State Medicaid programs have widely adopted coverage of services delivered by credentialed peer support specialists (PSSs), but no comprehensive analysis of state variations in credentialing requirements exists. State-level variation is important because it affects care delivery as well as PSS workforce development and mobility across states. This study aimed to characterize PSS credentialing requirements in 40 states with Medicaid coverage of peer support services for substance use disorder in 2024. State PSS credentialing requirements were identified with a structured systematic search protocol. Information was abstracted and summarized for 10 credentialing components: minimum age for certification, lived experience with substance use, criminal background check, minimum education level, minimum training hours, prior work experience, examination, certification validity period, continuing education, and certification fees. State PSS credentialing requirements varied considerably. Most states required lived experience with substance use (95%), a high school diploma or equivalent (85%), and an examination (95%). Fifty-five percent required a minimum age for certification, and 33% required a background check. Training requirements ranged from 30 to 80 hours, and prior work experience requirements ranged from 40 to 1,000 hours. Certification validity periods ranged from 1 to 4 years, and continuing education requirements ranged from 8 to 40 hours. States listed up to four separate certification costs, including a recertification fee ranging from $15 to $200. Although states included some common credentialing requirements, such as training and examination, considerable cross-state variation was found, highlighting the need for greater evaluation of credentialing models, improved transparency in requirements, and harmonization across states.
The increasing volume and complexity of orthopedic surgery have expanded the involvement of ward-based registered nurses in postoperative wound care. Although registered nurses receive foundational wound care education as part of their professional preparation, those without specialist wound care credentials may encounter challenges when managing complex orthopedic surgical wounds. Their experiences, role boundaries, and perceived support needs remain insufficiently explored. This study aimed to explore ward-based registered nurses' perceptions of their roles and professional boundaries in orthopedic surgical wound management and to identify perceived strategies for supporting their practice. A descriptive qualitative study was conducted in an orthopedic ward of a tertiary hospital in China. Fourteen ward-based registered nurses were purposively recruited and participated in semi-structured interviews. Data were analysed using Braun and Clarke's thematic analysis approach. Four themes were identified: negotiating professional boundaries within clinical hierarchies, evolving role identity in orthopedic surgical wound care, developing professional capacity for safe and responsive wound management, and sustaining practice development through continuing education and organizational support. Participants described surgical wound care as an expanding but ambiguously defined area of nursing practice. Their accounts highlighted a mismatch between foundational wound care education and the demands of complex orthopedic surgical wounds, variability in physicians' treatment preferences and local ward routines, limited decision-making authority, and inconsistent interprofessional collaboration. Participants also emphasized the importance of timely nursing involvement, clinically relevant continuing education, standardized protocols, and clearer escalation pathways for supporting safe and coordinated wound care. Ward-based registered nurses without specialist wound care credentials make important contributions to orthopedic surgical wound management through ongoing assessment, timely dressing care, patient education, and communication with physicians and wound care specialists. However, their expanding role is shaped by unclear professional boundaries, variable local practices, limited authority in wound-related decision-making, and uneven access to continuing education. Clearer role delineation, standardized protocols, structured continuing education, and collaborative escalation pathways are needed to support safe and consistent wound care.
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This study aimed to examine ongoing gaps in clinical nursing faculty preparation and identify evidence-based strategies to strengthen orientation, mentorship, and credentialing. Clinical educators, particularly adjunct and part-time faculty, are central to translating classroom learning into practice, yet the literature consistently reports limited structured support and professional development for these roles. This review examined 21 peer-reviewed studies published from 2009 to 2025 and identified recurring themes. Reports from professional organizations and national competency frameworks, including the American Association of Colleges of Nursing Essentials, the Quality and Safety Education for Nurses competencies, and the National League for Nursing certification standards, were also reviewed. Four themes emerged: inconsistent orientation, limited mentorship, minimal use of credentialing frameworks, and fragmented collaboration across academic and professional groups. Standardized orientation, sustained mentorship, and accessible credentialing supports are needed to strengthen teaching quality, support faculty retention, and prepare clinical educators for contemporary practice.
Nursing quackery; the unlicensed practice of nursing by unqualified individuals poses a major threat to patient safety and nursing integrity in Nigeria. Despite a regulatory council, systemic enforcement failures continue to enable imposters to operate countrywide. To examine perceptions of nursing quackery in Nigeria, assess registered nurses' professional values, professionalism, trust, and ethical practice, and identify predictors of quackery awareness. A cross-sectional survey of 618 registered nurses recruited across all six Nigerian geopolitical zones used multistage sampling. Data were collected using the Nigerian Nursing Professionalism and Quackery Assessment Tool (NNPQAT), adapted from the Nurses' Professional Values Scale-Revised (NPVS-R), Hall's Professionalism Scale, the Trust in Nurses Scale, and the Ethical Behaviour Rating Scale. Chi-square tests, Spearman's rho correlations, and multiple linear regression were performed using SPSS version 29. Participants demonstrated high professional values (M = 4.76, SD = 0.44), professionalism (M = 4.76, SD = 0.58), ethical practice (M = 4.84, SD = 0.59), and trust (M = 4.53, SD = 0.59). Quackery awareness was widespread (M = 4.53, SD = 0.58); 96.1% agreed quackery threatens patient safety and 97.1% agreed it damages public trust. Awareness did not vary by region (χ2 = 2.25, p = 0.814) or facility type (χ2 = 0.18, p = 0.915). Ethical practice (ρ = 0.421, p < 0.001) and trust (ρ = 0.361, p < 0.001) were the strongest correlates. Regression identified ethical practice (β = 0.541, p < 0.001) and trust (β = 0.215, p < 0.001) as the only significant predictors (R2 = 0.511); years of experience, professionalism, region, and facility type were non-significant. Nigerian registered nurses exhibit strong professional values, yet quackery persists as a system-level failure rooted in regulatory weakness rather than individual professional deficit. Ethical practice functions as professional vigilance, heightening sensitivity to quackery. Strengthening Nursing and Midwifery Council of Nigeria (NMCN) enforcement, investing in ethics education, and developing public awareness campaigns are essential to protect patients and preserve professional integrity. These findings call for heightened regulatory vigilance among registered nurses, nurse educators, and healthcare administrators in identifying and reporting suspected nursing quackery. Pre-registration and continuing professional development curricula should embed ethics education that develops professional vigilance, recognising that ethical orientation, not seniority or years of experience, is the strongest driver of quackery awareness. Clinical and educational leaders should establish routine credential verification practices at ward and facility level, supported by safe, protected reporting mechanisms for nurses who identify unqualified colleagues. Nurse educators are encouraged to incorporate public awareness content into community health teaching, equipping the public to verify nursing credentials and recognise warning signs of fraudulent practice. These actions are relevant across all facility types and regions, given the uniform national distribution of quackery awareness identified in this study. This study did not involve patients, service users, caregivers, or members of the public in its design, conduct, data analysis, or manuscript preparation. The study population comprised registered nursing professionals only, recruited as expert informants on the phenomenon of nursing quackery in Nigeria. Patient and public involvement was not applicable to this study.
The rapid expansion of theranostics has increased the stress felt by many nuclear medicine departments. One significant challenge relates to the training of nuclear medicine technology students in new therapy procedures during a time when protocols and expectations are in flux. Nuclear medicine technologist education programs are being asked to graduate fully functional theranostics technologists before the resources for such training are available in the clinical sphere. This article describes the basic parameters under which education programs operate, namely the national scope of practice, programmatic accreditation standards, and credentialing examination content. The approaches and limitations of several programs around the country are presented. Despite considerable variability in the extent of student participation in theranostic procedures, the foundational elements of their nuclear medicine education remain firmly in place and reliable. Graduates will learn the specifics of each procedure in the workplace, as happens with already-credentialed nuclear medicine technologists.
To describe the prevalence of clinical exercise physiologists (CEPs), hiring criteria, and job tasks in early outpatient cardiac and pulmonary rehabilitation (CR/PR) programs in the United States. In this cross-sectional study, a survey was sent by the American Association of Cardiovascular and Pulmonary Rehabilitation to CR/PR program leaders. Data were analyzed using descriptive statistics. Among 311 programs, 96% (n = 297) offered CR, 71% (n = 222) offered PR, and CEPs were the most frequently reported staff in both CR (86%; n = 256) and PR (83%; n = 185). Staff were exclusively CEPs in 10% (n = 30) of CR and 5% (n = 12) of PR. Hiring criteria for CEPs were a bachelor's degree in 92% (n = 240) and a master's in the remaining programs. Advanced Cardiac Life Support certification was required before or within 1 year of hire in 70% (n = 183) of programs. The American College of Sports Medicine Clinical Exercise Physiologist (ACSM-CEP) credential was required before or within 1 year of hire in 24% (n = 62) of programs. In 75% (n = 196) of programs, CEPs were responsible for the majority (≥23 of 29) of job tasks that are common to CR/PR. Clinical exercise physiologists serve integral roles in CR/PR programs in the United States with job responsibilities that allow them to work at the top of their scope of practice in many programs. Underutilization of CEPs at some institutions might be improved by better understanding the variability in academic preparation and the importance of the ACSM-CEP credential.
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.
Extracorporeal membrane oxygenation (ECMO) is a complex, high-risk therapy requiring interdisciplinary expertise and structured education to optimise patient outcomes. International experts recommend standardised, structured ECMO education, incorporating simulation, to support competency across clinician groups. To evaluate changes in intensive care unit (ICU) clinicians' self-reported ECMO knowledge, confidence and skills after participation in a 1-day ECMO interdisciplinary simulation workshop. A retrospective study of pre- and post-survey evaluation data from ECMO simulation workshops delivered at a metropolitan quaternary adult hospital (2014-2019). Participants (registered nurses, medical officers, perfusionists and physiotherapists) self-rated their knowledge of veno-venous (VV) and veno-arterial (VA) ECMO, confidence in providing regular care and emergency management of ECMO in the ICU, and ECMO circuit problem-solving skills on Likert-type scales [1 = lowest (worst possible/most negative), 9 = highest (best possible/most positive)]. Paired t-tests compared pre- and post-scores and were stratified by clinician group. Free-text response data were thematically analysed. Matched pre- and post-workshop evaluations were analysed (n = 275) across 20 ECMO simulation workshops (99% response rate). Most participants (65%) were self-rated novices at baseline. Significant improvements across all individual domains (p < 0.001) were measured: Clinicians' self-rated knowledge of VV-ECMO (3.63-6.59; mean change 2.95, 95% CI, 2.78-3.12) and VA-ECMO (3.44-6.41; mean change 2.97, 95% CI, 2.80-3.14) as well as confidence in routine ECMO management (3.24-6.31; mean change 3.07, 95% CI, 2.88-3.25) and emergency management (2.42-6.09; mean change 3.68, 95% CI, 3.49-3.87) plus ECMO circuit skills (2.41-6.10; mean change 3.69, 95% CI, 3.50-3.89). Registered nurses demonstrated the greatest improvements in most domains. Themes corroborated workshop effectiveness. These findings support incorporating interdisciplinary, simulation-based ECMO education into credentialing and continuing education frameworks, particularly for nurses. Future research should examine how workshop participation translates into sustained learning retention, meaningful changes in clinical practice and improved patient-centred outcomes. The findings indicate that the single-day, simulation-based ECMO workshop improved ICU clinicians' self-reported ECMO knowledge, confidence and skill, particularly in managing emergencies and circuit-related complications. All workshop domains were considered appropriate for nurses' ECMO learning. The workshop's interdisciplinary format supports its inclusion in local ECMO credentialing pathways, alongside supervised clinical practice and ongoing education.
Assisted Reproductive Technologies (ART) demand rigorous quality standards to ensure clinical safety, efficacy, and ethical responsibility. This review outlines key elements of Quality Management Systems (QMS) in ART laboratories, addressing technical, infrastructural, regulatory, and human dimensions essential to successful outcomes. Core components include standardized protocols, validation and maintenance of equipment, environmental monitoring, biosafety procedures, and robust traceability. Laboratory infrastructure must meet ISO cleanroom standards to support the microenvironment necessary for gamete and embryo viability. Biosafety in ART requires BSL-2 compliance, risk zoning, personal protective equipment, proper waste disposal, and comprehensive training, including ergonomic and psychological safety measures. Personnel qualification is essential, requiring academic credentials, continuing education, and structured competency assessments. Equipment such as incubators and cryogenic tanks must undergo regular validation, given their direct impact on embryo development. Performance indicators (KPIs), including fertilization, blastocyst formation, and cryosurvival rates, serve as benchmarks for quality improvement. Documentation and traceability systems must track all clinical and laboratory stages, supported by electronic platforms and witnessing systems. Regulatory adherence and accreditation by agencies reinforce institutional reliability and transparency. Ethical compliance remains foundational, including informed consent, embryo disposition policies, and data confidentiality. While the implementation of a comprehensive QMS involves significant investment, it yields measurable benefits: improved clinical outcomes, error reduction, enhanced patient satisfaction, and long-term sustainability. Quality management in ART is thus not only a regulatory mandate but a strategic imperative that aligns technological precision with ethical and clinical excellence.
The additional qualifications "Special Orthopaedic Surgery" and "Special Trauma Surgery" are well-established and recognised credentials for specialised care within the field of orthopaedics and trauma surgery. However, given the increasing prevalence of subspecialised care structures, the question arises as to whether the content and requirements of these additional qualifications remain up to date and relevant to clinical practice.The aim of this study was to conduct a systematic analysis of the content and requirements based on the Model Training Regulations (MWBO) of the German Medical Association (BÄK) from 2003 and 2018, as well as the current training regulations (WBO) of all regional medical chambers (LÄK). The number and types of required surgical procedures were examined, along with their distribution across subspecialised areas such as endoprosthetics, spine surgery, shoulder and elbow surgery, and foot and ankle surgery.The analysis reveals a general reduction in the total number of required surgical procedures in both additional qualifications and considerable harmonisation of requirements across regional chambers. In the "Special Orthopaedic Surgery" qualification, up to 49% of procedures involve endoprosthetics, particularly of the lower extremity. In contrast, subspecialised fields such as shoulder and elbow or foot and ankle surgery are underrepresented, despite their growing importance in clinical practice. Furthermore, modern minimally invasive techniques such as arthroscopy are still scarcely addressed.To address the gap between training content and the realities of clinical care-and to ensure high-quality training and long-term healthcare provision-reform of the current training regulations is needed. The Introduction of defined subspecialty tracks, such as shoulder and elbow surgery or foot and ankle surgery, could offer more differentiated and practice-oriented training, and help to ensure high-quality patient care in the future. Die Zusatzweiterbildungen „Spezielle Orthopädische Chirurgie“ und „Spezielle Unfallchirurgie“ gelten als etablierte und anerkannte Qualifikationen für die spezialisierte Versorgung innerhalb der Orthopädie und Unfallchirurgie (O&U). Angesichts zunehmend subspezialisierter Versorgungsstrukturen stellt sich jedoch die Frage nach der Aktualität und Praxisrelevanz der inhaltlichen Anforderungen dieser Zusatzqualifikationen.Ziel dieser Arbeit war eine systematische Analyse der Inhalte und Anforderungen auf Basis der Musterweiterbildungsordnungen (MWBO) der Bundesärztekammer (BÄK) von 2003 und 2018 sowie der aktuellen Weiterbildungsordnungen (WBO) aller Landesärztekammern (LÄK). Untersucht wurden sowohl Anzahl und Art der geforderten operativen Eingriffe als auch deren Verteilung auf subspezialisierte Themenbereiche wie die Endoprothetik, Wirbelsäulenchirurgie, Schulter- und Ellenbogenchirurgie sowie Fuß- und Sprunggelenkchirurgie.Die Analyse zeigt eine allgemeine Reduktion der geforderten operativen Eingriffe in beiden Zusatzweiterbildungen sowie eine weitgehende Vereinheitlichung der Anforderungen zwischen den LÄKs. In der Zusatzweiterbildung „Spezielle Orthopädische Chirurgie“ entfallen bis zu 49% der Eingriffe auf die Endoprothetik – insbesondere an der unteren Extremität. Demgegenüber sind subspezialisierte Bereiche wie Schulter- und Ellenbogenchirurgie oder Fuß- und Sprunggelenkchirurgie unterrepräsentiert, obwohl diese in der klinischen Praxis zunehmend an Bedeutung gewinnen. Auch moderne minimalinvasive Verfahren wie die Arthroskopie finden bislang kaum Berücksichtigung.Um die Diskrepanz zwischen den Weiterbildungsinhalten und der Versorgungsrealität zu verringern und sowohl die Qualität der Weiterbildung als auch die Versorgungssicherheit nachhaltig zu stärken, ist eine inhaltliche Reform der Weiterbildungsordnungen erforderlich. Die Einführung definierter Schwerpunkte – etwa in der Schulter- und Ellenbogenchirurgie oder der Fuß- und Sprunggelenkchirurgie – könnte eine differenziertere und praxisnähere Qualifikation ermöglichen und so zur langfristigen Sicherstellung einer qualitativ hochwertigen Patientenversorgung beitragen.
This study sought to examine differences in nursing-sensitive patient outcomes among Magnet® hospitals, Pathway To Excellence® (PTE) hospitals, and non-American Nurses Credentialing Center's (ANCC®) designated hospitals. The ANCC Magnet Recognition Program® and PTE Program provide frameworks that foster nursing excellence, although limited research has examined the differences of nursing-sensitive patient outcomes among recognition programs. A cross-sectional comparative analysis was conducted using 2023 data from the National Database of Nursing Quality Indicators® (NDNQI). Magnet hospitals reported significantly lower fall rates compared with non-ANCC hospitals (P=0.01). PTE hospitals exhibited significantly lower central line-associated bloodstream infection rates than non-ANCC hospitals (P<0.04). No statistically significant differences in catheter-associated urinary tract infection rates or hospital-acquired pressure injury prevalence were observed. ANCC designations were inconsistently associated with better nurse-sensitive patient outcomes in this study. The absence of consistent differences across outcomes may reflect unbalanced sample distribution across designation groups in this sample.
Multiple-choice questions are the primary assessment format for neurosurgical board certification. Creating high-quality examination questions requires significant expert time and resources. The goal of this study was to develop an automated system to generate board-style neurosurgical multiple-choice questions using state-of-the-art vision-language models and compare their quality with authentic self-assessment questions. We developed an automated pipeline using OpenAI generative pre-trained transformer (GPT)-4o and Anthropic Claude Sonnet-3.5 to generate neurosurgical board-style questions from Neurosurgery Publications articles. We generated 89 587 synthetic questions: 45 689 with GPT-4o and 43 898 with Claude. Each question was associated with a single image extracted from the articles' figures. We evaluated the quality of synthetic questions through 5 surveys comparing 20 synthetic questions (10 from each model) with 10 authentic questions from the Self-Assessment for Neurological Surgeons (SANS) question bank. Each survey was completed by a neurosurgery resident and an attending who guessed the source [human vs artificial intelligence (AI)-generated] and rated suitability for board examination use. We also evaluated the question-answering performance of the generalist GPT-4o and the specialized CNS-Obsidian. SANS questions were more often perceived as human-made than GPT-generated (residents, P = .0002; attendings, P = .1091) and Claude-generated (residents, P = .0002; attendings, P = .0272) questions. Notably, 54% of AI-generated questions misled at least one evaluator, and 23% misled both. In quality assessments, SANS questions outperformed GPT-generated (residents, P < 10-5; attendings, P = .0001) and Claude-generated (residents and attendings, P < 10-5) questions. Particularly, 25% of AI-generated questions were rated as suitable for board examinations vs 72% of human-generated questions when measured by evaluator consensus (P < 10-7). Although quality gaps exist between AI-generated and human-created neurosurgical board examination questions, our approach demonstrates the potential of vision-language models to augment assessment development in specialized medical fields, reducing the burden on examination boards and credentialing organizations.
Tumor-infiltrating lymphocyte (TIL) therapy, which involves extracting, expanding, and reinfusing immune cells to target cancer cells, has shown promise in melanoma treatment, but requires optimization for broader efficacy. The success of TIL therapy depends on the recognition of tumor-associated antigens, but neoantigen-reactive T-cells are often rare and exhausted in less immunogenic malignancies. Isolating T cells enriched in neoantigen reactivity prior to in vitro expansion and reinfusion may improve the response rates. To this end, our proprietary Specific Neo-Antigen Peptides (SNAP™) technology platform improves the accuracy of neoantigen prediction and validation by combining advanced computational modelling and PepSeq, a high-throughput screen for the physical credentialing of putative neoantigens based on their affinity to bind patient-specific HLA class II proteins. This approach allows for the education and enrichment of TILs (SNAP-TILs) with personalized, predefined, highly immunogenic neoantigens prior to expansion. Using the SNAP platform, we consistently achieved, on average, a SNAP-TIL product comprising 96% CD3+ cells, with a mixture of 75% effector and 23% central memory cells. SNAP-TILs exhibited greater efficacy and selectivity in immune infiltration than TIL, which was expanded by the rapid expansion protocol alone using ex vivo models. SNAP-TIL was also reactive in highly and poorly immunogenic tumors, with 70% and 50% tumor growth inhibition in melanoma and pancreatic patient-derived xenograft models, respectively. This study demonstrates the novel benefit of our Personalized Neoantigen Pipeline approach, potentially providing a durable antitumor immune response for a larger proportion of cancer patients.
Lactational mastitis is a prevalent postpartum infection that significantly impacts maternal health and the continuation of breastfeeding. While TikTok has emerged as a major platform for health information dissemination, concerns persist regarding the scientific quality and reliability of its content. To date, a systematic evaluation of lactational mastitis-related videos on this platform is lacking. To evaluate the characteristics, content completeness, quality, and reliability of Chinese TikTok videos on lactational mastitis. A cross-sectional content analysis was conducted on videos related to lactational mastitis on TikTok (Douyin). Between October 26 and 30, 2025, the top 150 videos returned under the default ranking were consecutively screened, of which 124 met the eligibility criteria and were included in the analysis. We used the Global Quality Score (GQS) to evaluate overall educational value, flow, and usefulness, and the modified DISCERN (mDISCERN) to assess information reliability and traceability; both are widely used and validated instruments for assessing online health information. Data were analyzed using descriptive statistics, group comparisons (Kruskal-Wallis), and Spearman correlations (two-sided p < 0.05) in R 4.3.2. Of 150 consecutively retrieved videos, 124 met the eligibility criteria. Videos were brief (median 68.00 s; IQR 42.00-111.75) and highly engaging, but overall educational quality and reliability were low, with median GQS and mDISCERN scores of 2.00 (IQR 2.00-3.00) and 3.00 (IQR 2.00-4.00), respectively. Content emphasized precipitating factors, clinical presentation, and treatment, whereas epidemiology and diagnosis were least covered; 83.9% of videos mentioned neither. Healthcare professionals scored higher than nonprofessionals on both GQS and mDISCERN (both p < 0.05). Video duration was weakly positively correlated with GQS (r = 0.35, p < 0.001), whereas engagement metrics were not meaningfully associated with GQS or mDISCERN (all ∣r∣ ≤ 0.18, p ≥ 0.05). The overall quality and reliability of TikTok videos on lactational mastitis are suboptimal. Future efforts should prioritize improving content completeness and scientific rigor; fostering greater participation by qualified health professionals; and promoting transparent citation of sources, clear disclosure of credentials and conflicts of interest, and routine updates to reflect current evidence. Educational interventions and authoring guidance tailored to short-video formats may further support accuracy and clarity for lay audiences.
Social media has become an important source of orthodontic information, yet patient experience content varies in completeness and may shape treatment expectations. This study evaluated information completeness, comment sentiment, and engagement patterns in orthodontic experience content on three major Chinese social media platforms. A cross-sectional sample of 180 eligible posts was collected from Bilibili, Douyin, and Xiaohongshu using two search terms, "orthodontic experience" and "braces diary." Information completeness was assessed using a modified 6-point Information Completeness Score (ICS). Comment sentiment and title sentiment were quantified using sentiment analysis scores (SAS). Engagement metrics, including likes, favorites, shares, and comments, were recorded. Platform differences and subgroup differences by appliance type, treatment population, video duration, and video age were analyzed. Inter-rater reliability for total ICS was excellent (ICC (3,1) = 0.954). The automated SAS classifications showed strong agreement with the human consensus gold standard, with an overall accuracy of 91.6% (κ = 0.848). ICS differed significantly across platforms (H = 40.70, p < 0.001), with Bilibili showing the highest score (3.53 ± 1.46) and Xiaohongshu the lowest (1.78 ± 1.24). Treatment details and treatment duration were the most frequently mentioned dimensions, whereas clinician or institution credentials and cost were least frequently covered. Title sentiment showed a statistically significant but weak positive correlation with comment sentiment in the full sample (rho = 0.247, p < 0.001), with platform-specific variation. Engagement indicators were strongly intercorrelated (rho = 0.69-0.87), but ICS showed no meaningful correlation with engagement. Longer videos, clear aligner content, adult orthodontic content, and older videos had higher ICS, whereas SAS varied only slightly across groups. Orthodontic patient experience content on Chinese social media shows substantial variation in information completeness. High engagement does not necessarily indicate high information quality. Professional orthodontic content should provide balanced information on treatment benefits, risks, costs, duration, and professional sources to support informed patient decision-making.
The twin transition requires a profound reconfiguration of human capital, yet substantial misalignments persist between the rapidly evolving skill requirements of industry and the comparatively slower pace of curriculum reform within Higher Education Institutions (HEIs). Although the need for professionals equipped with complex skill sets to navigate the twin transition is widely acknowledged, empirical evidence on how to practically operationalise the development of professionals with this skill set remains scarce. Moreover, there is a lack of replicable methodologies for fostering academic demand-driven collaboration between universities and industry. This paper addresses this gap using an explanatory sequential mixed-methods approach, combining a quantitative analysis of online job advertisements data (2018-2024) with qualitative themes from industry stakeholders in Catalonia, Spain. This process first maps skills, then structures a dialogue on translating these needs into educational strategy. Our findings reveal a rising demand for hybrid professionals, where soft skills are the essential enablers of technical expertise. The analysis uncovers a central paradox: while industry is hindered by strategic uncertainty over whether to upskill its current workforce or hire new external talent, HEIs face critical capacity constraints. This study's primary contribution is the analysis of a Higher Education-Industry collaborative framework that directly addresses this impasse. It provides a practical pathway for both companies and HEIs to co-develop agile training solutions, such as micro-credentials. Our framework shows that institutional agility emerges through structured partnerships.
To address identity cloning, credential leakage, and delayed authorization in unmanned aerial vehicle (UAV) systems operating in open airspace, we propose a zero-trust authentication and authorization framework. SM9 identity-based mutual authentication establishes a traceable digital identity anchor. On-demand rotor acoustic verification then checks whether the current platform matches the registered identity. A Beta-distribution trust model converts authentication, verification, and behavioral evidence into dynamic authorization decisions. Experimental results show that the acoustic module blocks 104 of 110 spoofing samples. Under identity-cloning attacks, the attacker's trust value decreases from about 0.97 to 0.27 and falls below the isolation threshold of 0.4. Compared with continuous acoustic authentication, on-demand triggering reduces authentication activation frequency, average inference latency, and normalized energy consumption by 86.8%, 83.6%, and 83.0%, respectively. These results indicate that the framework links identity confirmation, entity verification, and continuous authorization under resource-constrained UAV conditions.
This article examines nursing professionalization in the Republic of Korea in light of two Korean laws enacted in 2024: the Nursing Act and legislation on integrated community care. Drawing on nursing professionalism and sociology of professions literature, we distinguish professionalism-the identity, knowledge, values, clinical judgment, ethics, and accountability constituting nursing practice-from professionalization, the institutional process through which nursing work gains jurisdiction, authority, legal protection, reimbursement, and social legitimacy. The Korean case shows that legal recognition creates visibility but does not by itself produce professional authority. Nursing role development in Korea is shaped by population aging, chronic illness, community-care demand, physician-delegated medical support tasks, cost-containment pressures, uneven workforce distribution, and weak reimbursement for nursing services. We argue that professionalization requires more than role expansion: it requires scope and role standards, education-credentialing alignment, legal authority and accountability, reimbursement mechanisms, nurse-led community models, and academic-practice-policy governance. The Korean case offers a theoretically useful example of the gap between statutory recognition and institutionalized professional authority.
Pancreas transplantation remains a highly specialized and life-enhancing procedure for selected patients with insulin-dependent diabetes mellitus. As national transplant volumes have declined over the past decade, many U.S. transplant centers are finding it increasingly difficult to satisfy the personnel credentialing standards established by the Organ Procurement and Transplantation Network (OPTN). These standards, designed to ensure safety and competency, require documented case volumes and training experience that are difficult to achieve in today's landscape, where most programs perform fewer than 10 pancreas transplants annually, and training opportunities are limited. This growing mismatch between regulatory expectations and real-world practice highlights the need to reassess current personnel criteria and consider more flexible, competency-based approaches that maintain quality while supporting program viability and patient access.