Search Results (987)

Slow convergence remains a critical limitation hindering the practical deployment of consensus-based time synchronization protocols (CTSPs). Increasing algebraic connectivity is a key mechanism for improving the convergence speed of distributed algorithms. However, existing strategies inevitably introduce redundant packet communication, while forwarding stale timing information may degrade synchronization accuracy. To address this challenge, this paper proposes a high-order consensus time synchronization protocol (HCTSP). Unlike traditional CTSPs, HCTSP incorporates previous clock states from two-hop neighboring nodes to establish a virtual topology and further employs this information to enhance the estimation of logical clock parameters, thereby achieving fast estimation of clock parameters while effectively suppressing fluctuations in parameter estimation caused by a large initial synchronization error. Although the proposed method utilizes single-hop communication to relay information from non-adjacent nodes—an indirect transmission mechanism that inherently introduces additional communication overhead—we further develop an accumulator-based redundant information optimization scheme. Furthermore, the consensus algorithm integrates both an accumulator-based update mechanism and multi-hop historical memory, partially alleviating the impact of Gaussian communication delay jitter on clock correction. Theoretical proofs have verified the fast convergence of the proposed protocol. Extensive simulation experiments also demonstrate the superior efficiency of HCTSP in terms of convergence speed, communication overhead, and synchronization accuracy. Specifically, in random networks with 25 nodes, there is an approximately 50% reduction in single-round synchronization message length and a 66.67% decrease in total packet exchange volume compared to the virtual topology-based time synchronization protocol (VTSP). In the typical ring topology, where the convergence speed of the consensus algorithm is slow, HCTSP has a 59.33% increase in convergence speed compared to VTSP and a 75.29% increase compared to the gradient time synchronization protocol (GTSP). Full article

Background and Objectives: Seizures and epilepsy are common in children with life-limiting illnesses, particularly in the context of severe neurological impairment. However, data on the clinical profile of these patients in paediatric palliative care are limited, and the lack of standardised protocols adapted to this context represents a clinical challenge. To assess the prevalence of epilepsy and associated clinical characteristics in children receiving paediatric palliative care and to develop a clinical protocol for the management of seizures based on expert consensus. Materials and Methods: A retrospective observational study was conducted, based on the analysis of clinical data from children registered in a paediatric palliative care service (Lumina Association, Romania). Demographic, diagnostic, neurological status and anticonvulsant treatment data were collected. Based on the results obtained and the existing literature, a clinical protocol was developed using a modified Delphi method approach, involving a multidisciplinary panel of experts and two rounds of evaluation of clinical statements. Results: A total of 101 patients (54.5% boys and 45.5% girls) were included, with a mean age of 7.2 ± 4.7 years. Epilepsy was documented in 32.7% of patients and was significantly associated with a neurological diagnosis (p = 0.008), severe neurodevelopmental delay (p = 0.032) and severe motor impairment (p = 0.036). The Delphi process led to the validation of 13 clinical recommendations, the majority of which achieved a strong level of consensus (>85%). Conclusions: Epilepsy is common and closely associated with severe neurological impairment in paediatric palliative care. The integration of systematic neurological assessment and the implementation of a consensus-based clinical protocol can support a more structured approach to seizure management in paediatric palliative care. Full article

Oral health has significant implications for pulmonary outcomes, particularly among individuals with dysphagia who are at risk for aspiration. Moreover, oral health and condition affect nutrition accessibility and status. Inadequate oral hygiene promotes bacterial colonization, plaque accumulation, and aspiration-related respiratory complications. This narrative review aimed to explore current evidence and expert perspectives across palliative medicine, pulmonary and critical care, and dentistry on the role of oral hygiene in supporting pulmonary health and maintaining opportunities for oral nutrition. A comprehensive literature search was conducted through the Texas Tech University Health Sciences Center digital library using Cochrane Library (Wiley), EBSCO Discovery, Embase, Ovid databases, PubMed, SCOPUS, ScienceDirect, Web of Science, and Google Scholar between 14 January 2026 and 1 April 2026. From 1287 identified records, 70 studies were selected to be highlighted in the manuscript after duplicate removal and eligibility screening. Relevant literature was reviewed to examine associations among dysphagia, oral health and condition, oral hygiene and care protocols, feeding route, salivary composition and function, and respiratory outcomes. Emphasis was placed on studies addressing pneumonia, oral versus tube feeding, and evidence-based oral care practices. Findings indicate that pneumonia, depression, and mortality rates are higher in patients receiving tube feeding compared to oral feeding. Evidence-based oral care practices inclusive of mechanical plaque disruption, oral cleansing products (Chlorhexidine, hydrogen peroxide, and sodium bicarbonate), and structured oral hygiene protocols can reduce pulmonary consequences of aspiration and support safer/least risk oral intake. Saliva plays a pivotal role in plaque breakdown, microbial defense, and host immunity; oral feeding helps to preserve salivary function. Results of this review highlight the importance of oral hygiene in both restorative and palliative care contexts. This review establishes a framework for embedding oral cleansing agents and protocols into a nutrition-focused health care infrastructure. Based on the literature analysis and inter- and multidisciplinary clinical expertise of the author group, the manuscript proposes consensus statements intended as expert guidance rather than formal clinical practice guidelines. Adherence to best practices in oral care can mitigate pulmonary consequences of aspiration amid dysphagia, make oral nutrition more accessible and comfortable, sustain opportunities for least risk oral feeding across diagnoses and health care settings, and improve quality of life for patients with dysphagia amid life-limiting illness. Full article

This research focuses on a cooperative guidance scenario involving multiple unmanned aerial vehicles (UAVs). The objective is to achieve a simultaneous interception of a maneuvering target while maintaining strict constraints on the relative geometry. To tackle this challenge, we introduce a distributed optimal spatial–temporal cooperative pursuit strategy. Initially, the impact angles and interception times for each UAV are analytically predicted based on the augmented ideal proportional navigation (AIPN) guidance scheme. Subsequently, we employ an optimal distributed consensus protocol to synchronize the UAVs, ensuring they converge on the target at the same time while preserving a predetermined intercept geometry. The proposed method offers significant advantages in a distributed framework, notably reducing control energy consumption by approximately 63.0% compared to an existing state-of-the-art cooperative guidance law. Comprehensive simulations are conducted to validate the energy efficiency of the approach. Full article

Background: Early management of adult burn injuries in resource-constrained environments—such as battlefields and primary care facilities—remains hindered by the absence of standardized, evidence-based protocols. This study aimed to systematically synthesize existing evidence and develop an integrated framework of actionable recommendations to optimize prehospital and early emergency care. Methods: A comprehensive evidence synthesis was conducted across 14 international and domestic bibliographic databases and authoritative repositories. Eligible sources included clinical practice guidelines, expert consensus statements, evidence summaries, and systematic reviews. Literature quality was appraised using validated instruments, and best-practice recommendations were extracted and thematically synthesized across the continuum of early burn care. Results: Fifty-nine high-quality studies yielded 77 recommendations across 13 domains, spanning from scene safety and burn process cessation through airway, breathing, and circulatory management to wound care, infection control, and transfer preparation. An integrated, context-adaptive framework was established to guide resource-calibrated interventions rather than rigid protocol adherence. Conclusions: These findings provide tiered guidance for frontline healthcare providers and inform the development of emergency care standards in resource-limited settings. Future research should prioritize field validation and contextual implementation to address barriers to evidence translation and enhance real-world applicability. Full article

Pathology is foundational to biomarker-driven and translational oncology research, yet systemic barriers limit full pathology engagement in Canadian cancer clinical trials, compromising the tissue-based questions such trials are designed to answer. This commentary and white paper synthesizes the perspectives of a national pathology working group convened at the 2025 Canadian Cancer Trials Group (CCTG) Annual General Meeting with a descriptive internal audit of the CCTG Tumour Tissue Data Repository (TTDR), in which biospecimen attrition was tabulated at the patient level by disease site; no inferential testing was performed. The TTDR data revealed substantial attrition across disease sites, with no tissue submitted for 32–44% of patients and slides submitted in place of formalin-fixed paraffin-embedded blocks for up to 51% of cases, reflecting persistent misalignment between protocol expectations and laboratory capacity. From these observations, five interrelated gaps were identified—in trial design, funding and resourcing, digital pathology infrastructure, academic recognition, and knowledge translation around consent and ethics governance. Five corresponding strategies are proposed to align research demands with pathology capacity, reduce attrition, and strengthen biomarker-driven trials. As a consensus- and experience-driven analysis rather than a systematic review, these recommendations are intended to frame a national conversation and a starting point for prospective evaluation. Full article

The convergence of Software-Defined Networking (SDN) and Blockchain (BC) creates a symbiotic relationship in which SDN’s programmable global visibility complements BC’s decentralized, immutable trust model to address critical cybersecurity vulnerabilities and cyber attacks. Addressing the fragmentation in the current literature, this study rigorously investigates BC and SDN (B-SDN) integration with the primary objectives of: (1) differentiating impacts across varied sectors, including the Internet of Things (IoT), Smart Grids, and Vehicular Ad Hoc Networks (VANETs) and more; (2) analyzing critical performance metrics such as energy efficiency and scalability; (3) classifying mitigation, detection, and prevention schemes for specific threats; (4) examining novel Artificial Intelligence (AI) methods; and (5) identifying open challenges and future research directions. Methodologically, this study conducts a survey of state-of-the-art B-SDN studies to investigate six key areas: Industry-specific applications, security mechanisms, defense strategies, defenses against specific attacks, AI integration, and implementation performance. The findings demonstrate that B-SDN integration shows strong potential in simulated and prototype environments to mitigate specific high-impact threats, such as Distributed Denial of Service (DDoS), Man-in-the-Middle (MiTM), and spoofing, across various domains, including IoT, 5G/6G, VANETS, and Smart Grid. Despite the benefits and advantages promised by B-SDN, several limitations continue to exist, including the latency–security trade-off inherent to consensus protocols and scalability constraints in large-scale deployments. Finally, open research challenges persist in AI-driven automation, particularly in Federated Learning (FL) and in the development of standardized interoperability protocols required to enable the transition from conceptual models to operational systems. Full article

Nogo (RTN4) proteins and their receptors have emerged as candidate mediators of metabolic regulation and vascular pathology relevant to type 2 diabetes (T2D). The primary objective of this PRISMA-guided systematic review was to evaluate the clinical and cohort evidence for RTN4/RTN4R as potential biomarkers of T2D progression and vascular complications. A secondary objective was to synthesize preclinical mechanistic evidence on the effects of Nogo axis modulation on pathways relevant to the pathogenesis of T2D. We performed a PRISMA-guided systematic review. The protocol was not prospectively registered in PROSPERO. To ensure reproducibility, we provide complete search keywords, the screening log and the full-text exclusion table. PubMed/MEDLINE, EMBASE and Web of Science were searched for studies published 2000–2025; full search keywords are provided in the main text. The search strategy combined and free-text terms with Boolean operators. We included original preclinical and clinical studies, cohort/proteomic analyses, meta-analyses, and mechanistic papers reporting expression, function, signaling, or clinical associations of Nogo proteins/receptors in metabolic or vascular outcomes. Exclusion criteria: non-English articles, unclear methods, studies outside 2000–2025, and studies lacking primary data. Two reviewers independently screened records; conflicts were resolved by consensus. Study quality was appraised using established tools (SYRCLE for animal studies, Newcastle–Ottawa Scale for cohort/case-control studies). Preclinical evidence supports tissue-specific roles for RTN4 isoforms and receptors in the regulation of insulin secretion, proGCG → GLP-1 processing, ER homeostasis, and vascular permeability through the Src/PI3K/Akt and RhoA/ROCK axes. Cohort and proteomic analyses report associations between RTN4/RTN4R or serum NogoB and faster progression of T2D or vascular complications, but genetic assessment of causality (Mendelian randomization) has so far provided limited support in available data sets. Findings are heterogeneous with respect to directionality and tissue localization. RTN4 signaling exhibits tissue-specific mechanisms relevant to glucose regulation and vascular biology and warrants further translational study. However, heterogeneity across studies and limited genetic support for causality indicate that isoform-specific quantitative validation, longitudinal cohorts and integrated genetic–functional analyses are required before RTN4/RTN4R can be considered as clinical biomarkers. Full article

As cloud computing proliferates, outsourced data faces severe security threats, yet existing searchable encryption (SE) schemes rely on classical hardness assumptions, centralized trust authorities, and static access control, leaving critical gaps in quantum resistance, single-point-of-failure prevention, and dynamic permission management. To address these limitations, we propose BL-ABSE, a blockchain-enhanced, lattice-based attribute-based searchable encryption framework. BL-ABSE employs the Ring Learning With Errors (RLWE) problem as its security foundation and applies the Number Theoretic Transform (NTT) to reduce polynomial multiplication from $O\left(n^2\right)$ to $O(nlogn)$. To eliminate single-point trust risks, the framework further integrates a $(t,n)$ threshold key protocol across an edge-node consortium governed by Practical Byzantine Fault Tolerance (PBFT) consensus. A smart-contract-maintained on-chain revocation list enables permission withdrawal via a single blockchain transaction without re-encryption. Experimental evaluation demonstrates that commitment generation requires approximately 23 ms at $n=1024$, search latency scales linearly at roughly 29 µs per record, and revocation completes in approximately 2 s regardless of system scale. Formal security proofs under the quantum polynomial-time (QPT) adversary model reduce six security properties—index indistinguishability, query privacy, threshold key security, Byzantine fault tolerance, audit immutability, and revocation immediacy—to the hardness of RLWE and the Short Integer Solution (SIS) problems. To the best of our knowledge, BL-ABSE is the first framework to simultaneously achieve post-quantum security, attribute-based access control, decentralized key management, instant revocation, and immutable auditing within a single unified framework. We further conduct threshold parameter verification, end-to-end revocation latency decomposition, blockchain throughput stress testing, search-pattern leakage quantification, and communication/storage overhead analysis, providing a comprehensive evaluation of both performance and security trade-offs. We explicitly characterize the search-pattern leakage inherent in the deterministic commitment design as a correctness–privacy trade-off and discuss mitigation directions. Full article

One area of application for distributed ledger technologies is the Internet of Things. These technologies can provide an effective solution to many problems in this field. The consensus layer is a crucial architectural component of distributed ledger systems. Modern IoT networks place increased demands on the consensus mechanisms used in blockchain systems. There are many consensus protocols with different properties and purposes, including those for IoT blockchain networks. Selecting an appropriate consensus protocol for a specific IoT blockchain system is an important and complex task. Multi-criteria decision analysis methods are widely used in such problems, as they allow for the consideration of multiple conflicting criteria and provide a balanced approach to evaluating alternatives. Given the variability of network parameters and requirements of consensus mechanisms, multi-criteria decision-making methods can support more informed protocol selection. This paper presents a decision support framework for selecting a consensus protocol for blockchain-based Internet of Things networks. The system is an implementation of a previously developed conceptual model for a consensus protocol selection framework. A case study is also provided to demonstrate the application of the system. Full article

Background: Despite the widespread clinical use of dental implants, research in implant dentistry remains active, aiming to develop new materials, designs, and surface morphologies, as well as to better understand the biological mechanisms underlying the pathophysiology of certain diseases to improve patient outcomes. In this context, preclinical animal models provide an essential opportunity to explore and validate new technologies and protocols before their application in humans. Although large vertebrate species have historically been preferred due to their biological similarity to humans, small animal models such as rats offer significant advantages. Additionally, they allow researchers to work with larger sample sizes, improving the statistical power of experimental outcomes. This scoping review aimed to analyze the current literature on intraoral rat surgical models in the field of implant dentistry. Methods: We included the preclinical studies using rat models focused on implant placement in the oral cavity and published in English. We excluded all studies that involved animal models other than rats or used implant placements in anatomical sites different from the target region. An electronic search was conducted in the PubMed and Scopus databases. From an initial 1032 results, 680 articles remained after duplicate removal. A first screening retained 191 articles, and after full-text review, 98 studies were ultimately included. The selection process was conducted using the software Rayyan. Data were extracted and analyzed across nine domains: Publication metadata, Focused Research Questions, Animal specificities, Study Design, Surgical Protocol Features, Medications Administered to Establish the Experimental Model, Timing of Euthanasia, Characterization methods, and Drop-Out Information. Results: The evaluation of the selected literature revealed a lack of standardization in study design. There is no consensus regarding the rat species used, the age at the time of implant placement, the anatomical site, or the implant morphology. Even more concerning is the presence of methodological deficiencies in the reporting of study design and outcome measures. Conclusions: By summarizing the available data, this review proposes the most commonly used features across preclinical trials in rats. Moreover, it offers a comprehensive overview of the current scientific landscape in this field, enabling researchers to compare different study designs and more easily access relevant information. Full article

Background/Objectives: Large language models (LLMs) are increasingly consulted for information about cleft lip and palate (CLP), yet the reliability of their outputs across clinical domains has not been evaluated. This study aimed to compare the quality of CLP-related information generated by GPT-4o and Gemini 2.5 Pro across multiple thematic domains using a validated quality instrument and a reliability-first analytic framework. Methods: Fifty-four standardized CLP questions across six domains were submitted to GPT-4o (OpenAI) and Gemini 2.5 Pro (Google DeepMind) on 25 September 2024 via their public interfaces, using new, history-free sessions and default settings, yielding 108 responses. Three independent, CLP-experienced raters scored each response using the Global Quality Score (GQS; 1–5 scale assessing accuracy, completeness, and clinical usefulness). Before comparing models, we applied a reliability-first filter: only domains where all three raters showed substantial agreement (Fleiss’ kappa [κ] ≥ 0.60) were included in statistical comparisons. Domains that failed this threshold were analyzed qualitatively to identify the source of disagreement. A descriptive taxonomy of errors was developed for low-scoring responses. Results: Three domains met the reliability threshold (General Care Information, General Cleft Information, and Pre-Treatment Information; 30 paired questions). Both models performed at a high and practically equivalent level: GPT-4o median GQS 4.33 (IQR 4.00–5.00) versus Gemini 2.5 Pro 5.00 (IQR 4.00–5.00); the difference was not statistically significant (Wilcoxon V = 139.00, p = 0.691; Hodges–Lehmann median difference 0.00, 95% CI −0.33 to 0.67). Three domains were excluded because rater agreement was insufficient; qualitative review showed this reflected genuine clinical practice variation rather than clear model errors. The most common inaccuracies were overgeneralization of outcomes, outdated surgical timing, and omission of multidisciplinary team roles. Conclusions: Both models provided high-quality CLP information in domains supported by clinical consensus, indicating they may serve as useful adjuncts for general patient and family counseling. Clinicians should, however, verify any treatment-specific content against current institutional protocols before relaying it to patients. Future research should assess readability, alignment with health literacy, and patient comprehension of AI-generated CLP information. Full article

This paper addresses the prescribed-time (PT) bounded consensus tracking problem for high-order nonlinear multi-agent systems subject to actuator faults, system uncertainties, and unmatched disturbances under directed communication topologies. A sufficient condition for PT bounded stability is established by introducing a smooth and bounded time-varying scaling function, which avoids singular time-varying scaling gains in the resulting control design. Based on this condition, an adaptive neural network-based control protocol is developed within a backstepping framework to approximate unknown nonlinear dynamics. To enhance implementability, a finite-time differentiator is incorporated to circumvent the explosion of complexity problem, while an adaptive fault compensation mechanism is constructed to address actuator effectiveness loss and bias faults. Rigorous Lyapunov analysis demonstrates that all closed-loop signals remain bounded and the consensus tracking errors converge to a small neighborhood of the origin within a user-specified time. Finally, simulation results are provided to illustrate the feasibility of the proposed approach and the bounded closed-loop behavior under the considered actuator-fault scenarios. Full article

Background/Objectives: Anterior cruciate ligament (ACL) tears in children and adolescents are occurring at the intersection of skeletal growth and often early sports specialization, requiring a specialized approach, as pediatric ACL injury is not merely a scaled-down version of adult injury. Methods: This review synthesizes the current understanding of diagnostic protocols, evolution of knee morphology and neuromechanical risk factors characteristic of the pediatric population. It further examines the spectrum of specific management strategies including conservative approaches, primary repair and various reconstruction techniques, alongside rehabilitation, prevention and follow-up procedures. Results: In the diagnostic phase, pediatric-specific clinical and imaging findings must be carefully interpreted. Certain anatomical and neuromuscular characteristics seem to be linked to injury. Management remains complex, requiring a delicate balance between restoring stability and sparing bone growth. While conservative treatment may be attempted in specific cases, it must be promptly redirected toward surgical intervention if persistent instability occurs. Consensus on optimal surgical strategies remain impeded by the lack of robust evidence. Anterior cruciate ligament reconstruction (ACLR) still faces challenges such as growth disturbances, high graft failure, contralateral rupture rates and the biological process of graft remodeling. However, ACLR currently remains the gold standard compared to ACL repair. Tailored rehabilitation and robust prevention programs are needed. Conclusions: The management of ACL rupture in the pediatric population remains complex and constrained by important evidence gaps. Continued refinement of management strategies and future prospective, multicenter pediatric studies are needed. Full article

First-trimester sonographic examination remains a fundamental part of antenatal care, providing crucial information for the well-being of both the mother and fetus and leading to the best possible perinatal outcomes. This study aimed to review and compare the most recently published guidelines on first-trimester ultrasound. Therefore, a descriptive review of guidelines from the American Institute of Ultrasound in Medicine (AIUM), the Australasian Society of Ultrasound in Medicine (ASUM), the Association of the Scientific Medical Societies in Germany (AWMF), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the Society of Obstetrician and Gynecologists of Canada (SOGC) and the World Association of Perinatal Medicine (WAPM) regarding first-trimester scans was conducted. There is a consensus regarding the main parameters that should be evaluated, the qualifications of the examiner and specifications of the ultrasound machine, as well as the importance of informed consent. Additionally, the importance of careful visualization of fetal anatomy is discussed, with minor discrepancies regarding the appropriate protocol used. The use of combined first-trimester examination is encouraged by all the reviewed medical societies, although cell-free DNA testing is addressed only by a few, with similar indications. Controversy exists regarding the indications and appropriate gestational age at which the first-trimester scan should be performed, as well as the proper establishment of pregnancy dating. Notably, recommendations regarding fetal growth restriction (FGR) and diagnostic invasive procedures are made only by few medical societies, with the AWMF and SOGC addressing screening for FGR. Furthermore, invasive diagnostic testing is discussed by the AIUM, AWMF and SOGC, with differentiations among them regarding the indications for pursuing such procedures. First-trimester sonographic examination is essential for assessing fetal viability, establishing accurate pregnancy dating, evaluating fetal and maternal anatomy and calculating the risk of various fetal and maternal conditions. The implementation of evidence-based, unified protocols would advance both maternal and fetal outcomes. Full article