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The Edge-Cloud Continuum refers to the dynamic provisioning of distributed computing and network resources that can be scaled to support the creation of secure, resource-efficient, and decentralised digital ecosystems, which also support federated topologies for collaborating and sharing resources. Trusted interaction and orchestration of distributed edge-cloud resources are the fundamental principles of distributed network infrastructure and service provisioning. The zero trust architecture (ZTA) paradigm is gaining momentum based on being able to ensure trusted and secure interaction for edge-cloud networks. However, ZTA’s strict authentication policy mandates devices to be authenticated for every session, leading to significant overhead for resource-constrained devices engaged in multiple sessions. To address this challenge, this paper proposes a ZTA that integrates a performance-based trust assessment mechanism, allowing a higher number of consecutive sessions without the need for costly authentication/authorisation while preserving system integrity. Reputation, viewed through the performance lens, is a metric to gauge a node’s trustworthiness, considering its past behaviour and interactions. The proposed trust assessment mechanism is evaluated for its feasibility within our conceptualised ZTA for edge computing environments with limited resources, and simulation results demonstrate the practicality of utilising this technique in zero trust environments.

The concept of smart contracts (SCs) is becoming more prevalent, and their application is gaining traction across many diverse scenarios. However, producing poorly constructed contracts carries significant risks, including the potential for substantial financial loss, a lack of trust in the technology, and the risk of exposure to cyber-attacks. Several tools exist to assist in developing SCs, but their limited functionality increases development complexity. Expert knowledge is required to ensure contract reliability, resilience, and scalability. To overcome these risks and challenges, tools and services based on modeling and formal techniques are required that offer a robust methodology for SC verification and life-cycle management. This study proposes an engineering framework for the generation of a robust and verifiable smart contract (GRV-SC) framework that covers the entire SC life-cycle from design to deployment stages. It adopts SC modeling and automated formal verification methodologies to detect security vulnerabilities and improve resilience, extensibility, and code optimization to mitigate risks associated with SC development. Initially, the framework includes the implementation of a formal approach, using colored Petri nets (CPNs), to model cross-platform Digital Asset Modeling Language (DAML) SCs. It also incorporates a specialized type safety dynamic verifier, which is designed to detect and address new vulnerabilities that can arise in DAML contracts, such as access control and insecure direct object reference (Idor) vulnerabilities. The proposed GRV-SC framework provides a holistic approach to SC life-cycle management and aims to enhance the security, reliability, and adoption of SCs.

Abstract Digitalisation creates new opportunities for businesses to implement and manage collaborative ecosystems both internally and externally. Digital twin (DT) is a rapidly emerging technology that can be used to facilitate new models of interaction and sharing of information. DT is the digital version of a physical process or asset that can be used to model, manage, and optimise its physical counterpart. Connecting multiple DTs is vital to provide a holistic integration and view across complex ecosystems. To create a DT‐based collaborative ecosystem architecture, the following concerns need to be addressed. Trust is a fundamental requirement because multiple parties will work together as part of a composite DT. Interoperability is essential, as DTs from various domains will be required to interconnect and operate seamlessly. Finally, the governance is challenging as different scenarios require various mechanisms and governance structures. This study presents an architecture to enable multiple DT‐based collaborative ecosystems, and example use case scenarios to demonstrate its applicability in collaborative manufacturing.

Objectives The Intermountain Risk Score (IMRS), composed using published sex-specific weightings of parameters in the complete blood count (CBC) and basic metabolic profile (BMP), is a validated predictor of mortality. We hypothesised that IMRS calculated from prepandemic CBC and BMP predicts COVID-19 outcomes and that IMRS using laboratory results tested at COVID-19 diagnosis is also predictive.Design Prospective observational cohort study.Setting Primary, secondary, urgent and emergent care, and drive-through testing locations across Utah and in sections of adjacent US states. Viral RNA testing for SARS-CoV-2 was conducted from 3 March to 2 November 2020.Participants Patients aged ≥18 years were evaluated if they had CBC and BMP measured in 2019 and tested positive for COVID-19 in 2020.Primary and secondary outcome measures The primary outcome was a composite of hospitalisation or mortality, with secondary outcomes being hospitalisation and mortality separately.Results Among 3883 patients, 8.2% were hospitalised and 1.6% died. Subjects with low, mild, moderate and high-risk IMRS had the composite endpoint in 3.5% (52/1502), 8.6% (108/1256), 15.5% (152/979) and 28.1% (41/146) of patients, respectively. Compared with low-risk, subjects in mild-risk, moderate-risk and high-risk groups had HR=2.33 (95% CI 1.67 to 3.24), HR=4.01 (95% CI 2.93 to 5.50) and HR=8.34 (95% CI 5.54 to 12.57), respectively. Subjects aged

Abstract Background Internal medicine (IM) residency is a notoriously challenging time generally characterized by long work hours and adjustment to new roles and responsibilities. The COVID-19 pandemic has led to multiple emergent adjustments in training schedules to accommodate increasing needs in patient care. The physician training period, in itself, has been consistently shown to be associated with vulnerability with respect to mental well-being. The impact of the COVID-19 pandemic on the experience of IM trainees is not well established. Objective Characterize the impact of the COVID-19 pandemic on trainee clinical education, finances, and well-being. Methods We developed a survey composed of 25 multiple choice questions, 6 of which had an optional short-answer component. The survey was distributed by the American College of Physicians (ACP) to 23,289 IM residents and subspecialty fellows. We received 1,128 complete surveys and an additional 269 partially completed surveys. Results The majority of respondents reported a disruption in their clinical schedule (76%) and a decrease in both didactic conferences (71%) and protected time for education (56%). A majority of respondents (81%) reported an impact on their well-being with an increase in their level of burnout and 41% of respondents reported a decrease in level of direct supervision. Despite these changes, the majority of trainee respondents (78%) felt well prepared for clinical practice after graduation. Conclusions These results outline the vulnerable position of internal medicine physicians in training. Preserving educational experiences, adequate supervision, and humane work hours are essential in protecting trainees from mental illness and burnout during global emergencies.

ABSTRACT This study evaluated the performance of the PyloPlus Urea Breath Test (UBT) System, a Food and Drug Administration (FDA)-approved assay for diagnosis of Helicobacter pylori infection in adult patients, using samples from 111 pediatric patients (3–17 years old). Both qualitative results (100% correlation) and quantitative delta over baseline values (R 2 = 0.9989) from the PyloPlus UBT strongly correlated with the Meridian BreathTek POCone UBT reference method, which is FDA approved for use in pediatric patients (3–17 years old). The PyloPlus UBT performed comparably to the BreathTek UBT without any calculation correction factors for pediatric samples. Consistent with previous studies, male pediatric patients had a significantly higher positivity rate (64%) than female pediatric patients (33%) (P = 0.001). There was no difference in positivity rate between two performing locations. This study shows that the PyloPlus UBT system can be used for testing pediatric patient specimens. IMPORTANCE For the diagnosis and post-treatment monitoring of H. pylori infection, non-invasive testing methodologies improve patient comfort, particularly for children. Previously, only the BreathTek UBT had FDA approval for use in pediatric patients and required an adjustment calculation based on age, height, and weight of the patient. The purpose of this study was to evaluate the performance of the PyloPlus UBT assay in a pediatric population.

BackgroundThere have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress.MethodsWe conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 ("none") to 10 ("worst possible"). Outcomes were measured with short screening scales.ResultsThe response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2-2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 ("distressing"). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care.ConclusionsThe intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.