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OBJECTIVES We aimed to identify patient- and facility-specific predictors of collective adherence to 4 recommended best treatment practices in operable IIIAN2 non-small-cell lung cancer (NSCLC) and test the hypothesis that collective adherence is associated with superior survival. METHODS We queried the National Cancer Database for clinical stage IIIAN2 NSCLC patients undergoing surgery during 2010–2015. The following best practices were examined: performance of an anatomic resection, performance of an R0 resection, examination of regional lymph nodes and administration of induction therapy. Multivariable regression models were fitted to identify independent predictors of guideline-concordance. RESULTS We identified 7371 patients undergoing surgical resection for IIIAN2 lung cancer, of whom 90.8% underwent an anatomic resection, 88.2% received an R0 resection, 92.5% underwent a regional lymph node examination, 41.6% received induction therapy and 33.7% received all 4 best practices. Higher income, private insurance and treatment at an academic facility were independently associated with adherence to all 4 best practices (P < 0.01). A lower level of education and residence in a rural county were associated with a lack of adherence (P < 0.05). Adherence to all 4 practices correlated with improved survival (P < 0.01). CONCLUSIONS National adherence to best treatment practices in operable IIIAN2 lung cancer was variable as evidenced by the majority of patients not receiving recommended induction therapy. Socioeconomic factors and facility type are important determinants of guideline-concordance. Future efforts to improve outcomes should take this into account since guideline concordance, in the form of collective adherence to all 4 best practices, was associated with improved survival.

Precision agriculture encompasses automation and application of a wide range of information technology devices to improve farm output. In this environment, smart devices collect and exchange a massive number of messages with other devices and servers over public channels. Consequently, smart farming is exposed to diverse attacks, which can have serious consequences since the sensed data are normally processed to help determine the agricultural field status and facilitate decision-making. Although a myriad of security schemes has been presented in the literature to curb these challenges, they either have poor performance or are susceptible to attacks. In this paper, an elliptic curve cryptography-based scheme is presented, which is shown to be formally secure under the Burrows–Abadi–Needham (BAN) logic. In addition, it is semantically demonstrated to offer user privacy, anonymity, unlinkability, untraceability, robust authentication, session key agreement, and key secrecy and does not require the deployment of verifier tables. In addition, it can withstand side-channeling, physical capture, eavesdropping, password guessing, spoofing, forgery, replay, session hijacking, impersonation, de-synchronization, man-in-the-middle, privileged insider, denial of service, stolen smart device, and known session-specific temporary information attacks. In terms of performance, the proposed protocol results in 14.67% and 18% reductions in computation and communication costs, respectively, and a 35.29% improvement in supported security features.

Unmanned aerial vehicles have found applications in fields such as environmental monitoring and the military. Although the collected data in some of these application domains are sensitive, public channels are deployed during the communication process. Therefore, many protocols have been presented to preserve the confidentiality and integrity of the exchanged messages. However, numerous security and performance challenges have been noted in the majority of these protocols. In this paper, an elliptic curve cryptography (ECC) and symmetric key-based protocol is presented. The choice of ECC was informed by its relatively shorter key sizes compared to other asymmetric encryption algorithms such as the Rivest–Shamir–Adleman (RSA) algorithm. Security analysis showed that this protocol provides mutual authentication, session key agreement, untraceability, anonymity, forward key secrecy, backward key secrecy, and biometric privacy. In addition, it is robust against smart card loss, password guessing, known secret session temporary information (KSSTI), privileged insider, side-channeling, impersonation, denial-of-service (DoS), and man-in-the-middle (MitM) attacks. The comparative performance evaluation showed that it has relatively low computation, storage, and communication complexities.

Vehicular ad hoc networks (VANETs) provide intelligent navigation and efficient route management, resulting in time savings and cost reductions in the transportation sector. However, the exchange of beacons and messages over public channels among vehicles and roadside units renders these networks vulnerable to numerous attacks and privacy violations. To address these challenges, several privacy and security preservation protocols based on blockchain and public key cryptography have been proposed recently. However, most of these schemes are limited by a long execution time and massive communication costs, which make them inefficient for on-board units (OBUs). Additionally, some of them are still susceptible to many attacks. As such, this study presents a novel protocol based on the fusion of elliptic curve cryptography (ECC) and bilinear pairing (BP) operations. The formal security analysis is accomplished using the Burrows–Abadi–Needham (BAN) logic, demonstrating that our scheme is verifiably secure. The proposed scheme’s informal security assessment also shows that it provides salient security features, such as non-repudiation, anonymity, and unlinkability. Moreover, the scheme is shown to be resilient against attacks, such as packet replays, forgeries, message falsifications, and impersonations. From the performance perspective, this protocol yields a 37.88% reduction in communication overheads and a 44.44% improvement in the supported security features. Therefore, the proposed scheme can be deployed in VANETs to provide robust security at low overheads.

One of the segmentation techniques with the greatest degree of success used in numerous recent applications is multi-level thresholding. The selection of appropriate threshold values presents difficulties for traditional methods, however, and, as a result, techniques have been developed to address these difficulties multidimensionally. Such approaches have been shown to be an efficient way of identifying the areas affected in multi-cancer cases in order to define the treatment area. Multi-cancer methods that facilitate a certain degree of competence are thus required. This study tested storing MRI brain scans in a multidimensional image database, which is a significant departure from past studies, as a way to improve the efficacy, efficiency, and sensitivity of cancer detection.  The evaluation findings offered success rates for cancer diagnoses of 99.08%, 99.87%, 94%; 97.08%, 98.3%, and 93.38% sensitivity; the success rates of the LED Internet connection in particular were 99.99%; 98.23%, 99.53%, and 99.98%.

Peripherally inserted central catheters (PICCs) have become essential for providing long-term central venous access in critically ill patients. Despite their advantages, PICCs are associated with complications such as infections, venous thrombosis, and mechanical failures. This review aims to provide a comprehensive overview of PICC-related complications and prevention strategies to guide best practices in critical care settings. Patient factors, including comorbidities and catheter tip position, influence complication rates. Catheter selection, with a preference for smaller diameters and polyurethane materials, can mitigate risks. Strict adherence to sterile techniques, use of 2% chlorhexidine gluconate for skin antisepsis, and compliance with evidence-based guidelines are crucial for infection prevention. Ultrasound guidance during insertion and confirmation of tip placement in the distal superior vena cava can reduce thrombosis and mechanical complications. Innovations like the SecurAcath securement device help prevent catheter migration. The evolving role of PICC nurses necessitates ongoing education and practical training to effectively manage complications. Establishing standardized protocols, promoting multidisciplinary collaboration, and encouraging further research are essential for enhancing PICC care. Future studies should focus on evaluating preventive strategies and clinical outcomes in critically ill populations to advance evidence-based practices, ultimately improving patient outcomes and reducing healthcare costs associated with PICC-related complications.

A 10- year-old female, known to have bronchial asthma, presented with an unusual laryngeal lesion, eventually diagnosed as Churg-Strauss syndrome (CSS). She was referred to our hospital with history of recurrent stridor. On endoscopyhe, the larynx showed signs similar to recurrent respiratory papillomatosis (RRP). CSS is a systemic disorder and is now defined as one of the ANCA ( antineutrophil cytoplasmic antibodies)-associated vasculitides. CSS is a systemic disease that may involve unusual sites like the larynx. Such an unusual presentation of CSS should be kept in mind, especially in patients with history of asthma.