Designing and implementing a distributed earthquake early warning system for resilient communities: a PhD thesis

The present work aims to comprehensively contribute to the process, design, and technologies of Earthquake Early Warning (EEW). EEW systems aim to detect the earthquake immediately at the epicenter and relay the information in real-time to nearby areas, anticipating the arrival of the shake. These systems exploit the difference between the earthquake wave speed and the time needed to detect and send alerts. This Ph.D. thesis aims to improve the adoption, robustness, security, and scalability of Earthquake Early Warning systems using a decentralized approach to data processing and information exchange. The proposed architecture aims to have a more resilient detection, remove Single point of failure, higher efficiency, mitigate security vulnerabilities, and improve privacy regarding centralized EEW architectures. A prototype of the proposed architecture has been implemented using low-cost sensors and processing devices to quickly assess the ability to provide the expected information and guarantees. The capabilities of the proposed architecture are evaluated not only on the main EEW problem but also on the quick estimation of the epicentral area of an earthquake, and the results demonstrated that our proposal is capable of matching the performance of current centralized counterparts

Simplify Node-RED For End User Development in SeismoCloud

Networks of IoT devices often require configuration and definition of behavior by the final user. Node-RED is a flow-based programming platform commonly used for End User Development, but it requires networking and protocols skills in order to be efficiently used. We add a level of abstraction to Node-RED nodes in order to allow non-skilled users to configure and control networks of IoT devices and online services. We applied such abstractions to the SeismoCloud application for earthquake monitoring.Comment: 4 pages, 2 figures, worksho

A New Model for Testing IPv6 Fragment Handling

Since the origins of the Internet, various vulnerabilities exploiting the IP fragmentation process have plagued IPv4 protocol, many leading to a wide range of attacks. IPv6 modified the handling of fragmentations and introduced a specific extension header, not solving the related problems, as proved by extensive literature. One of the primary sources of problems has been the overlapping fragments, which result in unexpected or malicious packets when reassembled. To overcome the problem related to fragmentation, the authors of RFC 5722 decided that IPv6 hosts MUST silently drop overlapping fragments. Since then, several studies have proposed methodologies to check if IPv6 hosts accept overlapping fragments and are still vulnerable to related attacks. However, some of the above methodologies have not been proven complete or need to be more accurate. In this paper we propose a novel model to check IPv6 fragmentation handling specifically suited for the reassembling strategies of modern operating systems. Previous models, indeed, considered OS reassembly policy as byte-based. However, nowadays, reassembly policies are fragment-based, making previous models inadequate. Our model leverages the commutative property of the checksum, simplifying the whole assessing process. Starting with this new model, we were able to better evaluate the RFC-5722 and RFC-9099 compliance of modern operating systems against fragmentation handling. Our results suggest that IPv6 fragmentation can still be considered a threat and that more effort is needed to solve related security issues

Hydroxychloroquine and chloroquine retinal safety concerns during COVID-19 outbreak

Purpose: The current coronavirus disease 2019 (COVID-19) has been declared by the World Health Organization a global pandemic. Chloroquine (CQ) and hydroxychloroquine (HCQ) have been largely adopted in the clinical setting for the management of SARS-CoV-2 infection; however, their known retinal toxicity has raised some safety concerns, especially considering the higher-dosage employed for COVID-19 patients as compared with their suggested posology for their usual indications, including systemic lupus erythematosus and other rheumatic diseases. In this review, we will discuss the optimal dosages recommended for COVID-19 patients when treated with HCQ and CQ. Methods: A comprehensive literature search was performed in PubMed, Cochrane library, Embase and Scopus, by using the following search terms: "chloroquine retinal toxicity" and "hydroxychloroquine retinal toxicity" alone or in combination with "coronavirus", "COVID-19", " SARS-CoV-2 infection " from inception to August 2020. Results: Although there is still no consistent evidence about HCQ/CQ retinal toxicity in patients with COVID-19, these possible drug-related retinal adverse events may represent a major safety concern. For this reason, appropriate screening strategies, including telemedicine, should be developed in the near future. Conclusion: A possible future clinical perspective for patients with COVID-19 treated with HCQ/CQ could reside in the multidisciplinary collaboration between ophthalmologists monitoring the risk of HCQ/CQ-related retinal toxicity and those physicians treating COVID-19 infection

Adaptive mitigation of the Air-Time pressure in LoRa multi-gateway architectures

LoRa is a promising technology in the current Internet of Things market, which operates in un-licensed bands achieving long-range communications and with ultra power devices. In this work we capitalize on the idea introduced in [1], i.e. balance the Air-Time of the different modulation spreading factors (SF), and adapt it to operate in a typical metropolitan scenario comprising multiple gateways (GWs) interconnected to a same network server. Our proposed approach, named ADaptive Mitigation of the AIr-time pressure in lORa (AD MAIORA), relies on a suitable measure of the per-spreading-factor load at each GW - quantified by means of a so-called pressure table -, and on a relevant heuristic algorithm which attempts to balance such a per-SF-pressure. Especially in cases of very loaded scenarios, where a high number of nodes insist on the same GWs, the use of AD MAIORA shows significant performance gains, up to a factor of 5 improvements with respect to the legacy LoRaWAN's Adaptive Data Rate

Is first-line antimicrobial therapy still adequate to treat MRSA in the ICU? A report from a highly endemic country

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A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality

Abstract Purpose: Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce. Methods: We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011\u20132013) including patients from ICU, medical, and surgical wards. Results: A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) hadconcomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03\u20131.07, P\0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01\u20131.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02\u20132.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88\u20135.86, P\0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01\u20135.63, P\0.001) wereassociated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy. Conclusions: Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental

Efficacy and safety of reparixin in patients with severe covid-19 Pneumonia. A phase 3, randomized, double-blind placebo-controlled study

Introduction: Polymorphonuclear cell influx into the interstitial and bronchoalveolar spaces is a cardinal feature of severe coronavirus disease 2019 (COVID-19), principally mediated by interleukin-8 (IL-8). We sought to determine whether reparixin, a novel IL-8 pathway inhibitor, could reduce disease progression in patients hospitalized with severe COVID-19 pneumonia. Methods: In this Phase 3, randomized, double-blind, placebo-controlled, multicenter study, hospitalized adult patients with severe COVID-19 pneumonia were randomized 2:1 to receive oral reparixin 1200 mg three times daily or placebo for up to 21 days or until hospital discharge. The primary endpoint was the proportion of patients alive and free of respiratory failure at Day 28, with key secondary endpoints being the proportion of patients free of respiratory failure at Day 60, incidence of intensive care unit (ICU) admission by Day 28 and time to recovery by Day 28. Results: Of 279 patients randomized, 182 received at least one dose of reparixin and 88 received placebo. The proportion of patients alive and free of respiratory failure at Day 28 was similar in the two groups {83.5% versus 80.7%; odds ratio 1.63 [95% confidence interval (CI) 0.75, 3.51]; p = 0.216}. There were no statistically significant differences in the key secondary endpoints, but a numerically higher proportion of patients in the reparixin group were alive and free of respiratory failure at Day 60 (88.7% versus 84.6%; p = 0.195), fewer required ICU admissions by Day 28 (15.8% versus 21.7%; p = 0.168), and a higher proportion recovered by Day 28 compared with placebo (81.6% versus 74.9%; p = 0.167). Fewer patients experienced adverse events with reparixin than placebo (45.6% versus 54.5%), most mild or moderate intensity and not related to study treatment. Conclusions: This trial did not meet the primary efficacy endpoints, yet reparixin showed a trend toward limiting disease progression as an add-on therapy in COVID-19 severe pneumonia and was well tolerated. Trial registration: ClinicalTrials.gov: NCT04878055, EudraCT: 2020-005919-51

Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy

Background: Social determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy. Methods: All ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test. Results: A total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation. Conclusions: Despite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability