On the Production of Homeland Security Under True Uncertainty

Homeland security against possible terrorist attacks involves making decisions under true uncertainty. Not only are we ignorant of the form, place, and time of potential terrorist attacks, we are also largely ignorant of the likelihood of these attacks. In this paper, we conceptualize homeland security under true uncertainty as society’s immunity to unacceptable losses. We illustrate and analyze the consequences of this notion of security with a simple model of allocating a fixed budget for homeland security to defending the pathways through which a terrorist may launch an attack and to mitigating the damage from an attack that evades this defense. In this problem, immunity is the range of uncertainty about the likelihood of an attack within which the actual expected loss will not exceed some critical value. We analyze the allocation of a fixed homeland security budget to defensive and mitigative efforts to maximize immunity to alternative levels of expected loss. We show that the production of homeland security involves a fundamental trade-off between immunity and acceptable loss; that is, for fixed resources that are optimally allocated to defense and mitigation, increasing immunity requires accepting higher expected losses, and reducing acceptable expected losses requires lower immunity. Greater investments in homeland security allow society to increase its immunity to a particular expected loss, reduce the expected losses to which we are immune while holding the degree of immunity constant, or some combination of increased immunity to a lower critical expected loss.Homeland Security, Terrorism, True Uncertainty

Inspections To Avert Terrorism: Robustness Under Severe Uncertainty

Protecting against terrorist attacks requires making decisions in a world in which attack probabilities are largely unknown. The potential for very large losses encourages a conservative perspective, in particular toward decisions that are robust. But robustness, in the sense of assurance against extreme outcomes, ordinarily is not the only desideratum in uncertain environments. We adopt Yakov Ben-Haim’s (2001b) model of information gap decision making to investigate the problem of inspecting a number of similar targets when one of the targets may be attacked, but with unknown probability. We apply this to a problem of inspecting a sample of incoming shipping containers for a terrorist weapon. While it is always possible to lower the risk of a successful attack by inspecting more vessels, we show that robustness against the failure to guarantee a minimum level of expected utility might not be monotonic. Robustness modeling based on expected utility and incorporating inspection costs yields decision protocols that are a useful alternative to traditional risk analysis.Terrorism, Robustness, Severe Uncertainty, Port Security

The potential for using risk models in future lung cancer screening trials

Computed tomography screening for early diagnosis of lung cancer is one of the more potentially useful strategies, aside from smoking cessation programmes, for reducing mortality and improving the current poor survival from this disease. The long-term success of lung cancer screening will be dependent upon identifying populations at sufficient risk in order to maximise the benefit-to-harm ratio of the intervention. Risk prediction models could potentially play a major role in the selection of high-risk individuals who would benefit most from screening intervention programmes for the early detection of lung cancer. Improvements of developed lung cancer risk prediction models (through incorporation of objective clinical factors and genetic and molecular biomarkers for precise and accurate estimation of risks), demonstration of their clinical usefulness in decision making, and their use in future screening programmes are the focus of current research

Risk assessment in relation to the detection of small pulmonary nodules

The National Lung Cancer Screening trial (NLST) demonstrated that individuals assigned to the LDCT screening arm had a 20% lower mortality than those who were assigned to the conventional chest radiography. The NLST was thoroughly analyzed by the US Preventive Task Force on CT Screening and they recommended that lung cancer screening should be implemented. A number of other countries have also recommended implementation, whilst others are awaiting the outcome of the NELSON Trial. However, recommendations for the management of CT screen detected nodules have only recently had any clarity. The management of CT detected nodules in the NLST was based on the identification and reporting of 4 mm diameter nodules found on the CT screens but there was no NLST radiology protocol in place for the management of nodules. The use of volumetric analysis is not routinely used in the USA and there is still a reliance on utilising the CT nodule diameter as the management parameter. The first pulmonary risk model was developed by the Canadians, utilising data sets from the Pan-Canadian Early detection of Lung cancer (PanCan) and validated in the chemoprevention trial dataset at the British Columbian Agency. This Canadian model, known as the Brock Model, is currently available and has been integrated into the British Thoracic Society guidelines on the management of pulmonary nodules. The American College of Radiology setup a Lung Cancer Screening Committee subgroup on Lung-RADS, to standardize lung cancer screening CT reporting and provide management recommendations. However, it has been recommended that the Lung-RADS system should be revised as the system as it has never been studied in a prospective fashion. The NELSON trial introduced a third screening test, the "indeterminate" screening test result, this was done with the aim to reduce the false-positives CT screening results and also utilized by the UKLS trial successfully. On comparing the radiological CT screen volumetric and diameter based protocols in the NELSON trial, the sensitivity and negative predictive value appeared to be comparable, however a higher specificity and positive predictive value was found for the volume-based protocols, thus confirming the advantage of utilising the volumetric approach over diameter The British Thoracic Society (BTS) has undertaken an in-depth piece of work developing guidelines on the management of pulmonary nodules, utilising the wealth of data published by the NELSON team and support the use of volumetric analysis for the management of pulmonary nodules

Methylation enrichment pyrosequencing: combining the specificity of MSP with validation by pyrosequencing

It has been suggested that detection of aberrant DNA methylation in clinical specimens such as sputum or saliva may be a valuable tumour biomarker. Any clinically applicable detection technique must combine high sensitivity with high specificity. In this study we describe methylation enrichment pyrosequencing (MEP), which benefits from the high sensitivity and specificity of methylation-specific PCR (MSP) but has a second, confirmatory, pyrosequencing step. The pyrosequencing reaction is rapid, relatively inexpensive and offers significant logistical advantages over previously described validation methods. As proof of principle, we illustrate MEP using assays of p16 and cyclin A1 promoters in a methylated DNA dilution matrix and also in a clinical setting using paired saliva and oral tumour specimens. Our results confirm that mis-priming of MSP, with subsequent false positive results, can occur frequently (perhaps 10%) in assays combining high numbers of PCR cycles and low concentrations of starting DNA. In our clinical example, MEP of saliva-derived DNA was more sensitive than standard non-methylation-specific pyrosequencing as illustrated using p16 and cyclin A1 promoter methylation assays