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

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 middle-income 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 low-income 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 low-income, 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

Building sand castles within IaaS-based cloud instances

Enterprises continually seek innovative approaches to reduce operational computing costs while extracting the maximum utility from their resources. Cloud Computing technology play a major role in helping organizations to reduce the operational cost and it is a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources. Cloud consumers are allowed to upload and execute their code inside Cloud Instances(CI) to perform different tasks. At the same time they need to run applications which they cannot trust completely. A compelling approach is needed to mitigate the security risk of executing untrusted applications that could potentially corrupt the resources available for CIs. This paper proposes a confined execution environment, which provides Security and protection for CIs running untrusted applications. Cloud consumers can enable the proposed confined execution environment as and when required

A multi-tenancy aware architectural framework for SaaS application development

In the era of cloud computing, multi-tenant based Software as a Service (SaaS) applications have been widely identified as the next generation of cloud applications. SaaS allows multiple user organizations to customize an application in a reliable and secure manner. However, this customization is a complex and error prone exercise. In response, researchers and practitioners have come up with SaaS architectures based on frameworks, platforms and modelling approaches to ease the complexity of SaaS application development. However, these methods and tools have not focused on aspect of development methodology being tuned to support long-term maintenance of the SaaS application. This paper presents an architectural framework for SaaS application development that incorporates long-term maintenance requirements arising from multi-tenancy of the application. It consists of a methodology coupled with a tool chain, which brings multi-tenancy aware features to develop SaaS solutions that meet critical architectural requirements. It also includes a UML 2.0 based Profile named SaaSML for designing of main components, a skeletal framework to position these components and a methodology for benchmark evaluation of key design criteria

Am I Responsible for End-User’s Security?

Previous research has pointed that software applications shouldnot depend on programmers to provide security for end-usersas majority of programmers are not experts of computer security.On the other hand, some studies have revealed thatsecurity experts believe programmers have a major role toplay in ensuring the end-users’ security. However, there havebeen no investigation on what programmers perceive abouttheir responsibility for the end-users’ security of applicationsthey develop. In this work, by conducting a qualitative experimentalstudy with 40 software developers, we attemptedto understand the programmer’s perception on who is responsiblefor ensuring end-users’ security of the applicationsthey develop. Results revealed majority of programmersperceive that they are responsible for the end-users’ securityof applications they develop. Furthermore, results showedthat even though programmers aware of things they needto do to ensure end-users’ security, they do not often followthem. We believe these results would change the currentview on the role that different stakeholders of the softwaredevelopment process (i.e. researchers, security experts,programmers and Application Programming Interface (API)developers) have to play in order to ensure the security ofsoftware applications

Why Johnny Can’t Develop a Secure Application? A Usability Analysis of Java Secure Socket Extension API

Lack of usability of security Application Programming Interfaces (APIs) is one of the main reasons for mistakes that programmers make that result in security vulnerabilities in software applications they develop. Especially, APIs that provide Transport Layer Security (TLS) related functionalities are sometimes too complex for programmers to learn and use. Therefore, applications are often diagnosed with vulnerable TLS implementations due to mistakes made by programmers. In this work, we evaluated the usability of Java Secure Socket Extension (JSSE) API to identify usability issues in it that persuade programmers to make mistakes while developing applications that would result in security vulnerabilities. We conducted a study with 11 programmers where each of them spent around 2 hours and attempted to develop a secure programming solution using JSSE API. From data we collected, we identified 59 usability issues that exist in JSSE API. Then we divided those usability issues into 15 cognitive dimensions and analyzed how those issues affected the experience of participant programmers. Results of our study provided useful insights about how TLS APIs and similar security APIs should be designed, developed and improved to provide a better experience for programmers who use them

A Cell biology inspired model for managing packet broadcasts in mobile ad-hoc networksc

The modern computing paradigm is moving towards personal devices that incorporate wireless networking, mobility, and collaborative applications. The networking paradigm that best matches this scenario is the mobile ad-hoc network (MANET). A common instance of a MANET is the dense MANET that can be expected in any setting where large number of people congregate such as movie theatres, sports stadiums, shopping malls, transportation hubs, lobby of public offices, lecture rooms, etc. The existing packet transmission protocols for MANETs are inefficient for dense MANETs due to packet broadcast storms for stateless protocols and non-availability of anchor nodes for stateful protocols. This paper presents a new packet broadcast model developed based on cell biology and provides simulation results on protocol efficiency. As Smartphone devices and collaborative applications proliferate among users, the proposed dense MANET protocol could provide real benefits to Internet enabled users and devices

Chaos theory based cryptography in digital image distribution : visibility controlled image encryption scheme (ViCIEn)

The amount of visual information available in digital format has grown exponentially in recent years due to the wide availability of digital equipments, changes in the way people socially interact by setting up community web pages, wide spread use of the Internet in all types of personal and business activities, pay-after-trial services of digital multimedia and developments in high speed transmission of digital images with high reliability. However, the wide accessibility of the Internet and its connected hosts and availability of technology to capture network traffic or penetrate hosts have made digital images vulnerable to unauthorized access while in storage and during transmission over a network. Hence users of the Internet and application that use or process digital images need to address security issues to protect commercial value of images and also ensure user privacy and other issues. The objective of the research presented in this paper focused on proposing an image encryption technique which is capable of encrypting an image effectively and securely with a predefined visibility level. The stipulated objective is achieved by employing 2D chaotic map called the Kaplan-Yorke map