Background/Objectives: Insertional Achilles tendinopathy (IAT) is frequently associated with posterior calcaneal spurs; however, the prognostic significance of spur morphology for patient-centered treatment outcomes remains unquantified. This study aimed to establish treatment-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds after extracorporeal shockwave therapy (ESWT) and to determine whether quantitative spur morphology independently predicts achievement of these patient-centered endpoints. Methods: In this retrospective cohort study, 201 patients with IAT and radiographically confirmed posterior calcaneal spurs received standardized ESWT (three weekly sessions, 0.20 mJ/mm2, 8 Hz). Spur length and angle were measured on calibrated weight-bearing lateral radiographs. MCID and PASS thresholds for VISA-A, AOFAS, and VAS scores were determined using anchor-based receiver operating characteristic (ROC) analyses. Optimal spur morphology thresholds were derived from ROC curves using PASS achievement as the outcome criterion and the Youden index for cut-off selection. Multivariable logistic regression analyses, adjusted for age, sex, and body mass index, were performed to assess the independent prognostic value of spur morphology. Results: MCID thresholds were: ΔVISA-A ≥ 16.5 (AUC = 0.886), ΔAOFAS ≥ 11.5 (AUC = 0.830), and ΔVAS ≥ 2.5 (AUC = 0.897). PASS thresholds were: VISA-A ≥ 70.5 (AUC = 0.712), AOFAS ≥ 72.5 (AUC = 0.842), and VAS ≤ 3.5 (AUC = 0.753). While significant mean improvements occurred (all p < 0.001), only 36.8-43.3% of patients achieved MCID and 38.3-53.2% achieved PASS. ROC analysis identified spur length > 8.7 mm (AUC = 0.713) and spur angle > 16° (AUC = 0.738) as optimal thresholds predictive of PASS failure. In multivariable analysis, increased spur length (adjusted OR = 0.23-0.24, p < 0.001) and angle (adjusted OR = 0.16-0.23, p < 0.001) independently reduced the likelihood of achieving both MCID and PASS. Conclusions: This study provides the first anchor-based MCID and PASS thresholds for ESWT in IAT and demonstrates that posterior calcaneal spur morphology-specifically length > 8.7 mm and angle > 16°-independently predicts patient-defined treatment success. These findings support the integration of quantitative spur assessment into clinical decision-making for personalized management of IAT.
This study aims to compare the clinical efficacy of two endoscopic surgical approaches (medial double-incision and medial-lateral double-incision) in treating refractory plantar fasciitis complicated with calcaneal spur, to provide a reference for clinical surgical method selection. A total of 47 patients (54 feet) with refractory plantar fasciitis complicated with calcaneal spur who underwent CT-guided endoscopic surgery (Jan 2020-Mar 2024) were enrolled. They were divided into medial double-incision group (21 patients, 26 feet) and medial-lateral double-incision group (25 patients, 28 feet) by surgical approach. Clinical efficacy was evaluated with VAS scores, and operation time, calcaneal spur resection effect and postoperative functional recovery were compared between the two groups. The two groups had no significant differences in age, gender, BMI, or preoperative calcaneal spur length (P > 0.05). The medial-lateral double-incision approach had advantages: shorter operation time (54.29 ± 3.51 min vs 77.12 ± 4.95 min, P = 0.0004) and higher complete calcaneal spur resection rate (100% vs 84.62%, P = 0.031). No serious complications occurred in either group; 12-month follow-up showed both groups had significantly improved VAS scores vs preoperation, with no inter-group difference (P > 0.05). Both endoscopic approaches (medial double-incision and medial-lateral double-incision) have similar effects in improving pain and function in patients with refractory plantar fasciitis complicated with calcaneal spur. However, the medial-lateral double-incision approach-with shorter operation time and more thorough calcaneal spur resection-can be the preferred surgical method for this disease.
Achieving high density in complex powder metallurgy components like spur gears is often hindered by friction-induced density gradients and ejection defects. This study investigates a novel elastic die system designed to mitigate these issues through controlled radial deformation. Spur gears were compacted using Ancorsteel 2000 powder under pressures of 400-700 MPa, utilizing a tapered elastic sleeve to apply radial compression. Green and sintered densities were measured, while porosity distribution was quantified via image analysis. Additionally, a 3D finite element simulation using FORGE software was conducted to model the thermo-mechanical behavior and stress distribution during the process. Experimental trials demonstrated that the elastic relaxation of the sleeve enabled free ejection of the compacts without requiring an extraction force. Image analysis confirmed a homogenous porosity distribution across the gear teeth, and higher die pre-stressing strokes were found to correlate with increased sintered density. Finite element modeling accurately predicted critical stress concentrations of 700 MPa at the die-sleeve interface and validated the strain distribution. The results confirm that elastic die technology effectively eliminates ejection friction and improves density uniformity in complex gears, offering a viable solution for reducing tool wear and manufacturing defects in high-precision powder metallurgy.
Tethered cord syndrome (TCS) is most commonly associated with congenital spinal dysraphism, thickened filum terminale, lipomas, or split cord malformations (SCM ). Bony causes of tethering are typically described in association with diastematomyelia. Isolated intradural bony spurs without cord splitting or extradural communication are exceptionally rare. We report a young adult female presenting with long-standing progressive lower limb sensory disturbances, gait tightness, and urinary dysfunction. A delayed neurological diagnosis resulted in multiple orthopedic procedures for severe foot deformities without prior spinal evaluation. Magnetic resonance imaging revealed a low-lying tethered spinal cord with focal posterior indentation. Surgical exploration demonstrated a solitary posterior intradural bony spur adherent to the inner surface of the dura mater, causing mechanical tethering without SCM or extradural continuity. Complete excision resulted in effective detethering and clinical improvement. This case highlights a rare intradural cause of TCS and emphasizes the importance of early neurological assessment in patients with progressive lower limb deformities. Such isolated intradural bony anomalies may represent focal manifestations within the broader spectrum of caudal developmental disorders.
Endoscopic plantar fascia release (EPFR) is a common surgical option for recalcitrant plantar fasciitis. Although calcaneal spur excision (CSE) is frequently performed as an adjunct, its added clinical benefit remains unclear. This study compared outcomes of EPFR alone vs EPFR combined with CSE. This retrospective study included 23 patients (30 feet) who underwent endoscopic surgery for plantar fasciitis between 2017 and 2024. Patients were divided into 2 groups according to surgical procedure performed: EPFR (n = 22 feet) and EPFR+CSE (n = 8 feet). Pain and functional outcomes were assessed pre- and postoperatively using the visual analog scale (VAS), first-step VAS, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and Foot Function Index (FFI). Both procedures were associated with significant postoperative improvement in pain and function (all P < .001). Mean VAS scores improved from 6.2 to 1.5 in the EPFR group and from 6.4 to 1.2 in the EPFR+CSE group. AOFAS scores increased from 66.4 to 95.3 and from 64.5 to 94.5, respectively. Postoperative FFI values decreased from approximately 107 to 30 in both groups. However, comparison between groups revealed no statistically significant differences for any parameter (VAS p = 0.24; AOFAS p = 0.23; FFI p = 0.61). No recurrence or complications were observed. EPFR, with or without CSE, was associated with clinical and functional improvement. With the numbers available, no additional benefit of CSE could be detected. Level III, retrospective comparative study.
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Polymetallic sulfide deposits produced at hydrothermal vent fields are targets for mining exploitation along the Mid-Atlantic Ridge, threatening the functioning and resilience of vent ecosystems that provide multiple ecosystem services. Knowledge about connectivity between vents will inform conservation practices. The present-day genetic structure and demographic history of the two vent-dwelling gastropod species, Lepetodrilus atlanticus and Peltospira smaragdina, were investigated using more than 15,000 single-nucleotide polymorphisms and mtCox1 sequences. Each species comprised three genetic groups. Genetic breaks were stronger for L. atlanticus, separating three distinct operational taxonomic units (5°S, Broken Spur at 29°N, and the Azorean vent fields near 37°N). Peltospira smaragdina was also geographically separated into three groups: Broken Spur, TAG, and Snake Pit (23-29°N); Lucky Strike (37°N); and Moytirra (45°N). A semipermeable zone was detected south of Rainbow (35°N), similar to that of vent mussels in this area, suggesting the presence of a multispecies hybrid zone. Demographic inferences supported secondary contact between most pairs of metapopulations for both species, but the time since contact was insufficient for allele frequencies to rehomogenize. Gene flow between vent fields may be sporadic and rare or restricted by genetic barriers. The fragmentation of species into isolated metapopulations may reduce their resilience to disturbance and create the need for specific conservation measures. Isolated populations (e.g., Moytirra for P. smaragdina, 5°S and Broken Spur for L. atlanticus), source populations (e.g., Lucky Strike for P. smaragdina), admixture areas, and sites that may act as stepping stones within a metapopulation must be protected from deep-sea mining. An average distance of <100 km between favorable habitats in regional environmental management plans could help maintain the species' genetic diversity and connectivity along the ridge. Implicaciones para la conservación de la escasa conectividad actual a lo largo de la cordillera meso atlántica en gasterópodos de las fuentes hidrotermales Resumen Los yacimientos de sulfuros polimetálicos que se forman en los campos de fuentes hidrotermales son objeto de explotación minera a lo largo de la cordillera meso atlántica, lo que amenaza el funcionamiento y la resiliencia de los ecosistemas de las fuentes hidrotermales, que proporcionan múltiples servicios ecosistémicos. El conocimiento sobre la conectividad entre las fuentes hidrotermales servirá de base para las prácticas de conservación. Se investigó la estructura genética actual y la historia demográfica de las dos especies de gasterópodos que habitan en las fuentes hidrotermales, Lepetodrilus atlanticus y Peltospira smaragdina, utilizando más de 15,000 polimorfismos de un solo nucleótido y secuencias de mtCox1. Cada especie comprendía tres grupos genéticos. Las rupturas genéticas fueron más marcadas en L. atlanticus, separando tres unidades taxonómicas operativas distintas (5°S, Broken Spur a 29°N y los campos de fuentes hidrotermales de las Azores cerca de 37°N). Peltospira smaragdina también se separó geográficamente en tres grupos: Broken‐Spur, TAG, Snake Pit (23‐29°N), Lucky Strike (37°N) y Moytirra (45°N). Se detectó una zona semipermeable al sur de Rainbow (35° N), similar a la de los mejillones de las fuentes hidrotermales de esta zona, lo que sugiere la presencia de una zona híbrida multiespecífica. Las inferencias demográficas respaldaron el contacto secundario entre la mayoría de los pares de metapoblaciones de ambas especies, pero el tiempo transcurrido desde el contacto fue insuficiente para que las frecuencias alélicas se rehomogeneizaran. El flujo genético entre los campos de fuentes hidrotermales puede ser esporádico y poco frecuente o estar restringido por barreras genéticas. La fragmentación de las especies en metapoblaciones aisladas puede reducir su resiliencia ante las perturbaciones y crear la necesidad de medidas de conservación específicas. Las poblaciones aisladas (por ejemplo, Moytirra para P. smaragdina, 5°S y Broken‐Spur para L. atlanticus), las poblaciones de origen (por ejemplo, Lucky Strike para P. smaragdina), las zonas de mestizaje y los sitios que puedan actuar como puentes dentro de una metapoblación deben protegerse de la minería en aguas profundas. Una distancia media inferior a 100 km entre hábitats favorables en los planes regionales de gestión medioambiental podría ayudar a mantener la diversidad genética y la conectividad de las especies a lo largo de la cordillera.
To map anterior ocular wall thickness across quadrants and eccentricities in a heterogeneous adult population and to evaluate the anatomical adequacy of fixed-depth suprachoroidal injection strategies currently used in clinical practice. A cross-sectional observational study. 110 eyes from 110 participants (18-75 years; +3.00 to -11.00D) were included. Swept-source anterior segment optical coherence tomography was used to measure central corneal thickness (CCT), anterior scleral thickness (AST), conjunctival-Tenon capsule thickness (CTT), anterior choroidal thickness (ACT), anterior conjunctival-scleral thickness (ACST) and anterior conjunctival-scleral-choroidal thickness (ACSCT). Measurements were obtained in four quadrants at 0-5 mm posterior to the scleral spur at 1-mm intervals. Associations between thickness parameters and demographic, refractive and anatomical factors were analyzed using mixed-effects models. The frequency of measurements below commonly used suprachoroidal injection depths (900μm and 1100μm) was determined. Anterior ocular wall thickness exhibited marked spatial variability across quadrants (P < 0.001), decreasing sharply 1-2 mm posterior to the scleral spur before stabilizing. At 4 mm posterior to the scleral spur, all eyes exhibited AST values below 900μm, and ACSCT was below 900μm in 63.64% of eyes. AST was independently associated with age and CCT but showed no association with spherical equivalent or axial length. Anterior ocular wall thickness varies substantially by quadrant and eccentricity. While fixed-depth needles are clinically safe, understanding this anatomical variation may clarify injection mechanics and support anatomically guided approaches to optimize suprachoroidal drug delivery.
A finding in a fossil mysticete rib is used to get insights into biomechanical limits of extinct whales. The investigated specimen from the Miocene (Serravallian/Tortonian boundary) of Groß Pampau, North Germany, comprises a 252 mm distal fragment of a right posterior rib exhibiting distinctive pathological features including extensive periosteal new bone formation and a prominent 69 mm bony spur. The internal morphology was analysed with a clinical CT-scanner. Morphological examination and computed tomography analysis revealed irregular cortical thickening, excentric bone proliferation with a 17° anterior deviation, and trabecular bone continuity at the spur base, consistent with a healed stress fracture. Differential diagnoses including acute trauma, osteomyelitis, neoplasia, and dysbaric osteonecrosis were systematically excluded based on morphological criteria and the absence of associated lesions throughout the skeleton. The combination of an isolated rib fracture with periosteal reaction and the presence of an adaptive bony spur strongly suggests a stress fracture etiology resulting from repetitive biomechanical overload, analogous to stress injuries observed in human athletes, e.g., intensive swimming activities. Stress fractures are underreported in cetaceans. Our findings enhance our understanding of bone remodeling processes providing evidence for chronic, repetitive mechanical overload and highlight that fossil bone can be used to demonstrate long-term physiological strain in deep-time. To date, there have been few comparable studies on marine mammals. Further research into the locomotory behavior and biomechanical stress patterns of Miocene cetaceans is needed.
Perennial cover crops (also known as living mulch) continuously cover the soil, providing a sustainable method to prevent or reverse soil degradation by maintaining living roots throughout the growing season. This study examined the benefits of single or mixed species perennial cover crop systems with or without arbuscular mycorrhizal fungi (AMF) inoculation on soil biochemical properties. We conducted a greenhouse mesocosm experiment with a full-factorial randomized complete block design incorporating single and mixed species treatments of Aberlasting clover (Trifolium ambiguum) and Kentucky bluegrass (Poa pratensis) at different ratios (C75-G25, C50-G50, C25-G75), with and without AMF inoculation. AMF-inoculated C75-G25 showed the highest and most diverse root exudation, which was also associated with increased leaf chlorophyll, photosynthesis, and total biomass. The C75-G25 mixture with AMF further enhanced microbial biomass carbon (C), active microbial biomass, and the readily available soil C pool, indicating increased exudation with AMF spurs microbial activity. Critically, increasing the proportion of clover enhanced net nitrogen (N) mineralization, nitrification, and N₂O emissions; however, AMF inoculation increased net N mineralization while reducing both nitrification and N₂O emissions. Perennial cover crop mixtures containing at least 50% grass lowered N2O emission by 8-37.5%, while AMF inoculation further decreased fluxes by 40%, suggesting AMF uptake of inorganic N. Overall, AMF-inoculated C75-G25 maximized photosynthetic rate and biomass with cascading impacts to increased root exudate quantity and quality. Mixtures containing less than 50% grass plus AMF were most effective at increasing net mineralization but reducing gaseous N losses. Our study quantifying metrics along the plant-soil continuum shows how shifts in plant species composition alter root exudates and C and N cycling belowground. In addition, our results indicate that incorporating legume-grass perennial cover crops with an AMF inoculant can spur soil microbial activity and enhance internal C and N cycling.
The unified theory of split spinal cord malformation (SCM) comprises type I, with each one of the hemicords in one own dural tube, separated by a bone spur, and type II, with two hemicords in one dural tube, separated by a nonrigid septum. This classification is still evolving, with denominations SCM type 0.5 proposed for incomplete forms, SCM type 1.5 for lesions combining features of SCM types I and II, and SCM type III for the composite lesions occurring on different spinal levels. A newborn male patient presented with a complex SCM with two placodes, one in each hemicord, contained in one myelomeningocele (MMC) sac. In addition, caudal regression of the lumbosacral spine, hydrocephalus, and herniation of cerebellar tonsils down to thoracic levels were detected. This complex case of two asymmetrical nonneurulated hemicords attached to a single MMC sac, opening on different levels of the bone spur and on the right side covered by a rudimentary hemilamina, illustrates the difficulties in classifying SCMs. Since up to 15% of MMC patients additionally have SCM, the case description underlines the role of preoperative MRI in newborns before neurosurgical MMC closure. https://thejns.org/doi/10.3171/CASE251036.
In practice, the retrosigmoid approach is one of the most preferred approaches for cerebellopontine tumors, vascular compression syndromes, brainstem lesions, and many other pathologies. The anatomy of this region can vary, and the anterior inferior cerebellar artery is rarely involved. A dura-embedded subarcuate loop is one of these; it needs to be released and transposed to expand the surgical corridor. We present this report on expanding surgical exposure during the retrosigmoid approach in a case involving a dura-embedded subarcuate loop. A 44-year-old man underwent microvascular decompression by the retrosigmoid approach because of trigeminal neuralgia. During surgery, a dura-embedded subarcuate loop of the anterior inferior cerebellar artery was encountered. The subarcuate loop was hanging from the petrous bone spur. We safely released the subarcuate loop from the petrous bone spur by the dural incision technique, and further deep dissection and microvascular decompression were performed. The critical steps of the surgery were reviewed in a surgical video. These types of vascular variations can be encountered in any surgery using the retrosigmoid approach, and if the vessel is not released, it may be required to work through a narrow surgical corridor in prolonged surgeries. With this petrous dural incision technique, the vessel can be safely dissected from the bone, and the surgical corridor can be widened.
Anterior segment morphometric parameters, including the iris, ciliary body, ciliary process and anterior sclera, re ect uveal vascular physiology and scleral biomechanics. These structures may help clinicians better understand disorders associated with altered ocular uid dynamics within the pachychoroid spectrum. Complex central serous chorioretinopathy is characterised by serous neurosensory retinal detachment and is commonly associated with pachychoroid features, including increased subfoveal choroidal thickness. However, the potential contribution of anterior uveal and scleral structures to its pathophysiology remains insu ciently de ned. This study included 32 eyes with active complex central serous chorioretinopathy and 31 age- and gender-matched controls. Iris, ciliary body, and ciliary process thicknesses were measured using ultrasound biomicroscopy under standardised photo-pic conditions. Anterior scleral thickness was measured at 1, 2 and 3 mm posterior to the scleral spur using anterior segment optical coherence tomography. Subfoveal choroidal and central macular thickness were measured by spectral-domain optical coherence tomography. Correlations were analysed with false discovery rate correction. Ciliary body (0.93 ± 0.11 mm vs 0.78 ± 0.10 mm) and anterior scleral thickness (0.57 ± 0.06 mm vs 0.49 ± 0.05 mm) were signi cantly greater in complex disease than in controls (both p < 0.001). Subfoveal choroidal thickness (425.7 ± 83.8 µm vs 290.7 ± 68.5 µm) and central macular thickness (330.7 ± 74.0 µm vs 226.5 ± 18.8 µm) were also higher (p < 0.001). Anterior scleral thickness correlated with ciliary body (r = 0.494), ciliary process (r = 0.498) and subfoveal choroidal thickness (r = 0.509) (all p < 0.001). Temporal iris thickness correlated with temporal anterior scleral thickness (rs = 0.410; p = 0.006). Active complex disease is associated with increased anterior uveal and scleral thickness, suggesting anterior segment involvement parallel to posterior pachychoroid changes.
Cholera remains a significant public health challenge in Africa, where outbreaks routinely strain public health and healthcare systems. Cholera surveillance time series data could be used to inform the efficient distribution of resources like oral cholera vaccine (OCV) and emergency response personnel, spur research on the impacts of different cholera control activities, and investigate longer-term epidemiologic patterns in cholera dynamics in this region. However, public reporting of cholera surveillance data historically has been sporadic and often limited to outbreak periods, thus limiting the availability of these useful time series datasets. We sought to fill this gap by preparing, cleaning, and processing weekly consecutive time series and outbreak-specific time series from 2010 to 2023 for African countries from heterogeneous data contributed to a global cholera surveillance database. Cholera incidence data in Africa from 2010 to 2023 on suspected cases, confirmed cases, and deaths were compiled from public and non-public cholera surveillance from multiple sources, including ministries of health, World Health Organization, Médecins Sans Frontières, UNICEF, and other sources. Data were processed by aggregating daily records to weekly levels, averaging duplicate entries, filling gaps and surrounding weeks with zero cases, aligning epidemic weeks, adjusting population data, and removing identifying geographic information to preserve confidentiality as appropriate. Outbreaks were subsequently extracted using a systematic definition and summary statistics were produced by spatial scale and population density. Summary outbreak metrics were compared to previously published cholera outbreak datasets for data validation. The unified surveillance and outbreak datasets provide an extensive compilation of reported cholera activity in Africa from 2010 to 2023, serving as a valuable resource for long-term control planning and early warning systems. Public health researchers can also leverage these datasets to analyze outbreak dynamics, anticipate resource needs, and assess the theoretical impact of control strategies.
Space is one of the main drivers of biodiversity, as it regulates the underlying processes affecting the distribution and dynamics of species and communities. It is a fundamental factor when considering the rapid climate and land cover changes occurring at local and global scales, which are linked to habitat loss and fragmentation, as well as their impacts on biodiversity. The Atlantic Forest of South America is among the world's biodiversity hotspots because of its exceptionally high species richness and endemism. Most of the threats to the Atlantic Forest's biodiversity stem from the expansion of urbanization and industry, extensive agricultural and livestock production, and mining. Here, we provide integrated and fine-scale spatial information (30-m resolution) for the entire extent of the Atlantic Forest for the years 2020 to 2022. The spatial data include different vegetation classes (forest, and forest combined with other non-forest vegetation), the effects of linear structures (roads and railways), and landscape metrics computed at multiple scales (radius buffers-moving window sizes-ranging from 50 to 2500 m, and up to 10 km for some metrics). The dataset comprises the Atlantic Forest delimitation vector and more than 500 rasters, available through a series of thematically grouped files in multiple Zenodo repositories. This data can also be accessed using the R package atlanticr, which we developed to facilitate data retrieval and organization from Zenodo. The dataset includes landscape, topographic, hydrological, and anthropogenic metrics. Landscape metrics were calculated for two vegetation classes-Forest Vegetation (which combined different forest cover classes) and Natural Vegetation (which combined forest and non-forest cover classes)-as well as for a heterogeneous, multi-class classification of the landscape (31 land cover classes). The landscape metrics include landscape morphology (classification as matrix, core, edge, corridor, branch, stepping stone, and perforation), fragment area and proportion, patch area and number, edge and core areas and proportions, structural and functional connectivity (for different organisms' gap-crossing capabilities), distance to and from fragment edges, fragment perimeter and perimeter-area ratio, and landscape diversity (heterogeneity). Topographic metrics include elevation, slope, aspect, curvature, and landform elements (peak, ridge, shoulder, spur, slope, hollow, footslope, valley, pit, and flat). Hydrological metrics comprise potential springs (and their kernel density) and streams (and distance to the nearest feature). Anthropogenic metrics include maps of roads, railways, protected areas, Indigenous territories, and quilombola territories (localities of self-defined Afro-Brazilian traditional communities), as well as the distance to each feature. This dataset facilitates the efficient integration of biodiversity and spatially explicit data for the Atlantic Forest, serving as a data source for studies, landscape planning, biodiversity conservation, and forest restoration programs. The data are released under a CC BY-NC 4.0: Creative Commons Attribution-Non-Commercial 4.0 International license and this data paper should be cited when the data are reused.
Fostering biopharmaceutical R&D has been a key element of industrial and innovation policy worldwide. Typically, this requires complementary investments from the public and private sectors. However, there is little empirical evidence on the extent of public and private biopharmaceutical R&D investment in countries outside of the US and Europe. We conducted a literature review to assess the biopharmaceutical R&D environment and related public policies in seven middle- and high-income countries outside of Europe and the US, selected for geographic diversity and data availability: Australia, Brazil, India, Japan, Singapore, South Africa, and South Korea (n = 7). We researched and reported levels and shares of public and private investment in biopharmaceutical R&D via an aggregation of granular, public data from the most recent pre-Covid year available for each country, which ranged from 2017 to 2020. We contrast these figures to those estimated from supranational data sources such as the OECD and WHO. Aggregating across countries, the private sector accounted for 74% of biopharmaceutical R&D spending. Private sector spending within countries ranged from 35% to 92%, with a simple average of 58%. We contextualise differences between these estimates and those from supranational sources. Overall, the public and private sectors both have important roles in biopharmaceutical innovation across countries. The public sector often funds R&D in universities and basic science, with public funding for later stages of R&D, such as clinical trials, varying by country. There are differences in the extent to which countries invest in initiatives to bridge academia and the private sector. Aggregative biopharmaceutical R&D spending data may lead to different insights than data from supranational sources. Given the complementary nature of public and private R&D spending, countries wishing to encourage biopharmaceutical R&D should consider targeted public sector investment to spur an environment conducive to private investment. Since data are sparse and not always comparable across countries, there is a need for increased and consistent tracking of data on R&D spending. Further research is needed to connect country-specific data to policies that support R&D sector productivity.
Designing and developing high-efficient bifunctional electrocatalysts toward both oxygen reduction (ORR) and oxygen evolution (OER) reactions is paramount to advance rechargeable Zn-air batteries (ZABs) technology, but remains challenging. Here, the strong-coupled PdFeNi nanoalloys and oxygen-deficient NiFe2O4 spinel nanohybrids (PdFeNi/NiFe2O4), are fabricated by atomic implantation and in-situ alloying strategy. Due to the dense heterointerfaces, unique lattice strain, abundant oxygen vacancies, and strong metal-support interactions, the electronic distribution and intermediates' adsorption in PdFeNi/NiFe2O4 are collectively optimized, meanwhile promoting lattice oxygen participation in OER. As a result, such PdFeNi/NiFe2O4 nanohybrids manifest outstanding bifunctional electrocatalytic performances with a potential difference of 0.74 V between OER and ORR. Using them as air electrode, the assembled aqueous ZABs can deliver high peak power density (156.1 mW cm-2), and maintain excellent round-trip efficiency (61.4%) after cycling over 1200 h, surpassing that of Pt/C + IrO2 counterparts. Moreover, further fabricated quasi-solid-state ZABs showcase good flexibility, recoverability and practicability, which can be employed to power various electronic devices. This work offers a novel strategy to develop strong-coupled nanohybrids as bifunctional oxygen electrocatalysts, which may spur their applications in clean energy conversion and storage devices.