Association entre la polypharmacie aux médicaments cardiovasculaires et non cardiovasculaires et le risque de mortalité chez les patients nouvellement diagnostiqués d’une insuffisance cardiaque au Québec

Contexte : La polypharmacie et le taux de mortalité des patients atteints d’insuffisance cardiaque (IC) croissent avec l’âge. Cependant, le lien entre la polypharmacie et la mortalité des malades d’IC est peu documenté au Canada. Il paraît donc nécessaire d’étudier l’association entre la polypharmacie aux médicaments cardiovasculaires et non cardiovasculaires et le risque de mortalité chez les patients âgés (≥ 66 ans), dont un diagnostic récent d’IC a été posé. Méthodes : À partir de deux bases de données administratives du Québec, une cohorte de patients âgés avec un diagnostic récent d’IC entre 1998 et 2015 a été constituée. Un devis cas-témoin imbriqué dans cette cohorte a permis d’apparier les cas de décès aux contrôles sur l’âge, le sexe et leur durée de suivi. La polypharmacie a été évaluée dans les trois derniers mois précédant la date de décès des patients. La relation entre le risque de mortalité et la polypharmacie aux médicaments cardiovasculaires (≥5 médicaments) et non cardiovasculaires (≥ 6 médicaments) a été testée par application d’une régression logistique conditionnelle ajustée aux comorbidités et aux médicaments cardiovasculaires. Résultats : L’échantillon comportait 1530 cas d’âge moyen de 83,4 ans. Parmi eux, 98,6 % présentaient au moins une comorbidité. Leur prévalence d’exposition à la polypharmacie aux médicaments cardiovasculaires était de 65,0 % et celle aux médicaments non cardiovasculaires de 63,9 %. Les données montraient une réduction importante du nombre de médicaments dans le dernier mois précédant la date de décès. Les analyses, ajustées aux comorbidités et aux médicaments cardiovasculaires, ont révélé que les patients exposés à la polypharmacie ≥ 6 médicaments non cardiovasculaires avaient 1,43 fois le risque de mortalité (IC 95 % : 1,28-1,60), comparés aux patients avec une polypharmacie < 6 médicaments non cardiovasculaires. En revanche, cette association était non significative pour les aînés avec une polypharmacie ≥ 5 médicaments cardiovasculaires (OR=0,91; IC 95 % : 0,79-1,04). Conclusion : Cette étude a révélé une association positive entre la polypharmacie aux médicaments non cardiovasculaires et le risque mortalité chez les patients âgés nouvellement diagnostiqués d’une IC.Background : Polypharmacy and the mortality rate of heart failure (HF) patients increase with age. However, the link between polypharmacy and HF patients mortality is poorly documented in Canada. Therefore, it’s necessary to study the association between polypharmacy with cardiovascular and non-cardiovascular drugs and the risk of mortality in elderly (≥ 66 years) newly diagnosed HF patients. Methods : Using two Quebec administrative databases, a cohort of elderly patients with a recent diagnosis of HF between 1998 and 2015 was established. A nested case-control design study allowed the cases of death to be matched to controls on age, sex and duration of the follow-up. Polypharmacy was assessed in the last three months prior to the date of patient death. The relationship between mortality risk and polypharmacy to cardiovascular (≥ 5 drugs) and non-cardiovascular (≥ 6 drugs) drugs was tested using conditional logistic regression adjusted for comorbidities and cardiovascular drugs. Results : The sample consisted of 1530 cases with a mean age of 83.4 years. Among them, 98.6% had at least one comorbidity. Their prevalence of polypharmacy to cardiovascular drugs was 65.0% and 63.9% to non-cardiovascular drugs. The data showed a significant reduction in medications was seen in the last month the date of death. Comorbidities and cardiovascular drugs adjusted analyses reported that patients with polypharmacy ≥ 6 non-cardiovascular drugs had 1.43 times the risk of mortality (95 % CI : 1.28-1.60) compared to patients with polypharmacy < 6 non-cardiovascular drugs. On the other hand, this association wasn’t statistically significant for elderly with polypharmacy ≥ 5 cardiovascular drugs (OR=0.91; 95 % CI : 0.79-1.04). Conclusion : This study found a positive association between polypharmacy with non-cardiovascular drugs and the risk of mortality in elderly patients newly diagnosed with HF

Similarity hash based scoring of portable executable files for efficient malware detection in IoT

YesThe current rise in malicious attacks shows that existing security systems are bypassed by malicious files. Similarity hashing has been adopted for sample triaging in malware analysis and detection. File similarity is used to cluster malware into families such that their common signature can be designed. This paper explores four hash types currently used in malware analysis for portable executable (PE) files. Although each hashing technique produces interesting results, when applied independently, they have high false detection rates. This paper investigates into a central issue of how different hashing techniques can be combined to provide a quantitative malware score and to achieve better detection rates. We design and develop a novel approach for malware scoring based on the hashes results. The proposed approach is evaluated through a number of experiments. Evaluation clearly demonstrates a significant improvement (> 90%) in true detection rates of malware

A novel intrusion detection system (IDS) architecture. Attack detection based on snort for multistage attack scenarios in a multi-cores environment.

Recent research has indicated that although security systems are developing, illegal intrusion to computers is on the rise. The research conducted here illustrates that improving intrusion detection and prevention methods is fundamental for improving the overall security of systems. This research includes the design of a novel Intrusion Detection System (IDS) which identifies four levels of visibility of attacks. Two major areas of security concern were identified: speed and volume of attacks; and complexity of multistage attacks. Hence, the Multistage Intrusion Detection and Prevention System (MIDaPS) that is designed here is made of two fundamental elements: a multistage attack engine that heavily depends on attack trees and a Denial of Service Engine. MIDaPS were tested and found to improve current intrusion detection and processing performances. After an intensive literature review, over 25 GB of data was collected on honeynets. This was then used to analyse the complexity of attacks in a series of experiments. Statistical and analytic methods were used to design the novel MIDaPS. Key findings indicate that an attack needs to be protected at 4 different levels. Hence, MIDaPS is built with 4 levels of protection. As, recent attack vectors use legitimate actions, MIDaPS uses a novel approach of attack trees to trace the attacker¿s actions. MIDaPS was tested and results suggest an improvement to current system performance by 84% whilst detecting DDOS attacks within 10 minutes

DoS Attack Impact Assessment on Software Defined Networks

© 2018, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering. Software Defined Networking (SDN) is an evolving network paradigm which promises greater interoperability, more innovation, flexible and effective solutions. Although SDN on the surface provides a simple framework for network programmability and monitoring, few has been said about security measures to make it resilient to hitherto security flaws in traditional network and the new threats the architecture is ushering in. One of the security weaknesses the architecture is ushering in due to separation of control and data plane is Denial of Service (DoS) attack. The main goal of this attack is to make network resources unavailable to legitimate users or introduce large delays. In this paper, the effect of DoS attack on SDN is presented using Mininet, OpenDaylight (ODL) controller and network performance testing tools such as iperf and ping. Internet Control Message Protocol (ICMP) flood attack is performed on a Transmission Control Protocol (TCP) server and a User Datagram Protocol (UDP) server which are both connected to OpenFlow switches. The simulation results reveal a drop in network throughput from 233 Mbps to 87.4 Mbps and the introduction of large jitter between 0.003 ms and 0.789 ms during DoS attack.Published versio

Cyber-Attack Modeling Analysis Techniques: An Overview

YesCyber attack is a sensitive issue in the world of Internet security. Governments and business organisations around the world are providing enormous effort to secure their data. They are using various types of tools and techniques to keep the business running, while adversaries are trying to breach security and send malicious software such as botnets, viruses, trojans etc., to access valuable data. Everyday the situation is getting worse because of new types of malware emerging to attack networks. It is important to understand those attacks both before and after they happen in order to provide better security to our systems. Understanding attack models provide more insight into network vulnerability; which in turn can be used to protect the network from future attacks. In the cyber security world, it is difficult to predict a potential attack without understanding the vulnerability of the network. So, it is important to analyse the network to identify top possible vulnerability list, which will give an intuitive idea to protect the network. Also, handling an ongoing attack poses significant risk on the network and valuable data, where prompt action is necessary. Proper utilisation of attack modelling techniques provide advance planning, which can be implemented rapidly during an ongoing attack event. This paper aims to analyse various types of existing attack modelling techniques to understand the vulnerability of the network; and the behaviour and goals of the adversary. The ultimate goal is to handle cyber attack in efficient manner using attack modelling techniques

Cyber Threat Intelligence from Honeypot Data using Elasticsearch

yesCyber attacks are increasing in every aspect of daily life. There are a number of different technologies around to tackle cyber-attacks, such as Intrusion Detection Systems (IDS), Intrusion Prevention Systems (IPS), firewalls, switches, routers etc., which are active round the clock. These systems generate alerts and prevent cyber attacks. This is not a straightforward solution however, as IDSs generate a huge volume of alerts that may or may not be accurate: potentially resulting in a large number of false positives. In most cases therefore, these alerts are too many in number to handle. In addition, it is impossible to prevent cyber-attacks simply by using tools. Instead, it requires greater intelligence in order to fully understand an adversary’s motive by analysing various types of Indicator of Compromise (IoC). Also, it is important for the IT employees to have enough knowledge to identify true positive attacks and act according to the incident response process. In this paper, we have proposed a new threat intelligence technique which is evaluated by analysing honeypot log data to identify behaviour of attackers to find attack patterns. To achieve this goal, we have deployed a honeypot on an AWS cloud to collect cyber incident log data. The log data is analysed by using elasticsearch technology namely an ELK (Elasticsearch, Logstash and Kibana) stack

Assessing and augmenting SCADA cyber security: a survey of techniques

SCADA systems monitor and control critical infrastructures of national importance such as power generation and distribution, water supply, transportation networks, and manufacturing facilities. The pervasiveness, miniaturisations and declining costs of internet connectivity have transformed these systems from strictly isolated to highly interconnected networks. The connectivity provides immense benefits such as reliability, scalability and remote connectivity, but at the same time exposes an otherwise isolated and secure system, to global cyber security threats. This inevitable transformation to highly connected systems thus necessitates effective security safeguards to be in place as any compromise or downtime of SCADA systems can have severe economic, safety and security ramifications. One way to ensure vital asset protection is to adopt a viewpoint similar to an attacker to determine weaknesses and loopholes in defences. Such mind sets help to identify and fix potential breaches before their exploitation. This paper surveys tools and techniques to uncover SCADA system vulnerabilities. A comprehensive review of the selected approaches is provided along with their applicability

Analyzing customer journey with process mining: from discovery to recommendations

Customer journey analysis is a hot topic in marketing. Understanding how the customers behave is crucial and is considered as one of the key drivers of business success. To the best of our knowledge, a data-driven approach to analyze the customer journey is still missing. For instance, web analytics tools like Google Analytics provide an oversimplified version of the user behavior, focusing more on the frequency of page visits rather than discovering the process of the visit itself. On the other hand, customer journey maps have shown their usefulness, but they need to be created manually by domain experts. This paper contributes a novel approach for applying process mining techniques to web log customer journey analysis. Through process mining we are able to (i) discover the process that better describes the user behavior, (ii) find useful insights, (iii) compare the processes of different clusters of users, and then (iv) use this analysis to improve the journey by optimizing some KPIs (Key Performance Indicators) via personalized recommendations based on the user behavior. We show through a real-life case study a proof of the correctness of the introduced concept by improving the recommender accuracy when incorporating additional context information about the journey as extracted from the process model

Towards An Enterprise Self-healing System against Botnets Attacks

noProtecting against cyber attacks is no longer a problem of organizations and home users only. Cyber security programs are now a priority of most governments. Cyber criminals have been using botnets to gain control over millions of computer, steel information and commit other malicious activities. In this paper we propose a self-healing architecture that was originally inspired from a nature paradigm and applied in the computer field. Our solution is designed to work within a network domain. We present the initial design of our solution based on the principles of self healing systems and the analysis of botnet behaviour. We discuss how to either neutralize or reverse (correct) their actions ensuring that network operations continue without disruption