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Comprehensive 2024-2025 Test Bank and Solution Manual List 2 | Academic Resources

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Steen - Human Resource Management - 3ce, ISBN 0071060014 Canadian Version Test Bank.

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Statistics, Data Analysis, and Decision Modeling, 5E James R. Evans Test Bank.

Statistics, 12E James T. McClave Terry Sincich Test Bank.

Statistics, 11th Edition by Robert S. Witte, John S. Witte. 2016 Test Bank Test Bank.

Statistics, 10th Edition Witte, Witte Test Bank.

Statistics, 9th EditionWitte, Witte Test Bank.

Statistics with Pearson eText for Statistics for the Behavioral and Social Sciences A Brief Course -- Access Card, 6E Arthur Aron, Ph.D Test Bank.

Statistics Unlocking the Power of Data, 2nd Edition Lock, Frazer , Morgan, 2017 Test Bank.

Statistics The Art and Science of Learning from Data, Global Edition, 4th Edition Alan Agresti Test Bank.

Statistics The Art and Science of Learning from Data, 4EAlan Agresti Christine A. Franklin, Bernhard Klingenberg, Test Bank TG.

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Statistics Principles and Methods 8th Edition by Richard A. Johnson Test Bank.

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Statistics Learning from Data , 2nd Edition Roxy Peck; Tom Short Test Bank.

Statistics Informed Decisions Using Data, 5th Edition Michael Sullivan, Test Bank.

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Statistics for the Behavioral Sciences, 9th Edition Frederick J Gravetter, Larry B. Wallnau Instructor Manual and Test Bank.

Statistics for the Behavioral Sciences 2nd edition Nolan Heinzen ISBN-10 1-4292-3265-X Test Bank.

Statistics for the Behavioral and Social Sciences A Brief Course, 6th Edition Aron, J. Coups, Test Bank.

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STATIS~2.

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Statistics and Data Analysis for Nursing Research, 2nd Edition Denise F. Polit, Test Bank.

Statistics A Tool for Social Researchers in Canada, 4ce A Tool for Social Research , 4th Edition Joseph F. Healey; Steven Prus; Riva Lieflander Test Bank.

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Statistical Reasoning in the Behavioral Sciences, 6th Edition King, Rosopa, Minium Test Bank.

Statistical Reasoning for Everyday Life, 4E Jeff Bennett Bill Briggs, Mario F. Triola, Test Bank.

Statistical Concepts for the Behavioral Sciences, 4E Harold O. Kiess, Bonnie A. Green IM w Test Bank.

State and Local Politics Institutions and Reform, 3rd EditionTodd Donovan, Daniel A. Smith, Christopher Z. Mooney Test Bank.

State and Local Government, 11th Edition Ann O'M. Bowman, Richard C. Kearney, Carmine P. F. Scavo 2022 Test Bank.

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SO57C9~1.

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South-Western Federal Taxation 2013 Corporations, Partnerships, Estates and Trusts, 36th Edition William H. Raabe, James E. Smith, David M. MaloneyHoffman, Test Bank.

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Software Engineering A Practitioner's Approach 9th Edition By Roger Pressman and Bruce Maxim Test bank.

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Sociology of Education in Canada Karen Robson Test Bank.

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Sociology in a Changing World, 9th Edition William Kornblum Test Bank.

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Social Welfare in Canadian Society, 5th Edition Rosalie Chappell Test Bank.

Social Welfare A History of the American Response to Need, 8th Edition Mark J. Stern, June Axinn ISM +Test Bank.

Social Science An Introduction to the Study of Society 17th Edition C. Colander , F. Hunt Test Bank ( Routledge Publisher ).

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Skills for Success with Microsoft Office 2019 Introductory Margo Chaney Adkins Test Bank.

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fulltestbank · 2 years ago

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Solution Manuals For Intermediate Accounting, 3e by Hanlon

About Our Team (pg. iii) Preface (pg. v) Brief Contents (pg. xviii) Contents (pg. xix) Chapter 1: Accounting Environment and the Conceptual Framework (pg. 1-1) Chapter 2: Accounting Information System (pg. 2-1) Chapter 3: Income Statement and Comprehensive Income (pg. 3-1) Chapter 4: Balance Sheet and Financial Reporting (pg. 4-1) Chapter 5: Statement of Cash Flows and Financial Analysis (pg. 5-1) Chapter 6: Time Value of Money (pg. 6-1) Chapter 7: Revenue Recognition (pg. 7-1) Chapter 8: Cash and Receivables (pg. 8-1) Chapter 9: Inventory: Measurement (pg. 9-1) Chapter 10: Inventory: Additional Issues (pg. 10-1) Chapter 11: Property, Plant, and Equipment: Acquisition and Disposition (pg. 11-1) Chapter 12: Depreciation, Impairments, and Depletion (pg. 12-1) Chapter 13: Intangible Assets and Goodwill (pg. 13-1) Chapter 14: Investments in Debt and Equity Securities (pg. 14-1) Chapter 15: Current Liabilities and Contingencies (pg. 15-1) Chapter 16: Long-Term Liabilities (pg. 16-1) Chapter 17: Accounting for Leases (pg. 17-1) Chapter 18: Income Taxes (pg. 18-1) Chapter 19: Pensions and Postretirement Benefits (pg. 19-1) Chapter 20: Stockholders’ Equity (pg. 20-1) Chapter 21: Share-Based Compensation and Earnings per Share (pg. 21-1) Chapter 22: Statement of Cash Flows Revisited (pg. 22-1) Appendix A: Accounting Changes and Error Analysis Revisited (pg. A-1) Appendix B: IFRS (pg. B-1) Appendix C: Data Analytics and Blockchain Technology (pg. C-1) Index (pg. I-1) Read the full article

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tommosupport · 4 years ago

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We get some asks from time to time about where to get data from. Of course, we want to preface this by saying that you need proper context in order to be able to use the data fully and build on it. Nevertheless, there are a bunch of platforms available for you to use - we’ve added caveats where necessary.

1. Kworb (http://kworb.net)

a. Provides realtime iTunes chart updates for both singles and albums, as well as iTunes popularity updates for both singles and albums. You can sort by country or get worldwide data, and the platform also offers some data on YouTube and other metrics, such as Artist Popularity.

b. Drawbacks: Keep in mind that even though it’s realtime, there is a lag in Kworb’s data nonetheless. Popularity is updated only every four hours or so. iTunes charts will update more regularly, but will lag behind what people may already be able to see in their own iTunes stores.

2. DigitalSalesData (http://digitalsalesdata.com)

a. This website used to be able to provide you with the sales numbers for singles on iTunes charts.

b. Drawbacks: It no longer gives accurate data, because this is no longer included in the iTunes Store API. Nonetheless, it does give you an indication of the market as a whole in a country – are the margins to get into the Top 10 close or not, and what’s the sales velocity like? Keep in mind that these numbers therefore should be interpreted, and not just blankly copied or taken as reflective of the actual sales numbers.

3. Chartmetric (http://chartmetric.com)

a. Probably one of the most elaborate websites that lets you collect many KPIs from various platforms – TikTok, Shazam, Spotify, AppleMusic, YouTube, etc. They have over 25 different data sources. It also shows you things like fan conversion rate (the ratio of monthly listeners vs artist followers on Spotify, for example), and lets you sort playlists on whether they are editorial, personalized or both. They provide data on trends and give you updates in percentages as well when it comes to relative change in subscribers, views, etc. There’s a separate section on social insights, too. They also developed their own cross-platform index which is a useful tool to see if an artist is able to really create a robust fan foundation across all various social platforms. Chartmetric regularly publishes interesting pieces on their latest finds and data analysis. Reading them will help you understand the data they offer, and will let you know how to interpret it all.

b. Drawbacks: You can only follow up to 5 tracks/items and get email notifications for the free version. And most importantly, you need to actually put in some work to understand how you can interpret their data points. Otherwise it can be overwhelming, or you may just copy-paste the numbers without contextualizing them, which isn’t going to help anyone. It’s great for trends, but you need to be able to identify those and explain them, supported by the numbers. You also don’t have as much insight into radio on the free platform.

4. Songstats

a. Similar to Chartmetric, SongStats offers data on an artist and their discography, using various inputs (Spotify, Beatport, AppleMusic, Deezer, Shazam, SoundCloud, Amazon, Instagram, Twitter, TikTok, TraxSource, 1001 Tracklists, YouTube, iTunes). It can also provide you with an overview of the top current playlists where any music by Louis is playlisted. You can customise what data inputs you want to see.

b. Drawbacks: The data they provide for the free version is very limited, and while they do provide some analytics for free – those are all cumulative data. For example, they’ll say Defenceless is on 114 playlists and has a reach of 2,04M. This is in total, across time. It is not always current, so again you have to be very careful with reading the data they give you in analytics, and how you need to interpret it. It also depends per input source. iTunes & AppleMusic do offer a distinction between current or total/cumulative.

5. Soundcharts (http://soundcharts.com)

a. Similar to Chartmetric and Songstats (more like Songstats in how it’s formatted, but more like Chartmetric in the data it lets you see). Very useful specifically if you want to see a breakdown of radio play per country.

b. Drawbacks: This is only free for two weeks, then plans start at 41$ a month. Moreover, again, be careful in how you interpret data. They don’t properly account for syndicated shows, and they use a questionable metric to track audiences. It also makes no distinction between internet/terrestrial radio. (There’s a difference, because internet radio is traditionally not counted for charting, whereas airplay on ‘terrestrial’ radio does count if radio is tracked for charting purposes like in the US). When you look at e.g. radio play, make sure to use the function to filter out plays shorter than 30 seconds!

6. SpotifyCharts (http://spotifycharts.com)

a. The official site of Spotify that updates on Viral and Top 200 playlists. You may find that there’s a difference between the numbers shown here and on an artist’s own profile. It’s because these numbers have been audited extra carefully to filter out any sort of artificial inflation or fraudulent streaming activities. These update daily around 3PM EST, usually a bit earlier than the song specific numbers.

b. Drawbacks: While they do update daily, the time thereof is incredibly irregular.

7. Chartmasters (http://chartmasters.org)

a. A site that allows you to quickly see an artist’s overall Spotify streams in a table. You can sort based on popular songs or on discography.

b. Drawback: You need an account and only get to use it 3 times a day. Make sure you use them wisely.

8. Billboard (http://billboard.com)

a. Billboard offers a variety of charts – aside from the most well known Hot 100 and Album 200 (and the Social 50 in the past). It also used to offer artist-specific overviews of peak chart positions.

b. Drawbacks: We said ‘used to’, because they technically still offer it – you just need to have a paid subscription to be able to access that data, as well as the other charts they have. Think of split-out charts on digital download sales or streaming, as well as radio airplay or genre-specific charts.

9. NextBigSound (http://nextbigsound.com)

a. NBS is monitored and used by Nielsen to compile the Social 50 for Billboard. It provides you a good overview of social media clout and activity. It also gives margins as to whether or not an artist’s activity and engagement are on par with what you’d expect of an artist what x amount of followers, for example. Also unique: It gives you insights in Pandora. Pandora is part of SiriusXM, as well as its own streaming service and is therefore influential in US radio play as well.

b. Drawbacks: It only tracks a limited amount of data sources (Facebook, Pandora, Twitter, Wikipedia), and used to provide more insights as to e.g. gender & country demographics. It no longer will do that, unless you have access to an artist’s AMP on Pandora.

10. Radio Airplay Chart UK (http://ukairplaychart.com/)

a. Gives you an overview of Top 40 songs being played on UK radio. You can also choose whether you want a rolling overview or see last chart week.

b. Drawbacks: It doesn’t tell you how often a song needs to be played and if this is based on audience or amount of plays (or when songs were most often played)

11. AllAccess (http://allaccess.com)

a. This is the database that is most often used by radio in the US to find new songs to play and to track radioplay across the country. It’s also a great platform to keep updated with the latest changes in terms of program directors or hosts at particular radio stations (which is useful when requesting). It will show you when a song was played and how often, and the estimated audience that was reached. All these things factor in airplay charting, so it’s nice to have a breakdown of it. It’ll also tell you which radio stations are giving support.

b. Drawbacks: You need to have an existing account with them and you need to know how to navigate their platform, which can be quite tricky. Moreover, they use the callsigns of radio stations, which can further complicate finding the data you need, because you’re most likely not going to be familiar with those.

12. SpotonTrack (http://spotontrack.com)

a. Sends you daily reports of Spotify and AppleMusic tracking data for a song. Useful for playlist updates!

b. Drawbacks: Only lets you track one song for two weeks in the free trial, after that you’ll have to pay for the service. You could technically also monitor radioplay, but this is not available for free trial users.

13. RadioMonitor (http://radiomonitor.com)

a. This site shows you radio charts around the world, but can also provide aggregate data for particular regions.

b. Drawbacks: Only useful once a song has started charting in airplay Top 10s.

14. WARM Music (https://warmmusic.net/)

a. Allows you to track radio play starting from 3E per month

b. Drawbacks: Not sure how accurate their data is, though they monitor over 28000 stations around the world. When using the free trial from time to time, it always seemed somewhat limited and not in step with what other sites would say (i.e., currently it says Defenceless was only played 49 times in total over the past two weeks. We know this is not correct.).

#info #resources

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lex-co-il · 5 years ago

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Особенности консультаций юристов по трудовому праву

Защита прав работников

В случае нарушения трудовых прав работника необходимо воспользоваться юридической помощью. Консультация по трудовому праву может потребоваться в случаях, когда необходимо подать в суд на работодателя, если трудовой спор невозможно разрешить во внесудебном порядке.

Трудовое законодательство Израиле достаточно сложное и лучше незамедлительно обратиться к трудовому адвокату, который поможет найти выход из следующих сложных ситуаций: расчете пицуим при увольнении, компенсации в случае ухудшения условий труда, расчет начислений в счет отпуска, а также пенсионных отчислений. Если работодатель нарушил права работника, то адвокат поможет рассчитать компенсацию за дискриминацию работника, незаконное увольнение, задержку заработной платы, а также поможет получить выплаты работникам за работу в сверхурочное время.

Услуги адвоката для работодателей

Юридическая консультация в рамках трудовых споров позволяет разрешить конфликтные ситуации максимально сокращая издержки, при этом защищая права как работодателя, так и работника.

Профессиональная помощь квалифицированного русскоязычного адвоката помогает не только наладить рабочие отношения в коллективе компании, но и сохранить в рабочем состоянии все бизнес-процессы компании.

Особенно важна юридическая помощь в молодых компаниях, где еще не сложились трудовые отношения. Адвокат поможет разработать документацию с учетом специфики компании и соблюдением трудового законодательства Израиля. В крупных компаниях своевременная помощь адвоката позволит решить трудовые споры во внесудебном порядке.

Бизнес без трудовых споров в Израиле

Трудовые ресурсы предприятия — это один из важнейших факторов эффективности компании в современных рыночных условиях. Трудовые споры, возникающие на любом предприятии страны могут нанести ощутимый вред не только бизнес-процессам внутри компании, но и репутации компании на рынке.

Трудовое право в ответах

Потому все процессы, связанные с соблюдением прав и обязанностей работника и работодателя лучше предать квалифицированному трудовому юристу, знающему все тонкости трудового права Израиля. Юридическая помощь по разрешению и предупреждению трудовых споров позволит сохранить материальные ресурсы фирмы и улучшить моральный микроклимат организации.

Трудовые споры возникают во всех компаниях между работниками и работодателями. В случае, если конфликт не удается решить мирным путем, приходится даже подавать в суд. Обычно, решение подать в суд на работодателя, приходится принимать наемным рабочим, когда их трудовые права нарушаются.

Для того, чтобы выиграть дело необходимо обратиться за юридической консультацией. Это позволит не только задать все интересующие вопросы адвокату в Израиле, но и получить квалифицированную юридическую помощь для защиты прав во внесудебном и судебном порядке.

На странице “Трудовое право в ответах” вы можете не дожидаясь личной встречи задать все имеющиеся вопросы по трудовому законодательству и получить помощь адвоката. Для этого необходимо лишь отправить вопросы через форму обратной связи.

Статьи о трудовом праве

Всем приходилось сталкиваться с конфликтными ситуациями, когда кажется, что наши права или права наших близких ущемлены. Для того, чтобы разобраться в ситуации и понять как правильно действовать предлагаем познакомиться со статьями по трудовому праву.

Если вы столкнулись с дискриминацией на работе, или вам не выплатили компенсацию при увольнении, если размер выплат за сверхурочную работу вы считаете начислен неверно, то вам необходимо обратиться за юридической помощью.

Права работодателя как и права работника также необходимо защищать, потому все спорные вопросы по трудовому праву лучше внести в трудовой договор, образец которого можно составить, воспользовавшись правовой помощью адвоката.

Основные правила, которыми следуют руководствоваться в рамках сотрудничества наемным работникам и работодателям описаны в статьях, которые мы предлагаем прочитать на странице “Статьи о трудовом праве”. В случае возникновения вопросов будем рады оказать правовую помощь всем обратившимся клиентам.

Онлайн консультация

На представленном сайте каждый желающий может задать вопрос адвокату Израиль и получить компетентный, быстрый и бесплатный ответ.

Контакты

Получить юридическую помощь у адвоката Андрея Водотинского можно по указанным ниже контактам.

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marketresearchcapture · 2 years ago

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Espresso Grinder Market Report 2022, By Segmentations, Key Company Profiles & Demand Forecasts to 2030

Global Espresso Grinder Market report emphasizes on the detailed understanding of some decisive factors such as size, share, sales, forecast trends, supply, production, demands, industry and CAGR in order to provide a comprehensive outlook of the global market. Additionally, the report also highlights the challenges impeding market growth and expansion strategies employed by leading companies in the “Espresso Grinder Market”.

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By Top Key Players Mr. Coffee Bodum Gourmia Hario Hamilton Beach Baratza BLACK+DECKER Epica Capresso Philips DeLonghi KitchenAid SharkNinja Quiseen Hario 3e Home Cuisinart Bear KRUPS By Types Manual grinders Electric grinders By Applications Commercial Household

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7 Global Espresso Grinder Consumption by Regions (2018-2022)

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12 Expert Interview Record

13 Research Finding and Conclusion

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stoxfeed · 2 years ago

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The >>> you see is the prompt after which you’ll type code expressions. To exit the Python interpreter, you can either type exit() or press Ctrl-D (works on Linux and macOS only).

Python for Data Analysis, 3E - 2 Python Language Basics, IPython, and Jupyter Notebooks

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datascienceunicorn · 2 years ago

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marketresearchindia · 3 years ago

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neptunecreek · 3 years ago

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Podcast Episode: Securing the Internet of Things

Today almost everything is connected to the internet - from your coffeemaker to your car to your thermostat. But the “Internet of Things” may not be hardwired for security. Window Snyder, computer security expert and author, joins EFF hosts Cindy Cohn and Danny O’Brien as they delve into the scary insecurities lurking in so many of our modern conveniences—and how we can change policies and tech to improve our security and safety.

Window Snyder is the founder and CEO of Thistle Technologies. She’s the former Chief Security Officer of Square, Fastly and Mozilla, and she spent five years at Apple focusing on privacy strategy and features for OS X and iOS. Window is also the co-author of Threat Modeling, a manual for security architecture analysis in software.

Click below to listen to the episode now, or choose your podcast player:

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Privacy info. This embed will serve content from simplecast.com

You can also find the MP3 of this episode on the Internet Archive.

In this episode, Window explains why malicious hackers might be interested in getting access to your refrigerator, doorbell, or printer. These basic household electronics can be an entry point for attackers to gain access to other sensitive devices on your network. Some of these devices may themselves store sensitive data, like a printer or the camera in a kid’s bedroom. Unfortunately, many internet-connected devices in your home aren’t designed to be easily inspected and reviewed for inappropriate access. That means it can be hard for you to know whether they’ve been compromised.

But the answer is not forswearing all connected devices. Window approaches this problem with some optimism for the future. Software companies have learned, after an onslaught of attacks, to prioritize security. And we can bring the lessons of software security into the world of hardware devices.

In this episode, we explain:

How it was the hard costs of addressing security vulnerabilities, rather than the sharp stick of regulation, that pushed many tech companies to start prioritizing cybersecurity.

The particular threat of devices that are no longer being updated by the companies that originally deployed them, perhaps because that product is no longer produced, or because the company has folded or been sold.

Why we should adapt our best current systems for software security, like our processes for updating browsers and operating systems, for securing newly networked devices, like doorbells and refrigerators.

Why committing to a year or two of security updates isn’t good enough when it comes to consumer goods like cars and medical technology.

Why it’s important for hardware creators to build devices so that they will be able to reliably update the software without “bricking” the device.

The challenge of covering the cost of security updates when a user only pays once for the device – and how bundling security updates with new features can entice users to stay updated.

If you have any feedback on this episode, please email [email protected].

Below, you’ll find legal and technical resources as well as a full transcript of the audio.

Music

Music for How to Fix the Internet was created for us by Reed Mathis and Nat Keefe of BeatMower.

This podcast is licensed Creative Commons Attribution 4.0 International, and includes the following music licensed Creative Commons Attribution 3.0 Unported by their creators:

Drops of H2O (The Filtered Water Treatment ) by J.Lang Ft: Airtone. https://ift.tt/sBSvfaz

Warm Vacuum Tube by Admiral Bob Ft: starfrosch https://ift.tt/HPcjNg0

Xena's Kiss / Medea's Kiss by mwic https://ift.tt/0Zk1AWr

reCreation by airtone https://ift.tt/coRBY9p

Transcript:

Window: I bought a coffee mug that keeps my coffee at like 133 degrees, which I'm delighted by. But the first thing I did when I took it out of the package is it wanted a firmware update. I was like, "Yes, awesome." I had it for like two and a half weeks and it wanted another firmware update.

I don't even know it was a security issue, it could be a functionality issue, maybe they're making my battery performance last longer. I don't know what the updates do. It's completely opaque. But at least there's an opportunity for that to also include security issues being resolved if that's a problem for that specific device. So I think there's some folks that are making space for it, they recognize that security updates are a critical path to developing a resilient device that will support the actual lifespan of that device. I mean, how long do you expect to be able to use a cup?

Cindy: That's Window Snyder, and she'll be joining us today to walk us through her ideas about how we can build a more secure world of connected devices without, hopefully, having to start over from scratch. I'm Cindy Cohn, EFF's executive director.

Danny: And I'm Danny O'Brien, special advisor to the EFF. Welcome to How to Fix the Internet, a podcast of the Electronic Frontier Foundation, where we bring you big ideas, solutions, and hope that we can fix the biggest problems we face online.

Cindy: Window, we are so excited to have you join us on How to Fix the Internet. You are someone who is always working towards a real, concrete, tech world that supports everyone. And I'm so happy be to have you here to share your ideas.

Window: Thanks so much, Cindy. I'm really glad to be here.

Cindy: So we now have internet connected computers in so many things. They're in our thermostats, our doorbells, our fridges, our TVs. Now, you've been thinking about security in our devices for a very long time. So what about this keeps you up at night?

Window: One of the things that I've seen over the years as we've built so many different mechanisms into general purpose operating systems like Windows or Linux that you might find on a server or OS10 on your Mac, that we've not seen the same kind of investment in those kinds of security mechanisms in devices. There are good reasons for that. These devices are very often kind of minimal in their functionality. They're trying to do something that's specific to a purpose, and very often they're optimized for performance or for interoperability with different hardware components. And so very often they haven't spent the time to invest in the kinds of security mechanisms that make some of the general purpose OSes or even mobile device OSs more resilient. And so we've kind of got a problem now because we took those devices and then we attached them to the internet and all that attack surface is now how exposed to the world and without the same sort of investment in making those devices more security resilient, we’ve got a growing problem.

Cindy: I think some people have seen the images of hackers taking over the cameras in kids' bedrooms and telling kids what to do. I mean, this is, I think, the kind of problem that you have when you've got systems that are really not internet ready or internet protected, that then gets connected to the internet.

Window: Exactly.

Danny: So what are the incentives for someone to hack into these things? I mean, we can talk about like those sort of prank or threatening things, but what are the people breaking into this at such a large scale trying to do with this technology?

Window: Well, very often they're opportunistic and someone who finds a vulnerability in your refrigerator and then uses it to get onto your network, they're not trying to spoil your food by changing the temperature in your refrigerator, they're using your refrigerator as a launch point to see if there are any other interesting devices on your network. And some of the attacks that you can deploy on a local network are different than the attacks that you would otherwise have to deploy from outside of the network.

Window: So what they're leveraging is access, very often. Some of these devices actually have access to all kinds of things. So if it's in a corporate network and that embedded device happens to be a printer, right, that printer is basically a data store where you send all your most important documents to be printed, but they're still stored on that printer. And then the printer is mostly uninspectable by the administration team. So it's a great place to camp out if you're an attacker and set up shop and then use that access to launch attacks against the rest of the infrastructure.

Danny: So it's effectively that they're the weakest point in your home network and it's like the entry way for anything else that they want to hack.

Window: Sometimes it's the weakest point, but it's also that it's like a deep dark corner that's difficult to shine a light into, and so it's a great place to hide.

Cindy: The stakes in this can be really high. One of the things that we've heard is these taking over of hospital networks can end up really harming people. And even things like the ability to turn up the heat or turn down the heat or those kinds of things, they can end up being, not just pranks, but really life threatening for folks.

Window: The problem that we described about the refrigerator in your home is really different if we're talking about a refrigerator at a hospital that's intended to keep blood at a certain temperature, for example, right, or medicine at a certain temperature.

Danny: So you said that general purpose computers, the laptops, and to certain extent the phones that we have today, have had 20 years of security sort of concentration. What caused those companies to kind of shift into a more defensive posture?

What encouraged them to do that? Was it regulation?

Window: That would be amazing if we could use regulation to just fix everything, but no, can't regulate your way out of this. Basically it was pain and it was pain directed at the wallet. So Microsoft is feeling a lot of pain with malware and with worms. And I don't know if you guys remember Slammer and Melissa, I love you. These viruses that they're feeling and their customers were feeling a lot of pain around it and saying, "Hey, Microsoft, you need to get your house in order." And so Bill Gates sent out this memo saying we're going to do something about security. That was around the time that I joined Microsoft. And honestly, we had a tremendous amount of work to do. It was an attempt to boil the ocean. And I was very lucky to be in a situation there where both I had experience with it, and also this is what I came to do. And also now I had the support of executives all the way up.

But how do you take a code base that is so rich and has so many features and so much functionality and get to a place where it's got a more modern security posture? So for a general purpose operating system, they needed to reduce attack surface, they needed to get rid of functionality, make it optional so that if there was a vulnerability that was present in one of those components, it didn't impact the entire deployment of... Back then it was hundreds of millions. At this point, it'd be a billion plus devices out there. You want to make sure that you are compartmentalizing access as much as possible. They deployed modern memory mitigation mechanisms that made it difficult to exploit memory corruption issues.

Window: And then they worked at it and it's been 20 years and they're still working at it. There's still problems, but there are not the same kind of problems that you saw in 2002.

Cindy: You said you wished regulation could do something about that. Do you think that is something that's possible? I think oftentimes we worry that the pace of regulation, the pace of legislation is so slow compared to the pace of technological advancement that we will... It can't keep up, and in some ways it shouldn't try to keep up because we want innovation to be racing ahead. I don't know, from where you sit, how do you think about the role of law and regulations in this space?

Window: I think regulations are great for regulating responsibility. Like for example, saying that when a security issue has been identified and it has these kinds of characteristics, let's say it's critical in that it's reachable from the network, and without any special access an attacker's able to achieve arbitrary code execution, that means they can basically do whatever they want with the system at that point, right? Then a security update needs to be made available. That's something they could regulate because it's specific enough and it's about responsibility. This is actually one of the significant differences between the security problems on software systems and hardware devices.

When there's a problem on, let's say, in your web browser, right? And you go to do your update, if the update fails, you can try it again, pretty easily. You can figure out for yourself how to get back to that known good state. So a failure rate of like 3%, 4%, 5%, for the most part users can help themselves out. And they are able to, to, to get back to work pretty quickly. But if these low-level components need to be updated and they have a failure rate of like 1%, right, and that device doesn't come back up, there's no interface. What's the user going to do at this point? They can't even necessarily initiate it to try it again. That might just be a completely bricked device, completely useless at this point.

But if it's a car, now it has to go back to the dealership. And if it's a phone, it has to come back into the shop. But if it's a satellite, that's just gone forever. If it's an ATM, maybe somebody has to physically come out with a USB and plug it in and then try and update the firmware for that ATM. For physical devices in the world, it gets really different. And then here's the other end of this. For software developers, they get away with saying, "Oh, we'll send you security updates for a year or two," or maybe they don't say at all, and it's just kind of at their whim, because there is no regulatory requirement to ship security updates for any period of time. We're all just at the whim of the folks who produce these technology components that we rely on.

But if it's an MRI in a county hospital and they're not getting security updates, but they're vulnerable to something, they're not going to go buy a new MRI, right? We expect these devices to be in use for a lot longer than even a phone or a general purpose computer, a laptop, a web browser. For sure, those things get updated every 10 minutes, right? Both the difficulty of bring a highly reliable update mechanism and also the lifespan of these devices completely changed the story. So instead of saying it's efficient to deliver security updates for a year or two years, you now get to this place where it's just like, "Well, how long do you expect a car to be useful?" Right? I expect to be able to drive my car for 10 years, and then I sell it to somebody else, and then you can drive it for 10 years. And until it's in bits, like that car should still be functional, right?

Danny: “How to Fix the Internet” is supported by The Alfred P. Sloan Foundation’s Program in Public Understanding of Science. Enriching people’s lives through a keener appreciation of our increasingly technological world and portraying the complex humanity of scientists, engineers, and mathematicians.

Cindy: I wanted to circle back as the lawyer in the house about the... What I heard you saying about the role that regulation and law can play in this is really about liability, it's that if you need to build in ongoing security into your tool, and if you don't, you need to be responsible for the harm that comes, and the liability does work a little that way now, and I think one of the problems that we have is that some of the harms that happen are privacy harms or the other kinds of harm that the law is struggling with. But I really like this idea that the way that you have a lever on these companies is to basically make them responsible for the long tail of problems that these things can create, not just the moment of sale.

Window: Absolutely. That's exactly right. But on my end of things, since I'm not thinking of about liability, because that feels like something that someone like you can probably contribute to that conversation better, but in terms of how do we get there? Well, having an update mechanism that is robust enough that you're able to ship a security update or any sort of update with confidence that that device is going to come back up, right? Because that's one of the reasons that it's hard to update devices is that if you're worried that the device might not come back up, even if it's like a 1% failure rate, then you don't want to ship up updates unless you absolutely have to, because the cost of addressing that issue is really more significant potentially than a security issue might be. And they have to make a judgment about that for all these different kinds of ways their device might be used.

But on the updates side of things, since, as you described, they only make their money when you buy the device, and after that it's out the door. And so to continuously have to pay to support security updates is kind of difficult, but there are other ways to support it without actually being responsible for shipping the security update yourself. If you make the code open source, then the community can potentially support it. If you make the code available to a third party, then that third party can be able to provide security updates for those issues.

But even for the device manufacturer themselves, getting to a place where you have a highly reliable security update mechanism could be used, not just to deliver security updates, but functional updates. And then you could potentially have an ongoing relationship with that party who purchased the device by selling them new functionality once the device is already out the door, like they could sell new features for those existing devices. And Tesla has really embraced that, right? They're doing great with it, that you buy a car and then later you can buy a new functionality for your car. Fantastic.

Cindy: So to get to a world where our devices are really secure, I am hearing three things:a lot more open source, a lot more interoperability, and in general a lot more ability for third parties to repair or update or give us more security than we have now. Is that right?

Window: I think actually the most critical component is going to be leveraging existing security mechanisms that have been built for resilience and incorporating those into these devices, which is actually what I'm building right now. That's what Thistle Technologies is doing, we're trying to help companies get to that place where they've got modern security mechanisms in their devices without having to build all the infrastructure that's required in order to deliver that.

So the industry is in agreement, for the most part, that you should not implement your own cryptographic libraries, right? That you should leverage an existing cryptographic library that is tested, that was implemented by folks who understand cryptography and more importantly, understand how cryptographic implementations can fail, especially when they're being attacked, right? So this is actually true for security mechanisms way beyond cryptography. And that's why I think that building these security sensitive mechanisms in one place and letting folks pick and choose and incorporate those into their devices makes sense. And I think this is actually how devices are going to get there. And maybe some of those will be open source projects, and maybe some of those will be commercial projects like mine, but I think not having to all of us go it alone in all these different places, reinvent the wheel over and over again, get to a place where we've got security sensitive systems that are built and incorporated into all these different kinds of systems that don't have them yet.

Danny: So a lot of what you're describing seems to be like building or slotting in robust software that is built with security in mind. But one thing I hear from security researchers all the time is that security is a process. And is there some way that a small hardware manufacturer, right, someone who just makes light bulbs or just makes radios, if they still exist, what is part of the process there? What do they have to change in their outlook?

Window: So it's the same for any small development team that the most important stuff that you want to do is still true for software and for hardware, and that is to reduce the attack surface. And if there's functionality that's only in use by a small number of folks in your deployment, make it modular so that those folks can have the functionality, but not everybody has to have all of the risk, to move to memory-safe languages, higher-level languages, so that memory management is not managed by the developers, because that reduces the ability for an attacker to take advantage of any of the problems that can result in memory corruption.

Danny: And when you say attack surface here, you're sort of describing the bits of this technology which are vulnerable and are kind of exposed, right? You're just talking about making them less exposed and less likely to damage everything else if they break.

Window: Yeah. So if you think about your body as having some sort of attack surface, like as we're walking around in the world we can get infections through our mucus membranes, like our eyes, our nose, our mouth, and so on. So it reduces our risk if we wear a mask, it reduces, let's say, the risk for a healthcare worker if they're also wearing like a face shield to prevent somebody coughing on them and having it get in through their eyes, etc. So reducing your attack surface means providing a filter or a cover.

The attacker has a harder time coming in through the wall, they're going to come in through the doors. And so if you think of these services where you're listening as doors, then you want to make sure that you have authentication really early on in your protocol, so that there's less opportunity for them to say something that could be interpreted the wrong way by your computer, and now they're computing code on your system, for example. And then that same kind of idea, but applied through all the different components in the system.

Cindy: That's great. I love this idea that you're trying to shrink down 25 years worth of work in operating systems into a little box that somebody can plug into their internet connected thing. I think that's awesome.

Window: It's better than trying to wait 25 years for everyone else to catch up, right?

Cindy: Absolutely. So what are the values we're going to get if we get to this world? What is it going to feel like, what is it going to seem like when we have these a world in which we've got more protected devices?

Window: I think, first we'll feel some pain and then we'll feel devices that we're able to have more confidence in, that we might feel more comfortable sharing information that's very personal because we are able to evaluate what they're going to do with that data. Maybe that company that's building this thing has a very clear policy that is easy to understand, doesn't require 10 pages of legal language that's designed to be, as let's say, conservative as possible and reserve every possible right for the company to do whatever they want with your information, right? When folks are understand that, then they're more able to use it. One of the things that I'm thinking about constantly about every device I bring into my home is how is this increasing my attack surface? Do I need a separate network to manage these devices in my house? Yes, I do apparently.

Window: But is that reasonable? No, it's not reasonable. People should be able to bring home a device and use it and not worry that the microphone on their television is listening to them or that an attacker could leverage kids' baby camera to capture pictures of the inside of their house, right? People want to feel comfortable and safe when they use these things. And that's just consumers. If it's on the enterprise side, folks want to be able to, let's say, understand the risk for their organization, make reasonable trade offs, deploy their resources in things that build their business, not just things that, let's say, allow the business to function. And security is one of those things that if you have to spend money securing your infrastructure, then you're not spending money creating all the functionality that the infrastructure exists to serve.

Danny: So we have this sort of utopia where we have all these devices and they talk to one another and before I get home, my stove has set the water boiling and it's completely safe and okay. Then we have kind of another vision that I think people have of a secure world requiring this sort of bureaucracy, right? You know everything is locked down, I maybe have to go and sign out something at work, or there is someone who tells me, "I can't install this software."

In order to feel safe, do we have to head to that second future? Or do we still get all our cool gadgets in your vision of how this plays out?

Window: That's the problem, right? We want up to be able to install the software and that it's safe. It's not going to create a new vulnerability in your corporate network, right? When you tell folks to say like, "Oh, be careful on clicking links in email," or whatever. It's like, why on earth should that be a problem? If your email is allowing you to click on a link to launch another application or a web browser, then that should be safe. The problem's not with a user randomly clicking on things, they should be able to randomly click on things and have it not compromise their device. The problem is that the web browser, which for all the functionality that the web has brought us, it is honestly a terrible idea to say, "I'm going to take this software. I'm going to put all my passwords and credit cards in it. And then I'm going to go visit all these different servers. And I'm going to take code from these servers and execute it on my device locally and hope it doesn't create problems on my system."

That is a really difficult model to secure. So you should be able to go anywhere and install software from wherever. That would be the ideal that if we can get to a place where we have a high degree of compartmentalization, we could install software off the internet, it runs in a sandbox that we have a high degree of confidence is truly a high degree of compartmentalization away from everything else that you care about in the system. You use that functionality, it does something delightful, and you move on with your life without ever having to think about like, "Is this okay?" But right now you have to spend a lot of time thinking about like, "Do I want to let it in my house? What is it going to do?" So the ideal version is you just get to use your stuff and it works.

Danny: That is a vision of a future that I want.

Cindy: Yeah, me too. Me too. And I really love the embrace of like, we should have this cool stuff, we should have this cool functionality, new things shouldn't be so scary, right? It doesn't need to be that way. And we can build a world where we get all the cool stuff and we have this ongoing innovation space without all the risk. And that's the dream. Sometimes I talk to people and they're like, "Just don't do it. Don't buy-

Danny: Get off the internet.

Cindy: Yeah. Get off the internet. Don't buy a smart TV, don't buy this, don't buy that, don't buy that. And I totally understand that impulse, but I think that you're talking about a different world, one where we get all the cool stuff, but we also get our security too.

Window: Yeah. Wouldn't you love to be able to connect with your friends online, share pictures of the family and feel like no one is collecting this to better create a dossier about how to better advertise to you? And then where does this sit and how long does it sit there for, and who's it shared with? And what's it going to mean? Are they identifying who's influential in my network so they can tell me that so and so really enjoyed this new brand of cookware, right? I would love to be able to communicate freely in public or in forums and only worry about humans instead of like all the different ways this data is going to be collected and hashed and rehashed and used to create a profile of me that doesn't necessarily represent who I am today or who I might be 10 years from now.

Cindy: Well, and the nice thing about fixing the security is that that puts that control back into our hands, right? A lot of the things that are consumer surveillance stuff are really side effects of the fact that these systems are not designed to serve us, they're not designed to secure us. And so some of these business models kind of latch onto that and ride along with that. So the good thing about more security is that we not only get security from the bad guys, we also get maybe some more control over some of the companies who are riding along with the insecure world as part of their business models.

Danny: Well, thank you Window for both making us safer in the present day and building this secure and exciting future.

Cindy: Yeah. Thank you so much, Window.

Window: Thanks for having me, guys. It's definitely been a lot of fun.

Cindy: That was just great. And what I really love about Window is that sometimes security researchers are all about, no, don't do this, don't do that, this is dangerous, this is scary. And Window is firmly on the side of, we need to have of all our cool devices, even our coffee mug that connects to the internet for some strange reason, but we need to have all of our cool devices, but we need them to be secure too.

Danny: Yeah. She's always very modest. And I think she actually has been the calm, collected voice in Apple and Microsoft as they slowly try and fix these things I think one of the things I took away from that is that it is a different world, right, but we have got some knowledge that we can drop into that new plate.

Cindy: Yeah. And I love the idea of kind of taking all that we've learned in the 25 years of trying to make operating systems secure and shrink it down into modules that people can use in their devices in ways that will stop us from having to spend the next 25 years figuring out how to do security in devices.

Danny: Something else that struck me was that the kind of thing that prompted the solution, or the attempt to fix the security problems of big PCs and desktops and later phones was this Bill Gates memo. And it struck me that the challenge here is that there are there is not one company, there is not a monopoly and there is no Bill Gates to write the memo to the Samsungs and the anchors of this world. So I don't know how you do it, but I have a feeling Window does.

Cindy: Well, I think she's working on it, and I think that's great, but she also pointed to a place that regulation might come in as well, and specifically on the idea of liability, right? Like making sure that the companies that put this out are accountable, not just at the point of sale, but over the long run for the risks that they create. And then hopefully that will help spur a kind of long relationship where, not just the company that sold you the device, but a whole bunch of other companies and people, and hobbyists and other people can come in and help you keep your device secure over the long run. And also, as she pointed out, maybe even give you some additional features. So once again, we see interoperability being key to this better future, even in this other place where we're talking about just simply making our devices not so dangerous.

Danny: Yeah. The solution to not having one big company is not to put one big government or one new big company in charge, but to share the knowledge and communicate that round. And if somebody can't, or doesn't have the resources to take that responsibility, there's someone else who can represent the consumer or the hospital, and step in and fix and repair those problems.

Cindy: I think it was interesting to me how this conversation kind of started off as a hardcore security modeling kind of thing, but we ended up again with adversarial interoperability and right-to-repair being so central to how we fix this problem. And I really appreciate how these things are starting to connect together in a single story.

Danny: Music for How to Fix the Internet was created for us by Reed Mathis and Nat Keefe of BeatMower. This podcast is licensed Creative Commons Attribution 4.0 International, and includes music licensed Creative Commons Attribution 3.0 Unported by their creators. You can find their names and links to their music in our episode notes, or on our website at eff.org/podcast. Please visit eff.org/podcasts where you’ll find more episodes, learn about these issues, you can donate to become a member of EFF, as well as lots more. Members are the only reason we can do this work plus you can get cool stuff like an EFF hat, and EFF hoodie or an EFF camera cover for your laptop camera. How to fix the internet is supported by the Alfred P Sloan foundation’s program and public understanding of science and technology.

Danny: I'm Danny O'Brien. Cindy: And I'm Cindy Cohn. Thanks for listening.

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articlesfood · 3 years ago

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Environment Health & Safety Market Size, Opportunities, Key Growth Factors, Revenue Analysis, For 2020–2028

Environment Health & Safety Market 2021-2027

A New Market Study, Titled “Environment Health & Safety Market Upcoming Trends, Growth Drivers and Challenges” has been featured on fusionmarketresearch.

Description

This global study of the Environment Health & Safety market offers an overview of the existing market trends, drivers, restrictions, and metrics and also offers a viewpoint for important segments. The report also tracks product and services demand growth forecasts for the market. There is also to the study approach a detailed segmental review. A regional study of the global Environment Health & Safety industry is also carried out in North America, Latin America, Asia-Pacific, Europe, and the Near East & Africa. The report mentions growth parameters in the regional markets along with major players dominating the regional growth.

Request Free Sample Report @ https://www.fusionmarketresearch.com/sample_request/Global-Environment-Health-&-Safety-Market/58326

This report provides detailed historical analysis of global market for Environment Health & Safety from 2015-2020, and provides extensive market forecasts from 2021-2030 by region/country and subsectors. It covers the sales/revenue/value, gross margin, historical growth and future perspectives in the Environment Health & Safety market.

Moreover, the impact of COVID-19 is also concerned. Since outbreak in December 2019, the COVID-19 virus has spread to all around the world and caused huge losses of lives and economy, and the global manufacturing, tourism and financial markets have been hit hard, while the online market/industry increase. Fortunately, with the development of vaccine and other effort by global governments and organizations, the negative impact of COVID-19 is expected to subside and the global economy is expected to recover.

This research covers COVID-19 impacts on the upstream, midstream and downstream industries. Moreover, this research provides an in-depth market evaluation by highlighting information on various aspects covering market dynamics like drivers, barriers, opportunities, threats, and industry news & trends. In the end, this report also provides in-depth analysis and professional advices on how to face the post COIVD-19 period.

The research methodology used to estimate and forecast this market begins by capturing the revenues of the key players and their shares in the market. Various secondary sources such as press releases, annual reports, non-profit organizations, industry associations, governmental agencies and customs data, have been used to identify and collect information useful for this extensive commercial study of the market. Calculations based on this led to the overall market size. After arriving at the overall market size, the total market has been split into several segments and subsegments, which have then been verified through primary research by conducting extensive interviews with industry experts such as CEOs, VPs, directors, and executives. The data triangulation and market breakdown procedures have been employed to complete the overall market engineering process and arrive at the exact statistics for all segments and subsegments.

Leading players of Environment Health & Safety including: AECOM Corporation CH2M HILL Intelex Technologies Enablon Tetra Tech IHS SAP Golder Associates SGS Environmental Resource Management (ERM) VelocityEHS Amec Foster Wheeler EtQ RPS Group Cority (Medgate) Gensuite Enviance Verisk 3e Optial Sphera So Sitehawk

Market split by Type, can be divided into: EHS Software EHS Services

Market split by Application, can be divided into: Chemicals & Petrochemicals Energy & Mining Telecom & IT Construction Manufacturing

Market split by Sales Channel, can be divided into: Direct Channel Distribution Channel

Market segment by Region/Country including: North America (United States, Canada and Mexico) Europe (Germany, UK, France, Italy, Russia and Spain etc.) Asia-Pacific (China, Japan, Korea, India, Australia and Southeast Asia etc.) South America (Brazil, Argentina and Colombia etc.) Middle East & Africa (South Africa, UAE and Saudi Arabia etc.)

Ask Queries @ https://www.fusionmarketresearch.com/enquiry.php/Global-Environment-Health-&-Safety-Market/58326

Table of Contents

Chapter 1 Environment Health & Safety Market Overview 1.1 Environment Health & Safety Definition 1.2 Global Environment Health & Safety Market Size Status and Outlook (2015-2030) 1.3 Global Environment Health & Safety Market Size Comparison by Region (2015-2030) 1.4 Global Environment Health & Safety Market Size Comparison by Type (2015-2030) 1.5 Global Environment Health & Safety Market Size Comparison by Application (2015-2030) 1.6 Global Environment Health & Safety Market Size Comparison by Sales Channel (2015-2030) 1.7 Environment Health & Safety Market Dynamics (COVID-19 Impacts) 1.7.1 Market Drivers/Opportunities 1.7.2 Market Challenges/Risks 1.7.3 Market News (Mergers/Acquisitions/Expansion) 1.7.4 COVID-19 Impacts on Current Market 1.7.5 Post-Strategies of COVID-19 Outbreak

Chapter 2 Environment Health & Safety Market Segment Analysis by Player 2.1 Global Environment Health & Safety Sales and Market Share by Player (2018-2020) 2.2 Global Environment Health & Safety Revenue and Market Share by Player (2018-2020) 2.3 Global Environment Health & Safety Average Price by Player (2018-2020) 2.4 Players Competition Situation & Trends 2.5 Conclusion of Segment by Player

Chapter 3 Environment Health & Safety Market Segment Analysis by Type 3.1 Global Environment Health & Safety Market by Type 3.1.1 EHS Software 3.1.2 EHS Services 3.2 Global Environment Health & Safety Sales and Market Share by Type (2015-2020) 3.3 Global Environment Health & Safety Revenue and Market Share by Type (2015-2020) 3.4 Global Environment Health & Safety Average Price by Type (2015-2020) 3.5 Leading Players of Environment Health & Safety by Type in 2020 3.6 Conclusion of Segment by Type

Chapter 4 Environment Health & Safety Market Segment Analysis by Application 4.1 Global Environment Health & Safety Market by Application 4.1.1 Chemicals & Petrochemicals 4.1.2 Energy & Mining 4.1.3 Telecom & IT 4.1.4 Construction 4.1.5 Manufacturing 4.2 Global Environment Health & Safety Revenue and Market Share by Application (2015-2020) 4.3 Leading Consumers of Environment Health & Safety by Application in 2020 4.4 Conclusion of Segment by Application

Continue…

ABOUT US:

Fusion Market Research is one of the largest collections of market research reports from numerous publishers. We have a team of industry specialists providing unbiased insights on reports to best meet the requirements of our clients. We offer a comprehensive collection of competitive market research reports from a number of global leaders across industry segments.

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fusion-kunal · 3 years ago

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Environment Health & Safety Market Business Demand, Competitor Analysis, Market Share 2021-2027

Environment Health & Safety Market 2021-2027

A New Market Study, Titled “Environment Health & Safety Market Upcoming Trends, Growth Drivers and Challenges” has been featured on fusionmarketresearch.

Description

Request Free Sample Report @ https://www.fusionmarketresearch.com/sample_request/Global-Environment-Health-&-Safety-Market/58326

Market split by Type, can be divided into: EHS Software EHS Services

Market split by Application, can be divided into: Chemicals & Petrochemicals Energy & Mining Telecom & IT Construction Manufacturing

Market split by Sales Channel, can be divided into: Direct Channel Distribution Channel

Ask Queries @ https://www.fusionmarketresearch.com/enquiry.php/Global-Environment-Health-&-Safety-Market/58326

Table of Contents

Continue…

ABOUT US:

[email protected]

Phone: + (210) 775-2636 (USA) + (91) 853 060 7487

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clinicalsurgery · 3 years ago

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Individualized Costo-Sternal Reconstruction after Extensive Resection of Sternum due to Chondrosarcoma by Machak GN*

Abstract

A clinical case of surgical treatment of a 54-year-old female patient with a localized form of chondrosarcoma of the sternum is presented. During the process of preoperative planning, 3D additive technologies were used, allowing to determine the optimal volume of bone resection and reconstruction of the resulting defect of the chest wall with an individualized titanium costosternal implant. The patient underwent successful surgery with no early or long-term complications. Respiratory function after surgery was not impaired. With a follow-up period of more than four years, no signs of local recurrence or metastases were observed. The presented case demonstrates the current possibilities of reconstructive surgery of costosternal tumors using individualized 3D implants with excellent long-term clinical, functional and cosmetic results.

Keywords: chondrosarcoma, sternum, stereo-lithographic model, individualized titanium plate, surgical treatment, case report

Introduction

Tumors of the sternum constitute only 0.45% - 1% of all primary bone tumors [1-4], and most of them are malignant (5, 6). The most frequently diagnosed malignant tumor of the sternum is chondrosarcoma [1,2,7], followed by osteosarcoma, myeloma, and malignant bone lymphoma [8]. Radical resection is considered the primary treatment option for grade II-III chondrosarcomas. Chest wall tumor surgery is technically complicated due to the difficulties of extended tumor resection without compromising skeletal stability and the need for simultaneous reconstruction of the chest [3]. Extensive thoracic wall defects require pleural cavity and/or mediastinum closure as well as the restoring of chest wall rigidity. The latter is of paramount importance, as it helps to prevent the development of cardio-respiratory disorders in the early postoperative period and reduce mortality. Many methods have been proposed to replace a chest wall defect after resection: auto- and allografts, rib complexes, various implants, made of synthetic materials and metal [1-3,9-21] At the same time, a number of authors have noted a high rate of complications, associated with sternocostal resection and reconstruction [16,21]. With the development of modern technology, it has become possible to replace large defects of the chest wall with individualized metal implants. This approach allows to effectively restore the chest wall framework and to reduce the duration of the surgery. The current article describes a successful case of surgical treatment of a patient with a chondrosarcoma of the sternum using additive technology for surgical planning and post-resection chest wall reconstruction with an individualized titanium sternocostal implant.

Case Presentation

A 54 y.o. patient in 2012 has discovered a bulging of the sternal area during self-examination. She had not seeked medical help for more than a year. Only in 2014, after noting an increase in the dimensions of the lesion, she underwent a tumor biopsy at a thoracic surgery department of a large medical institution, after which she was diagnosed with a chondroma. Due to the need for a sternal resection and a complex reconstruction of the chest wall, the patient was referred to our institute in 2015. Upon admission, the patient complained of a tumor-like growth in the sternum. The patient’s general condition was satisfactory. Normosthenic physique, with an increased BMI was noted. No respiratory or hemodynamic disorders were noted. In the middle third of the sternal body, a painless, dense, immobile tumor mass, measuring 70 x 40 mm and protruding 35 mm above the skin surface could be palpated. Computed tomography of the chest (Figure 1A&B) revealed a focus of osteolytic destruction located in the body and upper part of the xiphoid process of the sternum, measuring 70.8 x 25.2 x 18 mm.

The cortical layer was unevenly thinned, moderately swollen, eroded along the anterior and posterior surfaces, with a soft tissue component extending beyond the bone tissue. The contours of the soft tissue component were irregular. The structure of the lesion was heterogeneous due to inclusions of higher density. In the preserved areas of the cortical layer, periosteal stratifications could be visualized. The CT findings corresponded to a cartilaginous tumor of the sternum, most likely a chondrosarcoma. Magnetic resonance imaging of the chest (Figure 1C&D) demonstrated an extensive lesion measuring up to 70 x 25 x 18 mm with uneven, irregular contours on the right side in the area of articulation of the ribs and sternum. The lesion invaded the cortical layer of the sternum and spread into the adjacent soft tissues. The MR findings corresponded to a chondrosarcoma of the sternum.

For staging purposes, a magnetic resonance diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) was performed revealing a focus of hyperintense signal in the sternum. No other lesions were detected. Upon revision of the biopsy specimens the diagnosis of chondrosarcoma was confirmed (IB, G1, according to Enneking staging system).

To better evaluate the case and to elect the optimal method of surgical treatment, a stereolithographic 3D model of the patient’s sterno-costal complex was produced using CT data in a 1:1 ratio (Figure 2A&2B). With the help of the 3D model the extent of resection was determined and an individualized titanium costosternal plate was manufactured (Figure 2C). To minimize the risk of recurrence and maximize the rigidity of plate fixation, it was planned to respect the cartilaginous ends of the ribs.

Unique traits of this custom implant include the relative simplicity of its production, solid structure, and large surface area, which make it robust and versatile in terms of freedom of fixation to the ribs. The selected implant thickness of 1,5 mm provides sufficient rigidity and strength, but, at the same time, preserves relative elasticity of the metal, allowing for some mobility of the thoracic wall. After meticulous planning, a subtotal resection of the sternum with anterior chest wall reconstruction using an individualized titanium plate was performed (Figure 2C).

Surgical details: with the patient in the supine position, under general endotracheal anesthesia in combination with high epidural anesthesia, a 15 cm incision was made along the midline of the sternum with excision of the scar from a previously performed biopsy of the sternum. The pectoral muscles were mobilized, followed by 10 mm parasternal subperichondrial resection of the II-VII costal cartilages. The sternum was intersected with an oscillating saw 1 cm proximally to the manubriosternal joint and 1 cm distally to the xiphisternal joint. The sternum was removed with a tumor in a single block. The defect of the anterior chest wall was reconstructed with an individualized titanium plate. The proximal end of the plate was inserted into the notch in the sternal manubrium and fixed to the underlying ribs with a titanium wire. The surgical site was drained and the wound closed in layers. Intraoperative blood loss amounted to 300 ml. The patient was put in a thoracic brace. In the early postoperative period, antibacterial, infusion, anticoagulant therapy, as well as multimodal analgesia (a combination of prolonged epidural anesthesia with opioid analgesics and NSAIDs) were administered. Three hours after surgery, the patient was extubated and transferred to spontaneous breathing with oxygen support. On the second day after surgery, the patient was transferred back to the ward from the intensive care unit. On the fourth day, the patient returned to sitting in bed and walking around the ward.

Pathological investigation of the tumor gross specimen showed dense bone tissue having an irregular nodular surface attached to fatty tissue, with dimensions of 11,0 x 4,5 x 4,0 cm. Bone section showed semi-translucent, relatively dense mostly gray hyaline cartilage with lobular structure and focal points of bone density, with overall dimensions of 7.3 x 3.8 x 3.3 cm (Figure 3A). Histological analysis demonstrated a cartilage-forming tumor of lobular structure with individual lobules of the tumor separated by fibrous tissue (Figure 3B). Cartilage cells with weakly and moderately expressed polymorphism and morphological atypism could be seen interspersed in the chondroid matrix of the tumor (Figure 3C). The cells were large, with a reduced nuclear-cytoplasmic ratio. The cell nuclei were enlarged, sometimes atypical in shape, hyperchromic, with numerous binuclear cells (Figure 3D). The chondroid matrix of the tumor showed signs of myxomatosis, microfocal necrosis. The tumor freely occupied the bone marrow space, eroding the bone trabeculae, infiltrating Volkmann's and Haversian canals, and eroding the cortical bone layer. Regions of complete destruction of the cortical plate with infiltrative tumor growth into adjacent soft tissues were observed (Figure 3E). Regions characteristic of enchondroma were not detected. Histological report: taking into account the MR and CT imaging data, the diagnosis corresponds to a chondrosarcoma (G2) with the destruction of the cortical plate and infiltrative growth into the adjacent soft tissues (stage IIB according to Enneking). The tumor has been removed within the healthy tissue margins (type of resection - R0).

The patient regularly underwent follow-up examinations. Four years after surgery, the patient had no complaints or foreign body sensations. No signs of respiratory dysfunction were observed. The anterior chest wall had a normal configuration and there were no signs of implant instability. A good cosmetic (Figure 4A&4B) and oncologic (Figure 4C&4D) result was achieved

Discussion

Bone chondrosarcomas are malignant tumors whose cells produce a cartilage matrix. In terms of the frequency of occurrence, chondrosarcoma takes the second place among primary malignant bone tumors after osteosarcoma, and, according to various authors, accounts for 10 to 25% of all primary bone sarcomas [4,22,23]. It is found in the age group from 5 to 90 years, mainly in middle and old age - most often between 40 and 60 years (about 60% of patients). It has a slightly higher frequency of occurrence in men. Any bone of cartilaginous origin can be affected. The most frequent localization (three quarters of patients) is in the bones of the trunk (pelvis, ribs) and the proximal ends of the femur and humerus [24]. Among the malignant tumors that affect the sternum, chondrosarcomas are diagnosed most frequently [1,2,7]. Among 458 common chondrosarcomas diagnosed during the period from 1987 to 2009 at the pathology department at our institute, only 5 (1%) were localized in the sternum [25]. Among the 2004 primary bone tumors in the registry of the St. James’s University Hospital (Leeds, West Yorkshire, England), 9 (0.45%) were localized in the sternum, of which 6 (0.3%) were chondrosarcomas [6].

The progression of chondrosarcomas varies from slowly growing tumors to aggressive metastatic sarcomas. Morphologically chondrosarcomas are divided into tumors of low (I), medium (II) and high (III) degrees of malignancy [4,22,23,26]. Almost 60–90% of chondrosarcomas belong to the category of low and moderate degree of malignancy [25]. In the case presented in this article, a chondrosarcoma (G2, stage IIB according to Enneking) was diagnosed based on histopathological examination. Numerous approaches to reconstructive surgery of the anterior chest wall after resection of the sternum have been described in literature [7,10,12-15,19].

Titanium is a biocompatible, inert material with physical characteristics that allow to design robust individualized implants that closely replicate the shape of the sternum and chest wall. The implant structure can also be perforated without sacrificing stiffness, which facilitates its fixation. Additionally, titanium does not interfere with computed tomography or magnetic resonance imaging, allowing for safe and informative postoperative evaluation [12].

Gonfiotti and Santini (2009) described a case of surgical treatment of a patient with a chondrosarcoma, in which, after a total resection of the sternum, the defect was reconstructed with 4 metal plates attached to the ribs with titanium clips [13]. А polytetrafluoroethylene sheet, which was fixed to the plates with non-absorbable suture material, was used to separate the chest organs from the metal plate. The postoperative period was uneventful. Six months after surgery, the implant was clinically and radiologically stable, there was no tumor recurrence, and no respiratory dysfunction was noted. In a study by Rocco et al, reconstruction of the anterior chest wall defect was performed using three metal plates and an omental flap. This approach allowed the authors to achieve full stability and to avoid complications [19].

Voronovich and Pashkevich (2011) reported on a case, where a perforated titanium plate was used for chest wall reconstruction after total sternum resection in a patient with a chondrosarcoma [10]. The plate had a thickness of 15 mm and was manufactured in advance based on the patient’s radiographs. The follow-up period was 2 years. The patient had a complicated case of chondrosarcoma recurrence, which required surgical removal of the recurrent tumor nodes twice. No plate instability was observed during the course of treatment. The patient died due to metastatic spread of the tumor.

Demondion et al reported on a case of a 28-year-old patient with intraductal invasive carcinoma of the left breast with metastases to the sternum [12]. After four courses of chemotherapy, the patient underwent radical mastectomy on the left, axillary lymphadenectomy and subtotal resection of the sternum. Reconstruction of the anterior chest wall was performed using an individualized titanium plate, manufactured based on a 3D model and CT data. Six months after surgery, the implant was clinically and radiologically stable, there were no signs of respiratory dysfunction. He and Huang reported on a case of a primary chondrosarcoma of the sternum in a 37-year-old woman [7]. The patient underwent resection of the sternum with defect reconstruction using a titanium mesh and steel wire. At a 12-month follow-up the clinical and radiological results were good.

Aranda reported on the use of an individualized titanium prosthetic costo-sternal complex, also manufactured using additive technology and CT data, in a patient with a primary chondrosarcoma [14]. No complications were observed in the early postoperative period. Mansour reported on 47 patients (24%) who underwent such surgeries and had complications during the hospital stay [16]. The most common complications were pneumonia (27 patients, 14%), acute respiratory distress syndrome (ARDS) - 11 patients (6%) and flap loss - 10 patients (5%).

Weyant et al (2006) noted that severe complications, such as infection, splitting, flap loss and hematomas, were reported to occur in 8%–20% of cases [21]. In our case, utilization of a stereo-lithographic model, 3D modeling, and manufacturing of an individualized titanium plate yielded excellent long-term clinical and cosmetic results, comparable to those of other authors. We believe that the described approach, as well as constantly developing technological advances can significantly improve the results of surgical treatment of patients with tumors of the sternum.

Conclusion

Additive technology allows to plan and execute the reconstructive stage following procedures involving major resection of the anterior chest wall due to aggressive tumors, leading to functionally and cosmetically excellent results and low rates of cardio-pulmonary complications.

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