How Do I Assess Our Cyber Risk?

The question “How do I assess our cyber risk?” addresses how to identify and characterize cyber risk unique to an organization’s critical systems, networks, and data. The chapter begins with a case study about a cyberattack on Ukraine’s electric grid. It details risk assessment for three types of critical systems: mission-critical systems, business-critical systems, and safety-critical systems. It explains the three types of networks critical to many organizations: business and administrative networks, operational and service delivery networks, and communication networks. In outlining the “CIA triad,” it shows how cyber risk can be characterized as a confidentiality, integrity, or availability issue relating to digital assets. Further, it describes how to assess the importance of different digital assets and how to prioritize them using a business impact analysis (BIA). The chapter concludes with real-world Embedded Endurance strategy lessons Rosenbach gained in Saudi Arabia in the wake of one of the world’s most destructive cyberattacks.

Discordance between Treatment Guideline Recommendations and Real-World Practice in a Group of Large Integrated Delivery Networks for Venous Thromboembolism (VTE) Patients: A Closer Look at VTE Patients with Cancer

Background: For patients with VTE, current American Society of Hematology (ASH) guideline panel suggests using direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) where VKAs are required to be bridged with a parenteral anticoagulant (PAC). For patients with VTE and cancer, current guidelines recommend DOACs over low molecular weight heparin (LMWH) and LMWH over unfractionated heparin (heparin) for the initial treatment of VTE. Limited evidence is available about the patterns of anticoagulant treatment for VTE in routine clinical practice of large healthcare delivery networks in the United States (US) and whether the VTE treatments are aligned with current guidelines. This study aimed to assess real-world anticoagulant treatment patterns among VTE patients using harmonized electronic health record (EHR) data from four Integrated Delivery Networks (IDNs) in the US. Methods: This was a retrospective, longitudinal, multicenter, cohort study using harmonized EHR data from both inpatient and outpatient settings. The study population included adult patients prescribed DOACs, warfarin, and/or PAC therapy as inpatient or outpatient treatment within ≤30 days of VTE diagnosis, between June 2015 through May 2018. Data from the four IDNs was pooled to describe demographic characteristics and treatment patterns among VTE patients overall and by subgroups. Results: A total of 10,527 patients who were treated with OACs after VTE diagnosis were included for analysis. The mean (SD) age was 61.9 (5.98) years, with 46.1% aged 65 or older. More than half (53.2%) were female, and White patients comprised the majority (74.4%), followed by African American patients (22.8%). Obese and morbidly obese patients comprised 39.1% and 16.1% of patients, respectively. Among all VTE patients, warfarin-only (n=3545; 33.7%) was the most commonly used OAC treatment, followed by warfarin + PAC (n=3128; 29.7%), rivaroxaban-only (n=1357; 12.9%), rivaroxaban + PAC (n=853; 8.1%), apixaban + PAC (n=839; 8.0%), apixaban-only (n=762; 7.2%), and Other OAC (n=357; 3.4%) (Table 1). When stratifying VTE patients by age, gender, race and BMI, some variations in OAC treatment were observed. Among both older (≥65 years) and younger (<65 years) patients, warfarin-only was most commonly used, then warfarin + PAC. Warfarin-only was more commonly used among obese (36.3%) and morbidly obese (40.4%) patients than non-obese (29.8%) patients. OAC treatment patterns were generally comparable among men and women. Among White patients, approximately equal proportions of patients received warfarin + PAC (31.9%) and warfarin-only (31.0%). However, among African-American patients, a higher proportion of patients used warfarin-only (40.9%) vs. warfarin + PAC (24.5%). Patterns of anticoagulant treatments including OACs and/or parental anticoagulants among VTE patients with cancer were further analyzed (Figure 1). Among VTE patients with cancer (n=3657), heparin had the highest use (26.7%), then enoxaparin (22.7%); approximately the same proportion of cancer patients received warfarin-only (16.0%) and warfarin + PAC (16.9%). Of DOACs, rivaroxaban-only was the most commonly used treatment (4.9%), then apixaban + PAC (3.5%), and lastly, rivaroxaban + PAC (3.4%) among cancer patients. Conclusion: Current VTE treatment guidelines recommend warfarin to be bridged with PAC, however, warfarin-only therapy remained the most used treatment option followed by warfarin + PAC. While rivaroxaban and apixaban are not required to be bridged with PAC, such practices were observed for a large proportion of apixaban- and rivaroxaban-treated VTE patients. VTE treatment among patients with cancer was not completely aligned with current guidelines, as heparin was more commonly used than LMWH (enoxaparin). Our findings suggest greater efforts are needed to improve anticoagulant treatment practices among VTE patients. Figure 1 Figure 1. Disclosures Dhamane: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Rosenblatt: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Jiang: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Guo: Bristol Myers Squibb: Ended employment in the past 24 months. Dorsch: Agency for Health Research and Quality: Research Funding; National Institutes of Health/National Institute of Aging: Research Funding; American Health Association Health IT Research Network: Research Funding; Janssen Pharmaceuticals: Honoraria; Bristol Myers Squibb/Pfizer: Research Funding; Amgen: Research Funding. Luo: Pfizer Inc: Current Employment, Current equity holder in publicly-traded company.

Online Service Function Chain Deployment for Live-Streaming in Virtualized Content Delivery Networks: A Deep Reinforcement Learning Approach

Video delivery is exploiting 5G networks to enable higher server consolidation and deployment flexibility. Performance optimization is also a key target in such network systems. We present a multi-objective optimization framework for service function chain deployment in the particular context of Live-Streaming in virtualized content delivery networks using deep reinforcement learning. We use an Enhanced Exploration, Dense-reward mechanism over a Dueling Double Deep Q Network (E2-D4QN). Our model assumes to use network function virtualization at the container level. We carefully model processing times as a function of current resource utilization in data ingestion and streaming processes. We assess the performance of our algorithm under bounded network resource conditions to build a safe exploration strategy that enables the market entry of new bounded-budget vCDN players. Trace-driven simulations with real-world data reveal that our approach is the only one to adapt to the complexity of the particular context of Live-Video delivery concerning the state-of-art algorithms designed for general-case service function chain deployment. In particular, our simulation test revealed a substantial QoS/QoE performance improvement in terms of session acceptance ratio against the compared algorithms while keeping operational costs within proper bounds.

Engaging Diverse Stakeholders in Interdisciplinary Co-Design Project for Better Service Design

The rapid development of information technology (IT) has enabled digital services to evolve continually and support a growing number of internet-enabled devices, along with user diversity. The end-user anticipation within the smart environments, which are internet-enabled, delivery networks and innovative technologies. What tools/methods can support the collaborative design and effectively choreograph the design process with dynamic knowledge between service designers and service users? The cooperative design is recognizable in the design environment with a collection wide-ranged by co-design methods and tools. In-depth interviews uncover contextually appropriate design process requirements from diverse stakeholder groups. A collection of design tools and methods are selected and implemented within a Web-based co-design platform. Uncovered design requirements are subsequently applied in extending the Double Diamond framework prior to operationalization into a design process blueprint with supporting service design tool selection as the main contributions for this paper.

Cost Optimization for Dynamic Content Delivery in Cloud-Based Content Delivery Network

Cloud computing is a technology to store, process, and manage the data virtually over remote data centers through the internet. Due to the rapid growth of cloud services, the content distribution network broadly uses them to deliver data all over the globe. Due to the rapid generation of the data, delivering on the network is a challenging problem. As the number of replicas increases, the storage cost will be increased. This is a major issue in cloud-based content delivery networks. To overcome this issue, the authors developed a new model for cloud-based CDN with cost optimization algorithm STLM (storage, traffic, latency, cost minimization) to reduce the number of replicas in order to optimize the cost of storage and cost of content delivery. The authors have compared their proposed STLM algorithm with other existing algorithms. They adopt simulation with YouTube e-learning data retrieval. The proposed algorithm is used to place the contents in an efficient way to the geologically dispersed proxy servers in the cloud to encounter quality of service (QoS) and quality of experience (QoE).

How Does China Promote Integrated Care Development? A Policy Content Analysis

Background: Multiple countries' experiences have illustrated that integrated care is an ideal choice regarding improving the quality of health care. In China, the central government has enacted a large number of policies to promote the development of integrated care in recent years. Yet, no existing research has examined how these policies to support the development of integrated care. In this paper we seek to address that gap. Methods: Document content analysis method was used in this paper. Data were collected by carrying out a review of integrated care policies (N=21) published from January 2015 to December 2020. The policy documents of integrated care issued by central governments are retrieved through the Internet. IHSDNSs (Integrated Health Service Delivery Networks)’s essential attributes framework was used to guide data analysis. Results: The most commonly referenced principal domains of integrated care in China were model of care, there were 45 references to the organization and management, financial allocation and incentives was the least often referenced source of information. The main purpose of reference to information was to support the reform of integrated care decision-making. Conclusions: A whole range of policies on integrated care were issued in a relatively short time. These policies propose a macro conceptual and operational framework for the development of integrated care. The development of integrated care has been mainly driven by the policy stimulus in China. However, the concrete measures still need clear negotiation and management by the local municipalities. Future policy should improve complementary policies such as financial allocation and financial incentive policy.