electronics

Review
Cybersecurity Risk Analysis in the IoT: A Systematic Review
Thanaa Saad AlSalem 1 , Mohammed Amin Almaiah 2,3 and Abdalwali Lutfi 4,5, *

1 Department of Information Systems, King Faisal University, Al-Ahsa 31982, Saudi Arabia
2 Department of Computer Science, Aqaba University of Technology, Aqaba 11947, Jordan;
[email protected]
3 King Abdullah the II IT School, The University of Jordan, Amman 11942, Jordan
4 School of Business, King Faisal University, Al-Ahsa 31982, Saudi Arabia
5 Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
* Correspondence: [email protected]

Abstract: The Internet of Things (IoT) is increasingly becoming a part of our daily lives, raising
significant concerns about future cybersecurity risks and the need for reliable solutions. This study
conducts a comprehensive systematic literature review to examine the various challenges and attacks
threatening IoT cybersecurity, as well as the proposed frameworks and solutions. Furthermore, it
explores emerging trends and identifies existing gaps in this domain. The study’s novelty lies in its
extensive exploration of machine learning techniques for detecting and countering IoT threats. It also
contributes by highlighting research gaps in economic impact assessment and industrial IoT security.
The systematic review analyzes 40 articles, providing valuable insights and guiding future research
directions. Results show that privacy issues and cybercrimes are the primary concerns in IoT security,
and artificial intelligence holds promise for future cybersecurity. However, some attacks remain
inadequately addressed by existing solutions, such as confidentiality, security authentication, and data
server connection attacks, necessitating further research and real-life testing of proposed remedies.

Keywords: Internet of Things (IoT); cybersecurity; cybersecurity frameworks; cybersecurity approaches

1. Introduction
Citation: AlSalem, T.S.; Almaiah,
The Internet of Things (IoT) has permeated numerous sensitive disciplines, including
M.A.; Lutfi, A. Cybersecurity Risk
the health sector and the economic sector. However, the IoT is emerging at home, in large
Analysis in the IoT: A Systematic
cities, and in other, different domains of life, which are not of less importance. In addition,
Review. Electronics 2023, 12, 3958.
https://doi.org/10.3390/
the IoT provides connections to intelligent objects, applications, and cloud computing;
electronics12183958
50 billion IoT devices were connected to the internet in 2020 [1]. This huge source of data,
as well as the future trend of artificial intelligence, which the world has come to rely on,
Academic Editor: Seokjoo Shin has put pressure on vendors and designers of IoT devices to secure this technology in order
Received: 16 July 2023 to enable it to meet upcoming demands. However, trusting a device starts with ensuring
Revised: 8 September 2023 its security, which has become a necessity, especially when these devices are connected
Accepted: 16 September 2023 to the internet, exposing them to many threats and cyberattacks [2]. The security threats
Published: 20 September 2023 include cybercrimes, software piracy, and malware attacks [1], as well as various damaging
attacks. However, this continuous field of improvement cannot adopt existing approaches
to provide security. New risks keep on arising, which requires updates to new frameworks
and solutions in parallel with updating IoT disciplines [3]. Furthermore, an updated review
Copyright: © 2023 by the authors. of the applied techniques and approaches is recommended regularly. For this reason,
Licensee MDPI, Basel, Switzerland. the proposed study reviews recent progress in the literature regarding cybersecurity risk
This article is an open access article analysis for the IoT. It also identifies various cybersecurity frameworks and approaches
distributed under the terms and
proposed for IoT cybersecurity risk analysis by identifying the various types of attacks and
conditions of the Creative Commons
challenges facing IoT devices. In addition, it highlights the most important techniques that
Attribution (CC BY) license (https://
have been used in detecting IoT risks, identifying the new trends in IoT cybersecurity, and
creativecommons.org/licenses/by/
identifying the gap found in the literature to recommend possible solutions.
4.0/).

Electronics 2023, 12, 3958. https://doi.org/10.3390/electronics12183958 https://www.mdpi.com/journal/electronics

Electronics 2023, 12, 3958 2 of 19

The key novelty of this study lies in its focused exploration of machine learning tech-
niques in the context of IoT security. We delve into specific algorithms and methodologies,
shedding light on their practical implementation and efficacy. Additionally, we identify crit-
ical research gaps in the assessment of economic impacts resulting from IoT cybersecurity
incidents, and the need for tailored security solutions in the industrial IoT domain.
A. Motivation
As the world is witnessing a turning point towards a new era of virtual reality, there
will be no limits to the IoT in the future. The IoT is a rapidly growing sector and is
considered a revolution in technology and artificial intelligence, wherein the usage of IoT
devices is increasing exponentially [4]. Concerns about the privacy and cybersecurity
challenges of the IoT are the most prioritized issues for risk management professionals.
The IoT will change the world soon, but security concerns will still be arising. However, if
security issues and challenges, for example, privacy and authentication, in addition to other
challenges like confidentiality, are treated properly, then everything will change with the
IoT [5]. Huge amounts of daily data produced from dealing with the IoT are transmitted
with high susceptibility to risks and threat attacks, which require a profound strategy of
risk management for the IoT with a focus on cybersecurity issues.
The motivation behind this research stems from the urgency of addressing the es-
calating cybersecurity concerns surrounding IoT systems. With cyberattacks becoming
more pervasive and evolving in complexity, it is imperative to thoroughly examine the
various types of threats affecting IoT devices and systems. By delving into the existing
literature and gaining insights from previous studies, we aim to provide a comprehensive
understanding of the landscape of IoT cybersecurity, including the types of attacks and
challenges that have emerged.
This investigation seeks to serve as a reference point for researchers, policymakers,
and industry practitioners in their efforts to bolster IoT security. By analyzing the proposed
frameworks, approaches, and detection techniques put forth in the literature, we aspire to
identify potential avenues for enhancing the protection of IoT ecosystems. Moreover, the
review will shed light on any existing gaps in the research, offering directions for future
investigations and innovations in the field of IoT cybersecurity.
Our primary objective is to consolidate and present a well-structured literature review
that not only highlights the prevalent attacks and challenges but also provides valuable
insights into the proposed solutions and their effectiveness. With a specific focus on
identifying the most vulnerable aspects of IoT security, we aim to offer a comprehensive
analysis that contributes to the growing body of knowledge concerning IoT cybersecurity.
By emphasizing the significance of IoT security and the criticality of mitigating poten-
tial threats, this study endeavors to raise awareness of the importance of robust cybersecu-
rity measures for IoT devices and systems. Ultimately, we aspire to foster a more secure
and resilient IoT environment that can continue to evolve and thrive in the face of emerging
cyber risks.
B. Problem Statement
The IoT is extremely exposed to risks and threats due to its highly connective nature,
the ongoing development in this discipline, and the rising global demand for it in the future.
New risks and vulnerability issues are presented [2], which require updated reviews
of the existing risk assessment and analysis frameworks and approaches. In addition,
the nature of the IoT, such as the way in which it is connected to many systems and
dealing with huge amounts of data, has increased the likelihood of exposure to attackers.
What is more, concerns regarding the cybersecurity of the IoT are not limited to vendors.
However, consumers require trustworthy technology [6]. There is an insistent demand
for the ultimate solutions for securing this growing technology [7]. On the other hand,
the variety of recommended and proposed approaches and solutions offered by the recent
studies regarding the cybersecurity of the IoT has raised the following questions. What are
Electronics 2023, 12, 3958 3 of 19

the most important techniques that have been used in detecting IoT risks? What are the
new trends in IoT cybersecurity? What are the attacks that the IoT is vulnerable to?
C. Scope
The scope of the current study focuses on the frameworks and approaches that have
been proposed recently by professionals and scholars for the risk assessment and analysis
processes for the cybersecurity of the IoT. To collect the data for the literature review, the
study focused on the usage of the following keywords: IoT, cybersecurity, cybersecurity
frameworks, and cybersecurity approaches.
D. Expected Outcomes
Cybersecurity in the IoT has caught the attention of many scholars; numerous articles
have been published, especially in the last five years. Several solutions and frameworks
were proposed by previous studies, tackling the most threatening cyberattacks. In addition,
an updated review of the cybersecurity of the IoT is essential, as this field is rapidly evolving
and spreading. The proposed paper makes a significant contribution to summarizing the
state-of-the-art studies and identifying the progress of research in this field. The aim of this
research is achieved by meeting the following objectives:
• Identify various cybersecurity frameworks and approaches proposed for IoT cyberse-
curity risk analysis.
• Identify the various types of attacks and challenges facing IoT devices.
• Highlight the most important techniques that have been used in IoT risk detection.
• Identify the new trends in IoT cybersecurity.
• Identify the gap found in the literature review and recommend expected solutions.

2. Methodology
This section presents the research methodology that is followed in this study; it
represents a sequence of steps, starting with the eligibility criteria of the research article
selection, and then addressing the information sources, search strategy, and selection
process. Moreover, data analysis and synthesis are discussed in this section.
The review process followed the steps of systematic literature review as outlined
in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
guidelines [8].

2.1. Eligibility Criterion

The current review research selected previous studies according to an eligibility crite-
rion, based on research articles that have discussed the cybersecurity of the IoT, research
that has addressed the challenges facing IoT cybersecurity, and studies that have proposed
frameworks and new approaches in an attempt to resolve cybersecurity issues. Further-
more, previous review papers that have addressed the risk assessment of IoT cybersecurity
were included.

2.2. Information Sources

The author depended on reliable databases, such as Science Direct and IEEE, in
addition to papers and articles that have been published in a high-impact-factor interna-
tional journal.

2.3. Search Strategy and Selection Process

The authors used the following keywords (IoT, cybersecurity, cybersecurity frame-
works, cybersecurity approaches) in trusted research engines (Google Scholar, Academia,
Science Direct, and IEEE). The research articles fitting the inclusion criterion were then
filtered according to the year of publication, which was mainly between 2015 and 2023,
focusing on the studies between 2018 and 2023. Another filtering process was undertaken
according to the area of research, so that research that offered no contribution towards
Electronics 2023, 12, x FOR PEER REVIEW 4 of 20

Electronics 2023, 12, 3958 filtered according to the year of publication, which was mainly between 2015 and 42023, of 19
focusing on the studies between 2018 and 2023. Another filtering process was undertaken
according to the area of research, so that research that offered no contribution towards
tackling the current
tackling the current research
research questions
questionswaswasdiscarded.
discarded.The
Theselected
selectedstudies were
studies alsoalso
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tered according to their discussion and depth of analysis, as well as according
filtered according to their discussion and depth of analysis, as well as according to theirto their
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area.Finally,
Finally,the
the authors
authors chose
chose 4040 articles
articles that
that hadhad a system-
a systematic
atic review process as shown in
review process as shown in Figure 1. Figure 1.

Figure 1.
Figure 1. Search
Search strategy
strategy framework.
framework.

2.4.
2.4. Data
Data Analysis and Synthesis
Each
Each study
studyofofthe
the4040
selected was
selected classified
was according
classified to itstotype:
according empirical
its type: study,study,
empirical prac-
tical study, survey study, review paper, and so on. Moreover, the objectives
practical study, survey study, review paper, and so on. Moreover, the objectives and prob- and problems
discussed were highlighted,
lems discussed and major
were highlighted, resultsresults
and major and recommendations
and recommendations were extracted. Then,
were extracted.
the
Then,author used a used
the author table atotable
represent the threats
to represent the and challenges,
threats the impact
and challenges, the of these of
impact attacks,
these
proposed frameworks and approaches, and the salient detection techniques.
attacks, proposed frameworks and approaches, and the salient detection techniques.
2.5. Findings
2.5. Findings
The findings included a summary of the knowledge gained from all the reviewed
The findings included a summary of the knowledge gained from all the reviewed
studies. Different types of attacks and challenges were also discussed. In addition, the au-
studies. Different types of attacks and challenges were also discussed. In addition, the au-
thors figured out a research gap that had not been included in the previous studies. Finally,
thors figured out a research gap that had not been included in the previous studies. Fi-
the new trends in IoT cybersecurity were extracted from the literature and summarized in
nally, the new trends in IoT cybersecurity were extracted from the literature and summa-
the findings.
rized in the findings.
3. Literature Review
This section presents previous studies that addressed the topic of IoT cybersecurity,
providing a critical analysis of the most noteworthy studies done by scholars and focusing
on those published in the last decade.
Electronics 2023, 12, 3958 5 of 19

3.1. IoT Risk Assessment

Study [1] discussed the importance of giving attention to the two main threats attack-
ing IoT with serious economic damages; these two threats are software piracy and malware
attacks. This study was an empirical one in which the methodology being used was based
on experiments conducted to check the proposed solution. However, the study aimed
to introduce a new solution approach in which pirated software and malware-infected
files across the IoT network were discovered. Moreover, the results of the experimenta-
tion showed that the proposed novel solution approach works better than the previous
approaches regarding the cybersecurity of the IoT.
Study [2] discussed the deeper everyday involvement of the IoT in our daily lives and
how this technology is exposed to numerous risks according to its nature. This empirical
study used the EBIOS methodology in order to conduct a risk analysis process for the
identification of vulnerabilities in IoT architecture. Its main aim was the identification of
the top significant security risk to an IoT application that a developer should take into
consideration, and then work on securing it. Its key results showed that the most vulnerable
parts of the IoT process are sensors, smart switches, and small actuators in specific contexts.
Study [3] discussed IoT risk assessment concepts. The main aim of this paper was to
identify the reason behind the inadequacy of current risk assessment approaches for the
IoT. Its results showed that the main reasons for the inadequacy of current risk assessment
approaches for the IoT are as follows:
• Shortcomings in periodic assessment.
• Changing system boundaries, yet limited systems knowledge.
• The challenge of understanding the glue.
• Failure to consider assets as an attack platform.
Moreover, automated and constant risk assessment approaches were required, in
addition to developing new backup tools that help simulate and model predictive powers.

3.2. Attacks and Challenges

Study [5] was a survey research paper that discussed the challenges and the ongoing
situation of the IoT. The main goal of the research paper was to offer an introduction to
the security standards and challenging issues, as well as IoT security forthcoming trends.
The authors used a methodology that was mainly based on reviewing the related literature.
Its results showed that recent studies of the IoT addressed authentication access and
control protocols.
Study [9] addressed cybersecurity threats to healthcare services, particularly hospitals
and clinics utilizing IoT technology. It introduced an adaptive cybersecurity framework
designed for dynamic adaptation to cyber threats. The research focused on leading adaptive
security measures that anticipate and respond to adaptive attacks targeting healthcare
services and infrastructures. The results demonstrated that the framework effectively
provided the best possible defense response against dynamic and adaptive attacks.
Study [10] emphasized the significance of cyber risk in IoT systems and sought to
identify risks within the IoT while defining relevant risk assessment techniques. It pre-
sented an analysis of existing cyber risk evaluation approaches through a review of related
literature. As a foundational study in the field, it provided essential definitions in the
context of IoT cybersecurity. The main outcomes included an overview of studies on IoT
cyber risk quantification, and strategies for mitigating and transferring cyber risks.
Study [11] discussed the privacy issues facing the IoT and how computational intelli-
gence (CI) can be part of cybersecurity. The study aimed to explore the relevance of using
CI technologies for solving IoT cybersecurity issues. This survey research paper collected
secondary data from a review of the related literature. The main contribution of this paper
was in highlighting the challenges facing the CI technologies involved in the cybersecurity
of the IoT.
Study [12] addressed the pressing need for novel solutions to combat cybercrimes
impacting IoT systems globally. The authors offered their insights and solutions concerning
Electronics 2023, 12, 3958 6 of 19

cybercrimes. Its primary contribution lay in providing a comprehensive summary of

diverse cybersecurity challenges in IoT, benefiting researchers and professionals interested
in IoT systems. The challenges are categorized based on IoT security features, and the study
proposes blockchain as an ideal solution, offering integrity, authentication, and encryption.
Study [13] discussed the various concerns related to IoT devices, mainly the robbery of
data and data violation forms. This review article aimed to identify IoT security challenges
and requirements as well as various solutions proposed. The main results showed that
the security of the IoT is affected by the cybersecurity solution’s cost, data volume, and
data sensitivity.
Study [14] discussed the IoT’s background and security. The study also discussed
the potential cybersecurity attacks on the IoT and the available solutions. In addition, the
study aimed to introduce a novel solution composed of three layers: lower, IoT; middle,
edge; and top, cloud. The study was empirical and the solution proposed took place as an
assessing process. The main results showed that the introduced solution model can cut out
certain potential vulnerabilities.
Study [15] aimed to provide a taxonomy of the types of threats affecting IoT devices
and systems, and an analysis of attacks and intruders. The results showed that issues like
confidentiality, privacy, and organization trust were of the highest priority regarding IoT
cybersecurity. Furthermore, the paper contributed to opening the way for future research
in digging further into the consequences of the mentioned threats.

3.3. Detection Techniques

Study [16] discussed the issue of stealing the information of users, as IoT technology,
according to the authors, is highly vulnerable to such issues. The purpose of the research
article was to upgrade the advancement of IoT studies by focusing on various types of
IoT security issues, as well as to identify the available solutions. The study discussed the
presence of physical, network, application, Zigbee, and Z-wave attacks. The major results
showed that authentication, secure communication solutions, and application security are
the existing solutions nowadays. However, the authors recommended a digital signature
as the ultimate solution, due to the nature of IoT devices.
Study [17] discussed IoT users’ lack of awareness of its risks, especially regarding
information loss and violation. The article was a review paper, in which authors relied on
previously published studies to extract the needed information. The study was limited to
devices unsupported by their manufacturers. The findings presented 12 different attacks,
including low-grade attacks, average-level attacks, great attacks, and high-intensity attacks.
In addition, it showed that the lack of appropriate security has led to a great concern that
any attacker with good expertise can benefit from the weaknesses in ecosystems.
• CI-enabled cybersecurity architecture.
• CI algorithms and tools.
• CI-enabled data mining in cybersecurity.
• Cognitive security with IoT devices.
• Efficient CI algorithms in cybersecurity.
• CI-enabled malware detection and classification.
• General data protection regulation vs. CI.
At the end of the research, the authors offered new trends in facing these challenges,
that is, using privacy-preserving data techniques and having a 5G IoT environment, in
addition to CI cyber defenses.
Study [18] discussed the importance of the flexibility of the techniques used in the
cybersecurity of the IoT. For this reason, the study aimed to introduce a technique for risk
detection, which combines the fuzzy inference system with the validation of experts, which
allows for the evaluation of security risks of IoT systems. The authors used interviews as
the data collection tool from experts. The research article was empirical and the proposed
techniques were subjected to simulation and evaluation via scenarios. The results showed
that the recommended technique was more accurate than the existing fuzzy techniques.
Electronics 2023, 12, 3958 7 of 19

Study [19] discussed the importance of using machine learning in the process of
securing the IoT. The study’s main aim was to identify the advantages of machine learning
technology in solving cybersecurity issues. The study was a review paper, and the authors’
methodology was to review the related literature in order to fulfill the research objective.
The findings of the research paper showed that Random Forest and K-Nearest Neighbor
(KNN) algorithms provided the most precise attack detection in the proposed solutions.
Moreover, Software Defined Networks (SDN) and the fog layer of networks resulted in
many efficient solutions.

3.4. Proposed Solutions

Study [20] conducted a systematic review to investigate cybersecurity incident re-
sponse in IoT ecosystems within smart city applications. The study aimed to advance
the cybersecurity assessment model for IoT solutions in smart cities. It highlighted the
increasing reliance of smart cities on IoT, raising concerns about their vulnerability to
cyberattacks. The proposed model supports cybersecurity development in smart cities and
suggests the incorporation of additional techniques to enhance its effectiveness.
Study [21] discussed the need for IoT devices to be trusted by consumers, especially
when it comes to cybersecurity issues. The main aim of the paper was to introduce a
cybersecurity solutions assessment approach based on taking advantage of virtual envi-
ronments and agent-based simulation. This research article was a practical one, based
on realistic scenarios. Its results showed that the efficacy of the recommended approach
was manifested by a case study of a smart home model setting that was evaluated by the
‘SmallWorld’ platform.
Study [22] discussed building trusted healthcare services based on IoT, complying
with international regulations. This practical study can be considered a case study whose
methodology was based on developing a case-oriented cybersecurity assessment, ASAC:
Advanced Security Assurance Case. Moreover, the hierarchical cybersecurity model for
healthcare IoT systems was developed. The main goal of this article was to build and
develop an authentic IoT architecture for healthcare systems. The major result was a de-
tailed model showing how each layer is being secured while obtaining verifiable, traceable,
justifiable results for both parties involved.
Study [23] addressed the security concerns attending the integration of industrial
control systems into the IoT domain. The empirical study aimed to introduce a novel model
for authenticating the security of distributed control systems during their initial design
phases. Through experimental scenarios, the model’s effectiveness was demonstrated in
identifying and mitigating potential cyber threats. The study’s main contributions lay in
the mechanization of an alloy analyzer and the development of a large-scale IoT assessment
framework, enhancing the security of distributed control systems at the early stages of
their design.
Study [24] is a review paper. It discussed the mobile computing technique used for
the cybersecurity of the IoT. The main aim of the research paper was to provide a holistic
analysis of major issues with and the complexities of the cybersecurity of IoT devices in
light of mobile computing. The major results of the paper showed the following:
• Devices based on the IoT showed vulnerability related to various attacks.
• A robust security mechanism is recommended to improve cybersecurity for the IoT.
• The suggested mechanism would preferably be based on mobile computing, which
covers the software and hardware security.
• New trends in this discipline indicate the importance of mobile computing in cyberse-
curity, which will be the focus of researchers.
Study [25] discussed the current deficiency of a standardized methodology for aligning
the impact and likelihood of cyberattacks in specific IoT-associated disciplines. The study’s
main aim was to provide improved knowledge of economic impact assessment models for
I4.0 by proposing a novel impact assessment model. The authors used grounded theory
in their methodology. The main results showed the impact of the method of evaluating
Electronics 2023, 12, 3958 8 of 19

the new risk metrics, together with a novel regulatory framework and standardization of
IoT databases.

3.5. Future Trends

Study [4] explored the cybersecurity challenges posed by the IoT and the potential
role of artificial intelligence in addressing these challenges. Through a comprehensive
literature review, it identified the key areas of concern and proposed strategies for enhancing
IoT security using artificial intelligence. The study emphasized the need for continuous
development of AI algorithms and highlighted the criminal motives behind IoT and AI-
related cyberattacks. The research aimed to equip cybersecurity experts with effective
techniques to secure IoT systems and foster a safer IoT environment.
Study [6] discussed the cybersecurity concerns of vendors and consumers in light of
the increasing use of IoT devices in our world. The study was an empirical paper, where
the authors used data from a review of the related literature and tested two scenarios for
different attacks. The main goal of this research was to identify the main IoT applications,
as well as to analyze the issues challenging cybersecurity in the near future. The results of
the paper showed that the tested scenarios revealed a high vulnerability of the IoT systems.
Study [26] addressed security concerns in organizations working with information
systems and extensively utilizing the IoT. It emphasized the importance of effective risk
management due to inevitable risk factors. The study identified the inadequacy of current
risk assessment approaches for information systems and introduced an advanced algorithm,
Improved Cuckoo Search (ICS), for information security risk assessment in a miniature IoT
system. The empirical study used a simulation experiment to demonstrate the success of
the proposed algorithm, although it is limited to one system.
Study [27] discussed privacy violation issues in smart homes that arise from the use of
IoT devices. It proposed an approach to help end-users lacking awareness of IoT risks in
assessing and responding effectively to these risks. The study employed a survey to gather
available risk approaches and implemented its model using a meta-modeling framework
(ADOXX). The main limitation is the focus solely on home devices. The findings provided
knowledge and awareness to end-users, empowering them to make informed decisions
and be conscious of known and expected risks in their smart homes.
Study [28] discussed the H2020 European research project GHOST, Safe-Guarding
Home IoT Environments with Personalized Realtime Risk Control. The main goal of the
research was to introduce the GHOST security framework for smart homes and explore the
main issues with its cybersecurity. This article is considered a practical study, adopting the
methodology of an architecture analysis with real-life trials that show the capabilities of the
framework. The study results showed that real-life trials provide crucial feedback on the
practicality and authentication of the system in reasonable cybersecurity circumstances.
Study [29] discussed a comprehensive exploration of the IoT cyber risk in Industry
4.0. The study type is a case study, however, the methodology being used was a literature
review survey in addition to a case study to extract novel perspectives for the evaluation of
the economic impacts of IoT cyber risks, using the grounded theory approach. The main
goal of the research article was to narrate the qualitative case study results. Key results
showed that, according to the revision undertaken, there was a proportionate deficiency in
planning for disaster recovery.
Study [30] discussed the rapid spread of cyber-physical systems and IoT use, which
have resulted in different security issues. The main aim of this paper was the recognition
of current IoT devices’ security vulnerabilities, as well as promoting the development of
low-cost IoT security methods. The article discussed two case studies, commercial and
industrial IoT devices. Major results showed that both case studies had a high vulnerability
to attacks and threats, and there should be an urgent solution before the wider spread of
IoT devices in the next few years.
Study [31] discussed related cyber risks and the economic impact assessment of the IoT.
The study type is empirical, where the methodology being used was based on calculations
Electronics 2023, 12, 3958 9 of 19

and experiments. Approaches being used were (1) the Cyber Value at Risk (CyVaR) and
(2) the MicroMort (MM). The study’s main aim was to give insights regarding economic
impact evaluation using mathematical calculations. Furthermore, the study’s major results
showed that economic impact can be evaluated by the following:
• Novel risk standards.
• Specific novel assessment method for the novel risk standards.
• Novel regulatory framework and standardization of IoT databases.
• Novel risk vectors as defined in the form of International IoT Asset Classification and
Key IoT Cyber Risk Factors.
Study [32] discussed the integration of sensors and actuators as a form of controlling
cyber-physical systems. The article was a case study, aiming to concentrate on an ontology-
based advancement of IoT cybersecurity and to introduce a framework based on knowledge
reasoning for the cybersecurity of the IoT. The methodology used was the application of the
Model-Driven Service Engineering Architecture. The main contribution of the paper was
the IoTSec ontology, and key results showed that the evaluation revealed great structural
uniformity, in addition to the dynamic order of the classes.
Study [33] discussed the issues related to the security of smart homes based on
IoT devices. The main aim was to discuss the different security issues that affect the
cybersecurity of smart homes, as well as to introduce a solution for these risky potential
attacks. This study is a practical one, in which the authors used the methodology of the
OCTAVE Allegro, which is based on information assets. The study results showed that
there exist 15 different attacks that threaten smart homes and need a solution.
Study [34] discussed the relationships between humans and their devices as necessary
elements of cybersecurity profiles. The main aim of the study was to attain cybersecurity
profiles via human factors. The main results of this practical study were:
• Defining the concept of human factors for cybersecurity;
• Proposing a methodology that can be used for different purposes.
Study [35] focuses on cybersecurity issues in the digital economy and introduces two
frameworks, one updated from existing risk evaluation and one novel. It adopts a practical
approach and employs a theoretical analysis through a literature review. One significant
result is the paper’s contribution to the domain of the ‘digital economy’, which was not
extensively covered in the literature. However, the study’s limitations include its reliance
on previous studies with case studies and specific approaches.
Study [36] addresses awareness regarding IoT device cybersecurity among organiza-
tions and aims to guide them in improving their cybersecurity practices. It is an introductory
study and part of a series of related studies. Notably, the study is accessible to individuals
without IoT expertise, requiring only basic knowledge of privacy and cybersecurity. Major
findings indicate the need for significant transformations in cybersecurity practices within
organizations, emphasizing the importance of risk management for device utilization
purposes, irrespective of device type.
Study [37] discussed the rising importance of cybersecurity among IoT systems man-
ufacturers. The paper aimed to mitigate the risks of cybersecurity among entities and
end-users based on the protection of IoT assets and privacy considerations. This review
paper tried to find a solution for cybersecurity by reviewing the technologies and frame-
works of IoT cybersecurity. Then, the authors proposed a framework based on four layers.
This study covered a gap regarding the risk management of IoT cybersecurity by providing
resource allocation methods to managers.
Study [38] discussed the issue of cybercriminals affecting the IoT infrastructure in ad-
dition to the importance of highlighting this issue internationally. For this reason, the study
aimed to critically analyze the cybersecurity challenges related to IoT infrastructure by review-
ing the related, reliable previous studies. The main contribution of this study was improving
cybersecurity solutions. The key results of the research article showed that cybersecurity is an
essential concern for the evolution of ecosystems and their appropriate operation.
Electronics 2023, 12, 3958 10 of 19

Study [39] discussed the idea of enhancing the security of IoT devices before offering
them for handling and usage, which can limit and mitigate cyberattacks. The study aimed
to propose a model using the technique of hardening processes. It is a practical study
that surfs the literature and then proposes a solution. It followed a qualitative analysis
methodology. The study’s main contribution was filling the gap in studies related to
hardening and security authentication.
Study [40] aimed to identify advancement areas of the IoT and the related threats to
their origin. The paper was a review article, wherein data were collected from the previous
related studies. Its key results are listed as follows:
• Public administration is the top sector attacked.
• The education sector had most data violation.
• The industrial sector is the sector which will mostly develop based on IoT systems.
Study [41] aimed to introduce a novel assessment tool for ther risks of attacking IoT
systems. The article was a comparative empirical study that relied on grounded theory as
the methodology. The framework proposed was drawn from the shortages of the previous
related studies. However, as per the authors, the study contributed to evaluating the
influence of the IoT cyber risk. Its major results showed that the framework provides a
comprehensive advanced knowledge of impact assessment.
Study [42] discussed how the emerging new IoT world is exposing data to violation
and loss of confidentiality. The paper aimed to interpret the challenges of securing IoT
devices and presented a debate about the technologies used for the purpose of IoT cyber-
security. This paper is a review article, in which the authors depended on collecting data
from previous studies. The results of the current article showed that a creditable security
technique is required for the purpose of developing IoT services.

3.6. Physical Layer Security Solutions for IoT Devices

In the context of physical layer security, a study focused on improving secrecy–energy
efficiency in a satellite–terrestrial integrated network by using secrecy-aware hybrid beam-
forming schemes. These schemes involved a multibeam satellite system sharing the mil-
limeter wave spectrum with a cellular system. The goal was to maximize achievable
secrecy–energy efficiency by jointly designing hybrid and digital beamformers at the base
station and satellite, respectively. The researchers used a sequential convex approximation
method to handle multiple ESs and converted the original problem into a linear one with
matrix inequalities and second-order cone constraints. Their proposed robust beamforming
design was shown to be effective and superior through simulations using realistic satellite
and terrestrial downlink channel models [43]. In another study, the researchers focused
on addressing two critical aspects of future satellite communications: security and energy
efficiency. They investigated secure energy efficient beamforming in multibeam satellite
systems, where each satellite user was vulnerable to eavesdroppers attempting to intercept
confidential information. The researchers employed the signal-to-leakage-plus-noise ratio
metric to derive closed-form normalized beamforming weight vectors. Additionally, they
utilized the successive convex approximation method to efficiently solve the power alloca-
tion subproblem. By combining these techniques, they proposed an iterative algorithm to
obtain suboptimal solutions for the design [44].
To meet the increasing demands of Internet-of-Things (IoT) devices, multiple access
techniques have been a focus of research. A study aimed to maximize the overall data
transmission rate in the system while satisfying signal-interference-plus-noise-ratio require-
ments for IoT devices and power constraints for the UAV and satellite. The optimization
problem was initially non-convex, but the researchers used sequential convex approxima-
tion and first-order Taylor expansion to transform it into a solvable one with a rank-one
constraint. They then developed an iterative penalty function-based algorithm to solve
this transformed problem. Simulations were conducted, and the results showed that the
proposed method effectively reduced mutual interference and improved the system’s
overall data transmission rate compared to existing benchmark schemes. In essence, the
Electronics 2023, 12, 3958 11 of 19

study focused on optimizing multiple access techniques for IoT devices in a satellite-UAV
communication system to enhance overall performance and accommodate explosive access
demands [45–51]. Whereas 6G networks offer customized end-to-end network services
and support emerging cloud-edge applications, 5G networks do not. As the resource
allocation problem in 6G is of utmost importance and requires more research attention, a
study introduced an efficient resource allocation algorithm called TailoredSlice-6G. This
algorithm is designed to enable tailored slices in 6G networks. When a slice request is
received, the TailoredSlice-6G algorithm first identifies the slice resource type. Based on
this information, it selects the most suitable sub-algorithm for resource allocation and
slicing deployment. Each type of slice is associated with a specific resource allocation
sub-algorithm incorporated into TailoredSlice-6G. A crucial aspect of the proposed algo-
rithm is that each sub-algorithm is designed to operate within polynomial time, ensuring
efficient and timely resource allocation for different slice types. In summary, the study
focuses on addressing resource allocation challenges in 6G networks by introducing the
TailoredSlice-6G algorithm, which allows for tailored end-to-end network services and
supports diverse cloud-edge applications [52–57].
This literature review section provides a comprehensive summary of the most impor-
tant previous studies related to the cybersecurity of the IoT. This summary encompasses the
study’s aims, identified problems, study types, major results, and limitations. Additionally,
this section thoroughly examines the proposed frameworks and approaches, as well as the
various cyberattacks discussed, which were used to populate the table below.

4. Evaluation and Analysis

Table 1 represents a comprehensive overview of the previous articles. We analyzed the
studies based on two primary dimensions. (1) Identification of the attacks and challenges
outlined in each article, (2) the proposed approach and framework.
The reviewed literature has addressed a wide range of attacks posing threats to the
IoT. The content of the studies varied, with some focusing on specific attacks, while others
addressed broader challenges in IoT cybersecurity. This section presents in-depth findings
and analysis of the different attacks identified in the literature, along with a comprehensive
discussion of the various frameworks and proposed solutions to mitigate these threats.
Starting with smart cities and smart homes, smart cities had concerns regarding
keeping their systems under control. Cybersecurity attacks can threaten the power grid
and water supply, resulting in the collapse of essential daily needs [20]. Staying in the same
domain, smart homes were attacked by privacy violations, which impacted the physical
world as a result [27]. Moreover, [28] mentioned that there are physical, network, and
software attacks that impact the safeguarding of smart homes. In addition, smart homes
had concerns about eavesdropping and impersonation attacks, as well as network routing
and service availability challenges [33]. The proposed solutions for the smart cities and
smart homes were OCTAVE Allegro evaluation methodology and GHOST safeguarding
homes. In addition, a smartphone application was proposed for monitoring the household
devices’ state.
The next discipline is the economic impact of cybersecurity, as cybersecurity attacks
created concerns regarding the impacts and consequences on the economy and industrial
devices. Industrial devices based on the IoT were widely used [25,29,30,35]. Proposed
solutions for this domain included mapping interactions among various factors in the IoT
devices, as well as the IoT MicroMort model for economic impact calculation.
Moreover, the health sector has suffered from cyberattacks, which were addressed by
the previous literature, as cybersecurity attacks threaten healthcare services and include
data loss and physical attacks [9,22]. Proposed solutions included a normative hierarchical
model of international cybersecurity standards. The authors also suggested supporting
dynamic adaptation to cyber threats.
Electronics 2023, 12, 3958 12 of 19

Table 1. The literature review summary table.

References Attacks/Challenges Proposed Framework/Approaches

- Approach to check the existence of pirated software
and malware-infected files in the IoT network.
- The TensorFlow deep neural network to recognize the
Software piracy and malware attacks pirated software.
[1]
Challenges: economic and reputational damages - Tokenization and weighting characteristics to get rid
of the noisy data.
- Deep learning approaches to check the source code
plagiarism.
[2] Confidentiality concerns and data exploitation Risk analysis based on EBIOS methodology.
[3] Organization’s assets attacks A form of runtime, near-real-time risk assessment support.
Controlling traffic light attacks against smart
vehicles Collapsing the power grid Surveillance
cameras
An evaluation model to assess the cybersecurity (level of
[20] Water supply (chemical levels)
maturity) of IoT solutions used in a smart city.
Power outage
Smart cities lose control of their systems as a result
of the attacks
A proposed framework for the security verification of
distributed industrial control systems.
Eavesdropping attack The framework is based on modeling industrial IoT
[23] Identity faking attack infrastructures.
Disclosure of sensitive data Patterns made by the attacks and mitigation techniques to
stop the attacks.
Using an alloy analyzer to prove mitigation techniques.
Healthcare services attacks including physical
[9] The dynamic adaptive cybersecurity framework.
attacks and data loss
Context privacy leakage
The algorithm Improved Cuckoo Search (ICS) for a
Staff lack of operation and abuse of power
[26] back-propagation neural network (BPNN) to enhance the
Lack of user awareness of protection
accuracy and stability.
Privacy cognition
Profiling attacks
A smartphone application that
Privacy violating
allows users to monitor the household devices that use the
[27] Lifecycle transitions
IoT in a quick process, while also checking the state of the
Inventory attack
security of these devices instantly.
It shows the impact on the physical world
IoT systems’ vulnerability
Malware detection Privacy-preserving data techniques and a 5G IoT
[11] Data security concerns environment, in addition to computational intelligence
Personal and public physical cyber defenses.
safety risk issues
Cybercrimes
[12] Blockchain technology.
Impact on the global economy
Normative hierarchical model of the
[22] Healthcare services and cybersecurity challenges
international cybersecurity standards.
Cybersecurity issues in smart homes:
Physical attack
GHOST, Safe-Guarding Home IoT Environments with
[28] Network attack
Personalized Real-Time Risk Control security framework.
Software attack
Impact on safeguarding homes

Furthermore, cybercrimes were a main concern and a significant field of study that
caught the attention of many scholars [3,12,17,34,38,42]. Attacks included impact on the
global economy, organizations’ assets, profiling of human data, and confidential data.
Electronics 2023, 12, 3958 13 of 19

Proposed methods included blockchain technology, runtime near real-time risk assessment
support, and human factor concept method to obtain cybersecurity profiles.
On the other hand, an important issue addressed by previous studies was privacy con-
cerns and attacks [6,11,13,15,16,18,19,21,23,24,26,32,36,37]. The privacy concerns included
eavesdropping, identity faking, exploitation, fabrication, theft, data integrity and falsifica-
tion, and access to sensitive information. Proposed solutions included a mitigation strategy
using an alloy analyzer, Improved Cuckoo Search, exploitation of the virtual environment,
hardware, software solutions, knowledge reasoning for the IoT, software-defined networks,
risk estimation techniques, privacy-preserving data techniques, a 5G IoT environment, and
computational intelligence cyber defenses.

5. Results and Discussion

This section aims to present and discuss the findings from the literature review, the
attacks and challenges, the frameworks and approaches proposed, and the detection
techniques according to each study (Table 1). This section also presents the gap found in
the systematic review and the future trends in IoT cybersecurity.

5.1. Most Frequent Attacks That IoT Is Vulnerable to

Different attacks on and challenges to IoT cybersecurity that were identified by the
previous studies were discussed in Table 1. The table represents the various approaches
and frameworks proposed, in addition to the attacks or vulnerability detection techniques.
Moreover, their percentages are shown in Figure 2. Results showed that the most-tackled
issues and concerns with IoT cybersecurity were the privacy issues [11,15,27,36,37] in
addition to the concerns related to cybercrimes [12,17,38]. Details related to the top two
issues concerning the cybersecurity of IoT are explained in Figure 3. Another notable issue
discussed in the literature was denial-of-access attacks [5,15,21,24,39]. Data exploitation
was also one of the critical challenges detected concerning IoT security [6,11,13,19,26,40],
followed by a Man-in-the-Middle attack as detected by [24].

5.2. Most Important Techniques That Have Been Used in IoT Risk Detection
Regarding detection techniques, the current study summarized a few techniques that
have been found in the literature as shown in Figure 4, such as artificial intelligence [1,4],
cognitive security technique [20], novel meta-heuristic technique [26], cloud computing [24],
and machine learning [19].

5.3. New Trends in IoT Cybersecurity

The literature review revealed several emerging trends and future directions in IoT cy-
bersecurity. While the available literature provided valuable insights, it is important to note
that the number of studies explicitly focusing on specific trends was limited. Nonetheless,
the identified trends are indicative of the potential advancements in securing IoT systems.
We discuss the prominent trends below:
• Integration of artificial intelligence (AI): artificial intelligence has emerged as a promising
technique in addressing the challenges of IoT cybersecurity. Several studies [19,38,40]
highlighted the role of AI, particularly machine learning algorithms, in detecting
and mitigating cybersecurity threats in IoT environments. AI-based solutions offer
the ability to analyze vast amounts of data from IoT devices, identify patterns, and
proactively respond to potential attacks. Future research in this area should focus on
refining AI algorithms, exploring ensemble learning approaches, and implementing
real-time adaptive cybersecurity systems.
• Blockchain technology for enhanced security: blockchain technology has gained
significant attention for its potential to enhance the security and privacy of IoT devices
and data [12]. By providing decentralized and tamper-resistant data storage and
communication, blockchain can reduce the risk of data manipulation and unauthorized
access. Research efforts should concentrate on optimizing blockchain solutions for
Electronics 2023, 12, 3958 14 of 19

Electronics 2023, 12, x FOR PEER REVIEW IoT, addressing scalability issues and ensuring interoperability with existing 14 of
IoT20
architectures.
• Dynamic adaptive cybersecurity frameworks: as the IoT ecosystem evolves, static
cybersecurity
5. Results measures may become inadequate to defend against constantly evolving
and Discussion
threats. Dynamic adaptive cybersecurity frameworks, as proposed by some studies [9],
This section aims to present and discuss the findings from the literature review, the
offer the ability to continuously assess and adjust security measures based on real-time
attacks and challenges, the frameworks and approaches proposed, and the detection tech-
threat intelligence. Future research should focus on developing intelligent and context-
niques according to each study (Table 1). This section also presents the gap found in the
aware cybersecurity frameworks that can adapt to the changing IoT environment
systematic review and the future trends in IoT cybersecurity.
while minimizing the impact on system performance.
• Privacy-preserving techniques: with increasing concerns over data privacy in IoT, sev-
5.1. Most Frequent Attacks That IoT Is Vulnerable to
eral studies [6,11,37] emphasized the need for privacy-preserving techniques. These
Different attacks
techniques aim toon and challenges
protect to IoTdata
sensitive user cybersecurity
while still that were meaningful
enabling identified bydata
the
previous studies
analysis were
for IoT discussed in
applications. Tableresearch
Future 1. The table
should represents the various
explore novel approaches
cryptographic pro-
and frameworks proposed, in addition
tocols, privacy-enhancing to theand
technologies, attacks or vulnerability
privacy-aware data detection techniques.
sharing mechanisms
Moreover, their percentages are shown in Figure
to strike a balance between data privacy and utility. 2. Results showed that the most-tackled
•issues and concerns
Secure firmwarewith IoT cybersecurity
and hardware were
design: the the privacy
security of IoTissues
devices [11,15,27,36,37]
heavily dependsin ad-
on
dition
thetointegrity
the concerns related
of their to cybercrimes
firmware and hardware [12,17,38].
components Details
[39].related
Studiestoemphasized
the top twotheis-
suesimportance
concerning of theimplementing
cybersecuritysecure
of IoTdevelopment
are explainedpractices
in Figure and3. Another
utilizing notable
hardwareissue
se-
discussed
curity in the literature
modules was denial-of-access
to safeguard against physicalattacks
attacks [5,15,21,24,39]. Data exploitation
and firmware tampering. Future
was research
also one should
of the critical
address challenges detected
the challenges concerning
of secure firmwareIoT security
updates,[6,11,13,19,26,40],
hardware-based
followed by a Man-in-the-Middle
attestation, attack as detected by [24].
and supply chain security.

Figure 2.
Figure 2. Percentages
Percentages of
of reviewed
reviewed attacks.
attacks.
Electronics 2023, 12, 3958 15 of 19

Despite the identified trends, it is essential to acknowledge that the field of IoT cyber-
security is continually evolving, and new trends may emerge over time. Additionally, the
limited number of studies addressing specific trends indicates the need for further research
to explore and validate the effectiveness of proposed solutions in real-world IoT scenarios.
Therefore, the identified trends in IoT cybersecurity hold significant potential in
addressing the challenges posed by the expanding IoT landscape. Research efforts should
continue to focus on these trends, exploring innovative approaches, and collaborating
across disciplines to create a robust and resilient IoT security ecosystem.

5.4. Literature Review Gap

The machine learning techniques used in IoT cybersecurity were not tackled deeply
by previous studies. Their role must be better identified and described. Moreover, there are
still some attacks not fully covered by the proposed solutions, for which we recommend
wider research and real-life examples to test the effectiveness of each proposed solution,
Electronics 2023, 12, x FOR PEER REVIEW 15 of in
20
agreement with the perspectives of [12,28]. These attacks include data server connection
attacks [4] in addition to confidentiality and security authentication [39].

Figure 3.
Figure 3. Top
Top two
two cybersecurity
cybersecurity concerns.
concerns.

5.2. Most Important Techniques That Have Been Used in IoT Risk Detection
Regarding detection techniques, the current study summarized a few techniques that
have been found in the literature as shown in Figure 4, such as artificial intelligence [1,4],
cognitive security technique [20], novel meta-heuristic technique [26], cloud computing
[24], and machine learning [19].
Electronics 2023,12,
Electronics 2023, 12,3958
x FOR PEER REVIEW 16 of
16 of 19
20

Figure 4.
Figure 4. Cybersecurity
Cybersecurity detection
detection techniques.
techniques.

6. Conclusions
5.3. New Trends in IoT Cybersecurity
In
Theconclusion, this systematic
literature review review emerging
revealed several has shed light
trendsonandthefuture
diverse and evolving
directions in IoT
landscape of IoT cybersecurity. The analysis of the reviewed literature
cybersecurity. While the available literature provided valuable insights, it is important revealed that
to
IoT devices and systems face a wide range of cyber threats, with
note that the number of studies explicitly focusing on specific trends was limited. None- privacy issues and
cybercrimes standing out
theless, the identified as the
trends are most significant
indicative of theconcerns.
potential While this finding
advancements aligns with
in securing IoT
common knowledge, it underscores
systems. We discuss the prominent trends below: the critical need for continuous efforts in addressing
these challenges.
• Integration of artificial intelligence (AI): artificial intelligence has emerged as a prom-
Furthermore, the literature review highlighted the potential of artificial intelligence
ising technique in addressing the challenges of IoT cybersecurity. Several studies
as a promising technique for enhancing IoT cybersecurity. As the IoT ecosystem grows
[19,38,40] and
in complexity highlighted the role ofsecurity
scale, traditional AI, particularly
measures machine learning
alone may not algorithms, in de-
suffice to protect
tecting and mitigating cybersecurity threats in IoT environments. AI-based
against sophisticated attacks. The integration of artificial intelligence and machine learning solutions
offersoffer the ability
the potential fortomore
analyze vast amounts
adaptive, proactive, ofand
dataeffective
from IoT devices,
security identifytopatterns,
solutions counter
and proactively
evolving threats. respond to potential attacks. Future research in this area should focus
on refining
However, AI algorithms,
while the review exploring ensembleinsights
provided valuable learning approaches,
into the existingand implement-
research, there
ingimportant
are still real-timeareas
adaptivewhere cybersecurity systems.
further exploration is needed. For instance, some attacks and
• Blockchainwere
vulnerabilities technology for enhanced security:
not comprehensively covered blockchain technology
by the proposed has gained
solutions, sig-
indicating
nificant attention for its potential
the need for more tailored and targeted approaches. to enhance the security and privacy of IoT devices
and data [12].
Therefore, futureByresearch
providing shoulddecentralized and tamper-resistant
focus on interdisciplinary data storage
collaborations, and
real-world
communication, blockchain can reduce the risk of data manipulation
validation of proposed solutions, and exploration of emerging technologies beyond artifi- and unauthor-
ized access. Research efforts should concentrate on optimizing blockchain solutions
cial intelligence.
for IoT,
The fieldaddressing scalability is
of IoT cybersecurity issues and ensuring
dynamic and ever interoperability
evolving, requiringwithconstant
existing vig-
IoT
ilancearchitectures.
and innovation to protect against cyber threats effectively. This review provides
Electronics 2023, 12, 3958 17 of 19

a foundation for future researchers to build upon and underscores the importance of
collective efforts to secure the IoT for the benefit of society at large.

Author Contributions: Conceptualization, T.S.A.; methodology, T.S.A., A.L. and M.A.A.; vali-
dation, T.S.A., A.L. and M.A.A.; formal analysis, T.S.A.; investigation, T.S.A.; resources, T.S.A.;
writing—original draft preparation, T.S.A.; writing—review and editing, T.S.A., A.L. and M.A.A.;
visualization, T.S.A.; supervision, M.A.A. and A.L.; project administration, M.A.A. and A.L. All
authors have read and agreed to the published version of the manuscript.
Funding: This work was supported through the Annual Funding track by the Deanship of Scientific
Research, Vice Presidency for Graduate Studies and Scientific Research, King Faisal University, Saudi
Arabia (Project No. Grant No. 4241).
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: This work was supported through the Annual Funding track by the Deanship
of Scientific Research, Vice Presidency for Graduate Studies and Scientific Research, King Faisal
University, Saudi Arabia (Project No. Grant No. 4241).
Conflicts of Interest: The authors declare no conflict of interest.

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