Selecting Countermeasures for ICT systems Before They are Attacked

A countermeasure is any change to a system to reduce the probability it is successfully attacked. We propose a model based approach that selects countermeasures through multiple simulations of the behaviors of an ICT system and of intelligent attackers that implement sequences of attacks. The simulations return information on the attacker sequences and the goals they reach we use to compute the statistics that drive the selection. Since attackers change their sequences as countermeasures are deployed, we have defined an iterative strategy where each iteration selects some countermeasures, updates the system models and runs the simulations to discover any new attacker sequence. The discovery of new sequences starts a new iteration. The Haruspex suite automates the proposed approach. Some of its tools acquire information on the target system and on the attackers and build the corresponding models. Another tool simulates the attacks through the models of the system and of the attackers. The tool to select countermeasures invokes the other ones to discover how countermeasures influence the attackers. We apply the whole suite to three systems and discuss how the connection topology influences the countermeasures to adop

Twin Based Continuous Patching To Minimize Cyber Risk

AbstractDigital twins are virtual replicas to simulate the behavior of physical devices before they are built and to support their maintenance. We extend this technology to cybersecurity and integrate it with adversary emulation to define a remediation policy that selects and schedules patches for the vulnerabilities of an information and communication infrastructure before threat actors can exploit them. Distinct twins model, respectively, the infrastructure and threat actors. The former twin describes the infrastructure modules, their vulnerabilities, and the elementary attacks actors can implement. The attributes of the twin of a threat actor describe its attack surface, its goals, how it selects attacks, and it handles attack failures. The Haruspex software platform builds the twins of the infrastructure and those of the threat actors, and it automates the emulation of an actor. In this way, it can discover the attack paths the actor implements without disturbing the infrastructure. In each path, the actor composes elementary attacks to reach its goal. Multiple emulations can discover all the paths of an actor by covering stochastic factors such as attack success or failure. The knowledge of these paths enables the remediation policy to minimize the patches to deploy. Since new vulnerabilities continuously become public, new countermeasures are needed. A twin-based approach supports a continuous remediation process to handle changes in the infrastructure, new vulnerabilities, and new threat actors because the platform can update the twins and run adversary emulations. If new attack paths exist, the platform applies the remediation policy. Experimental data confirm the effectiveness of this approach

Janus-faced amiodarone-induced pneumopathy

The authors describe a patient showing bilateral, peripheral, predominantly basal ground-glass and reticular opacities consistent with a non-specific interstitial pneumonia (NSIP) radiological pattern. This was followed by the occurrence of two nodules that progressively decreased in size after oral steroids had been given and therefore they were interpreted as an unusual manifestation of amiodarone-related pulmonary toxicity (APT)

Acute exacerbation of idiopathic pulmonary fibrosis: Lessons learned from acute respiratory distress syndrome?

Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease characterized by progressive loss of lung function and poor prognosis. The so-called acute exacerbation of IPF (AE-IPF) may lead to severe hypoxemia requiring mechanical ventilation in the intensive care unit (ICU). AE-IPF shares several pathophysiological features with acute respiratory distress syndrome (ARDS), a very severe condition commonly treated in this setting. A review of the literature has been conducted to underline similarities and differences in the management of patients with AE-IPF and ARDS. During AE-IPF, diffuse alveolar damage and massive loss of aeration occurs, similar to what is observed in patients with ARDS. Differently from ARDS, no studies have yet concluded on the optimal ventilatory strategy and management in AE-IPF patients admitted to the ICU. Notwithstanding, a protective ventilation strategy with low tidal volume and low driving pressure could be recommended similarly to ARDS. The beneficial effect of high levels of positive end-expiratory pressure and prone positioning has still to be elucidated in AE-IPF patients, as well as the precise role of other types of respiratory assistance (e.g., extracorporeal membrane oxygenation) or innovative therapies (e.g., polymyxin-B direct hemoperfusion). The use of systemic drugs such as steroids or immunosuppressive agents in AE-IPF is controversial and potentially associated with an increased risk of serious adverse reactions. Common pathophysiological abnormalities and similar clinical needs suggest translating to AE-IPF the lessons learned from the management of ARDS patients. Studies focused on specific therapeutic strategies during AE-IPF are warranted

Real-life comparison of Pirfenidone and Nintedanib in patients with Idiopathic Pulmonary Fibrosis: a 24-month assessment.

Background: Real-life data on the use of pirfenidone and nintedanib to treat patients with idiopathic pulmonary fibrosis (IPF) are still scarce. Methods: We compared the efficacy of either pirfenidone (n=78) or nintedanib (n=28) delivered over a 24-month period in patients with IPF, followed at two regional clinic centers in Italy, with a group of patients who refused the treatment (n=36), and who were considered to be controls. All patients completed regular visits at 1- to 3-month intervals, where primary [forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO)] and secondary outcomes (side effects, treatment compliance, and mortality) were recorded. Results: Over time, the decline in FVC and DLCO was significantly higher (p=0.0053 and p=0.037, respectively) in controls when compared with the combined treated group, with no significant difference between the two treated groups. Compared to patients with less advanced disease (GAP (Gender, Age, Physiology) stage I), those in GAP stages II and III showed a significantly higher decline in both FVC and DLCO irrespective of the drug taken. Side effects were similarly reported in patients receiving pirfenidone and nintedanib (5% and 7%, respectively), whereas mortality did not differ among the three groups. Conclusion: This real-life study demonstrated that both pirfenidone and nintedanib were equally effective in reducing the decline of FVC and DLCO versus non-treated patients after 24 months of treatment; however, patients with more advanced disease were likely to show a more rapid decline in respiratory function

Multidisciplinary geological excursion in the open-air laboratory of the Island of Malta. 11-18 November 2010. Field-Trip Guide.

Si tratta della guida all'escursione geologica multidisciplinare tenutasi a Malta dall'11 al 18 novembre 2010, nell'ambito del progetto di internazionalizzazione dell'Università di Modena e Reggio Emilia dal titolo "Multidisciplinary research in the open-air laboratory of the island of Malta: an internazional network for landslide hazard assessment in coastal areas" (2008-2010) finanziato dalla Fondazione Cassa di Risparmio di Modena e Reggio Emilia, per i Corsi di Laurea Triennale in Scienze Geologiche e Magistrale in Scienze e Tecnologie Geologiche

Ventilatory support and mechanical properties of the fibrotic lung acting as a "squishy ball"

Protective ventilation is the cornerstone of treatment of patients with the acute respiratory distress syndrome (ARDS); however, no studies have yet established the best ventilatory strategy to adopt when patients with acute exacerbation of interstitial lung disease (AE-ILD) are admitted to the intensive care unit. Due to the severe impairment of the respiratory mechanics, the fibrotic lung is at high risk of developing ventilator-induced lung injury, regardless of the lung fibrosis etiology. The purpose of this review is to analyze the effects of mechanical ventilation in AE-ILD and to increase the knowledge on the characteristics of fibrotic lung during artificial ventilation, introducing the concept of "squishy ball lung". The role of positive end-expiratory pressure is discussed, proposing a "lung resting strategy" as opposed to the "open lung approach". The review also discusses the practical management of AE-ILD patients discussing illustrative clinical cases

The Italian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Italian language.The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents.The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity).A total of 1296 JIA patients (7.2% systemic, 59.5% oligoarticular, 21.4% RF negative polyarthritis, 11.9% other categories) and 100 healthy children, were enrolled in 18 centres. The JAMAR components discriminated well healthy subjects from JIA patients except for the Health Related Quality of Life (HRQoL) Psychosocial Health (PsH) subscales. All JAMAR components revealed good psychometric performances.In conclusion, the Italian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research

Observation of Exclusive Gamma Gamma Production in p pbar Collisions at sqrt{s}=1.96 TeV

We have observed exclusive \gamma\gamma production in proton-antiproton collisions at \sqrt{s}=1.96 TeV, using data from 1.11 \pm 0.07 fb^{-1} integrated luminosity taken by the Run II Collider Detector at Fermilab. We selected events with two electromagnetic showers, each with transverse energy E_T > 2.5 GeV and pseudorapidity |\eta| < 1.0, with no other particles detected in -7.4 < \eta < +7.4. The two showers have similar E_T and azimuthal angle separation \Delta\phi \sim \pi; 34 events have two charged particle tracks, consistent with the QED process p \bar{p} to p + e^+e^- + \bar{p} by two-photon exchange, while 43 events have no charged tracks. The number of these events that are exclusive \pi^0\pi^0 is consistent with zero and is < 15 at 95% C.L. The cross section for p\bar{p} to p+\gamma\gamma+\bar{p} with |\eta(\gamma)| < 1.0 and E_T(\gamma) > 2.5$ GeV is 2.48^{+0.40}_{-0.35}(stat)^{+0.40}_{-0.51}(syst) pb.Comment: 7 pages, 4 figure