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.
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.
Healthcare-associated infections (HAIs) remain a persistent patient safety problem in acute hospital settings globally, with suboptimal personal protective equipment (PPE) compliance among nursing staff identified as a modifiable contributing factor. In Saudi Arabia, compliance rates are reported as low as 65%, yet the psychological and behavioural determinants have not been systematically examined using validated theoretical frameworks. The Integrated Behavioural Model (IBM) offers a theoretically grounded approach to understanding the cognitive, normative, and control-related factors shaping health-related intentions. To identify and quantify the attitudinal, normative, and perceived control factors influencing nurses' intentions to comply with PPE guidelines in two acute care hospitals in northern Saudi Arabia, using a phased mixed-methods design informed by the IBM. A sequential mixed-methods design was employed. Phase 1 comprised 14 semi-structured interviews with nurses; content analysis generated items for a purpose-built survey. Phase 2 involved administering the survey to a randomly selected sample of 289 nurses, with 279 completing it (response rate 96.5%). Internal consistency (Cronbach's alpha 0.92) and test-retest reliability (ICC > 0.80) were established. Multiple regression analyses identified significant predictors of compliance intention. The overall IBM model accounted for 62.3% of variance in nurses' intentions to comply (R2 =0.623, p < 0.001). Attitudes were the strongest predictor (indirect β = 0.405, p < 0.001; direct β = 0.229, p < 0.001), followed by subjective norms (direct β = 0.174, p < 0.001) and perceived behavioural control (indirect PBC β = 0.137, p = 0.002). Mean scores showed strong positive attitudes (5.7/7.0) and subjective norms (5.5/7.0), but notably lower perceived behavioural control (3.5/7.0), signaling a critical gap between intention and perceived ability. These findings suggest that while nurses report strong foundational motivation, the institutional environment may substantially constrain their capacity to act on these intentions. Targeted interventions may benefit from addressing systemic barriers, such as supply chains and clinical guidance, alongside rather than instead of attitude-focused approaches.
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.
Most research on suicide focuses on the progression toward lethal action. Fewer studies have looked at individuals' past experiences with the desire to die and why they did not die by suicide. Moreover, the existing use of reasons to live in assessment and treatment is generally grounded in inventories of questions that, while groundbreaking and well validated, were developed decades ago and without a focus on individuals' lived experiences. In this study, an online user's query to formerly suicidal people on the popular Reddit platform afforded a novel opportunity to investigate reasons people lived in a large, naturally occurring sample of 16,648 self-reports about their experiences. Using a new method for computer-assisted qualitative content analysis, we identify categories, and themes organizing those categories, that affirm prior work and also provide new perspectives on that work, as well as suggesting connections between ideas in the literatures on reasons people die, reasons people live, and subjective and psychological well-being. The study highlights the value of computer-assisted methods as a way of achieving both scale and interpretable results, and it identifies a number of theoretical and clinical avenues for further investigation.
Adolescents and young adults (AYAs) in Ethiopia face multiple challenges in accessing sexual and reproductive health (SRH) services. Understanding the barriers and facilitators to SRH service uptake is essential for designing tailored interventions. Therefore, this study aimed to explore barriers and facilitators to SRH service uptake from the perspectives of AYAs and stakeholders in southern Ethiopia. We conducted a qualitative study in the Sidama region, Southern Ethiopia using focus group discussions (FGDs) with AYAs recruited from schools, communities, and a non-governmental organisation. A supplemental FGD was conducted with government officials, clinicians and SRH experts to capture stakeholder perspectives. The FGD was conducted in the national language (Amharic), which was then transcribed and translated into English for analysis. A thematic content analysis was used to present emerging themes in the FGDs. A ranking of barriers and facilitators was conducted to identify the most influential factors for SRH service uptake. NVivo 15 was used for data management and organisation for the thematic analysis. Nine FGDs were conducted with 56 AYAs and seven experts, with each FGD comprising 6-8 participants. We identified four major themes: 1) health system and policy environment, 2) service access and delivery, 3) user experience and outcomes, and 4) sociocultural and economic determinants. Participants ranked service quality, cost, and privacy higher in their influence on determining SRH service uptake. Stigma, religious beliefs, poverty, and urban migration were also identified as barriers to SRH service access among AYAs. SRH service uptake among AYAs was shaped by their interconnected health system and policy environment; service access and delivery; user experiences and outcomes, and sociocultural and economic determinants. Barriers and facilitators from service access and delivery theme such as service quality, privacy and health system factors such as cost emerged as the most influential drivers shaping service uptake. Policy and programme efforts should consider improving service quality, strengthening confidentiality, and reducing financial barriers. The findings may also inform future quantitative research examining AYAs' preferences for SRH service. Young people in Ethiopia often face challenges when accessing sexual and reproductive health (SRH) services. These challenges may include poor service quality, lack of privacy, high costs, and cultural and economic barriers. This study examined at what helps or prevents adolescents and young adults (AYAs) from using SRH services and explored which service features matter most to them.We conducted focus group discussions (FGDs) in the Sidama region with 56 young people from schools, communities, and a charitable organisation working with children and young people. We also conducted an FGD with seven stakeholders, including government officials and healthcare providers, to explore their views. The FGDs were conducted in Amharic, and audio recorded. The recordings were transcribed and translated into English. Common ideas and patterns were then organised into themes.We identified four major themes that are important to young people’s uptake of SRH services: 1) health system and policy environment, 2) service access and delivery, 3) user experience and outcomes, and 4) sociocultural and economic determinants. The most important factors influencing whether young people used SRH services were service quality, privacy, and cost. Stigma, religious beliefs, poverty, and urban migration further hindered access to SRH services.We recommend that efforts to improve SRH service use among AYAs consider service quality, privacy, and affordability, alongside broader social and economic barriers. These findings may inform future research and support policy and programme design to better align SRH services with the needs and preferences of AYAs in Ethiopia.
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.
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.
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.
Severe pre-eclampsia is managed by using magnesium sulphate (MgSO4) to prevent its progression to eclampsia, with a success rate of more than 50%. Blood levels of Magnesium following initiation of the MgSO4 are key in ensuring effective management of severe pre-eclampsia while preventing toxicity. This study aimed at establishing reliable data pertaining to factors influencing the pharmacologic serum concentration of magnesium and their association to obstetric outcomes. This analytical cross-sectional study was carried out at the Iringa regional referral hospital for six months from November 2023 to April 2024. Due to the limited cases and study duration, a purposeful sampling technique was used to recruit 121 women with severe pre-eclampsia. Recruited women were tested for serum magnesium at admission, 4 and 12 hours after initial administration of MgSO4. IBM SPSS version 29 was used for analysis, where continuous variables were summarized using the median and interquartile range, while categorical variables were summarized using frequency and percentages. The associations between variables were determined using chi-square tests, univariate, and multivariable logistic regression models. A p value<0.05 was considered statistically significant. he proportion of women who attained none-therapeutic serum Mg at 4 hours was 38.8%, with a median of 1.9±1.02 IQR Mmol/L. Multivariable logistic regression showed that; low serum Mg at admission [p<0.001, OR= 9.17, 95% CI (3.07- 27.37)], high creatinine level [p = 0.012, OR= 4.49, 95% CI (1.38- 14.6)], overweight [p = 0.002, OR= 5.52, 95% CI (1.83- 16.68)] and proteinuria +++ [p-value = 0.004, OR= 7.13, 95% CI (1.84- 26.86)] were significantly associated with subtherapeutic level. After adjusting for other factors, it was found that subtherapeutic levels [p<0.001, OR=25.44(5.73-112.90)], elevated creatinine [p=0.040, OR=3.59(1.66-12.15)], and reduced urine output [p=0.001, OR=6.69(2.15-20.90)] were significant predictors of adverse maternal outcomes. A large proportion of women with severe pre-eclampsia were observed to have low serum magnesium concentration at admission prior to the administration of the loading dose of MgSO4. Subtherapeutic serum concentration of magnesium is associated with unfavorable obstetric outcomes.
The education sector is among the sectors most affected by the COVID-19 pandemic. Nursing students experienced different education models during the pandemic and the normalization process. This qualitative study explored the experiences of nursing students in Türkiye regarding online, hybrid, and face-to-face teaching models during the COVID-19 pandemic and the normalization process, aiming to identify the challenges, opportunities, and implications for nursing education practice and policy. Data were collected through semi-structured interviews with 13 third- and fourth-year nursing students and analysed using Graneheim and Lundman's qualitative content analysis approach within a qualitative descriptive design. Nursing students aged 18 years or older who had been enrolled in the third and fourth grades, had both traditional face-to-face and online courses, and could understand and speak Turkish were eligible to participate in the study. Snowball sampling was employed to reach the target population. The main themes identified were (1) challenges of online learning (social isolation, technical difficulties, task overload), (2) opportunities for online learning (flexibility, self-management, access to resources), and (3) adaptation to the new normal (valuing face-to-face teaching, integrating technologies, regaining confidence in clinical learning). Each theme is discussed separately in this study. The findings of this study emphasize the need to integrate the best practices of online, hybrid, and face-to-face teaching to create a more adaptable and student-centered learning environment. Nursing education institutions should invest in technological infrastructure, teacher training, and student support strategies to optimize the learning experience in all teaching models. Not applicable.
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.
This study examines the perceptions and lived experiences of cannabis business operators in Bangkok as they navigated Thailand's rapid transition from decriminalization in 2022 to a subsequent medical-only regulatory reversal. Using a qualitative design, the researchers conducted semi-structured in-depth interviews with 13 key informants in Bangkok between 2024 and 2025. Participants included retail shop operators (n = 8), farm operators (n = 3), and policy advocates (n = 2). Data were analyzed using the six-phase Thematic Analysis framework supported by ATLAS.ti Version 21. Five primary themes emerged: (1) Navigating Regulatory Unpredictability and Legal Uncertainty; (2) Structural Inequity and Enforcement Disparities; (3) Market Segmentation and Economic Drivers; (4) Adaptation and Survival Strategies; and (5) Socio-Cultural Perceptions and Public Health. Analysis revealed that while international tourists comprise approximately 60% of the market, domestic customers (40%) are primarily motivated by therapeutic needs. Furthermore, the study synthesized six domains for evidence-based policy, including regulatory formalization, equity promotion, and sustainable cannabis tourism development. The findings highlight that regulatory instability and the absence of a comprehensive Cannabis and Hemp Act place a disproportionate burden on small Thai operators, creating structural inequities. Additionally, in the absence of formal public health infrastructure, operators have emerged as informal harm reduction actors through proactive customer education and safety guidance. These results offer actionable insights for other jurisdictions navigating similar cannabis policy transitions.
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.
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.