Search

Your search keyword '"Shulman A"' showing total 50,173 results
Start Over Author "Shulman A"
50,173 results on '"Shulman A"'

106. Poster: The Unintended Consequences of Algorithm Agility in DNSSEC

Author

Heftrig, Elias, Shulman, Haya, and Waidner, Michael

Subjects
Computer Science - Cryptography and Security
Abstract

Cryptographic algorithm agility is an important property for DNSSEC: it allows easy deployment of new algorithms if the existing ones are no longer secure. In this work we show that the cryptographic agility in DNSSEC, although critical for provisioning DNS with strong cryptography, also introduces a vulnerability. We find that under certain conditions, when new algorithms are listed in signed DNS responses, the resolvers do not validate DNSSEC. As a result, domains that deploy new ciphers may in fact cause the resolvers not to validate DNSSEC. We exploit this to develop DNSSEC-downgrade attacks and experimentally and ethically evaluate them against popular DNS resolver implementations, public DNS providers, and DNS services used by web clients worldwide. We find that major DNS providers as well as 45% of DNS resolvers used by web clients are vulnerable to our attacks., Comment: This work has been accepted for publication at the ACM SIGSAC Conference on Computer and Communications Security (CCS 22)

Published
2022
Full Text
View/download PDF

107. From IP to transport and beyond: cross-layer attacks against applications

Author

Dai, Tianxiang, Jeitner, Philipp, Shulman, Haya, and Waidner, Michael

Subjects
Computer Science - Cryptography and Security
Abstract

We perform the first analysis of methodologies for launching DNS cache poisoning: manipulation at the IP layer, hijack of the inter-domain routing and probing open ports via side channels. We evaluate these methodologies against DNS resolvers in the Internet and compare them with respect to effectiveness, applicability and stealth. Our study shows that DNS cache poisoning is a practical and pervasive threat. We then demonstrate cross-layer attacks that leverage DNS cache poisoning for attacking popular systems, ranging from security mechanisms, such as RPKI, to applications, such as VoIP. In addition to more traditional adversarial goals, most notably impersonation and Denial of Service, we show for the first time that DNS cache poisoning can even enable adversaries to bypass cryptographic defences: we demonstrate how DNS cache poisoning can facilitate BGP prefix hijacking of networks protected with RPKI even when all the other networks apply route origin validation to filter invalid BGP announcements. Our study shows that DNS plays a much more central role in the Internet security than previously assumed. We recommend mitigations for securing the applications and for preventing cache poisoning.

Published
2022
Full Text
View/download PDF

108. Stalloris: RPKI Downgrade Attack

Author

Hlavacek, Tomas, Jeitner, Philipp, Mirdita, Donika, Shulman, Haya, and Waidner, Michael

Subjects
Computer Science - Cryptography and Security, Computer Science - Networking and Internet Architecture
Abstract

We demonstrate the first downgrade attacks against RPKI. The key design property in RPKI that allows our attacks is the tradeoff between connectivity and security: when networks cannot retrieve RPKI information from publication points, they make routing decisions in BGP without validating RPKI. We exploit this tradeoff to develop attacks that prevent the retrieval of the RPKI objects from the public repositories, thereby disabling RPKI validation and exposing the RPKI-protected networks to prefix hijack attacks. We demonstrate experimentally that at least 47% of the public repositories are vulnerable against a specific version of our attacks, a rate-limiting off-path downgrade attack. We also show that all the current RPKI relying party implementations are vulnerable to attacks by a malicious publication point. This translates to 20.4% of the IPv4 address space. We provide recommendations for preventing our downgrade attacks. However, resolving the fundamental problem is not straightforward: if the relying parties prefer security over connectivity and insist on RPKI validation when ROAs cannot be retrieved, the victim AS may become disconnected from many more networks than just the one that the adversary wishes to hijack. Our work shows that the publication points are a critical infrastructure for Internet connectivity and security. Our main recommendation is therefore that the publication points should be hosted on robust platforms guaranteeing a high degree of connectivity.

Published
2022

109. The Hijackers Guide To The Galaxy: Off-Path Taking Over Internet Resources

Author

Dai, Tianxiang, Jeitner, Philipp, Shulman, Haya, and Waidner, Michael

Subjects
Computer Science - Cryptography and Security
Abstract

Internet resources form the basic fabric of the digital society. They provide the fundamental platform for digital services and assets, e.g., for critical infrastructures, financial services, government. Whoever controls that fabric effectively controls the digital society. In this work we demonstrate that the current practices of Internet resources management, of IP addresses, domains, certificates and virtual platforms are insecure. Over long periods of time adversaries can maintain control over Internet resources which they do not own and perform stealthy manipulations, leading to devastating attacks. We show that network adversaries can take over and manipulate at least 68% of the assigned IPv4 address space as well as 31% of the top Alexa domains. We demonstrate such attacks by hijacking the accounts associated with the digital resources. For hijacking the accounts we launch off-path DNS cache poisoning attacks, to redirect the password recovery link to the adversarial hosts. We then demonstrate that the adversaries can manipulate the resources associated with these accounts. We find all the tested providers vulnerable to our attacks. We recommend mitigations for blocking the attacks that we present in this work. Nevertheless, the countermeasures cannot solve the fundamental problem - the management of the Internet resources should be revised to ensure that applying transactions cannot be done so easily and stealthily as is currently possible.

Published
2022

110. Injection Attacks Reloaded: Tunnelling Malicious Payloads over DNS

Author

Jeitner, Philipp and Shulman, Haya

Subjects
Computer Science - Cryptography and Security, Computer Science - Networking and Internet Architecture
Abstract

The traditional design principle for Internet protocols indicates: "Be strict when sending and tolerant when receiving" [RFC1958], and DNS is no exception to this. The transparency of DNS in handling the DNS records, also standardised specifically for DNS [RFC3597], is one of the key features that made it such a popular platform facilitating a constantly increasing number of new applications. An application simply creates a new DNS record and can instantly start distributing it over DNS without requiring any changes to the DNS servers and platforms. Our Internet wide study confirms that more than 1.3M (96% of tested) open DNS resolvers are standard compliant and treat DNS records transparently. In this work we show that this `transparency' introduces a severe vulnerability in the Internet: we demonstrate a new method to launch string injection attacks by encoding malicious payloads into DNS records. We show how to weaponise such DNS records to attack popular applications. For instance, we apply string injection to launch a new type of DNS cache poisoning attack, which we evaluated against a population of open resolvers and found 105K to be vulnerable. Such cache poisoning cannot be prevented with common setups of DNSSEC. Our attacks apply to internal as well as to public services, for instance, we reveal that all eduroam services are vulnerable to our injection attacks, allowing us to launch exploits ranging from unauthorised access to eduroam networks to resource starvation. Depending on the application, our attacks cause system crashes, data corruption and leakage, degradation of security, and can introduce remote code execution and arbitrary errors. In our evaluation of the attacks in the Internet we find that all the standard compliant open DNS resolvers we tested allow our injection attacks against applications and users on their networks.

Published
2022

111. Acute health care use among children during the first 2.5 years of the COVID-19 pandemic in Ontario, Canada: a population-based repeated cross-sectional study

Author

Iskander, Carina, Stukel, Therese A., Diong, Christina, Guan, Jun, Saunders, Natasha, Cohen, Eyal, Brownell, Marni, Mahar, Alyson, Shulman, Rayzel, Gandhi, Sima, and Guttmann, Astrid

Subjects
Medical care -- Utilization, Diabetes, Children -- Health aspects, Infants (Newborn), Health
Abstract

Background: The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic. Methods: We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care. Results: All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34). Interpretation: In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention., Although the direct impact of COVID-19 on children has been less severe than among adults, the indirect effect of the pandemic related to deferred care may confer important health consequences. [...]

Published
2023
Full Text
View/download PDF

112. The opioid use disorder core outcomes set (OUD-COS) for treatment research: findings from a Delphi consensus study.

Author

Karnik, Niranjan, Marsden, John, McCluskey, Connor, Boley, Randy, Bradley, Katharine, Campbell, Cynthia, Curtis, Megan, Fiellin, David, Ghitza, Udi, Hefner, Kathryn, Hser, Yih-Ing, McHugh, R, McPherson, Sterling, Mooney, Larissa, Moran, Landhing, Murphy, Sean, Schwartz, Robert, Shmueli-Blumberg, Dikla, Shulman, Matisyahu, Stephens, Kari, Watkins, Katherine, Weiss, Roger, and Wu, Li-Tzy

Subjects
Core outcomes set, Delphi consensus, US National Institute on Drug Abuse, efficacy and effectiveness research, opioid treatment cascade, opioid use disorder, Analgesics, Opioid, Consensus, Delphi Technique, Humans, Opioid-Related Disorders, Outcome Assessment, Health Care, Research Design, United States
Abstract

BACKGROUND AND AIM: There is no gold-standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD-COS). DESIGN: Four-round, e-Delphi expert panel consensus study and plenary research group discussion and targeted consultation. SETTING: United States. PARTICIPANTS: A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the networks affiliated clinical and community sites and the NIDA Centre for the CTN. MEASUREMENTS: From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on-line questionnaire to rank items with defined specification on a 9-point scale for importance, with a standard 70% consensus criterion. FINDINGS: After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient-reported (global impression of improvement and incident non-fatal overdose); one clinician-reported (illicit/non-medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). CONCLUSIONS: An e-Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research.

Published
2022

114. Prevalence and predictors of HIV among patients presenting to US emergency departments with opioid overdose

Author

Levine, Michael, Culbreth, Rachel, Amaducci, Alexandra, Calello, Diane P., Shulman, Joshua, Judge, Bryan, Love, Jennifer, Hughes, Adrienne, Schwarz, Evan S., Carpenter, Joseph, Wax, Paul, Aldy, Kim, Krotulski, Alex J., Logan, Barry K., Buchanan, Jennie, Brent, Jeffrey, Meaden, Christopher W., Hendrickson, Robert G., Abston, Stephanie, Li, Shao, Campleman, Sharan, and Manini, Alex F.

Published
2024
Full Text
View/download PDF

117. Environmental surveillance of a circulating vaccine-derived poliovirus type 2 outbreak in Israel between 2022 and 2023: a genomic epidemiology study

Author

Zuckerman, Neta S, Bucris, Efrat, Morad-Eliyahu, Hagar, Weiss, Leah, Vasserman, Rinat, Fratty, Ilana S, Aguvaev, Ira, Cohen-Said, Zvi, Matar, Rua, Erster, Oran, Shulman, Lester M, Yishai, Ruth, Hecht-Sagie, Lior, Alroy-Preis, Sharon, Mendelson, Ella, Lustig, Yaniv, Sofer, Danit, Bar-Or, Itay, and Weil, Merav

Published
2024
Full Text
View/download PDF

119. Return of genetic research results in 21,532 individuals with autism

Author

Aarrestad, Alexandria, Abbeduto, Leonard, Aberbach, Gabriella, Aberle, Shelley, Adegbite, Adediwura, Adeniji, Debbie, Aguilar, Maria, Ahlers, Kaitlyn, Albright, Charles, Alessandri, Michael, Algaze, Zach, Alkazi, Jasem, Amador, Raquel, Amaral, David, Amon, Logan, Amundsen, Leonor, Andrus, Alicia, Anglo, Claudine, Annett, Robert, Arar, Adam, Arnold, Jonathan, Arriaga, Ivette, Arzate, Eduardo, Ashley, Raven, Aslamy, Leilemah, Baalman, Kelli, Baer, Melissa, Bahi, Ethan, Bailey, Joshua, Baldlock, Zachary, Banks, Grabrielle, Baraghoshi, Gabriele, Bardett, Nicole, Barrett, Mallory, Bartholomew, Yan, Bates, Heidi, Beard, Katie, Becerra, Juana, Beckwith, Malia, Beechan, Paige, Beeson, Landon, Beeson, Josh, Bell, Brandi, Belli, Monica, Bentley, Dawn, Berger, Natalie, Berman, Anna, Bernier, Raphael, Berry-Kravis, Elizabeth, Berwanger, Mary, Birdwell, Shelby, Blank, Elizabeth, Bond, Rebecca, Booker, Stephanie, Bordofsky, Aniela, Bower, Erin, Bowers, Lukas, Bradley, Catherine, Brayer, Heather, Brewster, Stephanie, Brown, Hallie, Brown, Alison, Brown, Melissa, Buck, Catherine, Buescher, Cate, Bullon, Kayleigh, Buraima, Joy, Butter, Eric, Caamano, Amalia, Cacciato, Nicole, CaI, Wenteng, Calderon, Norma, Callahan, Kristen, Camba, Alexies, Campo-Soria, Claudia, Caprara, Giuliana, Carbone, Paul, Carpenter, Laura, Carpenter, Sarah, Casseus, Myriam, Casten, Lucas, Catherine, Sullivan, Chappo, Ashley, Chavez, Kimberly, Cheathem-Johnson, Randi, Chen, Tia, Chintalapalli, Sharmista, Cho, Daniel, Choi, Y.B., Clark, Nia, Clark, Renee, Coffman, Marika, Coleman, Laura, Coleman, Kendra, Collins, Alister, Columbi, Costanza, Comitre, Joaquin, Constant, Stephanie, Contra, Arin, Conyers, Sarah, Cooper, Lindsey, Cooper, Cameron, Coppola, Leigh, Corlett, Allison, Corrales, Lady, Correa, Dahriana, Cottrell, Hannah, Coughlin, Michelle, Courchesne, Eric, Coury, Dan, Crocetti, Deana, Croson, Carrie, Crowell, Judith, Cubells, Joseph, Cunningham, Sean, Currin, Mary, Cutri, Michele, D'Ambrosi, Sophia, David, Giancarla, Davis, Ayana, Davis, Sabrina, Decius, Nickelle, Delaporte, Jennifer, DeMarco, Lindsey, Dennis, Brandy, Deronda, Alyssa, Dhawan, Esha, Dichter, Gabriel, Doan, Ryan, Dominick, Kelli, Ortega, Leonardo Dominquez, Doyle, Erin, Drayton, Andrea, DuBois, Megan, Dudley, Johnny, Duhon, Gabrielle, Duncan, Grabrielle, Duncan, Amie, Dunlevy, Megan, Dyer, Meaghan, Earl, Rachel, Edmonson, Catherine, Eldred, Sara, Elliott, Nelita, Emery, Brooke, Enright, Barbara, Erb, Sarah, Erickson, Craig, Esler, Amy, Estevez, Liza, Fanta, Anne, Fassler, Carrie, Fatemi, Ali, Fazal, Faris, Featherston, Marilyn, Ferguson, Jonathan, Fish, Angela, Fitzgerald, Kate, Flores, Kathleen, Fombonne, Eric, Foster, Margaret, Fowler, Tiffany, Fox, Emma, Fox, Emily, Francis, Sunday, Frayne, Margot, Froman, Sierra, Fuller, Laura, Galbraith, Virginia, Gallimore, Dakota, Gambrell, Ariana, Gazestani, Vahid, Geisheker, Madeleine R., Gerdts, Jennifer, Geschwind, Daniel, Ghaziuddin, Mohammad, Ghina, Haidar, Given, Erin, Goetz, Mykayla, Gong, Jared, Gonring, Kelsey, Gonzalez, Natalia, Gonzalez, Antonio, Goodwill, Ellie, Gordon, Rachel, Graham, Carter, Gray, Catherine, Grimes, Ellen, Griswold, Anthony, Gu, Pan, Guilfoyle, Janna, Gulsrud, Amanda, Gunderson, Jaclyn, Gunter, Chris, Gupta, Sanya, Gupta, Abha, Gutierrez, Anibal, Gwynette, Frampton, Haidar, Ghina, Hale, Melissa, Haley, Monica, Hall, Lauren K., Hamer, Kira, Hamilton, Piper, Hanna, Nathan, Hardan, Antonio, Harkins, Christina, Harrell, Eldric, Harris, Jill, Harris, Nina, Hayes, Caitlin, Hayse, Braden, Heckers, Teryn, Heerwagen, Kathryn, Hennelly, Daniela, Herbert, Lynette, Hermle, Luke, Hernandez, Briana, Herrera, Clara, Hess, Amy, Heyman, Michelle, Higgins, Lorrin, Phillips, Brittani Hilscher, Hirst, Kathy, Ho, Theodore, Hoffman, Emily, Hojlo, Margaret, Honaker, Makayla, Hong, Michael, Hooks, Gregory, Horner, Susannah, Horton, Danielle, Hounchell, Melanie, Howes, Dain, Huang-Storm, Lark, Hunter, Samantha, Hutter, Hanna, Hyde, Emily, Ibanez, Teresa, Ingram, Kelly, Istephanous, Dalia, Jacob, Suma, Jarratt, Andrea, Jelinek, Anna, Johnson, Mary, Jones, Mya, Jones, Garland, Jones, Mark, Jorgenson, Alissa, Judge, Jessyca, Kalb, Luther, Kalmus, Taylor, Kang, Sungeun, Kangas, Elizabeth, Kanne, Stephen, Kaplan, Hannah, Khan, Sara, Kim, Sophy, Kim, Annes, Kitaygordsky, Alex, Klaiman, Cheryl, Klever, Adam, Koene, Hope, Koomar, Tanner, Koza, Melinda, Kramer, Sydney, Krushena, Meghan, Kurtz-Nelson, Eva, Lamarche, Elena, Lampert, Erica, Lamy, Martine, Landa, Rebecca, Lebron-Cruz, Alexa, Lechniak, Holly, Lee, Soo, Leight, Bruce, Lerner, Matthew, Lesher, Laurie, Lewis, Courtney, Li, Hai, Li, Deana, Libove, Robin, Lillie, Natasha, Limon, Danica, Limpoco, Desi, Lin, Melody, Littlefield, Sandy, Lobisi, Brandon, Locarno, Laura, Long, Nancy, Long, Bailey, Long, Kennadie, Lopez, Marilyn, Lovering, Taylor, Lozano, Ivana, Lucio, Daniella, Luo, Addie, Luu, My-Linh, Lyon, Audrey, Ma, Julia, Madi, Natalie, Malloch, Lacy, Mankaryous, Reanna, Manning, Patricia, Mantey, Alvin, Marini, Richard, Marsden, Alexandra, Marwali, Clarissa, Marzano, Gabriela, Mason, Andrew, Mastel, Sarah, Mathai, Sheena, Matthews, Emily, Matusoff, Emma, Maxim, Clara, McCarthy, Caitlin, McClellen, Lynn, Mccoy, Nicole, McCullough, Kaylen, McDonald, Brooke, McGalliard, Julie, McIntyre, Anne-Marie, McKenna, Brooke, McKenzie, Alexander, McTaggart, Megan, Meinen, Hannah, Melnyk, Sophia, Miceli, Alexandra, Michaels, Sarah, Michaelson, Jacob, Milan, Estefania, Miller, Melissa, Milliken, Anna, Minton, Kyla, Mitchell, Terry, Gunn, Amanda Moffitt, Mohiuddin, Sarah, Money, Gina, Montezuma, Jessie, Mooney, Lindsey, Moore, Margo, Morales-Lara, Amy, Morgan, Kelly, Morotti, Hadley, Morrier, Michael, Munoz, Maria, Lavanderos, Ambar Munoz, Murali, Shwetha, Murillo, Karla, Murray, Kailey, Myhre, Erin, Neely, Jason, Neuhaus, Emily, Newman, Olivia, Nguyen, Richard, Nguyen, Victoria, Nichols, Evelyn, Nicholson, Amy, Niederhauser, Melanie, Norris, Megan, Norton, Shai, Nowell, Kerri, O’Brien, Kaela, O’Meara, Mitchell, O’Neil, Molly, O'Roak, Brian, Ocampo, Edith, Ochoa-Lubinoff, Cesar, Oft, Anna, Orobio, Jessica, Ortiz, Crissy, Ousley, Opal, Oyeyemi, Motunrayo, Pacheco, Lillian, Palacios, Valeria, Palmer, Samiza, Palmeri, Isabella, Pama, Katrina, Pandey, Juhi, Paolicelli, Anna Marie, Parker, Jaylaan, Patterson, Morgan, Pawlowski, Katherine, Pedapati, Ernest, Pepper, Michah, Perrin, Jeremy, Peura, Christine, Phillips, Diamond, Pierce, Karen, Piven, Joseph, Plate, Juhi, Polanco, Jose, Pott-Schmidt, Natalie, Pramparo, Tiziano, Pratt, Taleen, Prock, Lisa, White, Stormi Pulver, Qi, Hongjian, Qiu, Shanping, Queen, Eva, Questel, Marcia, Quinones, Ashley, Rambeck, Desiree, Randall, Shelley, Ranganathan, Vaikunt, Raymond, Laurie, Rayos, Madelyn, Real, Kelly, Rhea, Anna, Rice, Catherine, Richardson, Harper, Riffle, Stacy, Robertson, Tracy, Roby, Erin, Rocha, Ana, Roche, Casey, Rodriguez, Nicki, Rodriguez, Bianca, Roeder, Katherine, Rojas, Daniela, Rosewater, Jacob, Rosselott, Hilary, Runyan, Payton, Russo, Nicole, Rutter, Tara, Ruzzo, Elizabeth, Sahin, Mustafa, Salem, Fatima, Sanchez, Rebecca, Sanders, Muave, Sanderson, Tayler, Sandhu, Sophie, Sanford, Katelyn, Santangelo, Susan, Santulli, Madeline, Sarver, Dustin, Savage, Madeline, Scherr, Jessica, Schneider, Hoa, Schools, Hayley, Schoonover, Gregory, Schultz, Robert, Sebolt, Cheyanne, Shaffer, Rebecca, Shameen, Sana, Sherard, Curry, Shikov, Roman, Shillington, Amelle, Shir, Mojeeb, Shocklee, Amanda, Shrier, Clara, Shulman, Lisa, Siegel, Matt, Simon, Andrea, Simon, Laura, Singh, Arushi, Singh, Vini, Smalley, Devin, Smith, Kaitlin, Smith, Chris, Smith, Ashlyn, Soorya, Latha, Soscia, Julia, Soucy, Aubrie, Stchur, Laura, Steele, Morgan, Srishyla, Diksha, Stamps, Danielle, Sussman, Nicole, Swanson, Amy, Sweeney, Megan, Sziklay, Anthony, Tafolla, Maira, Taiba, Jabeen, Takahashi, Nicole, Terroso, Sydney, Strathearn, Camilla, Thomas, Taylor, Thompson, Samantha, Touchette, Ellyn, Townsend, Laina, Trog, Madison, Tsai, Katherine, Tseng, Angela, Tshering, Paullani, Tso, Ivy, Valicenti-Mcdermott, Maria, VanMetre, Bonnie, VanWade, Candace, Turecki, Samuel, Vargo, Kerrigan, Vattuone, Cristiana, Veenstra-Vanderweele, Jeremy, Vehorn, Alison, Benitez Velazquez, Alan Jesus, Verdi, Mary, Villalobos, Michele, Vrittamani, Lakshmi, Wainer, Allison, Wallace, Jermel, Walston, Corrie, Wang, Jiayaho, Ward, Audrey, Warren, Zachary, Washington, Katherine, Westerkamp, Grace, White, Sabrina, Wink, Logan, Winoto, Fiona, Winters, Sarah, Wodka, Ericka, Xavier, Samantha, Xu, Sidi, Yang, Yi, Yang, WhaJames, Yang, Amy, Yinger, Meredith, Yu, Timothy, Zaro, Christopher, Zha, Cindy, Zhang, Haicang, Zhao, Haoquan, Zick, Allyson, Salmon, Lauren Ziegelmayer, Wright, Jessica R., Astrovskaya, Irina, Barns, Sarah D., Goler, Alexandra, Zhou, Xueya, Shu, Chang, Snyder, LeeAnne Green, Han, Bing, Shen, Yufeng, Volfovsky, Natalia, Hall, Jacob B., Feliciano, Pamela, and Chung, Wendy K.

Published
2024
Full Text
View/download PDF

120. Finger flexor rigidity in the healthy population

Author

Erez Grinbaum, Igor Shulman, Nimrod Rozen, and Guy Rubin

Subjects
Medicine, Science
Abstract

Abstract The involvement of the hand flexors in trigger finger is not clear. This study aimed to examine the rigidity of the flexor tendon in the first pulley territory in the hand by using ultrasound in a healthy population, as well as to create a reference scale of rigidity for the flexor tendons to compare those values in trigger fingers. We tested 35 healthy volunteers using a linear ultrasound transducer and the color Doppler method. Rigidity levels below the first pulley were examined and compared between the different fingers of the hand and the relationship between rigidity and sex and the three different age groups was evaluated. In the healthy population, the rigidity of the flexor tendons of the hand in the territory of the first pulley varied between 233.1 and 962.8 kPa, with an average of 486.42 kPa and standard deviation of 114.85. We showed that the flexors in the dominant hand were more rigid, there was a difference between the rigidity of the flexor tendons of the thumb and the other fingers of the same hand, and the ring finger of the dominant hand had stiffer flexor tendons than the fingers of the other hand in the male population. We created a value scale for the rigidity of the flexor tendons of the fingers. This base scale can be compared between different pathologies, including trigger finger. The study and all experimental protocols were approved by the local ethical committee.

Published
2024
Full Text
View/download PDF

121. Ethical dilemmas in prioritizing patients for scarce radiotherapy resources

Author

Rebecca J. DeBoer, Anita Ho, Espérance Mutoniwase, Cam Nguyen, Grace Umutesi, Jean Bosco Bigirimana, Nicaise Nsabimana, Katherine Van Loon, Lawrence N. Shulman, Scott A. Triedman, Vincent K. Cubaka, and Cyprien Shyirambere

Subjects
Health Care Rationing, Resource Allocation, Priority setting, Radiotherapy, Global Health, Africa, Medical philosophy. Medical ethics, R723-726
Abstract

Background Radiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles. Methods Semi-structured interviews were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles. Results Participants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier. Conclusions Multiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views.

Published
2024
Full Text
View/download PDF

122. Involving people with lived experience of homelessness in palliative and end of life care research: key considerations from experts in the field

Author

Jodie Crooks, Kate Flemming, Caroline Shulman, Emma Casey, and Briony Hudson

Subjects
Palliative care, Homelessness, Inclusion health, Co-production, Patient and Public Involvement, Medicine, Medicine (General), R5-920
Abstract

Abstract Background Co-production of research aims to include people with lived experience of a phenomena throughout the research process. People experiencing homelessness often experience advance ill-health at a young age, yet access palliative care services at a disparately low rate to the level of palliative care need. The voices of people experiencing homelessness are infrequently heard throughout palliative care research, despite the complexities and intricacies of the area. Aim To explore the experiences of experts in the field to identify key context considerations for involving people with lived experience of homelessness in palliative and end of life care research. Methods Qualitative study comprising two data collection streams: interviews with professionals with experience of involving people experiencing homelessness in their work, and focus groups with people with lived experience (PWLE) of homelessness. Data were analysed using iterative, reflexive thematic analysis. Patient and Public Involvement contributors gave feedback on themes. Results A total of 27 participants took part in semi-structured interviews (N = 16; professionals) or focus groups (N = 11; PWLE homelessness). Key considerations of involving people experiencing homelessness in palliative and end of life care research were developed into four key themes: complexity of lived experience of homelessness; representation of homelessness within experts by experience; professionalising lived experience; and methods for involvement. Conclusions Involvement of people with lived experience of homelessness is important in developing palliative care research. This paper begins to outline some contextual considerations for promoting involvement in a complex and intricate field of research.

Published
2024
Full Text
View/download PDF

123. Strict universes for Grothendieck topoi

Author

Gratzer, Daniel, Shulman, Michael, and Sterling, Jonathan

Subjects
Mathematics - Category Theory, Computer Science - Logic in Computer Science, Mathematics - Logic
Abstract

Hofmann and Streicher famously showed how to lift Grothendieck universes into presheaf topoi, and Streicher has extended their result to the case of sheaf topoi by sheafification. In parallel, van den Berg and Moerdijk have shown in the context of algebraic set theory that similar constructions continue to apply even in weaker metatheories. Unfortunately, sheafification seems not to preserve an important realignment property enjoyed by the presheaf universes that plays a critical role in models of univalent type theory as well as synthetic Tait computability, a recent technique to establish syntactic properties of type theories and programming languages. In the context of multiple universes, the realignment property also implies a coherent choice of codes for connectives at each universe level, thereby interpreting the cumulativity laws present in popular formulations of Martin-L\"of type theory. We observe that a slight adjustment to an argument of Shulman constructs a cumulative universe hierarchy satisfying the realignment property at every level in any Grothendieck topos. Hence one has direct-style interpretations of Martin-L\"of type theory with cumulative universes into all Grothendieck topoi. A further implication is to extend the reach of recent synthetic methods in the semantics of cubical type theory and the syntactic metatheory of type theory and programming languages to all Grothendieck topoi., Comment: Integrated feedback from reviewers, fixed typographic errors

Published
2022

124. The directed plump ordering

Author

Gratzer, Daniel, Shulman, Michael, and Sterling, Jonathan

Subjects
Computer Science - Logic in Computer Science, Mathematics - Logic
Abstract

Based on Taylor's hereditarily directed plump ordinals, we define the directed plump ordering on W-types in Martin-L\"of type theory. This ordering is similar to the plump ordering but comes equipped with non-empty finite joins in addition to the usual properties of the plump ordering., Comment: Added funding acknowledgment

Published
2022

126. Can We Use Blood Biomarkers as Entry Criteria and for Monitoring Drug Treatment Effects in Clinical Trials? A Report from the EU/US CTAD Task Force

Author

Angioni, D., Hansson, O., Bateman, R. J., Rabe, C., Toloue, M., Braunstein, J. B., Agus, S., Sims, J. R., Bittner, T., Carrillo, M. C., Fillit, H., Masters, C. L., Salloway, S., Aisen, P., Weiner, M., Vellas, B., Gauthier, S., Abushakra, Susan, Afshar, Mohammad, Alam, John, Algeciras-Schimnich, Alicia, Andrieu, Sandrine, Ballard, Clive, Baruch, Amos, Batrla, Richard, Baudler, Monika, Bell, Joanne, Bozeat, Sasha, Brooks, Dawn, Brooks, Tricia, Bullain, Szofia, Burmeister, Jan, Cho, Min, Collins, Emily, Cook, Gavin, Cummings, Jeffrey, Dague, Chris, De Santi, Susan, Doody, Rachelle, Dunn, Billy, Egan, Michael, Eriksson, Sven, Esquivel, Rianne, Fagan, Tom, Ferrell, Phyllis, Gallagher, Michela, Grönblad, Anna-Kaija, Hains, Avis, Hampel, Harald, Hefting, Nanco, Hendrix, Suzanne, Ho, Carole, Hu, Helen, Ismail, Zahinoor, Jones, Daryl, Kinney, Gene, Kinnon, Paul, Kurzman, Ricky, Lannfelt, Lars, Lawson, John, LeBastard, Nathalie, Legrand, Valérie, Lewandowski, Nicole, Lim, Carine, Lyketsos, Costantine, Masterman, Donna, Lu, Ming, Mintun, Mark, Molinuevo, José Luis, Monteiro, Cecilia, Navia, Bradford, Odergren, Tomas, Osswald, Gunilla, Penny, Lewis, Pontecorvo, Michael, Porsteinsson, Anton, Raman, Rema, Respondek, Gesine, Reyderman, Larisa, Rogers, Sharon, Rosenberg, Paul, Rosenzweig-Lipson, Sharon, Roskey, Mark, Carrie, Rubel, Saad, Ziad, Schindler, Rachel, Selkoe, Dennis, Shulman, Melanie, Sink, Kaycee, Sipe, Lisa, Skovronsky, Daniel, Somers, Elizabeth, Soto, Maria, Streffer, Johannes, Such, Pedro, Suhy, Joyce, Touchon, Jacques, Vandijck, Manu, White, Anne, Wilson, David, Zago, Wagner, and Zhou, Jin

Published
2023
Full Text
View/download PDF

127. Selective digestive tract decontamination to prevent healthcare associated infections in critically ill children: the PICNIC multicentre randomised pilot clinical trial

Author

Nazima Pathan, Kerry Woolfall, Mariana Popa, Gema Milla de la Fuente, Paloma Ferrando-Vivas, Alanna Brown, Theodore Gouliouris, Lyvonne N. Tume, Robert Shulman, Brian H. Cuthbertson, Isobel Sale, Richard G. Feltbower, John Myburgh, John Pappachan, David Harrison, Paul Mouncey, Kathryn Rowan, and the PICNIC study investigators

Subjects
Medicine, Science
Abstract

Abstract Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. Data from adult studies suggest Selective Decontamination of the Digestive tract (SDD) may reduce the incidence of HCAIs and improve survival. There are no data from randomised clinical trials in the paediatric setting. An open label, parallel group pilot cRCT and mixed-methods perspectives study was conducted in six paediatric intensive care units (PICUs) in England. Participants were children (> 37 weeks corrected gestational age, up to 16 years) requiring mechanical ventilation expected to last for at least 48 h. Sites undertook standard care for a period of 9 weeks and were randomised into 3 sites which continued standard care and 3 where SDD was incorporated into infection control practice for eligible children. Interviews and focus groups were conducted for parents and staff working in PICU. 434 children fulfilled eligibility criteria, of whom 368 (85%) were enrolled. This included 207 in the baseline phase (Period One) and 161 in the intervention period (Period Two). In sites delivering SDD, the majority (98%) of children received at least one dose of SDD and of these, 68% commenced within the first 6 h. Whilst admission swabs were collected in 91% of enrolled children, consent for the collection of additional swabs was low (44%). Recruited children were representative of the wider PICU population. Overall, 3.6 children/site/week were recruited compared with the potential recruitment rate for a definitive cRCT of 3 children/site/week, based on data from all UK PICUs. Parents (n = 65) and staff (n = 44) were supportive of the aims of the study, suggesting adaptations for a larger definitive trial including formulation and administration of SDD paste, approaches to consent and ecology monitoring. Stakeholders identified preferred clinical outcomes, focusing on complications of critical illness and quality-of-life. A definitive cRCT in SDD to prevent HCAIs in critically ill children is feasible but should include adaptations to ecology monitoring along with the dosing schedule and packaging into a paediatric specific format. A definitive study is supported by the findings with adaptations to ecology monitoring and SDD administration. Trial Registration: ISRCTN40310490 Registered 30/10/2020.

Published
2023
Full Text
View/download PDF

128. A novel technique for unilateral dissection of the penile neurovascular bundle to prevent loss of penile sensation during treatment of Peyronie’s disease—Initial results of a pilot study

Author

Alexandr M. Pinkhasov, Matthew Beamer, Daniel Shulman, Rachel Yakubov, Esther Pinkhasov, and Sergey Kravchick

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract. Background. Plaque incision/excision and grafting are surgical techniques used to treat patients with Peyronie's disease who are refractory to less invasive interventions, have severe penile curvature, or have an hourglass deformity. However, the procedure carries the risk of penile sensory loss because of the need for dissection of the neurovascular bundle (NVB). The aim of this study was to assess the feasibility of a novel technique for unilateral NVB dissection and its ability to preserve penile sensitivity while maintaining adequate correction of the penile curvature. Materials and methods. Charts of patients who underwent unilateral NVB dissection during Peyronie's plaque incision/excision and grafting were retrospectively reviewed. All patients received preprocedural intracavernosal injections of TriMix, and the curvature was measured to be >70 degrees. In 3 cases, an incision and minimal excision of the plaque were performed at the point of maximum curvature on the concave side of the curvature. In 3 cases, Tutoplast allografts (Coloplast US, Minneapolis, MN) were used, whereas autografts were used in 2 other cases. All patients were examined at 1, 3, and 6 months after the procedure when curvature and penile sensation were assessed. Results. Five patients underwent this procedure. The mean age of patients was 55 years (45–70 years). All plaques were dorsally located. The mean preoperative curvature was 78 degrees (75–90 degrees). At the 6-month follow-up, all patients had

Published
2023
Full Text
View/download PDF

131. Medial scapular body (MSB) Goutallier classification: MRI-based reliability and validity of evaluation of the Goutallier classification for grading fatty infiltration of the rotator cuff

Author

Gupta, Ashish, Hollman, Freek, Delaney, Ruth, Jomaa, Mohammad N., Ingoe, Helen, Pareyon, Roberto, Shulman, Ryan M., Dhupelia, Sanjay, Yihe Li, Acrane, En-Hui Tok, Amaris, Samsuya, Katreese K.M., Xu, Shaoyu, Salhi, Asma, Alzubaidi, Laith, Whitehouse, Sarah L., Pivonka, Peter, Gu, YuanTong, Maharaj, Jashint, and Cutbush, Kenneth

Published
2024
Full Text
View/download PDF

133. A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape

Author

Morgan, Jennifer, DeBoer, Rebecca J, Bigirimana, Jean Bosco, Nguyen, Cam, Ruhangaza, Deogratias, Paciorek, Alan, Mugabo, Fred, Villaverde, Chandler, Nsabimana, Nicaise, Bihizimana, Pascal, Umwizerwa, Aline, Lehmann, Leslie E, Shulman, Lawrence N, and Shyirambere, Cyprien

Subjects
Clinical Research, Rare Diseases, Hematology, Cancer, Vaccine Related, Prevention, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Agents, Child, Humans, Imatinib Mesylate, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Middle Aged, Retrospective Studies, Rwanda, Young Adult
Abstract

PurposeIn describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development.MethodsWe retrospectively reviewed all patients with BCR-ABL-positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test.ResultsOne hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days (P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis (P = .056) and imatinib initiation (P = .170) was not significantly different.ConclusionCoupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.

Published
2022

140. Malaria Vaccines

Author

Laurens, Matthew B., Plowe, Christopher V., Shulman, Lester M., Section editor, Meyers, Robert A., Editor-in-Chief, and Shulman, Lester M, editor

Published
2023
Full Text
View/download PDF

141. HIV/AIDS Global Epidemic

Author

Kanki, Phyllis J., Koofhethile, Catherine K., Shulman, Lester M., Section editor, Meyers, Robert A., Editor-in-Chief, and Shulman, Lester M, editor

Published
2023
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results