Neighborhood built environments may be associated with physical activity and sedentary behavior among older adults. However, evidence from rapidly urbanizing Chinese cities remains limited, particularly studies using objectively measured activity outcomes. This study aimed to examine the associations of perceived neighborhood built environment attributes with accelerometer-measured physical activity and sedentary behavior among older adults in urban China. Community-based cross-sectional study. A total of 499 older adults from 32 communities in Nanjing, China, were included. Physical activity and sedentary behavior were measured using ActiGraph GT3X + accelerometers. Perceived neighborhood built environment attributes were assessed using a questionnaire adapted from the Neighborhood Environment Walkability Scale. Multiple linear regression models were used to examine the associations of perceived built environment attributes with total physical activity, light-intensity physical activity, moderate-to-vigorous physical activity, and sedentary behavior, adjusting for sociodemographic and health-related covariates. Perceived access to service facilities was consistently associated with higher total physical activity, light-intensity physical activity, and moderate-to-vigorous physical activity, and with lower sedentary time. Access to fitness facilities was positively associated with total physical activity and light-intensity physical activity. Better neighborhood aesthetics was associated with higher moderate-to-vigorous physical activity. Traffic site accessibility and street connectivity were associated with lower sedentary time. In contrast, perceived access to commercial facilities was associated with lower total physical activity, light-intensity physical activity, and moderate-to-vigorous physical activity, and with higher sedentary time. Perceived neighborhood built environment attributes were associated with accelerometer-measured physical activity and sedentary behavior among older adults in urban China. Access to service and fitness facilities, neighborhood aesthetics, public transportation accessibility, and street connectivity may be relevant environmental correlates of active and sedentary lifestyles. The inverse association observed for commercial facility accessibility suggests that the role of destination accessibility may differ in high-density Chinese urban communities. These findings may inform age-friendly community planning and population-level public health strategies aimed at supporting active ageing and reducing sedentary behavior among older adults.
RNA viruses represent an integral component of human-associated environments and human health. However, the ecology of environmental RNA viruses remains largely unexplored. Here, we analyzed 2922 metatranscriptomic samples collected from urban and surrounding environments-including human-dense settings (e.g., transit hubs, hospitals, banks), alongside peri-urban settings - across 102 cities in 31 countries and constructed the Urban & Peri-urban RNA Virus Atlas (UPVAtlas), comprising 54,945 RNA viruses, 77% of which had not been previously observed. Phylogenetic reconstruction based on RNA-dependent RNA polymerases from UPVAtlas greatly expanded the evolutionary diversity of RNA viruses, leading to the identification of two potential candidate phyla, one candidate class, and several unclassified clades. Host association analyses further revealed the ecological complexity of environmental RNA viruses, with the diversity of vertebrate-related and ESKAPE pathogen-related viruses underscoring the importance of continued monitoring of urban environments for tracking RNA viral prevalence and dynamics, with direct relevance to future public health.
Hot food takeaways typically serve food that is energy dense and high in fat and sugar, leading to concerns around their contribution to population prevalence of excess weight. Local authorities have adopted a range of planning policy approaches to regulate new hot food takeaways across England. We used a systematic approach to describe health-focused hot food takeaway policies adopted by all local authorities to inform future policy development. We obtained Local Plans and other relevant planning guidance documents from local authority websites in November 2024. Documents were systematically reviewed, and health-focused hot food takeaway policies extracted for analysis of intent and mechanisms. Of 296 local authorities with planning power in England, 101 had adopted a health-focused hot food takeaway policy. Six main regulatory mechanisms were identified, with takeaway management zones (sometimes referred to as "exclusion zones") around schools and other approaches designed to prevent over-proliferation or over-concentration of takeaways adopted by around three-quarters of local authorities. Whilst six broad regulatory mechanisms were identified, there were numerous variations in policy approaches between local authorities. Furthermore, whilst some policies were clear and unambiguous, other policies lacked clarity, with potential implications for application and enforcement. With an increasing number of local planning authorities adopting hot food takeaway policies, this review provides a comprehensive overview of policy approaches successfully implemented across England that can be used to inform policy development.
Buxus hyrcana, an endangered and ecologically significant tree species of the Hyrcanian forests, faces severe threats from climate change, land-use pressures, and habitat degradation. Accurate prediction of its potential distribution is therefore critical for conservation and restoration planning. In this study, we applied the eXtreme Gradient Boosting (XGBoost) algorithm to model the distribution of B. hyrcana under three data combinations: (i) WorldClim bioclimatic and topographic variables, (ii) CHELSA bioclimatic and topographic variables, and (iii) WorldClim bioclimatic, topographic, and land-use variables. Model performance was evaluated using AUC, TSS, Kappa, and Accuracy metrics, all of which indicated strong predictive capacity, with the highest performance achieved when land-use data were incorporated. Variable importance analysis revealed a stable set of key predictors-thermal stability (Bio3), annual mean temperature (Bio1), mean temperature of the wettest quarter (Bio8), annual precipitation (Bio12), and slope-related indices (LS Factor)-highlighting the species' sensitivity to moderate climatic regimes and physiographic constraints. Response curve analysis confirmed that B. hyrcana thrives under moderate temperature and precipitation conditions, while extreme climatic values sharply reduce occurrence probability. Habitat suitability maps consistently identified Mazandaran Province as the most suitable region, with additional restoration potential in Golestan Province. Our findings demonstrate that integrating high-resolution climatic, topographic, and land-use data within advanced machine learning frameworks significantly enhances the accuracy and ecological realism of species distribution models. This study provides a robust methodological framework for predicting the distribution of climate-sensitive, endangered species and offers actionable insights for conservation prioritization and restoration planning in the Hyrcanian forests.
In sequential motor tasks, people reuse prior motor plans to reduce planning cost, causing a persistence of the prior posture. This persistence, termed motor hysteresis, is indicative of planning efficiency. To date, research on motor hysteresis has focused narrowly on reaching movements. However, hysteresis should also apply to full-body movements if it constitutes a general principle of planning efficiency. To test this, we asked participants to perform a binary full-body posture selection task: going over or ducking under a horizontal bar of varying height. Bar height was varied in ordered sequences to induce hysteresis, and binary decision data was recorded. To ascertain whether full-body tasks could be conducted in a virtual reality (VR) environment without compromising scientific validity, we replicated the task in VR with a second group of participants. Results showed that participants went over lower bar heights and ducked under higher ones. The critical height shifted with order. However, the shift direction indicated an inverse hysteresis effect. This inverse hysteresis was replicated in the second participant group in the virtual environment. Here, participants were more cautious in their decisions and switched to ducking under at lower heights. The similarity of the decision-making behavior across environments lends support to the feasibility of using VR to study full-body movements. Nevertheless, it seems advisable to validate the gained insights in a real environment. The inverse hysteresis effect found in the current study has previously been observed in perception research, where it was interpreted as repetition suppression. Our findings suggest that repetition suppression may also apply to motor planning, particularly when mechanical costs are high, like in full-body movements.
BackgroundThe COVID-19 pandemic created unprecedented operational challenges (such as surge-capacity demands and infection-control requirements) that disturbed the equilibrium of healthcare work systems worldwide. Physical environments can play a pivotal role in mitigating or exacerbating these challenges.PurposeThis article aims to strengthen healthcare-system resilience in future pandemics by synthesizing the findings of existing literature to identify environmental factors that supported or hindered healthcare work systems during the COVID-19 pandemic.MethodsWe conducted a systematic search of the CINAHL, MEDLINE, PubMed, and ScienceDirect databases and complemented this search with handsearching. We included studies if they addressed the COVID-19 pandemic, focused on physical healthcare environments, and were published in English in peer-reviewed journals. With a focus on environmental influences, we deductively coded the findings using components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultsForty-two studies met the inclusion criteria. The analysis revealed six major operational challenges: (1) surge capacity, (2) infection control, (3) increased risk of errors, (4) rethinking of care models, (5) financial losses, and (6) the pandemic's adverse psychological impacts on staff and patients. The article documents environmental factors that influenced either the overall healthcare work system or its individual components during the COVID-19 pandemic. We identified three overarching roles for these environmental factors: they served as barriers, solutions, or facilitators.ConclusionsUsing the SEIPS framework can enable well-orchestrated pandemic-response planning by guiding the creation of design strategies that will strengthen resilience, flexibility, and safety in future health crises.
Inflammatory Arthritis (IA) is an autoimmune condition that significantly impacts parenting roles. Limited research has specifically examined parenting within the context of IA. This qualitative evidence synthesis (QES), a systematic review of qualitative research, aimed to develop a comprehensive understanding of how IA shapes parenting experiences. A Qualitative Evidence Synthesis (QES) included primary qualitative studies of parents with IA caring for children (0-21 years). Data were analysed using the Person-Environment-Occupation-Performance (PEOP) model, with occupational impacts and strategies mapped to the Parenting Occupations and Purposes (POP) framework. Methodological quality was appraised using the CASP checklist, and confidence in findings assessed with GRADE-CERQual. Thirty-eight studies involving a minimum of 190 parents were synthesised. Six person-related themes emerged: (i) physical capacity, (ii) mental health, (iii) identity, (iv) future, (v) adaptive self-management, and (vi) psychosocial impact. Environment-focused themes included (i) social, (ii) physical, (iii) healthcare/statutory, and (iv) cultural. Parents reported challenges across all ten POP domains, from basic care to supporting social, emotional, and educational development, though research primarily focused on parents of young children. Adaptive strategies included environmental modifications, task modification, pacing, planning, and reliance support networks. IA affects all domains of parenting. Findings emphasise the need for occupation-focused, family-centred, multidisciplinary care. There is a need for rheumatology rehabilitation professionals to recognise parenting as a central and meaningful occupation which is significantly impacted by inflammatory arthritis.Interventions should address the complex interplay of physical and psychological challenges experienced by parents, including fatigue, pain, emotional burden, and threats to parental identity, while actively supporting the development of adaptive self-management strategiesRehabilitation planning must consider parents’ environments by assessing social supports, addressing physical accessibility barriers, and acknowledging the influence of cultural and social expectations on parenting roles.There is a need for occupation-focused interventions that are informed by parents’ lived experiences and tailored across different stages of child development, ensuring that both visible and invisible challenges of parenting with inflammatory arthritis are adequately recognised in practice.
South Asia continues to face significant challenges in maternal and neonatal health, particularly in rural and remote regions where healthcare access is limited. While governments and organisations have increasingly recognised the importance of deploying professionally trained midwives to address these disparities, the documented experiences of midwives working in these challenging environments remain limited. This scoping review aimed to explore the existing literature on the experiences of midwives practising in rural and remote areas of South Asia, with the goal of identifying key themes, gaps and opportunities for future policy and practice. A scoping review was carried out using the Scopus, CINAHL, Web of Science and PubMed databases. A search was conducted using keywords for articles published between 2000 and May 2025. Abstracts were screened based on eligibility criteria, and common themes were identified and categorised for analysis. Data were assessed using the Mixed Methods Appraisal Tool. A total of 21 studies met the inclusion criteria including case study (n=1) quantitative (n=9), qualitative (n=8) and mixed-method studies (n=3). The included studies spanned seven South Asian countries: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka. Seven themes were identified across published literature: commitment to clinical care, scope of practice, education, resources and workforce, technology, society and culture, and environment and weather. Midwives face challenges in providing care, including limited resources, sociocultural barriers related to gender roles and adverse weather conditions. The integration of technology, enabling midwives to practise to their full scope, enhancing education and fostering community acceptance could enhance midwifery practice in limited-resource settings. Available literature documents resilience and dedication of midwives in rural South Asia, while also highlighting the systemic barriers they face. The findings suggest that strengthening midwifery education, improving working conditions and promoting community engagement are essential for allowing midwives to provide effective and culturally appropriate care. Moreover, greater investment in infrastructure, workforce planning and technology integration is needed to address ongoing gaps. As countries in South Asia continue to build midwifery capacity, context-specific strategies that account for social, cultural and environmental realities will be critical. This review contributes valuable insight to the limited body of literature on rural midwifery in South Asia and offers a foundation for future research, policy development and program implementation aimed at improving maternal and neonatal health outcomes in these underserved regions.
This study integrates the TPB with Information Processing Theory and Sensory Marketing Theory to investigate the influence mechanisms of Plant-Rich Foods(PRF) attributes and their packaging on consumer purchase intention and healthy eating behaviors. Through the construction of a structural equation model, empirical analysis was conducted on seven core variables and their interrelationships: consumer attitude(CA), socio-cultural environment(SE), consumer individual requirements(CIR), packaging environmental considerations(ECP), perceived experiential value(PEV), food information factors(FIF), and packaging functional attributes(FPP), thereby validating the proposed hypotheses. The results indicate that all seven variables significantly and positively influence purchase intention, albeit with varying strengths. Packaging functional attributes demonstrated the strongest driving force, followed by individual consumer needs and food information factors. Perceived experiential value, consumer attitude, and packaging environmental considerations exhibited moderate influence, while the socio-cultural environment exerted the weakest impact. The overall influence of "externally oriented" product variables on purchase intention surpassed that of "internally oriented" consumer variables. The impact on healthy eating behaviors presented a dual logic of "direct drive and indirect transmission." consumer individual requirements exhibited a weaker direct influence on healthy eating behaviors compared to their influence on purchase intention, forming a chained transmission pathway from individual needs to purchase intention to healthy behaviors. Theoretically, this research extends the application of the Theory of Planned Behavior, elucidates the transmission mechanisms of variables, and constructs a multidimensional relational framework. Practically, it offers direction for plant-based food enterprises in optimizing packaging and marketing communication strategies, and provides a reference basis for policymakers.
Successful deployment of medical artificial intelligence (AI) systems should start with formulating clear goals and understanding organisational workflows. Comprehensive deployment planning is advised after identifying a suitable product, preliminary testing, and procurement. A structured approach supports effective adoption and improved efficiency. Planning involves evaluating the feasibility of integrating the AI into local clinical practice and creating a roadmap. Implementation is based on the specific use case and expected clinical outcomes. Defining stakeholder roles and establishing communication strategies facilitate collaboration between clinical, technical, and administrative teams. Key considerations include resource allocation, integration with hospital information systems, and compliance with regulatory requirements. Impact assessments, including Health Technology Assessment, Data Protection Impact Assessment, and AI risk evaluation, ensure patient safety and legal compliance. Planning involves outlining quality assurance (QA) protocols using clinically relevant key performance indicators (KPIs). The deployment phase focuses on preparing the AI system and clinical environment, including system installation, interoperability testing, security checks, cross-department communication, user training, workflow alignment, and initialization of QA monitoring. The rollout phase begins once preparations are completed and involves introducing the AI system into the workflow. A phased rollout and a small-scale pilot help to identify integration issues early with minimal workflow disruptions. In the follow-up phase, the performance of the AI system is monitored using QA parameters, user feedback, KPIs, and periodic effectiveness evaluations. A structured deployment of medical AI guided with technical, clinical, and operational preparation not only enhances patient safety and compliance but also ensures sustainable integration with measurable improvements in clinical practice.
Childhood obesity has surged dramatically in the United States over the past three decades, with over 30% of children now classified as overweight or obese. This rising trend presents a major public health and economic challenge, with obesity-related costs rising from just over 1% of United States gross domestic product in 2005 to 3.3% in 2019 and projected to reach 4.6% by 2060 if left unaddressed. While conventional narratives often attribute obesity to poor individual choices, this policy brief highlights the broader social determinants that shape childhood obesity across different levels of influence. Using a Socio-ecological Model Framework, the brief explores individual, interpersonal, community, and policy-level contributors, including genetic factors, psychosocial stress, family and cultural influences, school and neighborhood food environments, targeted marketing by food corporations, and regulatory gaps. The brief concludes by recommending four upstream policy interventions. These include banning the sale of unhealthy foods within school premises and promoting healthy school food environments through regulation and education, implementing fiscal measures by taxing unhealthy foods and subsidizing healthier alternatives, integrating physical activity into children's daily routines through school based and urban planning policies and Strengthening evidence systems and context-specific research. These strategies provide transferrable policy lessons for addressing childhood obesity in other settings including in low-and middle-income countries experiencing similar nutrition transitions. However, their implementation should be adapted to local health system capacities, food environments and policy contexts.
This systematic review aimed to evaluate the effectiveness of nutrition interventions delivered in Outside School Hours Care (OSHC) services for children aged 4-12 years. Five electronic databases were searched for articles published up to February 2024. Eligible studies were quantitative evaluations of nutrition interventions conducted in OSHC settings, including randomised controlled trials, quasi-experimental, and pre-post studies designs. Study selection, data extraction, and risk of bias assessments (ROB 2 and ROBINS-I tools) were conducted independently by two reviewers. Formal OSHC services operating before and/or after school and during school holidays in high-income countries. Outcomes assessed included children's dietary intake, food provision, healthy eating behaviours, staff practices, service policies, and health indicators such as Body Mass Index. Children (aged 4-12) and staff at OSHC services. Thirty-three studies involving approximately 13,880 participants were included. Interventions varied in duration (7 weeks to 3 years) and components, including nutrition education, staff training, family engagement, menu and policy changes, and many also a physical activity component. Most studies reported improvements in food provision, children's dietary intake, and staff nutrition practices. Interventions focused on food provision, menu planning and policy were most effective. Few studies reported significant changes in anthropometric outcomes. Risk of bias was moderate across studies. This review highlights effective strategies to improve children's dietary habits and food environments in OSHC services. Sustained interventions that focus on food provision, menu planning and/or policy are recommended. Future research should explore multi-level initiatives, digital tools, fidelity, and cost-effectiveness.
We introduce Grounded Multilingual Task Worlds for Romanian (GMTW-Ro), a benchmark designed to evaluate whether large language models can reliably follow complex instructions in Romanian, rather than merely produce fluent text. Existing Romanian benchmarks largely rely on multiple-choice formats, answer extraction, or model-based evaluation, which struggle to assess multi-constraint reasoning and structured task completion. GMTW-Ro addresses these limitations through grounded task worlds: fully specified environments in which model outputs are verified via deterministic, programmatic checks. The benchmark spans four task domains-travel planning, calendar scheduling, context-grounded question answering, and dietary menu planning-requiring both a structured JSON plan and a natural-language explanation in Romanian. Evaluation is decomposed into three orthogonal metrics: Understanding (U), measuring constraint adherence and instruction-following; Generation (G), assessing Romanian text quality through diacritic accuracy, language purity, and code-switching absence; and Faithfulness (F), quantifying consistency between generated plans and their explanations. All instances are automatically verified as solvable using backtracking algorithms. We release two curated datasets: a standard benchmark of 500 instances and an adversarial set of 300 instances with heightened constraint complexity, alongside the complete evaluation toolkit and a purpose-built Romanian NLP library. Evaluation of 11 models reveals substantial performance variation (58.6%-90.7%) and exposes a pronounced knowledge-behavior gap, where models with fluent Romanian generation nevertheless fail core reasoning tasks. Most notably, Romanian-finetuned models underperform their base counterparts: RoLlama3.1-8B scores 20.1 percentage points below Llama-3.1-8B, with structured JSON output success dropping from 95 to 44%. These results raise important questions about how current language adaptation pipelines preserve instruction-following and structured reasoning capabilities.
The PREgnancy Care Integrating Translational Science, Everywhere (PRECISE)-DYAD Study is a prospective observational cohort designed to investigate health outcomes among mother-child pairs (dyads) over the first 3 years of life in two contexts from sub-Saharan Africa. The primary objective of the study was to explore the effects of selected placenta-related complications, such as pregnancy hypertension, fetal growth restriction and preterm birth, on (1) Child health and development, and (2) Women's health and well-being, including outcomes after stillbirth. The PRECISE-DYAD Study enrolled women (and their children) originally recruited into the PRECISE pregnancy cohort study in The Gambia and Kenya between July 2021 and April 2024. Participants were seen at 6 weeks to 6 months, 12 months, 24 months and 36 months postpartum. Clinical and health data, including anthropometry and diet, were collected for both mothers and children. Mother assessment included a cardiology assessment and collection of data about symptoms of COVID-19 infection. In a subset of participants, mothers were asked about their mental health, their healthcare costs during and after pregnancy, and experiences of care during labour and childbirth/delivery. Additionally, a personal environmental exposure assessment was performed for a subset of the cohort by collecting air and water quality data alongside geographical, demographic and behavioural factors. Child development was assessed using neurodevelopmental assessments, home environment evaluation and quality of life measures. Biological samples were collected from mothers and children, processed promptly and biobanked locally. Sample data were entered into an OpenSpecimen database and linked to each individual, as well as to their corresponding social determinants and clinical data. A total of 2980 women and 2909 children completed at least one PRECISE-DYAD Study visit. The biorepository contains 108 897 biological samples from mothers and children. Baseline descriptive analysis of the cohort is reported here. Analysis of data and samples will include biomarker studies, social determinants of health and epidemiological investigations. These analyses will explore how placenta-related complications and environmental exposures, such as nutrition and air quality, interact to shape maternal health, mental well-being, subsequent pregnancies and mother-child interaction, as well as child growth and neurodevelopment through early childhood. Additional work will examine the biological pathways linking these exposures to outcomes and the impacts of caring for children with moderate-to-severe disabilities on maternal well-being. Findings will be disseminated through scientific publications, conference presentations, engagement with local stakeholders and continued community outreach.
Replicated hybrid zones between ecotypes established over environmental gradients provide an opportunity to study the genomic architecture of barriers to gene flow. The marine snail Littorina fabalis segregates locally into dwarf and large ecotypes over wave-exposure gradients on northwestern European shores. Previous work focusing on a hybrid zone in Sweden revealed strong genetic differentiation between the ecotypes, concentrated in 12 putative chromosomal inversions. Here we compare the Swedish hybrid zone with samples from France distributed across a similar wave-exposure gradient. Our aims were to test if similar exposure gradients promote parallel ecotype distributions and hybrid zones, and if similar genomic architectures contribute to divergence and adaptation across the gradients. Unpredictably, we found that the shell size cline was reversed in France compared to Sweden, with small individuals occupying the more sheltered end of the environmental gradient in Sweden but the more exposed end in France. We also observed a cline in shell colour in France, whereas nearly all Swedish snails were yellow. Using whole-genome sequencing, we found similar levels of genetic differentiation between ecotypes in both places. Most of the differences were accounted for by the same 15 inversions, and the arrangement clines showed similar associations to the wave-exposure gradient in both hybrid zones. These inversions were enriched in SNPs differentiating the ecotypes that were either specific to one hybrid zone or showed reversed cline patterns between zones. Genome-wide association studies (GWAS) detected significant associations between genomic regions within inversions and shell size in Sweden, while one inversion was associated with colour in France. Our results show that the same inversions play a dual role: they support ecotype differences across similar environmental gradients in distant locations while also habouring site-specific variation that contributes to local adaptation.
Soil organic carbon (SOC) is a critical component of the global carbon cycle, but existing estimates of SOC stocks across the contiguous United States (CONUS) vary widely for the top 30 cm, hindering efforts to assess carbon sequestration potential and inform climate mitigation strategies. We compiled and harmonized SOC measurements from five major databases spanning 1984-2022 across diverse environmental conditions. Using a parsimonious set of environmental covariates, we compared the performance of linear regression and three machine learning algorithms for predicting SOC stocks. Random Forest demonstrated the best validation performance (R2 = 0.47, root mean squared error (RMSE) = 0.95 kg/m2) and was used to generate nationally consistent annual 30 m SOC stock maps from 1990-2022. Our analysis estimates total CONUS SOC stocks at 60.4 Pg C, with agricultural soils, forested soils, and shrubland and grassland soils representing the three dominant pools. Comparison of predicted and observed annual SOC across U.S. Department of Agriculture Economic Research Service (USDA ERS) farm resource regions showed that annual means calculated from long-term observations were more variable than model predictions. This pattern indicates that apparent annual SOC trends are strongly influenced by the spatial and temporal distribution of available observations. These results demonstrate that the maps are most useful for evaluating broad spatial patterns, regional and land cover differences, and the limits of interpreting annual SOC change from heterogeneous long-term observations. This framework provides a complementary resource to existing SOC products for carbon accounting, land use planning, biofuel life cycle assessment, and prioritizing future SOC monitoring.
Human activities have profoundly altered freshwater ecosystems, reshaping host-parasite dynamics with sometimes far-reaching ecological and public health consequences. Based on the examples of stream degradation and restoration, dam construction, agriculture, and urbanization, this review synthesizes how habitat alteration influences parasite communities in freshwater systems. Restoration efforts, such as those in Germany's Emscher River, demonstrate partial recovery of parasite diversity, though persistent stressors often favour generalist taxa with simple life cycles, reflecting incomplete ecosystem recovery. Dams and reservoirs, by contrast, frequently amplify parasite transmission by creating lentic habitats that aggregate hosts and vectors, increasing risks for diseases such as schistosomiasis and malaria. Agricultural land use further complicates these dynamics: while eutrophication and irrigation can boost trematode transmission, agrochemicals and habitat fragmentation may depauperate parasite communities or disrupt complex life cycles. Additionally, urbanization-related stressors, such as pollutants and artificial light, can suppress sensitive parasites while benefiting those adapted to disturbed environments. Our review demonstrates that, under habitat alteration, freshwater parasites fulfil multiple roles: they constitute a component of the impacted biodiversity, serve as indicators of ecosystem health, and influence disease risk, with their responses governed by life cycle complexity, host specificity, and environmental resilience. These findings underscore the need for integrated management strategies that account for parasites in conservation and public health planning.
Aeromedical evacuation (AE) is a critical capability of military medical support systems, allowing patients to be transferred rapidly from forward medical facilities to higher levels of care while maintaining medical supervision during transport. Despite its importance, published information describing AE activities from Level 2 field hospitals operating in United Nations peacekeeping missions remains limited. A retrospective descriptive study was performed to examine AE missions conducted from the Vietnamese Level 2 Field Hospital deployed in Bentiu, South Sudan within the United Nations Mission, between July 2023 and December 2025. Data were extracted from mission documentation, including MEDEVAC logs and flight reports. Collected variables included patient demographics, mission characteristics, and medical interventions performed during transport. Associations between operational factors and the performance of in-flight interventions were evaluated using Fisher's exact test and the Mann-Whitney U test. Thirty AE missions were analyzed. The average patient age was 41.8 ± 8.8 years, and 25 (83.3%) were male. Medical conditions accounted for 16 (53.3%) of evacuations, followed by trauma, 8 (26.7%). Median flight time was 75 minutes (IQR 70-112.5). In-flight medical interventions were performed in 22 (73.3%) of missions, most commonly continuous physiologic monitoring, 16 (53.3%), intravenous medication administration, 14 (46.7%), and oxygen therapy, 12 (40.0%). Special flights and missions with ≥2 accompanying medical personnel were significantly associated with in-flight interventions (P = .01 and P = .032). No in-flight mortality occurred. Aeromedical evacuation from a Level 2 field hospital was operationally feasible and clinically safe. The frequent need for in-flight interventions highlights the importance of appropriate patient stabilization, escort team composition, and mission planning in deployed operational environments.
Children's and adolescents' mental health and cognitive development are shaped by complex environmental exposures across their life-course. The exposome framework provides an integrative approach to assess the interlinkages. While sleep is a prerequisite for mental and cognitive health, its role as an underlying pathway remains unclear. This review aims to map and contextualize the evidence on whether sleep mediates or moderates associations between the exposome and mental health, well-being, or cognitive outcomes in individuals aged 0-21 years. Following PRISMA-ScR guidelines, we conducted a scoping review of peer-reviewed studies published in English from 2000 to January 2025. Scopus and PsycINFO were searched, supplemented by reference screening and cohort-based searches. Two reviewers independently screened records and charted data, which were synthesised narratively. Twelve studies examined the full causal chain from multiple environmental exposures to mental health or cognitive outcomes via sleep, with 34 additional studies addressing specific partial pathways. Most studies were cross-sectional and conducted in high-income countries. Sleep was primarily assessed using self- or parent-reported measures. Evidence suggested that sleep may mediate or moderate associations between the exposome and mental health or cognitive outcomes, however, longitudinal evidence remains notably limited. The diversity of exposures and domains points to the effect being a result of multiple exposures emphasising the importance of an exposome perspective within early life exposures and outcomes. Sleep represents an important pathway linking the exposome to mental health and cognitive development, however longitudinal, child-centred exposome research remains scarce.
Digital transformation is increasingly reshaping healthcare delivery worldwide; however, the adoption of digital health systems in developing and resource-constrained economies remains constrained by infrastructural limitations, poor alignment with clinical workflows, inadequate user involvement, and resistance to organizational change. Many digital healthcare initiatives in these settings continue to experience implementation and sustainability challenges, partly due to the absence of context-specific and evidence-based transformation models. Consequently, this study aimed to develop a customized evidence-based digital transformation framework to support the sustainable adoption of digital healthcare systems within tertiary and university teaching hospitals in developing economies. This study emerged from a prolonged mixed-methods doctoral research project conducted across three tertiary healthcare institutions in southeastern Nigeria: the University of Nigeria Teaching Hospital (UNTH), ESUT Teaching Hospital (ESUTTH), and the National Orthopaedic Hospital Enugu (NOHE). The research involved close to 600 stakeholders, including doctors, nurses, medical records officers, patients, and clinical consultants. Data were collected through structured questionnaires, qualitative interviews, participatory co-design interactions, observational methods, usability testing, and iterative system evaluations. The study adopted an agile human-centered software engineering and participatory development approach to guide the design, implementation, and evaluation of the proposed TUMERIC digital healthcare support system and the resulting transformation framework. The findings demonstrated generally positive institutional readiness toward digital transformation, with over 70% of participating healthcare professionals indicating support for future digital initiatives within their institutions. Usability evaluations of the implemented TUMERIC system also demonstrated high levels of user acceptance and perceived usability among clinicians and patients. Qualitative findings further highlighted the importance of aligning digital systems with existing clinical workflows, involving end users throughout the development lifecycle, and addressing infrastructural and organizational constraints during implementation. These findings informed the development of the proposed evidence-based digital transformation framework tailored to resource-constrained healthcare environments. The study demonstrates that agile human-centered and participatory design approaches can support the development and adoption of context-appropriate digital healthcare systems in developing economies. The proposed framework provides an empirically informed model that may assist healthcare institutions and policymakers in planning and implementing more sustainable and user-aligned digital transformation initiatives within tertiary healthcare settings.