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Network (Bristol, England) Jun 2024The attacks like distributed denial-of-service (DDoS) are termed as severe defence issues in data centres, and are considered real network threat. These types of attacks...
The attacks like distributed denial-of-service (DDoS) are termed as severe defence issues in data centres, and are considered real network threat. These types of attacks can produce huge disturbances in information technologies. In addition, it is a complex task to determine and fully alleviate DDoS attacks. The new strategy is developed to identify and alleviate DDoS attacks in the Software-Defined Internet of Things (SD-IoT) model. SD-IoT simulation is executed to gather data. The data collected through nodes of SD-IoT are fed to the selection of feature phases. Here, the hybrid process is considered to select features, wherein features, like wrapper-based technique, cosine similarity-based technique, and entropy-based technique are utilized to choose the significant features. Thereafter, the attack discovery process is done with Elephant Water Cycle (EWC)-assisted deep neuro-fuzzy network (DNFN). The EWC is adapted to train DNFN, and here EWC is obtained by grouping Elephant Herd Optimization (EHO) and water cycle algorithm (WCA). Finally, attack mitigation is carried out to secure the SD-IoT. The EWC-assisted DNFN revealed the highest accuracy of 96.9%, TNR of 98%, TPR of 90%, precision of 93%, and F1-score of 91%, when compared with other related techniques.
PubMed: 38884373
DOI: 10.1080/0954898X.2024.2356852 -
Indian Journal of Otolaryngology and... Jun 2024The main aim of this study was to explore the psycho-social impacts of Otoacoustic Emissions (OAE) screenings on families. This involved understanding the initial...
UNLABELLED
The main aim of this study was to explore the psycho-social impacts of Otoacoustic Emissions (OAE) screenings on families. This involved understanding the initial responses of parents to test results, identifying any resulting concerns, and acknowledging the coping mechanisms utilized to handle these unexpectedly encountered difficulties. This retrospective observational study was conducted from January 2021 to December 2022 at a tertiary care facility. An extensive assessment was carried out on 1100 newborns that had undergone the OAE screening. Parental emotional reactions, worries regarding their child's prospects, and employed coping mechanisms were determined using structured questionnaires and interviews. The study aimed to explore the link between socio-economic status and varying levels of post-test anxiety and to study the effect of immediate post-screening counselling. A notable emotional reaction was observed, with 85% of parents, whose neonates were advised for subsequent tests, showing signs of shock and denial. Apprehensions related to the child's growth and societal acceptance were dominant, with 70% parents concerned about potential hurdles. There was a marked correlation between a lower socio-economic status and elevated post-test anxiety. Prompt counselling post-screening resulted in a substantial reduction in parental stress and anxiety levels. While the relevance of OAE testing concerning neonatal health is unequivocal, the psycho-social repercussions it imposes on families are significant. The findings underscore the need for holistic healthcare approaches that not only focus on physiological outcomes but also prioritize the mental well-being of families.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-024-04486-1.
PubMed: 38883548
DOI: 10.1007/s12070-024-04486-1 -
Dermatology and Therapy Jun 2024Despite advances in atopic dermatitis (AD) treatments, many patients face challenges obtaining medications. This study aimed to determine the frequency and causes of...
INTRODUCTION
Despite advances in atopic dermatitis (AD) treatments, many patients face challenges obtaining medications. This study aimed to determine the frequency and causes of insurance coverage delays and denials for AD prescriptions and characterize the associated wait times and extent to which patients understand what to do when faced with a coverage issue.
METHODS
This was a cross-sectional, observational study in which adult U.S. residents (aged 18+ years) with AD or caregivers of pediatric U.S. patients with AD (aged 0-17 years) completed an online survey (3 June-16 July 2021).
RESULTS
Respondents (N = 978) were primarily adults with AD (81.8%), female (67.7%), and white (70.2%). There were 645 insurance delays or denials for AD prescriptions, with 48.1% (470/978) of respondents experiencing at least one delay/denial in the past year. Most delays/denials were for topical steroids (39.2%, 253/645), the most highly used prescription treatment class (83.9%, 821/978). However, the highest rate of delay/denials was for biologics, of which 43.6% (109/250) of all prescriptions faced a delay or denial. Denials were caused primarily by step therapy (27.6%) and delays by prior authorization (55.1%). Only 56.0% of respondents said they would know what to do if they faced an issue with AD prescription coverage.
CONCLUSIONS
Patients with AD frequently experience insurance-related barriers to obtaining recommended therapies, and many do not know how to respond when these barriers arise. Strategies to improve timely therapeutic access are needed.
PubMed: 38880857
DOI: 10.1007/s13555-024-01205-0 -
ISA Transactions Jun 2024This paper is concerned with the secure output consensus problem for the heterogeneous multi-agent systems under the event-triggered scheme in the presence of the...
This paper is concerned with the secure output consensus problem for the heterogeneous multi-agent systems under the event-triggered scheme in the presence of the denial-of-service attack. Without detecting the attack, the hold-input controller update strategy is adopted when some transmission data may be lost due to the effect of the attack. Based on the tolerable duration of the attack, a novel edge-based event-triggered scheme is developed. The scheme can avoid continuous communication and exclude Zeno behavior. With the aid of the switched system theory, output consensus is preserved. An example shows the effectiveness.
PubMed: 38876951
DOI: 10.1016/j.isatra.2024.05.053 -
PCN Reports : Psychiatry and Clinical... Jun 2023In Japan, there is a tendency to view COVID-19 infection as one's own responsibility, which may result in more feelings of guilt than in other countries. During the...
BACKGROUND
In Japan, there is a tendency to view COVID-19 infection as one's own responsibility, which may result in more feelings of guilt than in other countries. During the COVID-19 pandemic, the curfew imposed by COVID-19 restricted social behavior and increased anxiety and loneliness, which may have increased the risk of suicide among young women, especially mothers who were highly stressed regarding COVID-19 infection in their children.
CASE PRESENTATION
This is a case report of two Japanese mothers who developed feelings of guilt following infection with COVID-19, leading to suicide attempts. They feared stigma or denial due to the infection, which they were unable to explain to others, leading to a heightened sense of self-blame and suicide attempts. In addition, Japanese women have a heavy burden of housework, despite their dual roles at home and at work; the pandemic's behavioral restrictions led to increased time at home and stress. These women were also more affected by the economic crisis in the early stages of the pandemic than men. Relatedly, neuropsychiatric symptoms that persisted after recovering from COVID-19, such as depression, anxiety, fatigue, and pain, namely postacute COVID-19 syndrome or long COVID, may have precipitated the suicidal ideation in these cases. Moreover, the complication of bipolar disorder by COVID-19 could have led to suicide attempts caused by infection-related neuropsychiatric symptoms and the exacerbation of the bipolar disorder by restrictions imposed during the pandemic.
CONCLUSION
Suicide prevention measures need to be taken more seriously among mothers during or after the COVID-19 pandemic.
PubMed: 38868140
DOI: 10.1002/pcn5.116 -
Journal of Perinatology : Official... Jun 2024
PubMed: 38866961
DOI: 10.1038/s41372-024-02028-9 -
American Journal of Psychoanalysis Jun 2024While screen-mediated analysis long predated the pandemic, it was largely seen as non-equivalent to in-person treatment by analysts and patients alike. When COVID forced...
While screen-mediated analysis long predated the pandemic, it was largely seen as non-equivalent to in-person treatment by analysts and patients alike. When COVID forced us to move our entire practices to the screen, our concerns about its limitations were replaced by relief; we could continue doing analytic work during a terrifying and challenging time. Three years later, many have chosen to continue practicing remotely for reasons that are no longer driven by fears of exposure. We mostly minimize or deny our earlier concerns about the limitations of screen work. Have we chosen convenience, ease, and a personal sense of safety over togetherness, while ignoring the underbelly of remote work? This paper identifies the convergence of several forces underlying our decision to stay remote, including guilt and anxiety about privileging our own self-interest, unmourned losses and collective PTSD, fear of the future and existential anxiety about living in a techno-culture that threatens to replace us. Our denial of these powerful forces makes it easy to rationalize a decision to embrace remote work and disavow the threat it poses to our field.
PubMed: 38866957
DOI: 10.1057/s11231-024-09457-7 -
JAMA Network Open Jun 2024Insurance barriers to cancer care can cause significant patient and clinician burden.
IMPORTANCE
Insurance barriers to cancer care can cause significant patient and clinician burden.
OBJECTIVE
To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.
DESIGN, SETTING, AND PARTICIPANTS
In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023.
EXPOSURE
Insurance denial for RT.
MAIN OUTCOMES AND MEASURES
Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
RESULTS
A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.
Topics: Humans; Female; Middle Aged; Male; Aged; Adult; Aged, 80 and over; Radiation Oncology; United States; Insurance, Health; Neoplasms; Academic Medical Centers; Cohort Studies
PubMed: 38865128
DOI: 10.1001/jamanetworkopen.2024.16359 -
Frontiers in Psychiatry 2024The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of...
OBJECTIVE
The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of caring stress, a scoping review study was designed. This scoping review aimed to investigate the concept of caring stress among clinical nurses and examine the strategies used for its management.
METHODS
This review employed a scoping review methodology to comprehensively map the essential concepts and attributes of the phenomenon by drawing on a wide range of sources. International databases including PubMed, Scopus, Web of Science, Google Scholar, and Scientific Information Database (SID) were searched to gather relevant studies published until October 1, 2023. MESH terms included "caring stress", "care", "stress", "nurse", and "stress management" were used. Two reviewers independently collected data from full-text papers, ensuring that each paper underwent assessment by at least two reviewers.
RESULTS
Out of 104,094 articles initially searched, 22 articles were included in this study. High workloads, transmitting the infection, stressful thoughts, stressful emotions, and stressful communications were the significant concepts and factors of caring stress among nurses. Also, rest breaks during patient care shifts, playing music in the ward, and denial of critical situations were examples of positive and negative coping and management ways to reduce caring stress.
CONCLUSION
Effective stress management strategies can lead to better patient care and safety. Stressed nurses are more likely to make errors or become less vigilant in their duties, impacting patient outcomes. By addressing caring stress, clinical practice can prioritize patient well-being. Further research is required to delve deeper into this critical issue concerning nurses in the future.
PubMed: 38863606
DOI: 10.3389/fpsyt.2024.1337938 -
Public Understanding of Science... Jun 2024Today, the dominant climate change discourses affirm its anthropogenic nature and the urgency for policies. However, minority discourses remain active in the worldwide...
Today, the dominant climate change discourses affirm its anthropogenic nature and the urgency for policies. However, minority discourses remain active in the worldwide debate, refining arguments beyond simple denial-as shown regarding formal/official discourses of the United States and European far-right parties. This makes it necessary to examine the public understanding of climate change in everyday, informal minority discourses, looking at how they work for broadening societal space for "quarantining" the transformative potential of climate change meanings/policies. For this, we analyze readers' comments on climate change articles from two Portuguese newspapers, drawing from the frameworks of neutralization techniques and meaning barriers. Findings show that although denial of anthropogenic climate change remains, discursive efforts concentrate on person-stigmatizing depictions of climate change actors, delegitimized as "elites" in populist vocabularies, reflecting a consistent alignment between everyday discourses and those of the United States and European official far-right. We discuss the functions this pattern may have for the growth of climate change minority positions.
PubMed: 38863437
DOI: 10.1177/09636625241254505