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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.
Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) “secret shopper” method and (2) to pilot test a novel feedback tool.
Quality improvement project using a quasi-experimental stepped-wedge design.
This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States.
Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016–September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method.
The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84–1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82–10.95).
HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.
To evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.
Academic medical center with single-occupancy rooms.
We compared hospital reportable adverse events 1 year before and 1 year after discontinuation of routine CP for endemic MRSA and VRE (preintervention and postintervention periods, respectively). Throughout the preintervention period, daily chlorhexidine gluconate bathing was expanded to nearly all inpatients. Chart reviews were performed to identify which patients and events were associated with CP for MRSA/VRE in the preintervention period as well as the patients that would have met prior criteria for MRSA/VRE CP but were not isolated in the postintervention period. Adverse events during the 2 periods were compared using segmented and mixed-effects Poisson regression models.
There were 24,732 admissions in the preintervention period and 25,536 in the postintervention period. Noninfectious adverse events (ie, postoperative respiratory failure, hemorrhage/hematoma, thrombosis, wound dehiscence, pressure ulcers, and falls or trauma) decreased by 19% (12.3 to 10.0 per 1,000 admissions, P=.022) from the preintervention to the postintervention period. There was no significant difference in the rate of infectious adverse events after CP discontinuation (20.7 to 19.4 per 1,000 admissions, P=.33). Patients with MRSA/VRE showed the largest reduction in noninfectious adverse events after CP discontinuation, with a 72% reduction (21.4 to 6.08 per 1,000 MRSA/VRE admissions; P<.001).
After discontinuing routine CP for endemic MRSA/VRE, the rate of noninfectious adverse events declined, especially in patients who no longer required isolation. This suggests that elimination of CP may substantially reduce noninfectious adverse events.
From 2000 to 2009, rates of multidrug-resistant Acinetobacter baumanii increased 10-fold to 0.2 per 1,000 patient days. From 2010 to 2015, however, rates markedly declined and have stayed below 0.05 per 1,000 patient days. Herein, we present a 15-year trend analysis and discuss interventions that may have led to the decline.
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).
Primary progressive aphasia (PPA) affects a range of language and cognitive domains that impact on conversation. Little is known about conversation breakdown in the semantic variant of PPA (svPPA, also known as semantic dementia). This study investigates conversation of people with svPPA.
Dyadic conversations about everyday activities between seven individuals with svPPA and their partners, and seven control pairs were video recorded and transcribed. Number of words, turns, and length of turns were measured. Trouble-indicating behaviors (TIBs) and repair behaviors were categorized and identified as successful or not for each participant in each dyad.
In general, individuals with svPPA were active participants in conversation, taking an equal proportion of turns, but indicating a great deal of more trouble in conversation, shown by the significantly higher number of TIBs than evidenced by partners or control participants. TIBs were interactive (asking for confirmation with a shorter repetition of the original utterance or a repetition which included a request for specific information) and non-interactive (such as failing to take up or continue the topic or a minimal response) and unlike those previously reported for people with other PPA variants and dementia of the Alzheimer type. Communication behaviors of the partner were critical to conversational success.
Examination of trouble and repair in 10-min conversations of individuals with svPPA and their important communication partners has potential to inform speech pathology interventions to enhance successful conversation, in svPPA and should be an integral part of the comprehensive care plan.
Objectives: The current study examines whether psychosocial outcomes following pediatric traumatic brain injury (TBI) vary as a function of children’s rejection sensitivity (RS), defined as their disposition to be hypersensitive to cues of rejection from peers. Methods: Children ages 8–13 with a history of severe TBI (STBI, n=16), complicated mild/moderate TBI (n=35), or orthopedic injury (OI, n=49) completed measures assessing self-esteem and RS on average 3.28 years post-injury (SD=1.33, range=1.25–6.34). Parents reported on their child’s emotional and behavioral functioning and social participation. Results: Regression analyses found moderation of group differences by RS for three outcomes: social participation, self-perceptions of social acceptance, and externalizing behavior problems. Conditional effects at varying levels of RS indicated that externalizing problems and social participation were significantly worse for children with STBI at high levels of RS, compared to children with OI. Social participation for the STBI group remained significantly lower than the OI group at mean levels of RS, but not at low levels of RS. At high levels of RS, self-perceptions of social acceptance were lower for children with moderate TBI compared to OI, but group differences were not significant at mean or low levels of RS. No evidence of moderation was found for global self-worth, self-perceptions of physical appearance or athletic ability, or internalizing problems. Conclusions: The findings highlight the salient nature of social outcomes in the context of varying levels of RS. These findings may have implications for the design of interventions to improve social outcomes following TBI. (JINS, 2017, 23, 451–459)
Environmental exposures during pregnancy may increase breast cancer risk for mothers and female offspring. Tumor tissue assays may provide insight regarding the mechanisms. This study assessed the feasibility of obtaining tumor samples and pathology reports from mothers (F0) who were enrolled in the Child Health and Development Studies during pregnancy from 1959 to 1967 and their daughters (F1) who developed breast cancer over more than 50 years of follow-up. Breast cancer cases were identified through linkage to the California Cancer Registry and self-report. Written consent was obtained from 116 F0 and 95 F1 breast cancer survivors to access their pathology reports and tumor blocks. Of those contacted, 62% consented, 13% refused and 24% did not respond. We obtained tissue samples for 57% and pathology reports for 75%, and if diagnosis was made ⩽10 years we obtained tissue samples and pathology reports for 91% and 79%, respectively. Obtaining pathology reports and tumor tissues of two generations is feasible and will support investigation of the relationship between early-life exposures and molecular tumor markers. However, we found that more recent diagnosis increased the accessibility of tumor tissue. We recommend that cohorts request consent for obtaining future tumor tissues at study enrollment and implement real-time tissue collection to enhance success of collecting tumor samples and data.
To evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system.
We compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing.
Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million).
Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery.
The Aquia (Paleocene) and Magothy (Late Cretaceous) Formations of the Atlantic Coastal Plain represent two well-characterized (hydrodynamically and geochemically) aquifers in southern Maryland. 14C measurements of the dissolved organic (DOC) and inorganic carbon (DIC) of Aquia and Magothy groundwaters have been made using accelerator mass spectrometry (AMS). Both DI14C and DO14C concentrations in the initial flow path are unexpectedly low. As the water progresses farther from the recharge area, the DI14C percent modern carbon (pMC) is consistently lower than the DO14C pMC; this difference stays constant for all samples. The 14C-derived ages for an Aquia water sample downgradient at Site 4 are 17 ka and 12 ka for DI14C and DO14C, respectively. Radiocarbon ages have been compared to ages determined by two other independent dating methods: computer-simulated hydrodynamic modeling and age estimates based on changes in Cl−, 18O and 2H distributions, which are interpreted to be influenced by sea level and climate.
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).
An MP tandem Van de Graaff accelerator at the University of Rochester has been employed since May 1977 to detect 14C in various terrestrial samples. The carbon sample sizes required are 1mg or less. Dating accuracies based on reproducibility now approach (± 80 years). Measurements have been made on 1850 wood, Australian sucrose, a carbon sample from Mt Shasta, a baby woolly mammoth, and an Egyptian bull mummy wrapping.
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.
We present new far-infrared line observations of the planetary nebulae (PNs) NGC 7027, NGC 7009, NGC 6210, NGC 6543, and IC 4997 obtained with the Kuiper Airborne Observatory (KAO). The bulk of our data are for NGC 7027 and NGC 7009, including [Ne V] 24 μm, [O IV] 26 μm, [O III] (52, 88μm), and [Nm] 57 μm. Our data for [O III] (52, 88) and [N III] 57 in NGC 7027 represent the first measurements of these lines in this source. The large [O III] 52/88 flux ratio implies an electron density (cm–3) of log Ne[O III] = 4.19, the largest Ne ever inferred from these lines. We derive N++/O++ = 0.394±0.062 for NGC 7027 and 0.179±0.043 for NGC 6210. We are able to infer the O+3/O++ ionic ratio from our data. As gauged by this ionic ratio, NGC 7027 is substantially higher ionization than is NGC 7009 – consistent with our observation that the former produces copious [Ne V] emission while the latter does not. These data help characterize the stellar ionizing radiation field.