Tabletop Exercise For Cybersecurity Educational Training; Theoretical Grounding And Development

Haridus- ja treeningaspektid on riiklike küberturvalisuse strateegiate vitaalsed komponendid, et kujundada, tugevdada ning proovile panna otsustajate valmisolekut nii aktuaalsete kui võimalike tulevaste küberväljakutsete ees. Küberkaitses ja -julgeolekus on otsuste langetamisel üliolulised kriisijuhtimisoskused, et suuta adekvaatselt vastata juhtumitele, mil era- või avalik heaolu ja turvalisus on ohustatud. Selle magistritöö eesmärk on välja pakkuda küberjulgeoleku strateegiate hariduslike komponentide võimalike ning teadaolevate nõrkuste parandamine, arutledes teadlikkuse väljaõpete mudeleid märkimisväärse mõjuga osavõtjatele, fookusega strateegilise otsustamisvõimega personalil, mis võiks osaleda küberjuhtumis. Töö toetab simulatsioonil põhinevate stsenaariumite kasutamist ning keskendub mudelõppuste kujundamisele. Käesolev töö näitab, kuidas mudelõpe võib olla tõhus viis küberjuhtumites strateegiliste otsuste langetamisel teadlikkuse, mõistmise ja ettevalmistuse kujundamiseks, parandamiseks ning proovilepanemiseks. Lõputöö tugineb ditsiplinaarsel ja kontseptuaalsel õpinguteooriate integratsioonil mängustamisel põhinevate ajenditega ning juhtimisteooriatega. Stsenaariumil põhinev treening pakub turvalist ja paindlikku keskkonda, kus osavõtja on pandud kriitilisse situatsiooni, säilitades realistlikku ülevaate küberkriisi tunnustest ning võimalikest ohtudest. Simulatsioon väljendab võimalikke väljakutseid, nõudes kriisijuhtimisoskusi ning kohast reaktsiooni. Mudelõppused võimaldavad andragoogilise kasu ja hariduslike eesmärkide realiseerimist innovatiivsel ja kaasaval meetodil. Selle treeningmudeli tulemused mõõdetakse kasutades Bloomi õppe-kasvatustöö eesmärkide liigituse kontrollitud taksonoomiat, arvesse võttes kogemusõppe ja paiknevustunnetuse elemente. VOOT-tsükkel pakub läbimõeldud otsustusprotsessi, mis samuti sobib antud ettepaneku dünaamikasse. Lisaks panustab töö originaalse modulaarse juhendiga, mida treenijad ning õppejõud saavad kasutada mudelõppe teostamiseks küberjulgeolekus. Riikliku ja rahvusvahelise tasandi mudelõppuste kogemus ja osavõtt sai empiirilist tuge teoreetilisele integratsioonile ning teadustas modulaarse juhendi arengut. Töö on kvalitatiivne. Lõputöö panustab asjakohasesse akadeemilisse dialoogi selle teoreetiliste alustega. Samuti praktiliselt, kuna pakub vahendeid simulatsioonipõhise mudelõppe läbiviimiseks.Education and training aspects are vital components of national cybersecurity strategies, to shape, enhance and test the decision maker’s level of preparedness before current and future challenges that can arise from a cyber incident. Decision-making processes in cyber defense and security require crucial crisis management competences capable of generating a comprehensive response where safety, well-being and other public and private assets could be put at stake. The purpose of this thesis is to suggest the improvement of potential and perceived weaknesses on the educational components of cyber security strategies, discussing awareness-training models with significant impact on the participants, focusing on strategic decision-making level personnel that could partake of cyber related incidents. The work supports the use of simulation-based scenarios, and concentrates on the design of Tabletop exercises. This thesis shows when a tabletop exercise could be an effective mechanism to shape, enhance and test the awareness, understanding and preparation for strategic decision makers in cyber related incidents. The thesis draws from a disciplinary integration of learning, human computer interaction, and management theories. A scenario-based training provides a safe and flexible environment where the participant is placed into a critical situation while maintaining a realistic insight into the characteristics of cyber crisis and the threats and attacks that may take place. The simulation represents possible challenges, demanding crisis management capacity and an appropriate response. Tabletop exercises permits that andragogical benefits and educational purposes be realized through an innovative and engaging method. Considering elements from experiential learning and situated cognition the learning outcomes of this training model will be measured, using Bloom’s revised taxonomy of educational objectives. The OODA Loop will suggest a thoughtful decision making process that also fits well the dynamic of the current proposal. Additionally, the thesis will contribute with an original modular guide that trainers and educators can use for the implementation of a Tabletop exercise on cyber security. National and international level tabletop exercises experience and participation provided empirical support to the theoretical contribution on theory integration, and informed the modular guide development. The work is qualitative and therefore seeks to observe, interpret and understand, by using documental analysis, and observation methods. The work contributes to the relevant academic dialog on its theoretical grounds and also in practical terms, by providing with tools readily applicable to the creation of simulation based tabletop exercises

Proyecto Ensamblando en Colombia

Los dos volúmenes de esta obra reúnen los resultados del proyecto ganador de la «Convocatoria nacional de proyectos bicentenario 1810-2010 “Historia social de la ciencia, la tecnología y la innovación en Colombia: ciudadanía, saberes y nación”», lanzada por Colciencias en el 2009. El proyecto, titulado «Ensamblado en Colombia: producción de saberes y construcción de ciudadanías» se propuso estudiar la manera como se constituyen en el presente y se han constituido en el pasado «asuntos de interés público» que tienen una clara dimensión epistémica y ontológica, pues la producción de saberes nos interpela y convoca como académicos y como ciudadanos, como académicas y como ciudadanas. Se trata de comprender cómo se ensamblan saberes, naturalezas, tecnologías y ciudadanías y de ensayar diálogos de estilos, enfoques y miradas que reconozcan la alteridad, la multiplicidad y la heteroglosia como partes esenciales en y para la producción simultánea de conocimiento y formas de sociedad

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Paisaje Cultural Urbano e Identitad Territorial

Linguaggio contemporaneo e preesistenze: dialogo in un mondo globalizzato Il tema del rapporto con l’antico trova una giusta dimensione operativa quando, superando la sfera delle ideologie e quella delle opposte ragioni della memoria e dello sviluppo, indirizza positivamente l’azione progettuale ora per differenza ora per empatia, a seconda delle circostanze, ma crea sempre una forte tensione tra le ragioni dell’esistente e le necessità del nuovo. Intervenire nell’antico e per l’antico significa, pertanto, riprogettare il nostro modo di relazionarci con il passato, rinegoziandone identità e valori alla luce del nostro presente. Da questa angolazione il patrimonio non è solo lo spazio della memoria o quello della storia, ma diviene lo spazio del desiderio che trae alimento dal mito dell’araba fenice: esso, come principio evolutivo, rappresenta l’inizio di un incessante ricominciamento e l'occasione per una mediazione tra globale e locale

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

Impact of cross-section uncertainties on supernova neutrino spectral parameter fitting in the Deep Underground Neutrino Experiment

International audienceA primary goal of the upcoming Deep Underground Neutrino Experiment (DUNE) is to measure the O(10)  MeV neutrinos produced by a Galactic core-collapse supernova if one should occur during the lifetime of the experiment. The liquid-argon-based detectors planned for DUNE are expected to be uniquely sensitive to the νe component of the supernova flux, enabling a wide variety of physics and astrophysics measurements. A key requirement for a correct interpretation of these measurements is a good understanding of the energy-dependent total cross section σ(Eν) for charged-current νe absorption on argon. In the context of a simulated extraction of supernova νe spectral parameters from a toy analysis, we investigate the impact of σ(Eν) modeling uncertainties on DUNE’s supernova neutrino physics sensitivity for the first time. We find that the currently large theoretical uncertainties on σ(Eν) must be substantially reduced before the νe flux parameters can be extracted reliably; in the absence of external constraints, a measurement of the integrated neutrino luminosity with less than 10% bias with DUNE requires σ(Eν) to be known to about 5%. The neutrino spectral shape parameters can be known to better than 10% for a 20% uncertainty on the cross-section scale, although they will be sensitive to uncertainties on the shape of σ(Eν). A direct measurement of low-energy νe-argon scattering would be invaluable for improving the theoretical precision to the needed level

Deep Underground Neutrino Experiment (DUNE) Near Detector Conceptual Design Report

International audienceThe Deep Underground Neutrino Experiment (DUNE) is an international, world-class experiment aimed at exploring fundamental questions about the universe that are at the forefront of astrophysics and particle physics research. DUNE will study questions pertaining to the preponderance of matter over antimatter in the early universe, the dynamics of supernovae, the subtleties of neutrino interaction physics, and a number of beyond the Standard Model topics accessible in a powerful neutrino beam. A critical component of the DUNE physics program involves the study of changes in a powerful beam of neutrinos, i.e., neutrino oscillations, as the neutrinos propagate a long distance. The experiment consists of a near detector, sited close to the source of the beam, and a far detector, sited along the beam at a large distance. This document, the DUNE Near Detector Conceptual Design Report (CDR), describes the design of the DUNE near detector and the science program that drives the design and technology choices. The goals and requirements underlying the design, along with projected performance are given. It serves as a starting point for a more detailed design that will be described in future documents

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit