Search Results (262)

The multi-factor authentication (MFA) protocol requires users to provide a combination of a password, a smart card and biometric data as verification factors to gain access to the services they need. In a single-server MFA system, users accessing multiple distinct servers must register separately for each server, manage multiple smart cards, and remember numerous passwords. In contrast, an MFA system designed for multi-server architecture allows users to register once at a registration center (RC) and then access all associated servers with a single smart card and one password. MFA with an offline RC addresses the computational bottleneck and single-point failure issues associated with the RC. In this paper, we propose a post-quantum secure MFA protocol for a multi-server architecture with an offline RC. Our MFA protocol utilizes the post-quantum secure Kyber key encapsulation mechanism and an information-theoretically secure fuzzy extractor as its building blocks. We formally prove the post-quantum semantic security of our MFA protocol under the real or random (ROR) model in the random oracle paradigm. Compared to related protocols, our protocol achieves higher efficiency and maintains reasonable communication overhead. Full article

Introduction: Few applications worldwide focus on psychosocial rehabilitation, and none specifically address psychosocial rehabilitation projects. This justifies the need for an application to assist mental health professionals in constructing and managing such projects in the Brazilian mental health scenario. Objective: This study aimed to present a web application, the “Psychosocial Rehabilitation Application” (Psychosocial Rehab App), and describe its development in detail through a technological survey conducted between May 2024 and February 2025. Method: The development process of the web app was carried out in the following four stages, adapted from the Novak method: theoretical basis, requirements survey, prototyping, and development with alpha testing. The active and collaborative participation of the main researcher (a psychiatric nurse) and two undergraduate software engineers, supervised by a software engineer and a professor of nursing and psychology, was essential for producing a suitable operational product available to mental health professionals. Interactions were conducted via video calls, WhatsApp, and email. These interactions were transcribed using the Transkriptor software and inserted into the ATLAS.ti software for thematic analysis. Results: The web app “Psychosocial Rehabilitation Application” displays a home screen for registration and other screens structured into the stages of the psychosocial rehabilitation project (assessment, diagnosis, goals, intervention, agreements, and re-assessment). It also has a home screen, a resource screen, and a function screen with options to add a new project, search for a project, or search for mental health support services. These features facilitate the operation and streamline psychosocial rehabilitation projects by mental health professionals. Thematic analysis revealed three themes and seven codes describing the entire development process and interactions among participants in collaborative, interrelational work. A collaborative approach between researchers and developers was essential for translating the complexity of the psychosocial rehabilitation project into practical and usable functionalities for future users, who will be mental health professionals. Discussion: The Psychosocial Rehab App was developed collaboratively by mental health professionals and developers. It supports the creation of structured rehabilitation projects, improving decision-making and documentation. Designed for clinical use, the app promotes autonomy and recovery by aligning technology with psychosocial rehabilitation theory and the actual needs of mental health services. Conclusions: The Psychosocial Rehab App was developed through collaborative work between mental health and technology professionals. The lead researcher mediated this process to ensure that the app’s functionalities reflected both technical feasibility and therapeutic goals. Empathy and dialog were key to translating complex clinical needs into usable and context-appropriate technological solutions. Full article

Background/Objectives: Virtual surgical planning (VSP) has become the gold standard in mandibular reconstructions with autografts. While commercial services are available, efforts are under way to address their shortcomings, which may include inefficiency, inconvenience, and susceptibility to error. We developed a novel approach to calculate knowledge-based reconstruction proposals. The objective of our work is to implement software for automated VSP and to evaluate it on retrospective clinical cases. Methods: We developed software, which incorporates registration of a naturally shaped mandible, tumor resection planning, knowledge-based calculation of reconstruction proposals, and manual refinement of proposals. Three surgeons planned 21 retrospective clinical cases utilizing our software. They rated its usability via the System Usability Scale (SUS) and rated the quality of the proposed reconstructions and the final surgical plan via a five-point Likert scale (1: totally disagree–5: totally agree). Results: Surgeons rated the usability with an average SUS score of 76.7. Times for VSP were consistently less than 20 min. The surgeons agreed with the proposals with a mean value of 4.7 ± 0.4. In 15 cases they made minor refinements. Finally, they agreed with the final surgical plan in twenty cases (score of 5) and with minor discrepancies in one case (score of 4). Conclusions: We developed an easy-to-use software for the automated VSP of mandibular reconstructions with autografts. The results demonstrate that reconstruction proposals can be calculated efficiently based on standardized rules. Our system allows surgeons to autonomously derive, compare, and rapidly refine high-quality reconstruction proposals based on key decisions. Full article

Background and Objectives: Air pollutants have been shown to affect hypertensive disorders and placental hypoxia due to vasoconstriction, inflammation, and oxidative stress. The objective of this study was to evaluate whether high levels of maternal exposure to heavy metals during the second trimester of pregnancy are associated with an increased risk of preeclampsia and eclampsia, using national health insurance claim data from South Korea. Methods: Data on mothers and their newborns from 2016 to 2020, provided by the National Health Insurance Service, were used (n = 1,274,671). Exposure data for ambient air pollutants (PM2.5, CO, SO₂, NO₂, and O₃) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during the second trimester of pregnancy were retrieved from the Korea Environment Corporation. Atmospheric condition data based on the mother’s registration area were matched. A logistic regression model was adjusted for maternal age, infant sex, season of conception, and household income. Results: In total, 16,920 cases of preeclampsia and 592 cases of eclampsia were identified. In the multivariate model, copper exposure remained significantly associated with an increased risk of preeclampsia (odds ratio: 1.011; 95% confidence interval: 1.001–1.023), and higher ozone exposure during pregnancy was associated with an elevated risk of eclampsia. Conclusions: Increased copper exposure during the second trimester of pregnancy was associated with a high incidence of preeclampsia. Full article

Background/Objective: Nurses play a critical role in addressing climate change. They are instrumental in both mitigation and adaptation to its effects. Through care provision, education, management, policy development, and research, nurses can undertake a variety of specific actions in response to climate change. However, their perceptions of this challenge remain under-researched. This study aims to investigate Spanish nurses’ knowledge of climate change and its impact on health. Methods: This is a qualitative descriptive study based on the constructivist paradigm. Purposive and snowball sampling strategies were used to recruit nurses from emergency services, geriatrics, cardiology, respiratory medicine and primary care in nine different regions of Spain. Semi-structured online interviews were conducted. Data analysis was carried out by three researchers via a three-stage inductive thematic analysis approach. Results: The sample consisted of 31 nurses, predominantly women (77.42%), with a mean age of 41 years. Seventy percent of the participants had less than 15 years of experience in the service. Four categories were identified: (i) general knowledge of climate change; (ii) knowledge of climate change and health; (iii) knowledge of actions to address climate change; and (iv) knowledge development. Overall, the nurses demonstrated awareness of the risks posed by climate change as well as actions to respond. However, barriers such as a lack of formal training and eco-anxiety affect their knowledge acquisition. Conclusions: Nurses play an important role in the response to climate change. However, more comprehensive and higher-quality educational programmes, provided by academic institutions, workplaces, and professional associations, are needed. This study was prospectively registered with the Clinical Research Ethics Committee of the Cuenca Health Area on 25 January 2022 (registration number 2021/PI3721). Full article

Scandinavian erratic boulders in central Poland represent a significant element of the region’s geodiversity, fulfilling important natural, scientific, and cultural functions. As objects of high perceptual value, they integrate into the landscape and provide a wide range of geosystem services. The main objectives of research conducted in two areas of the Małopolska Upland are to determine the concentration of these boulders and identify the geosystem benefits they offer, with particular emphasis on lichen species inhabiting their surfaces. Research has confirmed the currently limited use of geosystem services provided by the 25 erratic boulders studied. However, this may change with growing ecological awareness among local communities, enabling a deeper appreciation of inanimate nature. Erratic boulders have the potential to attract geotourists and thus support economic development (by improving the residents’ quality of life), but this potential requires broader promotion. Although the Central Register of Geosites of Poland is an appropriate platform for their registration, none of the analysed boulders have yet been included. The research findings are also partly directed at local government units to help them recognise the value of erratic boulders for sustainable development, in line with existing legal frameworks and development strategies. The detailed characterisation of 25 boulders may inspire broader initiatives and foster knowledge transfer to support regional development through geotourism. The ability to identify the ecosystem benefits provided by erratic boulders is essential for maintaining ecological balance and sustaining natural processes. However, there is growing evidence of the systematic disappearance of erratic boulders from the landscape, which disrupts geosystem balance and leads to further environmental degradation, negatively affecting human well-being. In light of the lack of effective nature protection measures in the study area, it is proposed that some of these boulders be designated as geological protected features. Such a conservation approach could help maintain ecological balance in the designated area. Full article

Objectives: The global rise in dementia prevalence is escalating the socioeconomic burden, prompting efforts in prevention and treatment. This study aimed to evaluate the effects of an 8-week oral nutrition supplement (ONS) program with or without a multi-domain intervention program (MIP) in patients with mild cognitive impairment. Methods: Forty-nine patients with mild cognitive impairment were divided into three groups: (1) ONS (ONS), (2) ONS+MIP (ONS+MIP), and (3) control (CON). Korean-style dementia prevention MIP was used in the ONS+MIP group. Two packs of ONS per day were provided to the ONS group during the intervention period. Cognitive function, nutritional evaluation, body composition analysis, and physical performance were measured. The paired t-test and one-way analysis of variance were used for statistical analyses. Results: A final analysis was performed on the final 46 participants. After intervention, the cognitive function test (Repeatable Battery for the Assessment of Neuropsychological Status, RBANS) scores of the ONS+MIP group were significantly increased compared to the baseline scores. However, no significant changes were observed in the ONS and CON groups. Eating behavior and food quality also improved in the ONS+MIP group, with a significant difference among the three groups. There was no significant change in body composition in all groups; however, grip strength (left hand), muscular endurance, and the total SPPB score improved in the ONS+MIP group. The total SPPB score decreased in the CON group. Conclusions: Along with ONS intake, intensive education and continuous monitoring through multi-domain interventions are important to improve cognitive function. Trial registration: Clinical Research Information Service identifier: KCT0007253. Full article

This paper investigated sectoral water use and trends in the Mzimvubu to Tsitsikamma Water Management Area 7 (WMA7). The investigation considered the Water Authorisation and Registration Management System (WARMS) database and field surveys as a source of water use information. The study was able to successfully make use of time series statistical analysis to show water use trends for identified priority sectors over a 5-year period by sourcing historical water use data of the study area. Further, the groundwater stress index and streamflow impact were applied to assess water use impacts on the surface and groundwater. The WARMS database and field survey results identified major sectoral water users such as agriculture (irrigation), municipal water services, dam storage, afforestation, power generation, recreation, mining, and industries. Study findings revealed that the agricultural sector is a major water user, with an estimated 60% of the total water requirement over a 5-year period (2018 to 2022). The application of the groundwater stress index revealed that the majority of the Quaternary catchments have surplus groundwater available. The application of streamflow impact revealed that the majority of catchments have low flow or no flow. The rise of water use clearly indicates a lack of water use compliance and enforcement. An increase in total water use could put water resources under stress, including an impact on the aquatic ecosystem, reduced water quality, and economic and social consequences. Therefore, the study recommends that a follow-up on compliance of surface water and groundwater use licenses be regularly conducted. Full article

Background: Yemen faces significant challenges related to drug smuggling and counterfeiting, exacerbated by socio-economic hardships and a fragile healthcare and regulatory system. These conditions create an environment conducive to illicit drug trafficking. This study aims to explore the perspectives of healthcare employees working in drug-related departments in the Capital Sana’a, Yemen, focusing on the factors contributing to drug smuggling and the broader challenges within Yemen’s pharmaceutical sector. Methods: A cross-sectional study was conducted among health employees in drug-related departments in the Capital Sana’a. Data were collected through a self-administered questionnaire and analyzed using SPSS version 22.0. Descriptive and inferential statistical analyses were performed to examine group differences, including t-tests and ANOVA. A significance level of p < 0.05 was considered statistically significant. Results: The t-test indicated significant disagreement among participants (50.3%) regarding the existence of a comprehensive pharmaceutical policy (p < 0.001). High levels of agreement were observed on commonly smuggled drugs (74.7%) and the underlying reasons for drug smuggling and counterfeiting (76%, p < 0.001). A significant gender difference emerged regarding perceptions of the Supreme Board of Drugs’ role, with males scoring lower (mean = 2.86, SD = 0.81) than females (mean = 3.43, SD = 0.42, p = 0.002). However, ANOVA results showed no significant differences within or between groups based on educational qualifications, professional roles, or years of service concerning pharmaceutical policy, the Supreme Board of Drugs, registration requirements, or drug smuggling and counterfeiting (p > 0.05). Conclusions: This study highlights critical challenges in Yemen’s pharmaceutical sector, including systemic weaknesses, policy gaps, and the prevalence of drug smuggling, while emphasizing the pivotal role of health employees in addressing these issues. Strengthening their capacity through targeted interventions—such as training, awareness campaigns, robust regulatory frameworks, equitable enforcement, and enhanced stakeholder engagement—is essential. Given the cross-border nature of drug smuggling, these findings underscore the urgent need for strengthened international cooperation, harmonized regulatory policies, and intelligence-sharing mechanisms to combat illicit pharmaceutical trade. Addressing these challenges at both national and international levels is vital for ensuring drug safety, protecting public health, and mitigating the global impact of counterfeit and smuggled medicines. Full article

In the evolving landscape of healthcare, telemedicine has emerged as a transformative solution, effectively bridging gaps in medical service delivery across diverse geographic regions. Particularly in rural areas, where access to immediate and specialized care remains limited, store-and-forward telemedicine provides a powerful and practical approach. In rural emergency healthcare settings, resource limitations, specialist shortages, and unreliable connectivity frequently delay critical medical interventions. To address these challenges, this study proposes a store-and-forward telemedicine framework optimized through the use of queueing networks, aiming to enhance emergency response efficiency. The proposed model is structured as a four-node system comprising initial registration, consultation, diagnosis, and treatment. Each node operates as a service queue where patient data are sequentially collected, prioritized, and forwarded. By employing an open queueing network structure, the model devises steady-state probabilities for the number of patients at each node, facilitating a detailed performance analysis of patient flows. Symmetry plays a critical role in maintaining patient flow balance and system stability within the store-and-forward telemedicine model. When the routing probabilities between nodes are balanced, the queueing network exhibits probabilistic symmetry, ensuring consistent transition behavior. Moreover, the directed graph representation of the system demonstrates structural symmetry, reflecting identical service times at all nodes and uniform transition probabilities between nodes. Incorporating the concept of symmetry enables a simplified analytical approach, reduces computational complexity, and provides a more accurate approximation model for evaluating system performance. Full article

Purpose: to identify evidence on the effectiveness of web-based interventions for lifestyle modification among women or couples of reproductive ages wishing to conceive. Methods: A systematic search was conducted in February 2023 across CENTRAL, PubMed, Web of Science, Embase, Emcare, ClinicalTrials.gov, and WHO ICTRP. Data from four randomized controlled trials involving 1965 preconception women were narratively synthesized following risk of bias assessment. Interventions included a web-based conversational agent system, an email-based mobile service, and a mobile app providing lifestyle-related information. Results: Despite diverse assessment tools, benefits were observed for systolic blood pressure, serum folate levels, and physical activity. However, no significant effects were found for intake of vegetables and fruit, folic acid supplementation, smoking, alcohol consumption, waist circumference, weight, BMI, overweight status, HbA1c, total cholesterol, HDL, stress, depression, anxiety, or pregnancy outcomes. Conclusions: Web-based interventions show potential in improving certain health behaviors among preconception women. Further high-quality studies are needed to assess their effectiveness on a broader range of outcomes, including dietary habits, physical activity, and substance use, and to inform their integration into preconception care strategies. Registration: We registered the study protocol with PROSPERO (CRD42023488277). Full article

This study aimed to evaluate the effects of no tail docking on the performance, health, and behavior of piglets raised under commercial conditions in Brazil. The study included 768 weaned piglets from the Pietrain synthetic line, randomly divided into two groups: DT = the final third part of the tail-docked (n = 384) and NTD = non-tail-docked (n = 384). Tail docking was performed on day two using an electrocautery clipper for piglets from the DT group, and both groups were subjected to standard environmental enrichment with branched chains. In cases of tail biting, a contingency plan was adopted to mitigate this problem by enriching the pen with a sisal rope. Behavioral measurements were performed using scan sampling. Tail biting, reactivity to humans, and health were assessed using a methodology adapted from the Welfare Quality Protocol^®. The piglets were weighed at 140 days of age and inspected according to the parameters established by the Pig Genealogical Registration Service to be used as reproduction animals. The off-test rate was calculated based on the total number of piglets approved for animal use relative to the total number evaluated. During the nursery stage, the NDT piglets showed a trend toward significance (p = 0.07) toward a higher occurrence of tail biting than the DT piglets and exhibited a higher incidence of severe lesions. They also engaged more frequently (p < 0.05) in exploratory behavior, interacting with branched chains and sisal rope, than the DT piglets. During the finishing phase, tail biting was observed only in the NDT piglets (p = 0.001). The NDT piglets that did not require the contingency plan exhibited lower fear responses (p = 0.02) during human interactions in the nursery phase than the DT piglets. Conversely, the NDT piglets that required a contingency plan showed higher fear levels (p < 0.001). Productivity performance was not affected (p > 0.05), and new cases of tail biting ceased after the contingency plan was implemented. The number of animals that died or were removed did not differ between the treatments (p > 0.05). In conclusion, managing piglets with intact tails on commercial farms presents a significant welfare challenge. By contrast, docking the final third of the tail, in accordance with regulations, was associated with fewer negative welfare outcomes, even when best management practices were applied. Full article

Background: Stress affects 45% of NHS staff. More research is needed to explore how to develop resilient mental health nurses who face multiple workplace stressors, including interacting with distressed clients. Higher Education Institutions are uniquely placed to introduce coping skills that help reduce anxiety and increase confidence for pre-registration nurses entering placements for the first time. Methods: A convenience sample of first year mental health student nurses (whole cohort), recruited before their first clinical placement, were invited to participate. Following a mixed methods design, we developed a 360-degree virtual reality (VR) video, depicting a distressed service user across three scenes, filmed in a real-life decommissioned in-patient ward. Participants followed the service user through the scenes, as though in real life. We used the video alongside a cognitive reappraisal/solution-focused/VERA worksheet and supportive clinical supervision technique to explore students’ experiences of VR as an educative tool and to help build emotional coping skills. Results: N = 21 mental health student nurses were recruited to the study. Behavioural responses to the distressed patient scenario were varied. Students that had prior experience in health work were more likely to feel detached from the distress of the service user. Although for some students VR provided a meaningful learning experience in developing emotional awareness, other students felt more like a ‘fly on the wall’ than an active participant. Empathetic and compassionate responses were strongest in those who perceived a strong immersive effect. Overall, the supportive supervision appeared to decrease the anxiety of the small sample involved, but confidence was not affected. Conclusion: The use of 360-degree VR technology as an educative, classroom-based tool to moderate anxiety and build confidence in pre-placement mental health nursing students was partially supported by this study. The effectiveness of such technology appeared to be dependent on the degree to which ‘immersion’ and a sense of presence were experienced by students. Our cognitive reappraisal intervention proved useful in reducing anxiety caused by ‘the patient in distress scenario’ but only for students who achieved a deep immersive effect. Students with prior exposure to distressing events (in their personal lives and in clinical settings) might have developed other coping mechanisms (e.g., detachment). These findings support the idea that ‘presence’ is a subjective VR experience and can vary among users. Full article

Pose estimation plays a crucial role in on-orbit servicing technologies. Currently, point cloud registration-based pose estimation methods for noncooperative spacecraft still face the issue of misalignment due to similar point cloud structural features. This paper proposes a pose estimation approach for noncooperative spacecraft based on the point cloud and optical image feature collaboration, inspired by methods such as Oriented FAST and Rotated BRIEF (ORB) and Robust Point Matching (RPM). The method integrates ORB feature descriptors with point cloud feature descriptors, aiming to reduce point cloud mismatches under the guidance of a transformer mechanism, thereby improving pose estimation accuracy. We conducted simulation experiments using the constructed dataset. Comparison with existing methods shows that the proposed approach improves pose estimation accuracy, achieving a rotation error of 0.84° and a translation error of 0.022 m on the validation set. Robustness analysis reveals the method’s stability boundaries within a 30-frame interval. Ablation studies validate the effectiveness of both ORB features and the transformer layer. Finally, we established a ground test platform, and the experimental data results validated the proposed method’s practical value. Full article

Background: Psychological problems post-stroke are common and debilitating, yet insufficient evidence-based psychological support exists for stroke survivors, either in stroke or general mental health services. Many stroke survivors with significant needs remain unsupported. To address this problem, we need pathways to identify, treat and manage psychological difficulties after stroke. The Accelerating Delivery of Psychological Therapies after Stroke (ADOPTS) study aimed to explore the feasibility of collaboratively developing, implementing and evaluating intervention packages (IPs) to facilitate access to, and increase the provision of, psychological support post-stroke. Methods: Stakeholder groups were formed across four sites in north-west England, comprising stroke and psychological services, to collaboratively develop site-specific IPs incorporating a psychological care pathway, staff training, a staff manual for stroke-specific psychological support and supervision. A feasibility stepped-wedge cluster randomised trial recruited patients admitted with stroke during the usual care (pre-implementation of the IP) and intervention (post-implementation) periods. The feasibility of IP implementation and their potential usefulness were evaluated through assessing wellbeing and the support received, and through a process evaluation incorporating interviews with staff, patients and carers. Feasibility evaluation included the recruitment rate and attrition rate; exploratory analysis (mixed-effects linear or logistic regression models) was used to assess the ‘promise’ of the intervention in achieving psychological distress outcomes (mood (PHQ-9), anxiety (GAD-7)), assessed using validated measures at 6 weeks and 6 months. Results: IPs were collaboratively developed at each site but implementation took longer than the per-study-protocol duration of three months. Nineteen training sessions (152 attendees) were delivered for nursing, therapy, NHS Talking Therapies and voluntary staff. Nursing staff were underrepresented due to difficulties with releasing staff. Manuals were developed for each site, incorporating a mood screening and referral algorithm, but these were not finalised at one site. Stroke and NHS Talking Therapies champions were identified in each site to facilitate cross-service staff supervision. A total of 270 patients were recruited over 14 months (133 usual care, 137 intervention), with 227 and 198 at 6 weeks and 6 months, respectively. Stroke staff found the training, manual and pathway helpful, and reported greater confidence in managing and referring psychological issues. NHS Talking Therapies staff found the training useful for adapting their therapy. However, the intervention took longer to implement in all sites, requiring an additional time period to be added to the stepped-wedge design. Conclusions: It is feasible to collaboratively develop and implement IPs for post-stroke psychological support. However, an alternative to the stepped-wedge design used here would be more appropriate for a future study. This study was registered in ISRCTN—the UK’s Clinical Study Registry (trial registration: ISRCTN12868810, registration date: 4 February 2016). Full article