A Misbehavior Authority System for Sybil Attack Detection in C-ITS

International audienceGlobal misbehavior detection is an important back-end mechanism in Cooperative Intelligent Transport Systems (C-ITS). It is based on the local misbehavior detection information sent by Vehicle's On-Board Units (OBUs) and by RoadSide Units (RSUs) called Misbehavior Reports (MBRs) to the Mis-behavior Authority (MA). By analyzing these reports, the MA provides more accurate and robust misbehavior detection results. Sybil attacks pose a significant threat to the C-ITS systems. Their detection and identification may be inaccurate and confusing. In this work, we propose a Machine Learning (ML) based solution for the internal detection process of the MA. We show through extensive simulation that our solution is able to precisely identify the type of the Sybil attack and provide promising detection accuracy results

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Plateforme de validation des communications véhicules sécurisées et de haut niveau de confiance pour les systèmes coopératifs ITS

Cooperative Intelligent Transportation System (C-ITS) has gained much attention in the recent years due to the large number of applications/use cases that can improve future driving experience. Future vehicles will be connected through several communication technologies which will open the door to new threats and vulnerabilities that must be taken into account. The security protection is a key subject to address before C-ITS deployment. Moreover, the wide variety of C-ITS use cases/application with different security requirements makes the security a big challenge. User's privacy and data protection are also a challenge. Automotive industry and operators should comply with the national and international legislation for the data protection in C-ITS. In order to deal with privacy issues, existing solution consists of having a pool of valid pseudonym identities, by the vehicle, and changing them during the communication. One of the motivations of this thesis is to study the performance of pseudonym certificate reloading. In other words, it is important to ensure that the latency of reloading pseudonym certificates from the PKI while driving at different speeds is acceptable. The second motivation is the investigation on threats and vulnerabilities, especially on those that come from the pseudonym certificate's use. The objective is to implement those attacks and propose new solutions or find improvements to the existing solution for detecting and preventing security attacks. Security and privacy in C-ITS are considered as big challenges. A Lot of work has been done and good solutions exist in the security and privacy domain. We notice that systems cannot be secure at 100% but driver's safety is related to system's security. For this, the aim of this thesis is to do white hack of the C-ITS in order to improve the existing solution. A risk assessment is needed to identify our target of evaluation and analyse potential risks. The final goal of this thesis is to propose a security and performance validation plate-form for vehicular communication in the context of C-ITS.Le système de transport coopératif intelligent (C-ITS) a attiré beaucoup d'attention ces dernières années en raison du grand nombre d'applications / cas d'usage qui peuvent améliorer l'expérience de conduite future.Les futurs véhicules seront connectés grâce aux plusieurs technologies de communication qui ouvriront la porte aux nouvelles menaces et vulnérabilités qui doivent être prises en compte. La protection de la vie privée et la sécurité est un sujet clé à aborder avant le déploiement de C-ITS. De plus, la grande variété de cas d'utilisation / applications C-ITS qui nécessitent des exigences de sécurité différentes fait de la sécurité un grand défi.La confidentialité et la protection des données des utilisateurs constituent également un défi. L'industrie automobile et les opérateurs doivent se conformer à la législation nationale et internationale pour la protection des données dans C-ITS. Afin de faire face aux problèmes de confidentialité, la solution existante consiste à disposer d'un pool d'identités pseudonymes valides, par le véhicule, et à les modifier lors de la communication.L'une des motivations de cette thèse est d'étudier les performances de rechargement de certificats pseudonymes. En d'autres termes, il est important de s'assurer que la latence du rechargement des certificats de pseudonyme à partir de l'ICP tout en conduisant à des vitesses différentes est acceptable. La deuxième motivation est l'analyse des menaces et des vulnérabilités, en particulier sur celles qui proviennent de l'utilisation du certificat pseudonyme. L'objectif est de mettre en œuvre ces attaques et de proposer de nouvelles solutions ou de trouver des améliorations à la solution existante pour détecter et prévenir les attaques de sécurité. La sécurité et la confidentialité dans C-ITS sont considérées comme de grands défis. Beaucoup de travail a été fait et de bonnes solutions existent dans le domaine de la sécurité et de la confidentialité. Nous remarquons que les systèmes ne peuvent pas être sécurisés à 100%, mais la sécurité du conducteur est liée à la sécurité du système. Pour cela, le but de cette thèse est de faire du hack blanc du C-ITS afin d'améliorer la solution existante. Une évaluation des risques est nécessaire pour identifier notre objectif d'évaluation et analyser les risques potentiels. L'objectif final de cette thèse est de proposer une plaque de validation de sécurité et de performance pour la communication véhiculaire dans le cadre des C-ITS

On the performance evaluation of vehicular PKI protocol for V2X communications security

International audienceCooperative Intelligent Transportation Systems (C-ITS) is an ongoing technology that will change our driving experience in the near future. In such systems, vehicles and RoadSide Units (RSU) cooperate by broadcasting V2X messages over the vehicular network (802.11p). Safety applications use these data to detect dangerous situations on time and avoid them. The security of V2X communications is based on the use of a vehicular Public Key Infrastructure (PKI) that delivers digital certificates to vehicles and RSU. Vehicles frequently change their certificate in order to make tracking more difficult and thus preserve drivers privacy. In this paper, we evaluate the performance of our PKI regarding the reloading of certificates by comparing two communication profiles (with and without V2X security). We developed a Proof-of-Concept (PoC) with real implementation of the PKI protocol and the embedded system. The obtained results show that the end-to-end latency between a requesting vehicle and the PKI is non-negligible. We then discuss and propose optimizations that can be done to improve the performance of the system

Cooperative ITS Security Standards: Implementation, assessment and next challenges

International audienceIn the near future connected will interact with each other, the road environment and the Cloud or edge servers, through Cooperative Intelligent Transportation System (C-ITS). C-ITS will significantly improve road safety, traffic efficiency and the driving comfort. Security and privacy protection are key elements forC-ITSsafety-related services. Authenticity and integrity of the communications are ensured using digital signatures and a Public Key Infrastructure (PKI) that delivers pseudonymous certificates to vehicles, Road Side Units (RSU)andCentral ITS-Stations (CS).In this paper, we present recent ETSI standardization progress, the PKI design and the overall C-ITS TrustSystemfor Day1deployment in Europeand we discuss open challenges for future new services and support of autonomous driving.An overview is given on interoperability testing of base standards and on pilot experimentations/ deployments in Europedealingwith trust and privacy management