Underground web: the cybercrime challenge

The two papers in this Special Report examine the central role that cybercrime plays in modern society and how technological developments create new opportunities for criminals to exploit. Overview Calum Jeffray’s paper, Caught in the net: the law enforcement response to international cybercrime, surveys the strategic cybercrime landscape and illustrates that, despite calls for law enforcement to ‘do more’ to prevent and investigate cybercrime, the agencies involved are often hampered in acting due to jurisdictional issues or the complexity of the investigations. Tobias Feakin’s paper, Cryptomarkets—illicit goods in the darknet, examines the emergence of the ‘darknet’, where trading in illicit goods and services in online black markets has become increasingly commonplace and exacerbates the problems that law enforcement already faces—tracing and prosecuting illegal activities online. This Special Report includes a foreword by Australian Federal Police Commissioner Andrew Colvin

The Case for an Army Stability Professional

The US Army is unprepared to occupy and stabilize territory because it does not adequately educate active-duty officers to do so. One way to professionalize the Army’s ability to carry out military government and stability operations is to develop active-duty functional area officers who can advise commanders and integrate staff planning for these operations. This article analyzes case studies, doctrine, and commentary to envision specialized staff officers with foreign language proficiency, cultural skills, advanced academic abilities, and a strong professional ethic. These officers would enhance the Army’s competence in stabilizing territory to achieve American policy objectives

The synthesis and spectroscopic studies of titanium-amido complexes as potential catalysts for small molecule activation and polymerization reactions

The last decade has seen what some have termed a \u27renaissance\u27 in amido--transition metal chemistry. In part, this has been due to a better appreciation of the amido moiety (R₂N) as a ligand. Moreover, it has been due to the dramatic reactivity that amido complexes have been shown to display, especially when the complex is low coordinate and high valent. This dissertation describes the utilization of dihydrodibenzoazepinyl and carbazolyl ligands to effectively stabilize titanium complexes. These two ligand sets vary in their electron contribution to the metal center due to reduced [pi]-donation from the carbazolyl ligand, this in turn effects the structural properties of the system. These novel titanium--amido systems are potential catalysts for small molecule activation and polymerization reactions. Their synthesis and extensive characterization through X-ray and NMR spectroscopy techniques is described herein. The synthesis of chelating amine ligands for the stabilization of metal centers can afford fascinating molecules. These compounds are fundamentally interesting due to the orientation of the four nitrogen lone pairs that are within close proximity to one another. The synthesis, reactivity and analysis of 1,2,3,4,5,6,7,8--octahydro-2a,4a,6a,8a-tetraazacyclopenta[f,g]acenaphthylene is reported

FLIGHT INFORMATION PRIORITY BY PHASE

Includes Supplementary MaterialMilitary helicopter pilots must receive, analyze, communicate, and react to large amounts of information during a flight. Pilots continuously filter through information to identify what is relevant at the current point in their mission based on the operational and flight-specific situation. While fusing information, pilots may experience cognitive overload that results in degraded performance and contributes to catastrophic events. This report investigates whether pilots require different information during different phases of flight, what specific information pilots need during these phases, and how pilots want to receive different types of information. A survey was sent to 3600 US Army UH-60 pilots (362 completed at least one portion of the survey; response rate of ~10%) asking them to prioritize 31 information items (very important, important, somewhat important) by phase of flight. The survey was followed by UH-60 pilot focus groups conducted at Fort Drum, NY. The research team found that desired information varies by phase, identified the specific information needed in each phase, and determined that pilots prefer most information to be presented visually. The conclusions of this study can inform future cockpit designs that integrate emerging technologies while reducing pilot cognitive load and increasing operational efficiency and safety.Captain, United States ArmyCaptain, United States ArmyCaptain, United States ArmyCaptain, United States ArmyCaptain, United States ArmyCaptain, United States ArmyApproved for public release. Distribution is unlimited

Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145354/1/ajt14885.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145354/2/ajt14885_am.pd

The Value of In Vivo Reflectance Confocal Microscopy as an Assessment Tool in Chemotherapy-Induced Peripheral Neuropathy:A Pilot Study

Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity with significant sequelae. There is a lack of standardized objective and reliable assessment tools in CIPN. In vivo reflectance confocal microscopy (RCM) imaging offers a non-invasive method to identify peripheral neuropathy markers, namely Meissner's corpuscles. This article reports on the feasibility and value of RCM in CIPN.Background There is a lack of standardized objective and reliable assessment tools for chemotherapy-induced peripheral neuropathy (CIPN). In vivo reflectance confocal microscopy (RCM) imaging offers a non-invasive method to identify peripheral neuropathy markers, namely Meissner's corpuscles (MC). This study investigated the feasibility and value of RCM in CIPN. Patients and Methods Reflectance confocal microscopy was performed on the fingertip to evaluate MC density in 45 healthy controls and 9 patients with cancer (prior, during, and post-chemotherapy). Quantification was completed by 2 reviewers (one blinded), with maximum MC count/3 x 3 mm image reported. Quantitative Sensory Testing (QST; thermal and mechanical detection thresholds), Grooved pegboard test, and patient-reported outcomes measures (PROMS) were conducted for comparison. Results In controls (25 females, 20 males; 24-81 years), females exhibited greater mean MC density compared with males (49.9 +/- 7.1 vs 30.9 +/- 4.2 MC/3 x 3 mm; P = .03). Differences existed across age by decade (P < .0001). Meissner's corpuscle density was correlated with mechanical detection (rho = -0.51), warm detection (rho = -0.47), cold pain (rho = 0.49) thresholds (P < .01); and completion time on the Grooved pegboard test in both hands (P <= .02). At baseline, patients had reduced MC density vs age and gender-matched controls (P = .03). Longitudinal assessment of MC density revealed significant relationships with QST and PROMS. Inter-rater reliability of MC count showed an intraclass correlation of 0.96 (P < .0001). Conclusions The findings support the clinical utility of RCM in CIPN as it provides meaningful markers of sensory nerve dysfunction. Novel, prospective assessment demonstrated the ability to detect subclinical deficits in patients at risk of CIPN and potential to monitor neuropathy progression

Too Much Medicine in older people? Deprescribing through Shared Decision Making

Too much medicine is an increasingly recognised problem,1 2 and one manifestation is inappropriate polypharmacy in older people. Polypharmacy is usually defined as taking more than five regular prescribed medicines.3 It can be appropriate (when potential benefits outweigh potential harms)4 but increases the risk of older people experiencing adverse drug reactions, impaired physical and cognitive function, and hospital admission.5 6 7 There is limited evidence to inform polypharmacy in older people, especially those with multimorbidity, cognitive impairment, or frailty.8 Systematic reviews of medication withdrawal trials (deprescribing) show that reducing specific classes of medicines may decrease adverse events and improve quality of life.9 10 11 Two recent reviews of the literature on deprescribing stressed the importance of patient involvement and shared decision making.12 13 Patients and clinicians typically overestimate the benefits of treatments and underestimate their harms.14 When they engage in shared decision making they become better informed about potential outcomes and as a result patients tend to choose more conservative options (eg, fewer medicines), facilitating deprescribing.15 However, shared decision making in this context is not easy, and there is little guidance on how to do it.16 We draw together evidence from the psychology, communication, and decision making literature (see appendix on thebmj.com). For each step of the shared decision making process we describe the unique tasks required for deprescribing decisions; identify challenges for older adults, their companions, and clinicians (figure); give practical advice on how challenges may be overcome; highlight where more work is needed; and identify priorities for future research (table). Key messages Deprescribing is a process of planned and supervised tapering or ceasing of inappropriate medicines Shared decision making should be an integral part of the deprescribing process Many factors affect this process, including trust in clinicians’ advice, contradictory patient attitudes about medication, cognitive biases that lead to a preference for the status quo and positive information, and information processing difficulties There is uncertainty about the effect of risk communication and preference elicitation tools in older people Older people’s preferences for discussing life expectancy and quality of life vary widely, but even those who wish to delegate their decisions still appreciate discussion of optionsJJ is supported by a National Health and Medical Research Council (NHMRC) early career fellowship (1037028) and KM is supported by an NHMRC career development fellowship (1029241