Search Results (93)

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients’ quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer. Full article

Secure authentication in vehicular ad hoc networks (VANETs) remains a fundamental challenge due to their dynamic topology, susceptibility to attacks, and scalability constraints in multi-hop communication. Existing approaches based on elliptic curve cryptography (ECC), blockchain, and fog computing have achieved partial success but suffer from latency, resource overhead, and limited adaptability, leaving a gap for lightweight and hardware-rooted trust models. To address this, we propose a multi-hop mutual authentication protocol leveraging Physical Unclonable Functions (PUFs), which provide tamper-evident, device-specific responses for cryptographic key generation. Our design introduces a structured sequence of phases, including pre-deployment, registration, login, authentication, key establishment, and session maintenance, with optional multi-hop extension through relay vehicles. Unlike prior schemes, our protocol integrates fuzzy extractors for error tolerance, employs both inductive and game-based proofs for security guarantees, and maps BAN-logic reasoning to specific attack resistances, ensuring robustness against replay, impersonation, and man-in-the-middle attacks. The protocol achieves mutual trust between vehicles and RSUs while preserving anonymity via temporary identifiers and achieving forward secrecy through non-reused CRPs. Conceptual comparison with state-of-the-art PUF-based and non-PUF schemes highlights the potential for reduced latency, lower communication overhead, and improved scalability via cloud-assisted CRP lifecycle management, while pointing to the need for future empirical validation through simulation and prototyping. This work not only provides a secure and efficient solution for VANET authentication but also advances the field by offering the first integrated taxonomy-driven evaluation of PUF-enabled V2X protocols in multi-hop Wi-Fi environments. Full article

In this paper, we have proposed a two-party authenticated key establishment (AKE), and authenticated key transport protocols based on lattice-based cryptography, aiming to provide security against quantum attacks for secure communication. This protocol enables two parties, who may share long-term public keys, to securely establish a shared session key, and transportation of the session key from the server while achieving mutual authentication. Our construction leverages the hardness of lattice problems Ring Learning With Errors (Ring-LWE), ensuring robustness against quantum and classical adversaries. Unlike traditional schemes whose security depends upon number-theoretic assumptions being vulnerable to quantum attacks, our protocol ensures security in the post-quantum era. The proposed protocol ensures forward secrecy, and provides security even if the long-term key is compromised. This protocol also provides essential property key freshness and resistance against man-in-the-middle attacks, impersonation attacks, replay attacks, and key mismatch attacks. On the other hand, the proposed key transport protocol provides essential property key freshness, anonymity, and resistance against man-in-the-middle attacks, impersonation attacks, replay attacks, and key mismatch attacks. A two-party key transport protocol is a cryptographic protocol in which one party (typically a trusted key distribution center or sender) securely generates and sends a session key to another party. Unlike key exchange protocols (where both parties contribute to key generation), key transport protocols rely on one party to generate the key and deliver it securely. The protocol possesses a minimum number of exchanged messages and can reduce the number of communication rounds to help minimize the communication overhead. Full article

Bluetongue virus serotype 3 (BTV-3) emerged in northwestern Europe in 2023–2024, raising concerns about its potential reproductive impact on rams, similar to previous outbreaks with BTV-8. This study assessed the effect of natural BTV-3 infection on the semen quality of 49 rams in Belgium using two cross-sectional sampling sessions during the 2024 outbreak. Semen and blood were tested for BTV RNA via RT-qPCR, and a composite semen quality score (SQS) was established based on key sperm parameters. On the first sampling date, 75% of rams were viremic, and 19% presented azoospermia. Rams with BTV RNA detectable in both semen and blood had significantly lower SQS and sperm concentrations than those with viral RNA in blood only or none at all. By the second sampling, 53 days later, semen quality had improved markedly, indicating a transient effect of infection. These findings confirm that BTV-3 can severely but temporarily impair ram fertility, particularly when viral replication occurs in the reproductive tract. Given the seasonal overlap between vector activity and breeding programs, these results underscore the importance of integrating reproductive health monitoring into outbreak response strategies. Full article

Objectives: Plyometric training is a well-established method for enhancing jump performance in basketball and volleyball athletes but has certain limitations. Kettlebell training may provide a viable alternative as it mimics key biomechanical aspects of jumping, like explosive hip and knee extension during a ballistic hip–hinge pattern. Because evidence remains limited, this study aimed to compare the effects of both training methods. Methods: Thirty-eight volleyball and basketball club athletes (age: 22 (4.3); male = 29, female = 9) completed this study. Countermovement jump (CMJ), squat jump (SJ), drop jump (DJ), body fat percentage (FM), and muscle mass percentage (MM) were assessed pre- and post-intervention. The participants were assigned to one of three groups: a kettlebell training group (KbG), a plyometric training group (PG), or a control group (CG). Both the KbG and PG completed two supervised 25-min training sessions per week for six weeks, while the CG did not engage in any additional training intervention. The level of significance was set at p ≤ 0.05. Results: There were no significant differences in CMJ, SJ, and DJ performance between the groups before the intervention. Significant differences in change between the groups from pre- to post-test were found for the SJ (p = 0.006), but not for the DJ (p = 0.06), CMJ (p = 0.26), FM (p = 0.9), and MM (p = 0.55). Pairwise comparisons revealed significantly greater positive change in the KbG than in the CG for the SJ (p = 0.003) and DJ (p = 0.03). Within-group analyses showed significant improvements in the KbG for the CMJ (p = 0.04), SJ (p < 0.001), and DJ (p = 0.003) performance, whereas FM and MM did not change. Within the PG and CG, no significant change occurred. Conclusions: Kettlebell training effectively improved jump performance and may therefore serve as a valuable component within strength and conditioning programs for basketball and volleyball athletes. Full article

Background: Robotic liver surgery is emerging as a key advancement in minimally invasive techniques, though it still faces several challenges. Meanwhile, colorectal cancer (CRC) continues to be a leading cause of cancer deaths, with liver metastases affecting 25–30% of patients. These metastases significantly burden healthcare systems by raising costs and resource demands. Methods: A narrative literature review was performed, resulting in the inclusion of 14 studies in our analysis. Fourteen studies met the inclusion criteria and were analyzed with attention to patient characteristics, surgical details, perioperative outcomes, and reporting limitations. For consistency, simultaneous robotic-assisted resection (RAR) refers to cases in which the colorectal primary and liver metastasectomy were performed during the same operative session. Results: The 14 studies included a total of 771 patients (520 males and 251 females), aged between 31 and 88, undergoing simultaneous robotic-assisted resection (RAR). Most were affected by rectal cancer (76%) and unilobar liver metastases (82%). All surgeries using the DaVinci system are represented by 62% wedge resection and 38% anatomical (21.39% major and 16.61% minor). Patients’ BMI ranged from 19.5 to 40.4 kg/m², the average blood loss was 181.5 mL (30–780), the median hospital stay was 7 days (range 2–28), and the mean operative time ranged from 30 to 682 min. Data on POLF (postoperative liver failure) are reported in two studies: Rocca et al., 1/90 patients; Marino et al., 1/40 patients. Biliary leak is reported in one case by Marino et al., while Winckelmans et al. reported a 2.6% incidence of biliary leak in the laparoscopic group and 3.4% in the robotic group. Conclusions: As research advances and new therapies emerge for colorectal liver metastasis (CRLM), surgery remains the mainstay of treatment. However, evidence is limited by small sample sizes, heterogeneous study designs, inconsistent reporting of perioperative chemotherapy, timing of surgery, metastasis localization, and complications. Robotic liver surgery has become a well-established technique and possibly represents the future for managing colorectal liver metastases. Further prospective and comparative studies with standardized outcome reporting are needed to define optimal patient selection and long-term effectiveness. Full article

The integration of AI-powered plush robots in educational and therapeutic settings for children with Autism Spectrum Disorders (ASD) necessitates a robust interdisciplinary methodology to evaluate usability, psychological impact, and therapeutic efficacy. This study proposes and applies a four-phase research framework designed to guide the development and assessment of AI-powered plush robots for social rehabilitation and education. Phase 1 involved semi-structured interviews with 13 ASD specialists to explore robot applications. Phase 2 tested initial usability with typically developing children (N = 10–15) through structured sessions. Phase 3 involved structured interaction sessions with children diagnosed with ASD (N = 6–8) to observe the robot’s potential for rehabilitation, observed by specialists and recorded on video. Finally, Phase 4 synthesized data via multidisciplinary triangulation. Results highlighted the importance of iterative, stakeholder-informed design, with experts emphasizing visual properties (color, texture), psychosocial aspects, and adjustable functions. The study identified key technical and psychological evaluation criteria, including engagement, emotional safety, and developmental alignment with ASD intervention models. Findings underscore the value of qualitative methodologies and phased testing in developing child-centered robotic tools. The research establishes a robust methodological framework and provides preliminary evidence for the potential of AI-powered plush robots to support personalized, ethically grounded interventions for children with ASD, though their therapeutic efficacy requires further longitudinal validation. This methodology bridges engineering innovation with psychological rigor, offering a template for future assistive technology research by prioritizing a rigorous, stakeholder-centered design process. Full article

In recent years, fog-based vehicular ad hoc networks (VANETs) have become a hot research topic. Due to the inherent insecurity of open wireless channels between vehicles and fog nodes, establishing session keys through authenticated key agreement (AKA) protocols is critically important for securing communications. However, existing AKA schemes face several critical challenges: (1) When a large number of vehicles initiate AKA requests within a short time window, existing schemes that process requests one by one individually incur severe signaling congestion, resulting in significant quality of service degradation. (2) Many AKA schemes incur excessive computational and communication overheads due to the adoption of computationally intensive cryptographic primitives (e.g., bilinear pairings and scalar multiplications on elliptic curve groups) and unreasonable design choices, making them unsuitable for the low-latency requirements of VANETs. To address these issues, we propose a lightweight batch AKA scheme based on fog computing. In our scheme, when a group of vehicles requests AKA sessions with the same fog node within the set time interval, the fog node aggregates these requests and, with assistance from the traffic control center, establishes session keys for all vehicles by a round of operations. It has significantly reduced the operational complexity of the entire system. Moreover, our scheme employs Lagrange interpolation and lightweight cryptographic tools, thereby significantly reducing both computational and communication overheads. Additionally, our scheme supports conditional privacy preservation and includes a revocation mechanism for malicious vehicles. Security analysis demonstrates that the proposed scheme meets the security and privacy requirements of VANETs. Performance evaluation indicates that our scheme outperforms existing state-of-the-art solutions in terms of efficiency. Full article

Introduction: Substance use disorders (SUDs) pose a significant public health challenge, with current treatments often exhibiting limited effectiveness and high relapse rates. Transcranial direct current stimulation (tDCS), a noninvasive neuromodulation technique that delivers low-intensity direct current via scalp electrodes, has shown promise in various psychiatric and neurological conditions. In SUDs, tDCS may help to modulate key neurocircuits involved in craving, executive control, and reward processing, potentially mitigating compulsive drug use. However, the precise neurobiological mechanisms by which tDCS exerts its therapeutic effects in SUDs remain only partly understood. This review addresses that gap by synthesizing evidence from clinical studies that used neuroimaging (fMRI, fNIRS, EEG) and blood-based biomarkers to elucidate tDCS’s mechanisms in treating SUDs. Methods: A targeted literature search identified articles published between 2008 and 2024 investigating tDCS interventions in alcohol, nicotine, opioid, and stimulant use disorders, focusing specifically on physiological and neurobiological assessments rather than purely behavioral outcomes. Studies were included if they employed either neuroimaging (fMRI, fNIRS, EEG) or blood tests (neurotrophic and neuroinflammatory markers) to investigate changes induced by single- or multi-session tDCS. Two reviewers screened titles/abstracts, conducted full-text assessments, and extracted key data on participant characteristics, tDCS protocols, neurobiological measures, and clinical outcomes. Results: Twenty-seven studies met the inclusion criteria. Across fMRI studies, tDCS—especially targeting the dorsolateral prefrontal cortex—consistently modulated large-scale network activity and connectivity in the default mode, salience, and executive control networks. Many of these changes correlated with subjective craving, attentional bias, or extended time to relapse. EEG-based investigations found that tDCS can alter event-related potentials (e.g., P3, N2, LPP) linked to inhibitory control and salience processing, often preceding or accompanying changes in craving. One fNIRS study revealed enhanced connectivity in prefrontal regions under active tDCS. At the same time, two blood-based investigations reported the partial normalization of neurotrophic (BDNF) and proinflammatory markers (TNF-α, IL-6) in participants receiving tDCS. Multi-session protocols were more apt to drive clinically meaningful neuroplastic changes than single-session interventions. Conclusions: Although significant questions remain regarding optimal stimulation parameters, sample heterogeneity, and the translation of acute neural shifts into lasting behavioral benefits, this research confirms that tDCS can induce detectable neurobiological effects in SUD populations. By reshaping activity across prefrontal and reward-related circuits, modulating electrophysiological indices, and altering relevant biomarkers, tDCS holds promise as a viable, mechanism-based adjunctive therapy for SUDs. Rigorous, large-scale studies with longer follow-up durations and attention to individual differences will be essential to establish how best to harness these neuromodulatory effects for durable clinical outcomes. Full article

Background/Objectives: The beneficial effects of physical activity on mental health and well-being are well established. The integration of physical activity into psychotherapeutic treatment for mental health difficulty holds promise as an avenue to reduce symptoms and support well-being. Mental health clinicians have previously indicated an interest in the use of physical activity in treatment, but it is unclear to what extent physical activity interventions are implemented in clinical mental health care. The present study aimed to understand mental health clinicians’ practices related to physical activity, as well as to investigate their related training and knowledge. Methods: Semi-structured interviews were conducted with mental health clinicians, including registered psychologists, psychotherapists, and social workers. Inductive content analysis was performed to identify key themes related to practices, training experiences, and training interests. Results: Clinicians reported making recommendations for physical activity and using a range of in-session strategies to include physical activity in mental health treatment. Clinicians reported that their knowledge and training about physical activity was obtained primarily from informal sources. Clinicians indicated an interest in further training, with an emphasis on practical strategies. Conclusions: Mental health clinicians demonstrated an interest in the use of physical activity as part of psychotherapeutic treatment. Some clinicians routinely integrate physical activity into treatment, while others express a need for further training in this area. Full article

Background/Objectives: Clinical simulation-based training has become established as an effective strategy to improve healthcare quality and patient safety. This pre–post observational study presents an innovative experience implemented at the Catalan Health Institute (ICS) through the evaluation of a training intervention based on Simulated Clinical Stations in Quality and Patient Safety. The main objective is to improve the competencies of Primary Care Teams (PCT) professionals in managing critical and urgent situations and to assess the impact of the intervention on knowledge and satisfaction using an immersive methodology based in active practice. Methods: More than 8.916 professionals participated in 285 training sessions at the Balmes Primary Care Center (CAP Balmes) simulation center (Barcelona). Knowledge data were collected before and after the training, along with satisfaction levels, showing significant improvement. Results: The analyses show a significant improvement in the knowledge acquired and a high level of participant satisfaction, reinforcing the value of clinical simulation as a key training tool. Conclusions: The study reinforces clinical simulation as an essential, scalable, and adaptable educational tool across different healthcare settings, establishing itself as a key resource for the continuous training of healthcare professionals. Full article

The accelerated uptake of unmanned aerial vehicles (UAVs) has significantly altered communication and data exchange landscapes but has also introduced substantial security challenges, especially in open-access UAV communication environments. To address these, Elliptic curve cryptography (ECC) offers robust security with computational efficiency, ideal for resource-constrained Internet of Drones (IoD) systems. This study proposes a Secure and Efficient Three-Way Key Exchange (SETKE) protocol using ECC, specifically tailored for IoD. The SETKE protocol’s security was rigorously analyzed within an extended Bellare–Pointcheval–Rogaway (BPR) model under the random oracle assumption, demonstrating its resilience. Formal verification using the AVISPA tool confirmed the protocol’s safety against man-in-the-middle (MITM) attacks, and formal proofs establish its Authenticated Key Exchange (AKE) security. In terms of performance, SETKE is highly efficient, requiring only 3 ECC scalar multiplications for the Service Requester drone, 4 for the Service Provider drone, and 3 for the Control Server, which is demonstrably lower than several existing schemes. My approach achieves this robust protection with minimal communication overhead (e.g., a maximum payload of 844 bits per session), ensuring its practicality for resource-limited IoD environments. The significance of this work for the IoD field lies in providing a provably secure, lightweight, and computationally efficient key exchange mechanism vital for addressing critical security challenges in IoD systems. Full article

As the adoption of integrated project delivery (IPD) progresses, increasing evidence has highlighted its potential to improve project outcomes. However, as an emerging practice, there remains a lack of structured mechanisms to evaluate the maturity of its implementation, which can limit opportunities for learning and improvement. Therefore, this study introduces an IPD Capability Maturity Model (IPDCMM) to evaluate the maturity of IPD implementation at the project level. This model enables organizations to benchmark their IPD capabilities against established best practices, facilitating structured development and continuous improvement. This model is designed as a post-project assessment tool that evaluates the maturity of IPD practice upon project completion, providing critical insights for learning and future project enhancements. The methodology, underpinned by a pragmatic philosophy and guided by the principles of design science research (DSR), prioritizes achieving practical outcomes (artifact). It combines insights from IPD frameworks, maturity models from other fields, and three case studies. The IPDCMM was developed alongside the IPD Maturity Assessment Tool (IPD-MAT), an artifact validated via evaluation sessions and feedback interviews with key stakeholders of IPD case studies. This model provides a structured framework for assessing IPD implementation maturity and facilitates a pathway for enhancing IPD practices and achieving efficiency in project delivery. Full article

(1) Background: University students’ mental health (MH) is in crisis due to academic stress, lack of physical activity (PA), and low self-esteem. This study evaluated a 12-week PA and meditation intervention to enhance psychological well-being in Spanish university students. (2) Methods: A quasi-experimental design was used, with a non-randomized control group and pretest-posttest assessments. The study lasted 14 weeks (12 weeks of intervention and two for evaluations). Initially, 149 students were recruited, but the final sample included 136 (82 intervention, 54 control) due to attrition. Participants were selected through convenience sampling, respecting university-established groups. The intervention consisted of six PA sessions (aerobic, cardiovascular, and strength exercises) and six meditation sessions (yoga and mindfulness). Validated questionnaires assessed resilience, psychological distress, self-esteem, mood, personality traits, sedentary behavior, PA levels, and sleep duration. (3) Results: Significant improvements were found in resilience (p < 0.001), depression (p < 0.01), and sleep duration (p < 0.05), with greater mood benefits in men. No major changes were observed in other variables. (4) Conclusions: PA- and meditation-based interventions can improve students’ MH, particularly in key psychological aspects. Further research should explore long-term effects and refine strategies by distinguishing between preventive and therapeutic approaches. Full article

The rapid expansion of the IoT has led to increasing concerns about security, particularly in the early stages of communication where many IoT application-layer protocols, such as CoAP and MQTT, lack native support for secure key exchange. This absence exposes IoT systems to critical vulnerabilities, including dictionary attacks, session hijacking, and MitM threats, especially in resource-constrained environments. To address this challenge, this paper proposes the integration of OWL, a password-authenticated key exchange (PAKE) protocol, into existing IoT communication frameworks. OWL introduces a lightweight and secure mechanism for establishing high-entropy session keys from low-entropy credentials, without reliance on complex certificate infrastructures. Its one-round exchange model and resistance to both passive and active attacks make it particularly well-suited for constrained devices and dynamic network topologies. The originality of the proposal lies in embedding OWL directly into protocols like CoAP, enabling secure session establishment as a native feature rather than as an auxiliary security layer. Experimental results and formal analysis indicate that OWL achieves reduced authentication latency and lower computational overhead, while enhancing scalability, resilience, and protocol performance. The proposed solution provides an innovative, practical, and efficient framework for securing IoT communications from the foundational protocol level. Full article