Significant Breaches Research Articles

Covering the Cover

Covering the Cover

Fire deaths – a review and an experimental investigation of post-mortem formation of carboxyhaemoglobin

The forensic investigation of deceased retrieved following a fire includes determining if death occurred before or during the event. A blood carboxyhaemoglobin level above 10% is considered indicative of respiration during a fire, implying that an individual was not deceased before the event. Previous spectroscopic studies have revealed that oxygen can passively diffuse through the skin and re-oxygenate haemoglobin. It was therefore questioned if carbon monoxide could also dermally diffuse and elevate post-mortem blood carboxyhaemoglobin levels, which could falsely insinuate that an individual had been alive and respired during a fire. Exposing both oxygenated and deoxygenated forms of haemoglobin to carbon monoxide converted them to carboxyhaemoglobin. This was measured using an ISP-REF Integrating sphere coupled to a USB spectrometer by fibre optic probe. Stillborn piglets were exposed to carbon monoxide to show that the gas can passively diffuse through the skin, resulting in formation of carboxyhaemoglobin in hypostasis, which was confirmed by observing a shift in the absorption spectrum. Piglets with significant cavity breaches, as could be found in cases with extensive stab/bullet wounds or heat defects, exposed to carbon monoxide demonstrated cavity carboxyhaemoglobin levels above 10% which could falsely suggest respiration of carbon monoxide had occurred.

Privacy and metadata: The hidden threat to whistle-blowers in public health systems

Summary A high quality public health system relies as much on a robust, accountable and transparent governance framework as it does on the integrity, professionalism and skill of its practitioners and administrators. Patients have an expectation, grounded in human rights entrenched in international law, to a reasonable quality of care and to not be exposed to exploitation, abuse or unreasonable risks of harm. A well-functioning public health system will deliver therapeutic outcomes accordingly, but must also provide a front-line defence for the public against communicable diseases or pandemics, and should also strive to facilitate medical research and innovation. The modern age of digitized personal health information, facilitated by rapid advances in telecommunications and computing technologies, presents both opportunities and hazards for public health systems. Digital collection of data assists healthcare providers by facilitating instant access to consolidated health records, and provides an abundance of information for epidemiologists and health economists alike. However, such systems have also exposed individuals to significant breaches of privacy, and threaten the viability of the doctor–patient relationship upon which a public health system depends. In Australia, the medical profession and healthcare consumers have voiced concerns regarding the general collection, use and secure storage of personal information, including data and metadata. Both forms of personal information have been the subject of high profile privacy breaches, raising questions about the legal protection of confidences between healthcare providers and patients, and whether surveillance of a physician's actions burdens their fidelity to patients in their care. For example, a data breach of the Red Cross Blood Service exposed the names, gender, addresses, dates of birth and responses to questions about ‘at-risk sexual behaviour’ of over half a million Australian blood donors. Regarding metadata, the tension between individual privacy and regulatory overreach is illustrated by powers previously granted under the Telecommunications (Interception and Access) Act 1979 (Cth) (commonly referred to as Australia's Metadata Retention Laws ) to the Australian Health Practitioner Regulatory Agency to examine the metadata of health practitioners under investigation, thus encompassing communication with all their patients, not simply those pertaining to a given complaint. This tension is also readily evident in the case study presented in this article of the Australian Federal Police's alleged warrantless access to a doctor's phone metadata to determine the identity of a suspected whistle-blower. In this case, an Australian doctor was being investigated on suspicion of having disclosed details without authorization pertaining to circumstances surrounding the death of an Iranian asylum seeker in August 2014 who was being held in an offshore detention centre on Manus Island. Media reports on evidence presented at the coronial inquest into the man's death in late 2016 allege that there were unreasonable delays in transporting the patient to a healthcare facility in Brisbane where he could have received life-saving treatment. While this example did not result in a prosecution, detention centre staff, including healthcare workers, who disclosed information about operations or matters within detention centres without authorization at that time, were potentially subject to a two-year jail term under the Border Force Act 2015 (Cth). As this case study illustrates, misuse of metadata for investigating and prosecuting doctors who act as whistle-blowers within the public health system is not an isolated concern and merits careful consideration. Doctors have an ethical duty to act as whistle-blowers (i.e., grounded in virtue ethics) in a range of situations, such as to report systemic failures, review clinical outcomes of both departments and individuals, or avoid catastrophic events. Indeed, whistle-blowing serves a crucial function to promote transparency of processes in health governance and thereby improve quality of care and patient safety. As such, doctors present a special case for legal protection when they act as whistle-blowers in good faith. Legal disincentives, such as punitive measures that purport to advance the aims of secrecy in government agencies, should be avoided. A failure to do so risks undermining the very foundations of the doctor–patient relationship, with consequent negative implications for patient safety and quality of care in public health systems.

PROCEEDING OF SOLDIER MILITARY DISCIPLINE OFFENSE

The article, based on the theoretical and practical analysis of military discipline infringement proceedings the military, identified the shortcomings of the legal framework in Latvia, when the rules allows an interested party in the investigation commission and does not exclude a conflict of interest situation that poses a significant soldier breaches disciplinary context. To prevent them, it is necessary to supplement the Military Service Act of 15. the first subparagraph of Article 5 of the Rules of Procedure and the Military Service Regulations, to establish the ban on the soldier from the performance of the activities related to the office of illegally using his official position or conflict of interest, and amendment of the National guard soldiers and military discipline of the Rules of Procedure 83. point and to specify that, if the performer of the investigation is, directly or indirectly, interested in the outcome of the internal investigation, or there are other circumstances which prevent the internal investigation, he is obliged to submit a report to the commander (superior officer).

Repairs to the Llangollen arm of the Shropshire Union Canal

The Llangollen arm navigable feeder to the Shropshire Union Canal between the River Dee at Llantisilio and Trevor Basin at Pontcysyllte Aqueduct has presented a series of major maintenance problems from its construction in 1805 until the present day. As this section of the canal is part of the recently designated Pontcysyllte Aqueduct and Canal World Heritage Site, there is particular interest in its civil engineering history. There have been 20 significant leaks and breaches of the arm since its construction and these are summarised and the more important ones discussed in this paper. There have been some rather innovative attempts at solving problems, notably those involving recurrent water loss. These have included stonewalling, concrete lining, corrugated iron sheets, interlocking steel sheets and asphalt lining with later repairs, as well as the usual clay puddling procedures. Many of the difficulties arose because of the nature of the route taken by the feeder canal on a geotechnically challenging hillside and very close to a rail line, a major road and the River Dee.

DDoS attacks on the rise and being used to mask other, more significant breaches

There has been a sharp rise in the number of Distributed Denial of Service (DDoS) attacks and we're seeing a larger proportion of massive ‘mega-attacks’. And DDoS is increasingly being used not to take down sites, but to mask other forms of hacking.

Effectiveness of the cold chain control procedure in the retail sector in Southern Spain

The official procedure adopted in Andalusia (Southern Spain) for implementing the hazard analysis and critical control points (HACCP) flexibility criteria for the control of the cold chain in the retail self-service sector set out in Regulation (CE) 852/2004 is based on a daily determination of the display temperature of the equipment. The main objective of our study was to test whether this approach was effective for the safety of the storage products, considering the influence of the position occupied by the foodstuffs inside the cooling equipment, and also possible seasonal fluctuations. The study was conducted in all self-service refrigerating equipments from every food retail store (11 supermarkets representing different national chain-store groups) located in various municipalities from Southern Spain. Statistically significant (p ≤ 0.05) breaches in the cold chain were recorded in the case of products located at the top shelf (TST) for all kinds of foodstuffs during the summer period, and also during winter time in the cases of TST of dairy products and refrigerated vegetables. Furthermore, using predictive microbiology as a tool, we calculated the potential reduction caused by those failures on the shelf life recorded in the food labelling of smoked salmon, cooked chicken breast and fresh cheese, which counted up to 40%, 57% and 25%, respectively. These findings show that the official procedure adopted does not ensure compliance with safety specifications of perishable food in the retail self-service sector. A revision of such procedure would be necessary, especially in those regions such as Andalusia where important temperature fluctuations throughout the year are recorded.

Effective Communication in P2P Network by Introducing GOSIP–PHE Algorithms

In more recent years peer-to-peer systems are becoming more popular in the area of research because of possessing a number of challenging issues. The entire P2P research can be divided into four areas: search, storage, security and sharing. In various circumstances, the P2P network makes sense in effective communication. The P2P networking increases the QOS, in terms of communication speed, delay, data success rate and less data loss and so on. Due to its open nature system, it deployed hugely in the area of transferring large files and it easily exposes them to the malicious activities. The election of malicious or compromised peer as a peer head is one of the most significant breaches in peer-to-peer networks. In light of these issues, we focus the improvement of P2P network performance by following the given mechanisms. Mechanism 1: topology construction based on grouping of similar interest peer (GOSIP). Mechanism 2: electing the peer-heads for each GOSIP, based on the trust-threshold value given by each peers about their neighbor peers and considering the MAC address of the top listed peers in each group. In this paper, the P2P functionality is improved in such a way that the number of request is reduced and the neighborhood peers communication is improved by finding optimized neighbor using GOSIP algorithm. We have taken these mechanisms into the test-bed through simulation. The simulations outcomes flashed out clearly that these methods significantly improve 25 % of network Scalability and 50 % of throughputs, in turn improvise the performance of P2P networks efficiently when compared to the existing methodologies.

Incidence of Lumbar Spine Pedicle Breach After Percutaneous Screw Fixation

Prospective clinical study. Although percutaneous pedicle screw fixation continues to be increasingly practiced, there remain few reports specifically addressing the accuracy and clinical safety of this technique. The goal of this study is to evaluate the accuracy of fluoroscopically guided pedicle screw placement in the lumbar spine. Pedicle breach rates vary substantially in the literature. Pedicle breach rates have been reported to be as high as 29% with the traditional, open technique. With the use of computer-assisted 2-dimensional fluoroscopy, breach rates have been reported between 5% and 23%. Furthermore, in a series of 225 pedicles instrumented with 3-dimensional fluoroscopy, the reported breach rate was 1.8%. A total of 151 patients were evaluated after instrumented single-level or 2-level minimally invasive transforaminal lumbar interbody fusion with 601 screws placed for percutaneous fixation. The treated patients had an average age of 56.6 y (20-85 y) and there were 129 cases of single-level and 22 cases of 2-level. The levels of pedicle screw fixation included (level, patient numbers): L1/L2 (1), L2/L3 (2), L3/L4 (33), L4/L5 (101), L5/S1 (46). Radiographic results included postoperative computed tomographic scan. Patients were followed prospectively for potential clinical symptoms. In a total of 601 instrumented pedicles, there were 37 pedicle breaches (6.2%). Of these, 22 (3.7%) were significant breaches (≥3 mm). The level of the breached pedicles were L3 (5/46, 10.2%), L4 (12/201, 7.0%), L5 (15/158, 9.5%), S1 (3/47, 3.4%). The side/location of breach was characterized as follows: medial (22), lateral (12), superior (2), and inferior (1). There were 2 symptomatic breaches, both associated with a medial breach at the L5 pedicle. Symptoms from these events were transient and did not require hardware repositioning. There were no other complications. Percutaneous pedicle screw fixation in the lumbar spine continues to be a technique embraced by modern spinal surgeons. The use of intraoperative fluoroscopic guidance is both a clinically safe and accurate method for instrumentation and is of comparable accuracy to other techniques. Although trajectory errors may occur, they are of rare clinical significance.

Research Note—Influence Techniques in Phishing Attacks: An Examination of Vulnerability and Resistance

Phishing is a major threat to individuals and organizations. Along with billions of dollars lost annually, phishing attacks have led to significant data breaches, loss of corporate secrets, and espionage. Despite the significant threat, potential phishing targets have little theoretical or practical guidance on which phishing tactics are most dangerous and require heightened caution. The current study extends persuasion and motivation theory to postulate why certain influence techniques are especially dangerous when used in phishing attacks. We evaluated our hypotheses using a large field experiment that involved sending phishing messages to more than 2,600 participants. Results indicated a disparity in levels of danger presented by different influence techniques used in phishing attacks. Specifically, participants were less vulnerable to phishing influence techniques that relied on fictitious prior shared experience and were more vulnerable to techniques offering a high level of self-determination. By extending persuasion and motivation theory to explain the relative efficacy of phishers' influence techniques, this work clarifies significant vulnerabilities and lays the foundation for individuals and organizations to combat phishing through awareness and training efforts.

Application of a drainage film reduces fibroblast ingrowth into large‐pored polyurethane foam during negative‐pressure wound therapy in an in vitro model

Negative-pressure wound therapy (NPWT) is an advantageous treatment option in wound management to promote healing and reduce the risk of complications. NPWT is mainly carried out using open-cell polyurethane (PU) foams that stimulate granulation tissue formation. However, growth of wound bed tissue into foam material, leading to disruption of newly formed tissue upon dressing removal, has been observed. Consequently, it would be of clinical interest to preserve the positive effects of open-cell PU foams while avoiding cellular ingrowth. The study presented analyzed effects of NPWT using large-pored PU foam, fine-pored PU foam, and the combination of large-pored foam with drainage film on human dermal fibroblasts grown in a collagen matrix. The results showed no difference between the dressings in stimulating cellular migration during NPWT. However, when NPWT was applied using a large-pored PU foam, the fibroblasts continued to migrate into the dressing. This led to significant breaches in the cell layers upon removal of the samples after vacuum treatment. In contrast, cell migration stopped at the collagen matrix edge when fine-pored PU foam was used, as well as with the combination of PU foam and drainage film. In conclusion, placing a drainage film between collagen matrix and the large-pored PU foam dressing reduced the ingrowth of cells into the foam significantly. Moreover, positive effects on cellular migration were not affected, and the effect of the foam on tissue surface roughness in vitro was also reduced.

GRP-028 Assessment of Compliance and Avoided Costs After Implementation of Guidelines For Candida Infection Treatment and Invasive Fungal Infections in Non-Haematology Patients

BackgroundThe recent marketing of new high-cost antifungal agents (echinocandins and azoles) requires the design of cost-effective treatment protocols.Purpose A new treatment guide for candidaemia and other invasive fungal infections for...

Global Telecommunications Security: Effects of Geomagnetic Disturbances

Global information and communication technologies permeate organizational structures, while questions of security pervade strategic plans of corporations worldwide. From the spectacular to the sublime, the effects of geomagnetic disturbances (i.e., electrical current produced by solar storms) can be as devastating to an organizationâ??s telecommunications systems as a hacker breaching a firewall. Using a dataset spanning 31 years (1978-2009) with 580,000 solar activity records, we investigate the effects and relationships of natural anomalies, specifically solar storms, on the security of corporate telecommunications. The ionosphere is a natural barrier around the earth to protect it from the sun and serve as a shield, but some electrical currents break this barrier causing significant telecommunications outages and security breaches within corporations. In this exploratory empirical study, we present the initial evidence that tracking geomagnetic disturbances can provide vital cautions for business continuity planning. The results of the study should help organizations with strategic planning efforts with respect to their overall security, especially as it relates to telecommunications.

Location-aware, Trust-based Detection and Isolation of Compromised Nodes in Wireless Sensor Networks

The detection and isolation of compromised nodes in wireless sensor networks is a difficult task. However, failure to identify and isolate compromised nodes results in significant security breaches which lowers the integrity of gathered data. Using a reputation-based trust framework for wireless sensor networks we introduce a location-aware, trust-based protocol that detects and isolates compromised nodes. We employ a secure cluster formation algorithm to facilitate the establishment of trusted clusters via pre-distributed keys. Reputation and trust is built over time through the monitoring of neighboring nodes. Our scheme provides a mechanism for developing reputation and trust so that a device can determine whether other devices have been compromised, and take corrective action, through negative information sharing and independent trust-based decision making. We also present a simple location verification algorithm that utilizes the received signal strength information in the process of verifying reported location information. The effectiveness of our approach in the detection and isolation of compromise nodes is validated through simulation. The results indicate that our scheme provides an effective mechanism for detecting and isolating compromised colluding nodes.

The Study of a Contaminated Colonoscope

The Study of a Contaminated Colonoscope

Develando los sentidos de la motrieidad en Colombia

Con la sospecha de que en el área de la educación física existen brechas significativas entre la realidad (educación formal) y los propósitos y misión que tiene la disciplina en el desarrollo humano, un grupo de investigadores en red nacional con intervención internacional, trazó un proyecto de estudio con el objetivo de develar "Los sentidos de la motricidad a partir de la visión de los actores de la Educación Física en Colombia", como punto de partida para invitar a un cambio y ruptura de paradigmas en estecampo. En el estudio, se entiende por "Sentidos" el conjunto de percepciones, discursos, vivencias y prácticas docentes que los maestros de la educación física en Colombia tienen en relación con la Motricidad; dimensión que supera desde su complejidad la comprensión y significados de lo humano, el concepto biofisiológico del cuerpo y dualismo mecánico instrumental que se le asigna al movimiento en el trasegar histórico de la disciplina.

Use of Templates to Identify Source of Norovirus Outbreak

Use of Templates to Identify Source of Norovirus Outbreak

Multistate outbreak of toxic anterior segment syndrome, 2005

To present the findings of an outbreak of toxic anterior segment syndrome (TASS). Six states, 7 ophthalmology surgical centers, United States. Cases were identified through electronic communication networks and via reports to a national TASS referral center. Information on the procedure, details of instrument reprocessing, and products used during cataract surgery were also collected. Medications used during the procedures were tested for endotoxin using a kinetic assay. The search identified 112 case patients (median age 74 years) from 7 centers from July 19, 2005, through November 28, 2005. Common presenting clinical features included blurred vision (60%), anterior segment inflammation (49%), and cell deposition (56%). Of the patients, 100 (89%) had been exposed to a single brand of balanced salt solution manufactured by Cytosol Laboratories and distributed by Advanced Medical Optics as AMO Endosol. Two patients continued to have residual symptoms. There were no reports of significant breaches in sterile technique or instrument reprocessing. Of 14 balanced salt solution lots, 5 (35%) had levels exceeding the endotoxin limit (0.5 EU/mL). Based on these findings, the balanced salt solution product was withdrawn, resulting in a termination of the outbreak. This is the first known report of an outbreak of TASS caused by intrinsic contamination of a product with endotoxin. Ophthalmologists and epidemiologists should be aware of TASS and its common causes. To facilitate investigations of adverse outcomes such as TASS, those performing cataract surgeries should document the type and lot numbers of products used intraoperatively.

Anticipated Detection of Imminent Surgeon–Patient Barrier Breaches. A Prospective Randomized Controlled Trial Using an Indicator Underglove System

The double gloving indicator underglove system (IUS) is based on a colored detection of the outer glove perforation. Our objective was to determine the IUS efficiency to detect outer glove perforations and to reduce the risks of blood and body fluids exposure, warning the surgeon before the breach of the surgeon-patient barrier (SPB). A series of 100 visceral surgical procedures were randomly assigned to either double (IUS) or single gloving. The noticed glove perforations (using the water test method) and the IUS efficiency were analyzed in 99 procedures. In 49 single-gloving procedures, 19 perforations were noticed: one was immediately perceived (perceived accidental exposure, PAE); 3 were discovered as the gloves were being removed, and 15 were undetected before the water test (unperceived prolonged contact, UPC). In 50 double-gloving procedures (IUS), 16 perforations were noticed, all of them involving only the outer glove: the IUS allowed immediate detection of 3 perforations without any blood exposure; 13 other perforations went undetected but without any UPC. In conjunction with the protective quality of double gloving, the IUS allows detection of significant breaches of the outer glove before the breach of the SPB.

Outbreak of Serratia marcescens bloodstream infections in cardiac surgery patients—Kentucky, 2004

BACKGROUND: Outbreaks of bacteremia following cardiac surgery (CS) have been associated with contamination of equipment and medications. Following detection of Serratia marcescens (SM) cases among CS patients, we conducted an investigation to identify potential sources of contamination and to define prevention measures. METHODS: A case was defined as SM bacteremia occurring in a patient who had CS between August 24 and September 30, 2004. Data on CS patients colonized or infected with SM in other sites were also analyzed. To identify risk factors, we conducted a case-control study comparing each case of SM bacteremia to two randomly selected controls who underwent CS during the outbreak period. To determine potential sources of SM in the environment, we performed observations of CS procedures and collected samples (e.g., water, open vials, cleaning products, and surfaces of equipment) from operating rooms. All patient isolates were evaluated by pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility testing. RESULTS: Seven patients with SM bacteremia were identified. Four additional patients had SM identified in pericardium, urine, and sputum cultures. Three patients with SM bacteremia developed signs and symptoms of infection within two hours after CS. All patient isolates, except one sputum isolate, were indistinguishable by PFGE. Patients with SM bacteremia were more likely to have received the proteinase inhibitor, aprotinin, a medication administered during CS from single-use vials (odds ratio [OR] 25.3, p = 0.01) and to have their CS performed in one of two adjacent operating rooms (OR 18.2, p = 0.02). Although no contamination of vials or other environmental sources of infection were detected, our observations of CS procedures revealed suboptimal hand hygiene and equipment cleaning, and retaining of open, single-use vials of medication after each patient. CONCLUSIONS: In our investigation, we observed significant breaches in infection control practices, which may have led to contamination of the operating rooms' environment and single-use medication vials, such as aprotinin. Our findings underscore the importance of careful attention to infection control measures and to proper medication handling.