Scabies outbreak in an intensive care unit with 1,659 exposed individuals--key factors for controlling the outbreak

OBJECTIVE: To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. DESIGN: Outbreak investigation. SETTING: The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center. METHODS: All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals. INTERVENTIONS: All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination. RESULTS: Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families. CONCLUSIONS: Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.

Growth hormone replacement therapy regulates microRNA-29a and targets involved in insulin resistance

Replacement of growth hormone (GH) in patients suffering from GH deficiency (GHD) offers clinical benefits on body composition, exercise capacity, and skeletal integrity. However, GH replacement therapy (GHRT) is also associated with insulin resistance, but the mechanisms are incompletely understood. We demonstrate that in GH-deficient mice (growth hormone-releasing hormone receptor (Ghrhr)(lit/lit)), insulin resistance after GHRT involves the upregulation of the extracellular matrix (ECM) and the downregulation of microRNA miR-29a in skeletal muscle. Based on RNA deep sequencing of skeletal muscle from GH-treated Ghrhr(lit/lit) mice, we identified several upregulated genes as predicted miR-29a targets that are negative regulators of insulin signaling or profibrotic/proinflammatory components of the ECM. Using gain- and loss-of-function studies, five of these genes were confirmed as endogenous targets of miR-29a in human myotubes (PTEN, COL3A1, FSTL1, SERPINH1, SPARC). In addition, in human myotubes, IGF1, but not GH, downregulated miR-29a expression and upregulated COL3A1. These results were confirmed in a group of GH-deficient patients after 4 months of GHRT. Serum IGF1 increased, skeletal muscle miR-29a decreased, and miR-29a targets were upregulated in patients with a reduced insulin response (homeostatic model assessment of insulin resistance (HOMA-IR)) after GHRT. We conclude that miR-29a could contribute to the metabolic response of muscle tissue to GHRT by regulating ECM components and PTEN. miR-29a and its targets might be valuable biomarkers for muscle metabolism following GH replacement. KEY MESSAGES GHRT most significantly affects the ECM cluster in skeletal muscle from mice. GHRT downregulates miR-29a and upregulates miR-29a targets in skeletal muscle from mice. PTEN, COL3A1, FSTL1, SERPINH1, and SPARC are endogenous miR-29a targets in human myotubes. IGF1 decreases miR-29a levels in human myotubes. miR-29a and its targets are regulated during GHRT in skeletal muscle from humans.

Enhanced Recovery after Urological Surgery: A Contemporary Systematic Review of Outcomes, Key Elements, and Research Needs

CONTEXT Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce recovery times. OBJECTIVE To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. EVIDENCE ACQUISITION A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms "postoperative period," "postoperative care," "enhanced recovery after surgery," "enhanced recovery," "accelerated recovery," "fast track recovery," "recovery program," "recovery pathway", "ERAS," and "urology" or "cystectomy" or "urologic surgery." EVIDENCE SYNTHESIS We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6h and perioperative liquid-carbohydrate loading up to 2h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. CONCLUSIONS ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. PATIENT SUMMARY This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.

Assessment of executive function before and after vitamin D replacement in vulnerable adults who self-neglect

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to do self-care and to protect themselves. The specific aims were to (1) determine the feasibility of using multiple EF measures with community-dwelling elders with SN, (2) identify changes in EF between baseline and 5-months in community-dwelling elders with SN who receive 50,000 IU or 400 IU of oral vitamin D monthly and (2) explore changes in specific dimensions of EF between the groups. ^ Methods: Fifty adults, 65 years of age and older, were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following tests at baseline and five-months: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Demographic data was collected at baseline and serum 25-OHD levels were collected at baseline and five-months. ^ Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the MMSE, CLOX II, TMT A & B and the EXIT 25. At five-months, the only statistically significant difference between groups was in the TMT A & B test scores; the control group did better than the treatment group. There was a non-significant increase in serum vitamin D levels for both groups and no difference between groups. ^ Conclusions: Results from this study provide support that individuals who SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: 'concept generation', 'planning', 'inhibition', and 'spatial working memory'. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN. ^ Key Words: Self-neglect, Executive Dysfunction, Executive Function, Adult Protective Services, Community-dwelling, Vitamin D ^

Side-Channel Attack Protection Techniques in FPGA Systems using Enhanced Dual-Rail Solutions

Esta tesis doctoral se centra principalmente en técnicas de ataque y contramedidas relacionadas con ataques de canal lateral (SCA por sus siglas en inglés), que han sido propuestas dentro del campo de investigación académica desde hace 17 años. Las investigaciones relacionadas han experimentado un notable crecimiento en las últimas décadas, mientras que los diseños enfocados en la protección sólida y eficaz contra dichos ataques aún se mantienen como un tema de investigación abierto, en el que se necesitan iniciativas más confiables para la protección de la información persona de empresa y de datos nacionales. El primer uso documentado de codificación secreta se remonta a alrededor de 1700 B.C., cuando los jeroglíficos del antiguo Egipto eran descritos en las inscripciones. La seguridad de la información siempre ha supuesto un factor clave en la transmisión de datos relacionados con inteligencia diplomática o militar. Debido a la evolución rápida de las técnicas modernas de comunicación, soluciones de cifrado se incorporaron por primera vez para garantizar la seguridad, integridad y confidencialidad de los contextos de transmisión a través de cables sin seguridad o medios inalámbricos. Debido a las restricciones de potencia de cálculo antes de la era del ordenador, la técnica de cifrado simple era un método más que suficiente para ocultar la información. Sin embargo, algunas vulnerabilidades algorítmicas pueden ser explotadas para restaurar la regla de codificación sin mucho esfuerzo. Esto ha motivado nuevas investigaciones en el área de la criptografía, con el fin de proteger el sistema de información ante sofisticados algoritmos. Con la invención de los ordenadores se ha acelerado en gran medida la implementación de criptografía segura, que ofrece resistencia eficiente encaminada a obtener mayores capacidades de computación altamente reforzadas. Igualmente, sofisticados cripto-análisis han impulsado las tecnologías de computación. Hoy en día, el mundo de la información ha estado involucrado con el campo de la criptografía, enfocada a proteger cualquier campo a través de diversas soluciones de cifrado. Estos enfoques se han fortalecido debido a la unificación optimizada de teorías matemáticas modernas y prácticas eficaces de hardware, siendo posible su implementación en varias plataformas (microprocesador, ASIC, FPGA, etc.). Las necesidades y requisitos de seguridad en la industria son las principales métricas de conducción en el diseño electrónico, con el objetivo de promover la fabricación de productos de gran alcance sin sacrificar la seguridad de los clientes. Sin embargo, una vulnerabilidad en la implementación práctica encontrada por el Prof. Paul Kocher, et al en 1996 implica que un circuito digital es inherentemente vulnerable a un ataque no convencional, lo cual fue nombrado posteriormente como ataque de canal lateral, debido a su fuente de análisis. Sin embargo, algunas críticas sobre los algoritmos criptográficos teóricamente seguros surgieron casi inmediatamente después de este descubrimiento. En este sentido, los circuitos digitales consisten típicamente en un gran número de celdas lógicas fundamentales (como MOS - Metal Oxide Semiconductor), construido sobre un sustrato de silicio durante la fabricación. La lógica de los circuitos se realiza en función de las innumerables conmutaciones de estas células. Este mecanismo provoca inevitablemente cierta emanación física especial que puede ser medida y correlacionada con el comportamiento interno del circuito. SCA se puede utilizar para revelar datos confidenciales (por ejemplo, la criptografía de claves), analizar la arquitectura lógica, el tiempo e incluso inyectar fallos malintencionados a los circuitos que se implementan en sistemas embebidos, como FPGAs, ASICs, o tarjetas inteligentes. Mediante el uso de la comparación de correlación entre la cantidad de fuga estimada y las fugas medidas de forma real, información confidencial puede ser reconstruida en mucho menos tiempo y computación. Para ser precisos, SCA básicamente cubre una amplia gama de tipos de ataques, como los análisis de consumo de energía y radiación ElectroMagnética (EM). Ambos se basan en análisis estadístico y, por lo tanto, requieren numerosas muestras. Los algoritmos de cifrado no están intrínsecamente preparados para ser resistentes ante SCA. Es por ello que se hace necesario durante la implementación de circuitos integrar medidas que permitan camuflar las fugas a través de "canales laterales". Las medidas contra SCA están evolucionando junto con el desarrollo de nuevas técnicas de ataque, así como la continua mejora de los dispositivos electrónicos. Las características físicas requieren contramedidas sobre la capa física, que generalmente se pueden clasificar en soluciones intrínsecas y extrínsecas. Contramedidas extrínsecas se ejecutan para confundir la fuente de ataque mediante la integración de ruido o mala alineación de la actividad interna. Comparativamente, las contramedidas intrínsecas están integradas en el propio algoritmo, para modificar la aplicación con el fin de minimizar las fugas medibles, o incluso hacer que dichas fugas no puedan ser medibles. Ocultación y Enmascaramiento son dos técnicas típicas incluidas en esta categoría. Concretamente, el enmascaramiento se aplica a nivel algorítmico, para alterar los datos intermedios sensibles con una máscara de manera reversible. A diferencia del enmascaramiento lineal, las operaciones no lineales que ampliamente existen en criptografías modernas son difíciles de enmascarar. Dicho método de ocultación, que ha sido verificado como una solución efectiva, comprende principalmente la codificación en doble carril, que está ideado especialmente para aplanar o eliminar la fuga dependiente de dato en potencia o en EM. En esta tesis doctoral, además de la descripción de las metodologías de ataque, se han dedicado grandes esfuerzos sobre la estructura del prototipo de la lógica propuesta, con el fin de realizar investigaciones enfocadas a la seguridad sobre contramedidas de arquitectura a nivel lógico. Una característica de SCA reside en el formato de las fuentes de fugas. Un típico ataque de canal lateral se refiere al análisis basado en la potencia, donde la capacidad fundamental del transistor MOS y otras capacidades parásitas son las fuentes esenciales de fugas. Por lo tanto, una lógica robusta resistente a SCA debe eliminar o mitigar las fugas de estas micro-unidades, como las puertas lógicas básicas, los puertos I/O y las rutas. Las herramientas EDA proporcionadas por los vendedores manipulan la lógica desde un nivel más alto, en lugar de realizarlo desde el nivel de puerta, donde las fugas de canal lateral se manifiestan. Por lo tanto, las implementaciones clásicas apenas satisfacen estas necesidades e inevitablemente atrofian el prototipo. Por todo ello, la implementación de un esquema de diseño personalizado y flexible ha de ser tomado en cuenta. En esta tesis se presenta el diseño y la implementación de una lógica innovadora para contrarrestar SCA, en la que se abordan 3 aspectos fundamentales: I. Se basa en ocultar la estrategia sobre el circuito en doble carril a nivel de puerta para obtener dinámicamente el equilibrio de las fugas en las capas inferiores; II. Esta lógica explota las características de la arquitectura de las FPGAs, para reducir al mínimo el gasto de recursos en la implementación; III. Se apoya en un conjunto de herramientas asistentes personalizadas, incorporadas al flujo genérico de diseño sobre FPGAs, con el fin de manipular los circuitos de forma automática. El kit de herramientas de diseño automático es compatible con la lógica de doble carril propuesta, para facilitar la aplicación práctica sobre la familia de FPGA del fabricante Xilinx. En este sentido, la metodología y las herramientas son flexibles para ser extendido a una amplia gama de aplicaciones en las que se desean obtener restricciones mucho más rígidas y sofisticadas a nivel de puerta o rutado. En esta tesis se realiza un gran esfuerzo para facilitar el proceso de implementación y reparación de lógica de doble carril genérica. La viabilidad de las soluciones propuestas es validada mediante la selección de algoritmos criptográficos ampliamente utilizados, y su evaluación exhaustiva en comparación con soluciones anteriores. Todas las propuestas están respaldadas eficazmente a través de ataques experimentales con el fin de validar las ventajas de seguridad del sistema. El presente trabajo de investigación tiene la intención de cerrar la brecha entre las barreras de implementación y la aplicación efectiva de lógica de doble carril. En esencia, a lo largo de esta tesis se describirá un conjunto de herramientas de implementación para FPGAs que se han desarrollado para trabajar junto con el flujo de diseño genérico de las mismas, con el fin de lograr crear de forma innovadora la lógica de doble carril. Un nuevo enfoque en el ámbito de la seguridad en el cifrado se propone para obtener personalización, automatización y flexibilidad en el prototipo de circuito de bajo nivel con granularidad fina. Las principales contribuciones del presente trabajo de investigación se resumen brevemente a continuación: Lógica de Precharge Absorbed-DPL logic: El uso de la conversión de netlist para reservar LUTs libres para ejecutar la señal de precharge y Ex en una lógica DPL. Posicionamiento entrelazado Row-crossed con pares idénticos de rutado en redes de doble carril, lo que ayuda a aumentar la resistencia frente a la medición EM selectiva y mitigar los impactos de las variaciones de proceso. Ejecución personalizada y herramientas de conversión automática para la generación de redes idénticas para la lógica de doble carril propuesta. (a) Para detectar y reparar conflictos en las conexiones; (b) Detectar y reparar las rutas asimétricas. (c) Para ser utilizado en otras lógicas donde se requiere un control estricto de las interconexiones en aplicaciones basadas en Xilinx. Plataforma CPA de pruebas personalizadas para el análisis de EM y potencia, incluyendo la construcción de dicha plataforma, el método de medición y análisis de los ataques. Análisis de tiempos para cuantificar los niveles de seguridad. División de Seguridad en la conversión parcial de un sistema de cifrado complejo para reducir los costes de la protección. Prueba de concepto de un sistema de calefacción auto-adaptativo para mitigar los impactos eléctricos debido a la variación del proceso de silicio de manera dinámica. La presente tesis doctoral se encuentra organizada tal y como se detalla a continuación: En el capítulo 1 se abordan los fundamentos de los ataques de canal lateral, que abarca desde conceptos básicos de teoría de modelos de análisis, además de la implementación de la plataforma y la ejecución de los ataques. En el capítulo 2 se incluyen las estrategias de resistencia SCA contra los ataques de potencia diferencial y de EM. Además de ello, en este capítulo se propone una lógica en doble carril compacta y segura como contribución de gran relevancia, así como también se presentará la transformación lógica basada en un diseño a nivel de puerta. Por otra parte, en el Capítulo 3 se abordan los desafíos relacionados con la implementación de lógica en doble carril genérica. Así mismo, se describirá un flujo de diseño personalizado para resolver los problemas de aplicación junto con una herramienta de desarrollo automático de aplicaciones propuesta, para mitigar las barreras de diseño y facilitar los procesos. En el capítulo 4 se describe de forma detallada la elaboración e implementación de las herramientas propuestas. Por otra parte, la verificación y validaciones de seguridad de la lógica propuesta, así como un sofisticado experimento de verificación de la seguridad del rutado, se describen en el capítulo 5. Por último, un resumen de las conclusiones de la tesis y las perspectivas como líneas futuras se incluyen en el capítulo 6. Con el fin de profundizar en el contenido de la tesis doctoral, cada capítulo se describe de forma más detallada a continuación: En el capítulo 1 se introduce plataforma de implementación hardware además las teorías básicas de ataque de canal lateral, y contiene principalmente: (a) La arquitectura genérica y las características de la FPGA a utilizar, en particular la Xilinx Virtex-5; (b) El algoritmo de cifrado seleccionado (un módulo comercial Advanced Encryption Standard (AES)); (c) Los elementos esenciales de los métodos de canal lateral, que permiten revelar las fugas de disipación correlacionadas con los comportamientos internos; y el método para recuperar esta relación entre las fluctuaciones físicas en los rastros de canal lateral y los datos internos procesados; (d) Las configuraciones de las plataformas de pruebas de potencia / EM abarcadas dentro de la presente tesis. El contenido de esta tesis se amplia y profundiza a partir del capítulo 2, en el cual se abordan varios aspectos claves. En primer lugar, el principio de protección de la compensación dinámica de la lógica genérica de precarga de doble carril (Dual-rail Precharge Logic-DPL) se explica mediante la descripción de los elementos compensados a nivel de puerta. En segundo lugar, la lógica PA-DPL es propuesta como aportación original, detallando el protocolo de la lógica y un caso de aplicación. En tercer lugar, dos flujos de diseño personalizados se muestran para realizar la conversión de doble carril. Junto con ello, se aclaran las definiciones técnicas relacionadas con la manipulación por encima de la netlist a nivel de LUT. Finalmente, una breve discusión sobre el proceso global se aborda en la parte final del capítulo. El Capítulo 3 estudia los principales retos durante la implementación de DPLs en FPGAs. El nivel de seguridad de las soluciones de resistencia a SCA encontradas en el estado del arte se ha degenerado debido a las barreras de implantación a través de herramientas EDA convencionales. En el escenario de la arquitectura FPGA estudiada, se discuten los problemas de los formatos de doble carril, impactos parásitos, sesgo tecnológico y la viabilidad de implementación. De acuerdo con estas elaboraciones, se plantean dos problemas: Cómo implementar la lógica propuesta sin penalizar los niveles de seguridad, y cómo manipular un gran número de celdas y automatizar el proceso. El PA-DPL propuesto en el capítulo 2 se valida con una serie de iniciativas, desde características estructurales como doble carril entrelazado o redes de rutado clonadas, hasta los métodos de aplicación tales como las herramientas de personalización y automatización de EDA. Por otra parte, un sistema de calefacción auto-adaptativo es representado y aplicado a una lógica de doble núcleo, con el fin de ajustar alternativamente la temperatura local para equilibrar los impactos negativos de la variación del proceso durante la operación en tiempo real. El capítulo 4 se centra en los detalles de la implementación del kit de herramientas. Desarrollado sobre una API third-party, el kit de herramientas personalizado es capaz de manipular los elementos de la lógica de circuito post P&R ncd (una versión binaria ilegible del xdl) convertido al formato XDL Xilinx. El mecanismo y razón de ser del conjunto de instrumentos propuestos son cuidadosamente descritos, que cubre la detección de enrutamiento y los enfoques para la reparación. El conjunto de herramientas desarrollado tiene como objetivo lograr redes de enrutamiento estrictamente idénticos para la lógica de doble carril, tanto para posicionamiento separado como para el entrelazado. Este capítulo particularmente especifica las bases técnicas para apoyar las implementaciones en los dispositivos de Xilinx y su flexibilidad para ser utilizado sobre otras aplicaciones. El capítulo 5 se enfoca en la aplicación de los casos de estudio para la validación de los grados de seguridad de la lógica propuesta. Se discuten los problemas técnicos detallados durante la ejecución y algunas nuevas técnicas de implementación. (a) Se discute el impacto en el proceso de posicionamiento de la lógica utilizando el kit de herramientas propuesto. Diferentes esquemas de implementación, tomando en cuenta la optimización global en seguridad y coste, se verifican con los experimentos con el fin de encontrar los planes de posicionamiento y reparación optimizados; (b) las validaciones de seguridad se realizan con los métodos de correlación y análisis de tiempo; (c) Una táctica asintótica se aplica a un núcleo AES sobre BCDL estructurado para validar de forma sofisticada el impacto de enrutamiento sobre métricas de seguridad; (d) Los resultados preliminares utilizando el sistema de calefacción auto-adaptativa sobre la variación del proceso son mostrados; (e) Se introduce una aplicación práctica de las herramientas para un diseño de cifrado completa. Capítulo 6 incluye el resumen general del trabajo presentado dentro de esta tesis doctoral. Por último, una breve perspectiva del trabajo futuro se expone, lo que puede ampliar el potencial de utilización de las contribuciones de esta tesis a un alcance más allá de los dominios de la criptografía en FPGAs. ABSTRACT This PhD thesis mainly concentrates on countermeasure techniques related to the Side Channel Attack (SCA), which has been put forward to academic exploitations since 17 years ago. The related research has seen a remarkable growth in the past decades, while the design of solid and efficient protection still curiously remain as an open research topic where more reliable initiatives are required for personal information privacy, enterprise and national data protections. The earliest documented usage of secret code can be traced back to around 1700 B.C., when the hieroglyphs in ancient Egypt are scribed in inscriptions. Information security always gained serious attention from diplomatic or military intelligence transmission. Due to the rapid evolvement of modern communication technique, crypto solution was first incorporated by electronic signal to ensure the confidentiality, integrity, availability, authenticity and non-repudiation of the transmitted contexts over unsecure cable or wireless channels. Restricted to the computation power before computer era, simple encryption tricks were practically sufficient to conceal information. However, algorithmic vulnerabilities can be excavated to restore the encoding rules with affordable efforts. This fact motivated the development of modern cryptography, aiming at guarding information system by complex and advanced algorithms. The appearance of computers has greatly pushed forward the invention of robust cryptographies, which efficiently offers resistance relying on highly strengthened computing capabilities. Likewise, advanced cryptanalysis has greatly driven the computing technologies in turn. Nowadays, the information world has been involved into a crypto world, protecting any fields by pervasive crypto solutions. These approaches are strong because of the optimized mergence between modern mathematical theories and effective hardware practices, being capable of implement crypto theories into various platforms (microprocessor, ASIC, FPGA, etc). Security needs from industries are actually the major driving metrics in electronic design, aiming at promoting the construction of systems with high performance without sacrificing security. Yet a vulnerability in practical implementation found by Prof. Paul Kocher, et al in 1996 implies that modern digital circuits are inherently vulnerable to an unconventional attack approach, which was named as side-channel attack since then from its analysis source. Critical suspicions to theoretically sound modern crypto algorithms surfaced almost immediately after this discovery. To be specifically, digital circuits typically consist of a great number of essential logic elements (as MOS - Metal Oxide Semiconductor), built upon a silicon substrate during the fabrication. Circuit logic is realized relying on the countless switch actions of these cells. This mechanism inevitably results in featured physical emanation that can be properly measured and correlated with internal circuit behaviors. SCAs can be used to reveal the confidential data (e.g. crypto-key), analyze the logic architecture, timing and even inject malicious faults to the circuits that are implemented in hardware system, like FPGA, ASIC, smart Card. Using various comparison solutions between the predicted leakage quantity and the measured leakage, secrets can be reconstructed at much less expense of time and computation. To be precisely, SCA basically encloses a wide range of attack types, typically as the analyses of power consumption or electromagnetic (EM) radiation. Both of them rely on statistical analyses, and hence require a number of samples. The crypto algorithms are not intrinsically fortified with SCA-resistance. Because of the severity, much attention has to be taken into the implementation so as to assemble countermeasures to camouflage the leakages via "side channels". Countermeasures against SCA are evolving along with the development of attack techniques. The physical characteristics requires countermeasures over physical layer, which can be generally classified into intrinsic and extrinsic vectors. Extrinsic countermeasures are executed to confuse the attacker by integrating noise, misalignment to the intra activities. Comparatively, intrinsic countermeasures are built into the algorithm itself, to modify the implementation for minimizing the measurable leakage, or making them not sensitive any more. Hiding and Masking are two typical techniques in this category. Concretely, masking applies to the algorithmic level, to alter the sensitive intermediate values with a mask in reversible ways. Unlike the linear masking, non-linear operations that widely exist in modern cryptographies are difficult to be masked. Approved to be an effective counter solution, hiding method mainly mentions dual-rail logic, which is specially devised for flattening or removing the data-dependent leakage in power or EM signatures. In this thesis, apart from the context describing the attack methodologies, efforts have also been dedicated to logic prototype, to mount extensive security investigations to countermeasures on logic-level. A characteristic of SCA resides on the format of leak sources. Typical side-channel attack concerns the power based analysis, where the fundamental capacitance from MOS transistors and other parasitic capacitances are the essential leak sources. Hence, a robust SCA-resistant logic must eliminate or mitigate the leakages from these micro units, such as basic logic gates, I/O ports and routings. The vendor provided EDA tools manipulate the logic from a higher behavioral-level, rather than the lower gate-level where side-channel leakage is generated. So, the classical implementations barely satisfy these needs and inevitably stunt the prototype. In this case, a customized and flexible design scheme is appealing to be devised. This thesis profiles an innovative logic style to counter SCA, which mainly addresses three major aspects: I. The proposed logic is based on the hiding strategy over gate-level dual-rail style to dynamically overbalance side-channel leakage from lower circuit layer; II. This logic exploits architectural features of modern FPGAs, to minimize the implementation expenses; III. It is supported by a set of assistant custom tools, incorporated by the generic FPGA design flow, to have circuit manipulations in an automatic manner. The automatic design toolkit supports the proposed dual-rail logic, facilitating the practical implementation on Xilinx FPGA families. While the methodologies and the tools are flexible to be expanded to a wide range of applications where rigid and sophisticated gate- or routing- constraints are desired. In this thesis a great effort is done to streamline the implementation workflow of generic dual-rail logic. The feasibility of the proposed solutions is validated by selected and widely used crypto algorithm, for thorough and fair evaluation w.r.t. prior solutions. All the proposals are effectively verified by security experiments. The presented research work attempts to solve the implementation troubles. The essence that will be formalized along this thesis is that a customized execution toolkit for modern FPGA systems is developed to work together with the generic FPGA design flow for creating innovative dual-rail logic. A method in crypto security area is constructed to obtain customization, automation and flexibility in low-level circuit prototype with fine-granularity in intractable routings. Main contributions of the presented work are summarized next: Precharge Absorbed-DPL logic: Using the netlist conversion to reserve free LUT inputs to execute the Precharge and Ex signal in a dual-rail logic style. A row-crossed interleaved placement method with identical routing pairs in dual-rail networks, which helps to increase the resistance against selective EM measurement and mitigate the impacts from process variations. Customized execution and automatic transformation tools for producing identical networks for the proposed dual-rail logic. (a) To detect and repair the conflict nets; (b) To detect and repair the asymmetric nets. (c) To be used in other logics where strict network control is required in Xilinx scenario. Customized correlation analysis testbed for EM and power attacks, including the platform construction, measurement method and attack analysis. A timing analysis based method for quantifying the security grades. A methodology of security partitions of complex crypto systems for reducing the protection cost. A proof-of-concept self-adaptive heating system to mitigate electrical impacts over process variations in dynamic dual-rail compensation manner. The thesis chapters are organized as follows: Chapter 1 discusses the side-channel attack fundamentals, which covers from theoretic basics to analysis models, and further to platform setup and attack execution. Chapter 2 centers to SCA-resistant strategies against generic power and EM attacks. In this chapter, a major contribution, a compact and secure dual-rail logic style, will be originally proposed. The logic transformation based on bottom-layer design will be presented. Chapter 3 is scheduled to elaborate the implementation challenges of generic dual-rail styles. A customized design flow to solve the implementation problems will be described along with a self-developed automatic implementation toolkit, for mitigating the design barriers and facilitating the processes. Chapter 4 will originally elaborate the tool specifics and construction details. The implementation case studies and security validations for the proposed logic style, as well as a sophisticated routing verification experiment, will be described in Chapter 5. Finally, a summary of thesis conclusions and perspectives for future work are included in Chapter 5. To better exhibit the thesis contents, each chapter is further described next: Chapter 1 provides the introduction of hardware implementation testbed and side-channel attack fundamentals, and mainly contains: (a) The FPGA generic architecture and device features, particularly of Virtex-5 FPGA; (b) The selected crypto algorithm - a commercially and extensively used Advanced Encryption Standard (AES) module - is detailed; (c) The essentials of Side-Channel methods are profiled. It reveals the correlated dissipation leakage to the internal behaviors, and the method to recover this relationship between the physical fluctuations in side-channel traces and the intra processed data; (d) The setups of the power/EM testing platforms enclosed inside the thesis work are given. The content of this thesis is expanded and deepened from chapter 2, which is divided into several aspects. First, the protection principle of dynamic compensation of the generic dual-rail precharge logic is explained by describing the compensated gate-level elements. Second, the novel DPL is originally proposed by detailing the logic protocol and an implementation case study. Third, a couple of custom workflows are shown next for realizing the rail conversion. Meanwhile, the technical definitions that are about to be manipulated above LUT-level netlist are clarified. A brief discussion about the batched process is given in the final part. Chapter 3 studies the implementation challenges of DPLs in FPGAs. The security level of state-of-the-art SCA-resistant solutions are decreased due to the implementation barriers using conventional EDA tools. In the studied FPGA scenario, problems are discussed from dual-rail format, parasitic impact, technological bias and implementation feasibility. According to these elaborations, two problems arise: How to implement the proposed logic without crippling the security level; and How to manipulate a large number of cells and automate the transformation. The proposed PA-DPL in chapter 2 is legalized with a series of initiatives, from structures to implementation methods. Furthermore, a self-adaptive heating system is depicted and implemented to a dual-core logic, assumed to alternatively adjust local temperature for balancing the negative impacts from silicon technological biases on real-time. Chapter 4 centers to the toolkit system. Built upon a third-party Application Program Interface (API) library, the customized toolkit is able to manipulate the logic elements from post P&R circuit (an unreadable binary version of the xdl one) converted to Xilinx xdl format. The mechanism and rationale of the proposed toolkit are carefully convoyed, covering the routing detection and repairing approaches. The developed toolkit aims to achieve very strictly identical routing networks for dual-rail logic both for separate and interleaved placement. This chapter particularly specifies the technical essentials to support the implementations in Xilinx devices and the flexibility to be expanded to other applications. Chapter 5 focuses on the implementation of the case studies for validating the security grades of the proposed logic style from the proposed toolkit. Comprehensive implementation techniques are discussed. (a) The placement impacts using the proposed toolkit are discussed. Different execution schemes, considering the global optimization in security and cost, are verified with experiments so as to find the optimized placement and repair schemes; (b) Security validations are realized with correlation, timing methods; (c) A systematic method is applied to a BCDL structured module to validate the routing impact over security metric; (d) The preliminary results using the self-adaptive heating system over process variation is given; (e) A practical implementation of the proposed toolkit to a large design is introduced. Chapter 6 includes the general summary of the complete work presented inside this thesis. Finally, a brief perspective for the future work is drawn which might expand the potential utilization of the thesis contributions to a wider range of implementation domains beyond cryptography on FPGAs.

Neurospora crassa transcriptomics reveals oxidative stress and plasma membrane homeostasis biology genes as key targets in response to chitosan

Chitosan is a natural polymer with antimicrobial activity. Chitosan causes plasma membrane permeabilization and induction of intracellular reactive oxygen species (ROS) in Neurospora crassa. We have determined the transcriptional profile of N. crassa to chitosan and identified the main gene targets involved in the cellular response to this compound. Global network analyses showed membrane, transport and oxidoreductase activity as key nodes affected by chitosan. Activation of oxidative metabolism indicates the importance of ROS and cell energy together with plasma membrane homeostasis in N. crassa response to chitosan. Deletion strain analysis of chitosan susceptibility pointed NCU03639 encoding a class 3 lipase, involved in plasma membrane repair by lipid replacement, and NCU04537 a MFS monosaccharide transporter related to assimilation of simple sugars, as main gene targets of chitosan. NCU10521, a glutathione S-transferase-4 involved in the generation of reducing power for scavenging intracellular ROS is also a determinant chitosan gene target. Ca2+ increased tolerance to chitosan in N. crassa. Growth of NCU10610 (fig 1 domain) and SYT1 (a synaptotagmin) deletion strains was significantly increased by Ca2+ in the presence of chitosan. Both genes play a determinant role in N. crassa membrane homeostasis. Our results are of paramount importance for developing chitosan as an antifungal.

Farm and forest produced alcohol [microform] : the key to liquid fuel independence : a compendium of papers /

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

Coherent-state quantum key distribution without random basis switching

The random switching of measurement bases is commonly assumed to be a necessary step of quantum key distribution protocols. In this paper we present a no-switching protocol and show that switching is not required for coherent-state continuous-variable quantum key distribution. Further, this protocol achieves higher information rates and a simpler experimental setup compared to previous protocols that rely on switching. We propose an optimal eavesdropping attack against this protocol, assuming individual Gaussian attacks. Finally, we investigate and compare the no-switching protocol applied to the original Bennett-Brassard 1984 scheme.

Key Agreement Protocol (KAP) Based on Matrix Power Function

* Work is partially supported by the Lithuanian State Science and Studies Foundation.

Long-range, high bit-rate secure key distribution link utilizing Raman Ultra-long fiber laser (UFL)

The distribution of the secret key is the weakest link of many data encryption systems. Quantum key distribution (QKD) schemes provide attractive solutions [1], however their implementation remains challenging and their range and bit-rate are limited. Moreover, practical QKD systems, employ real-life components and are, therefore, vulnerable to diverse attack schemes [2]. Ultra-Long fiber lasers (UFLs) have been drawing much attention recently because of their fundamentally different properties compared to conventional lasers as well as their unique applications [3]. Here, we demonstrate a 100Bps, practically secure key distribution, over a 500km link, employing Raman gain UFL. Fig. 1(a) depicts a schematic of the UFL system. Each user has an identical set of two wavelength selective mirrors centered at l0 and l 1. In order to exchange a key-bit, each user independently choose one of these mirrors and introduces it as a laser reflector at their end. If both users choose identical mirrors, a clear signal develops and the bits in these cases are discarded. However if they choose complementary mirrors, (1, 0 or 0, 1 states), the UFL remains below lasing threshold and no signal evolves. In these cases, an eavesdropper can only detect noise and is unable to determine the mirror choice of the users, where the choice of mirrors represent a single key bit (e.g. Alice's choice of mirror is the key-bit). These bits are kept and added to the key. The absence of signal in the secure states faxilitates fast measurements to distinguish between the non-secure and the secure states and to determine the key-bit in the later case, Sequentially reapeating the single bit exchange protocol generate the entire keys of any desirable length. © 2013 IEEE.

Mechanisms governing the eyewall replacement cycle in numerical simulations of tropical cyclones

Eyewall replacement cycle (ERC) is frequently observed during the evolution of intensifying Tropical Cyclones (TCs). Although intensely studied in recent years, the underlying mechanisms of ERC are still poorly understood, and the forecast of ERC remains a great challenge. To advance our understanding of ERC and provide insights in improvement of numerical forecast of ERC, a series of numerical simulations is performed to investigate ERCs in TC-like vortices on a f-plane. The simulated ERCs possess key features similar to those observed in real TCs including the formation of a secondary tangential wind maximum associated with the outer eyewall. The Sawyer-Eliassen equation and tangential momentum budget analyses are performed to diagnose the mechanisms underlying the secondary eyewall formation (SEF) and ERC. Our diagnoses reveal crucial roles of outer rainband heating in governing the formation and development of the secondary tangential wind maximum and demonstrate that the outer rainband convection must reach a critical strength relative to the eyewall before SEF and the subsequent ERC can occur. A positive feedback among low-level convection, acceleration of tangential winds in the boundary layer, and surface evaporation that leads to the development of ERC and a mechanism for the demise of inner eyewall that involves interaction between the transverse circulations induced by eyewall and outer rainband convection are proposed. The tangential momentum budget indicates that the net tendency of tangential wind is a small residual resultant from a large cancellation between tendencies induced by the resolved and sub-grid scale (SGS) processes. The large SGS contribution to the tangential wind budget explains different characteristics of ERC shown in previous numerical studies and poses a great challenge for a timely correct forecast of ERC. The sensitivity experiments show that ERCs are strongly subjected to model physics, vortex radial structure and background wind. The impact of model physics on ERC can be well understood with the interaction among eyewall/outer rainband heating, radilal inflow in the boundary layer, surface layer turbulent processes, and shallow convection in the moat. However, further investigations are needed to fully understand the exhibited sensitivities of ERC to vortex radial structure and background wind.

Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis.

BACKGROUND: The American College of Cardiology guidelines recommend 3 months of anticoagulation after replacement of the aortic valve with a bioprosthesis. However, there remains great variability in the current clinical practice and conflicting results from clinical studies. To assist clinical decision making, we pooled the existing evidence to assess whether anticoagulation in the setting of a new bioprosthesis was associated with improved outcomes or greater risk of bleeding. METHODS AND RESULTS: We searched the PubMed database from the inception of these databases until April 2015 to identify original studies (observational studies or clinical trials) that assessed anticoagulation with warfarin in comparison with either aspirin or no antiplatelet or anticoagulant therapy. We included the studies if their outcomes included thromboembolism or stroke/transient ischemic attacks and bleeding events. Quality assessment was performed in accordance with the Newland Ottawa Scale, and random effects analysis was used to pool the data from the available studies. I(2) testing was done to assess the heterogeneity of the included studies. After screening through 170 articles, a total of 13 studies (cases=6431; controls=18210) were included in the final analyses. The use of warfarin was associated with a significantly increased risk of overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08; P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With regard to composite primary outcome variables (risk of venous thromboembolism, stroke, or transient ischemic attack) at 3 months, no significant difference was seen with warfarin (odds ratio, 1.13; 95% confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was also not shown to improve outcomes at time interval >3 months (odds ratio, 1.12; 95% confidence interval, 0.80-1.58; P=0.79). CONCLUSIONS: Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.

Mechanisms Governing the Eyewall Replacement Cycle in Numerical Simulations of Tropical Cyclones

Eyewall replacement cycle (ERC) is frequently observed during the evolution of intensifying Tropical Cyclones (TCs). Although intensely studied in recent years, the underlying mechanisms of ERC are still poorly understood, and the forecast of ERC remains a great challenge. To advance our understanding of ERC and provide insights in improvement of numerical forecast of ERC, a series of numerical simulations is performed to investigate ERCs in TC-like vortices on a f-plane. The simulated ERCs possess key features similar to those observed in real TCs including the formation of a secondary tangential wind maximum associated with the outer eyewall. The Sawyer-Eliassen equation and tangential momentum budget analyses are performed to diagnose the mechanisms underlying the secondary eyewall formation (SEF) and ERC. Our diagnoses reveal crucial roles of outer rainband heating in governing the formation and development of the secondary tangential wind maximum and demonstrate that the outer rainband convection must reach a critical strength relative to the eyewall before SEF and the subsequent ERC can occur. A positive feedback among low-level convection, acceleration of tangential winds in the boundary layer, and surface evaporation that leads to the development of ERC and a mechanism for the demise of inner eyewall that involves interaction between the transverse circulations induced by eyewall and outer rainband convection are proposed. The tangential momentum budget indicates that the net tendency of tangential wind is a small residual resultant from a large cancellation between tendencies induced by the resolved and sub-grid scale (SGS) processes. The large SGS contribution to the tangential wind budget explains different characteristics of ERC shown in previous numerical studies and poses a great challenge for a timely correct forecast of ERC. The sensitivity experiments show that ERCs are strongly subjected to model physics, vortex radial structure and background wind. The impact of model physics on ERC can be well understood with the interaction among eyewall/outer rainband heating, radilal inflow in the boundary layer, surface layer turbulent processes, and shallow convection in the moat. However, further investigations are needed to fully understand the exhibited sensitivities of ERC to vortex radial structure and background wind.

Improving Patients’ Experience and Outcome of Total Joint Replacement: the RESTORE Programme

BACKGROUND: Total hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected. OBJECTIVE: To undertake a programme of research studies to work towards improving patient outcomes after THR and TKR. METHODS: We used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement. RESULTS: Systematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test. CONCLUSIONS: The RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.

Analysis of Automotive Cybersecurity - Attack surfaces and users’ privacy concerns

Modern automobiles are no longer just mechanical tools. The electronics and computing services they are shipping with are making them not less than a computer. They are massive kinetic devices with sophisticated computing power. Most of the modern vehicles are made with the added connectivity in mind which may be vulnerable to outside attack. Researchers have shown that it is possible to infiltrate into a vehicle’s internal system remotely and control the physical entities such as steering and brakes. It is quite possible to experience such attacks on a moving vehicle and unable to use the controls. These massive connected computers can be life threatening as they are related to everyday lifestyle. First part of this research studied the attack surfaces in the automotive cybersecurity domain. It also illustrated the attack methods and capabilities of the damages. Online survey has been deployed as data collection tool to learn about the consumers’ usage of such vulnerable automotive services. The second part of the research portrayed the consumers’ privacy in automotive world. It has been found that almost hundred percent of modern vehicles has the capabilities to send vehicle diagnostic data as well as user generated data to their manufacturers, and almost thirty five percent automotive companies are collecting them already. Internet privacy has been studies before in many related domain but no privacy scale were matched for automotive consumers. It created the research gap and motivation for this thesis. A study has been performed to use well established consumers privacy scale – IUIPC to match with the automotive consumers’ privacy situation. Hypotheses were developed based on the IUIPC model for internet consumers’ privacy and they were studied by the finding from the data collection methods. Based on the key findings of the research, all the hypotheses were accepted and hence it is found that automotive consumers’ privacy did follow the IUIPC model under certain conditions. It is also found that a majority of automotive consumers use the services and devices that are vulnerable and prone to cyber-attacks. It is also established that there is a market for automotive cybersecurity services and consumers are willing to pay certain fees to avail that.