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Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Cyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:
∙Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).
∙Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).
∙Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).
Limitations: The following sets out key limitations of the work set out in this paper:
∙While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.
∙There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.
∙No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)
∙No consideration has been given to the impact of the event on the share price of the company.
∙Correlation with other risk types has not been explicitly considered.
Conclusions: Cyber risk is a very real threat and should not be ignored or treated lightly in operational risk frameworks, as it has the potential to threaten the ongoing viability of an organisation. Risk managers and capital actuaries should be aware of the various sources of cyber risk and the potential impacts to ensure that the business is sufficiently prepared for such an event. When it comes to quantifying the impact of cyber risk on the operations of an insurer there are significant challenges. Not least that the threat landscape is ever changing and there is a lack of historical experience to base assumptions off. Given this uncertainty, this paper sets out a framework upon which readers can bring consistency to the way scenarios are developed over time. It provides a common taxonomy to ensure that key aspects of cyber risk are considered and sets out examples of how to implement the framework. It is critical that insurers endeavour to understand cyber risk better and look to refine assumptions over time as new information is received. In addition to ensuring that sufficient capital is being held for key operational risks, the investment in understanding cyber risk now will help to educate senior management and could have benefits through influencing internal cyber security capabilities.
Cognitive behavioral therapy (CBT) is an effective treatment for many patients suffering from major depressive disorder (MDD), but predictors of treatment outcome are lacking, and little is known about its neural mechanisms. We recently identified longitudinal changes in neural correlates of conscious emotion regulation that scaled with clinical responses to CBT for MDD, using a negative autobiographical memory-based task.
We now examine the neural correlates of emotional reactivity and emotion regulation during viewing of emotionally salient images as predictors of treatment outcome with CBT for MDD, and the relationship between longitudinal change in functional magnetic resonance imaging (fMRI) responses and clinical outcomes. Thirty-two participants with current MDD underwent baseline MRI scanning followed by 14 sessions of CBT. The fMRI task measured emotional reactivity and emotion regulation on separate trials using standardized images from the International Affective Pictures System. Twenty-one participants completed post-treatment scanning. Last observation carried forward was used to estimate clinical outcome for non-completers.
Pre-treatment emotional reactivity Blood Oxygen Level-Dependent (BOLD) signal within hippocampus including CA1 predicted worse treatment outcome. In contrast, better treatment outcome was associated with increased down-regulation of BOLD activity during emotion regulation from time 1 to time 2 in precuneus, occipital cortex, and middle frontal gyrus.
CBT may modulate the neural circuitry of emotion regulation. The neural correlates of emotional reactivity may be more strongly predictive of CBT outcome. The finding that treatment outcome was predicted by BOLD signal in CA1 may suggest overgeneralized memory as a negative prognostic factor in CBT outcome.
We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.
Prospective, patient-level surveillance program of incident VRE colonization.
Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.
All patients admitted to the SICU from June to August 2015.
We conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test.
In total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001).
We recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.
We assess the gas-phase abundances of Si, C, and Fe from our recent measurements of Si++, C++, and Fe++ in the Orion Nebula by expanding on our earlier “blister” models. The Fe++ 22.9 μm line measured with the KAO yields Fe/H ~ 3 × 10−6 - considerably larger than in the diffuse ISM, where relative to solar, Fe/H is down by ~ 100. However, in Orion, Fe/H is still lower than solar by a factor ~ 10. The C and Si abundances are derived from new IUE high dispersion spectra of the C++ 1907, 1909 Å and Si++ 1883, 1892 Å lines. Gas-phase Si/C = 0.016 in the Orion ionized volume and is particularly insensitive to uncertainties in extinction and temperature structure. The solar value is 0.098. Gas-phase C/H = 3 × 10−4 and Si/H = 4.8 × 10−6. Compared to solar, Si is depleted by 0.135 in the ionized region, while C is essentially undepleted. This suggests that most Si and Fe resides in dust grains even in the ionized volume.
We apply a 2-D, axisymmetric code for modeling H II regions (Rubin Ap. J. 287, 653, 1984) to observations of the Orion Nebula. The model solves for the ionization and thermal structure and radiative transfer for the quasi-equilibrium volume. Assuming that the Orion Nebula is viewed face-on (along the symmetry axis) and that the geometry/density distribution is plane parallel with an exponential density gradient perpendicular to the slab, we use a x2 minimization technique to best fit the radio continuum maps. The best fit to the Schraml and Mezger map (Astrophys. J. 156, 269, 1969) has a density at the star of ∼1800 cm−3, a scale height of ∼0.23 pc, and ∼1.5x1049 ionizing photons s−1 so that ∼ 1/3 of the ionizing photons from the exciting source are escaping the nebula through the frontal density-bounded direction. Our model for Orion requires circular symmetry in the plane of the sky; nonsymmetrical features such as the ionization bar toward the SE cannot be reproduced. Further modeling that compares with line observations has been delayed to incorporate the important role played by recombinations in populating low-lying [O II] levels (Rubin 1985, Astrophys. J., submitted).
Twenty-eight 14C analyses are reported for carbonized roots and other plant material collected from beneath 15 prehistoric lava flows erupted from the northeast rift zone (NERZ) of Mauna Loa Volcano (ML) utilizing the recovery techniques of Lockwood and Lipman (1980). Most samples were collected from the Hilo 7 1/2’ quadrangle during field work for a geologic map of that quadrangle (Buchanan-Banks, unpub data); a few sample sites are located in adjacent quadrangles: Piihonua to the west and Mountain View to the south. Altitudes are given in English units as well as metric to facilitate locating sites on USGS topographic maps.
Ninety-six new 14C dates are reported for carbonized roots and other plant material coll from beneath prehistoric lava flows and ash deposits from Mauna Loa (ML) and Kilauea volcanoes. Before 1976, only 10 flows from these volcanoes had been dated by radiocarbon methods. Collection of dateable material has been facilitated by an improved understanding of the conditions of charcoal formation and preservation beneath basaltic lavas (Lockwood & Lipman, 1979).
We obtained new HST/STIS long-slit spectra and WFPC2 imagery of the planetary nebula NGC 7009 in order to obtain high spatial resolution of the intrinsic flux ratio [O III] 4364/5008, which is a well-known diagnostic for electron temperature (Te). Our primary purpose was to quantify Te variations across the nebula. We address whether the observational data support the possibility that the [fractional] mean-square Te variation (t2) (Peimbert 1967) in NGC 7009 may be as large as ~0.1. Such large values are required to reconcile the “abundance dichotomy” by Te variations alone. The abundance dichotomy (discussed by Liu at greater length elsewhere in this volume) refers to the significantly higher heavy element abundances derived from optical recombination lines (e.g., a factor of ~5 for NGC 7009, Liu et al. 1995) compared with the corresponding values deduced from collisionally-excited lines.
The soft X-ray transient (SXT) GRO J0422+32 (Nova Persei 1992) was detected with the Burst And Transient Source Experiment (BATSE) on board the CGRO on 1992 August 5 (Paciesas et al. 1992) (Truncated Julian Day [TJD] 8839). The source intensity of GRO J0422+32 increased rapidly, reaching a flux of ~ 3 Crab (40-230 keV) within days after its first detection (Harmon et al. 1992). Hereafter, the X-ray intensity of the source decreased exponentially with a decay time of ~ 43 days (Vikhlinin et al. 1995). A secondary maximum of the X-ray intensity was reached at TJD 8978, 139 days after the first detection of the source. The daily averaged flux history of GRO J0422+32 in the 40-150 keV energy band is presented in Figure 1.
The Medium-l Program of the Michelson Doppler Imager (MDI) instrument on board SOHO provides continuous observations of oscillation modes of angular degree, l, from 0 to ∼ 300. The initial results show that the noise in the Medium-l oscillation power spectrum is substantially lower than in ground-based measurements. This enables us to detect lower amplitude modes and, thus, to extend the range of measured mode frequencies. The MDI observations also reveal the asymmetry of oscillation spectral lines. The line asymmetries agree with the theory of mode excitation by acoustic sources localized in the upper convective boundary layer. The sound-speed profile inferred from the mean frequencies gives evidence for a sharp variation at the edge of the energy-generating core. In a thin layer just beneath the convection zone, helium appears to be less abundant than predicted by theory. Inverting the multiplet frequency splittings from MDI, we detect significant rotational shear in this thin layer.
The present report covers the period 1976–1978. As with previous reports it has not been possible to write an all- inclusive account covering everything published, or even every field under investigation; the number of contributions to extragalactic research is increasing enormously fast. Summaries of the papers may be found in the Astronomy and Astrophysics Abstracts.
The report is divided into ten sections, including the four Working Groups, and they have been prepared by the Vice-President, by members of the Organizing Committee and by the Chairmen of the Working Groups.
The present Report covers the period 1982-1984. As with previous Reports, it has not been possible to cover all publications or even every field of research. Some subsections of this Report, the Magellanic Clouds for example, report a body of work as extensive as that in some commissions.
The remarkable filament system seen in radio observations in the vicinity of the galactic center includes two thin filaments which arch away from the galactic plane (E.G. Yusef-Zadem et al 1984). The brightest part of each of these thermal structures is located at GO.10+0.02 and GO.07+0.04. Morris and Yusef-Zadem (1989) reason that photoionization by OB stars is unlikely on geometrical and morphological grounds. They suggest a magnetohydrodynamic mechanism to account for the radio emission and ionization. Erickson et al. (1968) were able to explain most of their observations of the far infrared (FIR) fine structure line emission from these locations in terms of a photoionization model.
To explore unilateral vocal fold paralysis patients' perception of a proposed randomised, controlled trial of laryngeal reinnervation versus thyroplasty, and to identify patients' concerns regarding their voice.
Seventeen patients from five voice clinics in London were identified as being eligible for the randomised, controlled trial. Eleven of these patients (9 females and 2 males; age range, 18–65 years) were interviewed using a semi-structured topic guide (they were given a minimum of 2 weeks to read through the study information sheet). The interviews were recorded, transcribed and analysed using thematic analysis.
The patients were satisfied with the clarity of the information sheet. Most of them perceived that reinnervation was a more ‘attractive’ option than thyroplasty. This may have been the result of certain phraseology used in the information sheet and by recruiters. Patients' main concern was reduced voice strength and the effects of this on work and social life.
Phraseology that needed changing was identified; these changes may optimise the recruitment process for a trial. We propose using the voice handicap index 10 as the primary measure of outcome in the proposed randomised, controlled trial.
We determine the glass forming range (GFR) of co-deposited Ni1−xZrx (0 < x < 1) thin films by measuring their electrical resistance during in situ constant-heating-rate anneals. The measured GFR is continuous for 0.10 < x < 0.87. We calculate the GFR of Ni-Zr melts as a function of composition and cooling rate using homogeneous nucleation theory and a published CALPHAD-type thermodynamic modeling of the equilibrium phase diagram. Assuming that the main competition to the retention of the amorphous structure during the cooling of the liquid comes from the partitionless crystallization of the terminal solid solutions, we calculate that for dT/dt = 1012 K s−1, the GFR extends to x = 0.05 and x = 0.96. Better agreement with the measured values is obtained assuming a lower ‘effective’ cooling rate during the condensation of the films.