Return Instructions Research Articles

Evaluation of self-directed specimen collection for chlamydia and gonorrhea testing among people who use drugs.

Background: People who use drugs (PWUD) often have elevated sexually transmitted infection (STI) risk and unmet healthcare needs. Self-directed STI specimen collection (i.e., individuals collect the specimen and mail to the laboratory) may be valuable in addressing STI testing barriers among PWUD. Methods: Within a cohort study among PWUD in New York City, we conducted a cross-sectional substudy from November 2021-August 2022 assessing sexual health with a one-time online survey (n = 120); participants could opt-in to receive a self-collection kit. Participants who opted-in were mailed a kit containing collection materials (males: urine cup, females: vaginal swab), pre-paid return label, instructions, and educational information. Specimens were sent to the laboratory and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). We measured the number of kits requested, delivered, mailed to the lab, and CT/GC positive; and examined differences in requesting a kit by sociodemographic and behavioral characteristics. Results: Sixty-three total kits were requested by 44 unique participants. Of the 63 requested, 41 were delivered; one kit was undeliverable at the provided address and the rest were not sent due to no address provided or being duplicate requests. Of the 41 kits delivered, three participants returned the kit to the lab; of those, one was positive for CT and GC. The greatest differences in those who did and did not request a kit were observed by age, sexual orientation, past-year sex trade and casual partnerships, and experiences of relationship violence. Conclusions: Self-directed specimen collection may be desirable for PWUD, but research is needed to understand barriers to this testing approach for this population.

Home oxygen therapy from the emergency department for COVID-19 an observational study

Study objectiveDuring the COVID-19 pandemic, prescribing supplemental oxygen was a common reason for hospitalization of patients. We evaluated outcomes of COVID-19 patients discharged from the Emergency Department (ED) with home oxygen as part of a program to decrease hospital admissions. MethodsWe retrospectively observed COVID-19 patients with an ED visit resulting in direct discharge or observation from April 2020 to January 2022 at 14 hospitals in a single healthcare system. The cohort included those discharged with new oxygen supplementation, a pulse oximeter, and return instructions. Our primary outcome was subsequent hospitalization or death outside the hospital within 30 days of ED or observation discharge. ResultsAmong 28,960 patients visiting the ED for COVID-19, providers admitted 11,508 (39.7%) to the hospital, placed 907 (3.1%) in observation status, and discharged 16,545 (57.1%) to home. A total of 614 COVID-19 patients (535 discharge to home and 97 observation unit) went home on new oxygen therapy. We observed the primary outcome in 151 (24.6%, CI 21.3–28.1%) patients. There were 148 (24.1%) patients subsequently hospitalized and 3 (0.5%) patients who died outside the hospital. The subsequent hospitalized mortality rate was 29.7% with 44 of the 148 patients admitted to the hospital dying. Mortality all cause at 30 days in the entire cohort was 7.7%. ConclusionsMost patients discharged to home with new oxygen for COVID-19 safely avoid later hospitalization and few patients die within 30 days. This suggests the feasibility of the approach and offers support for ongoing research and implementation efforts.

Return Instruction Classification in Binary Code Using Machine Learning

Binary code analysis is vital in source code unavailable cases, such as malware analysis and software vulnerability mining. Its first step could be function identification. Most function identification methods are based on function prologs/epilogs. However, functions may not have standard prologs/epilogs. To identify these functions, we need to use other methods. One approach is to identify return instructions first and then identify the start of a function. Currently, the multi-layer perceptron model is exploited to identify and validate a return instruction at a specific location. On this basis, a new approach is proposed to improve accuracy and provide more details. Specifically, a return instruction is classified into three classes: (1) false return instruction, (2) true return instruction inner a function but not the last instruction, and (3) true return instruction at the end of a function. The evaluation is performed on 5782 real-world binaries. Meanwhile, common classifiers including fully connected neural network, Two-layer Bidirectional Recurrent Neural Network (TBRNN), Two-layer Bidirectional Gate Recurrent Unit (TBGRU), Two-layer Bidirectional Long Short-term Memory Network (TBLSTM), Decision Tree, Random Forest, XGBoost, and Support Vector Machine (SVM) are evaluated on the same data set. The result shows that TBLSTM achieves an accuracy of 99.78%, which is higher than that of other classifiers in the evaluation, including the state-of-the-art tool IDA Pro 7.7.

Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach

This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication...

Comprehensive Defense System against Vulnerabilities Based on Return-Oriented Programming

It is difficult or impossible to develop software without included errors. Errors can lead to an abnormal order of machine code execution during data transmission to a program. Program splitting into routines causes possible attacks by using return instructions from these routines. Most of existing security tools need to apply program source codes to protect against such attacks. The proposed defensive method is intended to a comprehensive solution to the problem. Firstly, it makes it difficult for an attacker to gain control over program execution, and secondly, the number of program routines, which can be used during the attack, decreases. Specific security code insertion is used at the beginning and end of the routines to make it complicated to gain control over the program execution. The return address is kept secure during a call of the protected routine, and the protected routine is restored after its execution if it was damaged by the attacker. To reduce the number of suitable routines for attacks, it was suggested to use synonymous substitutions of instructions that contain dangerous values. It should be mentioned that proposed defensive measures do not affect the original application`s algorithm. To confirm the effectiveness of the described defensive method, software implementation and its testing were accomplished. Acknowledging controls were conducted using synthetic tests, performance tests and real programs. Results of testing have demonstrated the reliability of the proposed measures. It ensures the elimination of program routines suitable for attacks and ensures the impossibility of using standard return instructions for conducting attacks. Performance tests have shown a 14 % drop in the operating speed, which approximately matches the level of the nearest analogues. The application of the proposed solution declines the number of possible attack scenarios, and its applicability level is higher in comparison with analogues.

Discharge Education for Mild Traumatic Brain Injury Patients at Emergency Department

This study aims to review the literature on educational interventions for the discharge of mild traumatic brain injury (mTBI) patients in the Emergency Room (IGD). Database searches were performed based on PICO queries and keywords. using ProQuest, ScienceDirect, Scopus, and PubMed for the period 2012-2019. Ten studies were reviewed. The findings revealed the contents of discharge information for mTBI patients including diagnosis, signs and symptoms, treatment and medication, pain management, home care, and ED return instructions. Four methods of discharge intervention are commonly used in the ED; written, spoken, animated and moving videos, and printed instructions measured over two time periods, either pre-discharge in the ED or follow-up 1-2 weeks post-discharge at home. In conclusion, combined teaching was more effective in terms of level of knowledge, understanding, and ED repeat visits.
 
 Keywords: Discharge education, Emergency, Minor Traumatic Brain Injury

A Content Analysis of Emergency Department Discharge Instructions for Acute Pediatric Febrile Illnesses: The Current State and Opportunities for Improvement.

Quality emergency department (ED) discharge communication is critical to understanding of disease progression, home management, and return instructions. Addressing social aspects of disease burden are important to improving satisfaction and healthcare utilization. The objective of this study was to understand the extent to which written ED discharge instructions address multifaceted aspects of disease to meet the comprehensive needs of families with common childhood illnesses. We analyzed a national sample of 28 written discharge instructions from pediatric EDs using thematic and inductive content analysis. Seven themes were identified. Nearly all discharge instructions devoted a majority of content to themes related to disease physiology. Other themes common to instructions were related to parental instructions for caring for the child and when to return for further care. Content on caregiver reassurance, returning to daily activities, improving well-being, and promoting community health were not a focus of discharge instructions. Inclusion of multifaceted discharge materials which address both medical and social aspects of disease may help improve family-centered emergency care and the quality of care transitions for common childhood illnesses.

Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis

We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED) and to assess their effects on comprehension and recall of the 4 domains of discharge instructions: diagnosis, treatment, follow-up, and return instructions. We performed a systematic search in the PubMed, EMBASE, Web of Science Google Scholar, and Cochrane databases for studies published before March 15, 2018. A quality assessment of included articles was performed. Pooled proportions of correct recall by manner of providing discharge instructions were calculated. A total of 1,842 articles were screened, and after selection, 51 articles were included. Of the 51 included studies, 12 used verbal discharge instructions only, 30 used written discharge instructions, and 7 used video. Correct recall of verbal, written, and video discharge instructions ranged from 8% to 94%, 23% to 92%, and 54% to 89%, respectively. Meta-analysis was performed on data of 1,460 patients who received verbal information only, 3,395 patients who received written information, and 459 patients who received video information. Pooled data showed differences in correct recall, with, on average, 47% for patients who received verbal information (95% confidence interval 32.2% to 61.7%), 58% for patients who received written information (95% confidence interval 44.2% to 71.2%), and 67% for patients who received video information (95% confidence interval 57.9% to 75.7%). Communicating discharge instructions verbally to patients in the ED may not be sufficient. Although overall correct recall was not significantly higher, adding video or written information to discharge instructions showed promising results for ED patients.

IRS Releases Draft 2018 Form 990‐T Instructions

Bruce R. Hopkins' Nonprofit CounselVolume 36, Issue 1 p. 2-3 Articles IRS Releases Draft 2018 Form 990-T Instructions First published: 12 December 2018 https://doi.org/10.1002/npc.30549Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract The IRS, on October 23, released its draft of the tax-exempt organizations business income tax return (Form 990-T) instructions for 2018. Needless to say, several paragraphs appear under What's New in the instructions. Citing Literature Volume36, Issue1January 2019Pages 2-3 RelatedInformation

Control Flow Integrity Based on Lightweight Encryption Architecture

Control-flow integrity (CFI) plays a very important role in defending against code reuse attacks by protecting the control flows of programs from being hijacked. However, previous CFI methods suffer from performance overheads, cost, or security issues. In this paper, we propose a new CFI based on a lightweight encryption architecture with advanced encryption standard (LEA-AES) to address the challenges above. The LEA exploits AES to encrypt and decrypt return addresses and instructions at indirect jump destinations, which protects function calls and indirect jumps from being reused by return-oriented programming (ROP) and jump-oriented programming (JOP) attacks. For ROP, the encryption and decryption of return addresses are performed when the call and ret instructions are executing; for JOP, the encryption of instructions are performed when programs are loading into memory and the decryption of instructions are performed right before they are executing. The LEA-AES does not need to revise instruction sets of CPU and its security is also guaranteed by the encryption mechanism in addition to its high performance. Experimental results showed that the run-time and loading time overheads of LEA-AES are both less than 4% and the memory overhead is 0.62%.

Hybrid Obfuscation Using Signals and Encryption

Obfuscation of software and data is one of the subcategories of software security. Hence, the outlines of the obfuscation problem and its various methods have been studied in this article. This paper proposes a hybrid of two signals and encryption obfuscation to hide the behaviour program and prevent reconstruction of the normal code by hackers. The usual signal method is strong enough for obfuscation, but its problem is the high complexity because of a lot of call and return instructions. In this study, a new dispatcher was added to the source code to reconstruct the original control flow graph from the hidden one to solve the problem of the signal method. This dispatcher code is encrypted to preclude access by the hacker. In this paper, the potency that makes the obfuscation strong has been increased and the resilience that makes the obfuscation poor has been decreased. The results of a comparison of the similarity among the ambiguous data with its original code and with available efficient methods present a performance advantage of the proposed hybrid obfuscation algorithm.

Identifying functions in binary code with reverse extended control flow graphs

AbstractIn binary code analysis, current function identification approaches are challenged by functions without explicit call sites and handcrafted assembly without standard prologues/epilogues. We propose a new function representation called a reverse extended control flow graph (RECFG) and a RECFG‐based method for identifying functions in stripped binary code. A function has at least one return instruction (an instruction that makes the control flow leave a function). Therefore, return instructions are more reliable than the function prologues and epilogues used by traditional methods. We first build RECFGs from any values that can be interpreted as return instructions in a code range. Then, for each independent RECFG, the multiple‐decision method chooses a subgraph as the control flow graph of a function. A prototype tool is developed for evaluation on seven open source applications, 138 binaries in MASM32 code examples, and 292 binaries in Windows XP SP3. Experimental results show that the proposed method can identify functions that cannot be identified by current methods with high precision and stable recall. Copyright © 2015 John Wiley & Sons, Ltd.

Hardware Support for Safe Execution of Native Client Applications

Over the past few years, there has been vast growth in the area of the web browser as an applications platform. One example of this trend is Google's Native Client (NaCl) platform, which is a software-fault isolation mechanism that allows the running of native x86 or ARM code on the browser. One of the security mechanisms employed by NaCl is that all branches must jump to the start of a valid instruction. In order to achieve this criteria though, all return instructions are replaced by a specific branch instruction sequence, which we call NaCl returns, that are guaranteed to return to a valid instruction. However, these NaCl returns lose the advantage of the highly accurate return-address stack (RAS) in exchange for the less accurate indirect branch predictor. In this paper, we propose a NaCl-RAS mechanism that can identify and accurately predict 76.9 on average compared to the 39.5 of a traditional BTB predictor.

Register-Based Process Virtual Machine Acceleration Using Hardware Extension with Hybrid Execution

The Process Virtual Machine (VM) is typical software that runs applications inside operating systems. Its purpose is to provide a platform-independent programming environment that abstracts away details of the underlying hardware, operating system and allows bytecodes (portable code) to be executed in the same way on any other platforms. The Process VMs are implemented using an interpreter to interpret bytecode instead of direct execution of host machine codes. Thus, the bytecode execution is slower than those of the compiled programming language execution. Several techniques including our previous paper, the “Fetch/Decode Hardware Extension”, have been proposed to speed up the interpretation of Process VMs. In this paper, we propose an additional methodology, the “Hardware Extension with Hybrid Execution” to further enhance the performance of Process VMs interpretation and focus on Register-based model. This new technique provides an additional decoder which can classify bytecodes into either simple or complex instructions. With “Hybrid Execution”, the simple instruction will be directly executed on hardware of native processor. The complex instruction will be emulated by the “extra optimized bytecode software handler” of native processor. In order to eliminate the overheads of retrieving and storing operand on memory, we utilize the physical registers instead of (low address) virtual registers. Moreover, the combination of 3 techniques: Delay scheduling, Mode predictor HW and Branch/goto controller can eliminate all of the switching mode overheads between native mode and bytecode mode. The experimental results show the improvements of execution speed on the Arithmetic instructions, loop & conditional instructions and method invocation & return instructions can be achieved up to 16.9x, 16.1x and 3.1x respectively. The approximate size of the proposed hardware extension is 0.04mm2 (or equivalent to 14.81k gates) and consumes an additional power of only 0.24mW. The stated results are obtained from logic synthesis using the TSMC 90nm technology @ 200MHz.

Zero-Sum Defender: Fast and Space-Efficient Defense against Return-Oriented Programming Attacks

Recently, return-oriented programming (ROP) attacks have been rapidly increasing. In this letter, we introduce a fast and space-efficient defense technique, called zero-sum defender, that can respond against general ROP attacks. Our technique generates additional codes, at compile time, just before return instructions to check whether the execution has been abused by ROP attacks. We achieve very low runtime overhead with very small increase in file size. In our experimental results, performance overhead is 1.7%, and file size overhead is 4.5%.

Low cost control flow protection using abstract control signatures

The continual trend of shrinking feature sizes and reducing voltage levels makes transistors faster and more efficient. However, it also makes them more susceptible to transient hardware faults. Transient faults due to high energy particle strikes or circuit crosstalk can corrupt the output of a program or cause it to crash. Previous studies have reported that as much as 70% of the transient faults disturb program control flow, making it critical to protect control flow. Traditional approaches employ signatures to check that every control flow transfer in a program is valid. While having high fault coverage, large performance overheads are introduced by such detailed checking. We propose a coarse-grain control flow checking method to detect transient faults in a cost effective way. Our software-only approach is centered on the principle of abstraction: control flow that exhibits simple run-time properties (e.g., proper path length) is almost always completely correct. Our solution targets off-the-shelf commodity embedded systems to provide a low cost protection against transient faults. The proposed technique achieves its efficiency by simplifying signature calculations in each basic block and by performing checking at a coarse-grain level. The coarse-grain signature comparison points are obtained by the use of a region based analysis. In addition, we propose a technique to protect control flow transfers via call and return instructions to ensure all control flow is covered by our technique. Overall, our proposed technique has an average of 11% performance overhead in comparison to 75% performance overhead of previously proposed signature based techniques while maintaining approximately the same degree of fault coverage.

Patient Understanding of Emergency Department Discharge Instructions: Where Are Knowledge Deficits Greatest?

Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post-ED care instructions (including medications, home care, and follow-up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. This was a prospective cohort, phone interview-based study of 159 adult English-speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow-up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis-specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow-up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two-thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow-up (18%), diagnosis (3%), and medications (3%). Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.

Disjoint out-of-order execution processor

High-performance superscalar architectures used to exploit instruction level parallelism in single-thread applications have become too complex and power hungry for the multicore processors era. We propose a new architecture that uses multiple small latency-tolerant out-of-order cores to improve single-thread performance. Improving single-thread performance with multiple small out-of-order cores allows designers to place more of these cores on the same die. Consequently, emerging highly parallel applications can take full advantage of the multicore parallel hardware without sacrificing performance of inherently serial and hard to parallelize applications. Our architecture combines speculative multithreading (SpMT) with checkpoint recovery and continual flow pipeline architectures. It splits single-thread program execution into disjoint control and data threads that execute concurrently on multiple cooperating small and latency-tolerant out-of-order cores. Hence we call this style of execution Disjoint Out-of-Order Execution (DOE). DOE uses latency tolerance to overcome performance issues of SpMT caused by interthread data dependences. To evaluate this architecture, we have developed a microarchitecture performance model of DOE based on PTLSim, a simulation infrastructure of the x86 instruction set architecture. We evaluate the potential performance of DOE processor architecture using a simple heuristic to fork control independent threads in hardware at the target addresses of future procedure return instructions. Using applications from SpecInt 2000, we study DOE under ideal as well as realistic architectural constraints. We discuss the performance impact of key DOE architecture and application variables such as number of cores, interthread data dependences, intercore data communication delay, buffers capacity, and branch mispredictions. Without any DOE specific compiler optimizations, our results show that DOE outperforms conventional SpMT architectures by 15%, on average. We also show that DOE with four small cores can perform on average equally well to a large superscalar core, consuming about the same power. Most importantly, DOE improves throughput performance by a significant amount over a large superscalar core, up to 2.5 times, when running multitasking applications.

Effective Hybrid Test Program Development for Software-Based Self-Testing of Pipeline Processor Cores

This paper presents an effective hybrid test program for the software-based self-testing (SBST) of pipeline processor cores. The test program combines a deterministically developed program which explores different levels of processor core information and a block-based random program which consists of a combination of in-order instructions, random-order instructions, return instructions, as well as instruction sequences used to trigger exception/interrupt requests. Due to the complementary nature of this hybrid test program, it can achieve processor fault coverage that is comparable to the performance of the conventional scan chain method. The test response observation methods and their impacts on fault coverage are also investigated. We present the concept of micro observation versus macro observation and show that the most effective method of using SBST is through a multiple input signature register connected to the processor local bus, while conventional methods that observe only the program results in the memory lead to significantly less processor fault coverage.

Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?

To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension. We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance). Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension. Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.