China's Use of Cyber Warfare: Espionage Meets Strategic Deterrence

This article presents three reasons for states to use cyber warfare and shows that cyberspace is—and will continue to be—a decisive element in China's strategy to ascend in the international system. The three reasons are: deterrence through infiltration of critical infrastructure; military technological espionage to gain military knowledge; and industrial espionage to gain economic advantage. China has a greater interest in using cyberspace offensively than other actors, such as the United States, since it has more to gain from spying on and deterring the United States than the other way around. The article also documents China's progress in cyber warfare and shows how it works as an extension of its traditional strategic thinking and the current debate within the country. Several examples of cyber attacks traceable to China are also presented. This includes cyber intrusions on a nuclear arms laboratory, attacks on defense ministries (including the Joint Strike Fighter and an airbase) and the U.S. electric grid, as well as the current Google affair, which has proved to be a small part of a broader attack that also targeted the U.S. Government. There are, however, certain constraints that qualify the image of China as an aggressive actor in cyberspace. Some believe that China itself is the victim of just as many attacks from other states. Furthermore, certain actors in the United States and the West have an interest in overestimating China's capabilities in cyberspace in order to maintain their budgets

Multiprofessional experiences concerning leadership in the trauma team a qualitative study

Background: Trauma is the leading cause of death for young people in Norway. Several of these deaths are preventable if the patient receives the correct initial treatment. The trauma team is responsible for initial treatment of traumatized patients, and better team function could perhaps improve the outcome. The aim of this study was to obtain a deeper understanding of which human factors are important in the trauma team when treating trauma patients. Methods: Twelve semi-structured interviews were conducted at four different hospitals of various sizes and with different trauma load. At each hospital we spoke with a nurse, an anaesthesiologist and a team leader (surgeon). The interviews were transcribed and analyzed using systematic text condensation according to the principals of Giorgi s phenomenological analysis as modified by Malterud. Results: According to our informants, leadership is an essential component in trauma management. The ideal leader should be an experienced surgeon, have extensive knowledge of trauma care, communicate clearly and radiate confidence. Most interviewed team leaders, however, had little experience with trauma. They wanted more guidance and experienced personnel present when receiving trauma patients. A leader can be corrected if done in a considerate and respectful manner. Conclusion: Norwegian trauma team members emphasized leadership as an essential factor for appropriate trauma team function. The leader should be experienced in trauma treatment. Paradoxically they all reported that trauma teams are frequently headed by inexperienced team leaders. Further steps should be taken to determine the reality of the situation

China\u27s Use of Cyber Warfare: Espionage Meets Strategic Deterrence

This article presents three reasons for states to use cyber warfare andshows that cyberspace is—and will continue to be—a decisive element inChina\u27s strategy to ascend in the international system. The three reasonsare: deterrence through infiltration of critical infrastructure; militarytechnologicalespionage to gain military knowledge; and industrial espionageto gain economic advantage. China has a greater interest in usingcyberspace offensively than other actors, such as the United States, sinceit has more to gain from spying on and deterring the United States thanthe other way around. The article also documents China\u27s progress incyber warfare and shows how it works as an extension of its traditionalstrategic thinking and the current debate within the country. Severalexamples of cyber attacks traceable to China are also presented. Thisincludes cyber intrusions on a nuclear arms laboratory, attacks on defenseministries (including the Joint Strike Fighter and an airbase) and the U.S.electric grid, as well as the current Google affair, which has proved to be asmall part of a broader attack that also targeted the U.S. Government.There are, however, certain constraints that qualify the image of China asan aggressive actor in cyberspace. Some believe that China itself is the victimof just as many attacks from other states. Furthermore, certain actorsin the United States and the West have an interest in overestimatingChina\u27s capabilities in cyberspace in order to maintain their budgets

KOLS-pasienter og underernæring : KLoK-oppgave

Bakgrunn: I geriatriundervisningen på 11. semester av medisinstudiet ble vi oppmerksom på den klare sammenhengen mellom underernæring og økt morbiditet og mortalitet. Vi ønsker i denne oppgaven å sette fokus på underernæring hos KOLS-pasienter. Gjennom sommerjobber og annen praksis har vi erfart at KOLS er en sykdom som rammer mange og som krever store ressurser, men at underernæring er et tema det legges liten vekt på. Kunnskapsgrunnlag: Vi utførte et litteratursøk i følgende databaser: PubMed/Medline, Cochrane Library og Tidsskrift for Den norske legeforeningen. KOLS er 5. vanligste dødsårsak på verdensbasis og rundt 20 % av alle innleggelser ved medisinske avdelinger i Norge gjelder disse pasientene (2). Studier viser at det er klar sammenheng mellom lav BMI (<20 kg/m2) og økt morbiditet og mortalitet. KOLS-pasienter med lav BMI har også flere eksaserbasjoner (3-5). Det vist at vektøkning ved hjelp av ernæringstilskudd, alene og i kombinasjon med røykestopp og trening, gir bedret helse (7-9). Begrunnet tiltak og metode: Vi ønsker å innføre systematisk BMI-måling hos alle pasienter innlagt med KOLS ved lungeavdelingen ved Ullevål sykehus. Dette skal skje ved første mulighet etter at pasienten har kommet til avdelingen. Pasienter med BMI under 20 kg/m2 skal henvises til ernæringsfysiolog. Disse tiltakene vil på en billig og enkel måte kunne gi underernærte KOLS-pasienter bedre behandling med tanke på ernæringssituasjonen og forhåpentligvis gi et bedre sykdomsforløp. Organisering: Forbedringsprosjektet vil bli ledet av en kvalitetsgruppe som skal bestå av én representant fra sykepleierne, én fra ernæringsfysiologene og én fra legene. Målt høyde og vekt, samt utregnet BMI føres på et eget blått skjema og legges inn i kurven. Pasientansvarlig lege og sykepleier har ansvar for at pasienter med BMI <20 kg/m2 henvises til ernæringsfysiolog så fort som mulig. Resultater/Vurdering: Mange enkeltstudier underbygger vårt forslag til kvalitetsforbedring. Vi mangler meta-analyser som understøtter prosjektet. Likevel mener vi det er en potensiell gevinst å hente. KOLS-pasientene behøver all den tilrettelegging de kan få. Prosjektet krever lite innkjøp av nytt materiell, relativt lite bruk av faglige ressurser og er først begrenset til en periode på 6 måneder. Kanskje er det aller viktigste med prosjektet, at det blir økt fokus på underernæring generelt

Type A Aortic Dissection Repair in Patients With Prior Cardiac Surgery

Background: Emergency surgery for acute type A aortic dissection in patients with previous cardiac surgery is controversial. This study aimed to evaluate the association between previous cardiac surgery and outcomes after surgery for acute type A aortic dissection, to appreciate whether emergency surgery can be offered with acceptable risks. Methods: All patients operated on for acute type A aortic dissection between 2005 and 2014 from the Nordic Consortium for Acute Type A Aortic Dissection database were eligible. Patients with previous cardiac surgery were compared with patients without previous cardiac surgery. Univariable and multivariable statistical analyses were performed to identify predictors of 30-day mortality and early major adverse events (a secondary composite endpoint comprising 30-day mortality, perioperative stroke, postoperative cardiac arrest, or de novo dialysis). Results: In all, 1159 patients were included, 40 (3.5%) with previous cardiac surgery. Patients with previous cardiac surgery had higher 30-day mortality (30% vs 17.8%, P = .049), worse medium-term survival (51.7% vs 71.2% at 5 years, log rank P = .020), and higher unadjusted prevalence of major adverse events (52.5% vs 35.7%, P = .030). In multivariable analysis, previous cardiac surgery was not associated with 30-day mortality (odds ratio 0.78; 95% CI, 0.30-2.07; P = .624) or major adverse events (odds ratio 1.07; 95% CI, 0.45-2.55, P = .879). Conclusions: Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery