Defending Against Firmware Cyber Attacks on Safety-Critical Systems

In the past, it was not possible to update the underlying software in many industrial control devices. Engineering teams had to ‘rip and replace’ obsolete components. However, the ability to make firmware updates has provided significant benefits to the companies who use Programmable Logic Controllers (PLCs), switches, gateways and bridges as well as an array of smart sensor/actuators. These updates include security patches when vulnerabilities are identified in existing devices; they can be distributed by physical media but are increasingly downloaded over Internet connections. These mechanisms pose a growing threat to the cyber security of safety-critical applications, which are illustrated by recent attacks on safety-related infrastructures across the Ukraine. Subsequent sections explain how malware can be distributed within firmware updates. Even when attackers cannot reverse engineer the code necessary to disguise their attack, they can undermine a device by forcing it into a constant upload cycle where the firmware installation never terminates. In this paper, we present means of mitigating the risks of firmware attack on safety-critical systems as part of wider initiatives to secure national critical infrastructures. Technical solutions, including firmware hashing, must be augmented by organizational measures to secure the supply chain within individual plants, across companies and throughout safety-related industries

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Assessment of Airborne Fungi in Indoor Environment for Biological Lab Rooms

Fungi can cause airborne diseases that need to consider in health plans due to its risk and threats of many communities worldwide. This study aims to assess indoor air quality of laboratory room environment for health industry sector. Open plate method was used to collect and culture of airborne fungi from 12 rooms of laboratories in faculty and hospital buildings. Identification of filamentous fungi grown on culture plates was based on standard mycological texts and manual. The results showed that the occurrence frequency and relative abundance were used to show the risk of airborne fungi. The colony forming unit of fungi species isolated from air samples of faculty and hospital laboratories were 304 and 83 respectively. Thirteen fungi genera including twenty-one species were identified overall air samples. The predominant fungi were Aspergillus, Penicillium and Alternaria among fungi. Among these species the most prevalence fungi was Penicillium chrysogenum at the highest at species level. Therefore, it is essential to set urgent steps to enhance the indoor air quality in laboratory environment such as providing air purification system in these labs

Optimum design of a standalone solar photovoltaic system based on novel integration of iterative-PESA-II and AHP-VIKOR methods

Solar energy is considered one of the most important renewable energy resources, and can be used to power a stand-alone photovoltaic (SAPV) system for supplying electricity in a remote area. However, inconstancy and unpredictable amounts of solar radiation are considered major obstacles in designing SAPV systems. Therefore, an accurate sizing method is necessary to apply in order to find an optimal configuration and fulfil the required load demand. In this study, a novel hybrid sizing approach was developed on the basis of techno-economic objectives to optimally size the SAPV system. The proposed hybrid method consisted of an intuitive method to estimate initial numbers of PV modules and storage battery, an iterative approach to accurately generate a set of wide ranges of optimal configurations, and a Pareto envelope-based selection algorithm (PESA-II) to reduce large configuration by efficacy obtaining a set of Pareto front (PF) solutions. Subsequently, the optimal configurations were ranked by using an integrated analytic hierarchy process (AHP) and vlsekeriterijumskaoptimizacija i kompromisonoresenje (VIKOR). The techno-economic objectives were loss of load probability, life cycle cost, and levelized cost of energy. The performance analysis results demonstrated that the lead–acid battery was reliable and more cost-effective than the other types of storage battery

Application of hybrid machine learning models and data pre-processing to predict water level of watersheds: Recent trends and future perspective

The community’s well-being and economic livelihoods are heavily influenced by the water level of watersheds. The changes in water levels directly affect the circulation processes of lakes and rivers that control water mixing and bottom sediment resuspension, further affecting water quality and aquatic ecosystems. Thus, these considerations have made the water level monitoring process essential to save the environment. Machine learning hybrid models are emerging robust tools that are successfully applied for water level monitoring. Various models have been developed, and selecting the optimal model would be a lengthy procedure. A timely, detailed, and instructive overview of the models’ concepts and historical uses would be beneficial in preventing researchers from overlooking models’ potential selection and saving significant time on the problem. Thus, recent research on water level prediction using hybrid machines is reviewed in this article to present the “state of the art” on the subject and provide some suggestions on research methodologies and models. This comprehensive study classifies hybrid models into four types algorithm parameter optimisation-based hybrid models (OBH), pre-processing-based hybrid models (PBH), the components combination-based hybrid models (CBH), and hybridisation of parameter optimisation-based with preprocessing-based hybrid models (HOPH); furthermore, it explains the pre-processing of data in detail. Finally, the most popular optimisation methods and future perspectives and conclusions have been discussed.Validerad;2022;Nivå 2;2022-11-14 (hanlid)</p

Assessing the Benefits of Nature-Inspired Algorithms for the Parameterization of ANN in the Prediction of Water Demand

Accurate forecasting techniques for a stochastic pattern of water demand are essential for any city that faces high variability in climate factors and a shortage of water resources. This study was the first research to assess the impact of climatic factors on urban water demand in Iraq, which is one of the hottest countries in the world. We developed a novel forecasting methodology that includes data preprocessing and an artificial neural network (ANN) model, which we integrated with a recent nature-inspired metaheuristic algorithm [marine predators algorithm (MPA)]. The MPA-ANN algorithm was compared with four nature-inspired metaheuristic algorithms. Nine climatic factors were examined with different scenarios to simulate the monthly stochastic urban water demand over 11 years for Baghdad City, Iraq. The results revealed that (1) precipitation, solar radiation, and dew point temperature are the most relevant factors; (2) the ANN model becomes more accurate when it is used in combination with the MPA; and (3) this methodology can accurately forecast water demand considering the variability in climatic factors. These findings are of considerable significance to water utilities in planning, reviewing, and comparing the availability of freshwater resources and increasing water requests (i.e., adaptation variability of climatic factors). Validerad;2022;Nivå 2;2022-11-09 (johcin)</p