Perspective of healthcare professionals on barriers and facilitators in exploring end-of-life care preferences of patients with pulmonary fibrosis: A qualitative study

by Lian Trapman, Lea M Dijksman, Jan C. Grutters, Saskia C.C.M. Teunissen, Everlien de Graaf

Background

Progressive pulmonary fibrosis is a lethal disease with a survival of 3–5 years with optimal medication treatment. Palliative care and advance care planning are therefore receiving increasing attention in the literature. However, structural implementation in clinical practice is still lacking. The aim of this study was to explore the needs, facilitators, and barriers for communication on the topic of end-of-life preferences of patients from the perspective of healthcare professionals.

Methods

A generic qualitative study was performed with focus groups and individual semi structured interviews with healthcare professionals. Data collection and analysis were performed iteratively. A thematic analysis was performed, following the methods of Braun and Clarke.

Results

Three focus groups and seven individual semi-structured interviews were conducted. Three themes were generated: (1) a lack of vision on palliative care, resulting in different approaches within the same clinic and showing the need for optimization of collaboration; (2) the importance of a learning-driven environment to support healthcare professionals skills and knowledge; and (3), the central role of the individual professional in developing skills and knowledge.

Conclusions/discussion

This study underscores the importance of behavioral and organizational change in palliative care to optimize conversations exploring values, preferences, and needs for end-of-life care for patients with pulmonary fibrosis. Leveraging the shared motivation of healthcare professionals to provide optimal care, integrating these findings into training and coaching programs can further enhance patient-centered approach in palliative care.

Coping with rejection as a sperm donor: A qualitative study of the personal impact of rejection and new health information

by Lina Thirup, Anne-Bine Skytte, Ulrik Schiøler Kesmodel, Ida Vogel, Guido Pennings, Allan Pacey, Stina Lou

Purpose

The demand for sperm donation is increasing, yet only a small percentage of applicants are accepted, and little attention has been given to those who are rejected. The application process may reveal new medical or genetic information with potential personal and emotional consequences. The aim of this study was to explore how men experience rejection as sperm donors, including how they cope with the rejection and integrate potential new information into their lives.

Methods

We conducted qualitative, in-depth interviews with 19 men rejected as sperm donors. Data was analyzed using thematic analysis.

Results

Some men received new medical information that raised significant concerns, particularly regarding their health, fertility, and family. However, for most it was not the reason for rejection that affected them most, but the rejection itself. They had begun to identify as donors, and being turned down felt like a blow to their sense of self. Over time, participants used different coping strategies: information seeking, actionable reasoning, positive reframing, normalizing, and postponing. Although the experience was personally and emotionally challenging for many, it ultimately did not have a lasting negative impact on their lives.

Conclusions

Sperm donation is not only a medical act but also tied to social identity, with rejection having personal and emotional consequences. For men whose rejection is based on new medical information that causes significant concerns, sperm banks should support rejected donors and help them exit the process positively. Further research is warranted to find out how this can be done.

Machine learning-guided identification and simulation-based validation of potent JAK3 inhibitors for cancer therapy

by Hailang Wei, Qingyun Wang

Janus kinase 3 (JAK3) is a hematopoietic-specific kinase implicated in cytokine signaling and immune dysregulation and has recently been associated with cancer progression. However, selective and potent JAK3 inhibitors remain underdeveloped. In this study, we established a machine learning (ML)-based pipeline to identify novel JAK3 inhibitors with anti-cancer potential. A curated ChEMBL dataset of JAK3 inhibitors was used to train multiple ML classifiers, with the Random Forest model achieving the highest performance (AUC = 0.80, F1-score = 0.92). This model was applied to virtually screen 25,084 ChEMBL compounds, yielding 400 high-confidence candidates (prediction score > 0.9). Docking analysis identified ten top binders (binding affinity ≤ –8.5 kcal/mol), of which three CHEMBL49087, CHEMBL4117527, and CHEMBL50064 exhibited optimal ADMET profiles. These compounds underwent 200 ns molecular dynamics simulations, showing low RMSD (0.10–0.20 nm), stable binding conformations, and preserved protein compactness. MM/GBSA calculations revealed that CHEMBL4117527 displayed the strongest binding free energy (–29.5 kcal/mol), surpassing even the co-crystallized ligand (–17.7 kcal/mol). Our integrative approach combining machine learning, docking, pharmacokinetics, molecular dynamics, and free energy analysis presents a robust computational strategy for JAK3 inhibitor discovery. These findings support CHEMBL4117527 as promising candidates for further experimental evaluation in cancer therapeutics.

Efficacy of imaginative vocal training for enhancing vocal awareness in non-professional singers

by Federica Biassoni, Giulia Vismara, Martina Gnerre

The objective of this study was to examine whether different types of mental-imagery training focused on the vocal apparatus can enhance awareness of the vocal tract and diaphragm (vocal awareness) in non-professional singers.Sixty participants with no singing education received one of three training conditions: following instructions based on 1) a description of the physiological changes that take place during phonation (physiological description), 2) imitating an action using the vocal apparatus (imitative action), and 3) a metaphorical narration. Imitative action and metaphorical narration were conceptualized as more imaginative forms of training. Vocal awareness was assessed with a questionnaire that participants completed before and after the training. The questionnaire measured three indices: vocal apparatus representation, vocal apparatus interoceptive awareness, and vocal self-regulation. Results showed that all three types of training program significantly enhanced vocal awareness, but imitative action and metaphorical narration were more effective for interoceptive awareness, and metaphorical narration was more effective for self-regulation. In conclusion, the two imaginative forms of training were more effective than physiological description for improving vocal awareness.

Drug-related stigma among people who inject drugs – development and validation of the drug use stigma scale (DUSS)

by Robin A. Pollini, Catherine E. Paquette, Brandon Irvin, Jennifer L. Syvertsen, Christa L. Lilly

Drug use is a highly stigmatized behavior, and drug-related stigma is a key driver of behavioral risk, lower health care utilization, and associated adverse health outcomes among people who inject drugs (PWID). While instruments exist for measuring drug-related stigma, their applicability to community-based PWID across multiple stigma types (enacted, anticipated, internalized) and settings (health care, society, family) is limited, as most were developed using treatment-based samples and all were developed in urban populations. This study sought to develop a Drug Use Stigma Scale (DUSS) that addresses these limitations. We developed an initial list of 39 items based on literature review and qualitative interviews (N = 27) and three focus groups (N = 28) with PWID recruited from syringe services programs and via peer referral in two predominantly rural West Virginia counties. The scale items were administered in a survey to 336 PWID recruited from the same two counties divided into development and validation samples. Responses to the 39-item scale went through a multidimensional refinement process, including examination of internal consistency, Confirmatory Factor Analysis (CFA), and a three-factor CFA based on stigma setting. Next, a set of final measurement CFAs were conducted. Finally, the resulting scale was examined for criterion-related concurrent validation. The final DUSS consisted of 16 items with excellent fit statistics for the development sample: SRMR: 0.03, RMSEA: 0.09, GFI: 0.92, CFI: 0.96, NFI: 0.94. Fit attenuated but remained satisfactory for the validation sample. DUSS scores were significantly associated with increased odds of not seeking healthcare when needed (OR: 1.47, p = 0.001; OR: 1.61, p 

Redirecting patients from the pediatric emergency department to community locations for care: A qualitative study of healthcare professional and leader perspectives

by Erica Qureshi, Quynh Doan, Jessica Moe, Steven P. Miller, Garth Meckler, Brett Burstein, Jehannine (J9) Austin

Objectives

Emergency department (ED) to community (ED2C) programs, which redirect patients from the pediatric ED to community healthcare professionals represent a promising strategy to reduce the impact of non-urgent visits on the pediatric ED. Given an ED2C program’s potential impact on various care professionals, we completed a qualitative study to explore key informants’ attitudes and perceptions of pediatric ED2C programs.

Methods

We conducted one-on-one semi-structured interviews with key informants in British Columbia, Canada. Participants included: pediatric ED staff – triage nurses and physicians; community professionals – pediatricians and family physicians; and health system leaders responsible for pediatric and emergency care in British Columbia. Interviews were recorded, transcribed verbatim, de-identified, and analyzed using reflexive thematic analysis within an interpretive description framework. A visual model was developed to depict key themes in attitudes and perceptions towards pediatric ED2C programs.

Results

We interviewed 24 participants: 6 community professionals, 11 pediatric ED professionals, and 7 healthcare leaders. Participants viewed the ED2C program as a valuable solution to address pediatric system strain provided that systemic barriers are addressed, and both emergency and community settings are equipped with adequate training and resources. Participants emphasized the need for clear guidelines on eligibility and operations to build confidence and enhance program effectiveness.

Conclusions

Our findings suggest there is support for ED2C programs as a means to reduce the impact of non-urgent pediatric ED visits and strengthen community-based care. Successful implementation will require coordinated planning, resource investment, and clear operational frameworks.

A multi-image codebook approach for secure text transmission

by Omar Fitian Rashid, Saba A. Tuama, Humam Al-Shahwani

In modern digital communication, Confidentiality of text transmission is remains a concern in the current online communication as cyber threats and intrusion. To address these challenges, this paper proposes a dual-layered security system that integrates cryptography and multi-image steganography to strengthen text protection during transmission. The cryptography layer is done based eight steps; in the first one, the message is converted to ASCII format, then convert the ASCII values into their equivalent binary numbers and make a complement to the binary values where each 0’s becomes 1’s and vice versa. In the next step, it needs to enter a key that includes a combination of characters, numbers, and special characters. This key is also converted to binary, and then the XOR operation is made between the message of the binary values and the key. In the fifth step, switching the values of each two adjacent binary values are together and converted to decimal values. While the second layer embeds the ciphertext in several cover images using a randomized codebook along with the Least Significant Bit (LSB) substitution, thus enhancing undetectability. Experimental evaluation demonstrates fast execution times for both the encryption/decryption processes and the multi-image hiding/extraction procedures. The achieved results validate that the proposed system provides an efficient and highly secure framework for protecting sensitive information.

Effects of aquatic exercise on arterial stiffness and endothelial function in adults: A systematic review and meta-analyses

by Emily Dunlap, Yanbing Zhou, Manny M.Y. Kwok, Billy C.L. So, Hirofumi Tanaka

Objective

To evaluate the effects of aquatic exercise compared with non-exercise controls and land-based exercise on arterial stiffness and endothelial function.

Design

Systematic review and meta-analyses of randomized controlled trials assessed using the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation.

Data sources

PubMed/MEDLINE, CINAHL Plus, SPORTDiscus, and reference lists, searched from database inception to April 16, 2025.

Eligibility criteria

Studies evaluating chronic aquatic exercise (multi-session interventions) compared with land-based exercise or non-exercise comparison groups in adults, measuring arterial stiffness via pulse wave velocity (PWV) or endothelial function via flow-mediated dilation (FMD).

Results

This review includes 18 randomized controlled trials with 845 participants (mean age 65 ± 7 years). Studies compared aquatic exercise with non-exercise controls (8 studies), land-based exercise (6 studies), or both (4 studies). Exercise sessions averaged 50 minutes, 3 times weekly for 11 weeks. Most studies (17 out of 18) implemented moderate-to-vigorous intensity protocols. Aquatic exercise resulted in improvements in arterial stiffness compared with non-exercise controls (7 studies; SMD = –2.37, 95% CI: –4.46 to –0.29; I² = 98%: low certainty), with most evidence reflecting systemic and peripheral PWV. Changes in arterial stiffness did not differ from those observed after land-based exercise (6 studies; SMD = –0.07, 95% CI: –0.34 to 0.20; I² = 0%, moderate certainty). For endothelial function, aquatic exercise may improve outcomes versus non-exercise controls (6 studies; SMD = 0.91, 95% CI: 0.39 to 1.43; I² = 68%; low certainty) and may lead to greater improvements than land-based exercise (7 studies; SMD = 0.55, 95% CI: 0.05 to 1.06; I² = 75%; low certainty).

Conclusion

Aquatic exercise improves systemic and peripheral arterial stiffness as well as endothelial function compared with non-exercising controls. Changes in arterial stiffness do not differ from those observed after land-based exercise. Aquatic exercise may provide greater improvement in endothelial function than land-based exercise, though this is supported by low-certainty evidence, and substantial heterogeneity limits confidence in the generalizability of this finding.

PROSPERO registration

CRD42025642087.

Channels and countermeasures of the COVID-19 pandemic’s impact on urban economic resilience: Lessons from China

by Xianxiang Lu, Yangrui Duan

Resilience is a crucial ability of an economy to withstand sudden events and uncertain shocks. Using the entropy method, this study measures the economic resilience of 281 Chinese cities (prefecture-level and above) from 2017 to 2022, and empirically examines the impact of COVID-19 on this resilience, as well as its transmission channels. The results show that COVID-19 adversely affected overall urban economic resilience, with contrasting effects across its sub-dimensions: an insignificant negative impact on shock resistance, a significant negative impact on adaptive recovery, and an insignificant positive impact on innovative transformation. Transmission channels analysis reveals COVID-19 impaired urban economic resilience through the channels of employment structure, consumption, investment, and unrelated diversification, with consumption identified as the predominant one. Heterogeneity analysis reveals that the economic resilience of cities in both the high and low manufacturing specialization groups was more adversely affected by COVID-19 than that of cities in the medium group. Regarding services specialization, the economic resilience of cities with a medium degree of services specialization were more negatively affected by COVID-19 than that of cities with low services specialization. Furthermore, the economic resilience of cities with a higher degree of related diversification was less negatively affected by COVID-19. This study provides a replicable analytical framework and empirical evidence for enhancing urban economic resilience in China and other countries in post-pandemic era.

“This needs to be told to everyone”: Content analysis of written immediate responses from an online experiment examining health warning messages about alcohol consumption and breast cancer risk

by Allison Anbari, Zachary Massey, Abigail Adediran, Na Wang, LaRissa Lawrie, Priscilla Martinez, Denis McCarthy

Alcohol consumption increases breast cancer risk. We evaluated the responses of 748 United States female participants ages 21–29 to health warning messages addressing the relationship between alcohol consumption and increased breast cancer risk. In an online experiment, participants were randomly assigned to view standalone health warning messages about alcohol, breast cancer, and breast cancer health effects with varying picture and text attributes. Participants then completed post-message exposure assessments that included an immediate open-ended response to the message prompt. We conducted a qualitative content analysis of the responses and coded deductively based on constructs from the Message Impact Framework including message reactions, attitudes and beliefs, and behavioral intentions. These constructs and corresponding variables were present in participants’ responses. Response type did not vary by participants’ demographics or the attributes of the health warning message they viewed. The code new information was applied to 20% of the responses, indicating that those participants had no prior knowledge of alcohol and breast cancer risk. Alcohol and breast cancer messaging could impact drinking behaviors. Given the frequency of responses indicating a lack of awareness, more work in cancer prevention and population health messaging is warranted.

Metabolomic characteristics of aerobic and resistance exercise modes

by Junjie Kuang, Jie Ju, Xin Xu

Aerobic and resistance exercises are the two most common modes of physical activity. They may cause some functional changes such as elevation of VO2max and muscle mass. However, descriptions of changes in complex molecular network induced by exercise are often insufficiently comprehensive, limiting the exploration of some new indicators. We utilized a metabolomics analysis method based on Liquid chromatography-mass spectrometry (LC-MS) to investigate the metabolic characteristics of 10 healthy male college students at two time points before and after a single session of aerobic and resistance exercise. The analysis was conducted at both the metabolite and metabolic pathway levels. Notably, the concentrations of several amino acids including aspartic acid, glutamic acid, histidine and tryptophan exhibited significant changes following both modes of exercise. These findings offer a more comprehensive understanding of the molecular effects of acute exercise on the human body, contributing to evaluating post-exercise physiological states and screening for relevant metabolite indicators. Future research could employ multi-omics approaches to validate these results and explore the long-term impact of exercise on human metabolic profiles, linking specific metabolic pathways to functional outcomes.

Physician-physician handover from acute care to rehabilitation setting: A scoping review protocol

by Seungjae Cho, Nancy Xi, Emma A. Bateman, Cynthia Chui, Eric Poon, Aran Bains, Patrick Fangping Yao, Meiqi Guo

Objective

The purpose of this scoping review is to map the existing evidence that describes strategies to improve handover from the acute care to rehabilitation settings.

Introduction

Poor handover processes have been associated with preventable errors, delays in care, and adverse patient outcomes. Effective physician-to-physician handover during transitions of care is critical to ensuring patient safety and optimizing clinical outcomes. Physician handover between acute and rehabilitation care settings is particularly complicated, as it requires transferring detailed and timely information for continuity of care for medically and/or surgically complex patients between components of healthcare systems with different cultures and goals of care. Despite numerous studies being published on handover, there has yet to be a synthesis of the existing literature that seeks to explore handovers across acute to rehabilitation settings as well as how care transitions can be improved. This scoping review aims to map the existing evidence on physician-to-physician handover from acute care to rehabilitation.

Methods

This review will be conducted following the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search will be performed across the following electronic databases: MEDLINE(R) ALL (Ovid), Embase Classic + Embase (Ovid), APA PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), Emcare (Ovid), CINAHL Ultimate (EBSCO) and Web of Science (Clarivate). All rounds of screening, data extraction, and data synthesis will be conducted independently with each stage performed in duplicate. The extracted data will be summarized both quantitively with descriptive statistics and qualitatively using content analysis.

Eligibility Criteria

Qualitative and quantitative studies published in English that discuss physician-physician handover from acute care to rehabilitation settings will be included. All geographical areas will be considered. Case reports, case series, commentaries, protocols, opinion pieces (editorials), or abstracts from conferences will be excluded.

Impacts of polymorphisms in drug-metabolizing enzyme and transporter genes on irinotecan toxicity and efficacy in Thai colorectal cancer patients

by Natthakul Akarapredee, Chalirmporn Atasilp, Chonlaphat Sukasem, Pimonpan Jinda, Rattanaporn Sukprasong, Jiraporn Jensuriyarkun, Soravit Wongjitjanyong, Patompong Satapornpong, Natchaya Vanwong

Introduction

Irinotecan is a chemotherapy agent commonly prescribed for metastatic colorectal cancer but often leads to neutropenia. Variations in genes encoding drug-metabolizing enzymes and transporters may affect the toxicity and effectiveness of irinotecan. This study aimed to examine the impact of these genetic polymorphisms on irinotecan outcomes in Thai colorectal cancer patients.

Methods

The study retrospectively analyzed 41 metastatic colorectal cancer patients treated with irinotecan-based chemotherapy. Genotyping was conducted for 23 single nucleotide polymorphisms in genes including UGT1A1, CYP3A4, CYP3A5, CES1, ABCB1, ABCC2, ABCC5, ABCG1, ABCG2, and SLCO1B1.Toxicity and efficacy were assessed, with statistical significance set at a Bonferroni-corrected P value  Results

In terms of toxicity, UGT1A1*6 was significantly associated with both all-grade and severe neutropenia in the first cycle (p p p ABCC2 -24C > T variant was linked to all-grade neutropenia in the second cycle (p = 0.001). For efficacy, patients with the wild-type UGT1A1*6 had longer progression-free survival (PFS) (p SLCO1B1 521T > C variant was associated with improved PFS (p  Conclusion

UGT1A1*6 and ABCC2 -24C > T variants emerge as potential predictors of irinotecan-induced neutropenia, while UGT1A1*6 and SLCO1B1 521T > C may serve as markers of prolonged PFS in Thai patients. Validation through larger prospective studies is essential to confirm and refine these genetic associations.

Preclinical safety and burn wound healing activity of “Novostron”, a novel topical iodine-based therapeutic

by Nailya Ibragimova, Arailym Aitynova, Seitzhan Turganbay, Marina Lyu, Alexandr Ilin, Tamari Gapurkhaeva, Galina Ponomareva, Karina Vassilyeva, Diana Issayeva, Amirkan Azembayev, Serzhan Mombekov, Aralbek Rsaliyev, Nurgul Sikhayeva, Yergali Abduraimov, Saki Raheem

Iodine-based antiseptics are essential in wound care but are often limited by cytotoxicity, instability, and rapid iodine release. Novostron is a novel polymer–iodine complex incorporating dextrin, polyvinyl alcohol, and metal ions, designed to enable controlled iodine release. Structural integrity and composition were confirmed by ¹H and ¹³C NMR spectroscopy and physicochemical analysis, indicating a molecular weight of ~9500 g/mol, a pH of 4.23, and an iodine content of 8.13%. Pharmacokinetic analysis in rabbits demonstrated that following a single dermal application, systemic iodine absorption was minimal, with peak blood iodine concentrations remaining within physiological limits and rapid elimination within 24 hours. Evaluation of thyroid function revealed no significant changes in serum T₃, T₄, or TSH levels compared with those of the controls, confirming that topical application of Novostron does not disrupt thyroid homeostasis. In compliance with OECD guidelines in rabbits, guinea pigs, and rats, Novostron showed no signs of dermal irritation, skin sensitization, or systemic toxicity (LD₅₀ > 2000 mg/kg). In a rat cotton pellet granuloma model, Novostron significantly reduced the inflammatory mass (23.65% inhibition), supporting its anti-inflammatory potential. In a murine burn model, Novostron accelerated wound contraction (25.95% at day 10), increased epidermal thickness, and enhanced collagen deposition (~44%), outperforming controls and matching or exceeding betadine. These findings suggest that Novostron promotes tissue repair by modulating inflammation. Overall, Novostron demonstrated a favourable preclinical safety and efficacy profile, and its polymer–iodine composition, which enables controlled release and localized activity highlights its potential as a promising topical therapeutic. However, the study was limited to animal models and short-term observation; further long-term and clinical investigations are needed to confirm its translational potential in human wound healing.

Prevalence of sexually transmitted infections and immunization status among registered sex workers: A pilot study in lower Bavaria, Germany

by Fabian Standl, Lena Senger, Heribert Stich

Background

Sex workers are often considered at elevated risk for sexually transmitted infections (STIs). This pilot study describes the socio‑epidemiological characteristics of registered sex workers in a rural German setting, estimates the prevalence of four STIs (HIV, hepatitis B [HBV], hepatitis C [HCV], and syphilis [lues]), compares these with the local population, and assesses HBV immunization coverage.

Methods

Under §10 of the Prostitute Protection Act (ProstSchG), annual health consultations are mandatory; voluntary serologic testing is permitted under §19 of the Infection Protection Act. We conducted a retrospective observational monocentric pilot study using routine consultation records and voluntary serologic results from the Public Health Service (PHS) of Landshut (2017–2021). In total, 523 consultations were documented; 99 blood samples from 48 registered sex workers (2019–2021) were analyzed. Primary screening assays were followed by confirmatory tests when indicated. Crude point/period prevalences and 95% confidence intervals (95% CI) were calculated. HBV immunization was defined according to Standing Committee on Vaccination (STIKO) recommendations.

Results

The cohort was predominantly female (n = 47; 97.9%), mean age 34.8 ± 11.2 years; 85.3% (n = 41) had a migration background (n = 27; 56.3% from Eastern EU countries). No acute HIV, HBV, or HCV infection was detected. Evidence of past HBV infection (anti‑HBc) was found in n = 7 (14.6%; 95% CI: 6.8–26.5), past HCV in n = 1 (2.1%; 95% CI: 0.2–9.3). Syphilis serology was reactive in 12.5% (n = 6), with n = 2 (4.2%; 95% CI: 0.9–12.7) meeting criteria for treatment‑requiring infection. HBV vaccine‑induced immunity was documented in 43.8%; only 29.2% achieved titers ≥100 mIU/ml. Compared with regional surveillance data, the prevalence of acute notifiable STIs among sex workers was not increased.

Conclusions

In this rural setting, acute notifiable STIs were uncommon among registered sex workers, while past HBV infection and suboptimal HBV immunization were frequent. Public health efforts should prioritize HBV vaccination and syphilis prevention or treatment, and expand low‑threshold, trusted services tailored to this workforce.

Agri-food supply chain resilience: An exploration of influencing factors based on fuzzy-DEMATEL-ISM analysis

by Min Zhang, Jining Yang

Increasingly frequent disruptions from diseases, disasters, and human activities pose a significant challenge to the resilience of the agri-food supply chain (AFSCRE). This study systematically explores the factors influencing AFSCRE and their mechanisms of action by integrating fuzzy Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Interpretative Structural Modeling (ISM). Based on bibliometrics and expert interviews, a three-dimensional indicator system (12 key factors) contains flexibility, agility, and visibility. Triangular fuzzy numbers were used to process expert rating data, and combined with the Converting Fuzzy Numbers into Crisp Scores (CFCS) defuzzification method to establish a total influence matrix. The strength of the influence relationships between factors was determined through the setting of appropriate thresholds, which ultimately results in a five-layer hierarchical structure. The research results show that: level of application of digital technologies, information system maturity, information sharing and synergies, data sharing and analysis capacity and risk management capacity constitute the deep driving factors; degree of simplification of the supply chain structure and level of inventory management are the direct surface factors, presenting isolated characteristics. The study proposes resilience enhancement strategies such as supplier diversification, blockchain traceability technology embedding, and multi-body collaborative decision-making mechanisms, which provide decision support for coping with climate change and public health emergencies.

A Late Pleistocene archaic human tooth from Gua Dagang (Trader’s Cave), Niah national park, Sarawak (Malaysia)

by Darren Curnoe, Mohammed S. Sauffi, Hsiao Mei Goh, Xue-feng Sun, Roshan Peiris

The rarity of Late Pleistocene hominin remains from Insular Southeast Asia (ISEA) has hampered our ability to understand a crucial episode of human evolutionary history, namely, the global dispersal of Homo sapiens from Africa. Moreover, recent discoveries indicate a surprising level of taxic diversity during this time with at least two species—H. floresiensis and H. luzonensis—endemic to the region when H. sapiens first arrived. A third hominin dubbed the ‘Denisovans’ is shown from DNA evidence to have interbred with the ancestors of contemporary Indigenous populations across ISEA, New Guinea and Australia. Yet, the Denisovans have not been identified from the fossil record of the area despite recent breakthroughs in this regard on mainland East Asia. New excavations by our team at the Trader’s Cave in the Niah National Park (‘Niah Caves’), northern Borneo, have yielded an isolated hominin upper central permanent incisor dated with Optically Stimulated Luminescence dating of sediments to about 52 − 55 thousand years ago. Specimen SMD-TC-AA210 has a massive crown absolutely and relative to its root size, the crown is wide (mesiodistally) and relatively short (labiolingually). Morphologically, it exhibits a very strong degree of labial convexity, pronounced shovelling, and the bulging basal eminence exhibits several upward finger-like projections. Labial enamel wrinking on the enamel-dentine junction is expressed as two large ridges exhibiting numerous spine-like projections, and the lingual extensions on the enamel surface of the basal eminence are expressed as six extensions. This combination of crown size and morphological traits is not normally found in H. sapiens and instead characterises archaic members of Homo such as H. erectus, H. neanderthalensis and Middle Pleistocene hominins sharing a clade with H. heidelbergensis. The Trader’s Cave tooth suggests that an archaic hominin population inhabited northern Borneo just prior to or coincident with the arrival of H. sapiens as documented at the nearby West Mouth of the Niah Great Cave.

Investigation on the knowledge-attitude-practice of medical students in controlling emerging infectious diseases: A case study of COVID-19

by Yizhe Yang, Ruifeng Liang, Yan Luo, Doudou Zhu, Yi Liu, Yuyan Guo, Jiafen Zhang, Qiao Niu

Objective

Investigate the Knowledge-Attitude-Practice (KAP) of students from Medical College towards emerging infectious diseases, and assess their impact, can provide a scientific basis and practical guidance for enhancing medico’s prevention and control capabilities.

Methods

A total of 2,395 participants from various grades and majors at Medical University were randomly selected using a stratified cluster sampling method. This cross-sectional study was conducted between April 25 and May 31, 2020, using a self-administered questionnaire developed on the Wenjuanxing platform to assess COVID-19-related knowledge, attitudes, and practices (KAP) among medical students.

Results

A total of 2,245 participants (aged 16–28 years) were included in the study, coming from five medical disciplines: Clinical Medicine, Preventive Medicine, Nursing, Clinical Pharmacy, Health Inspection and Quarantine. The average scores for the COVID-19 epidemiological knowledge and the control measures for the epidemic were 4.92 ± 1.03 and 4.50 ± 0.78, respectively. Among them, the scores of epidemiological knowledge exhibited significant differences in sex, nation, type of dwelling place, major, grade, annual per capita household income, and age. The scores of preventive knowledge significantly differed by sex, major, grade, physical condition, and age. Further, behavioral data indicated that 96.0% of the students thought the pandemic had severely affected their daily life, while >90% maintained consistent mask usage and >80% insisted on health-protective practices. Practice scores finally varied significantly by sex, family structure, and ethnicity.

Conclusions

Altogether, medical students possess certain basic knowledge in controlling emerging infectious diseases, but some still generally suffer from insufficient cognitive depth and anxiety. Colleges can systematically enhance students’ rational cognitive level which include offering specialized courses as well as promoting cutting-edge research achievements, and through standardized operations stabilize their psychological states.

Differential effects of synthetic estrogen on serum homocysteine levels before and after menopause

by Michael C. Reed, Ayako Suzuki, Allison Cruikshank, Mizuki Suzuki, H. Frederik Nijhout

Homocysteine (Hcy), a sulfur-containing amino acid, is produced in prodigious quantities by the methionine cycle in the liver. Hcy is the major biomarker for cardio-vascular disorders and is associated with many other diseases. In previous work, we have explained why menstruating women have lower serum homocysteine than men due to higher concentrations of estradiol. In this study, we first present epidemiological evidence from NHANES data that synthetic estradiol supplementation lowers serum Hcy in post-menopausal women, but raises Hcy in pre-menopausal women. Secondly, we give an explanation of this puzzling phenomenon using previously developed mathematical models of one-carbon and glutathione metabolism. The simulation analysis demonstrated that the non-monotonic response of glutathione to rising estradiol levels may account for the differing Hcy responses to estradiol supplementation in postmenopausal versus premenopausal women, through activation of cystathionine β-synthase, a key enzyme regulating tissue homocysteine levels. Our findings further highlight the importance of considering menopausal status and synthetic hormone use when evaluating the health effects of homocysteine.

Spatial clustering of zero dose children aged 12 to 59 months across 33 countries in sub-Saharan Africa: A multiscale geographically weighted regression analysis

by Chamberline E. Ozigbu, Zhenlong Li, Bankole Olatosi, James W. Hardin, Nicole L. Hair

While prior studies have identified sociodemographic correlates of zero-dose status within populations in sub-Saharan Africa (SSA), few have applied spatial regression techniques to explore geographic variability in these relationships. We aimed to address this gap using data from Demographic and Health Surveys conducted in SSA between 2010 and 2020. Our sample comprised children aged 12–59 months in 33 countries and 329 survey regions. Data were aggregated to the first-level administrative unit prior to analysis. First, using ordinary least squares regression, we documented global relationships between theoretically important sociodemographic characteristics and zero-dose prevalence. Next, we identified patterns, i.e., geographic clustering, of zero-dose prevalence. Finally, using multiscale geographically weighted regression, we described spatial variability in relationships between sociodemographic characteristics and zero-dose prevalence. We detected 27 regions with higher than expected concentrations of zero-dose children. All but one of these hot spots were observed in 7 Western and Central African countries; only 1 was located in an Eastern African country. Regions with higher proportions of mothers with no antenatal care visits were consistently found to have higher rates of zero-dose children. In contrast, relationships between zero-dose prevalence and indicators of religious affiliation, delivery site, maternal age, maternal education, and maternal employment were found to vary locally in terms of their strength and/or direction. Study findings underscore spatial disparities in zero-dose prevalence within SSA and, further, highlight the importance of geographically informed strategies to effectively address immunization gaps. Implementing targeted interventions based on regional sociodemographic dynamics is crucial for achieving comprehensive vaccination coverage in SSA.