Authentication systems often rely on individuals' ability to remember and accurately input complex passwords in digital environments. However, this task becomes impractical as the demand for higher security measures increases. Researchers have proposed several methods to improve password authentication over the years, yet most methods come with a trade-off between security and usability. Password managers are a well-known solution to make password security usable, but they introduce a widely discussed risk: if a password-manager (PM) vault is compromised, many accounts can be affected at once. This work augments passwords stored in PMs with a user-held secret to improve resilience in a vault-only compromise setting. The user's login secret is obtained by combining what is stored in the PM with a mnemonic remembered by the user, while the password stored in the PM serves as a decoy that can trigger an alarm indicating potential PM compromise. We conducted a user study using Mindlock, a browser-extension prototype that acts as a mnemonic application interface, to evaluate feasibility and usability in real login routines. Our study provides preliminary evidence that users can adopt mnemonic-based augmentation with limited impact on usability, and we discuss the security implications under a rate-limited online threat model.
ObjectiveThis study aimed to isolate the source of memorability benefits in recognition-based graphical authentication. The effects of retrieval (recall vs. recognition) and font representation (plain vs. distinctive) on usability measures were examined.BackgroundStrong system-assigned passwords are difficult to remember. This motivates next-generation authentication to develop schemes that are memorable. Some researchers claim that their memorability improvement is due to dual-coding in long-term memory, while others highlight recognition retrieval. A distinctiveness theory was employed to transform text into images. This study examined whether text distinctiveness and recognition could yield memorability improvements while still using strong system-assigned alphanumeric passwords.MethodParticipants learned strong alphanumeric passwords using both traditional (recall) and Use Your Illusion (UYI) (recognition) authentication schemes. The UYI scheme presented the passwords in either plain or distinctive fonts. After practice with each authentication type, participants completed a test login after 5 minutes and 3 weeks later. Measurements included initial practice errors, login errors, login time, and ease ratings.ResultsManipulating font distinctiveness did not significantly improve memorability. Recognition-based UYI interactions significantly outperformed recall-based password entry on all metrics after a 3-week delay. Text-based recognition achieved high memorability, comparable to performance reported for a graphical authentication benchmark.ConclusionAuthentication memorability was primarily driven by the retrieval type. Transforming passwords into images did not enhance memorability, possibly due to a ceiling effect. However, employing a recognition-based scheme dramatically increased text password memorability.ApplicationFindings suggest designers can significantly enhance authentication memorability by leveraging recognition memory, even with standard text.
Password-based authentication systems remain the most widely used method for user verification despite being highly susceptible to offline dictionary attacks. To mitigate such attacks, server-aided password-based authentication schemes utilize an independent server, which helps to harden the credentials to be stored on the website database. Existing server-aided password-based authentication schemes rely on number-theoretic assumptions that are vulnerable to quantum-enabled adversaries and incorporate complex computations such as bilinear pairings, exponentiation, and Zero-Knowledge Proofs. In this work, we introduce a novel post-quantum secure server-aided password-based authentication scheme based on the Module Learning With Errors (M-LWE) problem. A defining feature of our protocol is its complete operational transparency as it integrates with existing web interfaces without requiring users to modify their login behaviour or perform additional computation. To ensure long-term resilience, our scheme includes a transparent key rotation mechanism that allows service providers to update the entire credential database with a fresh secret key without user intervention. We provide a formal security analysis in the Real-or-Random (RoR) framework. This analysis demonstrates that our protocol's resistance to offline dictionary attacks reduces to the underlying hardness of the M-LWE problem, and the system achieves forward secrecy through a key rotation mechanism. Through an optimized Number Theoretic Transformation (NTT)-based implementation for faster polynomial multiplications, our empirical analysis demonstrates high computational efficiency, with average registration and authentication latencies of 0.88 ms and 0.96 ms, respectively.
Visual Cryptography (VC) is a method of encryption that allows images to be encrypted in such a manner that their decryption can be accomplished simply by viewing, which eliminates the need for complex algorithms. This method is crucial for protecting the sensitive visual data during transmission, which ensures its confidentiality. In light of this, the current research proposes a new method called Self-Improved Secretary Bird Optimization algorithm (SI-SBO)-based Visual Cryptography, which aims to enhance the security and efficiency of image encryption. Embedding and Extraction are the two main processes in this proposed method. The initial input for this method consists of three original and two secret images. The encryption employs a sharing image construction method based on Modified Principal Component Analysis (MPCA), followed by Kronecker product-based encryption using keys produced by the SI-SBO algorithm. A one-time password (OTP) is created using the HMAC-based One-time Password (HOTP) technique and integrated into a Modified Elliptic Curve Cryptography (MECC) algorithm, which is then securely sent to the client. For decryption, the process starts with MECC-based decryption, followed by Kronecker product-based decryption using the OTP for authentication. Finally, the MPCA-based encryption is decrypted, and the original secret images are reconstructed. The significance of this SI-SBO method lies in its capacity to improve security by integrating multiple encryption techniques and protective measures. To assess its effectiveness, the method has undergone several evaluations, which confirm its ability to securely transmit and reconstruct secret images in Visual Cryptography applications.
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Tunable fluorescence emission endows luminescent materials with immense applications in optoelectronic devices and information security. Herein, broad-wavelength photoluminescence (PL) tuning from yellow to white to blue is realized in a zero-dimensional (0D) K4CdCl6 halide via a facile Rb/Sn codoping strategy. Interestingly, K4CdCl6 and isostructural Rb4CdCl6 halides exhibit yellow and blue PL emissions via the homovalent doping of Sn2+, respectively. The relative intensity ratio of yellow and blue emission bands can be effectively regulated in K4CdCl6:Sn2+ halides by Rb+ alloying; accordingly, the continuous luminescence color tuning covering yellow, white, and blue spectral regions was successfully achieved. Density functional theory calculations further verify that the doping of Sn2+ leads to the appearance of an impurity energy level within the band gap, accelerates electronic transitions, and ultimately enhances PL emission efficiency. On the basis of this rationally designed tunable luminescent system, the three-level color-coded intelligent password devices, combining multimode optical anticounterfeiting and digital information encryption, were developed. This work not only develops a reliable ion doping strategy for luminescence modulation in the metal halides but also expands their diversified application prospects in advanced optoelectronic fields.
Establishing the Korean Pediatric and Congenital Heart Surgery Database (KPCHSD) and linking it to the World Database for Pediatric and Congenital Heart Surgery (WDPCHS) is an important step toward creating a global network for quality care. Worldwide outcomes data are needed to support quality assurance and advocacy for necessary resources for pediatric and congenital cardiac care. The Korean Society for Thoracic and Cardiovascular Surgery collaborated with the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) to develop and implement the KPCHSD. Variables selected for collection met the specific needs of Korean congenital heart surgery practice and were harmonized with the WDPCHS. Software was developed to link the databases in a secure environment, transfer data from KPCHSD to the WDPCHS, and produce outcomes reports. The initial data upload from the KPCHSD to the WDPCHS was successfully completed in 2023. Over 2,500 operations from a 2-year period were transferred from the KPCHSD into the WDPCHS. Comparisons of individual center data will be made with both national and international aggregates. These comparisons will be available to individual centers via a password-protected cloud-based dashboard. Working in collaboration with our Korean colleagues, the WSPCHS has taken the next step toward developing a global network to share knowledge and expertise and to promote quality improvement in the treatment of congenital heart disease. Using this platform, countries perform data validation and completeness checks while maintaining control over their data. This aggregated data can support quality assessment and help secure the necessary resources for all countries, regardless of economic status.
Lip reading technology has potential use across various fields, significantly enhancing communication for the deaf, aiding in noisy settings, and supporting information security through silent password entry. Although, notable progress has been made in constructing datasets of different types like digits, alphabets, words, phrases, and sentences levels for lip reading in various languages. However, developing a robust Urdu lip reading model remains a challenge due to the lack of a suitable dataset. Moreover, difficulties in adapting previous models, such as the LipNet model to Urdu. To address these barriers, we present the ULRA (Urdu lip reading alphabets) dataset, leverage advanced data augmentation techniques, and evaluate three cutting-edge DNN models: a LipNet-based 2D-CNN model, a Hybrid 2D_3D-CNN model, and a baseline 3D-CNN model. Each model undergoes rigorous testing in diverse environments, with both familiar and unfamiliar data. The results reveal that the LipNet-based 2D-CNN model achieves an impressive 81.97% accuracy on unknown data across diverse environments, while the Hybrid model excels in generalization, reaching 69.45% accuracy on unfamiliar data, thanks to its superior spatiotemporal feature extraction capabilities. Additionally, precision, recall, and F1-Score values of LipNet-Based 2D CNN are 0.83, 0.82, and 0.82 respectively. All three values of this model are also higher than the other two models. These findings underscore the strengths of various DNN architectures and the critical advancements made possible by the ULRA dataset, paving the way for future breakthroughs in Urdu lip reading research.
The rapid expansion of digital engagement has also exposed older adults to an increasing spectrum of cyber threats. Many older individuals encounter distinct challenges when navigating digital environments, including limited prior exposure to technology, lower levels of cybersecurity literacy, and heightened susceptibility to online misinformation. These vulnerabilities not only compromise their digital safety but also undermine their confidence in adopting and effectively using technology. This study aimed to examine the effect of cybersecurity awareness training on technology adoption, cybersecurity behaviors, and cybercrime awareness among older adults residing in assisted living facilities. A quasi-experimental pretest-posttest control group design was employed. A total of 160 older adults were recruited through convenience sampling. Participants were divided into intervention and control groups. The intervention group underwent a five-week cybersecurity training program, with weekly sessions of 60-90 min. Topics included password security, phishing awareness, social media safety, and secure browsing. Validated assessment tools were used to evaluate changes in cybersecurity awareness, technology acceptance, and security practices before and after the intervention. Post-intervention assessments showed that the intervention group experienced significant improvements in digital safety knowledge, attitudes toward technology use, control over digital tools, and awareness of cyber threats, especially on social media. Enhanced adoption of cybersecurity behaviors in daily life was also observed. Cybersecurity awareness training is effective in improving older adults' knowledge of digital threats, encouraging positive attitudes toward technology, and promoting safe online behavior. These findings underscore the potential of targeted interventions to reduce digital vulnerability and enhance inclusion among aging populations.
Despite rapid advances in whole-genome sequencing (WGS), translating genomic findings into individualized insights remains challenging. We present GenRiskPro, a clinical decision-support and research platform, which automates WGS variant calling, annotation, prioritization, and reporting to deliver actionable findings and facilitate precision wellness. (To test the GenRiskPro platform, log on to https://www.phenomeportal.org/dashboard using the following credentials: Username: user@test.com; Password: test.) GenRiskPro integrates rare and common variant prioritization in a unified pipeline and in-house database, enabling both rare and complex disease and trait association analyses. Variant reporting is supported via LongevityCloud, which features a web portal for clinicians to review, adjust, and authorize the return of results in tabular and PDF formats, alongside a mobile app with artificial intelligence (AI) integration for sequenced individuals. Case studies using Turkish (TR, n = 275) and Swedish (SW, n = 101) WGS data assessed platform performance and variant prioritization: (a) predefined gene panels yielded a 1.82% positive rate for actionable findings per American College of Medical Genetics and Genomics (ACMG) secondary findings guidelines; (b) phenotype-driven support diagnosed cases including muscular dystrophy and microcephaly; (c) cohort-level ClinVar reassessment identified potentially misclassified pathogenic variants; (d) rare variant burden analysis revealed enrichment in ABCA4 for TR and SMPD1 in SW; and (e) population analysis highlighted carrier differences in trait-associated SNPs (rs12913832 and rs4988235) and PGx variants (CYP2B64 and CYP2B66). GenRiskPro unifies databases, literature, web development, and AI for rapid, user-friendly genomic analysis and reporting, which fosters collaboration among hospitals, researchers, clinicians, and patients.
Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR. This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (≥18 years) with an LARS score >20, at least 6 months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3 months of daily TAI or conventional LARS care, followed by a 1 month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events. The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines. NCT05007015.
Large language model (LLM)-based chat systems generate fluent, second-person, turn-by-turn dialogue that may be anthropomorphized by users. In psychotic-spectrum vulnerability, neutral guidance may be personalized and misread as intentional "signals," potentially lowering the threshold for referential interpretation. A 33-year-old man with schizophrenia and a prior history of persecutory and referential themes had been stable on oral paliperidone 9 mg/day. Approximately 20 days before presentation, he began using ChatGPT for everyday tasks. After querying the system about home and device monitoring, he received generic safety tips (e.g., review microphone/camera/location permissions; check Wi-Fi security; inspect for unknown devices; update operating system; use strong passwords). Within days, he interpreted repeated keywords and typographical emphasis as "hidden signs" and personalized warnings ("my file has been opened"), which escalated into checking behaviors (repeated outlet/device inspections; toggling app permissions) and ultimately led to self-discontinuation of paliperidone in order to "read the signals" more clearly. On Day 0, he was alert and cooperative; persecutory and referential content dominated his thought, with markedly limited insight; Positive and Negative Syndrome Scale (PANSS) total score was 102, Brief Psychiatric Rating Scale (BPRS) score was 58; basic laboratory investigations and a prior brain MRI were unremarkable. Management included psychoeducation emphasizing that similar interpretations had occurred during previous relapses and that abrupt medication cessation likely contributed to symptom escalation; oral paliperidone was reinstated at the prior effective dose. In this case, neutral safety statements produced by an LLM were seemingly reinterpreted as personally targeted messages, likely through the combined influence of anthropomorphic attributions, aberrant salience, and reasoning biases. Incorporating structured assessments of digital media use, including AI chatbot interactions, into routine psychiatric evaluations, explicitly addressing misinterpretations in the therapeutic dialogue, and maintaining continuity of effective antipsychotic treatment may help reduce the risk of similar text-centered personalizations and their contribution to relapse in psychosis. Not applicable.
Over 2.3 million neonatal deaths occurred globally in 2022, representing 1 in 58 newborns, with neonatal deaths of about 6,300 every day. Of these, 73% died in the early neonatal period and one third within 24 h. Despite the 47% globally neonatal deaths decline from 2000 to 2015, Zambia's perinatal and neonatal mortality rates have remained high at 33 and 27 per 1000 total births, respectively. This study aimed to determine the aetiology of early neonatal deaths and to analyse survival time and mortality predictors among normal and low birthweight early neonates in the neonatal intensive care units at two tertiary hospitals of Lusaka, Zambia. A prospective cohort study was conducted involving neonatal deaths that occurred in the neonatal intensive care units at the Women Newborn Hospital (WNH) and Levy Mwanawasa Teaching Hospital (LMUTH) tertiary hospitals of Lusaka, Zambia from September 1, 2023 to January 30, 2024. Data were analysed using SPSS Version 30. Associations with death were studied using Chi square and Fischer's exact tests. Descriptive statistics were used to summarise frequency distributions, and cox proportional hazard regression to analyze predictors of early neonatal deaths and survival time. Among the 404 participants, prematurity, sepsis, birth asphyxia and congenital anomalies were notable causes of death. A total of 62 neonates (42.5%) died within the first 30 min of admission, while 224 (58.8%) died within 1.5 h of arrival. Predictors of shorter neonatal survivor included maternal age > 35 AHR 5.70 (95% CI: 1.41-23.10, p < 0.015), foetal seizures AHR 1.81 (95% CI: 1.33-2.46, p < 0.0001), ANC booking had strong association with birthweight (p = 0.001) but was not in the adjusted model. and Rhesus negative 10 (2.5%) AHR 4.48 (95% CI: 1.58-12.70, p < 0.005). Low birthweight babies had AHR 1.95 (1.33-2.86, p < 0.001), walking and use of public transport to hospital had AHR 4.99 (95% CI: 1.07-23.28, p < 0.041) and 4.24 (95% CI: 1.10-16.36, p < 0.036), respectively and foetal anomalies AHR 2.48 (95% CI: 1.25-4.94, p < 0.010). Almost 60% of early neonatal deaths occurred within 1.5 h of admission, with the majority (42%) having been within 30 min. Major causes of death included prematurity, sepsis, birth asphyxia, and congenital anomalies. Predictors to shorter survival time highlight critical areas that need attention. There is need to strengthen health promotion on the importance of early antenatal booking. This will enhance early detection of disease, targeted interventions to manage of high-risk pregnancies and access to comprehensive emergency obstetrics and neonatal care sites.
Gastrostomy tube placement is the preferred modality for long-term nutritional management in individuals with oral feeding disorders. However, acceptance of this intervention is often impeded by reluctance to discontinue oral feeding, concerns about increased caregiver burden, and apprehension regarding life prolongation with diminished quality of life. These factors may generate decisional conflict, negatively affecting patients' physical and psychological well-being and treatment outcomes. In this study, we aimed to explore the facilitators and barriers influencing gastrostomy-related decision-making among patients with cancer and dysphagia, providing a theoretical and empirical basis for developing culturally tailored decision aids and structured communication pathways. A qualitative descriptive design was employed. In-depth one-on-one interviews were conducted with 18 patients with cancer and dysphagia who had engaged in gastrostomy decision-making at two tertiary hospitals in Fujian Province, China. The transcripts were coded using NVivo and analyzed using conventional content analysis. Three overarching themes with seven subthemes were identified. Theme 1 included decision-making motivation, which comprised three subthemes: disease perception and survival needs, supportive communication from healthcare providers, and support from family members and peers. Theme 2 included decision-making challenges, which included two subthemes: emotional-rational dissonance and insufficient decision-making information. Theme 3 comprised decision-making optimization and included two subthemes: enhancing the transparency of gastrostomy-related information and improving the efficacy of healthcare provider-patient communication. Effective healthcare provider-patient communication and support from family members and peers emerged as key facilitators of decision-making regarding gastrostomy tube placement, whereas emotional-rational conflicts and informational deficits constituted major barriers. Future efforts should focus on developing culturally tailored, multimodal decision aids integrating paper and digital formats, establishing structured communication pathways that integrate these tools, and strengthening family-peer support while ensuring that autonomous decisions are aligned with patient values. Not applicable.
In a highly influential study across a wide breadth of literature, Kornell and Bjork (Psychological Science, 19[6], 585-592, 2008) showed that learning is enhanced by presenting exemplars (paintings) of to-be-learned categories (artists) in an interleaved sequence (e.g., A1, B1, C1 … A2, B2,, C2 …) rather than a blocked sequence (e.g., A1, A2, A3 … B1, B2, B3 …). However, this study, and nearly all direct replications, used an identification procedure that confounds memory abilities with response biases (i.e., one's criteria for using certain response choices); any interleaving effect assessed through an identification task may be an overestimate or, indeed, an underestimate of the effect (Hautus et al., Detection Theory, 2021). To address this, we conducted a direct replication: online, N = 288; t(287) = 8.08, p < 0.001, dz = 0.48, 96% CI [0.36, 0.59]-for the first time to our knowledge-accompanied by measures of differential learning and response biases across learned categories (which were substantial, with participants using some response categories at a rate several times higher than others). We then conducted a critical conceptual replication, changing the task from identification ("Which artist painted this?") to n-alternative forced-choice ("Which of these was painted by [e.g.] Seurat?"), the gold standard of memory tests (Brady et al., Psychonomic Bulletin & Review, 30, 2023). Reassuringly, the 2AFC experiment showed an interleaving effect comparable to our direct replication: online, N = 276; t(275) = 7.19, p < .001, dz = 0.43, 95% CI [0.32, 0.55]. Put together, this study showcases the challenges of interpretation facing any identification paradigm, illustrates a straightforward method to address them, and puts the interleaving effect on firmer footing.
We aimed to evaluate whether prandial insulin timing affects vascular function in people with type 1 diabetes. Our hypothesis was that premeal insulin administration would lead to greater myocardial microvascular blood flow (MBF) via blunting postprandial hyperglycaemia. People with type 1 diabetes between 18 and 35 years of age with BMI <30 kg/m2 underwent two protocols with a 1:1 randomised crossover design wherein prandial insulin was injected either 15 min before or 15 min after meal intake began. To provide a physiological comparison, age-, sex- and BMI-matched control participants completed one study where they consumed the same meal but received no exogenous insulin. Glucose, insulin, vascular function (including ultrasound measures of myocardial and skeletal muscle microvascular perfusion, aortic stiffness, brachial artery endothelial function) and biomarkers of systemic inflammation and endothelial dysfunction were assessed at baseline and then 2 h after meal ingestion within each protocol. The primary outcome was change in myocardial MBF within each protocol. Study personnel assessing outcomes were masked to group assignment. Eighteen people with type 1 diabetes and 18 matched control participants were analysed within each protocol. Glucose area under the curve was significantly greater (p=0.015) in the postmeal insulin study compared with the premeal insulin study in participants with type 1 diabetes. Myocardial microvascular flow velocity significantly increased (p=0.031) with premeal insulin administration in people with type 1 diabetes and this consequently led to greater myocardial MBF (p=0.044). There were no changes in myocardial MBF within the other protocols. Changes in vital signs were similar between all protocols. Appropriately timed premeal insulin led to lower postprandial blood glucose along with increased myocardial MBF in people with type 1 diabetes. Further work is needed to determine the underlying aetiology of these changes. ClinicalTrials.gov NCT04730882.
Prompt diagnosis and treatment of malaria remain central to malaria control strategies. The World Health Organization recommends testing suspected malaria cases before treatment using rapid diagnostic tests (RDTs) or microscopy. However, evidence on the readiness of health facilities to implement this policy in high-burden Nigerian states remains limited. This study assessed facility readiness, testing-before-treatment (TBT) coverage, and facility-level determinants of malaria diagnostic readiness among public health facilities in Kaduna and Kano States, Nigeria. A cross-sectional health facility assessment was conducted across 418 public health facilities in Kaduna and Kano States between August 5 and 28, 2025. A stratified two-stage sampling approach was used, with primary health facilities randomly selected proportionally across all 67 Local Government Areas and all secondary facilities purposively included. Data were collected using a structured Health Facility Assessment questionnaire. Facility readiness was assessed using five indicators: availability of RDTs, availability of microscopy services, trained staff on malaria case management, availability of standard operating procedures, and absence of stock-outs of RDTs or artemisinin-based combination therapy within the previous three months. A composite readiness index (0-5) was constructed and facilities were classified as having full or partial readiness. Associations between facility characteristics and readiness were examined using multivariable logistic regression. All facilities had RDTs and trained staff on malaria case management, and none reported commodity stock-outs during the three-month reference period. Overall, 381 facilities (91.1%) demonstrated full readiness, with a mean readiness score of 4.91 ± 0.29. Microscopy services were available in 23.0% of facilities. Most facilities reported high TBT coverage, with 90.4% reporting ≥ 85% testing coverage. Secondary facilities (aOR = 2.15, 95% CI:1.06-4.36), urban location (aOR = 1.78, 95% CI:1.01-3.12), supportive supervision (aOR = 2.54, 95% CI:1.28-5.02), malaria focal persons (aOR = 2.92, 95% CI:1.63-5.23), and availability of free malaria commodities (aOR = 1.98, 95% CI:1.07-3.68) were significantly associated with full readiness. Public health facilities assessed in Kaduna and Kano States demonstrated high structural readiness for malaria diagnosis. Study limitations include the cross-sectional design, reliance on facility records which may be subject to reporting bias, and the exclusion of private health facilities, limiting generalizability. These findings highlight the need for sustained commodity security, regular supportive supervision, and targeted investments in rural facilities to maintain and strengthen diagnostic readiness.
The increasing insecurity of traditional methods such as passwords and PINs has raised significant interest in behavioral biometrics. Keystroke Dynamics (KSD), which relies on the unique manner in which an individual types, is a promising candidate for continuous and unobtrusive authentication. This study presents a hybrid model for KSD that combines a Long Short-Term Memory (LSTM) network with an ensemble of Random Forest, XGBoost, and Multilayer Perceptron classifiers using a soft-voting strategy. The model incorporates advanced feature engineering techniques to capture meaningful typing patterns and user-specific behavioral characteristics. The temporal features extracted by the LSTM are effectively classified by the ensemble model, resulting in strong authentication performance on the KDA Keystroke Dynamics dataset. The proposed approach achieved an accuracy of 94.75%, with a recall of 94.89%, precision of 94.75%, F1-score of 94.76%, and MCC of 94.65%. Furthermore, the model demonstrated efficient real-time performance with a throughput of 16,092.93 samples per second and a detection time of only 0.0621 ms per sample. In addition, SHAP-based explainability analysis enhanced model interpretability by identifying the most influential keystroke features contributing to authentication decisions. Overall, the proposed framework provides a secure, scalable, interpretable, and computationally efficient solution for real-time keystroke dynamics-based user authentication.
Maternal mortality remains a major public health concern globally despite significant progress over the past two decades. Nigeria is among the countries with the highest maternal mortality rates. Within the country, marked regional disparities persist, with northern Nigeria experiencing a significantly higher burden. These disparities are shaped by a complex interaction of sociocultural norms, household power relations, geographic constraints, and health system limitations that influence women's access to skilled birth attendance and facility-based delivery. The study explored skilled birth attendants' perceived barriers to the provision of maternal healthcare services that prevent pregnant women from seeking appropriate care in government-based facilities. This study employed a qualitative research design to explore skilled birth attendants' perspectives on barriers preventing women from accessing maternal healthcare services. Twenty-four skilled birth attendants were purposively selected from primary healthcare facilities across six high-burden northern Nigerian states: Bauchi, Kaduna, Katsina, Kano, Jigawa, and Niger. Data were collected through in-depth interviews using a semi-structured and pretested interview guide. The Three Delay Model guided the study to examine factors affecting women's decisions to seek care, their ability to reach healthcare facilities, and their experiences receiving care within facilities. The findings revealed multiple barriers across the three phases of delay. At the household level, cultural expectations, generational beliefs, and patriarchal decision-making structures limited women's autonomy to seek skilled care. Mothers-in-law and husbands often influenced or determined childbirth decisions, sometimes discouraging facility delivery. Structural barriers also affected women's ability to reach health facilities, including long travel distances, poor road infrastructure, and limited transportation options. Even when women arrived at health facilities, systemic challenges such as shortages of skilled health workers, inadequate medical supplies, insufficient delivery beds, financial constraints, and weak referral systems contributed to delays in receiving appropriate care. In conclusion, maternal healthcare service utilization in northern Nigeria is shaped by interconnected sociocultural, economic, and health system factors that contribute to delays in seeking, reaching, and receiving care. Therefore, addressing maternal mortality in this context requires comprehensive strategies that strengthen health system capacity, improve transportation and referral systems, reduce financial barriers, and promote gender-equitable decision-making within households and communities. Such integrated efforts are essential for improving access to skilled birth attendance and advancing progress toward global maternal health targets.
Transfusion transmissible infections (TTIs) such as Human Immunodeficiency Virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, remain a major public health concern in low-income countries due to inadequate blood donation systems. This highlights the urgent need for continuous surveillance and a deeper understanding of the factors associated with TTIs in Rwanda. A retrospective cross-sectional study analyzed voluntary blood donor records from the National Center for Blood Transfusion (NCBT) in Kigali, Rwanda, spanning January 2019 to December 2023. A census of all available records was used to select 38,345 eligible donors aged 18-60 years. Data were extracted from electronic databases and analyzed using SPSS version 25, with chi-square tests and multivariate logistic regression to identify predictors of transfusion-transmissible infections. The overall prevalence of transfusion-transmissible infections declined from 2019 to 2023, with HBV decreasing from 0.76% to 0.41%, HCV from 0.30% to 0.18%, HIV remaining stable at 0.04%-0.08%, and syphilis slightly increasing to 0.26%. Multivariate analysis showed that male gender was independently associated with HBV (aOR = 2.60, 95% CI: 1.54-4.38, p < 0.001) and HIV (aOR = 3.84, 95% CI: 1.63-9.05, p = 0.002). First-time donor status was independently associated with higher odds of HBV (aOR = 4.09, 95% CI: 2.26-7.39, p < 0.001) and HIV (aOR = 2.95, 95% CI: 0.77-11.34, p < 0.001). Gasabo district was independently associated with lower odds of HBV (aOR = 0.56, 95% CI: 0.34-0.90, p = 0.017) and higher odds of HCV (aOR = 2.34, 95% CI: 1.25-4.40, p = 0.008), relative to Nyarugenge. TTI prevalence among Kigali blood donors remained low with declining HBV and HCV trends from 2019 to 2023, while HIV rates stayed consistently low. Male gender, older age, first-time donor status, and specific occupations were independently associated with TTI positivity. Rwanda's blood screening protocols appear effective, though targeted interventions for high-risk groups and continued surveillance are recommended. Not applicable.