bluuebunny/crossref_metadata_2025 huggingface dataset:
Selection of countermeasures against network attacks based on dynamical calculation of security metrics
Authors: Kotenko Igor , Doynikova Elena
Published: December 2017

This paper considers the issue of countermeasure selection for ongoing computer network attacks. We outline several challenges that should be overcome for the efficient response: the uncertainty of an attacker behavior, the complexity of interconnections between the resources of the modern distributed systems, the huge set of security data, time limitations, and balancing between countermeasure costs and attack losses. Although there are many works that are focused on the particular challenges, we suppose that there is still a need for an integrated solution that takes into account all of these issues. We suggest a model-driven approach to the security assessment and countermeasure selection in the computer networks that takes into account characteristics of different objects of assessment. The approach is based on integration with security information and event management systems to consider the dynamics of attack development, taking into account security event processing. Open standards and databases are used to automate security data processing. The suggested technique for countermeasure selection is based on the countermeasure model that was defined on the basis of open standards, the family of interrelated security metrics, and the security analysis technique based on attack graphs and service dependencies. We describe the prototype of the developed system and validate it on several case studies.
Implementing the decoy state protocol in a practically oriented Quantum Key Distribution system-level model
Authors: Engle Ryan D , Mailloux Logan O , Grimaila Michael R , Hodson Douglas D , McLaughlin Colin V , Baumgartner Gerald
Published: December 2017

Quantum Key Distribution (QKD) is an emerging cybersecurity technology that exploits the laws of quantum mechanics to generate unconditionally secure symmetric cryptographic keying material. The unique nature of QKD shows promise for high-security environments such as those found in banking, government, and the military. However, QKD systems often have implementation non-idealities that can negatively impact their performance and security. This article describes the development of a system-level model designed to study implementation non-idealities in commercially available decoy state enabled QKD systems. Specifically, this paper provides a detailed discussion of the decoy state protocol, its implementation, and its usage to detect sophisticated attacks, such as the photon number splitting attack. In addition, this work suggests an efficient and repeatable systems engineering methodology for understanding and studying communications protocols, architectures, operational configurations, and implementation tradeoffs in complex cyber systems.
A game theoretic approach to cyber security risk management
Authors: Musman Scott , Turner Andrew
Published: December 2017

This paper describes the Cyber Security Game (CSG). Cyber Security Game is a method that has been implemented in software that quantitatively identifies cyber security risks and uses this metric to determine the optimal employment of security methods for any given investment level. Cyber Security Game maximizes a system’s ability to operate in today’s contested cyber environment by minimizing its mission risk. The risk score is calculated by using a mission impact model to compute the consequences of cyber incidents and combining that with the likelihood that attacks will succeed. The likelihood of attacks succeeding is computed by applying a threat model to a system topology model and defender model. Cyber Security Game takes into account the widespread interconnectedness of cyber systems, where defenders must defend all multi-step attack paths and an attacker only needs one to succeed. It employs a game theoretic solution using a game formulation that identifies defense strategies to minimize the maximum cyber risk (MiniMax). This paper discusses the methods and models that compose Cyber Security Game . A limited example of a Point of Sale system is used to provide specific demonstrations of Cyber Security Game models and analyses.
Cyber defense in breadth: Modeling and analysis of integrated defense systems
Authors: Cho Jin-Hee , Ben-Asher Noam
Published: December 2017

Cybersecurity is one of most critical concerns for any organization, as frequency and severity of cyber attacks constantly increase, resulting in loss of vital assets and/or services. To preserve key security goals such as confidentiality, integrity, and availability, a variety of defense techniques have been introduced. While intrusion detection system (IDS) has played a key role in cybersecurity for a long time, recently new proactive defense techniques, called intrusion prevention techniques, have emerged, aiming to resolve the known IDS limitations. The intrusion prevention techniques have been introduced to control actions of attackers as a proactive defense that can be deployed independently or combined with other defense techniques that have the purpose of achieving “Defense in Breadth.” In this work, we develop a probability model using Stochastic Petri Nets that describes an integrated defense system with the defense techniques of both intrusion detection (i.e., IDS) and intrusion prevention (i.e., honeypots and platform migration) and analyze its performance compared to single defense or partially integrated defense approaches. Our result shows that the integrated defense system outperforms the compared approaches by minimizing attack success while maximizing system lifetime (i.e., mean time to security failure). Further, we investigate the effect of the interplay between different defense techniques in terms of the defense cost and attack cost.
Modeling the behavior of a hierarchy of command agents with context-based reasoning
Authors: Løvlid Rikke Amilde , Bruvoll Solveig , Brathen Karsten , Gonzalez Avelino
Published: December 2017

Context-based reasoning is a paradigm for modeling agent behavior that is based on the idea that humans only use a small portion of their knowledge at any given time. It was specially designed to represent human tactical behavior and has been successfully implemented in systems with single agents or two agents working together. In this paper, we apply this idea in a hierarchical multi-agent system of command agents, where the agents’ actions are to command and coordinate subordinates, send reports to their superiors, and communicate with other agents at the same level. We focus on how contexts and actions can be defined for these higher level command agents and how the contexts and actions for the different command agents are related. The proposed methodology is implemented and tested for a hierarchy of command agents that are interpreting and planning an operational order at a battalion level and carrying it out in a computer generated forces environment.
Validation of the finite state machine model for network simulation and a proposed testbed
Authors: Brown Scott , Brown Harold
Published: December 2017

Under the Cyber Army Modeling and Simulation (CyAMS) program a new model has been created to efficiently model various cyber events. The finite state machine model allows for the modeling of applications by creating behaviors that map to properties of real world applications. The finite state machine model is originally implemented by utilizing the ns-3 parallel discrete event simulator and validated using data from an emulation testbed experiment featuring malware applications. Following the completion of the ns-3 validation work, the CyAMS behavioral simulator was developed to allow for larger scale networks to be modeled, while also allowing both the network and applications to be defined using a behavioral network. This allows for the creation of an accurate mapping between both the simulation and the emulation applications. Validation tests are then carried out to determine both the validity of the model and the potential scalability. Finally, a testbed is proposed that will combine behavioral simulation, traditional parallel discrete event simulation, and emulation. The creation of this end-to-end environment for cyber simulation will allow past, present, and potentially future cyber events to be modeled in order to help understand and potentially mitigate future malicious attacks.
Comparative analysis and patch optimization using the cyber security analytics framework
Authors: Abraham Subil , Nair Suku
Published: December 2017

Dependable metrics are one of the critical elements of an organization’s information security program and are crucial for its long-term success. Current research in the area of enterprise security metrics provides limited insight on understanding the impact that attacks have on the overall security goals of an enterprise as well as predicting the future security state of the network. In this paper we present a novel security analytics framework that takes into account both the inter-relationship between different vulnerabilities and the temporal features that evolve over time, such as the vulnerability discovery rate and the lifecycle events. We then formally define a non-homogenous stochastic model that incorporates time dependent covariates, namely the vulnerability age and the vulnerability discovery rate, to help visualize the future security state of the network leading to actionable knowledge and insight. We will perform a comparative analysis and also describe the patch optimization methodology by applying this model on a sample network to demonstrate the practicality of our approach.
A Graphical Model to Assess the Impact of Multi-Step Attacks
Authors: Albanese Massimiliano , Jajodia Sushil
Published: December 2017

In the last several decades, networked systems have grown in complexity and sophistication, introducing complex interdependencies amongst their numerous and diverse components. Attackers can leverage such interdependencies to penetrate seemingly well-guarded networks through sophisticated multi-step attacks. Research has shown that explicit and implicit interdependencies exist at various layers of the hardware and software architecture. In particular, dependencies between vulnerabilities and dependencies between applications and services are critical for assessing the impact of multi-step attacks. These two classes of interdependencies have been traditionally studied using attack and dependency graphs respectively. Although significant work has been done in the area of both attack and dependency graphs, we demonstrate that neither of these models can provide an accurate assessment of an attack’s impact, when used in isolation. To address this limitation, we take a mission-centric approach and present a solution to integrate these two powerful models into a unified framework that enables us to accurately assess the impact of multi-step attacks and identify high-impact attack paths within a network. This analysis can ultimately generate effective hardening recommendations, and can be seen as one phase of a continuous process that iteratively cycles through impact analysis and vulnerability remediation stages.
Deterring the development and use of nuclear weapons: a multi-level modeling approach
Authors: Carley Kathleen M , Morgan Geoffrey P , Lanham Michael J
Published: December 2017

We describe a multi-country, multi-stakeholder model for the accrual and use of nuclear weapons and illustrate the model’s value for addressing nuclear weapon proliferation issues using a historic Pacific Rim scenario. We instantiate the agent-based dynamic network model for information and belief diffusion using data from subject matter experts and data mined from open source news documents. We present the techniques that supported model instantiation. A key feature of this model and these techniques is enabling rapid model re-use through the ability to instantiate at two levels: generically and for specific cases. We demonstrate these generic and specific cases using a scenario regarding North Korea’s interest in nuclear weapons and the resulting impact on the Pacific Rim circa 2014, that is, prior to the fourth and fifth nuclear weapons tests by the Democratic People’s Republic of Korea. A key feature of this model is that it uses two levels of network interaction, the country level and the stakeholder level, thus supporting the inclusion of non-state actors and the assessment of complex scenarios. Using this model, we conducted virtual experiments in which we assessed the impact of alternative courses of action on the overall force posture and desire to develop and use nuclear weapons.
Surgeon Preference, Influence, and Treatment of Thumb Carpometacarpal Arthritis
Authors: Deutch Zachary , Niedermeier Steven R. , Awan Hisham M.
Published: December 2017

Background: The purpose of this study was to evaluate current surgical practice patterns, the factors that influence these patterns, and overall trends in the treatment of thumb carpometacarpal osteoarthritis. Methods: An online survey containing 14 questions was sent to all active members of the American Society for Surgery of the Hand. Information on demographics and treatments was collected. Results were anonymously uploaded to an online spreadsheet. Results: A total of 823 responses were recorded. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) using whole flexor carpi radialis was the most popular technique at 37.44%. In all, 26.38% of surgeons with fewer than 5 years of experience utilize trapeziectomy with suture suspension (bone anchor based or tendon based); 55.76% choose a particular procedure because of “Personal Clinical Experience” over “Current Evidence” and “Training.” In addition, 24.17% of surgeons who have been practicing for longer than 5 years have changed procedures in the last 5 years. In the United States, 97.2% of hand surgeons prescribe either oxycodone or hydrocodone postoperatively compared with just 23.75% of international hand surgeons. Conclusions: The results show that trapeziectomy with LRTI remains the most popular treatment of choice. The use of trapeziectomy with suture suspension is on the rise, particularly in younger surgeons. International hand surgeons rely more on current evidence, utilize less postoperative therapy and opioid medications, and change procedures more often than US hand surgeons.
Management of hemothorax after thoracic endovascular aortic repair for ruptured aneurysms
Authors: Ju Mila H , Nooromid Michael J , Rodriguez Heron E , Eskandari Mark K
Published: December 2017

Background

Thoracic aortic aneurysm rupture is often a fatal condition. Emergent thoracic endovascular aortic repair (TEVAR) has emerged as a suitable treatment option. Unfortunately, respiratory complications from hemothorax continue to be an important cause of morbidity and mortality even after successful management of the aortic rupture. We hypothesize that early hemothorax decompression after TEVAR for ruptured aneurysms decreases the rate of postoperative respiratory complications.

Methods

Single-center, retrospective eight-year review of ruptured thoracic aneurysms treated with TEVAR.

Results

Seventeen patients presented with ruptured degenerative thoracic aortic aneurysms, all of which were successfully treated emergently with TEVAR. The mean age was 74 years among the 12 (70.6%) men and 5 (29.4%) women treated. Inpatient and 30-day mortality rates for the entire cohort were both 17.6% (three patients). The 90-day mortality rate was 47.1% (eight patients). Thirty-day morbidities of the entire cohort included stroke ( n = 1, 5.9%), spinal cord ischemia ( n = 3, 17.6%; only one was temporary), cardiac arrest ( n = 4, 23.5%; 3 were fatal), respiratory failure ( n = 5, 29.4%), and renal failure ( n = 5, 29.4%). A large hemothorax was identified in the majority of patients ( n = 14, 82.4%). While six (42.9% of 14) patients had immediate chest tube decompression on the day of index procedure, three (21.4% of 14) patients had decompression on postoperative day 1, 4, and 7, respectively. Although not statistically significant, there were trends toward higher rates of respiratory failure (50.0% vs. 16.7%, P = 0.198) and 90-day mortality (62.5% vs. 33.3%, P = 0.280) for patients with delayed or no hemothorax decompression when compared to patients with immediate hemothorax decompression.

Conclusions

The morbidity and mortality of ruptured degenerative thoracic aortic aneurysms remains high despite the introduction of TEVAR. In this single-center experience, there was a trend toward decreased respiratory complications and increased survival with early chest decompression of hemothorax after TEVAR.
Women on the walls: Representations of women in political murals in Northern Ireland
Authors: Rolston Bill
Published: December 2017

The article documents the under-representation of women in political wall murals in Northern Ireland. There are significantly fewer representations of women than of men in these murals. Where women do appear, it is within a number of specific themes: as political activists, prisoners, victims or historical or mythological characters. The findings will be located within an analysis which sees the murals as a specific articulation of gender as a dimension of political mobilisation during conflict and in the period of transition from conflict. In short, the images sometimes reinforce and at other times challenge gender role expectations and norms. The extent of that reinforcement and challenge differs significantly between republican and loyalist murals. Nowhere do women receive representational equality with men, but in relation to loyalist murals, that absence comes close to being tantamount to silence.
Indoor hygrothermal loads for the deterministic and stochastic design of the building envelope for dwellings in cold climates
Authors: Ilomets Simo , Kalamees Targo , Vinha Juha
Published: December 2017

In this study, several years of field measurements of indoor hygrothermal loads in 237 dwelling units are analysed. Moisture excess is calculated from hourly values of temperature, and relative humidity measured both indoors and outdoors. Air change rate and moisture production in bedrooms are calculated on the basis of carbon dioxide measurements. It is found that indoor temperature profiles differ depending on whether a building has central heating, a stove or combined heating system. The determined average moisture excess value, 2.8 g/m3 with a standard deviation of 1.6 g/m3 for cold periods, can be used in stochastic calculations. Critical values for moisture excess at the 90th percentile, ranging from 3–8 g/m3, depending upon occupancy rates, can be used in the deterministic analysis. Averages and weekly maxima of moisture excess in the study are reported at different percentiles. Considerable deviations from the EN ISO 13788 standard are discovered, concerning the breaking point depending on outdoor temperature and moisture excess during the summer. The average and critical moisture production in bedroom is presented and insufficient ventilation determined based on measurements. During the heating period, the air change rate is relatively stable while moisture production levels increase along with the dropping outdoor temperature. Two indoor temperatures and three humidity models with different levels of detail and influencing factors are proposed. Temperature and humidity loads derived using the proposed models can be used to determine the indoor hygrothermal boundary conditions for the building envelope of dwellings in cold climates.
(De)constructing ethical research narratives in criminological research
Authors: Mahoney Ian , Kearon Tony
Published: December 2017

This case study article draws upon experiences of a doctoral student (Mahoney) and supervisor (Kearon) to reflect on the way in which we construct ethical narratives around our research. We seek to draw attention to the manner in which strict adherence to ERB guidelines can be problematic and risks causing more harm than it seeks to mitigate. We aim to show that we as researchers should focus on the potential harm caused to particularly vulnerable participants and draw attention to the need to refocus conceptions of ethics away from a narrow, bureaucratic framework and towards moral concerns so as to avoid causing undue harm.
Contamination of overt data with covert data
Authors: Pickles James
Published: December 2017

A research project was conducted which explored LGBT (lesbian, gay, bisexual, transgender) hate crime. Participants were invited to share their narratives and personal experiences of hate crime, discrimination and violence through semi-structured interviews. The study helped us understand how people who experience ‘hate’ responded to, managed and reconciled the identities for which they were victimized. This case study focuses on a situation where a research participant requested a copy of an interview they gave for the hate crime project. The interview copy was to be used for the participant’s own personal purposes. The participant’s request potentially risked the contamination of ethical (overt) data collection, with their own covert data gathering. The ethical implications of this scenario raise many questions for ethicists and researchers to discuss.
An unprecedented wartime practice: Kodaking the Egyptian Sudan
Authors: Fox Paul
Published: December 2017

This article examines Kodak photographs made by participant soldiers and photographer–correspondents working in the field for the illustrated press during the concluding phase of the 1883–1898 campaign to defeat an Islamist insurgency in the Egyptian Sudan, whose leaders sought to create a regional caliphate. It explores how the presence of early generation portable cameras impacted on image making practices on British operations, and how aspects of campaign experience were subsequently represented in Kodak-derived photograph albums. With reference to graphic art and commercial photographic practices associated with Nile tourism and recent military activity in the Nile valley after 1882, the author argues, firstly, that the representation of combat was transformed by handheld photography and, secondly, that in the context of photographs of logistical activity and leisure, picturesque aesthetics were occluded by a ‘documentary’ mode of representation synonymous with the increasingly industrial nature of Western armed conflict. The article also calls attention to how photomechanical reproduction made possible the widespread availability of affordable albums for a public here identified as the readership of the illustrated general interest weeklies. More generally, the sheer number of photographs resulting from the use of Kodak technology prompted a more fluid use of montage-like techniques by album makers, for public and private use, including text and multiple image combinations, to build more dynamic visual narratives of experience on campaign than had hitherto been possible.
Diversity in ethnicization: War memory landscape in Bosnia and Herzegovina
Authors: Božić Gordana
Published: December 2017

The article analyzes public commemorations of the 1992–1995 war in Bosnia and Herzegovina with regard to the naming of the war, the causes and the character of the war, and collective sentiments. My main argument is that the Bosnia and Herzegovina’s memory landscape is discursively simplified and that its diversity remains peripheral in our analysis of war memory sites.
Refractory severe immune thrombocytopenia in a twin pregnancy
Authors: Harrington Patrick , Nelson-Piercy Catherine , Williamson Catherine , Cooper Nichola , Kesse-Adu Rachel , Robinson Susan
Published: December 2017

A 34-year-old woman presented at 29 weeks gestation of a twin pregnancy, with a platelet count of 1 × 109/l. She was extensively investigated and was subsequently diagnosed with severe immune thrombocytopenia. She did not respond to initial treatment with corticosteroids and intravenous immunoglobulin. She also failed to respond to second-line therapies of Anti-D immunoglobulin, Azathioprine and the thrombopoietin agonist Romiplostim. Her case was further complicated by an episode of obstetric cholestasis possibly related to Azathioprine treatment. She went on to require plasma exchange around the time of an elective Caesarean section which provided temporary improvement in the platelet count and enabled safe delivery. This case highlights some of the challenges faced in the management of patients with severe and refractory immune thrombocytopenia during pregnancy.
Arthroscopic repair of bony Bankart lesions in collision athletes
Authors: Shah Nasir , Nadiri Muhammed Nasir , Torrance Emma , Funk Lennard
Published: December 2017

Background

The present study aimed to report the outcomes of acute and subacute arthroscopic bony Bankart repairs in collision athletes.

Methods

We reviewed 22 consecutive rugby players with traumatic anterior glenohumeral instability who underwent arthroscopic bony Bankart repair within 4 months of injury over a 2-year period. All lesions were less than 25% of the glenoid bony area.

Results

A significant improvement was noted at three months and was maintained at 28 months postoperatively. The mean Constant score improved from 61.5 to 84.1, the mean Oxford shoulder score decreased from 26.3 to 13.6 and the mean Oxford instability score decreased from 42.9 to 13.5. The mean satisfaction score was 8.3 out of 10 at final follow-up. All patients returned to their pre-injury sporting level. Twenty patients (91%) remained stable and asymptomatic, although two (9%) had recurrent instability after further traumatic sports injuries. One required a modified Latarjet procedure, whereas the other patient sustained a soft tissue Bankart lesion and had a revision arthroscopic repair.

Conclusions

Acute and sub-acute bony Bankart lesions in collision athletes can be addressed through arthroscopic repair with a satisfactory outcome and return to pre-injury level of sport
The influence of full-thickness supraspinatus tears on abduction moments: the importance of the central tendon
Authors: Thompson Simon M. , Prinold Joe A. I. , Hill Adam M. , Reilly Peter , Emery Roger J. H. , Bull Anthony M. J.
Published: December 2017

Background

Detachment of the central tendon of the supraspinatus from its insertion is considered to be crucial to functional deficit. The aim of the present study was to assess the function of the supraspinatus in terms of abduction moments by introducing different tear configurations to assess the functional effect of the central tendon insertion.

Methods

Ten fresh frozen shoulders from five cadavers were prepared for testing. A testing protocol was established to measure the abduction moment of the supraspinatus under physiological loading tailored to the anthropometrics of each specimen. Four conditions were tested: intact supraspinatus; complete detachment of portion of the supraspinatus tendon anterior to the main central tendon; detachment of the main central tendon; and detachment of the region of the supraspinatus posterior to the main central tendon.

Results

There was a significant and large reduction in abduction moment when the central tendon was sectioned ( p < 0.05). A smaller reduction in abduction moment was found when the regions anterior and posterior to the main central tendon were sectioned ( p < 0.05).

Conclusions

The central tendon is vital in the role of functional arm abduction through force transmission through the intact rotator cuff. Reinsertion of the central tendon in the correct anatomical location is desirable to optimize functional outcome of surgery.
Interobserver reliability of radiographic assessment after radial head arthroplasty
Authors: Bexkens Rens , Claessen Femke M. A. P. , Kodde Izaäk F. , Oh Luke S. , Eygendaal Denise , van den Bekerom Michel P. J.
Published: December 2017

Background

Radiographs are part of routine clinical care after radial head arthroplasty (RHA). Therefore, the aim of this diagnostic study was to assess the interobserver reliability of radiographic assessment following RHA.

Methods

Anteroposterior (AP) and lateral radiographs of 24 consecutive patients who underwent press-fit bipolar RHA were evaluated with respect to 14 parameters by 14 orthopaedic surgeons specializing in the elbow: shaft loosening (AP, lateral), subcollar bone resorption, nonbridging heterotopic ossification, capitellar erosion, capitellar osteopenia, implant size, ulnohumeral joint gapping, ulnohumeral joint degeneration, proximal radio-ulnar joint congruency, stem size, stem positioning (AP, lateral) and component dissociation or polyethylene wear of the head with increased angulation. Observer agreement was evaluated using the multirater kappa (κ) measure.

Results

Nine of 14 parameters had poor interobserver agreement [κ = 0.0 to 0.20, confidence interval (CI) = 0.0 to 0.31). Four parameters had fair agreement: subcollar bone resorption (κ = 0.27, CI = 0.12 to 0.40), capitellar erosion (κ = 0.30, CI = 0.20 to 0.40), ulnohumeral joint degeneration (κ = 0.35, CI = 0.22 to 0.51) and stem positioning in AP view (κ = 0.24, CI = 0.14 to 0.36). One parameter had moderate agreement: nonbridging heterotopic ossification (κ = 0.47, CI = 0.31 to 0.64).

Conclusions

The overall interobserver reliability of radiographic assessment following press-fit bipolar RHA was poor among experienced elbow surgeons. Therefore, radiographic evaluation after RHA should be interpreted with caution when making treatment decisions.
Content Relevance of the Foot and Ankle Ability Measure in Patients With Achilles Tendon Diseases
Authors: Reb Christopher W. , Saini Sundeep S. , Stenson James F. , Albana Mohamed F. , Pedowitz David I. , Raikin Steven M. , Daniel Joseph N.
Published: December 2017

Background. The Foot and Ankle Ability Measure (FAAM) is among the most widely utilized and best psychometrically supported lower extremity–specific patient-reported outcome measures. However, its content relevance has never been directly subjected to patient assessment. Methods. This was an institutional review board–approved, prospective, cross-sectional study of 75 patients with Achilles tendon diseases who ranked the relevance of the FAAM’s items and subscales as 1 = Not relevant, 2 = Somewhat relevant, or 3 = Very relevant. Substantial content relevance was indicated by a minimum mean item or subscale score of 2.0. Nonsurgical and surgical subgroups were compared. Results. At the whole group level, the mean score was above 2.0 for each individual item and subscale. Subgroup analysis revealed that the mean relevance was above 2.0 for each of the items and subscales with the exception of the “Personal Care” item, which nonsurgical patients ranked significantly lower than did surgical patients (mean = 1.74 vs 2.23, P = .02). Additionally, this was part of a general trend across items with more 95% confidence intervals crossing below 2.0 in the nonsurgical data set (15 items, 52%) than the surgical data set (1 item, 3%). Conclusion. These data confirm that the FAAM has substantial content relevance to patients with Achilles tendon diseases. However, it is unclear why the surgical subgroup consistently ranked items higher than did the nonsurgical subgroup. Future work should address how a patient’s content relevance perception is influenced by the relative effects of their Achilles disease type and their perceived level of disease-related functional impairment.

Levels of Evidence: Diagnostic, Level III
Factors Contributing to Hospital Stay and Total Inpatient Charges in Total Ankle Arthroplasty: Review of the National Inpatient Sample
Authors: Codding Jason L. , Zmistowski Benjamin M. , Davis Daniel E. , Maltenfort Mitchell G. , Pedowitz David I.
Published: December 2017

Total ankle arthroplasty (TAA) is commonly performed for end-stage ankle osteoarthritis. Given rising costs and declining reimbursements, identifying variables increasing length of stay (LOS) and total inpatient charges (TICs) of TAA is necessary for providing cost-effective care. The National Inpatient Sample (NIS) database was reviewed between 1993 and 2010, identifying LOS and TIC for TAA. Using a multivariate analysis, patient comorbidities, demographics, payment, and hospital details were evaluated. Median LOS decreased from 5 to 2 days, whereas median TICs increased from $21 382.53 to $62 028.00. Regionally, the South and Midwest had decreased TICs, whereas the West had an increased TIC. There was no significant difference in LOS geographically. Rural hospitals demonstrated decreased TICs, whereas urban private hospitals showed decreased LOS and decreased TICs. Large hospitals were associated with increased LOS and TICs. Compared with Medicare, private insurers demonstrated decreased LOS with equivalent TICs. Diabetics significantly increased mean LOS by 1 day, without a significantly increased TIC. Despite a decreased LOS, hospital charges have increased between 1993 and 2010 in TAA. We found that regional differences and hospital characteristics were associated with differences in LOS and TICs. Identification of these factors provides important information to facilities and surgeons.

Levels of Evidence: Level IV: Economic/decision analysis
Developing Data Leadership: Contextual Influences on Administrators’ Data Use
Authors: Roegman Rachel , Perkins-Williams Ruqayyah , Maeda Yukiko , Greenan Kathleen A.
Published: December 2017

This study aimed to understand administrators’ data leadership influenced by multiple contexts by analyzing interviews with 24 administrators from three Midwestern districts. Findings highlight ways that the accountability movement narrowed administrators’ data leadership. At the same time, the accountability movement was not totalizing, as principals’ teaching backgrounds offered possibilities for alternative narratives to thinking about how data can inform instruction. We conclude with implications for practice around ways to combat the accountability movement’s conceptions of data and provide administrators with knowledge and skills to engage in more holistic data leadership.
Effects of Anti-Inflammatory Agents on Expression of Early Responsive Inflammatory and Catabolic Genes in Ex Vivo Porcine Model of Acute Knee Cartilage Injury
Authors: Genemaras Amaris A. , Ennis Hayley , Bradshaw Brad , Kaplan Lee , Huang C.-Y. Charles
Published: December 2017

Objective

Early intervention therapies targeting inflammation and cell death during the acute phase of cartilage injury have the potential to prevent posttraumatic osteoarthritis. The objective of this study was to investigate the effects of interleukin receptor antagonist protein (IRAP), hyaluronan (HA), dexamethasone (DEX), and mesenchymal stem cell (MSC) treatment on the expression of established genetic markers for matrix degradation, apoptosis, and inflammation in articular cartilage during the acute phase of injury.

Design

A custom impact device was used to create replicable injury ex vivo to intact porcine knee joint. One hour after impact, IRAP, HA, DEX, or MSCs was intra-articularly injected. At 8 hours postinjury, cartilage and meniscus samples were harvested for genetic expression analysis. Expression of miR-27b, miR-140, miR-125b, miR-16, miR-34a, miR-146a, miR-22, ADAMTS-4, ADAMTS-5, MMP-3, IL-1β, and TNF-α was analyzed by real-time polymerase chain reaction.

Results

At 8 hours postinjury, expression of ADAMTS-4, ADAMTS-5, MMP-3, IL-1β, and TNF-α in cartilage was significantly decreased in IRAP- and DEX-treated joints as compared to nontreated injured joints, whereas only IRAP upregulated expression of miR-140, miR-125b, miR-27b, miR-146a, and miR-22 in cartilage. HA and MSC treatments had no significant effects on catabolic and inflammatory gene expression in cartilage. However, HA treatment significantly upregulated expression of all miRNAs except miR-16. In addition, the treatments tested also exhibited significant influences on meniscus.

Conclusions

This study provides a valuable starting point for further research into potential targets for and efficacy of various early intervention strategies that may delay or prevent the progression of posttraumatic osteoarthritis after acute cartilage injury.
Cartilage Health in Knees Treated with Metal Resurfacing Implants or Untreated Focal Cartilage Lesions: A Preclinical Study in Sheep
Authors: Martinez-Carranza Nicolas , Hultenby Kjell , Lagerstedt Anne Sofie , Schupbach Peter , Berg Hans E.
Published: December 2017

Background

Full-depth cartilage lesions do not heal and the long-term clinical outcome is uncertain. In the symptomatic middle-aged (35-60 years) patient, treatment with metal implants has been proposed. However, the cartilage health surrounding these implants has not been thoroughly studied. Our objective was to evaluate the health of cartilage opposing and adjacent to metal resurfacing implants.

Methods

The medial femoral condyle was operated in 9 sheep bilaterally. A metallic resurfacing metallic implant was immediately inserted into an artificially created 7.5 mm defect while on the contralateral knee the defect was left untreated. Euthanasia was performed at 6 months. Six animals, of similar age and study duration, from a previous study were used for comparison in the evaluation of cartilage health adjacent to the implant. Cartilage damage to joint surfaces within the knee, cartilage repair of the defect, and cartilage adjacent to the implant was evaluated macroscopically and microscopically.

Results

Six animals available for evaluation of cartilage health within the knee showed a varying degree of cartilage damage with no statistical difference between defects treated with implants or left untreated ( P = 0.51; 95% CI −3.7 to 6.5). The cartilage adjacent to the implant (score 0-14; where 14 indicates no damage) remained healthy in these 6 animals showing promising results (averaged 10.5; range 9-11.5, SD 0.95). Cartilage defects did not heal in any case.

Conclusion

Treatment of a critical size focal lesion with a metal implant is a viable alternative treatment.
Will the Real Factors of Prosociality Please Stand Up? A Comment on Böckler, Tusche, and Singer (2016)
Authors: Wilhelm Oliver , Kaltwasser Laura , Hildebrandt Andrea
Published: December 2017

Based on a large individual differences study, Böckler, Tusche, and Singer aimed to develop and psychometrically evaluate measurement procedures that capture individual differences in multiple facets of human prosociality. Böckler et al. claimed that they identified four reliable and method-independent subcomponents of human prosociality: altruistically motivated prosocial behavior, norm-motivated prosocial behavior, strategically motivated prosocial behavior, and self-reported prosocial behavior. We show that this claim is not supported by the data. The abnormalities of the factor solution are visible in reported standardized loadings much larger than unity and negative residual variances at the indicator level. Additionally, the strong dispersion in factor loadings reported in the article hinders factor interpretation. We reanalyze the correlation matrices and propose a model with one overarching prosociality factor and a specific factor for game-theoretical conflicts. This simpler model is a more sustainable representation of prosocial behavior.
Poisoned Praise
Authors: Kunstman Jonathan W. , Fitzpatrick Christina B. , Smith Pamela K.
Published: December 2017

High-power people frequently receive compliments from subordinates, yet little is known about how high-power people respond to praise. The current research addresses this gap in the empirical literature by testing the primary hypothesis that high-power people discount others’ praise more than equal- and low-power people. Secondary hypotheses also tested whether high-power people’s tendency to discount positive feedback would paradoxically heighten negative perceptions of others. Evidence from two experiments (one preregistered) reveals that high-power participants discounted feedback from others more than low- and equal-power participants. However, high-power people’s tendency to discount feedback only produced negative partner perceptions when positive feedback, but not neutral feedback, was discounted. These results suggest that compliments may sometimes backfire and lead high-power people to discount praise and form negative impressions of subordinates.
Are Negative Community Attitudes Toward Welfare Recipients Associated With Unemployment? Evidence From an Australian Cross-Sectional Sample and Longitudinal Cohort
Authors: Schofield Timothy P. , Butterworth Peter
Published: December 2017

Negative stereotyping and stigmatization of welfare recipients may account for the negative outcomes they experience. Much is known about the impact of stigma on welfare take-up, whereas much is hypothesized about the stigma–unemployment association. In two representative Australian samples, we show that individuals previously exposed to unemployment benefits held negative attitudes to welfare recipients only when these reflected those of their community. Temporal patterns in the data suggest this could reflect an internalization of negative community attitudes. These stigmatizing negative attitudes were not associated with prior unemployment but were linked with current employment, future employment, and a return to employment among the previously unemployed. Community attitudes had no direct effect on employment outcomes. Thus, the effects observed may have an indirect path through the internalization of negative community attitudes. These findings underscore the importance of multilevel analyses of social stigma and highlight that welfare stigma may promote recovery from the underlying characteristic.
Time resolved computed tomography angiography in the evaluation of brain arteriovenous malformation: a feasibility study
Authors: Singh Rupinder , Gupta Vivek , Ahuja Chirag , Khandelwal Niranjan
Published: December 2017

Background and purpose

Digital subtraction angiography is the current gold standard for diagnosing as well as the follow-up of cerebral arteriovenous malformations. However, as it is invasive, relatively expensive and time-consuming, a non-invasive alternative is of interest. We aimed to evaluate the feasibility of time resolved computed tomography angiography (TR-CTA) in a series of five diagnosed cranial arteriovenous malformation patients, demonstrated by conventional digital subtraction angiography with respect to acquisition, depiction of angiographic phases and radiation exposure.

Materials and methods

Five patients demonstrating a cranial arteriovenous malformation on digital subtraction angiography were studied with TR-CTA. The TR-CTA imaging was done by using a 128-detector computed tomography scanner. Digital subtraction angiography and TR-CTA studies were independently read by two blinded observers, by using a standardised scoring sheet. TR-CTA results were analysed with digital subtraction angiography as the criterion standard.

Results

TR-CTA generated comparable angiographic phases. In all five cases, there was complete agreement between digital subtraction angiography and TR-CTA regarding the size, arterial feeders, nidal morphology and venous drainage of the arteriovenous malformation.

Conclusions

TR-CTA imaging as a technique is feasible, providing images with good temporal and spatial resolution at an acceptable radiation dose. It appears to be a promising non-invasive adjunct to digital subtraction angiography.
Diffusion tensor imaging findings suggestive of white matter alterations in a canine model of mucopolysaccharidosis type I
Authors: Middleton Dana M , Li Jonathan Y , Chen Steven D , White Leonard E , Dickson Patricia , Ellinwood N Matthew , Provenzale James M
Published: December 2017

Purpose

We investigated fractional anisotropy (FA) and radial diffusivity (RD) in a canine model of mucopolysaccharidosis (MPS). We hypothesized that canines affected with MPS would exhibit decreased FA and increased RD values when compared to unaffected canines, a trend that has been previously described in humans with white matter diseases.

Methods

Four unaffected canines and two canines with MPS were euthanized at 18 weeks of age. Their brains were imaged using high-resolution diffusion tensor imaging (DTI) on a 7T small-animal magnetic resonance imaging system. One hundred regions of interest (ROIs) were placed in each of four white matter regions: anterior and posterior regions of the internal capsule (AIC and PIC, respectively) and anterior and posterior regions of the centrum semiovale (ACS and PCS, respectively). For each specimen, average FA and RD values and associated 95% confidence intervals were calculated from 100 ROIs for each brain region.

Results

For each brain region, the FA values in MPS brains were consistently lower than in unaffected dogs, and the RD values in MPS dogs were consistently higher, supporting our hypothesis. The confidence intervals for affected and unaffected canines did not overlap in any brain region.

Conclusion

FA and RD values followed the predicted trend in canines affected with MPS, a trend that has been described in humans with lysosomal storage and dysmyelinating diseases. These findings suggest that the canine model parallels MPS in humans, and further indicates that quantitative DTI analysis of such animals may be suitable for future study of disease progression and therapeutic response in MPS.
Early increase in serum fatty acid binding protein 4 levels in patients with acute myocardial infarction
Authors: Obokata Masaru , Iso Tatsuya , Ohyama Yoshiaki , Sunaga Hiroaki , Kawaguchi Tomoka , Matsui Hiroki , Iizuka Takashi , Fukuda Nobuaki , Takamatsu Hiroto , Koitabashi Norimichi , Funada Ryuichi , Takama Noriaki , Kasama Shu , Kaneko Yoshiaki , Yokoyama Tomoyuki , Murakami Masami , Kurabayashi Masahiko
Published: December 2017

Background:

Acute myocardial infarction (AMI) induces marked activation of the sympathetic nervous system. Fatty acid binding protein 4 (FABP4) is not only an intracellular protein, but also a secreted adipokine that contributes to obesity-related metabolic complications. Here, we examined the role of serum FABP4 as a pathophysiological marker in patients with AMI.

Methods and results:

We studied 106 patients presenting to the emergency unit with a final diagnosis of AMI, including 12 patients resuscitated from out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation. FABP4 levels peaked on admission or just after percutaneous coronary intervention and declined thereafter. Regression analysis revealed no significant correlation between peak FABP4 and peak cardiac troponin T determined by Roche high-sensitive assays (hs-TnT). Notably, FABP4 levels were particularly elevated in AMI patients who were resuscitated from OHCA (median 130.2 ng/mL, interquartile range (IQR) 51.8–243.9 ng/mL) compared with those without OHCA (median 26.1 ng/ml, IQR 17.1–43.4 ng/mL), while hs-TnT levels on admission were not associated with OHCA. Immunohistochemistry of the human heart revealed that FABP4 is abundantly present in adipocytes within myocardial tissue and epicardial adipose tissue. An in vitro study using cultured adipocytes showed that FABP4 is released through a β3-adrenergic receptor (AR)-mediated mechanism.

Conclusions:

FABP4 levels were significantly elevated during the early hours after the onset of AMI and were robustly increased in OHCA survivors. Together with the finding that FABP4 is released from adipocytes via β3-AR-mediated lipolysis, our data provide a novel hypothesis that serum FABP4 may represent the adrenergic overdrive that accompanies acute cardiovascular disease, including AMI.