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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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.
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.
Implementing cryptographic primitives on resource-constrained IoT devices involves tight latency, code-size, and energy budgets. This work proposes a general LLVM backend instruction-selection strategy that recognizes single-bit update idioms-typically expressed as LOAD--(AND/OR)--STORE sequences in SHA-256 and similar bit-oriented code-and lowers them to the most efficient target-specific bit-manipulation primitive when legality and cost conditions are met. As a concrete instantiation, we implement the strategy for the Renesas RL78/G23 ISA by rewriting eligible patterns into SET1/CLR1 instructions when the constant mask targets exactly one bit. We evaluate the resulting backend on an RL78/G23 platform using cycle counts and code size (bytes) across SHA-256-driven workloads motivated by firmware integrity checking, Merkle-tree hashing, HMAC-based authentication, password-based key derivation (PBKDF2), and chunk-level update validation. The observed cycle reductions are also converted to absolute time across the device's supported on-chip oscillator frequencies to quantify latency impact under different clocking modes. The experimental validation in this work is limited to the RL78/G23 backend implementation. The underlying instruction-selection idea may be adaptable to other RL78-family devices or to other embedded architectures that provide equivalent single-bit set/clear or bitfield operations; however, such adaptations require target-specific legality checks, cost modeling, and separate experimental validation.
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.
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 co-occurrence of substance use and mental health problems in pregnant women implies higher maternal-foetal morbidity, and treatments often do not meet care needs. This study aims to generate preliminary evidence and hypothesis by exploring the potential effect of an integrated intervention based on third-generation therapies by comparing a telephone intervention with a digital intervention and treatment as usual. In an exploratory randomised trial, 111 pregnant women (out of 2014 screened) with co-occurring mental health and substance use symptoms were assigned to either telephone-delivered intervention, digitally-delivered intervention, or treatment as usual groups. Interventions, based on third-generation therapy, lasted eight weeks. Outcomes (alcohol, tobacco use, depression, anxiety, and trauma) were measured at baseline and after two, four, eight, and twelve months. The telephone intervention group performed significantly better with regard to alcohol, depression, and trauma symptoms after two and four months compared to the digital intervention and treatment as usual groups. The digital intervention group showed limited benefit and higher attrition. All groups had returned to baseline by the 12 month point. Standardised clinical interventions delivered by telephone can improve the treatment outcomes of pregnant women with co-occurring mental health and substance use problems. New approaches are needed to effectively implement these interventions via digital support. ClinicalTrials.gov ID NCT06965270 (retrospectively registered in May 11, 2025).
Young women with limited education who migrate from rural to urban areas in Uganda for household domestic work face multiple, intersecting vulnerabilities that increase their risk of sexual violence and other forms of exploitation. These vulnerabilities are often shaped by economic dependence, limited social support, and unequal power dynamics within households. This study explored their lived experiences, perceptions, barriers, and facilitators to accessing support following sexual violence. Within a community-based cross-sectional study, we conducted a qualitative study using 18 in-depth interviews (IDIs) and 10 focus group discussions (FGDs) between November 2023 and March 2024. A total of 84 female domestic workers aged 15-24 years were purposively selected from urban communities in Uganda to capture diverse experiences. Interviews and discussions were audio-recorded with participants' consent, transcribed verbatim, and translated into English where necessary. Data were analyzed using an inductive thematic analysis in NVivo 12 to identify key themes and subthemes related to sexual violence. The study findings are reported narratively, supported by illustrative quotes from participants. Multiple levels of intersecting individual, interpersonal, and structural vulnerabilities were identified. (1) Male household members perpetrated sexual violence, exploiting workers' social isolation and economic dependence. (2) Sexual violence resulted in negative reproductive and mental health outcomes. (3) Survivors remained silent due to victim-blaming, stigma, shame, and police corruption. (4) Exploitative workplace practices, like wage theft, denial of formal contracts, and long working hours, increased young women's vulnerability to sexual violence and limited their ability to seek help. (5) Domestic workers advocated comprehensive interventions, including legal reforms, workplace protections, community services, and labor rights advocacy. Overlapping vulnerabilities, including exploitative workplace practices, power imbalances within households, social isolation, economic dependence, and limited access to reporting and support systems, drive sexual violence against domestic workers. Addressing these issues requires comprehensive, rights-based approaches, including stronger legal protections, enforcement of labor rights, improved access to survivor-centered services, and community efforts to reduce stigma and foster protective norms, thereby safeguarding the safety, dignity, and justice of these marginalized young women.
To evaluate whether progesterone-induced changes in endometrial thickness (EMT) affect singleton infant outcomes during frozen-thawed embryo transfer (FET) cycles. This retrospective study analyzed 6,331 singleton live births following frozen-thawed Day 3 embryo transfers. EMT was measured via transvaginal ultrasound one day before progesterone initiation and on the day of FET. Participants were grouped by EMT change: increase, decrease, or stable. Primary outcomes included mean birthweight, low birthweight (LBW), and small-for-gestational-age (SGA) status. Associations between EMT changes and neonatal outcomes were evaluated using multivariable linear and logistic regression. No significant differences in mean birthweight were observed among the three groups (3,355.30 ± 502.69 g vs. 3,351.30 ± 474.79 g vs. 3,344.26 ± 514.54 g; p = 0.753). Compared with the EMT stable group, the EMT decreased group showed no significant increase in LBW (1.1%; aOR 1.645, 95% CI 0.818-3.307) or SGA (2.7%; aOR 1.141, 95% CI 0.783-1.662). Similarly, the EMT increased group showed no significant association with LBW (aOR 1.310, 95% CI 0.723-2.375) or SGA (aOR 0.912, 95% CI 0.660-1.261). Multiple linear regression confirmed that gestational age and infant gender significantly influenced birthweight, while EMT change did not. EMT may increase, decrease, or remain stable after progesterone administration in FET cycles. However, these changes do not demonstrate an independent association with adverse perinatal outcomes in term singleton infants.
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.
Dementia is one of the greatest global health challenges requiring multimodal efforts to address its impact on people and societies. Walking the Talk for Dementia (WTD) is a unique global initiative designed to challenge the stigma that surrounds dementia, foster intergenerational dialogue, build a community, and inspire a renewed sense of purpose among participants. A social network analysis (SNA) was conducted to provide greater detail and contextualization of the connections made during WTD and insights into the collaborations that arose from this immersive event which may influence dementia policy, care, and services. A robust, comprehensive, and minimally intrusive evaluation was created in 2024 to capture the results, outcomes, and impacts of WTD 2024. This mixed methods research examined the experiences of the WTD 2024 participants, 79 of whom consented to participate in this research. Pre- and post-surveys collected quantitative and qualitative data (94% and 87% response rates), and were augmented by 95 written, audio, or video reflections. To further investigate the social network of the larger WTD community, a follow-up survey was sent six months after WTD 2024 to the 2024 participants plus the additional 40 participants from WTD 2023. Quantitative survey data were analyzed with descriptive and inferential statistics; qualitative data were analyzed using content analysis to identify core aspects and common themes of the experience. A social network analysis (SNA) was used to visualize and quantify connections between participants of WTD. Results from the SNA analyses illustrate the development of multiple new connections and collaborations among WTD participants. The results also point to how connections and collaborations among participants that existed prior to WTD 2024 may have changed as a result of WTD. Connections appear to have increased post-WTD. A community developed among WTD participants, who are a multi-disciplinary, global group of professionals and people with lived experience of dementia. This analysis provides evidence of the benefits of social connections for individuals living with dementia and their care partners with other dementia advocates. These findings are important to future advancement of dementia awareness, advocacy, and policy change.
This study aimed to examine in depth the spiritual care experiences of nurses working in hemodialysis units in Türkiye. A qualitative phenomenological design was employed, and data were collected through in-depth, face-to-face, semi-structured interviews with 10 hemodialysis nurses working in public hospitals in western Türkiye. A total of 12 eligible nurses were invited, and 10 participated in the study, resulting in a response rate of 83.3%. The data were analyzed using Colaizzi's seven-step phenomenological analysis method with MAXQDA 2022 software. The findings were grouped under four main themes: definition of spiritual care, effects of spiritual care, barriers to spiritual care, and suggestions for improving spiritual care. The results showed that nurses perceive spiritual care as a holistic approach involving empathy, respect for privacy, therapeutic communication, and emotional support. However, excessive workload, lack of time, and insufficient organizational support were identified as key barriers. Strengthening institutional support and training programs is recommended to improve the integration of spiritual care into clinical practice.
Adolescents and young adults (AYAs), defined as individuals aged 15-39 years, face unique medical, psychosocial, and existential challenges when living with life-limiting illness. Despite evidence supporting early palliative care integration, Canadian adult palliative care curricula lack formalized AYA-specific competencies. Healthcare providers consistently report insufficient preparation in this area. A descriptive cross-sectional needs assessment survey was administered nationally to physicians who completed Canadian adult palliative care residency training between 2019 and 2024. A multidisciplinary steering committee of experts in AYA palliative care and medical education, alongside a patient partner, guided the development of the bilingual 25-item questionnaire guided by an established framework for medical education survey design. The questionnaire assessed clinical exposure, self-rated knowledge across 20 competency areas, comfort levels across 21 competency areas, training needs and barriers, and preferred learning formats. Responses were anonymous. Descriptive statistics were used for analysis. Of 71 responses received, 55 met eligibility criteria for analysis (response rate 35%, eligibility rate 77%). Only 31% of participants received AYA-specific training during residency. Most participants (82%) reported low comfort when caring for the youngest AYA age group (15-18 years). The greatest knowledge gaps were in pediatric-to-adult care transitions (69%), sexual health and fertility concerns (62%), and social support navigation (39%). Top training priorities were AYA developmental and psychosocial factors (75%), grief and bereavement support (65%), and care transitions (60%). The most common training barriers were limited clinical exposure (78%), lack of mentors (65%), and absence of AYA-specific programs (61%). Our findings revealed substantial gaps in training, knowledge, and comfort levels in providing AYA palliative care among recent graduates from the adult palliative care programs in Canada. This may represent an initial step towards the development of a competency-based AYA-focused residency training curriculum.
Intensive care unit (ICU) patients are at high risk for pressure injuries (PIs), medical device-related pressure injuries (MDRPIs), and skin tears (STs). Although nurses play a key role in preventing all three conditions, existing research has mainly focused on PIs, with limited evidence addressing nurses' combined knowledge related to MDRPIs and STs. In particular, shared deficiencies across these conditions remain unclear. This study aimed to assess ICU nurses' knowledge of PIs, MDRPIs, and STs together to identify overlapping knowledge gaps that may affect skin integrity management in ICU settings. A cross-sectional online survey was conducted with 283 ICU nurses. Data were collected using three validated tools: the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0), the Medical Device-Related Pressure Injury Knowledge Assessment Tool (MDRPI-KAT), and the Skin Tear Knowledge Assessment Instrument (OASES), enabling construct-specific measurement across related conditions. Knowledge levels varied across domains, with mean total scores of 14.44 ± 3.43 (PUKAT 2.0), 8.73 ± 1.83 (MDRPI-KAT), and 10.17 ± 2.44 (OASES). Across all three tools, prevention consistently emerged as the lowest-scoring domain. Higher knowledge scores were observed among nurses with greater professional experience, postgraduate education, and prior care experience related to STs. The findings provide a comprehensive overview of ICU nurses' knowledge regarding PIs, MDRPIs, and STs, highlighting variability across domains and consistently lower scores in prevention-related areas. These results underscore the need for targeted educational strategies to strengthen knowledge across key aspects of skin integrity management in intensive care settings. However, findings should be interpreted with caution due to potential sampling bias related to social media-based recruitment and the absence of multivariable analysis. 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.
Genomic data sharing enhances efficiency in medical practice by facilitating faster data access and collaboration across settings. However, the same arrangements that enable efficiency could also raise legal inequalities, especially concerning data ownership and access. Yet these inequities are intensified in cross-border collaborations where power dynamics disadvantage low and middle income (LMIC) researchers. A qualitative phenomenological study was conducted in Uganda. Key informant interviews (KIIs) were conducted with 49 stakeholders working at different points across the genomic research landscape and four focus group discussions (FGDs) were conducted with people currently or previously enrolled in genomic studies, or their caretakers. The stakeholders who took part in the KIIs included genomic researchers (16), research ethics committee (REC) members (14), practicing lawyers (3), community advisory board (CAB) members (8) and national research regulators (8). A theory of decolonization was used to clarify rooted power imbalances and unfairness. Through thematic analysis six concerns were identified: (1) inadequate regulatory frameworks, (2) limited access to the shared data, (3) unclear data ownership (4) absence of benefit sharing frameworks, (5) contested intellectual property rights and (6) rethinking power asymmetries and struggles. The wide spread perception by research participants that the Global North collaborators owned the data, eroded community trust. There was limited clarity on data ownership, with Ugandan researchers expressing differing views, on ownership, custodianship, and shared ownership leading to calls for co-ownership. In the absence of benefit-sharing frameworks to regulate the distribution of commercial value, data commercialization disadvantaged Ugandan researchers and participants, reinforcing colonial-like inequalities. Current governance systems mirror colonial patterns in the control and sharing of genomic data in Uganda. These patterns are reinforced not only by cross-border power asymmetries but also by internal power dynamics within the country, including institutional hierarchies and regulatory gaps that limit local decision-making authority. Addressing this requires rethinking governance structures and promoting local or co-ownership models that reflect African interests and support decolonized approaches to data governance. Not applicable. This study did not involve a clinical trial.