Enabling NATO’s Collective Defense: Critical Infrastructure Security and Resiliency (NATO COE-DAT Handbook 1)

In 2014 NATO’s Center of Excellence-Defence Against Terrorism (COE-DAT) launched the inaugural course on “Critical Infrastructure Protection Against Terrorist Attacks.” As this course garnered increased attendance and interest, the core lecturer team felt the need to update the course in critical infrastructure (CI) taking into account the shift from an emphasis on “protection” of CI assets to “security and resiliency.” What was lacking in the fields of academe, emergency management, and the industry practitioner community was a handbook that leveraged the collective subject matter expertise of the core lecturer team, a handbook that could serve to educate government leaders, state and private-sector owners and operators of critical infrastructure, academicians, and policymakers in NATO and partner countries. Enabling NATO’s Collective Defense: Critical Infrastructure Security and Resiliency is the culmination of such an effort, the first major collaborative research project under a Memorandum of Understanding between the US Army War College Strategic Studies Institute (SSI), and NATO COE-DAT. The research project began in October 2020 with a series of four workshops hosted by SSI. The draft chapters for the book were completed in late January 2022. Little did the research team envision the Russian invasion of Ukraine in February this year. The Russian occupation of the Zaporizhzhya nuclear power plant, successive missile attacks against Ukraine’s electric generation and distribution facilities, rail transport, and cyberattacks against almost every sector of the country’s critical infrastructure have been on world display. Russian use of its gas supplies as a means of economic warfare against Europe—designed to undermine NATO unity and support for Ukraine—is another timely example of why adversaries, nation-states, and terrorists alike target critical infrastructure. Hence, the need for public-private sector partnerships to secure that infrastructure and build the resiliency to sustain it when attacked. Ukraine also highlights the need for NATO allies to understand where vulnerabilities exist in host nation infrastructure that will undermine collective defense and give more urgency to redressing and mitigating those fissures.https://press.armywarcollege.edu/monographs/1951/thumbnail.jp

Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

BACKGROUND: Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an "intrinsic" parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. METHODS: Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling). Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's "K" value. RESULTS: Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. CONCLUSIONS: Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct brushing in the detection of malignant diseases (p < 0.01)

The search for stable prognostic models in multiple imputed data sets

<p>Abstract</p> <p>Background</p> <p>In prognostic studies model instability and missing data can be troubling factors. Proposed methods for handling these situations are bootstrapping (B) and Multiple imputation (MI). The authors examined the influence of these methods on model composition.</p> <p>Methods</p> <p>Models were constructed using a cohort of 587 patients consulting between January 2001 and January 2003 with a shoulder problem in general practice in the Netherlands (the Dutch Shoulder Study). Outcome measures were persistent shoulder disability and persistent shoulder pain. Potential predictors included socio-demographic variables, characteristics of the pain problem, physical activity and psychosocial factors. Model composition and performance (calibration and discrimination) were assessed for models using a complete case analysis, MI, bootstrapping or both MI and bootstrapping.</p> <p>Results</p> <p>Results showed that model composition varied between models as a result of how missing data was handled and that bootstrapping provided additional information on the stability of the selected prognostic model.</p> <p>Conclusion</p> <p>In prognostic modeling missing data needs to be handled by MI and bootstrap model selection is advised in order to provide information on model stability.</p