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AEKA: FPGA Implementation of Area-Efficient Karatsuba Accelerator for Ring-Binary-LWE-Based Lightweight PQC

Lightweight PQC-related research and development have gradually gained attention from the research community recently. Ring-Binary-Learning-with-Errors (RBLWE)-based encryption scheme (RBLWE-ENC), a promising lightweight PQC based on small parameter sets to fit related applications (but not in favor of deploying popular fast algorithms like number theoretic transform). To solve this problem, in this article, we present a novel implementation of hardware acceleration for RBLWE-ENC based on Karatsuba algorithm, particularly on the field-programmable gate array (FPGA) platform. In detail, we have proposed an area-efficient Karatsuba Accelerator (AEKA) for RBLWE-ENC, based on three layers of innovative efforts. First of all, we reformulate the signal processing sequence within the major arithmetic component of the KA-based polynomial multiplication for RBLWE-ENC to obtain a new algorithm. Then, we have designed the proposed algorithm into a new hardware accelerator with several novel algorithm-to-architecture mapping techniques. Finally, we have conducted thorough complexity analysis and comparison to demonstrate the efficiency of the proposed accelerator, e.g., it involves 62.5% higher throughput and 60.2% less area-delay product (ADP) than the state-of-the-art design for n =512 (Virtex-7 device, similar setup). The proposed AEKA design strategy is highly efficient on the FPGA devices, i.e., small resource usage with superior timing, which can be integrated with other necessary systems for lightweight-oriented high-performance applications (e.g., servers). The outcome of this work is also expected to generate impacts for lightweight PQC advancement.

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Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia.

From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance. This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities. After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54). These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.

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The symptom perception processes of monitoring, awareness, and evaluation in patients with heart failure: a qualitative descriptive study.

Patients with heart failure (HF) experience various signs and symptoms and have difficulties in perceiving them. Integrating insights from patients who have engaged in the process of symptom perception is crucial for enhancing our understanding of the theoretical concept of symptom perception. This study aimed to describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation and what influences the process. Using a qualitative descriptive design, we conducted in-person semi-structured interviews with a purposeful sample of 40 adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analysed using directed qualitative content analysis. One overarching theme and three major themes emerged. Patients demonstrated Body listening, which involved active and individualized symptom monitoring tactics to observe bodily changes outside one's usual range. Trajectory of bodily change involved the patterns or characteristics of bodily changes that became apparent to patients. Three subthemes-sudden and alarming change, gradual change, and fluctuating change emerged. Patients evaluated symptoms through an Exclusionary process, sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained. Facilitators and barriers to symptom monitoring, awareness, and evaluation were identified. This study elaborates the comprehensive symptom perception process used by adults with HF. Tailored nursing interventions should be developed based on the factors identified in each phase of the process to improve symptom perception in HF.

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Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care.

This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach. Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described. We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements. We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC. This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study. We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.

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