Search Results (59,473)

The CPace protocol (Internet-Draft:draft-irtf-cfrg-cpace-14) is a password-authenticated key exchange optimized for simplicity. In particular, it involves only two messages exchanged in an arbitrary order. CPace combines a simple and elegant design with privacy guarantees obtained via strict mathematical proofs. In this paper, we go further and analyze its resilience against malicious cryptography implementations. While the clever design of CPace immediately eliminates many kleptographic techniques applicable to many other protocols of this kind, we point to the remaining risks related to kleptographic setups. We show that such attacks can break the security and privacy features of CPace. Thereby, we point to the necessity of very careful certification of the devices running CPace, focusing in particular on critical threats related to random number generators. Full article

Background: Vancomycin-resistant Enterococcus faecium (VREfm), particularly vanA-positive strains, represents a growing threat in hospital settings worldwide. These bacteria are able to survive under severe environmental conditions, including high temperatures and saline concentrations. High genome plasticity and advanced ability of inheriting antimicrobial resistance determinants defined the success of E. faecium as a hospital pathogen. Methods: This study presents the whole genomic characterization of vanA-positive VREfm isolates, analyzing 10 clinical isolates collected from three tertiary care hospitals in Moscow, Russia. Several typing approaches, including two MLST schemes and cgMLST profiles, were used to elucidate the relationship between the isolates. Phylogenetic analysis placed the isolates in context with global VREfm populations, demonstrating both local clonal expansion and possible international connections. Phenotypic and genomic antimicrobial resistance profiles were obtained, as well as data regarding the repertoire of virulence factors and plasmid content. Results: Whole genome sequencing revealed that all isolates belonged to the clinically significant CC17 lineage, specifically sequence types ST80 and ST552. Notably, two isolates possessed truncated Tn1546-type transposons lacking vanY and vanZ genes, representing a potentially emerging variant of the vanA operon in Russian clinical settings. A plasmid carrying a truncated vanA operon was reconstructed using long-read sequencing. Conclusions: The study highlights the utility of genomic investigation for tracking resistance mechanisms and strain dissemination, providing crucial baseline data for epidemiological surveillance of infections caused by VREfm in Russia. These findings emphasize the need for continued genomic monitoring to understand the evolution and spread of antimicrobial resistance in clinically important enterococcal lineages. Full article

Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs. Full article

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on adequately conducted OAT, the so-called resistant stroke (RS). We aimed to describe pre-stroke prevention therapy, management on hospital discharge, and therapy at follow-up in all patients with AF hospitalized for IS and in the RS subgroup. Methods: We conducted a retrospective monocentric study of patients with known AF hospitalized for an IS. A subgroup with RS was identified. We recorded information on prevention therapy at home, recommended therapy at discharge, and data on outcome and prevention therapy at follow-up. Results: We identified 226 patients, 61% females, median age 84.04 years. Preventive therapy at home was performed in 121 (53.5%) (119 OAT and 2 Left Atrial Appendage Occlusion). At hospital discharge OAT was prescribed to 78.2% of patients. RS was diagnosed in 33 patients whose management at discharge was: same OAT in 12, shift to another Direct Oral Anticoauglant (DOAC) in 5, from DOAC to Vitamin K Antagonist (VKA) and vice versa in 11, non-specified OAT in 4. At final, follow-up of 208 days (range 85–443) 23.3% (34/146) did not assume OAT. OAT was significantly associated with survival probability (p < 0.001). Conclusions: Our findings confirm a scarce adoption of guidelines for AF-related embolic events, even in the absence of absolute contraindication to OAT. RS remains an underexplored clinical entity with empirical management, highlighting the need for targeted research and tailored therapeutic strategies. Full article

The production of alumina produces red mud (RM), a highly alkaline solid waste. The majority of it is disposed of in landfills, which seriously pollutes the environment. It needs to be recycled and handled with care to protect the environment. RM is a promising raw material for wastewater and waste gas treatment owing to its high alkalinity and abundant metal compounds. It can efficiently remove diverse pollutants while facilitating large-scale utilization of RM resources. Reviews of the use of RM resources to create catalysts for environmental governance are, nevertheless, scarce. Therefore, this paper analyzes and summarizes the pertinent research on RM-based catalysts to remove pollutants from the environment based on journal literature related to RM resource utilization from 2015 to 2025. This study reviews the application of RM-based catalysts for degrading pollutants in wastewater and exhaust gases via advanced oxidation processes (AOPs)—including photocatalysis, Fenton-like catalysis, ozonation catalysis, and persulfate catalysis—as well as catalytic oxidation, chemical looping combustion (CLC), and selective catalytic reduction (SCR). The paper emphasizes the analysis of modification strategies and catalytic mechanisms of RM-based catalysts in environmental remediation and examines the environmental risks and corresponding mitigation measures related to their preparation from RM resources. Finally, it outlines that future research should prioritize green, low-energy modification processes; catalytic systems for the synergistic removal of multiple pollutants; and efficient, recyclable separation and recovery technologies. These directions aim to promote the sustainable application of RM in large-scale environmental remediation and to achieve the integrated advancement of resource utilization and ecological protection. Full article

Background/Objectives: Oral health plays a crucial role in the physical, emotional, and social well-being of children. Data from 2019 indicate that oral diseases remain a major concern in the Italian paediatric population, affecting not only children’s health but also caregivers’ well-being. This study aimed to assess the importance attributed by Italian families to their children’s oral health and correlate parents’ perceptions with children’s actual oral health status. Methods: A total of 131 children aged 0–12 years, admitted to the IRCCS Giannina Gaslini Children’s Hospital (Genoa, Italy) for reasons other than dental problems, were enroled between January 1 and December 31, 2024. Parents completed validated questionnaires (ECOHIS or PCPQ + FIS) based on their child’s age, along with supplementary questions on socio-demographic background and dental history. Oral examination was performed to assess dmft/DMFT scores, the Index of Orthodontic Treatment Need (IOTN), and the Modified Gingival Index (MGI). Results: In younger children (0–5 years), oral health was generally good, but the presence of caries negatively impacted the family’s quality of life. Older children (6–12 years) showed higher rates of caries and gingival inflammation, affecting their daily functioning and emotional well-being. Poor oral health was more common among children of non-European backgrounds and those with lower parental education. Early dental visits, within the recommended 24 months of age, were rare. Conclusions: Despite clear international recommendations, early dental visits remain uncommon, and many children experience preventable oral health issues. These findings highlight the urgent need to improve caregiver education and public health strategies to promote early preventive dental care. Full article

Background: Breast cancer is the most common malignancy affecting women worldwide and continues to pose significant challenges despite progress in early detection and personalized therapies. While its pathogenesis has traditionally been associated with genetic, hormonal, and environmental factors, recent studies have highlighted the potential role of dysbiosis—an imbalance in gut and systemic microbiota—in breast cancer development and progression. This article aims to examine the mechanisms through which systemic dysbiosis may contribute to breast cancer risk and explore its therapeutic implications. Methods: This study seeks to analyze and compare the fecal microbiota profiles of breast cancer patients and healthy individuals from a single center in Craiova, Romania, in order to identify microbial signatures linked to breast cancer and BRCA mutation status. Special attention is given to the gut–liver axis and its influence on estrogen circulation, a key factor in hormone-sensitive breast cancers. Results: Evidence suggests that dysbiosis can influence breast cancer progression by promoting chronic inflammation, impairing immune regulation, and altering estrogen metabolism through the gut–liver axis. These effects may contribute to tumor development, immune evasion, and therapeutic resistance. Interventions aimed at restoring microbial balance show promise in preclinical studies for mitigating these effects. Conclusions: Systemic dysbiosis represents a potentially modifiable risk factor in breast cancer. Microbiota profiling may serve as a useful biomarker for risk stratification and therapeutic response. Future research into microbiome-based interventions could offer novel approaches for prevention and treatment in breast cancer care. Full article

Free water surface constructed wetlands can be effective systems for contaminant removal, but their performance is sensitive to interactions among flow dynamics, vegetation, and bed topography. This study presents a numerical investigation into how heterogeneous bed topographies influence hydraulic and contaminant transport behavior in a rectangular wetland. Topographies were generated using a correlated pseudo-random pattern generator, and flow and solute transport were simulated with a two-dimensional, depth-averaged model. Residence time distributions and contaminant removal efficiencies were analyzed as functions of the variance and correlation length of the bed elevation. Results indicate that increasing the variability of bed elevation leads to greater dispersion in residence times, reducing hydraulic efficiency. Moreover, as the variability of bed elevation increases, so does the spread in hydraulic performance among wetlands with the same statistical topographic parameters, indicating a growing sensitivity of flow behavior to the specific spatial configurations of bed features. Larger spatial correlation lengths were found to reduce the residence time variance, as shorter correlation lengths promoted complex flow structures with lateral dead zones and internal islands. Contaminant removal efficiency, evaluated under the assumption of uniform vegetation, was influenced by bed topography, with variations becoming more pronounced under conditions of lower vegetation density. The results underscore the significant impact of bed topography on hydraulic behavior and contaminant removal performance, highlighting the importance of careful topographic design to ensure high wetland efficiency. Full article

Background: Undergraduate nursing students (UNSs) often enter clinical training just as they are still mastering the emotional labor of the profession. In Nepal, where teaching hierarchies discourage upward dialogue and hospitals routinely struggle with overcrowding, supply shortages, and outward nurse migration, these learners confront a distinct, under-documented burden of psychological distress. Objective: This study examines how UNSs interpret, negotiate, and cope with the mental health challenges that arise at the intersection of cultural deference, resource scarcity, and migration-fueled uncertainty. Methods: A qualitative design employing reflexive thematic analysis (RTA), guided by the Reflexive Thematic Analysis Reporting Guidelines (RTARG), was used. Fifteen second-, third-, and fourth-year Bachelor of Science in Nursing students at a major urban tertiary institution in Nepal were purposively recruited via on-campus digital flyers and brief in-class announcements that directed students (by QR code) to a secure sign-up form. Participants then completed semi-structured interviews; audio files were transcribed verbatim and iteratively analyzed through an inductive, reflexive coding process to ensure methodological rigor. Results: Four themes portray a continuum from silenced struggle to systemic constraint. First, Shrouded Voices, Quiet Connections captures how students confide only in trusted peers, fearing that formal disclosure could be perceived as weakness or incompetence. Second, Performing Resilience: Masking Authentic Struggles describes the institutional narratives of “strong nurses” that drive students to suppress anxiety, adopting scripted positivity to satisfy assessment expectations. Third, Power, Hierarchy, and the Weight of Tradition reveals that strict authority gradients inhibit questions in classrooms and clinical placements, leaving stress unvoiced and unaddressed. Finally, Overshadowed by Systemic Realities shows how chronic understaffing, equipment shortages, and patient poverty compel students to prioritize patients’ hardships, normalizing self-neglect. Conclusions: Psychological distress among Nepalese UNSs is not an individual failing but a product of structural silence and resource poverty. Educators and policymakers must move beyond resilience-only rhetoric toward concrete reforms that dismantle punitive hierarchies, create confidential support avenues, and embed collaborative pedagogy. Institutional accountability—through regulated workloads, faculty-endorsed wellbeing forums, and systematic mentoring—can shift mental health care from a private struggle to a shared professional responsibility. Multi-site studies across low- and middle-income countries are now essential for testing such system-level interventions and building a globally resilient, compassionate nursing workforce. Full article

Cystinosis is a rare lysosomal storage disease characterised by cystine crystal formation within cells. In the eyes, crystals accumulate in the cornea causing photophobia, loss of visual acuity, and corneal complications. Strict adherence to topical cysteamine treatment is the only therapy that reduces corneal crystal accumulation. Cystinosis, a crystallopathy, is also a disease of inflammation. As the disease progresses the inflammatory processes have a greater impact on the ocular manifestations. The age at which inflammation becomes increasingly significant is dependent on the adequacy of early patient management and adherence with therapy. As patients are living longer with cystinosis, optimising ocular management is increasingly important. No clinical guidelines addressing the long-term ocular management of cystinosis exist. Similarly, there is little recognition in the literature of how to address the inflammatory component of the disease. This paper presents management guidelines, linked to the 3C Classification of severity, used at our centre that provides a framework for optimising care. Adoption of these can help preserve the sight of cystinosis patients. The paper also hypothesises the molecular pathway leading to corneal inflammation. Full article

Most sweet cherry varieties exhibit typical gametophytic self-incompatibility (GSI) characteristics, necessitating careful configuration of pollination trees to ensure adequate yields. This requirement increases the costs associated with orchard labor, management, and other related expenses. Consequently, cultivating and developing sweet cherry cultivars with self-compatibility can effectively address these challenges. Research into the molecular mechanisms underlying GSI formation can provide vital theoretical support and genetic resources for breeding self-compatible sweet cherries. In this study, we assessed the fruit set rates of ‘Tieton’ following both self- and cross-pollination. Additionally, we conducted a transcriptome analysis of the ‘Tieton’ style (which includes the stigma) at 0, 12, 24, and 48 h post-pollination to identify key genes involved in the self-incompatibility process of sweet cherries. The results indicated that the self-fruiting rate of ‘Tieton’ was significantly lower than that of cross-pollination. We identified a total of 8148 differentially expressed genes (DEGs) through transcriptome analysis, with KEGG pathway analysis revealing that the plant-pathogen interaction, plant hormone signal transduction, and plant MAPK signaling pathways were primarily involved in sweet cherry GSI. Furthermore, we identified 13 core transcription factors (TFs) based on their differential expression patterns, including three ERFs, three NACs, three WRKYs, two HD-ZIPs, one RAV, and one MYB. Co-expression analysis identified 132 core DEGs significantly associated with these TFs. Ultimately, this study provides initial insights into the key genes within the sweet cherry GSI network, laying a theoretical foundation and offering genetic resources for the future molecular design breeding of new self-compatible varieties. Full article

The rapid evolution of ventilators and their circuits, coupled with varying maximum usage durations set by different hospitals globally, poses a significant risk for the proliferation and transmission of nosocomial infections in intensive care settings. This study investigated temporal changes in bacterial community structure and predicted metabolic functions in ventilator circuits over a three-week period, with a specific focus on ESKAPE pathogens. The results of full-length 16S rRNA sequencing revealed dynamic shifts in bacterial communities, with an increased bacterial diversity and unique species prevalence in week-2 compared to week-1 and week-3. However, a marked emergence of pathogenic bacteria, including Serratia marcescens and Chryseobacterium indologenes, was observed in week-3 compared to week-1 and week-2. Additionally, the abundance of ESKAPE pathogens, including Klebsiella pneumoniae and Acinetobacter baumannii, was higher in week-3 compared to week-1 and week-2. Furthermore, the PCR analysis revealed a higher detection rate of Pseudomonas aeruginosa and K. pneumoniae in week-3 than in the previous weeks. FAPROTAX analysis further revealed a high abundance of specific functions associated with the pathogens of pneumonia, nosocomial, and septicemia in week-3 compared to the other two weeks, suggesting a shift toward more virulent or opportunistic pathogens with increased utilization of ventilator circuits. These findings highlight the microbial risks associated with prolonged use of ventilator circuits, underscoring the need for continuous microbial surveillance throughout their usage, and provide a foundation for optimizing infection control strategies in intensive care settings. Full article

Despite medical advances having made HIV a survivable condition, HIV persists as the 11th leading cause of death among young Black women. Enhancing the quality of care engagement through beneficial patient–provider relationships can close gaps in retention and adherence, enabling long, healthy lives. Using constructivist grounded theory informed by an established framework for patient-centered care in complex cancer settings and insight from local HIV advocates, this work identifies what provider actions retain women in care and why. Through focus groups and interviews, eleven Black women in the Southwestern United States, an understudied population, express that providers who engage them as co-creators in maintaining good health are more likely to retain them. Concurrently, when women are attuned to their own health care and interpersonal needs, they discern which providers are equally committed to their health based upon observed provider actions. These actions, such as listening attentively, taking time, and paying attention to the whole person, in conjunction with women’s motivation and active involvement, create a reciprocal dynamic that increases the likelihood these women will remain virally suppressed. The ideal relationship is one in which the provider empowers and champions women as drivers of their own care. Full article

Background/Objectives: This study aimed to examine the dynamic thermal variations that occur in the posterior body regions of pregnant women by employing thermal imaging techniques. Methods: The study involved the participation of 34 women in various stages of pregnancy. The skin temperature (Tsk) distribution in specific body areas, including the spinal region and lower limbs, was analyzed under standard conditions. Results: The most considerable increase in body temperature (Tsk) recorded in female volunteers was achieved during the second trimester of pregnancy in physiologically stressed areas, such as the upper back (0.4 °C), lower back (0.77 °C), thighs (0.94 °C) and calves (0.32 °C). Contrastingly, a decrease in Tsk of noteworthy magnitude was observed in all body regions during the third trimester, with an average decrease of 1.7 °C. The lower back’s most substantial decrease was observed (1.95 °C). Furthermore, a disparity was observed in the Tsk distribution of the calves, with the highest ∆T_mean value recorded at approximately 0.5 °C, and the thighs exhibiting a ∆T_mean value of 0.25 °C. Conclusions: Preliminary studies have demonstrated the potential of thermal imaging as a reliable and safe method to support prenatal diagnosis. Its application can facilitate the early detection of health complications, including inflammatory states or posture and circulatory system disorders, thereby enhancing the standard of prenatal care. Full article

In the development of large wireless networks, scaling law studies can provide fundamental insights. For example, is it possible to build an arbitrarily large wireless network without a wired infrastructure while maintaining a constant communication rate for each user? This is equivalent to asking if a linear scaling law is achievable for wireless networks. Whether too ambitious a goal or not, this question has attracted intensive research but still remains open. Among many proposals, the hierarchical scheme is impressive in exploiting the MIMO gain with a bootstrapping strategy. In this paper, a careful analysis of the hierarchical scheme exposes the potential influence of the pre-constant in deriving scaling laws. It is found that a modified hierarchical scheme can achieve a throughput up to an arbitrary factor higher than the original one, although it is still short of linear scaling. This study demonstrates the essential importance of the throughput formula itself, rather than the scaling laws consequently derived. Full article