Several interventional therapies are in development to treat functional tricuspid regurgitation. Most have failed to achieve adequate efficacy, as animal models of this lesion are lacking. We developed a new image-guided technique in swine, by tethering the tricuspid valve chordae using echo-guided chordal encircling snares. Five swine underwent baseline echocardiographic assessment of tricuspid valve function, followed by echo-guided placement of snares that encircle the chordae inserting into the anterior and posterior tricuspid valve leaflets. Tethering these snares and stabilizing them on the right ventricle caused the regurgitant fraction to increase from 8.48±5.38% to 48.76±12.5%, and the valve tenting area to increase from 60.26±52.19 to 160.9±86.92 mm2. Image-guided chordal encircling snares could reproducibly induce clinically significant levels of functional tricuspid regurgitation and create a valve geometry like that seen in patients, providing a new animal model for use to study novel interventional devices.

The objective was to compare the failure rate of incision and drainage (I&D) with LOOP technique versus I&D with standard packing technique in adults and children presenting to the emergency department (ED) with subcutaneous abscess. This prospective, randomized controlled trial (NCT03398746) enrolled a convenience sample of patients presenting to two Level 1 trauma centers over 12months with skin abscesses. Of 256 patients screened, 217 patients were enrolled, 109 randomized to I&D with packing (50%) and 108 (50%) to I&D with LOOP. The primary outcome was treatment failure defined by admission, IV antibiotics, or repeat drainage within 10-day follow-up. The secondary outcomes included ease of procedure, ease of care, pain, and satisfaction using a 10-point numeric rating scale. There were no differences in patient characteristics between groups. Follow-up data were available in 196 (90%). Treatment failure occurred in 20% (range= 12%-28%) of packing patients and 13% (range= 6%-20%) of LOOP patients (p=0.25). There were no significant differences in failure rates in adults (p=0.82), but there was a significant difference in children (age ≤ 18 years) at 21% (range = 8%-34%) in the packing group and 0 (0%) in the LOOP group (p=0.002). Operators reported no significant differences in ease of procedure between techniques (p=0.221). There was significantly less pain at follow-up in the LOOP group versus packing (p=0.004). The wound was much easier to care for over the first 36hours in the LOOP group (p=0.002). Patient satisfaction at 10days postprocedure was significantly higher in the LOOP group (p=0.005). The LOOP and packing techniques had similar failure rates for treatment of subcutaneous abscesses in adults, but the LOOP technique had significantly fewer failures in children. Overall, pain and patient satisfaction were significantly better in patients treated using the LOOP technique.

Information security teams deal with a lot of noise. This noise is meant to be both negative and positive in tone. Negative noise can include statements like

Before jumping into specific safeguards of HIPAA and how security operations center (SOC) activities relate, some background may help put things in perspective. The Health Insurance Portability and Accountability Act (HIPAA) was enacted on August 21, 1996. HIPAA focused on health coverage during gaps when workers change jobs to another. The act provided early incentives for entities to adopt digital records. The Security Rule was implemented on April 21, 2005, focusing on electronic Protected Health Information (ePHI) stored digitally. Enforcement of HIPAA was granted to the Department of Health and Human Services (HHS) on March 16, 2006, under the Enforcement Rule. HHS had the authority to investigate complaints and levy fines for privacy violations. The Health Information Technology for Economic and Clinical Act (HITECH) of 2009 incentivized healthcare organizations for adopting digital medical records. These incentives were part of a program termed Meaningful Use. Finally, in 2013 the Final Omnibus Rule went into effect. It was at this point when news of proactive audit programs surfaced, more news about investigations by HHS after breaches and fines became mainstream news.

Security operations is a mindset. Healthcare entities do not necessarily need to have a dedicated security operations center or contract with a managed service provider delivering virtual security operations center (SOC) services. But the mindset needs to be there. Once the overarching cybersecurity program is designed and implemented, the real work on implementing security begins. In the forward to Snort: IDS and IPS Toolkit, Stephen Northcutt talks about the difference between managing security via checklists and policies and understanding how to implement security. This means frameworks like the NIST Cybersecurity Framework (CSF) are great tools to guide entities in implementing security, risk assessment, and management strategies – but more is needed. Entities must perform threat assessments and in-depth analysis of vulnerabilities and attack vectors to implement high-functioning detection capabilities. This comes from knowledge of the network traffic characteristics and how to protect it from malicious use. As the security operations center grows in maturity, higher levels of visibility and understanding create opportunities for granular detection of specific activities in the environment.