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C2070-448 IBM Content Collector (ICC) v2.2

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C2070-448 exam Dumps Source : IBM Content Collector (ICC) v2.2

Test Code : C2070-448
Test cognomen : IBM Content Collector (ICC) v2.2
Vendor cognomen : IBM
: 142 existent Questions

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IBM IBM Content Collector (ICC)

Counteracting APTs with a satisfactory-tuned SIEM solution | killexams.com existent Questions and Pass4sure dumps

  • put up
  • besides the fact that not a prevalent classification of cyber assaults, superior persistent threats (APTs) are truly probably the most devastating ones. identical to a sudden volcano eruption that’s been  slowly surging below, an ATP may also remain invisible for a lot of months however finally upshot in sedate fiscal hurt, ruining groups’ attractiveness and even judgement human victims as it happened after the scandalous Ashley Madison information breach.

    The annual cyber danger record M-tendencies 2016 through Mandiant mentioned that the general number of days in 2015 throughout which agencies were compromised before they found out the transgression (or own been notified in regards to the breach) changed into 146. To manufacture issues even worse, protection consultants panoply the vast majority of APTs by chance, which potential that APTs’ actual lifecycle is limited simplest via the vigor of vigilance. So is the battle with APTs in fact a matter of profitable fortune? Or is there anything to solemnize them earlier than they smash a firm’s assets?

    commercial Why are typical tools no first rate?

    With APTs, you may additionally believe that companies are too a profitable deal neglectful about their safety and select inadequate safety measures. truly, focused entities always undertake the entire latitude of security rig from regular firewalls and antiviruses to subtle anti-malware items. The issue is that these ordinary rig aren’t able to stand up to an APT attack, leaving a pretty profitable variety of blind spots in an commercial enterprise’s infrastructure.

    as an instance, firewalls as a vital Part of network safety can close useless ports and shroud unsolicited incoming network site visitors. Their advanced versions may also in Part tender protection to against DDoS assaults. but they really can’t notice malicious clients, dissect packets containing malware and obviously they can't cope with assaults that don’t depart through them. due to common firewalls’ confined functionality, most corporations supplement them with intrusion prevention systems (IPS) that enable to examine network site visitors flows, detect and desist vulnerability exploits. youngsters, IPS also own their barriers as they are helpless towards client-aspect utility assaults. 

    in addition, managing an array of security rig is involved and dear, as you deserve to purchase distinct utility licenses and rent consultants to select reliance of each particular piece of application. It’s also unattainable to manually correlate statistics from diverse techniques with a view to solemnize and respond to proliferating assaults. And, ultimately, scattered options cannot subsist certain a 360° view of an organization’s IT ambiance, which finally outcomes in loopholes that let hackers in.

    on the equal time, these days’s protection utility market offers advanced safety counsel and sustain administration (SIEM) options that are able to exchange multiple scattered solutions. in spite of the fact that not regarded as the most excellent treatment against APTs, SIEM systems may aid security officers at distinctive degrees of an attack.

    getting to know from life instructions: The case of Carbanak attacks

    To salvage complete armed for viable assaults, it’s efficacious to investigate previous errors. within the history of safety breaches, APTs own a ’music list’ of calamitous intrusions. amongst them there are a string of attacks with the aid of the Carbanak group that focused greater than one hundred banks and other fiscal institutions in 30 nations (the united states named the 2nd largest target), which made it one of the crucial largest fiscal institution thefts ever.

    started out in August 2013, this refined hacking gang turned into first publicly disclosed simplest in 2015 when the replete profit already reached $1 billion. To reside overlooked and learn every fiscal institution internal out, attackers used a gross range of tactics from spear phishing to quiescent watch, stealing cash in modest batches. The theft changed into published unintentionally, after inspecting one ATM’s extraordinary habits. although, disclosure didn’t cease the Carbanak hackers from their shady affairs: a brand modern string of attacks had been already registered in 2016. This time, the crowd goals to double down the old-fashioned catch. however what if victims had a great-tuned SIEM answer?

    because the banks were unprepared for these assaults and had no valuable solutions in location to realize the APTs, they determined to select this case as an instance and illustrate how a pleasant-tuned SIEM solution, equivalent to IBM QRadar, might support to demonstrate the Carbanak superior persistent threats.

    Malware an infection

    in line with the publicly available particulars of the assault, the hackers acquired access to fiscal institution personnel’ computers through opportunistic malware. IBM protection QRadar QFlow Collector could pinpoint a malware infection by guaranteeing steady monitoring of the traffic poignant into and out of a company. The device procedures sessions and stream information from exterior sources in such formats as QFlow, NetFlow, SFlow, JFlow and sessions from Packeteer, which permits to baseline community traffic and attach in coerce anomaly rules, in addition to to build up particular correlation rules to ascertain here:

  • communications with customary botnet handle facilities and malicious IP addresses. This tips can subsist subscribed (IBM X-drive) or built-in with SIEM from open sources.

  • communications with odd and potentially malicious international locations and areas

  • communications via odd ports (e.g. 6667/IRC)

  • communications containing particular payloads (e.g. bot handle instructions), which is feasible with IBM safety QRadar QFlow Collector’s functionality.

  • Spear Phishing

    as soon as the attackers gained access to employees’ computers, they started a big spear phishing crusade that turned into very difficult to establish. indeed, a SIEM reply can hardly ever distinguish an infected electronic mail message originating from a legitimate e mail account (a computing device with malware) from a sound electronic mail. besides the fact that children, if the e-mail server is related to a SIEM solution as a log supply, it’s viable to solemnize the following abnormalities:

  • a immense volume of messages sent from the identical account within a short while 

  • electronic mail messages sent in non-company hours from a corporate account

  • a huge variety of messages with the same district to distinctive mailboxes

  • The superior correlation with actual security controls additionally makes it viable for detection of mailouts from clients earlier than their determine-in through a physical protection gate.

    Privilege escalation and deeper reconnaissance

    Systematic spare phishing coupled with malware infection allowed the crowd to proceed their storm via privilege escalation and deeper reconnaissance which are regular for complete APTs.  

    Privilege escalation may well subsist monitored with a first-rate-tuned SIEM solution with the following:

  • audit enabled and adequately configured on workstations

  • log records accumulated from workstations and despatched to a SIEM

  • user accounts and roles mapped in a SIEM reply the usage of counsel from LDAP/ad

  • In such a situation, any consumer with out a Admin role logging in with administrative privileges would set off an alert in a SIEM solution. furthermore, most of SIEM options comprise out-of-the-field reconnaissance detection correlation rules that will also subsist first-rate-tuned to crop false-positives. In their case, a deeper reconnaissance originating from an inside corporate network may well subsist identified if firewalls own been sending entry logs to a SIEM solution.

    Latent watch

    To stronger select note the internal programs, the hackers assigned operators to work with video- and reveal-trap feeds grabbed and transmitted to the attackers with the in the past injected malware.

    The peculiar traffic evaluation according to anomaly suggestions would solemnize video and reveal shooting actions on account that video translation produces loads of traffic that could subsist caught via IBM safety QRadar QFlow Collector.

    infection of computers connected to ATMs

    The Carbanak gang correctly infected computer systems connected to ATMs so as to manufacture the machines dispense cash. In case if compromised administrative bills own been used to spread an infection, a SIEM solution would subsist able to alert the protection personnel about the following:

  • a logged admin person account didn’t belong to the attacked server’s guide crew (mapping with LDAP/ad)

  • a specific admin person account became logged in to many servers in a short time.
  • moreover, an advanced correlation with id and entry management solutions and Ticketing programs would enable to solemnize circumstances when an admin consumer became logging to the rig and not using a acceptable ticket or IAM allowance.

    Compromise of inside databases and introduction of fraudulent accounts

    all the route through the attacks, hackers manipulated Oracle databases to open payment or debit card accounts on the same bank or to transfer cash between bills the exercise of the on-line banking equipment. consistently, complete pastime regarding growing modern bills should pass via a validation manner. reckoning on such a procedure and rig used for validation, this assistance could subsist integrated with a SIEM solution to alert on sudden account introduction. If there’s no such validation in location, every modern account advent may well subsist alerted and investigated by route of a protection analyst.

    A SIEM consultant might assist a fiscal institution to salvage experiences on company-important information change by using doing here:

  • enabling Oracle best Grained Auditing (FGA) or a similar audit mechanism 

  • compiling and integrating a listing of accredited database clients. this could permit to become vigilant of information amendment carried out by using unapproved bills, which may well subsist alerted to by means of a SIEM answer.

  • Abuse of the Society for worldwide Interbank monetary Telecommunication system

    To subsist in a position to circulation massive amounts of money into managed bills, the attackers abused the Society for worldwide Interbank fiscal Telecommunication system. A smartly-configured SIEM solution might ensure a relentless monitoring of complete critical economic purposes. If a selected application weren’t supported by using QRadar out-of-the-box, commandeer parsing, mapping and categorization may subsist developed. once custom records is properly normalized, a SIEM solution would subsist able to become vigilant of abnormal money transfers with anomaly correlation guidelines, if right here are proper:

  • a unique account has transferred over the limit

  • a unique account has made many petite transfers to one or several certain debts

  • a complete amount of transfers from one account in a particular timeframe passed the limit
  • many bills made transfers to the equal goal account in a particular period

  • which you could thwart it

    The case we’ve just analyzed proves that organizations don't appear to subsist helpless of their combat in opposition t APTs. it might sound unusual, but while refined as they are, APTs own their weakness hiding in the missive “P.” Persistence, which is the most problematic to select reliance of, definitely aptitude that attackers depart a lot of traces for the duration of their attacks. as a result safety directors neatly-armed with a central SIEM reply own varied touchpoints to notice intruders and prevent them before their illegal activities result in dramatic records and funds losses.

    This submit turned into backed by route of ScienceSoft. The content material turned into created with the aid of Dmitry Nikalayenia, SIEM branch Coordinator for ScienceSoft and a guest contributor to Gigaom.


    Product roundup: aspects of loyal SIEM utility on the market | killexams.com existent Questions and Pass4sure dumps

    security assistance and sustain management utility products and features own become common accessories of the...

    cybersecurity programs of many businesses.

    safety guidance and sustain management (SIEM) application combines protection tips management and safety event management, presenting real-time analysis of security indicators generated by means of applications and community hardware.

    here's a glance at probably the most most efficient SIEM utility products at present on the market.

    AlienVault Inc. USM any place

    AlienVault Unified protection administration (USM) any position is a cloud-primarily based, SaaS platform.

    The product's core SIEM application features encompass log collection, experience management, sustain correlation and reporting. USM anywhere makes it viable for the centralized storage of complete log statistics in the AlienVault relaxed Cloud, a certified-compliant atmosphere. This alleviates the business's cross of getting to maneuver and relaxed logs on premises, while additionally featuring a compliance-able log administration ambiance.

    Going beyond a gardenvariety SIEM product, USM anywhere combines multiple unified security capabilities that allow threat detection and incident response: asset discovery, vulnerability evaluation, intrusion detection -- community, host and cloud -- endpoint detection and response, file integrity monitoring, security orchestration and automation, and constantly up to date danger intelligence from the AlienVault Labs protection analysis crew, which is backed by means of the Open threat exchange.

    USM anywhere offers varied security capabilities in a unique SaaS providing. both computerized and orchestrated, these capabilities supply security gurus the rig and tips they should control hazard detection, incident response and compliance, the company claims.

    The company also makes exercise of an tocsin dashboard, named the destroy Chain Taxonomy, to focus consideration on essentially the most severe threats. safety analytics enable safety authorities to drill down into alarms to peer the linked belongings, vulnerabilities and hobbies.

    USM anywhere also provides a library of predefined file templates for a number of necessities and regulations. These stories can aid accelerate safety and compliance reporting necessities and support with audit readiness. It additionally comprises more than 50 predefined event experiences by information source and statistics source category, helping to manufacture daily monitoring and reporting activities more efficient.

    As a subscription-primarily based cloud service, USM anywhere is available in three variants -- essentials, regular and commercial enterprise -- for businesses of complete sizes and budgets. Pricing for USM any position essentials edition starts at $1,695 per thirty days.

    IBM QRadar

    edition 7.3.1 of IBM QRadar integrates with greater than 450 log sources and offers a universal rig assist Module to assist companies ingest statistics across on-premises and cloud-primarily based components.

    The product parses and normalizes log information from endpoints, assets, users, purposes and cloud resources. QRadar then correlates this information to community flows, vulnerability scanner results and hazard intelligence to establish both gardenvariety threats and anomalous network and device recreation. These could subsist the signs of an unknown danger.

    linked pastime instantly links and aggregates into an offense, and IBM QRadar then prioritizes these offenses in accordance with the severity of the situation and the sensitivity of the assets involved. QRadar's approach to offenses helps distill massive volumes of facts into a handful of actual, actionable alerts. The platform includes hundreds of prebuilt guidelines, and businesses can add stories, dashboards, integrations and extra prebuilt suggestions from the IBM security App change.

    Dashboard showing multiple graphs and maps used to  hold track of threats IBM QRadar leading dashboard continues tune of skills threats, both international and native

    organizations may additionally deploy QRadar on premises as hardware or software, in public and private clouds, or by route of any of IBM's managed safety capabilities provider companions. bendy architecture can birth petite with an all-in-one device with a console, sustain collector and event processor, and can then scale out into totally dispensed environments with sunder collectors, processors and consoles.

    QRadar SIEM utility is significant to the IBM protection Intelligence Platform. The platform extends beyond commonplace SIEM capabilities to consist of:

  • QRadar network Insights, which provides true-time packet inspection to identify malware, computer screen the transfer of sensitive records and establish data exfiltration; and
  • QRadar consumer behavior Analytics, which makes exercise of a fuse of suggestions, anomaly detection and machine getting to know algorithms to establish malicious insiders and compromised credentials.
  • different capabilities encompass QRadar guide with Watson, which applies ersatz intelligence to automatically mine endemic QRadar records to find the root judgement and existent scope of a risk in the atmosphere.

    It additionally comprises the QRadar records shop, which presents fixed-price log storage, enabling businesses to shop immense amounts of data while not having to correlate every microscopic thing. This helps agencies tackle regulatory necessities and maintain records that can subsist vital to future investigations and danger searching.

    QRadar offers greater than 1,600 customizable reviews that are classified in accordance with compliance, govt and operational summary reports, protection overview stories, network exercise and management reviews, functions, and device-level studies.

    Licensed in accordance with movements per second (EPS), the product's starting cost for an all-in-one digital appliance with one hundred EPS is $10,seven hundred, and the starting fee for QRadar on Cloud with one hundred EPS is $800 monthly. extent discounting is purchasable.

    LogRhythm Inc. security Intelligence Platform

    LogRhythm edition 7.4 elements several core capabilities, together with a immense data analytics architecture; superior records processing; centralized visibility into protection signals and alarms; centralized visibility into forensic records; and the means to succeed synthetic intelligence, advanced status of affairs modeling, and abysmal behavioral analytics throughout a 360-diploma view of forensic facts. other features comprise case management, which allows for security teams to engage in workflows using a centralized and at ease case administration facility; chore automation; and immediately guided workflows.

    in accordance with the company, extra granular measurements, corresponding to time to qualify and time to investigate, can encourage analysts select into account workflow effectiveness. These performance metrics can encourage uncover alternatives to enrich operational effectivity, together with determining initiatives greater-appropriate for automation and permitting safety leaders to measure and report on the effectiveness of protection classes. 

    Dashboard showing graphs and clients to  hold track of user activity LogRhythm leading dashboard has the capacity to focal point on multiple clients

    Pricing for the LogRhythm platform starts at $forty three,500, with subscription alternatives also accessible. Designed with that in mind, its modular structure can provide trade scalability to meet long-term needs, inspite of changing performance, storage and geographic necessities, the trade claims.

    McAfee LLC commercial enterprise protection supervisor (ESM)

    McAfee's commercial enterprise security manager (ESM) is a SIEM application utensil for business, commercial enterprise and government corporations, in addition to managed security service providers. ESM offers random and danger insurance policy according to a SIEM structure built for massive information security analytics.

    ESM collects logs from tons of of records sources, integrates them with dozens of partners and supplements pursuits with probability intelligence, featuring actionable intelligence and actual-time random administration with modern cybersecurity protections. An embedded compliance framework and content Packs simplify its safety and compliance operations.

    commercial enterprise security supervisor eleven.1 is the existing version, as of this writing. version eleven introduced facets together with:

  • flexible statistics architecture, which is an open and scalable records bus that shares giant facts volumes;
  • scalable Ingestion and question efficiency, which give horizontal expansion with high availability and the potential to unexpectedly query billions of routine; and
  • increased cloud assist for hardware virtual desktop for AWS, office 365, Azure, Xen, Hyper-V and a customary cloud API to on board cloud statistics sources.
  • ESM is obtainable as an rig or digital computing device that clients can fuse and healthy. ESM fashions comprise all-in-one fashions and discrete appliances, and it will also subsist deployed on premises, within the cloud or in a hybrid ambiance. It supports deployments on AWS, Azure, Hyper-V, VMware and Xen.

    whereas ESM provides the core SIEM capabilities, different accessories encompass excessive-pace statistics assortment and adventure correlation, elastic quest quick querying of hobbies, archival of uncooked routine for compliance and forensics, and layer three and seven utility-level monitoring.

    Main overview of the software, with bar graphs depicting levels of threats, as well as users and events fundamental overview of McAfee application, which continues track of exercise and viable threats

    The superior Correlation Engine delivers rule-based mostly and statistical and behavioral-based mostly analytics for billions of events. McAfee global risk Intelligence can augment random detection and investigation with a proprietary feed of probably malicious and favourite-dangerous IP addresses.

    other protection elements of ESM consist of free content Packs, McAfee's edition of an app redeem that gives prebuilt exercise instances, and ESM's Cyber danger supervisor, which consumes probability intelligence and indications of compromised statistics, enabling returned tracing and the advent of a watchlist.

    ESM also includes a case management gadget to song incident investigation, select notes and enable remediation by the exercise of integrations inside the McAfee product ecosystem and any third-birthday party product that supports movements via URL, command line, APIs or records alternate Layer. When bigger volumes or complexities prescribe extra orchestration, ESM integrates with companions, including ServiceNow, Phantom, Swimlane and Demisto.

    ESM provides greater than 800 document templates that cowl areas comparable to compliance, protection, functions, databases, network move, dangers and government content. clients can create and adjust reviews using a wizard.

    home rig are rated and bought by means of their capacity to tackle a certain event-per-2nd potential rather than a cost per statistics source or charge per EPS. There are not any enforced EPS limits on an ESM appliance and no licensing charges for introduced statistics sources.

    VMs are licensed the exercise of the equal philosophy and sold through the number of CPU cores essential to encourage a given EPS. This allows shoppers so as to add cores as vital without changing hardware. Pricing for a typical, all-in-one, VM-based SKU centered at smaller clients is $forty,000 to $50,000.

    Rapid7 Inc. InsightIDR

    Rapid7's InsightIDR is a cloud-based incident detection and response platform that may encourage protection practitioners determine and investigate threats and centered attacks. InsightIDR combines SIEM software with person and attacker behavior analytics, endpoint detection, and response brokers so users can determine a compromise as soon because it happens and comprise it as straight away as feasible.

    one of the most key facets of the software is consumer habits Analytics, which normally baselines suit consumer activity throughout the corporation. This could subsist the optimal SIEM product for an organization, as this extends beyond described indications of compromise in order that protection experts can detect attackers impersonating employees, as well as insider threats.

    moreover, Attacker behavior Analytics select Rapid7's abilities of prior storm endeavor and turns it into intelligence that can support security experts detect assaults early.

    Rapid7 also comprises endpoint detection and visibility. With the device's insight Agent, security groups can notice universal and unknown malware, grab forensic artifacts on demand, and select containment actions for detected threats from within InsightIDR. The Centralized Log administration feature links millions of every day events in a unique setting at once to the clients and property in the back of them. InsightIDR comes with a quick log search, prebuilt compliance playing cards and dashboards for fundamental, constant reporting.

    For any alert in InsightIDR, automatic moves can fireplace to accelerate case management and hazard containment. This contains developing situations in third-birthday celebration ticketing techniques, as well as taking direct motion on person debts and endpoints.

    furthermore, deception technology makes it viable for security gurus so as to add crucial monitoring alternatives and trick attackers with traps comparable to honeypots, honey clients, honey credentials and honey information. These traps ascertain behaviors that log analysis by myself can fail to catch.

    InsightIDR makes it viable for clients to create stories out of customized dashboards, generating studies both once or on a preconfigured schedule.

    Rapid7 fees InsightIDR in accordance with the entire variety of assets in an organization.

    RSA NetWitness Platform

    RSA NetWitness Platform is constructed from RSA NetWitness Logs, RSA NetWitness community and RSA NetWitness Endpoint. RSA NetWitness UEBA -- user and Entity behavior Analytics -- and RSA NetWitness Orchestrator augment the core platform with behavioral analytics and safety orchestration, automation, and response capabilities.

    The platform facets a safety Analytics Engine, which allows for analysts to realize and respond to threats complete over an organization's infrastructure, together with within the cloud, virtualized systems and containerized components.

    agencies can install add-ons in any aggregate of application or physical or virtual equipment, in addition to inside cloud environments.

    The RSA NetWitness Logs, network and Endpoint modules can subsist deployed in my feeling or together, and that they aid a range of third-birthday party statistics sources and purposes.

    RSA NetWitness UEBA provides unsupervised, wholly computerized, and continuous risk detection and monitoring the usage of a turnkey facts science model. RSA NetWitness Orchestrator offers protection automation and orchestration capabilities that can allow analysts to rapidly investigate incidents and automate workflows. The device's platform reporting capabilities encompass developed-in and customized reviews supporting a yoke of safety and compliance requirements.

    businesses should purchase the RSA NetWitness Platform as a term or perpetual license and deploy it as a application, appliance or virtual appliance, in any aggregate. Pricing for the RSA NetWitness Platform is in line with both records throughput for RSA NetWitness Logs and Packets, users monitored for RSA NetWitness UEBA, variety of analysts the exercise of RSA NetWitness Orchestrator, or means -- rig hardware. organizations can fuse and in shape utility and appliance licenses for granular aptitude and boom.

    Splunk Inc. commercial enterprise security

    Splunk trade security (ES) is a Part of Splunk business, and it presents the means to look, panoply screen and dissect statistics to convey insights about security the usage of SIEM utility.

    Splunk ES uses analytics that allow safety teams to discover, investigate and respond to interior and exterior attacks. The software aggregates safety activities as quickly because the sources generate them.

    Use case library with advisories for abuse, best practices and cloud security exercise case library showcasing most efficacious practices in the Splunk software

    adventure Sequencing presents the aptitude to community correlated searches into clusters of events. Splunk claims this clustering enhances the visibility and responsiveness of activities and accelerates investigations.

    further protection capabilities comprise Splunk's Adaptive Response. With this feature, users can apply alterations to conform to the strategies of a given attacker. Splunk ES incorporates with Splunk user behavior Analytics, the position unsupervised machine discovering algorithms give anomaly and threat detection. Splunk has also improved its safety tools to maintain song of the ever-becoming mass of information.

    The exercise Case Library characteristic can encourage groups bolster safety with principal content through automatically identifying which makes exercise of cases are most valuable to their personal environment according to the ingested statistics.

    companies can also exercise the platform to create, curate, set up and maneuver content material, which can encourage crop back random via featuring quicker detection and incident response to modern threats. furthermore, Splunk ES offers ad hoc searching and reporting capabilities for transgression evaluation, Splunk claims.

    Splunk bases pricing for Splunk ES on highest each day quantity of information indexed in GB per day.


    the route to Diagnose Java aid starvation | killexams.com existent Questions and Pass4sure dumps

    we can visualize useful resource starvation using an intricate rendition of the dining Philosophers difficulty. This classic metaphor of aid allocation amongst procedures became first introduced in 1971 with the aid of Edsger Dijkstra in his paper "Hierarchical Ordering of Sequential processes." it's been a model and customary system for verifying theories on useful resource allocation ever considering the fact that.

    The metaphor goes enjoy this: There are three familiar philosophers in an Asian bistro. Dinner is served however they are only given three chopsticks because the restaurant's supply truck has been caught in a snow storm for a few days. Naturally every philosopher wants two chopsticks to ingest his dinner and each is protected from interference whereas he makes exercise of a chopstick.

    Plato skipped lunch that day and insists that he should quiet own priority or else he'll faint. If he doesn't surrender his chopsticks, the other philosophers won't subsist in a position to ingest and eventually they will starve. If Plato drops his chopsticks and automatically picks them up before the different philosophers can salvage them then they won't subsist in a position to devour and they'll ultimately starve.

    Dijkstra's dining Philosophers vicissitude employed spaghetti and forks but I used chopsticks and Asian cuisine for a extra useful illustration because you cannot devour spaghetti with a unique chopstick (see determine 1).

    These are examples of useful resource hunger. You could also foster across deadlock. There are a few options enjoy semaphores and screens. however they may not suppose about options or deadlocks in this article. they are going to seat of attention on detecting aid hunger the usage of IBM Thread and panoply screen Dump Analyzer for Java.

    what is the IBM Thread and panoply screen Dump Analyzer for Java?all through the runtime of a Java process, some Java digital Machines (JVMs) can also not reply predictably and sometimes appear to hang up for a very long time or indefinitely (except the JVM shuts down). it's on occasion very challenging to examine the root motives of those types of issues.

    by using triggering Java thread dumps or Javacores when a Java process does not respond, or not it's feasible to compile diagnostic suggestions involving the JVM and a Java application captured at a particular factor complete through execution.

    On some structures, a Javacore is called "javadump." The code that creates a Javacore is Part of the JVM. one could manage it through the exercise of environment variables and runtime switches. by using default, a Javacore occurs when the JVM terminates unexpectedly. A Javacore can even subsist prompted by sending particular signals to the JVM. despite the fact a Javacore or javadump can spin up in Solaris JVMs, a lot of the content material of the Javacore is added by using IBM and, so, is latest only in IBM JVMs.

    IBM Thread and video panoply Dump Analyzer for Java analyzes thread dumps/Javacores and diagnoses computer screen locks and thread activities to identify the basis factors of hangs, deadlocks, and useful resource competition or panoply screen bottlenecks. it may well dissect IBM, Solaris, and HP-UX Java thread dumps from Java virtual laptop 1.three.1, 1.four.x, 5.0, and 6.0

    greater than three years in the past, I created IBM Thread and monitor Dump Analyzer for Java as a storage challenge and spent heaps of hours complete over weeknights, weekends, and holidays to supply my valued clientele and colleagues with anything that may support diagnose these complications easily, inspired with the aid of the same reasons as my different garage initiatives enjoy IBM HeapAnalyzer, IBM pattern Modeling and evaluation device, and IBM performance Analyzer for Java for home windows. complete of the algorithms used were filed with the U.S. Patent and Trademark workplace.

    The widgetry was delivered to the public about two years ago through alphaWorks where it's been one of the most excellent downloads for 30 consecutive months. it subsist recorded 23,296 downloads up to now and or not it's been used by means of greater than 14,600 groups, govt organizations, research facilities, and universities global (these facts are decent as of October 2008).

    what's a Thread Dump?A Java thread dump is the one of the most traces/dumps that JVM gives to encourage prognosis a grasp, impasse, or monitor rivalry subject. It includes diagnostic tips regarding the JVM and a Java application captured at a point complete through execution. as an instance, the assistance can also subsist a list of complete of the threads that Run on a Java digital computer. continually thread dumps own more than simply thread suggestions. Thread dumps can relent counsel in regards to the operating system, software atmosphere, threads, stacks, locks, and reminiscence. IBM Thread Dumps/Javacores deliver plenty extra counsel enjoy core interface, information conversion/unicode, category, diagnosis, execution management/thread administration, lock, execution engine, blended mode interpreter, JIT (simply-in-Time compiler), storage/JVM heap, and hardware portability interface/extended hardware portability interface.

    The contents and formats of Java thread dumps rely upon the platform you might subsist working on and the JVM company.

    considering that a thread dump's format isn't a Part of the SDK specification, every SDK seller provides a different thread dump structure and its personal JVM suggestions. currently IBM Thread and panoply screen Dump Analyzer for Java is vigilant IBM, Solaris, and HP-UX Java thread dump formats.

    by default, IBM JVM thread dumps spin up when the JVM terminates complete at once. A thread dump can even subsist brought on via sending selected indicators to the JVM. Thread dumps are constantly human readable text. In an IBM JVM, the thread dump is frequently called a Javadump or Javacore. Javacore is not the identical as a core file, which is generated via a rig dump.

    earlier than IBM Thread and monitor Dump Analyzer for Java became delivered, people needed to manually check a gross bunch of threads within the thread dumps the usage of their favourite editors. With IBM Thread and video panoply Dump Analyzer for Java, they are able to effortlessly diagnose lots of issues with out reading via lots of of thread stack traces.

    always thread dumps don't appear to subsist as gigantic as heap dumps. constantly its measurement is round 1MB or less unless you own colossal number of threads or classes. it subsist not a big deal to manually evaluation thread dumps if you best own a handful of threads operating on your JVM. if you own hundreds of threads with dozens of Java monitors, it gets complicated.

    How Does It Work?This technology analyzes the tips in each thread and offers diagnostic assistance, similar to current thread information, the signal that caused the Javacore/Java heap tips (highest Java heap measurement, preparatory Java heap size, rubbish collector counter, allocation failure counter, free Java heap dimension, and allocated Java heap size), number of runnable threads, complete variety of threads, variety of displays locked, endemic reminiscence utilization of each and every JVM part, and impasse information.

    IBM Thread and panoply screen Dump Analyzer for Java also gives you with the suggested dimension of the Java heap cluster (relevant best to IBM SDK 1.four.2 and 1.three.1 SR7 or above) in line with a heuristic analysis engine.

    It compares each and every Javacore and provides process identification recommendation for threads, a time stamp of the primary Javacore, a time stamp of the final Javacore, the number of rubbish collections a minute, the variety of allocation disasters a minute, the time between the first Javacore and the final Javacore, the variety of dangle suspects, and an inventory of hold suspects.

    This expertise additionally compares complete monitor information in a Javacore and detects impasse and useful resource rivalry or video panoply bottlenecks, if there are any.

    Let's salvage StartedWe can simulate a hunger vicissitude with an facile Java software.

    In DiningPhilosophers.java, they created three chopsticks, c1, c2, and c3 with the names, chopstick 1, chopstick 2, and chopstick3. Then they created three philosophers, p1, p2, and p3 with the names, Socrates, Plato, and Aristotle. You might own noticed that every philosopher's identify has a suffix that represents a precedence on account that they wish to provide Plato greater of a random to consume. besides a cognomen and priority, each philosopher is also given a left chopstick and a commandeer chopstick. They beginning with every philosopher, p1, p2,  and p3 as shown in record 1. (down load Listings 1-6 right here.)

    In Chopstick.java, they simply create a constructor, a getter, and a setter for the cognomen of chopstick as shown in list 2

    In thinker.java, they create a constructor, getters and setters for right and left chopsticks, and the philosopher's name. They also override the run() routine through which they acquire Java's developed-in displays for left and commandeer chopsticks and manufacture contact with the eat() formula. In each and every () formula, they recess for two seconds to simulate consuming with the sleep() components however bear in mind that the philosopher is eating, no longer drowsing in the eat() formula. see listing three.

    Now let's attach complete the courses in a subdirectory, compile, and Run them.

    Compiling courses on a Unix platformjavac com/ibm/Jinwoo/starvation/DiningPhilosophers.java

    Compiling courses on a windows platformjavac com\ibm\jinwoo\starvation\DiningPhilosophers.java

    I used the newest unencumber of IBM Java digital computer 6.0 (construct jvmwi3260-20080816_22093 VM construct 20080816_022093_lHdSMr) and an additional dealer's newest unencumber of a Java digital computing device 6.0 after I wrote this for a objective comparison.

    Executing classesjava com.ibm.jinwoo.hunger.DiningPhilosophersPlato priority9 is ingesting with chopstick three and chopstick 1Plato priority9 is consuming with chopstick 3 and chopstick 1Plato priority9 is consuming with chopstick 3 and chopstick 1Plato priority9 is ingesting with chopstick 3 and chopstick 1Plato priority9 is consuming with chopstick 3 and chopstick 1

    many of the time Plato can subsist consuming and the other two philosophers will own less of a random to eat. they will generate thread dumps by route of sending signal three to the process. On the home windows platform, which you can exercise keyboard combos enjoy Ctrl-break to ship sign 3 to a manner working in a command line window. checklist four has the results from the IBM Java virtual computer.

    We used one other vendor's Java digital computer and redirected output to a file.

    producing thread dumps with one more seller's Java virtual machinejava com.ibm.jinwoo.hunger.DiningPhilosophers 1> sun.log

    Now let's focus on thread dump a bit greater. In most Java platforms, thread dumps are generated when the JVM terminates abruptly as a result of an working rig sign or when the consumer enters a reserved key mixture handle-ruin on home windows, say. they are able to also generate thread dumps with IBM's JavaDump API: com.ibm.jvm.Dump.JavaDump() if you are working a IBM Java virtual desktop.

    which you can exercise the destroy command on most Unix systems:

  • SIGQUIT[3] : JVM will now not terminate
  • for instance, destroy -three $PID

  • SIGSEGV[11] : JVM will terminate
  • as an example, destroy -eleven $PID

    On the IBM WebSphere application Server 5/6 ambiance, which you can exercise wsadmin script to generate thread dumps:

    wsadmin.sh -conntype cleaning soap -port <port number>> set jvm [$AdminControl completeObjectName type=JVM,process=server1,*]> $AdminControl invoke $jvm dumpThreads


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    T1ρ and T2 Mapping of the Intervertebral Disk: Comparison of Different Methods of Segmentation | killexams.com existent questions and Pass4sure dumps

    Abstract

    BACKGROUND AND PURPOSE: Intervertebral disk biochemical composition could subsist accessed in vivo by T1ρ and T2 relaxometry. They found no studies in the literature comparing different segmentation methods for data extraction using these techniques. Their aim was to compare different manual segmentation methods used to extract T1ρ and T2 relaxation times of intervertebral disks from MR imaging. Seven different methods of partial-disk segmentation techniques were compared with whole-disk segmentation as the reference standard.

    MATERIALS AND METHODS: Sagittal T1ρ and T2 maps were generated by using a 1.5T MR imaging scanner in 57 asymptomatic volunteers 20–40 years of age. Two hundred eighty-five lumbar disks were separated into 2 groups: nondegenerated disk (Pfirrmann I and II) and degenerated disk (Pfirrmann III and IV). In whole-disk segmentation, the disk was segmented in its entirety on complete sections. Partial-disk segmentation methods included segmentation of the disk into 6, 5, 4, 3, and 1 sagittal sections. Circular ROIs positioned in the nucleus pulposus and annulus fibrosus were also used to extract T1ρ and T2, and data were compared with whole-disk segmentation

    RESULTS: In the nondegenerated group, segmentation of ≥5 sagittal sections showed no statistical inequity with whole-disk segmentation. complete the remaining partial-disk segmentation methods and circular ROIs showed different results from whole-disk segmentation (P < .001). In the degenerated disk group, complete methods were statistically similar to whole-disk segmentation. complete partial-segmentation methods, including circular ROIs, showed tenacious linear correlation with whole-disk segmentation in both the degenerated and nondegenerated disk groups.

    CONCLUSIONS: Manual segmentation showed tenacious reproducibility for T1ρ and T2 and tenacious linear correlation between partial- and whole-disk segmentation. Absolute T1ρ and T2 values extracted from different segmentation techniques were statistically different in disks with Pfirrmann grades I and II.

    ABBREVIATIONS: AAF anterior annulus fibrosus AF annulus fibrosus CROI circular ROIs ICC intraclass correlation coefficient NP nucleus pulposus PAF posterior annulus fibrosus PDS partial-disk segmentation WDS whole-disk segmentation

    MR imaging is considered the best noninvasive routine to study intervertebral disks. MR imaging allows the visualization of clearly different anatomic disk subregions, including the nucleus pulposus (NP) and the annulus fibrosus (AF).1,2 However, routine clinical images provide a qualitative or semiquantitative assessment made by an expert.3 The requisite for a better understanding of physiologic and pathologic processes in the disk led to the application of quantitative techniques in MR imaging such as T1ρ and T2 mapping.3,4

    For the extraction of quantitative data from a given region of interest, it is necessary to execute segmentation procedures that involve selecting the region to subsist analyzed.5 This segmentation can subsist manual, semiautomatic, or automatic. In studies assessing the lumbar intervertebral disk composition, different authors used different methods to execute disk segmentation with subsequent data extraction. The most common routine in the literature with esteem to T1ρ and T2 is to acquire petite regions of interest that are anatomically based.6⇓⇓–9 Authors own used touchstone ROIs, delineating subregions within the intervertebral disk to extract quantitative data specifically from the NP and AF.6,7 Additional intermediate ROIs on boundaries between the nucleus and annulus own also been used.8,9 In the latter, intermediate ROIs were implemented to compensate for the increased steps for segmentation in each image. These studies analyzed a limited number of MR imaging sections. The segmentation using a few MR imaging sections and regional ROIs allows the extraction of data more quickly than segmenting the gross intervertebral disk. Other authors chose to execute the segmentation of the disk as a whole, with the region of interest covering the NP and AF simultaneously.10,11 The exercise of segmentation of only the central MR imaging sagittal section to extract quantitative data from the intervertebral disk is also very common in the literature.12,13

    The intervertebral disk structure is nonuniform with differences in hydration and collagen content between NP and AF. Therefore, the extraction of different T1ρ and T2 relaxation times may subsist expected depending on the segmentation routine used.10,14 Despite the potential weight of using different segmentation methods in the evaluation of the intervertebral disk composition, they own not found studies comparing the accuracy, reliability, and reproducibility of the results generated by different segmentation methods. Their hypothesis is that partial segmentation of intervertebral disks, especially through touchstone geometric regional ROIs, will result in the extraction of different T1ρ and T2 relaxation times compared with replete segmentation.

    Materials and Methods Population Sample

    This study was approved by the institutional review board. The volunteers were recruited through institutional review board–approved local advertisement and were selected on the basis of the inclusion criteria. They recruited 57 asymptomatic adults (25 men and 32 women), with a spell age of 26.54 ± 5.0 years (range, 20–40 years); spell height, 1.69 ± 0.08 m (1.53–1.90 m); spell weight, 67.52 ± 13.85 kg (range, 46.5–105 kg); and spell carcass mass index, 23.5 ± 3.4 kg/m2 (range, 15.9–30.3 kg/m2). The inclusion criteria for the volunteers were the following: 20–40 years of age with an Oswestry Dysfunction Index score <10. Volunteers with persistent low back twinge for at least 6 months; an Oswestry Dysfunction Index score >10; or previous spinal pathology, significant scoliosis, or surgery were excluded from the study.

    All 5 lumbar disks of the 57 volunteers were studied; therefore, they evaluated 285 disks. The intervertebral disks were graded according to the Pfirrmann et al classification.14 After classification by the Pfirrmann grading system, they divided the intervertebral disks into 2 subgroups: nondegenerated (grades I and II) = 224 disks and degenerated (grades III and IV) = 61 disks. In their sample, they found no grade V intervertebral disks according to the Pfirrmann et al classification.

    MR Imaging

    All MR imaging examinations were performed by using a 1.5T scanner (Achieva; Philips Healthcare, Best, the Netherlands). They used a 16-channel spine coil (SENSE-SPINE; Philips). Volunteers were kept quiet in a supine position with the lower limbs extended and relaxed. The study protocol included a 2D speedy spin-echo sequence with the following characteristics: orientation = sagittal, FOV = 22 × 22 cm, thickness = 4 mm, number of sections = 16, matrix = 256 × 256 and no intersection gap. For the segmentation process, they acquired a T2-weighted sagittal sequence, with TE = 120 ms and TR = 3900 ms. Spin-echo sequences were acquired to generate quantitative T1ρ and T2 maps. They used the following parameters—T2 multiecho sequence: TE = 20/40/60/80/100/120/140/160 ms and TR = 3000 ms; T1ρ multilocker times sequence: TE = 20 ms, TR = 2000 ms, Tlock = 2/10/20/40/60 ms. The total MR imaging acquisition time was 13 minutes.

    Image Evaluation

    The panoply software (McConell Brain Imaging Center, Montreal, Quebec, Canada) was used for image analysis and segmentation. The segmentation process was performed on the sagittal plane according to the illustrations in Figs 1 and 2. The segmentation of 285 disks was performed by 2 independent and blinded observers, taking reliance not to comprise regions of subchondral bone. They were previously trained for 2 months in manual spinal MR imaging segmentation and were supervised by a senior radiologist with 15 years' sustain in musculoskeletal radiology and spine MR imaging. First, replete manual segmentation of the gross intervertebral disk, encompassing NP and AF, for each disk in complete 12 sections was performed for complete lumbar disks of each volunteer (whole-disk segmentation [WDS]). Partial-disk segmentation (PDS) methods were performed by using 6 different techniques according to the illustration in Fig 1 by using the following: 6 sections (PDS-6), 5 sections (PDS-5A and PDS-5B), 4 sections (PDS-4), 3 sections (PDS-3), and only 1 central section (PDS-1). Extraction of T1ρ and T2 relaxation times was also performed by using 3 circular ROIs (CROI) placed on the NP, anterior annulus fibrosus (AAF), and posterior annulus fibrosus (PAF) by using 3 distinct sagittal sections as shown in Fig 2. The most central region of the NP was marked by using a region of interest with an district of 26.77 mm2. This region was labeled regardless of the presence or absence of a nuclear cleft. ROIs with 12.75 mm2 each were used in the regions of AAF and PAF. They placed ROIs on the most anterior and posterior regions of the annulus, avoiding selecting the transition regions between the AF and NP.

    Fig 1.

    On the left is a sagittal T2-weighted image representing the segmented region of the intervertebral disk. On the right is the number of sections used in partial segmentation methods. A, Whole-disk segmentation. B, Partial-disk segmentation using 6 sections (PDS-6). C, Partial-disk segmentations using 5 sections, routine A (PDS-5A). D, Partial disk segmentation using 5 sections, routine B (PDS-5B). E, Partial-disk segmentation using 4 sections (PDS-4). F, Partial disk segmentation using 3 sections (PDS-3). G, Partial-disk segmentation using 1 central section (PDS-1).

    Fig 2.

    A, The CROI subregions are indicated in a T2-weighted image in the sagittal plane of a volunteer: blue for the nucleus pulposus, red for the anterior annulus fibrosus, and yellow for the posterior annulus fibrosus. B, Axial image in which the CROI routine was used.

    The main researcher was the first observer, responsible for the segmentation of complete 285 lumbar disks. One hundred disks were randomly selected for intra- and interobserver reproducibility analysis, 50 from the degenerated group and 50 from the nondegenerated group. These disks were segmented a second time by the first and second observer with an interval of 2 months after the first segmentation.

    Statistical Analysis

    The analysis of intra- and interobserver variability was performed by the intraclass correlation coefficient (ICC) with 99% assurance intervals for complete lumbar levels.

    To dissect the distribution of T2 and T1ρ relaxation times, the Shapiro-Wilk test (99% significance level) was used for each segmentation method. The WDS was chosen as the reference touchstone with which complete PDS methods and CROI were compared. Repeated-measures ANOVA with the Dunnett posttest was used for parametric samples. For the nonparametric samples, they used the Friedman test with the Dunn posttest. P values < .05 were statistically significant. They also performed a linear regression and correlation to verify that the relaxation times of partial segmentation methods showed a linear relationship to the WDS values. For statistical analysis and for the creation of graphs and tables, they used GraphPad Prism software, Version 5 (GraphPad Software, San Diego, California). To compute the ICC, they used SPSS, Version 20 (IBM, Armonk, modern York).

    Results

    The values of T2 and T1ρ relaxation times of the regions of the disk are shown in Table 1. In the nondegenerated group, in both T2 and T1ρ mapping, the methods PDS-6 and PDS-5B showed the mediocre nearest to WDS, also with a lower SD. In the segmentation techniques with fewer sections, the mediocre relaxation times extracted were more distanced from the results obtained with WDS and had a larger SD. In the degenerated disk subgroup, on the other hand, the values obtained from both T2 and T1ρ mappings were similar and did not vary statistically between the WDS, PDS, and CROI.

    Table 1:

    Values of the T2 and T1ρ relaxation times (ms) expressed as mediocre and SD for each experimental routine (n = 285 disks)

    In Tables 2 and 3 are the results of intraclass correlation coefficients and assurance intervals for each technique in the nondegenerated and degenerated groups. The ICC was higher for T1ρ and T2 in the NP and gross disk than for AAF and PAF. These results of intraobserver and interobserver reproducibility were similar between degenerated and nondegenerated disk groups.

    Table 2:

    ICCs and 99% CIs for intra-and interobserver analysis of quantitative techniques (n = 50) used in the nondegenerated group

    Table 3:

    ICCs and 99% CIs for intra- and interobserver analysis of quantitative techniques (n = 50) used in the degenerated group

    The ANOVA test for T2 relaxometry and the Friedman test for T1ρ relaxometry were used to evaluate whether the relaxation times obtained by different segmentation methods were similar. Their results showed statistically significant differences between the results of different segmentation techniques of nondegenerated cases (T2: P < .0001, F = 74.33; T1ρ: P < .0001, Friedman = 299.2). The exception occurred for the PDS-6 and PDS-5B methods, in which relaxation times extracted for both T2 and for the T1ρ were not statistically different from those of WDS. The degenerated group showed a different behavior, in which there was no statistical inequity among WDS, PDS, and CROI for both T2 (P = .45, F = 0.97) and T1ρ mapping (P = .14, Friedman = 64.41).

    Table 4 presents the correlations between the partial-segmentation methods and WDS. The R values were higher in the methods that used more sections. Comparing T1ρ and T2 mapping, one could see that the values of T2 relaxation times were discretely more scattered compared with those of T1ρ relaxation times. In both mappings, the number of sections used decreased and the assurance intervals were larger. complete methods also showed a significant positive correlation with WDS (Table 4) (P < .0001). The values were much higher in NP compared with AF in the nondegenerated group for the both T1ρ and T2 relaxometry. In the degenerated disk group, the relaxation times of NP and AF had a more similar behavior in relation to the gross disk. This result was more evident for T1ρ mapping.

    Table 4:

    Correlation between whole-disk and partial-disk segmentation methodsa

    Discussion

    In this research, they studied different techniques of extraction of T2 and T1ρ relaxation times from the lumbar intervertebral disks and compared various PDS methods with the WDS. Their results hint that the selection of the segmentation routine can influence the absolute results obtained. For practical reasons, most previous studies own used petite geometric ROIs for degenerative disk disease.9,15 They did not find any previous study in vivo that explored the segmentation of the intervertebral disk to its replete extent.

    Our results (Tables 2 and 3) showed a high intra- and interobserver reproducibility for T2 and T1ρ, both for the nondegenerated and degenerated groups. The intra- and interobserver ICCs were stronger for NP and WDS. AF ICC values were qualify because the placement of ROIs in AF tends to subsist a bit more difficult. This is especially loyal in cases of severely degenerated disks, when the brink zone between the NP and AF becomes indistinct with progressive incorporation of nucleus pulposus material into the interior of the annular lamellae.16⇓–18

    PDS-6 and PDS-5B results for T2 and T1ρ were statistically similar to those of WDS in the nondegenerated group. Their results hint that about 50% of the disk structure needs to subsist segmented so that the results would subsist comparable with those extracted via WDS on intervertebral disks with Pfirrmann grades I and II. As previously described in the literature,3,11,19 if the extraction of T2 and T1ρ emphasizes the central sections, it may overestimate the glycosaminoglycan content of the disk.

    In the degenerated disk group, partial segmentation methods and CROI showed results similar to those of the replete segmentation. This outcome may own occurred by the accentuated loss of proteoglycans and water and replacement by sort I collagen in NP.20 Thus, in degenerated disks, the relaxation time of NP became very close to that of AF because the disk composition becomes more homogeneous.15,21

    In cases of severe scoliosis, disk degeneration may occur unevenly in different regions of the disk.22⇓–24 The presence of volunteers with scoliosis could potentially strike their results of comparison between different segmentation techniques, but it did not occur because they had no case of scoliosis. Panoramic radiographs were available for each case due to another research project in progress from their group. The presence of osteophytes should also subsist considered carefully so that the segmentation does not encompass these regions.25 Other accentuated postural changes, vertebral fractures, listhesis, or extruded disk herniation could also result in uneven disk degeneration,24,26 so that using only central sagittal sections for data extraction could result in a different composition assessment of the disk. Their sample had no volunteer with deformities, fractures, or disk herniation.

    Our results support the exercise of partial segmentation methods in the study of intervertebral disk composition because PDS and CROI methods showed, in general, excellent correlation to the WDS routine (Table 4). However, the comparison among results of different studies that used different segmentation methods should subsist done with caution.15,27 Their results demonstrate that the exercise of different segmentation techniques may result in measurement of different values of intervertebral disk relaxation times.

    Regarding the comparison of their results with the literature, the NP T2 relaxation times were very close to those reported in previous studies.9,28,29 For the AF T2, their results were similar to those of Stelzeneder et al28 and Welsch et al,29 and slightly higher than those of Trattnig et al.9 With respect to the T1ρ relaxation times, the values encountered for the NP and AF in their study were lower than those found in the literature.12,30⇓–32 They hypothesize that at least in part, this inequity may subsist due to different magnetic field strengths, because most of the previous studies used 3T MR imaging.12,31,32 In common with authors of other studies, they found that a greater degree of degeneration implies lower T2 and T1ρ relaxation times.

    When they compared the individual relaxation times of NP, AAF, and PAF, complete 3 regions showed statistical correlation with the WDS values. In the nondegenerated group, the NP values had a stronger correlation with WDS, suggesting that their influence on the relaxation time of the gross disk is larger than that from AF, as has already been described in the literature.19,20 The annulus fibrosus also follows the uniform changes of the gross disk, but less than the nucleus.33 However, in the degenerated group, the relaxation times of NP and AF showed a more similar behavior in relation to the gross disk. Antoniou et al21 used MR imaging quantitative techniques and also a mechanical test to study the intervertebral disks and found similarities in the NP and AF behavior over the degenerative processes. This finding shows that both regions are affected evenly, especially at the beginning of the degeneration. This phenomenon was more evident in T1ρ mapping because this routine has proved more affinity with loss of proteoglycan content, which has been suggested as a major trigger of the degenerative process, resulting in a low relaxation time.12,13

    Most studies in the literature preferred segmentation of NP and AF individually.28⇓⇓⇓–32,34 In intervertebral disks with Pfirrmann grades I and II, segmenting these structures separately usually makes it viable to distinguish them better. If the degeneration increases to grades III and IV, this distinction becomes more difficult.14 Thus, a relative handicap of performing segmentation of the gross district or the gross volume of the disk is to enable a more secure comparison among disks with different degrees of degeneration.

    A relative limitation of their study is that they included only young and asymptomatic volunteers; therefore, the results may not subsist extended to the symptomatic population. They also did not own Pfirrmann grade V intervertebral disks. This probably is not an critical practical limitation in the research field because composition studies from quantitative MR imaging are less likely to subsist applied to severely degenerated disks.

    Numerous researchers own used quantitative MR imaging to ameliorate the understanding of intervertebral disk degeneration. During the past 10 years, the exercise of quantitative MR imaging techniques, especially T2 and T1ρ relaxometry, own allowed the evaluation of the intervertebral disk composition in vivo. However, the lack of standardization for data collection may impair the comparison of results from different studies. Despite the growing weight of relaxometry for in vivo evaluation of intervertebral disk biochemical composition and disk degeneration, they did not find studies concerned with the comparison of different segmentation techniques. When one envisions future research about the etiology and risk factors for disk degeneration, the standardization of T2 and T1ρ mapping may assume a magnificient importance.

    Conclusions

    Manual segmentation showed tenacious reproducibility for degenerated and nondegenerated disks. The segmentation methods they compared showed excellent linear correlation with each other. Absolute T1ρ and T2 values extracted from different segmentation techniques were statistically different in intervertebral disks with Pfirrmann grades I and II.

    Acknowledgments

    The authors acknowledge the funding support from CNPq, CAPES and FINEP.

    Footnotes
  • Disclosures: Rafael Menezes-Reis—RELATED: Grant: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Comments: Masters scholarship; support for Travel to Meetings for the Study or Other Purposes: Council for Scientific and Technological Development, Comments: support provided by CNPq. Camila Silva de Carvalho—RELATED: Grant: scientific initiation scholarship from R-USP, Comments: from August 1, 2012, to July 31, 2013, $400.00. Gustavo P. Bonugli—UNRELATED: Board Membership: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Christine B. Chung—UNRELATED: Grants/Grants Pending: National Institutes of Health,* Comments: NIDCR TMJ grant. Marcello H. Nogueira-Barbosa—RELATED: Grant: FINEP,* Comments: funding sources: Financiadora de Estudos e Projetos, Brazil, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. *Money paid to the institution.

  • Received June 30, 2014.
  • Accepted after revision August 15, 2014.

  • Validity of Bronchiolitis Outcome Measures | killexams.com existent questions and Pass4sure dumps

    What’s Known on This Subject:

    The Respiratory Distress Assessment Instrument (RDAI) and the Respiratory Assessment Change Score (RACS) are the most frequently used measurement instruments in bronchiolitis clinical trials. Evidence is scarce regarding their measurement properties and their suitability for exercise as evaluative instruments in clinical trials.

    What This Study Adds:

    The RDAI is an incomplete measure of respiratory distress in bronchiolitis, with impoverished to qualify construct validity. It has adequate discriminative properties but considerable test-retest measurement error. The RDAI and RACS were moderately responsive, but methodologic issues restrict the interpretation of this finding.

    Results

    Figure 2 shows data sources and participants included in the analysis of each measurement property. The baseline characteristics of participants and selected outcomes from both studies are presented in Table 4. Participants in CanBEST were older than those in the cohort study, whereas baseline severity was greater in the latter study.

    FIGURE 2

    Sources of data and number of participants included in the analysis of each measurement property.

    TABLE 4

    Baseline Characteristics of Participants and Selected Outcomes From the CanBEST visitation and the Cohort Study

    Construct Validity of the RDAI

    We found a decrepit positive correlation between RDAI score and respiratory rate at baseline with data from both studies (Pearson’s r = 0.38; 95% CI: 0.35 to 0.45; P < .001; N = 1765). Correlations for retractions and wheezing subscores were r = 0.41 and r = 0.17, respectively. By using simple linear regression, the coefficient rate was a 1.55 (95% CI: 1.38 to 1.73) increase in respiratory rate (breaths per minute) per increase in RDAI unit (P < .001). The rate was comparable when adjusting for fever and activity status (adjusted estimate: 1.52). When restricting the analysis to CanBEST data, the correlation was weaker (Pearson’s r = 0.22; unadjusted linear regression estimate: 0.98; n = 800). The association was not confounded by age, weight, fever, or activity status (adjusted estimate: 0.92).

    There was a decrepit negative correlation between baseline RDAI scores and Sao2 levels (Spearman’s r = −0.24; P < .001; n = 1761). Correlations for retractions and wheezing were r = −0.25 and r = −0.14, respectively. RDAI scores increased in lower Sao2 categories (Fig 3). The median (interquartile range) RDAI scores were 10 (8–12), 8 (6–10), and 7 (5–10) for Sao2 <92%, 92%–95%, and >95%, respectively (Kruskal-Wallis test, P < .001).

    FIGURE 3

    Box plot displaying baseline RDAI scores by categories of Sao2. The box spans the interquartile range (IQR), the solid horizontal line through the box is the median value, and the whiskers denote values within 1.5 IQRs lower than the first quartile and 1.5 IQRs higher than the third quartile.

    We found an association between the conclusion to admit or discharge and the terminal RDAI score of CanBEST participants. The preceding RDAI score was higher in admitted patients than in those who were discharged (mean difference: 2.28; 95% CI: 1.75 to 2.81; t test, P < .001; n = 798). A higher RDAI score was associated with higher risk of admission (OR:1.36; 95% CI: 1.26 to 1.47) per increase in RDAI unit; and 2.54 (95% CI: 1.65 to 3.92) when the RDAI was > 8). Adjusted analyses for center, treatment group, age, and Sao2 revealed no germane changes in these associations.

    In addition, they found that RDAI scores measured after CanBEST interventions differed between the groups of participants who were discharged (median [interquartile range]: 5 [2–6]), hospitalized (8 [5–10]), or who stayed in the ED (6 [4–8]) (n = 695; Kruskal-Wallis test, P < .001) (Fig 4). Differences between discharged participants and the 2 latter groups were statistically significant (P = .01 and P < .01, respectively; Bonferroni post hoc test). Patients with a higher RDAI score at 90 minutes had higher risk of ED remain >240 minutes (OR: 1.33; 95% CI: 1.24 to 1.43 per increase in RDAI unit). Overall, although results were in accordance with their validity hypotheses, the magnitude of the associations was mostly below their predefined thresholds.

    FIGURE 4

    Box plot displaying RDAI scores and clinical decisions at 90 minutes. The box spans the interquartile range (IQR), the solid horizontal line through the box is the median value, and the whiskers denote values within 1.5 IQRs lower than the first quartile and 1.5 IQRs higher than the third quartile.

    Reliability of the RDAI

    Test-retest assessments were available from 79 CanBEST participants. The spell inequity between the 2 repeated assessments was 0.08 (95% CI: −0.35 to 0.5; P = .72). The SEM was 1.34 and the SDC was 3.72 RDAI units. The test-retest 95% LoA were −3.8 to 3.64 RDAI units (95% CI: −4.53 to −3.07, to 2.91 to 4.37). This finding means that if a child is assessed twice, the second score could subsist between 3.64 points lower and 3.8 points higher than the first score, just because of measurement error. The magnitudes of differences between repeated measurements remained the same over the gross range of spell values as shown in the Bland-Altman plot (Fig 5). The test-retest ICC was 0.80 (95% CI: 0.70 to 0.87).

    FIGURE 5

    Bland-Altman plot of the inequity between test-retest RDAI scores at t1 (90 minutes) and t2 (120 minutes) plotted against the spell value of both scores. The central line corresponds to the mediocre inequity between 2 RDAI scores (which reflects systematic error), whereas the lower and upper dotted lines correspond to lower and upper 95% LoA (which reflect random error), respectively.

    Interrater assessments were performed in 107 participants. There was no significant inequity between 2 repeated assessments (mean difference: −0.06; 95% CI: −0.28 to 0.15; P = .54). The SEM was 0.78, and the interrater LoA were −2.1 to 2.22 RDAI units (95% CI: −2.46 to −1.74, to 1.86 to 2.58]. The ICC was 0.93 (95% CI: 0.9 to 0.94).

    Responsiveness of the RDAI and RACS

    Measures of responsiveness for RDAI and RACS based on the different constructs of change are presented in Table 5. By using both anchors, the spell RDAI scores decreased in both improved and stable groups (paired t test, P < .001; for complete within-group comparisons), with larger spell changes in scores of the improved group (unpaired t test, P < .001; for complete between-group comparisons). These results were in accordance with their predefined hypotheses. Between-group differences in spell RDAI change scores ranged from −1.31 (95% CI: −1.85 to −0.77) for the 25% respiratory rate reduction criterion to −2.03 (95% CI: −2.9 to −1.16) for the probability of admission criterion. Standardized ESs for the improved group ranged from 1.43 to 1.71, whereas responsiveness ratios ranged from 1.54 to 1.61, and AUCs from 0.64 to 0.7. The RACS was larger in the improved group (between-group difference: −2.81; 95% CI: −3.92 to −1.7), with a responsiveness ratio of 1.96 and an AUC of 0.72.

    TABLE 5

    Measures of Responsiveness for RDAI and RACS Using Different Anchors of Change

    Discussion

    This study of measurement properties of RDAI and RACS in acute bronchiolitis identifies strengths and limitations of their exercise as outcome measures. The RDAI was evaluated in 3 systematic reviews of measurement properties of asthma or wheezing severity scales in children.13–15 Limited data on its reliability and responsiveness were provided in the original description of the scale and in later reports of RCTs.12,19,24 However, nonexistent of these were adequately designed measurement studies, and no formal assessment of validity was found. Destino et al16 recently reported the first validation study on RDAI in bronchiolitis, showing impoverished construct validity, interrater reliability, and responsiveness. Findings on validity were fairly consistent with their results; differences in setting, raters, and methods may interpret why results on reliability and responsiveness were distinct.

    Our results attest that the RDAI has impoverished to qualify construct validity. The RDAI was developed ad hoc with no elaboration on the underlying conceptual model, item selection, scoring, or weighting. Although in the original report only the RACS was used as an outcome measure, later trials used RDAI scores separately for unique or repeated assessments.12 In their conceptual framework, respiratory distress was putatively reflected by RDAI items (ie, reflective model) and contributed to the multidimensional construct of bronchiolitis.21 They found impoverished convergent validity with respiratory rate, but RDAI scores discriminated well between clinically meaningful Sao2 subgroups. Measurement properties from other respiratory scales or their individual items, which often comprise respiratory rate or Sao2, are seldom available.13–15 When they are reported, there is substantial heterogeneity in correlations with Sao2, ranging from impoverished to moderate. Thus, their predefined cutoffs may own been too strict. Most, but not all, studies are consistent with their findings of weaker correlations between Sao2 and auscultatory items when compared with work of breathing.13–15,25

    These results reflect the pathophysiology and clinical correlates of respiratory distress in bronchiolitis. It is known that as disease progresses and severity increases, so finish the disturbances in ventilation and ventilation-perfusion matching.26,27 Many patients own efficacious compensatory mechanisms for these disturbances, although others finish not. However, clinical signs of respiratory distress may not capture hypoxemia/hypercapnia equipoise equally. Furthermore, the correlation between Sao2 (reflecting oxygenation), and respiratory rate (also contingent on respiratory drive and ventilation) varies across conditions.25 Therefore, the RDAI likely does not picture complete dimensions of respiratory distress in bronchiolitis, and a combination of parameters may subsist more germane for the measurement of respiratory distress, as seen in formally developed scales.28,29 However, most other scales were not developed specifically for bronchiolitis, and their measurement properties cannot subsist transferred between different respiratory conditions without further validation.

    We found that the RDAI had reasonable predictive validity based on its association with hospitalization and length of remain in the ED. Their findings are consistent with those of Corneli et al,30 who identified RDAI score, Sao2, and respiratory rate as predictors of hospitalization in bronchiolitis. On the contrary, Destino et al16 found that RDAI sum scores did not discriminate well between admitted and discharged patients, but the item on retractions did. Two big prognostic studies own also identified retractions as predictors of severe disease in ED and hospitalized patients.31,32 Decisions regarding hospitalization and length of remain in the ED are multifactorial. Nonrespiratory severity parameters (eg, feeding), prognostic factors (eg, age), companionable issues, clinical judgment, available resources, and local practices influence decision-making.30 Furthermore, there are limits to the validity of static measurements of respiratory distress in a highly dynamic condition. From an outcome measure perspective, the RDAI does not encompass complete determinants of bronchiolitis severity.

    Interrater reliability measured by the ICC was good, both at the group and individual level, as was interrater measurement error. These findings spell that RDAI scores can adequately discriminate participants assessed by different raters at the same time point in both clinical and research settings. Data from previous RCT reports also showed profitable interrater reliability, but Destino et al16 found a strikingly low ICC. Differences may relate to training, familiarity with the instrument, raters, and population heterogeneity. On the other hand, they found considerable test-retest measurement mistake at the individual level, because a patient should change at least close to 4 points (approximately one-fifth of the scale) before a change is detectable beyond measurement error. Thus, in clinical practice, changes in individual patients should subsist interpreted with caution. For the RACS, they must also esteem measurement mistake for respiratory rate.33,34 The SDC is paramount to interpretability parameters such as the minimal critical change (MIC), because a big SDC relative to the MIC means that observed change may subsist caused by measurement mistake rather than change per se.35 At the individual level, taking repeated measurements and averaging the value would reduce the measurement mistake with a factor √k (k is the number of measurements). Although reassessment is a key component when evaluating children with respiratory distress, many repeated measurements might not subsist practical in clinical practice. At the group level, the SDC of a spell change is equal to SDC/√n, which reduces its impact.21 Because the ICC was high, the RDAI is dependable for exercise in studies. Overall, these results hint that the RDAI has adequate discriminative properties, but test-retest measurement mistake should subsist minimized.

    The RDAI was responsive according to their predefined hypotheses based on 2 distinct constructs of change. Previous data on RDAI responsiveness are scarce.13–15 Hardly any intervention can subsist considered clearly efficacious in bronchiolitis in the ED setting, and thus nonexistent is a reasonable gold touchstone to assess change. Destino et al16 reported a mild correlation between the change in the RACS and the Children’s Hospital of Wisconsin Respiratory Score, but data on responsiveness of this latter scale are also missing. They anchored their constructs of change on physiologic change and change in clinical status likely to subsist germane for decisions regarding patient personality at the ED. Measures of responsiveness that took into account both improved and stable groups (responsiveness ratio and AUC) were comparable between anchors for the RDAI. The AUC value was close to the frequently used cutoff of acceptability (0.7) for both the RDAI and RACS, with the RACS being slightly more responsive. These data hint that the RDAI and RACS are moderately responsive, but any comparison with other respiratory scales is limited.

    Our study has limitations related to design constraints of both included studies. First, less heterogeneity of RDAI scores in the selected sample of CanBEST participants may interpret why they found a weaker correlation with respiratory rate and lower test-retest ICC scores. Further validation is needed when considering children with very mild or severe disease, who were excluded in CanBEST. Second, their results are applicable to infants with a first episode of wheezing and no germane comorbidities and should subsist interpreted with caution when defining bronchiolitis differently in other populations.36 Third, concurrent factors that strike decisions of hospitalization were not collected, and the exact timing of this conclusion was not known. Although, in model conditions, managing physicians would subsist blinded to RDAI/RACS scores, blinding to their individual items is not expected. Finally, defining stability and change can subsist problematic and time-dependent due to the dynamic nature of bronchiolitis. When assessing responsiveness by using data collected at different time points (mostly between 90 and 240 minutes), they observed significant improvements in RDAI scores in groups that they considered a priori to subsist stable. This finding is likely a limitation of their anchors and may also reflect the upshot of supportive measures and the nebulized “placebo.” These limitations should subsist considered when calculating the MIC of the RDAI, which will subsist the focus of future work.

    In conclusion, they found the RDAI to subsist an incomplete measure of respiratory distress in bronchiolitis, with impoverished to qualify construct validity and adequate interrater reliability. The RDAI had considerable test-retest measurement error, and although both the RDAI and RACS were moderately responsive, methodologic issues may restrict the interpretation of this finding. Finally, the RDAI does not encompass complete determinants of bronchiolitis severity.



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