Lattice-based Direct Anonymous Attestation (LDAA)

The Cloud-Edges (CE) framework, wherein small groups of Internet of Things(IoT) devices are serviced by local edge devices, enables a more scalable solution to IoT networks. The trustworthiness of the network may be ensured with Trusted Platform Modules (TPMs). This small hardware chip is capable of measuring and reporting a representation of the state of an IoT device. When connecting to a network, the IoT platform might have its state signed by the TPM in an anonymous way to prove both its genuineness and secure state through the Direct Anonymous Attestation (DAA) protocol. Currently standardised DAA schemes have their security supported on the factoring and discrete logarithm problems. Should a quantum-computer become available in the next few decades, these schemes will be broken. There is therefore a need to start developing a post-quantum DAA protocol. This paper presents a Lattice-based DAA (LDAA) scheme to meet this requirement. The security of this scheme is proved in the Universally Composable (UC) security model under the hardness assumptions of the Ring Inhomogeneous Short Integer Solution (Ring-ISIS) and Ring Learning With Errors (Ring-LWE) problems. Compared to the only other post-quantum DAA scheme available in related art, the storage requirements of the TPM are reduced twofold and the signature sizes 5 times. Moreover, experimental results show that the signing and verification operations are accelerated 1.1 and 2.0 times, respectively

Efficient Attribute-Based Signatures for Unbounded Arithmetic Branching Programs

This paper presents the first attribute-based signature (ABS) scheme in which the correspondence between signers and signatures is captured in an arithmetic model of computation. Specifically, we design a fully secure, i.e., adaptively unforgeable and perfectly signer-private ABS scheme for signing policies realizable by arithmetic branching programs (ABP), which are a quite expressive model of arithmetic computations. On a more positive note, the proposed scheme places no bound on the size and input length of the supported signing policy ABP’s, and at the same time, supports the use of an input attribute for an arbitrary number of times inside a signing policy ABP, i.e., the so called unbounded multi-use of attributes. The size of our public parameters is constant with respect to the sizes of the signing attribute vectors and signing policies available in the system. The construction is built in (asymmetric) bilinear groups of prime order, and its unforgeability is derived in the standard model under (asymmetric version of) the well-studied decisional linear (DLIN) assumption coupled with the existence of standard collision resistant hash functions. Due to the use of the arithmetic model as opposed to the boolean one, our ABS scheme not only excels significantly over the existing state-of-the-art constructions in terms of concrete efficiency, but also achieves improved applicability in various practical scenarios. Our principal technical contributions are (a) extending the techniques of Okamoto and Takashima [PKC 2011, PKC 2013], which were originally developed in the context of boolean span programs, to the arithmetic setting; and (b) innovating new ideas to allow unbounded multi-use of attributes inside ABP’s, which themselves are of unbounded size and input length

Stronger security notions for decentralized traceable attribute-based signatures and more efficient constructions

We revisit the notion of Decentralized Traceable Attribute-Based Signatures (DTABS) introduced by El Kaafarani et al. (CT-RSA 2014) and improve the state-of-the-art in three dimensions: Firstly, we provide a new stronger security model which circumvents some shortcomings in existing models. Our model minimizes the trust placed in attribute authorities and hence provides, among other things, a stronger definition for non-frameability. In addition, our model captures the notion of tracing soundness which is important for many applications of the primitive. Secondly, we provide a generic construction that is secure w.r.t. our strong security model and show two example instantiations in the standard model which are more efficient than existing constructions (secure under weaker security definitions). Finally, we dispense with the need for the expensive zero-knowledge proofs required for proving tracing correctness by the tracing authority. As a result, tracing a signature in our constructions is significantly more efficient than existing constructions, both in terms of the size of the tracing proof and the computational cost required to generate and verify it. For instance, verifying tracing correctness in our constructions requires only 4 pairings compared to 34 pairings in the most efficient existing construction

Further Lower Bounds for Structure-Preserving Signatures in Asymmetric Bilinear Groups

Structure-Preserving Signatures (SPSs) are a useful tool for the design of modular cryptographic protocols. Recent series of works have shown that by limiting the message space of those schemes to the set of Diffie-Hellman (DH) pairs, it is possible to circumvent the known lower bounds in the Type-3 bilinear group setting thus obtaining the shortest signatures consisting of only 2 elements from the shorter source group. It has been shown that such a variant yields efficiency gains for some cryptographic constructions, including attribute-based signatures and direct anonymous attestation. Only the cases of signing a single DH pair or a DH pair and a vector from $\Z_p$ have been considered. Signing a vector of group elements is required for various applications of SPSs, especially if the aim is to forgo relying on heuristic assumptions. An open question is whether such an improved lower bound also applies to signing a vector of $\ell > 1$ messages. We answer this question negatively for schemes existentially unforgeable under an adaptive chosen-message attack (EUF-CMA) whereas we answer it positively for schemes existentially unforgeable under a random-message attack (EUF-RMA) and those which are existentially unforgeable under a combined chosen-random-message attack (EUF-CMA-RMA). The latter notion is a leeway between the two former notions where it allows the adversary to adaptively choose part of the message to be signed whereas the remaining part of the message is chosen uniformly at random by the signer. Another open question is whether strongly existentially unforgeable under an adaptive chosen-message attack (sEUF-CMA) schemes with 2-element signatures exist. We answer this question negatively, proving it is impossible to construct sEUF-CMA schemes with 2-element signatures even if the signature consists of elements from both source groups. On the other hand, we prove that sEUF-RMA and sEUF-CMA-RMA schemes with 2-element (unilateral) signatures are possible by giving constructions for those notions. Among other things, our findings show a gap between random-message/combined chosen-random-message security and chosen-message security in this setting

Accountable privacy preserving attribute based framework for authenticated encrypted access in clouds

In this paper, we propose an accountable privacy preserving attribute-based framework, called Ins-PAbAC, that combines attribute based encryption and attribute based signature techniques for securely sharing outsourced data contents via public cloud servers. The proposed framework presents several advantages. First, it provides an encrypted access control feature, enforced at the data owner’s side, while providing the desired expressiveness of access control policies. Second, Ins-PAbAC preserves users’ privacy, relying on an anonymous authentication mechanism, derived from a privacy preserving attribute based signature scheme that hides the users’ identifying information. Furthermore, our proposal introduces an accountable attribute based signature that enables an inspection authority to reveal the identity of the anonymously-authenticated user if needed. Third, Ins-PAbAC is provably secure, as it is resistant to both curious cloud providers and malicious users adversaries. Finally, experimental results, built upon OpenStack Swift testbed, point out the applicability of the proposed scheme in real world scenarios

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease