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Decentralized trust optimization in VANETs: A blockchain-driven hybrid PoS-PBFT architecture for enhanced security and energy-efficient communication
Vehicular Ad Hoc Networks (VANETs) are essential for the success of Intelligent Transportation Systems (ITS), providing real-time communication between vehicles and infrastructure. However, the highly dynamic and decentralized nature of VANETs introduces significant challenges in ensuring trust and security across the network, including security threats, communication overhead, and energy inefficiencies. This paper presents a novel blockchain-based trust management framework that addresses these issues by incorporating lightweight consensus mechanisms, optimized data propagation strategies, and energy-aware protocols. Our approach reduces communication overhead by selectively propagating trust updates, leading to a 35% decrease in overall network traffic compared to traditional broadcast-based systems. In terms of trust accuracy, our model achieves over 95% accuracy in detecting malicious nodes, significantly outperforming existing solutions. The proposed system demonstrates the identification and penalization of malicious behaviors such as Sybil attacks and false reporting with a 25% improvement in detection rate, while maintaining low latency (an average reduction of 30% compared to PoW-based systems) and efficient energy consumption, reducing energy use by up to 40%. The proposed model also incorporates a hybrid Proof of Stake (PoS) and Practical Byzantine Fault Tolerance (PBFT) consensus mechanism, which further enhances its scalability and fault tolerance. Simulation results show that our framework converges to accurate trust values faster than traditional methods, ensuring that reliable trust evaluations are made in real-time, even under high mobility conditions. The combination of these optimizations ensures that our framework is not only secure but also highly efficient, capable of supporting scalable and resilient VANET deployments. Furthermore, our decentralized approach ensures that trust decisions are made in real-time without the need for a centralized authority, making the system more adaptable to the high-mobility conditions of VANETs. This research offers a comprehensive solution for VANETs trust management, significantly improving communication efficiency, trust accuracy, and energy consumption while maintaining robust security and scalability. Our proposed blockchain-based trust management system provides a secure, energy-efficient, and scalable solution for VANETs, setting the stage for future developments in secure vehicular communication networks.
Reduction of noise pollution in CNC wood milling through multi-parameter optimization using response surface methodology
Background CNC (Computer Numerical Control) wood milling machines offer significant productivity advantages but are associated with excessive noise pollution, posing health risks to workers. This study investigates the influence of machining parameters on Noise Pollution Level (NPL) in CNC wood milling and aims to optimize these parameters to minimize noise emissions. Methods A Response Surface Methodology (RSM) based on Box-Behnken Design (BBD) was employed to model the effects of cutting speed, feed rate, depth of cut, and step over on NPL. A total of 27 experimental runs were conducted. Statistical analysis, including ANOVA and regression modeling, was performed to determine the significance of each parameter. The model was further optimized using a Genetic Algorithm (GA). Results The NPL observed across experiments ranged from 97.4 dB to 103.8 dB, with all values exceeding the NIOSH recommended limit of 85 dB. ANOVA results revealed that cutting speed, cutting speed squared, feed rate, and depth of cut had a statistically significant effect on NPL (p < 0.05). The regression model showed a high degree of fit (R² = 0.945). Optimal parameters—cutting speed of 12,730 rpm, feed rate of 58 mm/s, depth of cut of 3.2 mm, and step over of 6.4 mm—were identified using GA, resulting in a predicted NPL of 96.2 dB, which closely matched the experimentally validated value of 95.8 dB. Conclusion The study confirms that NPL in CNC wood milling can be significantly reduced by optimizing machining parameters. The integration of RSM and GA provides a reliable framework for minimizing occupational noise exposure, thereby enhancing worker safety in woodworking environments.
Association between fusion and clinical outcomes after anterior cervical discectomy at 1-, 2- and 5-year follow-up
Introduction Fusion achievement is considered a crucial factor in recovery following anterior discectomy. Nevertheless, the direct correlation between fusion and clinical outcomes, such as pain and disability, remains ambiguous due to inconsistent fusion measurement methods. Recent advancements in diagnostic fusion criteria now enable a more accurate fusion assessment. This study aimed to assess the association between fusion and clinical outcomes in patients undergoing anterior cervical discectomy. Methods This post-hoc analysis was conducted using data from the NEtherlands Cervical Kinematics (NECK) trial (NTR1289). Patients with a single level herniated disc that underwent anterior cervical discectomy between 2010 and 2014 were evaluated at 52, 104, and 260 weeks. Fusion was assessed using dynamic radiographs, applying the de Vries-Vleggeert criterion (≤3.0° Cobb angle and ≤2.0 mm interspinous distance). Clinical outcomes included the Neck Disability Index (NDI) and Visual Analog Scale (VAS) for arm and neck pain. Linear and logistic regressions were performed to evaluate correlations. Results Fusion was present in 57% (52 weeks), 75% (104 weeks), and 83% (260 weeks) of patients. Linear regression analyses revealed a clear trend suggesting favorable long-term VAS arm and neck pain scores in the patient’s demonstrating fusion with statistically significant lower VAS arm pain (mean difference: –18.9, 95% CI –36.9 to –0.9, p = 0.040) in the fusion group at 260 weeks follow-up. At earlier follow-up points, the differences in VAS arm pain did show a trend, but did not reach statistical significance (W52: 6.0, 95% CI –6.6 to 18.6, p = 0.346; W104: –11.5, 95% CI –24.2 to 1.3, p = 0.076). VAS neck pain scores showed a trend, but no statistically significant differences between groups across follow-up (W52: 3.2, 95% CI –8.1 to 14.5, p = 0.572; W104: –1.5, 95% CI –13.8 to 10.8, p = 0.808; W260: –12.7, 95% CI –30.9 to 5.6, p = 0.170). No significant differences were observed in NDI outcomes at any time point (W52: 3.2, 95% CI –4.8 to 11.2, p = 0.431; W104: –3.7, 95% CI –11.6 to 4.2, p = 0.358; W260: 2.5, 95% CI –7.2 to 12.1, p = 0.608). Logistic regression analysis using success rates based on established cut-off values showed a trend towards patients with fusion having markedly higher odds of success long term, with a significant higher odd of success in VAS arm pain at 260 weeks FU (OR 9.88, 95% CI 1.55–62.80, p = 0.015). Conclusion A comparative analysis indicated reduced arm and neck pain in the fusion group at the 260-week follow-up. This finding becomes apparent only in the long-term post-intervention period, suggesting that muscle tension may function as a natural brace during the initial years following surgery. This tension effectively limits excessive flexion-extension movements, thereby mitigating discomfort. These results have potential implications for routine clinical surgical practice. Future studies with larger sample sizes are needed to validate these findings, including short-term follow-up.
PRCnet: An efficient model for automatic detection of brain tumor in MRI images
Brain tumors are the most prevalent and life-threatening cancer; an early and accurate diagnosis of brain tumors increases the chances of patient survival and treatment planning. However, manual tumor detection is a complex, cumbersome and time-consuming task and is prone to errors, which relies on the radiologist’s experience. As a result, the development of an accurate and automatic tumor detection system is critical. In this paper, we proposed a new model called Parallel Residual Convolutional Network (PRCnet) model to classify brain tumors from Magnetic Resonance Imaging. The PCRnet model uses several techniques (such as filters of different sizes with parallel layers, connections between layers, batch normalization layer, and ReLU) and dropout layer to overcome the over-fitting problem, for achieving accurate and automatic classification of brain tumors. Our methodology used data augmentation techniques such as rotation, flipping, and scaling. These enhanced the diversity and quantity of the training dataset, contributing significantly to the model’s improved performance. The PRCnet model is trained and tested on two different datasets and obtained an accuracy of 94.77% and 97.1% for dataset A and dataset B, respectively which is way better as compared to the state-of-the-art models. Our PRCnet code publicly available at: https://github.com/Ahmeed-Suliman-Farhan/PRCnet-Model
A mixed-methods study to explore the modifiable aspects of treatment burden in Parkinson’s disease and develop recommendations for improvement
Background People with Parkinson’s (PwP) and their caregivers have to manage multiple daily healthcare tasks (treatment burden). This can be challenging and may lead to poor health outcomes. Objective To assess the extent of treatment burden in Parkinson’s disease(PD), identify key modifiable factors, and develop recommendations to improve treatment burden. Methods A mixed-methods study was conducted consisting of: 1) a UK-wide cross-sectional survey for PwP and caregivers using the Multimorbidity Treatment Burden Questionnaire (MTBQ) to measure treatment burden levels and associated factors and 2) focus groups with key stakeholders to discuss survey findings and develop recommendations. Results 160 PwP (mean age = 68 years) and 30 caregivers (mean age = 69 years) completed the surveys. High treatment burden was reported by 21% (N = 34) of PwP and 50% (N = 15) of caregivers using the MTBQ. Amongst PwP, higher treatment burden was significantly associated with advancing PD severity, frailty, a higher number of non-motor symptoms, and more frequent medication timings (>3 times/day). Caregivers reporting higher treatment burden were more likely to care for someone with memory issues, had lower mental well-being scores and higher caregiver burden. Three online focus groups involved 11 participants (3 PwP, 1 caregiver and 7 healthcare professionals) recruited from the South of England. Recommendations to reduce treatment burden that were discussed in the focus groups include improving communication. clear expectation setting, and better signposting from healthcare professionals, increasing education and awareness of PD complexity, flexibility of appointment structures, increasing access to healthcare professionals, and embracing the supportive role of technology. Conclusions Treatment burden is common amongst PwP and caregivers and could be identified in clinical practice using the MTBQ. There is a need for change at individual provider and system levels to recognise and minimise treatment burden to improve health outcomes in PD.
Correction: Associations between age at natural menopause and risk of hypothyroidism among postmenopausal women from the Canadian Longitudinal Study on Aging (CLSA)
Health risk realization versus warning: Impact on lifestyle behaviours
Using individual-level panel data from Understanding Society I estimate the response to a health risk realization on a healthy lifestyle index. To overcome the endogeneity of a diagnosis, I match on initial health risks. I find individuals improve their overall lifestyle healthiness when faced with a large negative health event such as a heart attack or diabetes diagnosis, interpreted as a precise signal about their health status, whereas they do not respond to a noisier signal through solely receiving information about certain health risk factors, such as a diagnosis of high blood pressure or angina (chest pain). The drivers of the overall effect are a decrease in the number of cigarettes smoked and an increase in not drinking alcohol; there is no significant effect found for either diet or exercise. I find some heterogeneity by sex, but only when looking at individual lifestyle behaviours. Overall, the findings suggest that the realization of a health risk leads individuals to improve their lifestyle behaviours, while only a noisier signal about their health risks leads to no such change.
High-protein diets reduce plasma pro-inflammatory cytokines following lipopolysaccharide challenge in Swiss Albino mice
Macronutrients serve as principal sources of energy, structural components, and regulators of physiological processes. However, the optimal macronutrient combination for health remains unclear. While previous studies indicate that dietary macronutrient composition influences immune function, many have examined individual nutrients in isolation, failing to reflect the interactive effects of macronutrients. This study addresses this gap by examining how varying ratios of dietary carbohydrates, proteins, and lipids modulate serum cytokine responses to lipopolysaccharide challenge in Swiss albino mice. Male and female Swiss albino mice (n = 6 per group), aged 6–8 weeks, were randomly assigned to six purified isocaloric diets with differing macronutrient ratios for 15 weeks. Body weights were monitored to assess nutritional status. Serum levels of TNF-α, IL-6, IL-1β, and IL-10 were measured in unchallenged mice and after three hours of intraperitoneal LPS administration. Mice fed high-carbohydrate, low-protein diets had the highest weight (33.1 g ± 1.1), while those on high-lipid, low-protein diets had the lowest (28.3 g ± 0.6). Plasma levels of TNF-α and IL-10 varied significantly (p < 0.05) by diet in the unchallenged mice. IL-1β did not differ markedly (p = 0.085) across the dietary groups, and IL-6 levels were below the assay’s detection limit (<230.312 pg/mL). Following the lipopolysaccharide challenge, all cytokines increased, with significant differences among diets. Mice on high-protein diets exhibited notably lower TNF-α, IL-6, and IL-1β levels compared to those on high-carbohydrate or high-lipid diets. In contrast, IL-10 levels were higher in mice fed low-protein, high-carbohydrate, or high-lipid diets. In conclusion, high-protein diets appeared to dampen the responsiveness to lipopolysaccharide challenge, as indicated by smaller increases in pro-inflammatory cytokine levels, whereas high-carbohydrate and high-lipid diets elicited greater cytokine responses. We recommend that nutritional strategies aimed at modulating inflammation should ensure adequate dietary protein to help protect against both acute and chronic inflammation.
A fast regulation algorithm for low voltage in regional grids with high uncertainty and high penetration of wind and solar loads at the grid end
To address the issue of low voltage fluctuations at the grid end caused by the high penetration of wind and solar loads in the power grid, a fast low-voltage regulation algorithm is proposed. This algorithm aims to resolve the stability challenges brought by the uncertainty of wind and solar power sources. The method involves predicting the power output fluctuations of wind turbines, photovoltaics, and loads. A multi-objective fast regulation model is constructed, incorporating safety, efficiency, and cost factors, with corresponding constraints established. A simultaneous optimization transmission mechanism is adopted to achieve rapid voltage regulation. Results indicate that the algorithm has a high degree of prediction accuracy, rapidly restoring voltage to normal levels and maintaining stability within a tolerance level of 0.95 or higher. In conclusion, this algorithm effectively improves the stability and reliability of the power grid, providing a practical technical solution for handling high penetration levels of wind and solar energy in the grid.
Enhancing drug repositioning: A multi-class ensemble model for drug-target interaction prediction with action type categorization
Accurate prediction of drug–target interactions (DTIs) is critical for accelerating drug repositioning and reducing the cost of pharmaceutical development. Most existing studies frame DTI prediction as a binary task and often neglect the pharmacological action types and the quality of non-interaction data. This study introduces a multi-class classification framework that categorizes interactions into activators, inhibitors, and non-action classes. A novel zero-interaction selection algorithm is proposed, based on weighted drug–drug and protein–protein similarity scores, to improve dataset diversity and reliability. Drug and protein features were extracted from DrugBank, PubChem, and UniProt, and various feature selection and dimensionality reduction techniques—including decision tree, random forest importance scores, principal component analysis (PCA), Autoencoders, and Permutation importance—were evaluated to identify the most informative features for classification. We also compare concatenation-based and convolution-based feature integration strategies and systematically evaluate a range of classifiers, including both feature-based and graph-based models, with special attention to ensemble learning approaches. The concatenation method consistently outperforms convolution, and Histogram-based Gradient Boosting (HGB) achieves the best predictive overall accuracy with an average of 87.90% on the external test set. Meanwhile, HeteroGNN demonstrates more balanced class-wise performance, particularly for underrepresented classes. This work provides a scalable and interpretable framework for computational drug repositioning, supporting faster and more cost-effective identification of therapeutic candidates.
“You just forget about preeclampsia and move on” –awareness of chronic disease risks and follow-up preferences after preeclampsia in Ireland: a national qualitative study
Background Preeclampsia is associated with increased long-term risks of cardiovascular disease, kidney disease, and stroke. International guidelines recommend structured follow-up care to prevent chronic disease, but limited research has explored women’s knowledge of these risks, and their preferences regarding long-term follow-up care. This may impede how obstetric information is used for chronic disease prevention in practice. Methods This qualitative study used purposive and snowball sampling to recruit women in Ireland diagnosed with preeclampsia at least one year prior. Semi-structured interviews were conducted online, exploring awareness of chronic disease risks and provision of follow-up care. Thematic analysis was performed using an inductive approach. Results Twelve women aged 28–64 years were interviewed, at median six years since preeclampsia diagnosis. Participants’ antenatal and postnatal care experiences varied widely, but most described follow-up care after preeclampsia as being inconsistent or absent. Three key themes were generated: (1) Preeclampsia in the ‘rear-view mirror’ —women often viewed preeclampsia as an acute, resolved event, and had limited awareness of any long-term risks. However, they regarded chronic disease risk information as valuable and empowering; (2) Changing priorities as ‘life takes over’ — women often prioritised other family members’ health needs above their own, particularly in the newborn phase. They favoured delaying discussions about chronic disease risks, ideally to 6–12 months after pregnancy, preferably provided through primary care; (3) Desire for proactive, ‘blameless’ follow-up care—women favoured systematic, non-judgmental follow-up programmes underpinned by clear communication between obstetric and primary care services, continuity of healthcare providers, and free access. Some described residual anxiety relating to their preeclampsia experience, and emphasised the importance of sensitive, person-centred follow-up care. Conclusion Women affected by preeclampsia in Ireland typically have limited awareness of its links with long-term chronic disease risks, and frequently experience a lack of structured follow-up care. They expressed strong support for receiving personalised information about opportunities for secondary prevention, and advocated for systematic, proactive follow-up. Participants emphasised that future models of care should be pragmatic, person-centred, and include default enrolment for all women.
Correction: The impacts of product characteristics and regulatory environment on smokers’ preferences for tobacco and alcohol: Evidence from a volumetric choice experiment
Investigating risk factors of hemorrhagic fever of renal syndrome (HFRS) in Qingdao, Shandong province, China
Background Qingdao, a historically high-risk area for hemorrhagic fever with renal syndrome (HFRS) in China, is undergoing agricultural mechanization and urbanization. However, the specific risk factors for HFRS in this context remain unclear. This study sought to determine the risk factors for HFRS in Qingdao. Methods Community-based, 1:2 case-control study. Each case was matched with two healthy neighborhood controls based on biological sex, age, and the same neighborhood or village. Univariate and multivariate conditional logistic regression analyses were performed. Furthermore, stratified analyses were performed to explore risk factor heterogeneity between the peak season for Hantaan virus (HTNV) type HFRS (October-January) and other months. Results 93 cases (73.2%, 93/127) reported from January 2022 to September 2023 and 186 controls completed this questionnaire. Farmers accounted for the highest proportion (68.8%, 64/93). In multivariate logistic regression analysis, there were three significant risk factors for HFRS: piles of firewood and/or grain in residential yards (odds ratio [ OR ]=3.75, 95% CI : 2.14–6.55), mite and/or flea bites ( OR =1.83, 95% CI : 1.06–3.18) and contacting with rats and/or their excreta ( OR =1.73, 95% CI : 1.09–2.74); three variables represented significant protective factors for HFRS: frequency of sun exposure for quilts and bedding ( OR =0.41, 95% CI : 0.19–0.90), rodent control measures at home ( OR =0.50, 95% CI : 0.30–0.81) and knowing the main sources of HFRS transmission ( OR =0.58, 95% CI : 0.36–0.90). Stratified analysis revealed that the influence of these factors varied by season, with rodent contact and control measures being particularly salient during the HTNV peak season. Conclusion This study provides the first comprehensive evidence of risk and protective factors for HFRS in Qingdao, highlighting the role of rodent control, promoting comprehensive health education, environmental management, and personal protection. However, the results should be interpreted considering the study’s limitations, including a 73.2% response rate and the potential for recall bias.
Factors influencing physical activity for hypertension prevention among older adults in a peri-urban community in Ho, Ghana
Background Regular physical activity is proven to be an effective risk-reduction strategy against hypertension among older adults. This study assessed the factors influencing regular physical activity among older adults in a peri-urban community. Methodology A cross-sectional study was conducted among 276 older adults aged 60 years and above, with or without hypertension, in the Ho Municipality. A convenience sampling method was employed for older adults to respond to a self-developed pretested questionnaire. Data was cleaned and analyzed using Statistical Package for Social Sciences (SPSS) and summarized using descriptive statistics, and chi-square tests of association. Variables found to be statistically significant ( p-value = 0.05) from the univariate analysis were modeled into a regression equation and reported as odds ratios. Findings The overall knowledge levels of the participants on regular physical activity showed a majority (57.6%) had low knowledge of regular physical activity, a significant association between the level of education (χ² = 8.518, p-value = 0.004), and the number of people in the household (χ² = 8.154, p-value = 0.043) with the level of knowledge. The results also showed that the majority (56.2%) of the participants self-reported low levels of regular physical activity. Participants between 60 to 64 years old had 4.740 times the odds of participating in physical activities than those aged above 80 years (AOR = 4.740, 95%CI:1.472–15.257 p-value = 0.009). The respondent’s level of education significantly predicted the likelihood of engaging in physical activity (AOR = 1.814, 95%CI:1.024–3.212, p-value = 0.041). Conclusion The reported low knowledge of physical activity among older adults highlights the importance of health education through leveraging community health workers and volunteers. Understanding specific barriers older adults face in engaging in physical activity, such as health concerns, lack of access to appropriate facilities, and cultural beliefs, may influence the strategic allocation of resources.
Mycobacterium tuberculosis complex lineages and drug resistance patterns among tuberculosis patients with or without diabetes mellitus in southern Ghana
Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (p < 0.001), included a higher proportion of females [TB-DM: 31/75 (41.3%) vs. TB-only: 150/683 (22.0%), p < 0.001], and had greater mean BMI (TB-DM: 23.36 ± 0.99 vs. TB-only: 19.97 ± 0.45 kg/m², p = 0.003). Analysis of 501 (TB-only: 448, TB-DM: 53) MTBC isolates revealed that TB-DM patients are more likely to get TB caused by L6 [TB-DM: 10/53 (18.9%) vs. TB-only: 37/448 (8.3%), p = 0.022] compared to the general TB population Lineage 4 [TB-DM: 36/53 (67.9%) vs. TB-only: 362/448 (80.8%), p = 0.046], Mycobacterial strains from TB-DM exhibited higher isoniazid mono-resistance [TB-DM: 15/50 (30.0%) vs. 42/288 (14.6%), p = 0.012] and harbored more multidrug-resistant TB [TB-DM: 5/50 (10.0%) vs. TB-only: 16/288 (5.6%), p = 0.215] although this did not reach statistical significance. These findings indicate that DM not only predisposes individuals to TB but may also shift the spectrum of infecting lineages and promotes the emergence of DR strains. Integrated TB-DM screening, lineage-aware diagnostics, and tailored treatment protocols are urgently needed in high-burden settings to address this dual threat.
Expression of Concern: Governance and competitiveness evaluation of China’s financial asset management corporations
Correction: Additional outreach effort of providing an opportunity to obtain a kit for fecal immunochemical test during the general health check-up to improve colorectal cancer screening rate in Japan: A longitudinal study
The willingness and perceptions of Surinamese individuals in the Netherlands on living tissue donation: A qualitative and exploratory study
Background The Surinamese population in the Netherlands is an ethnically diverse group with a specific need for transfusion or transplantation due to a higher prevalence of diseases like beta-thalassaemia and sickle cell disease. This study explored the willingness of Surinamese individuals in the Netherlands to donate blood, stem cell, and live organ donation, and preferred information dissemination methods. Methods A sequential, qualitative, exploratory study was conducted using an online questionnaire and a focus group to examine the willingness to donate living tissue. Participants were Surinamese individuals aged 18–55 residing in the Netherlands. The questionnaires were inductively thematically analysed. The results led to in-depth questioning and discussion among the focus group, which consisted of four men and four women. The session was recorded and transcribed verbatim for thematic analysis. Results We identified ten themes across tissue types: 1) awareness of needs; 2) information and knowledge; 3) donation process; 4) cues to action; 5) attitude; 6) religion; 7) health challenges; 8) fear; 9) social cohesion and solidarity; 10) relationship with recipient. Willingness to donate blood was high, but they faced barriers, including registration challenges and limited access. Stem cell donation was seen as invasive. Living organ donation was considered only for emotionally close recipients. Participants were unaware of shortages and the importance of ethnic matching. They called for inclusive campaigns reflecting broader ethnic diversity, not just Suriname. Future strategies should simplify access to information, registration, and donation processes. Conclusion Most participants were unfamiliar with living donations, and perceived barriers were key reasons for not donating. Emotional bonds and awareness of ethnic matching and shortages motivated willingness. Participants stressed the need for tailored, ethnic-specific campaigns to address barriers and misconceptions, emphasise ethnic matching, and highlight reliance on their communities for successful living donation.