Personalizing Cancer Pain Therapy: Insights from the Rational Use of Analgesics (RUA) Group

Introduction: A previous Delphi survey from the Rational Use of Analgesics (RUA) project involving Italian palliative care specialists revealed some discrepancies between current guidelines and clinical practice with a lack of consensus on items regarding the use of strong opioids in treating cancer pain. Those results represented the basis for a new Delphi study addressing a better approach to pain treatment in patients with cancer. Methods: The study consisted of a two-round multidisciplinary Delphi study. Specialists rated their agreement with a set of 17 statements using a 5-point Likert scale (0 = totally disagree and 4 = totally agree). Consensus on a statement was achieved if the median consensus score (MCS) (expressed as value at which at least 50% of participants agreed) was at least 4 and the interquartile range (IQR) was 3–4. Results: This survey included input from 186 palliative care specialists representing all Italian territory. Consensus was reached on seven statements. More than 70% of participants agreed with the use of low dose of strong opioids in moderate pain treatment and valued transdermal route as an effective option when the oral route is not available. There was strong consensus on the importance of knowing opioid pharmacokinetics for therapy personalization and on identifying immediate-release opioids as key for tailoring therapy to patients’ needs. Limited agreement was reached on items regarding breakthrough pain and the management of opioid-induced bowel dysfunction. Conclusion: These findings may assist clinicians in applying clinical evidence to routine care settings and call for a reappraisal of current pain treatment recommendations with the final aim of optimizing the clinical use of strong opioids in patients with cancer

Terrorist Attacks for Fake Exposure Notifications in Contact Tracing Systems

In this work we show that an adversary can attack the integrity of contact tracing systems based on Google-Apple Exposure Notifications (GAEN) by leveraging blockchain technology. We show that through smart contracts there can be an on-line market where infected individuals interested in monetizing their status can upload to the servers of the GAEN-based systems some keys (i.e., TEKs) chosen by a non-infected adversary. In particular, the infected individual can anonymously and digitally trade the upload of TEKs without a mediator and without running risks of being cheated. This vulnerability can therefore be exploited to generate large-scale fake exposure notifications of at-risk contacts with serious consequences (e.g., jeopardizing parts of the health system, affecting results of elections, imposing the closure of schools, hotels or factories). As main contribution, we design a smart contract with two collateral deposits that works, in general, on GAEN-based systems. We then also suggest the design of a more sophisticated smart contract, using DECO, that could be used to attack in a different way GAEN-based systems (i.e., this second smart contract can succeed even in case GAEN systems are repaired making ineffective the first smart contract). Our work shows how to realize with GAEN-based systems (in particular with Immuni and SwissCovid), the terrorist attack to decentralized contact tracing systems envisioned by Vaudenay

Shielded Computations in Smart Contracts Overcoming Forks

In this work, we consider executions of smart contracts for implementing secure multi-party computation (MPC) protocols on forking blockchains (e.g., Ethereum), and we study security and delay issues due to forks. In this setting, the classical double-spending problem tells us that messages of the MPC protocol should be confirmed on-chain before playing the next ones, thus slowing down the entire execution. Our contributions are twofold: For the concrete case of fairly tossing multiple coins with penalties, we notice that the lottery protocol of Andrychowicz et al. (S&P ’14) becomes insecure if players do not wait for the confirmations of several transactions. In addition, we present a smart contract that instead retains security even when all honest players immediately answer to transactions appearing on-chain. We analyze the performance using Ethereum as testbed.We design a compiler that takes any “digital and universally composable” MPC protocol (with or without honest majority), and transforms it into another one (for the same task and same setup) which maintains security even if all messages are played on-chain without delays. The special requirements on the starting protocol mean that messages consist only of bits (e.g., no hardware token is sent) and security holds also in the presence of other protocols. We further show that our compiler satisfies fairness with penalties as long as honest players only wait for confirmations once. By reducing the number of confirmations, our protocols can be significantly faster than natural constructions

Efficient Proofs of Knowledge for Threshold Relations

Recently, there has been great interest towards constructing efficient zero-knowledge proofs for practical languages. In this work, we focus on proofs for threshold relations, in which the prover is required to prove knowledge of witnesses for k out of ℓ statements. The main contribution of our work is an efficient and modular transformation that starting from a large class of Σ -protocols and a corresponding threshold relation Rk,ℓ, provides an efficient Σ -protocol for Rk,ℓ with improved communication complexity w.r.t. prior results. Our transformation preserves statistical/perfect honest-verifier zero knowledge

Affordable security or big guy vs small guy: Does the depth of your pockets impact your protocols?

When we design a security protocol we assume that the humans (or organizations) playing Alice and Bob do not make a difference. In particular, their financial capacity seems to be irrelevant. In the latest trend to guarantee that secure multi-party computation protocols are fair and not vulnerable to malicious aborts, a slate of protocols has been proposed based on penalty mechanisms. We look at two well-known penalty mechanisms, and show that the so-called see-saw mechanism (Kumaresan et al., CCS 15), is only fit for people with deep pockets, well beyond the stake in the multi-party computation itself. Depending on the scheme, fairness is not affordable by everyone which has several policy implications on protocol design. To explicitly capture the above issues, we introduce a new property called financial fairness