New Method in Encryption

Encryption in this paper includes the use of  three values which they are the two shadows values of a base value, and the base value is attained from the three shadows values . Encryption  based on two keys was proposed to increase the security of single encryption. We introduce a novel combination of  asymmetric (two public –key) and symmetric ( private-key). Public key and private key  involves odd and even whole values (first shadow value , second shadow value and third shadow value) . shadows values are multiplied making a product value and the value of 1 is subtracted from the produce value, The base value is along with the chosen shadows values ,then we employ  values to find public key to encrypt message and private key to decrypt the encrypted message , as well as introduce new ideal to conclude the private key from the public key in two method ,first method determine the values agreed on some of them between the sender and the recipient . Second raised prime number to different value. Key words: Encryption,  shadows value,  public key, private ke

Design and implementation of a novel secured and wide WebRTC signalling mechanism for multimedia over internet

A modern and free technology called web real-time communication (WebRTC) was enhanced to allow browser-to-browser multimedia communication without plugins. In contract, WebRTC has not categorised a specific signalling mechanism to set, establish and end communication between browsers. The primary target of this application is to produce and implement a novel WebRTC signalling mechanism for multimedia communication between different users over the Internet without plugins. Furthermore, it has been applied over different browsers, such as Explorer, Safari, Google Chrome, Firefox and Opera without any downloading or fees. This application designed using JavaScript language under ASP.net and C# language. Moreover, to prevent irrelevant users from accessing or attacking the session, user-id for initiating and joining the course using encryption technique was done. This system has been employed in real implementation among various users; therefore, an evaluation of bandwidth consumption, CPU, and quality of experience (QoE) was accomplished. The results show an original signalling mechanism which applied to different browsers, multiple users, and diverse networks such as Ethernet and Wireless. Besides, it sets session initiator, saves the communication efficient even if the initiator leaves, and communicating new participator with existing participants, etc. This studying focuses on the creation of a new signalling mechanism, the limitations of resources for WebRTC video conferencing

Relation proximal point with some dynamical properties

In this paper we discussed relation proximal points with many of  dynamical properties through studied topological transformation group , and it will given  necessary condition for proximal relation to be minimal set ,and introduce  new define replete set and semi-replete set by using concept of the replete set and semi-replete set as well as  we introduce that many of  new  relations  and theorem. Key words: Proximal point, replete proximal point, syndetic set, semi-replete set, minimal set, almost periodic point             .

The Effects of Surface Roughness on the Squeeze Film Characteristics with Couple stress fluids in Hip joint

On the basis of the Stokes micro continuum theory , This paper aims to study the effects of surface roughness and couple stress on the squeeze film Characteristics in hip joint. The cartilage is modeled as biphasic poro-elastic  matrix and synovial fluid is modeled as couple stress fluid  . Compared to the conventional Newtonian lubricant case, the couple stress and surface roughness effects characterized by the couple stress and surface roughness parameter signify an improvement in the squeeze film Characteristics. Increasing values of the  surface roughness  parameter increases the load-carrying capacity and the squeeze in the squeeze film can be decreased and provides a longer time to prevent sphere –plane surface contact .The approaching time of the sphere in reducing the film thickness h*=1 to h*= 0for the couple stress fluid lubricant which is longer than surface roughness. Keywords: Surface roughness, Couple stress fluid, Articular cartilage, Synovial fluid, Micro continuum theory, Hip joint

The hydrodynamic Effect of the Hyaluronic Acid on the Performance Improvement of the Human Synovial Joint

The aim of this article is to present an the theoretical analysis of the problem is presented through a mathematical model  depended on the idea of a Hyaluronic acid (HA) in cartilage  and  synovial fluid surrounding the joints (hip, knee and ankle)  where are a major component of synovial fluid modified  Reynolds equation  governing the fluid film pressure was derived and solved analytically,  and closed form expressions for the squeeze film pressure and load carry capacity were  presented. The influence of film thickness and sliding motion on the squeeze film Characteristics were discussed .It has been found that the effect of  decreased film thickness tend to increased the load carry capacity , friction force and decreased  flow rate, The effect of decreased sliding motion tend to increasing frication force and decreased flow rate and  when additives Hyaluronic acid (HA) to bearing material (articular cartilage ) .The results indicate to  increasing pressure distribution (P) and improve both load carry capacity (W), friction force (F) Compared to the disease synovial hip joint. Keywords: Hyaluronic acid , Hip joint, load carry capacity, friction force.

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

CARDIOGENIC PULMONARY EDEMA IN CRITICAL CARE

The pathobiology and classification of pulmonary edoema are more complex than the previous dichotomy of hydrostatic vs. permeability. The mechanisms of alveolar fluid clearance and the factors that influence the clearance rate are being studied thoroughly in order to develop therapeutic strategies. Patients require early oxygenation and ventilation stabilization, preferably with high-flow nasal cannula oxygen or noninvasive ventilation, while the diagnostic cause is quickly sought with echocardiography and other testing. Treatments must begin as soon as possible while evaluation continues and requires multimodal intervention. Diuretics, possibly morphine, and frequently nitrates, are used to treat cardiogenic pulmonary edema. This review summarizes current knowledge of the pathophysiology, causes, and treatment of cardiogenic pulmonary edema