Differential symptomology of possible and confirmed Ebola virus disease infection in the Democratic Republic of the Congo: a retrospective cohort study.

BACKGROUND: In its earliest phases, Ebola virus disease's rapid-onset, high fever, and gastrointestinal symptoms are largely indistinguishable from other infectious illnesses. We aimed to characterise the clinical indicators associated with Ebola virus disease to improve outbreak response. METHODS: In this retrospective analysis, we assessed routinely collected data from individuals with possible Ebola virus disease attending 30 Ebola health facilities in two provinces of the Democratic Republic of the Congo between Aug 1, 2018, and Aug 28, 2019. We used logistic regression analysis to model the probability of Ebola infection across 34 clinical variables and four types of possible Ebola virus disease exposures: contact with an individual known to have Ebola virus disease, attendance at any funeral, health facility consultation, or consultation with an informal health practitioner. FINDINGS: Data for 24 666 individuals were included. If a patient presented to care in the early symptomatic phase (ie, days 0-2), Ebola virus disease positivity was most associated with previous exposure to an individual with Ebola virus disease (odds ratio [OR] 11·9, 95% CI 9·1-15·8), funeral attendance (2·1, 1·6-2·7), or health facility consultations (2·1, 1·6-2·8), rather than clinical parameters. If presentation occurred on day 3 or later (after symptom onset), bleeding at an injection site (OR 33·9, 95% CI 12·7-101·3), bleeding gums (7·5, 3·7-15·4), conjunctivitis (2·4, 1·7-3·4), asthenia (1·9, 1·5-2·3), sore throat (1·8, 1·3-2·4), dysphagia (1·8, 1·4-2·3), and diarrhoea (1·6, 1·3-1·9) were additional strong predictors of Ebola virus disease. Some Ebola virus disease-specific signs were less prevalent among vaccinated individuals who were positive for Ebola virus disease when compared with the unvaccinated, such as dysphagia (-47%, p=0·0024), haematemesis (-90%, p=0·0131), and bleeding gums (-100%, p=0·0035). INTERPRETATION: Establishing the exact time an individual first had symptoms is essential to assessing their infection risk. An individual's exposure history remains of paramount importance, especially in the early phase. Ebola virus disease vaccination reduces symptom severity and should also be considered when assessing the likelihood of infection. These findings about symptomatology should be translated into practice during triage and should inform testing and quarantine procedures. FUNDING: Médecins Sans Frontières and its research affiliate Epicentre.

Design and Experimental Validation of a LoRaWAN Fog Computing Based Architecture for IoT Enabled Smart Campus Applications.

A smart campus is an intelligent infrastructure where smart sensors and actuators collaborate to collect information and interact with the machines, tools, and users of a university campus. As in a smart city, a smart campus represents a challenging scenario for Internet of Things (IoT) networks, especially in terms of cost, coverage, availability, latency, power consumption, and scalability. The technologies employed so far to cope with such a scenario are not yet able to manage simultaneously all the previously mentioned demanding requirements. Nevertheless, recent paradigms such as fog computing, which extends cloud computing to the edge of a network, make possible low-latency and location-aware IoT applications. Moreover, technologies such as Low-Power Wide-Area Networks (LPWANs) have emerged as a promising solution to provide low-cost and low-power consumption connectivity to nodes spread throughout a wide area. Specifically, the Long-Range Wide-Area Network (LoRaWAN) standard is one of the most recent developments, receiving attention both from industry and academia. In this article, the use of a LoRaWAN fog computing-based architecture is proposed for providing connectivity to IoT nodes deployed in a campus of the University of A Coruña (UDC), Spain. To validate the proposed system, the smart campus has been recreated realistically through an in-house developed 3D Ray-Launching radio-planning simulator that is able to take into consideration even small details, such as traffic lights, vehicles, people, buildings, urban furniture, or vegetation. The developed tool can provide accurate radio propagation estimations within the smart campus scenario in terms of coverage, capacity, and energy efficiency of the network. The results obtained with the planning simulator can then be compared with empirical measurements to assess the operating conditions and the system accuracy. Specifically, this article presents experiments that show the accurate results obtained by the planning simulator in the largest scenario ever built for it (a campus that covers an area of 26,000 m 2 ), which are corroborated with empirical measurements. Then, how the tool can be used to design the deployment of LoRaWAN infrastructure for three smart campus outdoor applications is explained: a mobility pattern detection system, a smart irrigation solution, and a smart traffic-monitoring deployment. Consequently, the presented results provide guidelines to smart campus designers and developers, and for easing LoRaWAN network deployment and research in other smart campuses and large environments such as smart cities.

Clock Frequency Impact on the Performance of High-Security Cryptographic Cipher Suites for Energy-Efficient Resource-Constrained IoT Devices.

Modern Internet of Things (IoT) systems have to be able to provide high-security levels, but it is difficult to accommodate computationally-intensive cryptographic algorithms on the resource-constrained hardware used to deploy IoT end nodes. Although this scenario brings the opportunity for using advanced security mechanisms such as Transport Layer Security (TLS), several configuration factors impact both the performance and the energy consumption of IoT systems. In this study, two of the most used TLS authentication algorithms (ECDSA and RSA) were compared when executed on a resource-constrained IoT node based on the ESP32 System-on-Chip (SoC), which was tested at different clock frequencies (80, 160 and 240 MHz) when providing different security levels (from 80 to 192 bits). With every tested configuration, energy consumption and average time per transaction were measured. The results show that ECDSA outperforms RSA in all performed tests and that certain software implementations may lead to scenarios where higher security-level alternatives outperform cryptosystems that are theoretically simpler and lighter in terms of energy consumption and data throughput. Moreover, the performed experiments allow for concluding that higher clock frequencies provide better performance in terms of throughput and, in contrast to what may be expected, less energy consumption.

A Practical Evaluation on RSA and ECC-Based Cipher Suites for IoT High-Security Energy-Efficient Fog and Mist Computing Devices.

The latest Internet of Things (IoT) edge-centric architectures allow for unburdening higher layers from part of their computational and data processing requirements. In the specific case of fog computing systems, they reduce greatly the requirements of cloud-centric systems by processing in fog gateways part of the data generated by end devices, thus providing services that were previously offered by a remote cloud. Thanks to recent advances in System-on-Chip (SoC) energy efficiency, it is currently possible to create IoT end devices with enough computational power to process the data generated by their sensors and actuators while providing complex services, which in recent years derived into the development of the mist computing paradigm. To allow mist computing nodes to provide the previously mentioned benefits and guarantee the same level of security as in other architectures, end-to-end standard security mechanisms need to be implemented. In this paper, a high-security energy-efficient fog and mist computing architecture and a testbed are presented and evaluated. The testbed makes use of Transport Layer Security (TLS) 1.2 Elliptic Curve Cryptography (ECC) and Rivest-Shamir-Adleman (RSA) cipher suites (that comply with the yet to come TLS 1.3 standard requirements), which are evaluated and compared in terms of energy consumption and data throughput for a fog gateway and two mist end devices. The obtained results allow a conclusion that ECC outperforms RSA in both energy consumption and data throughput for all the tested security levels. Moreover, the importance of selecting a proper ECC curve is demonstrated, showing that, for the tested devices, some curves present worse energy consumption and data throughput than other curves that provide a higher security level. As a result, this article not only presents a novel mist computing testbed, but also provides guidelines for future researchers to find out efficient and secure implementations for advanced IoT devices.

A post-conflict vaccination campaign, Central African Republic.

OBJECTIVE: To rapidly increase childhood immunization through a preventive, multi-antigen, vaccination campaign in Mambéré-Kadéï prefecture, Central African Republic, where a conflict from 2012 to 2015 reduced vaccination coverage. METHODS: The three-round campaign took place between December 2015 and June 2016 using: (i) oral poliomyelitis vaccine (OPV); (ii) combined diphtheria, tetanus and pertussis (DTP) vaccine, Haemophilus influenza type B (Hib) and hepatitis B (DTP-Hib-hepatitis B) vaccine; (iii) pneumococcal conjugate vaccine (PCV); (iv) measles vaccine; and (v) yellow fever vaccine. Administrative data were collected on vaccines administered by age group and vaccination coverage surveys were carried out before and after the campaign. FINDINGS: Overall, 294 054 vaccine doses were administered. Vaccination coverage for children aged 6 weeks to 59 months increased to over 85% for the first doses of OPV, DTP-Hib-hepatitis B vaccine and PCV and, in children aged 9 weeks to 59 months, to over 70% for the first measles vaccine dose. In children aged 6 weeks to 23 months, coverage of the second doses of OPV, DTP-Hib-hepatitis B vaccine and PCV was over 58% and coverage of the third doses of OPV and DTP-Hib-hepatitis B vaccine was over 20%. Moreover, 61% (5804/9589) of children aged 12 to 23 months had received two PCV doses and 90% (25933/28764) aged 24 to 59 months had received one dose. CONCLUSION: A preventive, multi-antigen, vaccination campaign was effective in rapidly increasing immunization coverage in a post-conflict setting. To sustain high coverage, routine immunization must be reinforced.

A Fog Computing Based Cyber-Physical System for the Automation of Pipe-Related Tasks in the Industry 4.0 Shipyard.

Pipes are one of the key elements in the construction of ships, which usually contain between 15,000 and 40,000 of them. This huge number, as well as the variety of processes that may be performed on a pipe, require rigorous identification, quality assessment and traceability. Traditionally, such tasks have been carried out by using manual procedures and following documentation on paper, which slows down the production processes and reduces the output of a pipe workshop. This article presents a system that allows for identifying and tracking the pipes of a ship through their construction cycle. For such a purpose, a fog computing architecture is proposed to extend cloud computing to the edge of the shipyard network. The system has been developed jointly by Navantia, one of the largest shipbuilders in the world, and the University of A Coruña (Spain), through a project that makes use of some of the latest Industry 4.0 technologies. Specifically, a Cyber-Physical System (CPS) is described, which uses active Radio Frequency Identification (RFID) tags to track pipes and detect relevant events. Furthermore, the CPS has been integrated and tested in conjunction with Siemens’ Manufacturing Execution System (MES) (Simatic IT). The experiments performed on the CPS show that, in the selected real-world scenarios, fog gateways respond faster than the tested cloud server, being such gateways are also able to process successfully more samples under high-load situations. In addition, under regular loads, fog gateways react between five and 481 times faster than the alternative cloud approach.

A Fog Computing and Cloudlet Based Augmented Reality System for the Industry 4.0 Shipyard.

Augmented Reality (AR) is one of the key technologies pointed out by Industry 4.0 as a tool for enhancing the next generation of automated and computerized factories. AR can also help shipbuilding operators, since they usually need to interact with information (e.g., product datasheets, instructions, maintenance procedures, quality control forms) that could be handled easily and more efficiently through AR devices. This is the reason why Navantia, one of the 10 largest shipbuilders in the world, is studying the application of AR (among other technologies) in different shipyard environments in a project called "Shipyard 4.0". This article presents Navantia's industrial AR (IAR) architecture, which is based on cloudlets and on the fog computing paradigm. Both technologies are ideal for supporting physically-distributed, low-latency and QoS-aware applications that decrease the network traffic and the computational load of traditional cloud computing systems. The proposed IAR communications architecture is evaluated in real-world scenarios with payload sizes according to demanding Microsoft HoloLens applications and when using a cloud, a cloudlet and a fog computing system. The results show that, in terms of response delay, the fog computing system is the fastest when transferring small payloads (less than 128 KB), while for larger file sizes, the cloudlet solution is faster than the others. Moreover, under high loads (with many concurrent IAR clients), the cloudlet in some cases is more than four times faster than the fog computing system in terms of response delay.

A post-conflict vaccination campaign, Central African Republic

Objective : To rapidly increase childhood immunization through a preventive, multi-antigen, vaccination campaign in Mambéré-Kadéï prefecture, Central African Republic, where a conflict from 2012 to 2015 reduced vaccination coverage. Methods:The three-round campaign took place between December 2015 and June 2016 using: (i) oral poliomyelitis vaccine (OPV); (ii) combined diphtheria, tetanus and pertussis (DTP) vaccine, Haemophilus influenza type B (Hib) and hepatitis B (DTP­Hib­hepatitis B) vaccine; (iii) pneumococcal conjugate vaccine (PCV); (iv) measles vaccine; and (v) yellow fever vaccine. Administrative data were collected on vaccines administered by age group and vaccination coverage surveys were carried out before and after the campaign.Findings:Overall, 294 054 vaccine doses were administered. Vaccination coverage for children aged 6 weeks to 59 months increased to over 85% for the first doses of OPV, DTP­Hib­hepatitis B vaccine and PCV and, in children aged 9 weeks to 59 months, to over 70% for the first measles vaccine dose. In children aged 6 weeks to 23 months, coverage of the second doses of OPV, DTP­Hib­hepatitis B vaccine and PCV was over 58% and coverage of the third doses of OPV and DTP­Hib­hepatitis B vaccine was over 20%. Moreover, 61% (5804/9589) of children aged 12 to 23 months had received two PCV doses and 90% (25933/28764) aged 24 to 59 months had received one dose.Conclusion:A preventive, multi-antigen, vaccination campaign was effective in rapidly increasing immunization coverage in a post-conflict setting. To sustain high coverage, routine immunization must be reinforced

A Practical Evaluation of a High-Security Energy-Efficient Gateway for IoT Fog Computing Applications.

Fog computing extends cloud computing to the edge of a network enabling new Internet of Things (IoT) applications and services, which may involve critical data that require privacy and security. In an IoT fog computing system, three elements can be distinguished: IoT nodes that collect data, the cloud, and interconnected IoT gateways that exchange messages with the IoT nodes and with the cloud. This article focuses on securing IoT gateways, which are assumed to be constrained in terms of computational resources, but that are able to offload some processing from the cloud and to reduce the latency in the responses to the IoT nodes. However, it is usually taken for granted that IoT gateways have direct access to the electrical grid, which is not always the case: in mission-critical applications like natural disaster relief or environmental monitoring, it is common to deploy IoT nodes and gateways in large areas where electricity comes from solar or wind energy that charge the batteries that power every device. In this article, how to secure IoT gateway communications while minimizing power consumption is analyzed. The throughput and power consumption of Rivest-Shamir-Adleman (RSA) and Elliptic Curve Cryptography (ECC) are considered, since they are really popular, but have not been thoroughly analyzed when applied to IoT scenarios. Moreover, the most widespread Transport Layer Security (TLS) cipher suites use RSA as the main public key-exchange algorithm, but the key sizes needed are not practical for most IoT devices and cannot be scaled to high security levels. In contrast, ECC represents a much lighter and scalable alternative. Thus, RSA and ECC are compared for equivalent security levels, and power consumption and data throughput are measured using a testbed of IoT gateways. The measurements obtained indicate that, in the specific fog computing scenario proposed, ECC is clearly a much better alternative than RSA, obtaining energy consumption reductions of up to 50% and a data throughput that doubles RSA in most scenarios. These conclusions are then corroborated by a frame temporal analysis of Ethernet packets. In addition, current data compression algorithms are evaluated, concluding that, when dealing with the small payloads related to IoT applications, they do not pay off in terms of real data throughput and power consumption.

Reverse Engineering and Security Evaluation of Commercial Tags for RFID-Based IoT Applications.

The Internet of Things (IoT) is a distributed system of physical objects that requires the seamless integration of hardware (e.g., sensors, actuators, electronics) and network communications in order to collect and exchange data. IoT smart objects need to be somehow identified to determine the origin of the data and to automatically detect the elements around us. One of the best positioned technologies to perform identification is RFID (Radio Frequency Identification), which in the last years has gained a lot of popularity in applications like access control, payment cards or logistics. Despite its popularity, RFID security has not been properly handled in numerous applications. To foster security in such applications, this article includes three main contributions. First, in order to establish the basics, a detailed review of the most common flaws found in RFID-based IoT systems is provided, including the latest attacks described in the literature. Second, a novel methodology that eases the detection and mitigation of such flaws is presented. Third, the latest RFID security tools are analyzed and the methodology proposed is applied through one of them (Proxmark 3) to validate it. Thus, the methodology is tested in different scenarios where tags are commonly used for identification. In such systems it was possible to clone transponders, extract information, and even emulate both tags and readers. Therefore, it is shown that the methodology proposed is useful for auditing security and reverse engineering RFID communications in IoT applications. It must be noted that, although this paper is aimed at fostering RFID communications security in IoT applications, the methodology can be applied to any RFID communications protocol.

A Review on Internet of Things for Defense and Public Safety.

The Internet of Things (IoT) is undeniably transforming the way that organizations communicate and organize everyday businesses and industrial procedures. Its adoption has proven well suited for sectors that manage a large number of assets and coordinate complex and distributed processes. This survey analyzes the great potential for applying IoT technologies (i.e., data-driven applications or embedded automation and intelligent adaptive systems) to revolutionize modern warfare and provide benefits similar to those in industry. It identifies scenarios where Defense and Public Safety (PS) could leverage better commercial IoT capabilities to deliver greater survivability to the warfighter or first responders, while reducing costs and increasing operation efficiency and effectiveness. This article reviews the main tactical requirements and the architecture, examining gaps and shortcomings in existing IoT systems across the military field and mission-critical scenarios. The review characterizes the open challenges for a broad deployment and presents a research roadmap for enabling an affordable IoT for defense and PS.

Home Automation System Based on Intelligent Transducer Enablers.

This paper presents a novel home automation system named HASITE (Home Automation System based on Intelligent Transducer Enablers), which has been specifically designed to identify and configure transducers easily and quickly. These features are especially useful in situations where many transducers are deployed, since their setup becomes a cumbersome task that consumes a significant amount of time and human resources. HASITE simplifies the deployment of a home automation system by using wireless networks and both self-configuration and self-registration protocols. Thanks to the application of these three elements, HASITE is able to add new transducers by just powering them up. According to the tests performed in different realistic scenarios, a transducer is ready to be used in less than 13 s. Moreover, all HASITE functionalities can be accessed through an API, which also allows for the integration of third-party systems. As an example, an Android application based on the API is presented. Remote users can use it to interact with transducers by just using a regular smartphone or a tablet.

Hospital stay as a proxy indicator for severe injury in earthquakes: a retrospective analysis.

INTRODUCTION: Earthquakes are the most violent type of natural disasters and injuries are the dominant medical problem in the early phases after earthquakes. However, likely because of poor data availability, high-quality research on injuries after earthquakes is lacking. Length of hospital stay (LOS) has been validated as a proxy indicator for injury severity in high-income settings and could potentially be used in retrospective research of injuries after earthquakes. In this study, we assessed LOS as an adequate proxy indicator for severe injury in trauma survivors of an earthquake. METHODS: A retrospective analysis was conducted using a database of 1,878 injured patients from the 2008 Wenchuan earthquake. Our primary outcome was severe injury, defined as a composite measure of serious injury or resource use. Secondary outcomes were serious injury and resource use, analysed separately. Non-parametric receiver operating characteristics (ROC) and area under the curve (AUC) analysis was used to test the discriminatory accuracy of LOS when used to identify severe injury. An 0.7

Multiple injuries after earthquakes: a retrospective analysis on 1,871 injured patients from the 2008 Wenchuan earthquake.

INTRODUCTION: Multiple injuries have been highlighted as an important clinical dimension of the injury profile following earthquakes, but studies are scarce. We investigated the pattern and combination of injuries among patients with two injuries following the 2008 Wenchuan earthquake. We also described the general injury profile, causes of injury and socio-demographic characteristics of the injured patients. METHODS: A retrospective hospital-based analysis of 1,871 earthquake injured patients, totaling 3,177 injuries, admitted between 12 and 31 May 2008 to the People's Hospital of Deyang city (PHDC). An electronic, webserver-based database with International Classification of Diseases (ICD)-10-based classification of earthquake-related injury diagnoses (IDs), anatomical sites and additional background variables of the inpatients was used. We analyzed this dataset for injury profile and number of injuries per patient. We then included all patients (856) with two injuries for more in-depth analysis. Possible spatial anatomical associations were determined a priori. Cross-tabulation and more complex frequency matrices for combination analyses were used to investigate the injury profile. RESULTS: Out of the 1,871 injured patients, 810 (43.3%) presented with a single injury. The rest had multiple injuries; 856 (45.8%) had two, 169 (9.0%) patients had three, 32 (1.7%) presented with four injuries, while only 4 (0.2%) were diagnosed with five injuries. The injury diagnoses of patients presenting with two-injuries showed important anatomical intra-site or neighboring clustering, which explained 49.1% of the combinations. For fractures, the result was even more marked as spatial clustering explained 57.9% of the association pattern. The most frequent combination of IDs was a double-fracture, affecting 20.7% of the two-injury patients (n = 177). Another 108 patients (12.6%) presented with fractures associated with crush injury and organ-soft tissue injury. Of the 3,177 injuries, 1,476 (46.5%) were fractures. Most injuries were located in the head (22.9%) and lower extremities (30.8%). CONCLUSIONS: Multiple injuries are put forward as an important component of the injury profile after this earthquake. A pattern of injury combinations and spatial aggregation of injuries was also found. Clinical diagnosis and treatment should be adapted to care of these patients. More studies are needed to generalize these findings.