A Defense Framework Against Denial-of-Service in Computer Networks

Denial-of-Service (DoS) is a computer security problem that poses a serious challenge totrustworthiness of services deployed over computer networks. The aim of DoS attacks isto make services unavailable to legitimate users, and current network architectures alloweasy-to-launch, hard-to-stop DoS attacks. Particularly challenging are the service-level DoSattacks, whereby the victim service is flooded with legitimate-like requests, and the jammingattack, in which wireless communication is blocked by malicious radio interference. Theseattacks are overwhelming even for massively-resourced services, and effective and efficientdefenses are highly needed. This work contributes a novel defense framework, which I call dodging, against service-level DoS and wireless jamming. Dodging has two components: (1) the careful assignment ofservers to clients to achieve accurate and quick identification of service-level DoS attackersand (2) the continuous and unpredictable-to-attackers reconfiguration of the client-serverassignment and the radio-channel mapping to withstand service-level and jamming DoSattacks. Dodging creates hard-to-evade baits, or traps, and dilutes the attack "fire power".The traps identify the attackers when they violate the mapping function and even when theyattack while correctly following the mapping function. Moreover, dodging keeps attackers"in the dark", trying to follow the unpredictably changing mapping. They may hit a fewtimes but lose "precious" time before they are identified and stopped. Three dodging-based DoS defense algorithms are developed in this work. They are moreresource-efficient than state-of-the-art DoS detection and mitigation techniques. Honeybees combines channel hopping and error-correcting codes to achieve bandwidth-efficientand energy-efficient mitigation of jamming in multi-radio networks. In roaming honeypots, dodging enables the camouflaging of honeypots, or trap machines, as real servers,making it hard for attackers to locate and avoid the traps. Furthermore, shuffling requestsover servers opens up windows of opportunity, during which legitimate requests are serviced.Live baiting, efficiently identifies service-level DoS attackers by employing results fromthe group-testing theory, discovering defective members in a population using the minimumnumber of tests. The cost and benefit of the dodging algorithms are analyzed theoretically,in simulation, and using prototype experiments

PERFORMANCE EXAMINATION OF AES ENCRYPTION ALGORITHM WITH CONSTANT AND DYNAMIC ROTATION

ABTRACT Lately, the Rijndael algorithm has been standardized by the NIST as the Advanced Encryption Standard (AES). This makes AES an essential and necessary data-protection mechanism for federal agencies in the US and other countries. In AES, rotation occurs in key expansion, ciphering, and deciphering. Rotation is vital for confusion and diffusion, which play an important role in any cryptography technique. Confusion and diffusion make breaking the key complex and difficult. This paper studies the effect of reconfiguring the structure of AES, especially replacing constant rotation with variable rotation. The resulting twin cipher is called Dynamic Rotation for Advanced Encryption Standard (DRAES). DRAES with variable rotation increases the complexity of the algorithm, and thus, increases the time consumed for brute-force attacks. We measured the diffusion of AES and DRAES algorithms. DRAES reached acceptable level of diffusion faster than AES

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Primary anterior vaginal wall pure ammonium acid urate stone. Case report

Vaginal stones are extremely rare and are classified as primary and secondary. A 45 year-old female presented with an unexplained dyspareunia and vaginal discomfort for 2 years unresponsive to traditional treatment. Vaginal examination revealed no prolapse or vaginal fistula. Digital examination revealed multiple small rounded firm to hard or tender masses varying in size from 0.5 to 1.5 cm anterior to the vagina. Patient was treated with midline anterior vaginal wall incision with the extraction of eight smooth surfaced stones with uneventful postoperative course. Stone analysis revealed that they were composed of pure ammonium acid urate (AU). We recommend that for any patient with unexplained dyspareunia or vaginal discomfort that has proved to be unresponsive to traditional treatment, the possibility of anterior vaginal wall stones should be kept in mind

Role of multidetector computed tomography in assessment of fibro-osseous lesions of the craniofacial complex

AbstractAimTo assess the role of multidetector CT in assessment of fibro-osseous lesions of the craniofacial complex.Materials and methodsThis study included 25 patients. Their age ranged from 15 to 64years with a mean age of 37.56±15.17years. All the studied individuals were chosen selectively regarding complaint (those with known fibro-osseous lesions, facial disfigurement, and facial swelling) regardless of age and gender and examined using MDCT in detection of the lesion, and assessment of the extensions.ResultsIn the present study, the cranio-facial fibrous dysplasia represented almost half of the presented cases (48%) followed by osteomas (36%) then ossifying fibroma (12%) and brown tumor (4%). 13 out of 25 cases in this study were pathologically proven to be fibro-osseous lesions and surgically operated. The final diagnosis was made by consensus of imaging, clinical findings and pathological features.ConclusionsMulti-detector row CT images, including reformations, better delineate craniofacial complex anatomy than do single-detector row CT images. Using multi-slice CT scanning in the craniofacial complex becomes possible to depict the complete path of complex structures

Synchronization of antral follicles: a step further towards a friendly IVF Program

Objective: To evaluate the value of synchronization of follicles using luteal phase estradiol for a friendly IVF program. Materials and Methods: A total of 108 infertile couples were included in a pragmatic trial. Group I (n=48) received Progynova 4mg/day for 10 days in the luteal phase preceding the ICSI cycle. Clomiphene citrate was started on the 2nd day of the cycle for five days, and hMG was administered on day 6 for 5 days. Group II (n=60) received the standard long protocol. The dose of hMG was then adjusted according to the ovarian response. Results: There was no significant difference between both groups regarding age, duration of infertility and body mass index. Group I showed a statistically significant reduction in duration of stimulation, dose of hMG (16.4 ± 4.7 vs. 40.9 ± 7.9), and number of oocytes retrieved (4.8 ± 2.6 vs. 16.2 ± 7.5), but it also showed a significant increase in cycle cancellation (8.3%). Even so, there was no significant difference in clinical pregnancy rate/ transfer (33.3% vs. 40%) between the two groups. Conclusion: This approach is both simple and effective and it may prove to be an attractive alternative to the standard GnRH agonist long protocol

Clinical and hemodynamic predictors of natriuretic peptide elevation among aortic valve disease patients

We investigated the relative contribution of hemodynamic and clinical factors to serum natriuretic peptide elevation in seventy-one patients with either aortic stenosis or aortic regurgitation. We found that pulmonary hypertension, heart failure and renal failure are the most powerful independent predictors of natriuretic peptide elevation in patients with aortic valve disease, irrespective of the type or severity of valvular lesion itself