The Qualified Legal Compliance Committee: Using the Attorney Conduct Rules to Restructure the Board of Directors

The Securities and Exchange Commission introduced a new corporate governance structure, the qualified legal compliance committee, as part of the professional standards of conduct for attorneys mandated by the Sarbanes-Oxley Act of 2002. QLCCs are consistent with the Commission\u27s general approach to improving corporate governance through specialized committees of independent directors. This Article suggests, however, that assessing the benefits and costs of creating QLCCs may be more complex than is initially apparent. Importantly, QLCCs are unlikely to be effective in the absence of incentives for active director monitoring. This Article concludes by considering three ways of increasing these incentives

Keeping the Initiative through disruptions – Developing a Business Continuity

Background: Historically, the risk management activities in Gambro have been focused to ensure safety for patients and users of the company’s products where Regulatory and legal demands have driven the development. Lately, the need for a similar approach to assess and manage business risks has risen. When an earthquake hit the company’s facilities in northern Italy in 2012, the company did not have a predetermined plan for how to solve the crisis. Through good management and a dedicated workforce, production was quickly recovered and no patient harm occurred. After the experience the company realised the potential benefits of proactive assessment and management of risks for business interruptions. Purpose: The purpose of this thesis is to develop a model for assessment of risks that affects Gambro’s ability to deliver their products, i.e. operational disruption risks. The model should capture different types and levels of risks and be applicable and easy to use throughout the company. The harmonised model should enable Gambro to identify and mitigate risks in a structured and analytical manner. Method: A constructive research approach is used where a practical solution to the proposed problem is suggested. Academic literature, benchmarking, and Gambro’s current organisation is the basis for the development of a framework and governance for business risk management. Conclusions: A model for assessing disruption risks was developed. The model is divided into two general areas: the organisation and the procedure. An organisation with three different levels with different responsibilities of the process was developed. The three step procedure consists of the methodologies and tools required for identification of critical activities and resources, analyse and quantification of risks in terms of likelihood and business interruption value, and evaluate possible the risk responses

Hospital-acquired pneumonia in intensive care patients

The present thesis describes the incidence and risk factors for pneumonia and especially ventilator-associated pneumonia (VAP) among Intensive Care Unit (ICU) patients. Bacteria in samples from the lower respiratory tract of patients receiving mechanical ventilation are reported, including the duration of treatment prior to the first occurrence of different pathogens. The frequency of VAP using Swedish criteria (Swedish Intensive Registry, SIR) was compared with the VAP rate measured with international criteria (US Centre for Disease Control, CDC). Data were extracted from a local infection surveillance database (paper I-IV) and a trauma registry (paper II). In Paper I the incidence and risk factors for pneumonia and associated death over a two-year period was studied in 221 patients on mechanical ventilation. In paper II pre-hospital and hospital parameters associated with pneumonia within 10 days of ICU admission were evaluated in 322 ICU-treated trauma patients. Paper III focus on 443 bacterial isolates from the lower respiratory tract of 346 mechanically ventilated ICU patients. The occurrence of different pathogens was correlated with duration of hospital stay and time on mechanical ventilation at the time of sampling. In paper IV patients with (n=112) and without (n=224) a new lung infiltrate after ≥48 hours of mechanical ventilation were studied to evaluate the proportion of patients meeting different criteria used to define VAP according to CDC and SIR, respectively. Paper I shows that 15% of patients developed VAP, corresponding to a rate of 29 VAP/1000 ventilator days. Risk factors were aspiration, recent surgery and trauma. The 28-day mortality in patients with VAP was 33% as compared to 16% in those without ICU-acquired pneumonia. In Paper II risk factors for pneumonia were intubation at the site of injury, shock, an initial Glasgow Coma Scale (GCS) of ≤8, major surgery within 24 h of admission to hospital, massive transfusion of blood and ISS > 24. Enterobacteriacae and Stafylocoocus aureus were the most common pathogens. Paper III shows that duration of hospital care and mechanical ventilation prior to sampling was ≤2 days for Streptococcus pneumoniae, betastreptococci and Haemophilus influenzae. With the exception of Stenotrophomonas maltophilia and Pseudomonas aeruginosa, the median duration of time on mechanical ventilation was short and similar for most bacteria. In samples taken on the first day of mechanical ventilation, the rate of pathogens expected to be resistant to cefotaxime was 23%. In Paper IV the SIR and CDC criteria for VAP was met in 84% and 93%, respectively, in 112 situations with a new infiltrate when applying a ± 48 hours time frame for the other criteria in relation to the occurrence of the lung infiltrate. It is concluded that VAP is a common complication in the ICU, especially among trauma patients. The most important risk factor for VAP in a general ICU patient is aspiration and for a trauma patient an initial GCS of <8. Staphylococcus aureus and Enterobacteriacae are the most common bacteria in samples from the lower respiratory tract in both general ICU patients and in a trauma population. Occurrence of pathogens resistant to common antibiotics increases with the duration of hospital care and mechanical ventilation. The diagnosis of VAP should rely on presence of lung infiltrate and microbiological samples from the lower respiratory tract; clinical criteria add little value

Potential risk factors for diabetic neuropathy: a case control study

BACKGROUND: Diabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patient's quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression. METHODS: In this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography). The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI), blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality. RESULTS: Statistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, < 0.001 and 0.005). No correlation was found with any atherosclerosis risk factor (high BP, hyperlipidemia, cigarette smoking). CONCLUSION: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patient's quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education

Impact of Diabetes and Its Treatment on Cognitive Function Among Adolescents Who Participated in the Diabetes Control and Complications Trial

OBJECTIVE—The purpose of this study was to evaluate whether severe hypoglycemia or intensive therapy affects cognitive performance over time in a subgroup of patients who were aged 13–19 years at entry in the Diabetes Control and Complications Trial (DCCT)

Seizures in 204 comatose children: incidence and outcome

Purpose: Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain. Methods: cEEG (one to three channels) was performed for a median 42 h (range 2–630 h) in 204 unventilated and ventilated children aged $\leq$ 15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state). Results: Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36 %, 95 % confidence interval, 95 % CI, 32–41 %) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46 %) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95 % CI 1.012–1.042; p 3 % fast, aOR 5.43, 95 % CI 1.90–15.6; excess slow with <3 % fast, aOR 8.71, 95 % CI 2.58–29.4; low amplitude, 10th centile <9 $\mu$V, aOR 3.78, 95 % CI 1.23–11.7; and burst suppression, aOR 10.68, 95 % CI 2.31–49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95 % CI 1.18–4.81). Unfavourable outcome (29/111 survivors; 26 %) was independently predicted by the presence of ES (aOR 15.4, 95 % CI 4.7–49.7) and PIM (aOR 1.036, 95 % CI 1.013–1.059). Conclusion: Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool

Short-Term Visual Deprivation Does Not Enhance Passive Tactile Spatial Acuity

An important unresolved question in sensory neuroscience is whether, and if so with what time course, tactile perception is enhanced by visual deprivation. In three experiments involving 158 normally sighted human participants, we assessed whether tactile spatial acuity improves with short-term visual deprivation over periods ranging from under 10 to over 110 minutes. We used an automated, precisely controlled two-interval forced-choice grating orientation task to assess each participant's ability to discern the orientation of square-wave gratings pressed against the stationary index finger pad of the dominant hand. A two-down one-up staircase (Experiment 1) or a Bayesian adaptive procedure (Experiments 2 and 3) was used to determine the groove width of the grating whose orientation each participant could reliably discriminate. The experiments consistently showed that tactile grating orientation discrimination does not improve with short-term visual deprivation. In fact, we found that tactile performance degraded slightly but significantly upon a brief period of visual deprivation (Experiment 1) and did not improve over periods of up to 110 minutes of deprivation (Experiments 2 and 3). The results additionally showed that grating orientation discrimination tends to improve upon repeated testing, and confirmed that women significantly outperform men on the grating orientation task. We conclude that, contrary to two recent reports but consistent with an earlier literature, passive tactile spatial acuity is not enhanced by short-term visual deprivation. Our findings have important theoretical and practical implications. On the theoretical side, the findings set limits on the time course over which neural mechanisms such as crossmodal plasticity may operate to drive sensory changes; on the practical side, the findings suggest that researchers who compare tactile acuity of blind and sighted participants should not blindfold the sighted participants

Evaluation of two vulnerability scanners accuracy and consistency in a cyber range

One challenge when conducting exercises in a cyber range is to know what applications and vulnerabilities are present on deployed computers. In this paper, the reliability of application-and vulnerability reporting by two vulnerability scanners, OpenVas and Nexpose, have been evaluated based on their accuracy and consistency. Followed by an experiment, the configurations on two virtual computers were varied in order to identify where each scanner gathers information. Accuracy was evaluated with the f1-score, which combines the precision and recall metric into a single number. Precision and recall values were calculated by comparing installed ap-plications and vulnerabilities on virtual computers with the scanning reports. Consistency was evaluated by quantifying how similar the reporting of applications and vulnerabilities between multiple vulnerability scans were into a number between 0 and 1. The vulnerabilities reported by both scanners were also combined with their union and intersection to increase the accuracy. The evaluation reveal that neither Nexpose or OpenVas accurately and consistently report installed applications and vulnerabilities. Nexpose reported vulnerabilities better than OpenVas with an accuracy of 0.78. Nexpose also reported applications more accurately with an accuracy of 0.96. None of the scanners reported both applications and vulnerabilities consistently over three vulnerability scans. By taking the union of the reported vulnerabilities by both scanners, the accuracy increased by 8 percent compared with the accuracy of Nexpose alone. However, our conclusion is that the scanners’ reporting does not perform well enough to be used for a reliable inventory of applications and vulnerabilities in a cyber range