patient preference sensitivity of decisions on medical products. Stakeholders mentioned that patient preferences are hardly used in current decision-making. Potential applications for patient preferences across industry, regulatory and HTA processes were identified. Four applications seemed most promising for systematic integration of patient preferences: 1) benefit-risk assessment by industry and regulators at the marketing-authorization phase; 2) assessment of major contribution to patient care by European regulators; 3) cost-effectiveness analysis; and 4) multi criteria decision analysis in HTA. The value of patient preferences for decision-making depends on the level of collaboration across stakeholders; the match between the research question, MPLC phase, sample, and preference method used in PPS; and the sensitivity of the decision regarding a medical product to patient preferences. Promising applications for patient preferences should be further explored with stakeholders to optimize their inclusion in decision-making.

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.

Internet of Things (IoT) provides a wide range of services in domestic and industrial environments. Access control plays a crucial role in granting access rights to users and devices when an IoT device is connected to a network. However, many challenges exist in designing and implementing an ideal access control solution for the IoT due to the characteristics of the IoT including but not limited to the variety of the IoT devices, the resource constraints on the IoT devices, and the heterogeneous nature of the IoT. This paper conducts a comprehensive survey on access control in the IoT, including access control requirements, authorization architecture, access control models, access control policies, access control research challenges, and future directions. It identifies and summarizes key access control requirements in the IoT. The paper further evaluates the existing access control models to fulfill the access control requirements. Access control decisions are governed by access control policies. The existing approaches on dynamic policies’ specification are reviewed. The challenges faced by the existing solutions for policies’ specification are highlighted. Finally, the paper presents the research challenges and future directions of access control in the IoT. Due to the variety of IoT applications, there is no one-size-fits-all solution for access control in the IoT. Despite the challenges encountered in designing and implementing the access control in the IoT, it is desired to have an access control solution to meet all the identified requirements to secure the IoT.

Purpose>Authorization and access control have been a topic of research for several decades. However, existing definitions are inconsistent and even contradicting each other. Furthermore, there are numerous access control models and even more have recently evolved to conform with the challenging requirements of resource protection. That makes it hard to classify the models and decide for an appropriate one satisfying security needs. Therefore, this study aims to guide through the plenty of access control models in the current state of the art besides this opaque accumulation of terms meaning and how they are related.Design/methodology/approach>This study follows the systematic literature review approach to investigate current research regarding access control models and illustrate the findings of the conducted review. To provide a detailed understanding of the topic, this study identified the need for an additional study on the terms related to the domain of authorization and access control.Findings>The authors’ research results in this paper are the distinction between authorization and access control with respect to definition, strategies, and models in addition to the classification schema. This study provides a comprehensive overview of existing models and an analysis according to the proposed five classes of access control models.Originality/value>Based on the authors’ definitions of authorization and access control along with their related terms, i.e. authorization strategy, model and policy as well as access control model and mechanism, this study gives an overview of authorization strategies and propose a classification of access control models providing examples for each category. In contrast to other comparative studies, this study discusses more access control models, including the conventional state-of-the-art models and novel ones. This study also summarizes each of the literature works after selecting the relevant ones focusing on the database system domain or providing a survey, a classification or evaluation criteria of access control models. Additionally, the introduced categories of models are analyzed with respect to various criteria that are partly selected from the standard access control system evaluation metrics by the National Institute of Standards and Technology.

The proliferation of smart devices in the Internet of Things (IoT) networks creates significant security challenges for the communications between such devices. Blockchain is a decentralized and distributed technology that can potentially tackle the security problems within the 5G-enabled IoT networks. This paper proposes a Multi layer Blockchain Security model to protect IoT networks while simplifying the implementation. The concept of clustering is utilized in order to facilitate the multi-layer architecture. The K-unknown clusters are defined within the IoT network by applying techniques that utillize a hybrid Evolutionary Computation Algorithm while using Simulated Annealing and Genetic Algorithms. The chosen cluster heads are responsible for local authentication and authorization. Local private blockchain implementation facilitates communications between the cluster heads and relevant base stations. Such a blockchain enhances credibility assurance and security while also providing a network authentication mechanism. The open-source Hyperledger Fabric Blockchain platform is deployed for the proposed model development. Base stations adopt a global blockchain approach to communicate with each other securely. The simulation results demonstrate that the proposed clustering algorithm performs well when compared to the earlier reported approaches. The proposed lightweight blockchain model is also shown to be better suited to balance network latency and throughput as compared to a traditional global blockchain.