Early and intensive intervention is crucial for children with cerebral palsy (CP), particularly during the period when gross motor activities typically develop. Despite the prevalence of CP, robust evidence for effective early mobility interventions remains limited. Frame Running, which enables children with limited walking ability to engage in dynamic, high-intensity activities, has emerged as a promising approach, yet research on its effect in young children is currently lacking. The aim of this study is to implement and evaluate the effects of a mobility-focused training program combining Frame Running and goal-directed gross motor training, on mobility in every day life and cardiovascular health in children aged 2-5 years with CP. The study uses a prospective repeated-measures intervention design with assessments conducted during baseline, intervention, and post-intervention follow-up phases. At least 18 children meeting the inclusion criteria (CP diagnosis, age 2-5 years, GMFCS II-IV) will participate. The design consists of three baseline measurements, a 12-week intervention phase and three post-intervention measurements, across approximately 5-6 months. The program combines home-based training and hospital-based group training, with parents as active trainers and therapists providing coaching. Frame Running and goal-directed training are tailored to individual goals, set collaboratively with families. Outcome measures include the Gross Motor Function Measure (GMFM-66), Functional Mobility Scale (FMS), Paediatric Evaluation of Disability Inventory Computerised Assessment Test (PEDI-CAT), time-based mobility tests: ultrasound assessment of muscle size and morphology, gait analysis, accelerometry (7-day activity monitoring), heart rate monitoring during training, and Goal Attainment Scaling (GAS). Feasibility and fidelity will be investigated by questionnaires. By evaluating the Full Speed Ahead program, this study aims to improve understanding of how an early intensive family-centered mobility intervention may influence developmental trajectories and health in children with CP. If effective, the findings will have significant implications for planning both short- and long-term treatment and services for young children with CP. The prospective repeated-measures intervention design allows for both group-level and individual-level analysis of changes over time, thereby strengthening the evidence base for early, intensive, family-centered mobility interventions. ClinicalTrial.gov NCTO7374432, Registered November 18 2025.
The latest drug-eluting stents (DESs) are the gold standard for patient treatment during percutaneous coronary intervention (PCI). The latest advancements in DES innovation have resulted in the development of new stent technologies with reduced thickness in the struts. The new DES design, ultrathin-strut DESs, features struts measuring less than 70 μm in thickness. The evidence for these devices is derived from observational studies, extensive meta-analyses, and randomized trials with long-term outcomes. The investigation is focused on determining the comparative performance of ultrathin-strut DESs and conventional new-generation DESs across various clinical settings and patient lesion profiles. The objective of the seminar is to examine recent advancements in the use of very thin DESs and the potential of computational modeling in coronary arteries during PCI. An analysis of the mechanical performance of ultrathin DESs has been conducted in terms of radial expansion and stresses within the stent-vessel system. Residual stresses generated by the crimping process will also be considered.
Lower-grade gliomas (LGG) are a subgroup of primary brain tumours. People with LGG often live long-term with wide-ranging symptoms and impairments (e.g., seizures, cognitive impairment) and uncertainty about their disease progression. Self-management interventions can improve quality-of-life (QoL) in cancer survivors; however, adaptability, acceptability, and feasibility of existing interventions for people with LGG is unclear. Co-design, with multiple stakeholders, an early prototype supported self-management intervention for people with LGG. Co-design activities followed two sequential phases. Phase one comprised three semi-structured interview sets with people with LGG, caregivers, and healthcare professionals (HCP). Desired support and design preferences were inductively identified and mapped to the TIDieR checklist; this informed a paper prototype outline. Phase two comprised four discussion groups with people with brain tumours, caregivers, and HCPs, and a survey. These activities considered the prototype design, feasibility, and acceptability. A preliminary intervention logic model was developed from Phases one and two, evidence and self-management theory. Early co-design findings indicate preference for a blend of online and face-to-face access to information and support with consideration given to technology literacy and accessibility. A support 'toolkit' was desired for advice, signposting, and support, with the option for caregivers to access intervention content, where appropriate. To improve QoL, the intervention needs to improve symptom knowledge and self-efficacy for symptom management, and support psychological adjustment and independence. This groundwork, involving multiple stakeholders, will help ensure intervention acceptability, feasibility and effectiveness. There is scope for wider applicability to other brain tumour groups.
Diabetic kidney disease (DKD) management has advanced rapidly in recent years, with new therapies supplementing established treatments. The cardiorenal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) in patients with DKD have been proven in several large randomised controlled trials. Recent studies show that combining SGLT2i, ns-MRA and renin-angiotensin-aldosterone system (RAAS) blockade significantly slows DKD progression compared with using single agents. The concurrent use of four agents, including GLP-1RA, SGLT2i, ns-MRA and RAAS blockade, may confer additional benefits, and a four-pillar approach to managing DKD could become standard therapy in the future. Additional investigational agents, including endothelin receptor antagonists, aldosterone synthesis inhibitors, and Janus kinase 1 and Janus kinase 2 inhibitors, have demonstrated encouraging results in Phase 2 trials. These therapies may offer further treatment options for patients who are unable to use other agents.
Neurosurgical services remain critically underdeveloped in Afghanistan, where decades of conflict, political instability, sanctions, donor contraction, and workforce migration have compounded the baseline challenges faced by many low- and middle-income countries. Afghanistan has an estimated 124 neurosurgeons, approximately 0.3 neurosurgeons per 100,000 people, concentrated primarily in urban hospitals despite a largely rural population. This historical report and contextual analysis describes recent Afghan-led and internationally supported efforts to strengthen neurosurgical capacity through a structured change-management approach. Major milestones include a national capacity assessment, installation of stable internet and power support at nine hospitals; procurement and distribution of cranial, spinal, and drill sets to public hospitals; short- and long-term training pathways for neurosurgeons and nurses; smart-glasses-enabled telemedicine and intraoperative mentoring; reactivation of the Afghan Neurosurgical Society; national neurosurgical conferences; and diaspora-supported fundraising. Persistent challenges include geographic barriers to care, out-of-pocket costs, limited neurosurgical epidemiologic data, border closures, customs and sanctions-related logistical barriers, restricted travel and visa access, unstable internet connectivity, and gender-related constraints on medical education and professional mobility. The Afghan experience highlights both the fragility and possibility of neurosurgical capacity-building in conflict-affected settings. Locally led partnerships, diaspora engagement, practical infrastructure investments, remote mentorship, and flexible logistics can create meaningful progress even when conventional global health pathways are disrupted.
Bats navigating clutter must steer around obstacles to avoid collision, while simultaneously planning future flight trajectories. In this study, we investigated active sensing strategies of two bat species negotiating turns under matched geometric constraints. We compare the Egyptian fruit bat (Rousettus aegyptiacus), a lingual echolocator that can actively direct its sonar beam axis using tongue driven mechanisms, and the short-tailed fruit bat (Carollia perspicillata), a laryngeal nasal echolocator whose head aim and nose leaf shape emission directionality. Bats flew through a felt lined, 'L' shaped corridor designed to elicit turns. A 32-channel ultrasonic array and 3D video tracking system captured their sonar emissions and flight trajectories. In both species, bats reduced flight speeds and increased angular deviation between sonar beam aim (acoustic gaze) and flight direction before the apex of high angle turns. A directional prediction analysis showed that sonar gaze reliably anticipated the direction of the subsequent heading change in both species (77% in R. aegyptiacus; 70% in C. perspicillata). However, baseline flight and echolocation behavior differed between species: C. perspicillata flew faster and, produced higher sonar pulse rates than R. aegyptiacus, consistent with species differences in body size, wing morphology, and sensory ecology. Together, these data demonstrate that fruit bats prospectively orient acoustic gaze to guide upcoming trajectory changes, extending "steering by hearing" beyond prey tracking by insectivorous bats to navigation of cluttered space by frugivorous bats.
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Day-to-day fluctuations in heart rate variability (HRV) are widely used to infer autonomic recovery in endurance athletes. However, the extent to which HRV can be forecast one day ahead from readily available external and internal training-load metrics remains unclear. In this study, we evaluated whether machine learning models can predict next-day HRV in competitive cyclists using the two load descriptors most commonly collected in practice: external load quantified as total mechanical work in kilojoules (kJ) and internal load quantified as session rating of perceived exertion (RPE). Seven male competitive endurance cyclists were monitored daily for sixteen weeks, yielding 590 athlete-days of longitudinal data (seven independent time series). Two machine learning approaches-support vector regression (SVR) and extreme gradient boosting (XGBoost)-were compared with a conventional autoregressive model with exogenous inputs (ARX) as a traditional time-series benchmark. Each model was trained individually per athlete under two predictor scenarios (using past HRV-only or past HRV plus kJ and RPE) and across multiple lag orders (1, 4, 7, 10 and 14 days), with forecasting accuracy expressed as root mean squared error (RMSE). Across all athletes, adding kJ and RPE to the past HRV produced only modest reductions in RMSE relative to HRV-only models. XGBoost achieved the lowest one-step-ahead RMSE at short lag, while all models converged at longer lag orders. Predictive accuracy differed markedly between athletes, reflecting the well-known individual nature of autonomic responses. These findings suggest that the two routinely collected load descriptors examined here-total work (kJ) and RPE-add limited information beyond recent HRV history for forecasting next-day HRV, and that broader contextual variables are likely required to meaningfully improve athlete monitoring.
Background: Hepatitis C virus (HCV) affects approximately 50 million people worldwide and progresses silently through distinct hepatic stages, yet most machine learning staging approaches offer no clinician-facing explanation and rarely evaluate whether explanations hold across architectures. Methods: We trained five models-Logistic Regression, Random Forest, XGBoost, LightGBM, and SVM-on the UCI HCV dataset (615 patients, four classes after merging the seven-instance suspect blood-donor group into a single Donor/Control class) and applied SHAP, LIME, and DiCE counterfactuals. A cross-model Spearman agreement analysis quantified feature ranking consistency, with a leakage-controlled pipeline and five-fold stratified cross-validation applied. Results: In the main 5-fold cross-validation, LightGBM achieved the highest macro-F1 (0.684 ± 0.031). Under repeated-seed cross-validation, XGBoost and LightGBM gave closely matched values (0.648 ± 0.023 and 0.645 ± 0.026), indicating comparable robustness among the boosted-tree models, both marginally ahead of the remaining three, with Random Forest close behind. Logistic Regression reached the highest macro-F1 on the single held-out split (0.790), but its cross-validated score was markedly lower (0.598 ± 0.063), underlining how unstable single-split estimates are in a small, imbalanced cohort. SHAP consistently identified AST, GGT, CHE, and ALP across the tree-based models, with CHE emerging as the leading Cirrhosis-stage marker in the boosted models. Cross-model Spearman correlations reached 0.923-0.958 among tree-based models; SHAP-LIME overlap ranged from 1/5 to 4/5. Conclusions: The framework identifies stage-specific biochemical importance patterns consistent with known HCV disease progression. The convergent finding on CHE for Cirrhosis, supported by SHAP in the tree-based models and appearing among the top LIME features in three of the five model-specific Cirrhosis explanations, supports CHE as a candidate marker worth evaluating in advanced disease.
Robotic cholecystectomy has emerged as an important minimally invasive option for gallstone disease, yet the rapid expansion and scattered distribution of related research may present challenges for researchers in identifying knowledge gaps and future directions. Bibliometric analysis offers a systematic and quantitative approach to summarize research output, hotspots, and trends within a field. All eligible publications included in this study were retrieved from the Web of Science Core Collection, covering papers published between 2000 and 2025 that focus on robot-assisted surgery for the treatment of gallstones and related diseases. Two bibliometric software programs, VOSviewer 1.6.20 and CiteSpace 6.4.R2, were adopted to conduct multiple analyses, including author collaboration analysis, co-citation analysis, and keyword co-occurrence analysis. Meanwhile, the built-in keyword burst detection module of CiteSpace was used to accurately identify mainstream research hotspots and emerging frontier directions in this field. Furthermore, we applied the dual-map overlay function of CiteSpace to explore the interdisciplinary characteristics of this research field and identify its core journals. A total of 126 qualified papers contributed by 685 scholars affiliated with 248 institutes in 35 nations were enrolled in this research. Bibliometric tendency analysis indicated a consistent growing tendency of yearly publications. In particular, the output of pertinent literatures experienced a dramatic boost after 2021, hitting two maximum output points in 2023 and 2025 separately. National-level bibliometric analysis indicated that the United States dominates global research productivity regarding robotic surgery for biliary calculi and associated biliary diseases. A total of 40 publications originating from the U.S. were included, accounting for 31.7% of all eligible literature, with an aggregate citation count of 1230 and ranking first worldwide. China, the United Kingdom, Italy, South Korea, and Turkey sequentially constituted the leading contributing countries in this field. At the institutional level, the University Hospitals of Geneva produced the highest volume of relevant research outputs. Author productivity analysis identified Buchs, Nicolas C., Hagen, Monika E., and Morel, Philippe as the most prolific scholars who have substantially advanced research on robotic biliary surgery. In terms of publication channels, Surgical Endoscopy and Other Interventional Techniques and Asian Journal of Surgery represented the primary academic journals for publications concerning robotic applications in biliary stone disease management. Keyword cluster analysis categorized the research landscape into four core thematic domains: robotic surgery, laparoscopic cholecystectomy, cholecystectomy, and postoperative care after cholecystectomy. Keyword trend analysis reveals that research priorities have gradually shifted from conventional laparoscopic management of gallstones to robotic surgical intervention. Looking ahead, with continuous upgrades of robotic platforms, optimized surgical training frameworks and accumulated clinical experience, research focus is expected to progressively turn to multidimensional assessments of perioperative outcomes. Over the past 26 years, the research focus on gallstones management has gradually shifted from conventional laparoscopic surgery toward robotic surgical intervention. Looking forward, with continuous upgrades of robotic systems, optimized surgical training frameworks and accumulating clinical experience, research priorities are anticipated to transition toward multidimensional assessments of perioperative outcomes.
Fetal intervention for lower urinary tract obstruction (LUTO) has advanced more slowly than other areas of fetal surgery. Thirteen years after the PLUTO trial, three core problems remain unresolved. Firstly, prenatal ultrasound diagnosis is not accurate enough to reliably distinguish LUTO from non-obstructive megacystis. Secondly, selection criteria for vesico-amniotic shunting (VAS) remain poorly defined, since the developmental impact of bladder outlet obstruction is highly variable between fetuses. Thirdly, outcome reporting is inconsistent, with "perinatal survival" obscuring the true long-term picture for posterior urethral valves (PUV). The introduction of the low-profile SOMATEX© shunt has enabled VAS from as early as 11 weeks' gestation. A recent prospective cohort study (IUS1st) of first-trimester shunting for severe megacystis reported 73% perinatal survival and largely preserved renal function at one year, but also revealed striking urological morbidity, with over half of infants requiring diversion procedures for urethral hypoplasia. Whether this reflects a consequence of urethral bypass throughout gestation, or simply the natural history of the underlying disease, remains unresolved - underscoring the continued need for a control group. Looking ahead, more selective patient stratification may come from combining ultrasound with fetal MRI, fetal urinary peptidomic signatures, and AI-assisted image analysis, while next-generation, pressure-limiting shunts such as the Vortex© device aim to preserve physiological bladder cycling rather than fully defunctionalising the bladder. An international collaborative registry, rather than a further randomised controlled trial, may offer the most realistic route to answering these questions.
Madagascar has a high number of unvaccinated (zero-dose) children. In 2023, an estimated 74% received any dose of the diphtheria-tetanus-pertussis (DTP) vaccine. In southern Madagascar, service gaps, poverty, drought and limited access leave many children unreached by routine immunization. Within the Sorohy ny Aretina Manaova Ezaka Vaksiny initiative, a community-based enumeration and vaccination-status verification was conducted in 16 districts in August 2024-June 2025 under health ministry authorization. A total of 3975 community health workers (CHWs) were recruited and trained to verify the vaccination status of all children younger than 5 years from available documentation in targeted fokontany (lowest administrative unit). Digital tools supported data collection, validation and CHW incentive payments. The southern regions of Atsimo Andrefana, Androy and Anosy have about 3.7 million inhabitants, most in remote areas. Health indicators lag behind national averages. Volunteer CHWs lack training, supervision and financial protection, resulting in incomplete population data and weak microplanning. Among the fokontany, 81% (3538/4347) completed registry updating. Overall, 58% (213 173/368 227) of the children enumerated had no documented DTP dose. District-level prevalence of no-dose children ranged from 25% (7956/32 015) to 86% (14 989/17 445). These data guided zero-dose mapping and targeted outreach. As of March 2026, 42 700 zero-dose children had received DTP vaccination, surpassing the programme target ahead of schedule. Locally led partnerships and CHW engagement, supported by simple digital tools and transparent financial mechanisms, produced actionable data on zero-dose children. Prior agreement on zero-dose case definitions ensures compatibility with national reporting. Madagascar compte un nombre élevé d’enfants non vaccinés. En 2023, on estimait que 74% des enfants avaient reçu au moins une dose du vaccin contre la diphtérie, le tétanos et la coqueluche (DTC). Dans le sud de Madagascar, les lacunes dans les services, la pauvreté, la sécheresse et un accès limité empêchent de nombreux enfants de bénéficier de la vaccination systématique. Dans le cadre de l’initiative Sorohy ny Aretina Manaova Ezaka Vaksiny, un recensement communautaire et une vérification du statut vaccinal ont été menés dans 16 districts entre août 2024 et juin 2025, sous l’égide du ministère malgache de la Santé. En tout, 3 975 agents de santé communautaires (ASC) ont été recrutés et formés pour vérifier le statut vaccinal de tous les enfants de moins de 5 ans à partir des documents disponibles dans les fokontany (unités administratives de base) ciblées. Des outils numériques ont facilité la collecte et la validation des données, ainsi que le versement des primes aux ASC. Les régions méridionales d’Atsimo-Andrefana, d’Androy et d’Anôsy comptent environ 3,7 millions d’habitants, dont la plupart vivent dans des zones reculées. Les indicateurs de santé y sont inférieurs aux moyennes nationales. Les ASC bénévoles manquent de formation, de supervision et de protection financière, ce qui se traduit par des données démographiques incomplètes et une planification locale déficiente. Parmi les fokontany, 81% (3 538 sur 4 347) ont achevé la mise à jour des registres. En tout, 58% (213 173 sur 368 227) des enfants recensés n’avaient aucune dose de vaccin DTC documentée. Au niveau des districts, la prévalence des enfants non vaccinés variait de 25% (7 956 sur 32 015) à 86% (14 989 sur 17 445). Ces données ont guidé la cartographie des enfants n’ayant reçu aucune dose de vaccin et les actions de sensibilisation ciblées. En mars 2026, 42 700 enfants n’ayant reçu aucune dose avaient reçu le vaccin DTC, dépassant ainsi l’objectif du programme avant la date prévue. Les partenariats menés au niveau local et l’engagement des ASC, soutenus par des outils numériques simples et des mécanismes financiers transparents, ont permis d’obtenir des données exploitables sur les enfants n’ayant reçu aucune dose de vaccin. Un accord préalable sur les définitions des cas d’enfants n’ayant reçu aucune dose garantit la compatibilité avec les rapports nationaux. Madagascar tiene un número elevado de niños no vacunados (dosis cero). En 2023, se estimó que el 74% recibió alguna dosis de la vacuna contra la difteria, el tétanos y la tos ferina (DTP). En el sur de Madagascar, las deficiencias en los servicios, la pobreza, la sequía y el acceso limitado hacen que muchos niños queden fuera de la inmunización sistemática. En el marco de la iniciativa Sorohy ny Aretina Manaova Ezaka Vaksiny, se llevó a cabo un registro comunitario y una verificación del estado de vacunación en 16 distritos entre agosto de 2024 y junio de 2025, con autorización del ministerio de salud. Se reclutó y formó a un total de 3975 trabajadores comunitarios de salud (TCS) para verificar el estado de vacunación de todos los niños menores de 5 años a partir de la documentación disponible en los fokontany (unidad administrativa más pequeña) seleccionados. Herramientas digitales apoyaron la recopilación y la validación de datos, así como el pago de incentivos a los TCS. Las regiones meridionales de Atsimo Andrefana, Androy y Anosy tienen aproximadamente 3,7 millones de habitantes, la mayoría en zonas remotas. Los indicadores sanitarios se sitúan por debajo de los promedios nacionales. Los TCS voluntarios carecen de formación, supervisión y protección financiera, lo que da lugar a datos poblacionales incompletos y a una microplanificación deficiente. Entre los fokontany, el 81% (3538/4347) completó la actualización de registros. En conjunto, el 58% (213 173/368 227) de los niños registrados no tenía ninguna dosis de DTP documentada. La prevalencia de niños con dosis cero a nivel distrital osciló entre el 25% (7956/32 015) y el 86% (14 989/17 445). Estos datos orientaron el mapeo de niños con dosis cero y las actividades de alcance dirigidas. En marzo de 2026, 42 700 niños con dosis cero habían recibido la vacuna DTP, superando antes de lo previsto el objetivo del programa. Las alianzas lideradas a nivel local y la participación de los TCS, apoyadas por herramientas digitales sencillas y mecanismos financieros transparentes, generaron datos útiles para la acción sobre los niños con dosis cero. El acuerdo previo sobre las definiciones de casos de dosis cero asegura la compatibilidad con los sistemas nacionales de notificación. تعاني مدغشقر من نسبة مرتفعة للأطفال الذين لم يحصلوا على اللقاح (لم يتلقوا أية جرعة). في عام 2023، تلقى ما يقدر بـ 74% منهم جرعة واحدة من لقاحات الدفتيريا والتيتانوس والسعال الديكي (DTP). في جنوب مدغشقر، يتعرض العديد من الأطفال للحرمان من التحصين الروتيني بسبب نقص الخدمات والفقر والجفاف وفرص الوصول المحدودة. في إطار مبادرة Sorohy ny Aretina Manaova Ezaka Vaksiny ، تم إجراء إحصاء مجتمعي، وتحقق من حالة التلقيح في 16 مقاطعة خلال الفترة من أغسطس/آب 2024 إلى يونيو/حزيران 2025 بموجب تفويض من وزارة الصحة. تم توظيف وتدريب 3975 من العاملين في مجال الخدمات الصحية المجتمعية (CHW) للتحقق من حالة اللقاح لجميع الأطفال دون سن الخامسة من خلال الوثائق المتاحة في وحدات fokontany المستهدفة (أصغر وحدة إدارية). تم استخدام الأدوات الرقمية لدعم جمع البيانات، وتحقيقها، ودفع حوافز العاملين في مجال الخدمات الصحية المجتمعية (CHW). يبلغ عدد سكان المناطق الجنوبية من أتسيمو أندريفانا، وأندروي، وأنوسي حوالي 3.7 مليون نسمة، معظمهم في مناطق نائية. وتتأخر المؤشرات الصحية خلف المتوسطات الوطنية. ويفتقر العاملون المتطوعون في مجال الخدمات الصحية المجتمعية (CHW) إلى التدريب والإشراف والحماية المالية، مما يؤدي إلى نقص في بيانات السكان وضعف التخطيط الجزئي. من بين وحدات fokontany ، أكمل 81% (3538/4347) تحديث سجلاتهم. وبشكل عام، لم يحصل 58% (213173/368227) من الأطفال الذين تم إحصاؤهم أية جرعة موثقة من لقاحات الدفتيريا والتيتانوس والسعال الديكي (DTP). وتراوحت نسبة انتشار الأطفال الذين لم يتلقوا أي جرعة على مستوى المقاطعات من 25% (7956/32015) إلى 86% (14989/17445). وقد قامت هذه البيانات بتوجيه عملية تحديد المناطق التي لم تحصل على أية جرعة، والحملات المستهدفة. بدءًا من مارس/آذار 2026، فإن الـ 42700 طفلاً الذين لم يحصلوا على أي لقاح، قد تلقوا لقاح الدفتيريا والتيتانوس والسعال الديكي (DTP)، متجاوزين بذلك هدف البرنامج قبل الموعد المحدد. إن الشراكات المحلية، ومشاركة العاملين في مجال الخدمات الصحية المجتمعية (CHW)، مع دعم من أدوات رقمية بسيطة وآليات مالية شفافة، قد أسفرت عن بيانات قابلة للاستخدام والتخطيط بشأن الأطفال الذين لم íÍÕáæÇ Úáì ÃíÉ ÌÑÚÉ. Åä ÇáÇÊÝÇÞ ÇáãÓÈÞ ÈÎÕæÕ ÊÚÑíÝ ÇáÍÇáÇÊ ÇáÊí áã ÊÍÕá Úáì ÃíÉ ÌÑÚÇÊ¡ íÖãä ÇáÊæÇÝÞ ãÚ ÅÚÏÇÏ ÇáÊÞÇÑíÑ ÇáæØäíÉ. 在马达加斯加，未接种疫苗儿童（零剂量儿童）的占比很高。2023 年，无任何白喉-破伤风-百日咳 (DTP) 疫苗接种记录的儿童约占 74%。在马达加斯加南部地区，因服务缺口、贫困、干旱和可及性受限等原因而导致许多儿童无法定期接种疫苗。. 根据“接种疫苗，远离疾病 (Sorohy ny Aretina Manaova Ezaka Vaksiny) 倡议，2024 年 8 月至 2025 年 6 月期间，经卫生部授权，有 16 个地区开展了基于社区的查点和疫苗接种状态核查活动。被招募而来的总计 3975 名社区卫生工作者 (CHW) 接受培训后，在目标社区 (fokontany)（最低行政单位）中根据现有接种记录，核查所有 5 岁以下儿童的疫苗接种状态。数字工具支持数据收集、验证和 CHW 激励性报酬支付。. 马达加斯加南部的阿齐莫-安德列发娜区、安德罗伊区和阿诺西区共有约 370 万居民，且大部分生活在偏远地区。卫生指标低于国家平均水平。志愿者性质的 CHW 未能接受培训监管和获得财务保障，从而导致人口数据不完整且微观计划薄弱。. 在社区 (fokontany) 中，有 81% (3538/4347) 的儿童完成了登记更新。总体来说，在接受查点的儿童中，有 58% (213173/368227) 无 DTP 疫苗接种记录。各地区零剂量儿童的比例分别为 25% (7956/32015) 至 86% (14989/17445) 不等。这些数据能够为确定零剂量儿童分布和有针对性地推行外展服务提供指导。截至 2026 年 3 月，42700 名零剂量儿童完成了 DTP 疫苗接种，这表示提前超目标完成了计划任务。. 通过当地主导开展合作、招募 CHW 有效参与、利用简单数字工具以及实施透明财务机制，生成了有关零剂量儿童的可操作数据。事先约定零剂量儿童的定义确保最终结果与国家报告体系相兼容。. На Мадагаскаре многие дети не были охвачены вакцинацией (дети с нулевой дозой). В 2023 году около 74% детей получили хотя бы одну дозу вакцины от коклюша, столбняка и дифтерии (КДС). На юге Мадагаскара многие дети остаются не охваченными плановой иммунизацией из-за пробелов в предоставлении услуг, бедности, засухи и затрудненного доступа. В период с августа 2024 года по июнь 2025 года в рамках инициативы Sorohy ny Aretina Manaova Ezaka Vaksiny и с разрешения Министерства здравоохранения на базе отдельных общин был проведен поименный учет и определение статуса вакцинации населения в 16 районах. Было нанято и проинструктировано в общей сложности 3975 общинных медицинских работников, которые проверяли статус вакцинирования всех детей в возрасте до 5 лет в целевых фоконтанах (низших административных единицах). Цифровые инструменты обеспечивали сбор и проверку данных, а также выплату бонусов общинным медицинским работникам. В южных регионах Андруй, Ануси и Ациму-Андрефана проживают около 3,7 миллиона жителей, по большей части в труднодоступной местности. Показатели здравоохранения здесь отстают от средних по стране. Общинным медицинским работникам, работающим на добровольных началах, недостает обучения, надзора и финансовой защиты, что приводит к неполноте данных о населении и слабому микропланированию. В 81% фоконтанов (3538 из 4347) были обновлены реестры. В целом 58% (213 173 из 368 227) выявленных детей не имели документального подтверждения получения дозы КДС. По отдельным районам количество невакцинированных детей колебалось от 25% (7956 из 32 015) до 86% (14 989 из 17 445). Эти данные использовались для картирования лиц с нулевой дозой вакцинации и адресной работы с ними. По состоянию на март 2026 года 42 700 невакцинированных детей получили вакцину КДС, тем самым цель программы была перевыполнена досрочно. Партнерства под местным руководством и участие общинных медицинских работников, поддерживаемые простыми цифровыми инструментами и прозрачными финансовыми механизмами, позволили получить практические данные о детях с нулевой дозой вакцинации. Предварительное согласование определений случаев нулевой дозы обеспечивает совместимость с национальной системой отчетности.
This study investigates the microstructural evolution, mechanical performance, and electrochemical corrosion behavior of nanocrystalline boride layers formed on an Fe-20Cr-5Al ferritic alloy by pack boriding at 950 °C for 4 h. X-ray diffraction (XRD) and scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS) analyses confirmed the formation of a hierarchical boride layer approximately 80-85 μm in thickness, consisting of orthorhombic (Fe,Cr)B and tetragonal (Fe,Cr)2B phases at the surface and (Fe,Cr)23(C,B)6 carboboride phases in the diffusion zone, the latter attributed to the carbon push-ahead mechanism. Rietveld refinement yielded a quantitative phase fraction of 51.9 wt.%. (Fe,Cr)B, 46.1 wt.% Fe2B, and 2.0 wt.% (Fe,Cr)23(C,B)6, with a theoretical boride layer density of 7.40 g cm-3. Williamson-Hall analysis yielded an average crystallite size of 50.7 nm and a microstrain of 1.686 × 10-3, confirming the nanocrystalline character of the boride phases. Mechanical evaluation revealed a ~9-fold increase in surface hardness in Fe20Cr5Al-B relative to Fe20Cr5Al, reaching 1854 HV (18.18 GPa). Tribological testing demonstrated an ~18-fold reduction in wear rate (from 3.29 × 10-4 to 1.82 × 10-5 mm3/m) and a 14.5% reduction in the coefficient of friction (0.76→0.65), confirming the effectiveness of the boride layer as a tribological barrier. However, electrochemical analyses in 5 wt.% H2SO4 revealed a paradoxical deterioration in corrosion resistance: despite a noble shift in Ecorr from -0.459 to -0.295 V, the corrosion rate increased ~4-fold (from 9.67 × 10-3 to 3.83 × 10-2 mm/year), driven by Al-repulsion-induced passive film loss and micro-galvanic cell formation through micro-crack and porosity networks. These findings emphasize that while pack-boriding is highly effective for tribological enhancement of FeCrAl alloys, minimizing boride layer defects is essential to achieve concurrent corrosion protection in acidic environments.
Pharmacists play a key role in managing and mitigating mpox through clinical care, pharmacovigilance, vaccine management, and resilient supply chains. Management focuses on supportive care, infection prevention, and accurate diagnosis, with pharmacists ensuring the availability and rational use of vaccines, disinfectants, laboratory reagents, and personal protective equipment. They also promote vaccine equity, community engagement, pharmacovigilance, and efficient production and distribution of health commodities. In Africa, where 1.2 billion people lack access to mpox vaccines, pharmacists help address inequities through community outreach and trust-building. They further strengthen supply chains using inventory management, local production, and technologies such as artificial intelligence, blockchain, and continuous manufacturing. Pharmacists support humanitarian supply chains by promoting rational medicine use, preventing antimicrobial resistance, and supporting adherence. However, their impact is limited by vaccine inequities, varying clinical authority, inadequate training, and limited involvement in outbreak planning. Expanding their roles in surveillance, pharmacoeconomics, and real-world evidence is crucial to improve outcomes and cost-effectiveness. Looking ahead, pharmacists are essential in smallpox and mpox vaccine research, contributing to safety and efficacy through involvement in drug development and clinical trials. This narrative review employs a thematic synthesis to evaluate the pharmacist's role in the global mpox response. By analyzing literature from major databases (PubMed, Scopus, and Google Scholar) and technical reports, it identifies systemic opportunities and structural challenges within the pharmaceutical lifecycle. Integrating pharmacists into multidisciplinary teams and enhancing their training in pharmacovigilance and infectious disease management are critical to achieving sustainable outbreak preparedness. Empowering pharmacists through structural reforms can enhance health system resilience, optimize cost, and safeguard public health in current and future pandemics.
This paper introduces a new benchmark test, Medical-Checklist, for assessing medical multimodal models. The recent advancements in multimodal models have demonstrated significant potential in the field of medical vision-language tasks. However, it is becoming increasingly clear that evaluating these models' performance, whether they are applied to natural or medical images, is challenging. The critical question is whether the models can accurately understand an input image while associating it with relevant input text. To address this, Medical-Checklist imposes a binary test on the models: they are given an image and two captions, where one is correct and the other incorrect, and the model must select the correct one. The incorrect caption contains a single medical concept (word or phrase) that is inaccurately substituted from the correct caption. Although the task is simple, this simplicity enables the unified assessment of diverse multimodal models designed and learned on different principles. It also enables us to verify whether models correctly understand a wide range of medical concepts across various medical sub-domains. Medical-Checklist is designed to reduce potential biases in data and to enable evaluation of the models' ability to handle out-of-distribution inputs, which were difficult in existing datasets. When evaluating four state-of-the-art medical multimodal models with Medical-Checklist, it was revealed that despite their excellent performance in specific tasks such as Med-VQA, they may not correctly understand images, suggesting a long journey ahead for clinical application. The dataset and code will be made public upon acceptance.