Doubling daily inhaled corticosteroid dose is ineffective in mild to moderately severe attacks of asthma in adults

Background: Asthma guidelines recommend increasing or doubling inhaled corticosteroid (ICS) dose to treat mild and moderate exacerbations of asthma in adults. Aim: To: (i) compare the effectiveness of doubling existing daily ICS dose (fluticasone) with maintaining usual ICS dose and usual daily ICS dose accompanied by oral steroids (OS) (dexamethasone) during mild and moderately severe exacerbations of asthma in adults; (ii) examine determinants of success and failure; and (iii) compare side-effect profiles. Methods: A randomized, double-blind, placebo-controlled (double-dummy), triple crossover trial. Participants acted as their own control. Outcome measures included treatment success/failure, peak expiratory flow (PEF) after 7 days therapy or at treatment failure, and side-effects. Results: From 22 participants (nine males and 13 females), 18 pairs of data were available for maintaining usual ICS versus doubling ICS and doubling ICS versus OS, and 19 for maintaining usual ICS versus OS. Median (fifth-95th percentile) age was 46.5 (32-64) years and forced expiratory volume in one second (FEV1) 73% (29-97%) predicted. The outcome after doubling ICS was not superior to maintaining usual ICS, with 11 (61%) failures in both arms (P = 0.66). OS, with only 5 (26%) failures, was superior to maintaining usual ICS with 12 (63%) failures (P = 0.04), and to doubling ICS with 5 (28%) versus 11 (61%) failures (P = 0.07). Median PEF (as percentage of run-in best) at end-points were 90.5% (57.1-177.1) for OS, 78.3% (39.5-103.1) for maintaining usual ICS and 77.9 (27.7-110.3) for doubling ICS. Neither gender nor PEF at exacerbation were predictive of failure. Although doubling ICS was not an effective therapy overall, ICS dose at exacerbation were predictive of success in the doubling ICS arm (P = 0.04). Treatment failures when doubling daily ICS dose were more common if achieved fluticasone dose was less than 2000 mu g (three of 11, 73%) compared to 2000 mu g or greater (eight of eight, 37.5%). Increasing age and the presence of an upper respiratory tract infection (URTI) were predictive of failure with OS. Side-effects were more commonly reported with OS (52.6%) than doubling ICS (42.1%) or maintaining usual ICS (19.1%) with the most common being mood changes (36.8%), sleep disturbance (31.6%) and changes in appetite (26.3%). Conclusions: Doubling daily ICS dose per se is not effective for the treatment of mild to moderately severe exacerbations of asthma in adults. Success may depend on achieved ICS dose. Oral steroids are effective, but side-effects are common. A review of current guidelines may be warranted.

Looking beyond the negatives: A time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive-behavior therapy for panic disorder

Time period analysis was used in an international sample of clients ( N = 106) to demonstrate that cognitive - behavioral therapy (CBT) for panic disorder is associated with specific changes in both negative and positive cognitions during the treatment period. In the first 6 weeks of the treatment phase, working alliance failed to predict changes in panic severity, whereas changes in panic self-efficacy and catastrophic misinterpretation of bodily sensations predicted rapid symptom relief. In the last 6 weeks of treatment, higher doses of CBT were associated with further changes in positive and negative cognitions. The findings can be interpreted as suggesting that the role of the working alliance in CBT for panic disorder is to facilitate cognitive change.

Cognitive mediation of panic severity: The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy

This study examined the differential role of negative and positive cognitions in mediating treatment outcome in CBT for Panic Disorder through comparison of a Standard CBT (n = 36) versus a Waitlist Condition (n = 24). Regression analyses indicated that, relative to the Waitlist Condition, patients in the Standard CBT condition reported significantly greater shifts both towards higher panic self-efficacy and lower catastrophic misinterpretation of bodily sensations during treatment, as well as a significantly lower level of panic severity at posttreatment. Changes in catastrophic misinterpretation of bodily sensations and panic self-efficacy contributed significantly more to prediction of panic severity than did assignment to either Standard CB T or a Waitlist Condition. Results are discussed in terms of the importance of including both negative and positive cognitions in demonstrating cognitive mediation.

Internet-based indicated prevention for panic disorder: An effectiveness trial in primary care

Previous studies have shown that an internet delivered indicated prevention program for panic disorder can be effective. However, those studies were done with select populations. Most individuals who are at risk for panic disorder present to hospital emergency rooms and primary care settings. This paper reports on a study currently being undertaken in Scotland where the program is being trialed in primary care. The intervention and experimental design will be described. However the key research question is whether General Practitioners will make use of the internet-based intervention system. Preliminary results will be reported. The results of the study will have implications for the way that primary care is recruited into the prevention of mental health problems.

Formal verification of type flaw attacks in security protocols

Security protocols are often modelled at a high level of abstraction, potentially overlooking implementation-dependent vulnerabilities. Here we use the Z specification language's rich set of data structures to formally model potentially ambiguous messages that may be exploited in a 'type flaw' attack. We then show how to formally verify whether or not such an attack is actually possible in a particular protocol using Z's schema calculus.

Analysis of common attacks in public-key cryptosystems based on low-density parity-check codes

The security and reliability of a class of public-key cryptosystems against attacks by unauthorized parties, who had acquired partial knowledge of one or more of the private key components and/or of the message, were discussed. The standard statistical mechanical methods of dealing with diluted spin systems with replica symmetric considerations were analyzed. The dynamical transition which defined decryption success in practical situation was studied. The phase diagrams which showed the dynamical threshold as a function of the partial acquired knowledge of the private key were also presented.

Protecting agents against malicious host attacks

The introduction of agent technology raises several security issues that are beyond conventional security mechanisms capability and considerations, but research in protecting the agent from malicious host attack is evolving. This research proposes two approaches to protecting an agent from being attacked by a malicious host. The first approach consists of an obfuscation algorithm that is able to protect the confidentiality of an agent and make it more difficult for a malicious host to spy on the agent. The algorithm uses multiple polynomial functions with multiple random inputs to convert an agent's critical data to a value that is meaningless to the malicious host. The effectiveness of the obfuscation algorithm is enhanced by addition of noise code. The second approach consists of a mechanism that is able to protect the integrity of the agent using state information, recorded during the agent execution process in a remote host environment, to detect a manipulation attack by a malicious host. Both approaches are implemented using a master-slave agent architecture that operates on a distributed migration pattern. Two sets of experimental test were conducted. The first set of experiments measures the migration and migration+computation overheads of the itinerary and distributed migration patterns. The second set of experiments is used to measure the security overhead of the proposed approaches. The protection of the agent is assessed by analysis of its effectiveness under known attacks. Finally, an agent-based application, known as Secure Flight Finder Agent-based System (SecureFAS) is developed, in order to prove the function of the proposed approaches.

Investigating the Relations of Attacks, Methods and Objects in Regard to Information Security in Network TCP/IP Environment

Possibilities for investigations of 43 varieties of file formats (objects), joined in 10 groups; 89 information attacks, joined in 33 groups and 73 methods of compression, joined in 10 groups are described in the paper. Experimental, expert, possible and real relations between attacks’ groups, method’ groups and objects’ groups are determined by means of matrix transformations and the respective maximum and potential sets are defined. At the end assessments and conclusions for future investigation are proposed.

Research of the Influence of Methods of Compression on the Co-efficient of Information Security of Objects Under Attacks

In this paper a possibility for quantitative measuring of information security of objects, exposed to information attacks and processed with methods of compression, is represented. A co-efficient of information security, which reflects the influence of the level of compression obtained after applying methods of compression to objects and the time, required by the attack to get access to the corresponding object, is proposed. Methods’ groups with the highest and respectively the lowest values of the co-efficient of information security for all methods’ groups in relation to all attacks’ groups are determined. Assessments and conclusions for future investigations are proposed.