Protection of Medical Information Systems Against Cyber Attacks: A Graph Theoretical Approach

Securing electronic health records of patients is the paramount concern in medical information systems which faces unique set of challenges. Safeguarding a health care's computer network against attacks on its nodes and links requires placing mobile guards on the nodes of a network. Bloom topologies are attractive networks that are potential structures for massively parallel computers. This paper focuses on the evaluation of exact value of the parameters which gives the minimum number of guards required to protect the bloom networks. A linear time algorithm is proposed for finding these parameters. This study is beneficial in locating the minimum number of detection devices or cyber security employees (mobile guards) to be deployed on the significant servers (nodes) of the bloom's architecture (healthcare system) which is essential for defending the network against a single malware attack by network monitoring.

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada

The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.

Post-tsunami relocation of fisher settlements in South Asia: evidence from the Coromandel Coast, India

The tsunami that struck the coasts of India on 26 December 2004 resulted in the large-scale destruction of fisher habitations. The post-tsunami rehabilitation effort in Tamil Nadu was directed towards relocating fisher settlements in the interior. This paper discusses the outcomes of a study on the social effects of relocation in a sample of nine communities along the Coromandel Coast. It concludes that, although the participation of fishing communities in house design and in allocation procedures has been limited, many fisher households are satisfied with the quality of the facilities. The distance of the new settlements to the shore, however, is regarded as an impediment to engaging in the fishing profession, and many fishers are actually moving back to their old locations. This raises questions as to the direction of coastal zone policy in India, as well as to the weight accorded to safety (and other coastal development interests) vis-à-vis the livelihood needs of fishers.

A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas: The PERSEUS experience

PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also independently performed. The comparison between meta-analysis results and IAs shows similarities for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification of additional research themes targeting research topics that are requested to the achievement of GES.

Calciphylaxis: emerging concept in vascular patients

Calciphylaxis is a small vessel vasculopathy with medial calcification associated with intimal proliferation, fibrosis and thrombosis. This study discusses the clinical features and treatment of calciphylaxis and assesses the prognosis of patients with calciphylaxis. All patients admitted to vascular or renal wards from January 2003 to December 2004 at Royal Perth Hospital, with diagnosis of calciphylaxis confirmed histologically were included in the study. Five patients were included in the study; four male and one female. Three patients had end stage renal failure on haemodialysis and two had normal renal function. All three patients with end-stage renal failure had secondary hyperparathyroidism associated with elevated parathormone and corrected ionised calcium. The two patients with normal renal function had normal calcium, phosphate, and parathormone levels. The diagnosis of calciphylaxis was confirmed in all patients. The wounds of four patients healed and one patient died 8 months after the diagnosis of calciphylaxis had been made. Calciphylaxis is a condition mostly present in patients with end-stage renal failure and can occur in patients with normal renal function. It usually carries a poor prognosis, but in this small series the outcome of patients was good with satisfactory healing of wounds.

The capybara (Hydrochoerus hydrochaeris) as a reservoir host for Trypanosoma evansi

Discovery of two ill horses and three dogs naturally infected with Trypanosoma evansi near an experimental station in the Eastern Plains of Colombia led to a search for reservoir hosts of the parasite. Infection was detected in 8/33 healthy capybaras (Hydrochoerus hydrochaeris), none of the remaining 14 horses, and none of 32 Zebu cattle (Bos indicus), 18 paca (Cuniculus paca) and 20 spiny rats (Proechimys sp.). Contrary to common opinion, the results indicated a carrier state in the capybara. Diagnosis was based on morphology, behaviour in albino rats, and pathogenicity and host range in domestic animals.

The technique for growth plate sparing in soft-tissue sarcoma around the knee

Amputation in a growing child should be performed through a joint and not above or below a joint, as is commonly the case in an adult. We describe a technique for performing a through-knee amputation in a situation in which a soft-tissue sarcoma involved a leg, reaching up to the knee joint. Soft-tissue dissection was performed above the knee, leaving a safe zone from the tumor. The distal femur was dissected free of all attachments to the tibia and leg, leaving it intact but protruding from the soft-tissue sleeve of the thigh. To be able to close the stump over the protruding distal femur, the femur was shortened in the metaphysodiaphyseal area. Follow-up over 3 years shows a good through-knee stump, tumor free, and a normal distal growth plate.

The Scottish Rite abduction orthosis for the treatment of Legg-Perthes disease. A radiographic analysis

We evaluated a consecutive series of thirty-four patients who had had Legg-Perthes disease to determine the results of treatment with the Scottish Rite weight-bearing abduction orthosis. All patients had been older than six years at the time of the onset of the symptoms, had been in the fragmentation phase of the disease when they were first seen, and had had Catterall group-III or IV involvement. Although comparison of this series with those reported previously is difficult due to the variability of the presentation of data in the literature, this orthosis does not appear to offer an advantage compared with other methods of management, or with no treatment, for patients such as those whom we studied.

Brucellosis: an unusual diagnosis for a seronegative patient with abscesses, osteomyelitis, and ulcerative colitis

A 16-year-old girl developed multiple subcutaneous abscesses, osteomyelitis, and severe colitis. On the patient's second admission, a single blood culture--and, subsequently, a specimen of pus--yielded Brucella melitensis biovar 1. A second set of serologic tests, including the rose bengal test, the standard tube agglutination test, the CF test, and Coombs' test, were all negative for Brucella on the patient's second admission and 1 month later. However, a lymphocyte proliferation assay with extracted antigen of Brucella was markedly positive. Thus, this case illustrates that patients with B. melitensis infection may have a unique clinical presentation and that the lymphocyte proliferation assay is an important diagnostic tool for patients whose serologic test results are negative but for whom brucellosis is suspected.

A composite hip implant

Composites are made of two or more different components that combine their properties into a new material. By modifying the type or structure or volume of the components, a theoretically endless number of new materials can be produced and their properties can be altered as desired. A composite hip implant made of carbon fiber and polysulfone is described.

Ligament and tendon substitution with composite carbon fiber strands

Carbon fiber strands were used experimentally to substitute for tendons in dogs and clinically to reconstruct tendons and ligaments in human. The investigation was carried out to determine the histologic appearance of the new composite structure and its tensile strength in comparison to the natural structure. The histologic picture disclosed a remarkable structure evolved by continuous irritation of the carbon fibers and consisting of two interrelated components: synthetic carbon fibers and biologic collagenous tissue. This carbon fiber composite structure was composed of long cylindrical units containing concentric layers of collagenous fibers and cells enveloping the core of each carbon fiber. After one year of physiologic use in dogs, the average ultimate tensile strength of the composite structure which replaced the quadriceps and triceps was 372 N, or 88% the strength of the natural tendons. One year after implantation the histologic picture of the composite structure in human showed a relatively dense collagenous architecture. However, a significant proportion of the structure was taken up by histiofibroblasts produced by the irritation of the carbon fibers. Thus, the density of the collagen in the composite structure remained relatively deficient in comparison to the nature tendon, and the structural tensile strength continued to depend entirely on the integrity of the carbon fibers.

Anatomy of the normal knee as seen by magnetic resonance imaging

Nuclear magnetic resonance imaging (MRI) was used to study the normal knee. As well as revealing bone quality, MRI provided useful information on intra-articular and extra-articular soft tissues. Midsagittal views gave clear images of the cruciate ligaments, and of the patellar and quadriceps tendons. Parasagittal views were the best for delineating the menisci which, like ligaments and tendons, are of low intensity; the semimembranosus tendon and its insertion to the proximal tibia were also seen clearly in these views. The cruciate ligaments and menisci, though visible in the coronal view also, were better seen in the sagittal view. Axial views provided information on the structure of the patella, its cartilage, the patellofemoral joint and posterior soft-tissue structures.

Histological response to carbon fibre

The soft tissue response to carbon fibre was studied histologically one and a half years after being used to reconstruct the lateral collateral ligament of the human knee. A remarkably consistent pattern was seen in the induced ligament. The basic pattern was a "composite unit", consisting of a core of carbon fibre enveloped in a concentric manner by coherent layers of fibroblasts and collagen fibres. This new structure seemed to have been induced by continuous irritation caused by the physical structure of the carbon fibres; it is unlikely ever to acquire the structure of a natural ligament. However, it is biologically compatible and is biomechanically sufficient as long as the entire tow of carbon fibres is preserved.

Histologic pattern of biomechanic properties of the carbon fiber-augmented ligament tendon. A laboratory and clinical study

Implantation of carbon fiber tow (CFT) for ligament and tendon augmentation was investigated in ten dogs and 45 patients. CFT produced a new structure with a remarkably consistent structural pattern. The basic pattern of the CFT-augmented unit consisted of a core of carbon fiber surround by concentric layers of fibroblasts and collagen fibers. This unit structure was developed from continuous irritation of physical structure of the carbon fiber. In dogs, ultimate tensile strength of the augmented tendon one year after surgery averaged 88% of natural tendon. Digestion of the connective tissue component of the CFT unit exposed the original carbon fiber tow. The connective tissue-free CFT maintained its original tensile strength. The continuous production of collagenous tissue surrounding carbon fibers produced a ligamentous structure that was physiologically compatible and biomechanically sufficient.

Echinococcus infections in Colombian animals

The results of a survey involving more than 4,000 Colombian mammals, carried out to detect Echinococcus infections, are presented. Adult worms were found in 5 of 121 carnivores: E. oligarthrus in 1 of 11 ocelots, 2 of 9 jaguarundi cats and single puma; and E. vogeli in 1 of 15 domestic dogs. Although bush dogs were present, none could be examined. Polycystic larvae were found in 96 of 325 pacas (29.5%) and in 6 of 1,168 (0.5%) spiny rats, Proechimys spp. None of the 118 agouti showed hydatids but an infected heart was provided by hunters. The paca's infection rate increased with age but was not related to sex or geographic region. In 73 of 96 pacas the infection was due to E. vogeli, and the cysts were located in the liver. In 3 it was due to E. oligarthrus and the hydatids were extrahepatic, mainly attached to muscles. In the remaining 20, the species involved could not be determined. The parasites in two of the spiny rats, and in the agouti heart were E. oligarthrus. Although most of the infected animals were collected in the eastern plains, other records and verbal information indicate that, at least in Colombia where man has not exterminated pacas, agoutis, wild canids and felids, one still can find enzootic neotropical Echinococcus infection. The cycle of E. vogeli involves the bush dog and paca as hosts, and that of E. oligarthrus, the paca, agouti, spiny rat, and several species of wild felids.

Mammalian wildlife diseases as hazards to man and livestock in an area of the Llanos Orientales of Colombia

Development of the LLanos Orientales of Colombia, and access to underdeveloped areas in the Llanos, may create disease hazards to man and domestic animals or introduce exotic pathogens, creating reservoirs of infection for domestic animals and acting as limiting factors on the native wild species. A survey of wild animals common to the Llanos revealed a number of parasites indigenous to the area. A total total of 59 mammalian species, representing eight orders were examined. Haematozoa were represented by Trypanosoma cruzi, T. evansi and T. rangeli. Eight species of ticks were found: Amblyomma cajennense, A. auricularium, A. rotundatum, A. maculatum, A. longirostre, A. pacae, Ixodes luciae and Boophilus microplus. Four species of fleas were found: Rhopalopsyllus lugubris lugubris, R. australis tupinus, R. cacicus saevus and Polygenis klagesi samuelis. A species of Echinococcus was commonly found in Cuniculus paca. Serologic titers and/or isolations of pathogenic viral and bacterial agents generally indicated that the wildlife population had not been exposed to the diseases common to the domestic population. A low prevalence of titers to Venezuelan equine encephalomyelitis was found in Cebus apella and Proechimys sp. Neutralizing antibodies to Group B viruses were found in Proechimys sp., Coendor sp. and Nectomys squamipes. Antibodies to Group C viruses were found in Proechimys sp. Serologic titers to Leptospira sejroe and L. tarassovi were found in Proechimys sp. and Didelphis marsupialis. L. tarassovi was isolated from Proechimys sp. Titers to Brucella were not found in 1964 animals. The significance of these findings are discussed.

Polycystic echinococcosis in Colombia: the larval cestodes in infected rodents

Described are the characteristics of the polycystic larval cestodes found in an endemic area of echinococcosis in the Easter Plains of Colombia and the tissue reaction evoked in infected rodents. Of 848 free-ranging animals examined, polycystic hydatids were found in 44/93 Cuniculus paca and 1/369 Proechimys sp. None of 20 Dasyprocta fuliginosa examined was infected, but hunters provided a heart with hydatid cysts and information about two additional animals with infected livers. Recognition of an endemic area of polycystic echinococcosis provides a means to investigate the life cycle of the parasites and to study the histogenesis of the larval cestodes in susceptible laboratory animals.

Vascular damage caused by Cruorifilaria tuberocauda in the capybara (Hydrochoerus hydrochaeris)

Infection with Cruorifilaria tuberocauda caused vascular damage in the kidneys, lungs and heart of the capybara (Hydrochoerus hydrochaeris). The most significant lesions observed were in the renal and pulmonary arteries. They consisted of villous endarteritis, intimal and medial hypertrophy of the vessel walls, and large rugose protuberances that encroached upon the lumen leading to pyramidal infarcts in the kidneys. Coronary vascular lesions were related to dead and calcified parasites.

Multiple sclerosis: a clinico-biological study of 100 cases in Spain

A study was carried out on 100 cases with the clinical diagnosis of multiple sclerosis. Several clinical and analytical factors were considered and correlated. Special attention was paid to data obtained from cerebrospinal fluid (CSF) electrophoresis. The degree of severity of the disease does not affect the selective evaluation frequency of gamma-globulin or its average values. A greater frequency of definite gamma-globulin increase is observed in patients with a stationary development than in those a progressive development although, in both instances, the average values of gamma-globulin do not show any significant difference. There is no correlation between the CSF data and the presumed clinical site of the lesion. Those patients with a single lesion have a lower incidence of pathological data in CSF than those with multiple lesions. A higher proportion of pathological results is seen in CSF of patients with a chronic evolution from the onset than in chronic-intermittent cases. The cases studied during a relapse show a marked decrease in the frequency of definite gamma-globulin increase and paretic colloidal curves. This group of patients gives lower average values of gamma-globulin, total protein and cells, than those patients examined out of relapse. These results are in agreement with recent immunopathological observations.