Towards a Qatar Cybersecurity Capability Maturity Model with a Legislative Framework

في هذا العصر، يجب على الدول وضع التشريعات التي تقيس قدرات أمنها السيبراني وتطوير برامجها، بالأخص عندما تُستخدم ثغرات الأمن السيبراني كذريعة لفرض الحصار، كما هو الحال في دولة قطر، وذلك بعد أن تم اختراق وكالة الأنباء القطرية. يقترح هذا البحث نموذجًا لتعزيز قدرات الأمن السيبراني (Q-C2M2) في دولة قطر ضمن إطار تشريعي. ويتناول البحث نموذجًا أصيلًا لتعزيز قدرات الأمن السيبراني مع تسليط الضوء على غرضه وخصائصه واعتماده. كما يعرض البحث نماذجًا لتعزيز قدرات الأمن السيبراني الحالية والمعترف بها عالميًا، ودراسة عن الأمن السيبراني في دولة قطر باستخدام الوثائق المتاحة، وذلك بناء على منهجية التحليل الموضوعي للوثائق. كما يقدم هذا البحث تحليلًا مقارنًا لنماذج تعزيز قدرات الأمن السيبراني في ضوء الأمن السيبراني القطري. وفي هذا الإطار، ساعد التحليل المقارن للوثائق في تحديد الثغرات الموجودة في سياسة تأمين المعلومات الوطنية القطرية بشكل عام، ودليل تأمين المعلومات الوطنية القطرية بشكل خاص. يهدف نموذج  (Q-C2M2) المقترح إلى تعزيز إطار عمل الأمن السيبراني في قطر من خلال توفير نموذج عملي مع عنصر تشريعي يمكن استخدامه لقياس أداء الأمن السيبراني وتطويره. كما يقترح هذا النموذج مجالات للمستخدمين “USERS” التي تتكون من الفهم (Understand)، والأمن(Secure) ، والكشف(Expose) ، والاستعادة(Recover) ، والاستدامة(Sustain) ، حيث يتضمن كل مجال مجالات فرعية، والتي بموجبها يمكن للمؤسسة إنشاء أنشطة للأمن السيبراني عند التقييم الأولي. يستخدم نموذج (Q-C2M2) المستويات الخمسة التالية لقياس تعزيز قدرات الأمن السيبراني للمنظمات: البدء والتطبيق والتطوير والتكيف والمرونة.In an age when cybersecurity vulnerabilities can be used as a pretext for a blockade, as in the case of Qatar prompted by a hack of the Qatar News Agency, it becomes incumbent upon states to consider legislating the capability maturity measurement and the development of their cybersecurity programs across the community. This paper proposes a Qatar Cybersecurity Capability Maturity Model (Q-C2M2) with a legislative framework. The paper discusses the origin, purpose and characteristics of a capability maturity model and its adoption in the cybersecurity domain. Driven by a thematic analysis under the document analysis methodology, the paper examines existing globally recognized cybersecurity capability maturity models and Qatar’s cybersecurity framework using publicly available documents. This paper also conducts a comparative analysis of existing cybersecurity capability maturity models in light of the Qatari cybersecurity framework, including a comparative analysis of cybersecurity capability maturity model literature. The comparative document analysis helped identify gaps in the existing Qatar National Information Assurance Policy and specifically the Qatar National Information Assurance Manual. The proposed Q-C2M2 aims to enhance Qatar’s cybersecurity framework by providing a workable Q-C2M2 with a legislative component that can be used to benchmark, measure and develop Qatar’s cybersecurity framework. The Q-C2M2 proposes the USERS domains consisting of Understand, Secure, Expose, Recover and Sustain. Each domain consists of subdomains, under which an organization can create cybersecurity activities at initial benchmarking. The Q-C2M2 uses the following five levels to measure the cybersecurity capability maturity of an organization: Initiating, Implementing, Developing, Adaptive and Agile

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used