Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion: Italy 2006-2018

Abstract Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1%) with a large predominance of serotypes 1 (42.4%), 3 (23.7%), 7F (5.1%) and 19A (11.9%). The impact of vaccination, calculated on children 0–8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95%CL 2.32–3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95% CL 0.37–1.99) in the post-PCV13 era, p  In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention

Using Digital Twin to Detect Cyber-Attacks in Industrial Control Systems

The digital transition is largely impacting industrial control systems. The integration of information and communication technologies in industrial control systems on the one hand is improving the related functionalities, on the other hand is increasing the related vulnerabilities and the attack surfaces of industrial systems. This results in the non-negligible need for protection of the operational and production processes. Although many tools are available from the Information Technology sector, these are currently not appropriate to guarantee confidentiality, integrity, and availability in the industrial domain. As a consequence, it is crucial to investigate the proper strategies and methodologies to guarantee the protection of industrial control systems. In this context, this paper aims at defining a novel tool for the detection of cyber-attacks in industrial control systems, which is based on the implementation of a virtual model for both the physical and the control layers to detect attacks. In fact, the majority of literature contributions consider the implementation of a virtual model for the only physical layer. In this paper, the virtual model for the physical and the control layers is defined as a digital twin based on a hybrid automaton. The effectiveness of the proposed approach is demonstrated by considering its application to a water distribution system case study

Industrial Control Systems Attack Detection by Hybrid Digital Twin

The massive digital transformation of industrial control systems, based on tight integration between information and telecommunication technologies, has enlarged the attack surfaces of the industrial systems, thus increasing the need to protect the operational and production processes. Information Technology tools are currently not able to guarantee confidentiality, integrity, and availability in the industrial domain, therefore it is of paramount importance to understand the interaction of the physical components with the information networks. This paper aims to provide a novel Intrusion Detection System for identifying cyber-attacks in cyber-physical systems: the key novel idea is to consider a virtual model for both the plant and the controller to detect attacks. In fact, most of the approaches presented in literature rely on a virtual model representing only the plant, while in this contribution we consider the plant and the controller as a system to be replicated in the digital twin and resulting in a hybrid automata. This allows the detection of attacks to the actuators, that otherwise cannot be revealed. Advantages of this approach are demonstrated by exploiting data from a water distribution system

Ataxia Telangiectasia Arising as Immunodeficiency: The Intriguing Differential Diagnosis

Ataxia telangiectasia (AT) is a rare disease characterized by the early onset and slow progression of neurodegenerative defects, mainly affecting the cerebellum, associated with immunodeficiency and teleangiectasias. Ataxia is the hallmark of the disease and usually its first manifestation. Overt cerebellar ataxia usually becomes evident between 16 and 18 months of age, after the onset of walking, and is characterized by frequent falls and an ataxic gait with an enlarged base. We report the case of a child who first presented with serious recurrent infectious, without exhibiting neurological symptoms. The patient was initially diagnosed with combined immunodeficiency (CID) of unknown etiology for nearly 3 years, before he was definitively diagnosed with ataxia telangiectasia