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besides the fact that not a prevailing 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 stay invisible for a lot of months however finally effect in serious financial hurt, ruining groups’ attractiveness and even cause 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 breach (or have been notified in regards to the breach) changed into 146. To make issues even worse, protection consultants display 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 good fortune? Or is there anything to observe 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 good deal negligent about their safety and take inadequate safety measures. truly, focused entities always undertake the entire latitude of security equipment from regular firewalls and antiviruses to subtle anti-malware items. The issue is that these ordinary equipment aren’t able to stand up to an APT attack, leaving a pretty good 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 block unsolicited incoming network site visitors. Their advanced versions may also in part offer protection to against DDoS assaults. but they really can’t notice malicious clients, analyze packets containing malware and obviously they can't cope with assaults that don’t go 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 stop vulnerability exploits. youngsters, IPS also have their barriers as they are helpless towards client-aspect utility assaults.
in addition, managing an array of security equipment is complex and dear, as you deserve to purchase distinct utility licenses and rent consultants to take care of each particular piece of application. It’s also unattainable to manually correlate statistics from diverse techniques with a view to observe and respond to proliferating assaults. And, ultimately, scattered options cannot be 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 experience 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 get all armed for possible assaults, it’s effective to investigate previous errors. within the history of safety breaches, APTs have a ’music list’ of calamitous intrusions. amongst them there are a series of attacks with the aid of the Carbanak group that focused greater than one hundred banks and other financial institutions in 30 nations (the united states named the 2nd largest target), which made it one of the crucial largest financial institution thefts ever.
started out in August 2013, this refined hacking gang turned into first publicly disclosed simplest in 2015 when the full profit already reached $1 billion. To reside overlooked and learn every financial institution internal out, attackers used a whole range of tactics from spear phishing to latent 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 new series of attacks had been already registered in 2016. This time, the crowd goals to double down the old 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 take 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 financial institution personnel’ computers through opportunistic malware. IBM protection QRadar QFlow Collector could pinpoint a malware infection by guaranteeing steady monitoring of the traffic moving 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 put in force anomaly rules, in addition to to build up particular correlation rules to discover here:
as soon as the attackers gained access to employees’ computers, they started a large spear phishing campaign that turned into very difficult to establish. indeed, a SIEM answer can hardly ever distinguish an infected electronic mail message originating from a legitimate e mail account (a computing device with malware) from a valid electronic mail. besides the fact that children, if the e-mail server is related to a SIEM solution as a log supply, it’s possible to observe the following abnormalities:
The superior correlation with actual security controls additionally makes it possible 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 attack via privilege escalation and deeper reconnaissance which are regular for all APTs.
Privilege escalation may well be monitored with a first-rate-tuned SIEM solution with the following:
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 include out-of-the-field reconnaissance detection correlation rules that will also be first-rate-tuned to cut false-positives. In their case, a deeper reconnaissance originating from an inside corporate network may well be identified if firewalls have been sending entry logs to a SIEM solution.Latent watch
To stronger take 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 observe video and reveal shooting actions on account that video translation produces loads of traffic that could be 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 make the machines dispense cash. In case if compromised administrative bills have been used to spread an infection, a SIEM solution would be able to alert the protection personnel about the following:
moreover, an advanced correlation with id and entry management solutions and Ticketing programs would enable to observe circumstances when an admin consumer became logging to the equipment and not using a acceptable ticket or IAM allowance.Compromise of inside databases and introduction of fraudulent accounts
all the way 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 use of the on-line banking equipment. consistently, all pastime regarding growing new bills should pass via a validation manner. reckoning on such a procedure and equipment used for validation, this assistance could be integrated with a SIEM solution to alert on sudden account introduction. If there’s no such validation in location, every new account advent may well be alerted and investigated by way of a protection analyst.
A SIEM consultant might assist a financial institution to get experiences on company-important information change by using doing here:
To be in a position to circulation massive amounts of money into managed bills, the attackers abused the Society for worldwide Interbank financial Telecommunication system. A smartly-configured SIEM solution might ensure a relentless monitoring of all critical economic purposes. If a selected application weren’t supported by using QRadar out-of-the-box, appropriate parsing, mapping and categorization may be developed. once custom records is properly normalized, a SIEM solution would be able to become aware of abnormal money transfers with anomaly correlation guidelines, if right here are proper:
The case we’ve just analyzed proves that organizations don't seem to be helpless of their combat in opposition t APTs. it might sound unusual, but while refined as they are, APTs have their weakness hiding in the letter “P.” Persistence, which is the most problematic to take care of, definitely ability that attackers depart a lot of traces for the duration of their attacks. as a result safety directors neatly-armed with a central SIEM answer have 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 way 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.
security assistance and experience management utility products and features have become common accessories of the...
cybersecurity programs of many businesses.
safety guidance and experience 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 place is a cloud-primarily based, SaaS platform.
The product's core SIEM application features encompass log collection, experience management, experience correlation and reporting. USM anywhere makes it possible for the centralized storage of all log statistics in the AlienVault relaxed Cloud, a certified-compliant atmosphere. This alleviates the business's burden of getting to manipulate and relaxed logs on premises, while additionally featuring a compliance-able log administration ambiance.
Going beyond a normal 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 single SaaS providing. both computerized and orchestrated, these capabilities supply security gurus the equipment and tips they should control hazard detection, incident response and compliance, the company claims.
The company also makes use of an alarm dashboard, named the Kill 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 make 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 all sizes and budgets. Pricing for USM any place 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 equipment 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 normal threats and anomalous network and device recreation. These could be 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.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 way of any of IBM's managed safety capabilities provider companions. bendy architecture can birth small with an all-in-one device with a console, experience collector and event processor, and can then scale out into totally dispensed environments with separate 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:
different capabilities encompass QRadar guide with Watson, which applies artificial intelligence to automatically mine native QRadar records to find the root cause and real scope of a risk in the atmosphere.
It additionally comprises the QRadar records shop, which presents fixed-price log storage, enabling businesses to shop big amounts of data while not having to correlate every little thing. This helps agencies tackle regulatory necessities and maintain records that can be 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 big data analytics architecture; superior records processing; centralized visibility into protection signals and alarms; centralized visibility into forensic records; and the means to follow synthetic intelligence, advanced state of affairs modeling, and deep behavioral analytics throughout a 360-diploma view of forensic facts. other features include case management, which allows for security teams to engage in workflows using a centralized and at ease case administration facility; task automation; and immediately guided workflows.
in accordance with the company, extra granular measurements, corresponding to time to qualify and time to investigate, can help analysts take into account workflow effectiveness. These performance metrics can help 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.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 business scalability to meet long-term needs, inspite of changing performance, storage and geographic necessities, the business claims.McAfee LLC commercial enterprise protection supervisor (ESM)
McAfee's commercial enterprise security manager (ESM) is a SIEM application tool for business, commercial enterprise and government corporations, in addition to managed security service providers. ESM offers chance 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 chance administration with new 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:
ESM is obtainable as an equipment or digital computing device that clients can mix and healthy. ESM fashions include all-in-one fashions and discrete appliances, and it will also be 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 seek quick querying of hobbies, archival of uncooked routine for compliance and forensics, and layer three and seven utility-level monitoring.fundamental overview of McAfee application, which continues track of exercise and possible 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 chance 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 save that gives prebuilt use 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, take notes and enable remediation by the use 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 dictate 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 equipment 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 price 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 use of the equal philosophy and sold through the number of CPU cores essential to help 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 help 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 include 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 be 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 take Rapid7's abilities of prior attack 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 take containment actions for detected threats from within InsightIDR. The Centralized Log administration feature links millions of every day events in a single 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 possible 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 discover behaviors that log analysis by myself can fail to catch.
InsightIDR makes it possible 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 all 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 be deployed in my opinion 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 couple 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 use of RSA NetWitness Orchestrator, or means -- equipment hardware. organizations can mix and in shape utility and appliance licenses for granular ability and boom.Splunk Inc. commercial enterprise security
Splunk business security (ES) is a part of Splunk business, and it presents the means to look, display screen and analyze 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 showcasing most effective practices in the Splunk software
adventure Sequencing presents the ability 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 include Splunk's Adaptive Response. With this feature, users can apply alterations to adapt to the strategies of a given attacker. Splunk ES incorporates with Splunk user behavior Analytics, the place 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 Use Case Library characteristic can help groups bolster safety with principal content through automatically identifying which makes use of cases are most valuable to their personal environment according to the ingested statistics.
companies can also use the platform to create, curate, set up and manipulate content material, which can help cut back chance via featuring quicker detection and incident response to new threats. furthermore, Splunk ES offers ad hoc searching and reporting capabilities for breach evaluation, Splunk claims.
Splunk bases pricing for Splunk ES on highest each day quantity of information indexed in GB per day.
we can visualize useful resource starvation using an elaborate 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 like 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 eat his dinner and each is protected from interference whereas he makes use of a chopstick.
Plato skipped lunch that day and insists that he should still have priority or else he'll faint. If he doesn't surrender his chopsticks, the other philosophers won't be in a position to eat and eventually they will starve. If Plato drops his chopsticks and automatically picks them up before the different philosophers can get them then they won't be in a position to devour and they'll ultimately starve.
Dijkstra's dining Philosophers difficulty employed spaghetti and forks but I used chopsticks and Asian cuisine for a extra useful illustration because you cannot devour spaghetti with a single chopstick (see determine 1).
These are examples of useful resource hunger. You could also come across deadlock. There are a few options like semaphores and screens. however they may not suppose about options or deadlocks in this article. they are going to center of attention on detecting aid hunger the usage of IBM Thread and display screen Dump Analyzer for Java.
what is the IBM Thread and display 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 seem 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 all 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 use of environment variables and runtime switches. by using default, a Javacore occurs when the JVM terminates unexpectedly. A Javacore can even be prompted by sending particular signals to the JVM. despite the fact a Javacore or javadump can turn 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 display 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 display screen bottlenecks. it may well analyze 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 all 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 like IBM HeapAnalyzer, IBM pattern Modeling and evaluation device, and IBM performance Analyzer for Java for home windows. all 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 be 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 help prognosis a grasp, impasse, or monitor rivalry subject. It includes diagnostic tips regarding the JVM and a Java application captured at a point all through execution. as an instance, the assistance can also be a list of all of the threads that run on a Java digital computer. continually thread dumps have more than simply thread suggestions. Thread dumps can produce counsel in regards to the operating system, software atmosphere, threads, stacks, locks, and reminiscence. IBM Thread Dumps/Javacores deliver plenty extra counsel like 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 be 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 display screen Dump Analyzer for Java is aware IBM, Solaris, and HP-UX Java thread dump formats.
by default, IBM JVM thread dumps turn up when the JVM terminates all at once. A thread dump can even be 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 equipment dump.
earlier than IBM Thread and monitor Dump Analyzer for Java became delivered, people needed to manually check a whole bunch of threads within the thread dumps the usage of their favourite editors. With IBM Thread and video display 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 seem to be as gigantic as heap dumps. constantly its measurement is round 1MB or less unless you have colossal number of threads or classes. it be not a large deal to manually evaluation thread dumps if you best have a handful of threads operating on your JVM. if you have 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, preliminary 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, native reminiscence utilization of each and every JVM part, and impasse information.
IBM Thread and display 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 advice 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 all monitor information in a Javacore and detects impasse and useful resource rivalry or video display bottlenecks, if there are any.
Let's Get StartedWe can simulate a hunger difficulty with an easy 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 have noticed that every philosopher's identify has a suffix that represents a precedence on account that they wish to provide Plato greater of a chance to consume. besides a name and priority, each philosopher is also given a left chopstick and a appropriate 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 name 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() method through which they acquire Java's developed-in displays for left and appropriate chopsticks and make contact with the eat() formula. In each and every () formula, they pause 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 put all 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 fair 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 be consuming and the other two philosophers will have less of a chance to eat. they will generate thread dumps by way of sending signal three to the process. On the home windows platform, which you can use keyboard combos like 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 equipment 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 use the kill command on most Unix systems:
for instance, kill -three $PID
as an example, kill -eleven $PID
On the IBM WebSphere application Server 5/6 ambiance, which you can use wsadmin script to generate thread dumps:
wsadmin.sh -conntype cleaning soap -port <port number>> set jvm [$AdminControl completeObjectName type=JVM,process=server1,*]> $AdminControl invoke $jvm dumpThreads
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Surfline, the world's leading action sports website, today announced it has accepted a strategic round of financing from prominent Internet pioneer, Kevin O'Connor, who will also been joining the Surfline board of directors.
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BACKGROUND AND PURPOSE: Intervertebral disk biochemical composition could be 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 all 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 difference with whole-disk segmentation. All the remaining partial-disk segmentation methods and circular ROIs showed different results from whole-disk segmentation (P < .001). In the degenerated disk group, all methods were statistically similar to whole-disk segmentation. All partial-segmentation methods, including circular ROIs, showed strong linear correlation with whole-disk segmentation in both the degenerated and nondegenerated disk groups.
CONCLUSIONS: Manual segmentation showed strong reproducibility for T1ρ and T2 and strong 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 method 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 need 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 perform segmentation procedures that involve selecting the region to be analyzed.5 This segmentation can be manual, semiautomatic, or automatic. In studies assessing the lumbar intervertebral disk composition, different authors used different methods to perform disk segmentation with subsequent data extraction. The most common method in the literature with regard to T1ρ and T2 is to acquire small regions of interest that are anatomically based.6⇓⇓–9 Authors have used standard 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 have 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 whole intervertebral disk. Other authors chose to perform the segmentation of the disk as a whole, with the region of interest covering the NP and AF simultaneously.10,11 The use 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 be expected depending on the segmentation method used.10,14 Despite the potential importance of using different segmentation methods in the evaluation of the intervertebral disk composition, they have 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 standard geometric regional ROIs, will result in the extraction of different T1ρ and T2 relaxation times compared with full 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 mean age of 26.54 ± 5.0 years (range, 20–40 years); mean height, 1.69 ± 0.08 m (1.53–1.90 m); mean weight, 67.52 ± 13.85 kg (range, 46.5–105 kg); and mean body 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 pain 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 still in a supine position with the lower limbs extended and relaxed. The study protocol included a 2D fast 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 Display 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 care not to include 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' experience in musculoskeletal radiology and spine MR imaging. First, full manual segmentation of the whole intervertebral disk, encompassing NP and AF, for each disk in all 12 sections was performed for all 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 area 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, method A (PDS-5A). D, Partial disk segmentation using 5 sections, method 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 method was used.
The main researcher was the first observer, responsible for the segmentation of all 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% confidence intervals for all lumbar levels.
To analyze 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 standard with which all 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 calculate the ICC, they used SPSS, Version 20 (IBM, Armonk, New 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 average nearest to WDS, also with a lower SD. In the segmentation techniques with fewer sections, the average 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 differ statistically between the WDS, PDS, and CROI.Table 1:
Values of the T2 and T1ρ relaxation times (ms) expressed as average and SD for each experimental method (n = 285 disks)
In Tables 2 and 3 are the results of intraclass correlation coefficients and confidence intervals for each technique in the nondegenerated and degenerated groups. The ICC was higher for T1ρ and T2 in the NP and whole 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 groupTable 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 difference 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 confidence intervals were larger. All 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 whole disk. This result was more evident for T1ρ mapping.Table 4:
Correlation between whole-disk and partial-disk segmentation methodsaDiscussion
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 suggest that the choice of the segmentation method can influence the absolute results obtained. For practical reasons, most previous studies have used small 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 full 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 moderate because the placement of ROIs in AF tends to be a bit more difficult. This is especially true in cases of severely degenerated disks, when the border 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 suggest that about 50% of the disk structure needs to be segmented so that the results would be 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 full segmentation. This outcome may have occurred by the accentuated loss of proteoglycans and water and replacement by type 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 affect 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 be 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 use of partial segmentation methods in the study of intervertebral disk composition because PDS and CROI methods showed, in general, excellent correlation to the WDS method (Table 4). However, the comparison among results of different studies that used different segmentation methods should be done with caution.15,27 Their results demonstrate that the use 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 difference may be 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, all 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 whole 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 whole 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 whole 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 method 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 possible to distinguish them better. If the degeneration increases to grades III and IV, this distinction becomes more difficult.14 Thus, a relative advantage of performing segmentation of the whole area or the whole 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 be extended to the symptomatic population. They also did not have Pfirrmann grade V intervertebral disks. This probably is not an important practical limitation in the research field because composition studies from quantitative MR imaging are less likely to be applied to severely degenerated disks.
Numerous researchers have used quantitative MR imaging to improve the understanding of intervertebral disk degeneration. During the past 10 years, the use of quantitative MR imaging techniques, especially T2 and T1ρ relaxometry, have 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 importance 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 great importance.Conclusions
Manual segmentation showed strong 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.
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 use as evaluative instruments in clinical trials.What This Study Adds:
The RDAI is an incomplete measure of respiratory distress in bronchiolitis, with poor to moderate construct validity. It has adequate discriminative properties but considerable test-retest measurement error. The RDAI and RACS were moderately responsive, but methodologic issues limit 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 Trial and the Cohort StudyConstruct Validity of the RDAI
We found a weak 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 estimate 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 estimate 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 weak 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 decision to admit or discharge and the last 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 relevant 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 stay >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 mean difference 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 be 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 whole range of mean 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 difference between test-retest RDAI scores at t1 (90 minutes) and t2 (120 minutes) plotted against the mean value of both scores. The central line corresponds to the average difference 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 difference 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 mean RDAI scores decreased in both improved and stable groups (paired t test, P < .001; for all within-group comparisons), with larger mean changes in scores of the improved group (unpaired t test, P < .001; for all between-group comparisons). These results were in accordance with their predefined hypotheses. Between-group differences in mean 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 ChangeDiscussion
This study of measurement properties of RDAI and RACS in acute bronchiolitis identifies strengths and limitations of their use 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, none 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 poor construct validity, interrater reliability, and responsiveness. Findings on validity were fairly consistent with their results; differences in setting, raters, and methods may explain why results on reliability and responsiveness were distinct.
Our results show that the RDAI has poor to moderate 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 single 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 poor 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 include respiratory rate or Sao2, are seldom available.13–15 When they are reported, there is substantial heterogeneity in correlations with Sao2, ranging from poor to moderate. Thus, their predefined cutoffs may have 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 do the disturbances in ventilation and ventilation-perfusion matching.26,27 Many patients have effective compensatory mechanisms for these disturbances, although others do not. However, clinical signs of respiratory distress may not capture hypoxemia/hypercapnia balance equally. Furthermore, the correlation between Sao2 (reflecting oxygenation), and respiratory rate (also dependent on respiratory drive and ventilation) varies across conditions.25 Therefore, the RDAI likely does not represent all dimensions of respiratory distress in bronchiolitis, and a combination of parameters may be more relevant 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 be 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 stay 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 large prognostic studies have also identified retractions as predictors of severe disease in ED and hospitalized patients.31,32 Decisions regarding hospitalization and length of stay in the ED are multifactorial. Nonrespiratory severity parameters (eg, feeding), prognostic factors (eg, age), social 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 all 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 mean 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 good 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 error 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 be interpreted with caution. For the RACS, they must also consider measurement error for respiratory rate.33,34 The SDC is paramount to interpretability parameters such as the minimal important change (MIC), because a large SDC relative to the MIC means that observed change may be caused by measurement error rather than change per se.35 At the individual level, taking repeated measurements and averaging the value would reduce the measurement error 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 be practical in clinical practice. At the group level, the SDC of a mean change is equal to SDC/√n, which reduces its impact.21 Because the ICC was high, the RDAI is reliable for use in studies. Overall, these results suggest that the RDAI has adequate discriminative properties, but test-retest measurement error should be 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 be considered clearly effective in bronchiolitis in the ED setting, and thus none is a reasonable gold standard 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 be relevant for decisions regarding patient disposition 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 suggest 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 explain 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 relevant comorbidities and should be interpreted with caution when defining bronchiolitis differently in other populations.36 Third, concurrent factors that affect decisions of hospitalization were not collected, and the exact timing of this decision was not known. Although, in ideal conditions, managing physicians would be blinded to RDAI/RACS scores, blinding to their individual items is not expected. Finally, defining stability and change can be 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 be stable. This finding is likely a limitation of their anchors and may also reflect the effect of supportive measures and the nebulized “placebo.” These limitations should be considered when calculating the MIC of the RDAI, which will be the focus of future work.
In conclusion, they found the RDAI to be an incomplete measure of respiratory distress in bronchiolitis, with poor to moderate 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 limit the interpretation of this finding. Finally, the RDAI does not encompass all determinants of bronchiolitis severity.
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