Cyber Mutually Assured Destruction & Counterproliferation for the 21st Century: “How I stopped worrying and learned to love the software exploit.”

The growth of cyberspace has challenged existing frameworks for strategic competition. As a result, government, private, and academic planners seek to develop a novel framework for integrating cyberspace into diplomatic, military, and intelligence planning. This has been a difficult proposition and continues to be an area of vulnerability for the United States. To date, the United States has threatened nuclear retaliation for large scale cyber-attacks, but a comprehensive strategy has not been made publicly clear. However, this integration challenge has been encountered and solved previously. Nuclear weapons changed warfare in the twentieth century, but the United States used Mutual Assured Destruction (MAD) and Counterproliferation to adapt to the new warfront. This paper seeks to dissect the nuclear strategy, apply the extracted fundamental principles in creating a loose integration framework, and propose policy measures to implement that framework. The advent of nuclear and cyberweapons shares intrinsic similarity, making such a comparison viable. As proposed in this paper, the cyber strategy would treat near-peer actors differently from non-peer and non-state actors. Against near-peers, it would emphasize survivability and deterrence with implanted exploits or survivable data center infrastructure. For non-peers and non-states, it calls for development of military mission areas to prevent cyberweapon proliferation. Such a dualistic approach may provide a reasonable framework for integrating the cyberspace into international competition and allow the United States to adapt in the technology age

3,5,7-Trimeth­oxy-2-(4-methoxy­phen­yl)-4H-1-benzopyran-4-one

In the title compound, C19H18O6, also known as 3,4′,5,7-tetra­methoxy­flavone, the dihedral angle between the benzopyran-4-one group and the attached benzene ring is 11.23 (8)°. An intra­molecular C—H⋯O hydrogen bond generates an S(6) ring motif. In the crystal, mol­ecules are linked into a two-dimensional network parallel to (01) by inter­molecular C—H⋯O hydrogen bonds, which generate R 4 4(20), R 4 4(12) and R 2 2(14) ring motifs. Adjacent networks interact by π–π inter­actions between the pyran ring and its methoxy­phenyl substituent [centroid–centroid distance = 3.5267 (8) Å]

5,7-Dimeth­oxy-2-(4-methoxy­phen­yl)-4H-1-benzopyran-4-one methanol solvate monohydrate

In the title compound (alternatively called 4′,5,7-trimethoxy­flavone methanol solvate hydrate), C18H16O5·CH3OH·H2O, the flavone mol­ecule is almost planar, the inter­planar angle between the planes of the benzopyran-4-one group and the attached benzene ring being 4.69 (9)°. In the crystal, the flavone mol­ecule makes inter­molecular C—H⋯O hydrogen bonds to adjacent inversion-related flavone mol­ecules, generating R 2 2(8) and R 2 2(14) rings and an infinite ribbon. The inversion-related ribbons are stabilized through the inter­stitial water and methanol mol­ecules via inter­molecular O—H⋯O hydrogen bonds, generating R 4 2(8) and R 2 1(6) rings and C 2 2(4) chains, and are further sustained by π–π inter­actions with an inter­planar spacing of 3.365 (2)Å

Development of an alcohol intervention model for predicting healthcare costs, life years, quality-adjusted life years and using for economic evaluation

Objectives To develop an alcohol intervention model that predicts life years (LYs), quality adjusted life years (QALYs), and healthcare costs classified by the Alcohol Use Disorder Identification Test (AUDIT) screening tool and other various risk factors related to alcohol consumption. Furthermore, the developed model was transferred to the Thai setting. Methods Eight Scottish Health Surveys from 1995-2012 were linked to Scottish morbidity records and death records for the period 1981 to the end of 2013. Parametric survival analysis was used to estimate the hazard risks of first alcohol-related and non-alcohol related hospitalisations and deaths. For men and women, multivariate data analyses were applied separately for each gender in modelling the utility score, risks of subsequent hospitalisation and annual healthcare costs within the follow-up period. Risk profiles were used for the covariates of the models as follows: age, socio-economic status, health condition, alcohol drinking (i.e. AUDIT and binge drinking), smoking, body mass index, and physical activity. According to the under-reporting bias of alcohol consumption among the survey population, this study adjusted the reported alcohol consumption using alcohol sales data. Multiple imputation approach was applied to deal with missing data. A health-state transition model with annual cycle length was developed to predict LYs, QALYs, lifetime costs, and cost-effectiveness. Probabilistic sensitivity analysis was also performed to deal with parameter uncertainty. Moreover, a methodological transferability protocol of the Thai study was detailed. Results The sample size of the cohort was 46,230. The developed model showed the association between drinking and alcohol-related and non-alcohol related hospitalisations and deaths which were calculated as LYs and QALYs. Other risk factors were also taken into account that would likely affect the outcomes of interest. The modelling showed that an increasing AUDIT score and the number of cigarettes per day were associated with an increased risk of first alcohol-attributable hospitalisation. Predicted outcomes for a male aged 30 year with high-risk drinking levels (AUDIT >7) were worse than males with low risk drinking (AUDIT ≤7), with approximately 5 LY gained and 7 QALY gained. The same results for females were obtained for high-risk drinking (AUDIT >4) compared to low-risk drinking (AUDIT ≤4), with approximately 10 LY gained and 12 QALY gained. Furthermore, an economic evaluation was performed to compare the no-intervention situation with a hypothetical health promotion intervention - which aimed to stop drinking (measured by the AUDIT) and smoking (measured by the number of cigarettes per day) behaviours. To compare the costs and benefits of the hypothetical intervention and no intervention over the lifetime period, a within-trial analysis combined with the developed model was able to capture both short- and longer-term consequences (i.e. LYs, QALYs, and healthcare costs) of the intervention. Finally, the model was able to compare cost-effectiveness ratio between risk behaviours without the new intervention and the modified risk behaviours when the new intervention is implemented. Conclusions The study highlights the potential and importance of developing health economic models utilising data from routine national health surveys linked to national hospitalisation and death records. The developed framework can be used for further economic evaluation of alcohol interventions and other health behaviour change interventions. The framework can further be transferred to other country settings

KOMUNIKASI ANTAR BUDAYA (STUDI KASUS : PERTUKARAN PELAJAR INDONESIA DI MALAYSIA)

Intercultural communication occurs during communication between individual or groups of different races, ethnicities, or socio-economic level. The differences between two or more cultures that meet each other can of course give rise to different patterns of intraction and communication, this is a resultof the diverse experiences, values and perspectives of each culture. This research was conducted to understand intercultural communication that course among Indonesian studens and how they overcome these communications barriers , as well as their efforts to interact with each other. This research uses qualitative methods. Data was collected using interview techniques with three Indonesian students studying at the state University of Malang. To achive this aim, five research questions were asked. The results of this research show that Indonesian intercultural communication is quite good, although initially there were many obstacles in the communication process, such as problems with diffrences in terms in the language used, habits, and the way of conveying information (both directly and via social media) which caused misunderstandings. However, this is not an obstacle for them to continue interacting and communicating with each other. To overcome this problem, they must learn more about Malaysian culture and respect each other’s cultural differences

การเปรียบเทียบ 5 วิธีในการวัดค่าอรรถประโยชน์ของคุณภาพชีวิตด้านสุขภาพ ของนักศึกษาปริญญาตรี A Comparison of Five Approaches for Measuring Utility Values of Health-related Quality of Life among Undergraduate Students

บทคัดย่อ   วัตถุประสงค์: เพื่อทดสอบคุณสมบัติและความสอดคล้องกันของคะแนนอรรถประโยชน์จาก 5 วิธี คือ EQ-5D-3L, EQ-5D-5L (cTTO model), EQ-5D-5L (DCE model), EQ-5D-5L (Hybrid model) และ VAS ของนักศึกษาระดับปริญญาตรี วิธีการศึกษา: การศึกษาเชิงสำรวจแบบภาพตัดขวางเก็บข้อมูลระหว่างมีนาคมถึงเมษายน 2565 กับกลุ่มตัวอย่าง 393 คน ใช้สถิติสัมประสิทธิ์สหสัมพันธ์ภายในชั้น (Intraclass Correlation Coefficient; ICC) เพื่อทดสอบความสอดคล้องของค่าอรรถประโยชน์ 5 วิธี การวิเคราะห์การถดถอยเชิงเส้นพหุคูณเพื่อเปรียบเทียบค่าอรรถประโยชน์ตามกลุ่มย่อยตามลักษณะทางประชากร ได้แก่ เพศ อายุ โรคประจำตัว ประวัติการสูบบุหรี่ และประวัติการดื่มเหล้าหรือเครื่องดื่มผสมแอลกอฮอล์ ผลการศึกษา: ค่าอรรถประโยชน์เฉลี่ย (SD) จากน้อยไปหามาก คือ 0.79 ± 0.13 (VAS), 0.84 ± 0.18 (EQ-5D-3L), 0.92 ± 0.11 (Hybrid model)  0.93 ± 0.12 (cTTO model) และ 0.94 ± 0.10 (DCE model) ค่า ICC แสดงคู่วิธีที่สอดคล้องกันในระดับยอดเยี่ยม ได้แก่ cTTO model-Hybrid model, cTTO model-DCE model, DCE model-Hybrid model แต่พบว่า VAS และ EQ-5D-3L และ EQ-5D-5L มีความสอดคล้องระดับแย่ พบว่าเพศหญิงและผู้สูบบุหรี่มีค่าอรรถประโยชน์ EQ-5D-3L, cTTO model, DCE model และ Hybrid model ต่ำกว่าเพศชายและผู้ที่ไม่สูบบุหรี่ (P-value < 0.05) สรุป: EQ-5D-5L (DCE model) เป็นวิธีที่ดีที่สุดในการหาประเมินอรรถประโยชน์สำหรับนักศึกษาปริญญาตรีเพราะสามารถจำแนกค่าอรรถประโยชน์ได้ระหว่างกลุ่มย่อย คำสำคัญ: คุณภาพชีวิตทางด้านสุขภาพ, ค่าอรรถประโยชน์, แบบสอบถามอีคิวไฟว์ดีทรีแอล, แบบสอบถามอีคิวไฟว์ดีไฟว์แอล, ความสอดคล้องกัน    Abstract Objective: To investigate the performance and agreement of utility scores elicited from various elicitation methods of EQ-5D-3L, the three value sets of the EQ-5D-5L (cTTO model, DCE model, and Hybrid model), and VAS among undergraduate students. Methods: A cross-sectional survey study was conducted with 393 undergraduate students between March and April 2022. Intraclass correlation (ICC) was used to determine the agreement of utility values derived from five approaches. Multiple regression was used to compare the utility values with differences in gender, age, smoking status, alcohol consumption and medical conditions. Results: The mean (SD) utility values derived from five approaches were as follows: 0.79 ± 0.13 (VAS), 0.84 ± 0.18 (EQ-5D-3L), 0.92 ± 0.11 (Hybrid model)  0.93 ± 0.12 (cTTO model), and 0.94 ± 0.10 (DCE model). The ICC showed excellent agreement among these following pairs: cTTO model-Hybrid model, cTTO model-DCE model, DCE model-Hybrid model. However, the agreement of utility values from VAS and EQ-5D-3L and EQ-5D-5L was poor. Females and smokers reported lower the utility values from EQ-5D-3L, cTTO model, DCE model, and the Hybrid model than their counterparts (P-value < 0.05).  Conclusion: The EQ-5D-5L (DCE model) is the best elicitation method among undergraduate students because it can discriminate utility scores between predefined subgroups. Keywords: Health-related quality of life, Utility scores, EQ-5D-3L, EQ-5D-5L, agreemen