Defense Against Distributed Denial of Service Attacks in Computer Networks

Tohoku University亀山充隆課

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC. Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system. Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy. Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC

Existence and uniqueness of near-coupled coincidence points in partial cone-interval metric spaces

This paper introduces a new type of space called partial cone-interval metric space, and explores some of its topological properties. Using a novel fixed-point technique, we investigate the existence and uniqueness of near-coupled coincidence points in this setting. We provide numerical examples to demonstrate the effectiveness of our approach

Ballbot Simulation System: Modeling, Verification, and Gym Environment Development

This paper introduces the development of a sophisticated simulation model for the ball-balancing robot (ballbot), implemented as a Gymnasium (Gym) environment in Python. The main purpose of this environment is to facilitate the application of Reinforcement Learning (RL) techniques to effectively control the ballbot system. Initially, a standard ballbot model is created using Solidworks, and a Unified Robot Description Format (URDF) file is generated to precisely capture the dynamics of the ballbot. To validate the model, simulations are performed within MATLAB/Simulink, comparing the ballbot URDF model against its nonlinear mathematical model with a simple PID controller. The simulation results demonstrate that the URDF model accurately represents the ballbot dynamics, exhibiting a comparable response to the mathematical model. Subsequently, the high-fidelity URDF model is integrated into the Gym environment using the Pybullet simulator. The ongoing objective of this research is to utilize the developed ballbot environment for RL-based control design

The Impact of Corporate Governance and Audit Quality on the Investment Decision

The main purpose of this research is to study the impact of corporate governance and audit quality on the investment decision. In order to achieve this objective, the research collected literature review about previous variables. This research used survey method on the construction sector in Egypt. They are 97 completed questionnaires. Data was analyzed and hypotheses tested by using Statistical Package for the Social Sciences (SPSS). The research found that there's significant positive impact of corporate governance on the audit quality and investment decision which means investors will depend on the corporate governance when they make their investment decision. In addition, investors will depend on the audit quality (the ability of an auditor to detect a breach (auditor competence) and the willingness to report such a breach (auditor independence) when they make their investment decision

Conversion from Intermittent Hemodialysis to Peritoneal Dialysis in Metastatic Catheter-Related Bloodstream Infection

Of all complications from central venous catheters (CVC) in end-stage renal disease (ESRD) patients, catheter-related bloodstream infection (CRBSI) is one of the most devastating consequences. The option of catheter salvage is not an effective measure with metastatic infections. However, in patients with severe vasculopathy and/or near end-stage vascular disease, preservation of the venous access should be given utmost importance as the luxury of utilizing another vascular site is markedly limited. Providing adequate renal replacement therapy in this group of patients can be remarkably challenging for nephrologists. We are presenting an ESRD patient with advanced vascular disease who developed metastatic CRBSI with worsening uremia who was successfully converted from intermittent hemodialysis (IHD) to peritoneal dialysis (PD). Our rationale was to minimize repeated intravascular procedures coupled with the presence of another intravascular device. This has led to a complete resolution of persistent bacteremia, with a steady improvement in the uremic state. Conversion from IHD to PD for persistent bacteremia with metastatic complications was seldom addressed in literature. In the absence of a significant contraindication to PD, it can be considered as a valid alternative possibility in order to interrupt this viscous cycle, especially in vasculopathic patients

Effect of nano-silica on the mechanical properties of LWC

Nanotechnology has made significant inroads across various sectors, augmenting properties and economic impacts. Its pivotal role extends notably to the realm of construction and building. This study focuses on the tangible consequences of incorporating nano-silica (NS) into lightweight concrete (LWC) and its influence on mechanical attributes. The primary aim is to illustrate how NS impacts the mechanical properties of LWC, specifically its effects on compressive strength, flexural strength, and tensile strength in comparison to conventional LWC. The research encompassed the casting and examination of seven distinct concrete mixtures, including a reference mix, in laboratory settings. The study findings highlight that the utilization of lightweight Iraqi porcelanite stone resulted in a one-third reduction in the weight of standard concrete. Furthermore, the introduction of varying quantities of NS into structural LWC yielded enhancements in compressive, tensile, and flexural strength when contrasted with the reference mix, albeit at the expense of workability. Remarkably, The results showed an introduction of varying quantities of NS into structural LWC yielded enhancements in compressive, tensile, and flexural strength when contrasted with the reference mix, albeit at the expense of workability. The findings demonstrated that when doses of 1, 3, 5, 10, 15, and 20% NS were applied, the rate of three models for determining compressive strength at 90 days old rose by 19, 45, 62, 32, 15, and 37%, respectively. On the other hand, when dosages 1, 3, 5, 10, 15, and 20% were added, the percentage of improvement in tensile strength at 28 days of age was 77, 75, 84, 51, 55, and 53%. Additionally, while employing the same above doses, the bending strength at 28 days of age improved by 141, 140, 171, 115, 114, and 108%, respectively. Remarkably, the results also underscored the sustained efficacy of NS, particularly during the later stages of concrete maturation. © 2024 the author(s

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Prediction of Wilms’ Tumor Susceptibility to Preoperative Chemotherapy Using a Novel Computer-Aided Prediction System

Wilms’ tumor, the most prevalent renal tumor in children, is known for its aggressive prognosis and recurrence. Treatment of Wilms’ tumor is multimodal, including surgery, chemotherapy, and occasionally, radiation therapy. Preoperative chemotherapy is used routinely in European studies and in select indications in North American trials. The objective of this study was to build a novel computer-aided prediction system for preoperative chemotherapy response in Wilms’ tumors. A total of 63 patients (age range: 6 months–14 years) were included in this study, after receiving their guardians’ informed consent. We incorporated contrast-enhanced computed tomography imaging to extract the texture, shape, and functionality-based features from Wilms’ tumors before chemotherapy. The proposed system consists of six steps: (i) delineate the tumors’ images across the three contrast phases; (ii) characterize the texture of the tumors using first- and second-order textural features; (iii) extract the shape features by applying a parametric spherical harmonics model, sphericity, and elongation; (iv) capture the intensity changes across the contrast phases to describe the tumors’ functionality; (v) apply features fusion based on the extracted features; and (vi) determine the final prediction as responsive or non-responsive via a tuned support vector machine classifier. The system achieved an overall accuracy of 95.24%, with 95.65% sensitivity and 94.12% specificity. Using the support vector machine along with the integrated features led to superior results compared with other classification models. This study integrates novel imaging markers with a machine learning classification model to make early predictions about how a Wilms’ tumor will respond to preoperative chemotherapy. This can lead to personalized management plans for Wilms’ tumors