Detecting and Refactoring Operational Smells within the Domain Name System

The Domain Name System (DNS) is one of the most important components of the Internet infrastructure. DNS relies on a delegation-based architecture, where resolution of names to their IP addresses requires resolving the names of the servers responsible for those names. The recursive structures of the inter dependencies that exist between name servers associated with each zone are called dependency graphs. System administrators' operational decisions have far reaching effects on the DNSs qualities. They need to be soundly made to create a balance between the availability, security and resilience of the system. We utilize dependency graphs to identify, detect and catalogue operational bad smells. Our method deals with smells on a high-level of abstraction using a consistent taxonomy and reusable vocabulary, defined by a DNS Operational Model. The method will be used to build a diagnostic advisory tool that will detect configuration changes that might decrease the robustness or security posture of domain names before they become into production.Comment: In Proceedings GaM 2015, arXiv:1504.0244

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

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

The Domain Name System Advisor, A Model-Based Quality Assurance Framework

The Domain Name System (DNS) has a direct and strong impact on the performance of nearly all aspects of the Internet. DNS relies on a delegation-based architecture, where resolution of names to their IP addresses require resolving the names of the servers responsible for those names. The recursive graphs of the inter-dependencies that exist between servers associated with each zone are called Dependency Graphs. We constructed a DNS Dependency Model as a unified representation of these Dependency Graphs. We utilized a set of Structural Metrics defined over this model as indicators of external quality attributes of the DNS. We applied machine learning in order to construct Prediction Models of the perceived quality attributes of the DNS out of the structural metrics of the model and evaluate the accuracy of these models. Operational Bad Smells are configuration and deployment decisions, made by zone administrators, that are not totally errant or technically incorrect and do not currently prevent the system from doing its designated functionality. Instead, they indicate weaknesses that may impose additional overhead on DNS queries, or increase system vulnerability to threats, or increase the risk of failures in the future. We proposed the ISDR (Identification, Specification, Detection and Refactoring) Method that enables DNS administrators to identify bad smells on a high-level abstraction using a consistent taxonomy and reusable vocabulary. We developed techniques for systematic detection and recommendations of reaction mechanisms in the form of graph-based refactoring rules. The ISDR Method along with the DNS Quality Prediction Models are used to build the DNS Quality Assurance Framework and the DNS Advisor Tool. Assessing the perceived quality attributes of the DNS at an early stage enables us to avoid the implications of defective and low-quality designs. We identify configuration changes that improve the availability, security, stability and resiliency postures of the DNS

Generalisability theory analyses of concept mapping assessment scores in a problem-based medical curriculum

Context In problem-based learning (PBL), students construct concept maps that integrate different concepts related to the PBL case and are guided by the learning needs generated in small-group tutorials. Although an instrument to measure students’ concept maps in PBL programmes has been developed, the psychometric properties of this instrument have not yet been assessed. Objectives This study evaluated the generalisability of and sources of variance in medical students’ concept map assessment scores in a PBL context. Methods Medical students (Year 4, n = 116) were asked to construct three integrated concept maps in which the content domain of each map was to be focused on a PBL clinical case. Concept maps were independently evaluated by four raters based on five criteria: valid selection of concepts; hierarchical arrangement of concepts; degree of integration; relationship to the context of the problem, and degree of student creativity. Generalisability theory was used to compute the reliability of the concept map scores. Results The dependability coefficient, which indicates the reliability of scores across the measured facets for making absolute decisions, was 0.814. Students’ concept map scores (universe scores) accounted for the largest proportion of total variance (47%) across all score comparisons. Rater differences accounted for 10% of total variance, and the student × rater interaction accounted for 25% of total variance. The variance attributable to differences in the content domain of the maps was negligible (2%). The remaining 16% of the variance reflected unexplained sources of error. Results from the D study suggested that a dependability level of 0.80 can be achieved by using three raters who each score two concept map domains, or by using five raters who each score only one concept map domain. Conclusions This study demonstrated that concept mapping assessment scores of medical students in PBL have high reliability. Results suggested that greater improvements in dependability might be made by increasing the number of raters rather than by increasing the number of concept map domains.Scopu

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Supine vs. Nonsupine Endotracheal Intubation

Background. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the safety and efficacy of supine vs. nonsupine positions during intubation. Methods. Based on the literature from inception to October 2020, 13 studies with nonemergent intubation in supine and nonsupine positions were chosen using PRISMA and MOOSE protocols. Pooled estimates were calculated using random-effects models with 95% confidence interval (CI). The primary outcome was a successful intubation, attempt, and duration of intubation. The secondary outcome was adverse events (trauma and hypoxia). Bias was evaluated qualitatively, by visual analysis, and quantitatively through the Egger test. Results. The final analysis included 13 clinical trials with 1,916 patients. The pooled success rates in the supine vs. lateral positions were 99.21% and 98.82%. The supine vs. semierect positions were 99.21% and 98.82%. The 1st attempt success rate in the supine vs. lateral position was 85.35% and 88.56% compared to 91.38% and 90.76% for the supine vs. semierect position. The rate of total adverse events in the supine position was 3.73% vs. 6.74% in the lateral position, and the rate of total adverse events in the supine position was 0.44% vs. 0.93% in semierect position. Low to substantial heterogeneity was noted in our analysis. Discussion. There is no significant difference between total successful intubations and success from 1st intubation attempt between supine and nonsupine positions. However, there are slightly higher rates of adverse events in nonsupine position. Addition of more recent studies on supine vs. nonsupine intubations would improve this study. Given these findings, it is important to develop more studies regarding different intubation positions and techniques with the aim of improving efficacy and decreasing adverse outcomes. Other. This review is not registered in a public database. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

An Efficient Multi-Secret Image Sharing System Based on Chinese Remainder Theorem and Its FPGA Realization

Multi-Secret Image Sharing (MSIS) is important in information security when multiple images are shared in an unintelligible form to different participants, where the images can only be recovered using the shares from participants. This paper proposes a simple and efficient ( $n,n$ )-MSIS system for colored images based on XOR and Chinese Remainder Theorem (CRT), where all the $n$ share are required in the recovery. The system improves the security by adding dependency on the input images to be robust against differential attacks, and by using several delay units. It works with even and odd number of inputs, and has a long sensitive system key design for the CRT. Security analysis and a comparison with related literature are introduced with good results including statistical tests, differential attack measures, and key sensitivity tests as well as performance analysis tests such as time and space complexity. In addition, Field Programmable Gate Array (FPGA) realization of the proposed system is presented with throughput 530 Mbits/sec. Finally, the proposed MSIS system is validated through software and hardware with all statistical analyses and proper hardware resources with low power consumption, high throughput and high level of security

The Lebanese Red Algae Jania rubens: Promising Biomolecules against Colon Cancer Cells

International audienceColorectal cancer (CRC) is ranked the second most lethal type of tumor globally. Thus, developing novel anti-cancer therapeutics that are less aggressive and more potent is needed. Recently, natural bioactive molecules are gaining interest as complementary and supportive antineoplastic treatments due to their safety, effectiveness, and low cost. Jania rubens (J. rubens) is a red coral seaweed abundant in the Mediterranean and bears a significant pharmacological essence. Despite its therapeutic potential, the natural biomolecules extracted from this alga are poorly identified. In this study, the proximal analysis revealed high levels of total ash content (66%), 11.3% proteins, 14.5% carbohydrates, and only 4.5% lipids. The elemental identification showed magnesium and calcium were high among its macro minerals, (24 ± 0.5 mg/g) and (33 ± 0.5 mg/g), respectively. The Chlorophyll of J. rubens was dominated by other pigments with (0.82 ± 0.02 mg/g). A 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay identified effective antioxidant activity in various J. rubens extracts. More importantly, a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) tetrazolium reduction and wound healing assays indicate that organic extracts from J. rubens significantly counteract the proliferation of colon cancer cell lines (HCT-116 and HT-29) and inhibit their migratory and metastatic properties in a dose and time-dependent manner. Overall, this study provides insight into the physicochemical properties of red seaweed, J. rubens, and identifies its significant antioxidant, cytotoxic, and anti-migratory potential on two colorectal cell lines, HCT-116 and HT-29

A Pin1/PML/P53 axis activated by retinoic acid in <i>NPM-1c</i> acute myeloid leukemia

International audienceRetinoic acid (RA) was proposed to increase survival of chemotherapy- treated patients with nucleophosmin-1 (NPM-1c)-mutated acute myeloid leukemia. We reported that, ex vivo, RA triggers NPM-1c degradation, P53 activation and growth arrest. PML organizes domains that control senescence or proteolysis. Here, we demonstrate that PML is required to initiate RA-driven NPM-1c degradation, P53 activation and cell death. Mechanistically, RA enhances PML basal expression through inhibition of activated Pin1, prior to NPM-1c degradation. Such PML induction drives P53 activation, favoring blast response to chemotherapy or arsenic in vivo. This RA/PML/P53 cascade could mechanistically explain RA-facilitated chemotherapy response in patients with NPM-1c mutated acute myeloid leukemia

Vitamin C enhances co-localization of novel TET1 nuclear bodies with both Cajal and PML bodies in colorectal cancer cells

Deregulation of ten-eleven Translocation protein 1 (TET1) is commonly reported to induce imbalances in gene expression and subsequently to colorectal cancer development (CRC). On the other hand, vitamin C (VitC) improves the prognosis of colorectal cancer by reprogramming the cancer epigenome and limiting chemotherapeutic drug resistance events. In this study, we aimed to characterize TET1-specific subcellular compartments and evaluate the effect of VitC on TET1 compartmentalization in colonic tumour cells. We demonstrated that TET1 is concentrated in coarse nuclear bodies (NB) and 5-hydroxymethylcytosine (5hmC) in foci in colorectal cancer cells (HCT116, Caco-2, and HT-29). To our knowledge, this is the first report of a novel intracellular localization profile of TET1 and its demethylation marker, 5hmC, in CRC cells. Interestingly, we found that TET1-NBs frequently interacted with Cajal bodies, but not with promyelocytic leukaemia (PML) bodies. In addition, we report that VitC treatment of HCT116 cells induces 5hmC foci biogenesis and triggers 5hmC marks to form active complexes with nuclear body components, including both Cajal and PML proteins. Our data highlight novel NB-concentrating TET1 in CRC cells and demonstrate that VitC modulates TET1-NBs’ interactions with other nuclear structures. These findings reveal novel TET1-dependent cellular functions and potentially provide new insights for CRC management.</p