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Achieving both high catalytic activity and long-term electrochemical stability remains a central challenge for acidic oxygen evolution reaction (OER) catalysts. Using benchmark ruthenium oxide (RuO2) as a model system, we employ the Pourbaix decomposition free energy (ΔGpbx) as a quantitative stability descriptor and demonstrate that high-entropy design enables access to RuO2-based oxides with enhanced stability. Guided by this insight, we computationally identify an idealized stoichiometric high-entropy oxide, RuMnFeNiCuO2, with markedly reduced ΔGpbx. Machine-learning-assisted density functional theory calculations reveal that compositional complexity modulates Ru-O bonding characteristics and diversifies the electronic structure of surface Ru sites, enabling roughly two-thirds of them to outperform those on pristine RuO2. Proof-of-concept experiments validate these predictions using the corresponding synthesized RuMnFeNiCuOx catalyst, where x accounts for oxygen nonstoichiometry. This catalyst exhibits an overpotential of 196 mV at 10 mA cm-2 and only 2% activity loss after 1000 accelerated CV cycles, surpassing RuO2 in both activity and durability. This work establishes an entropy-enabled and ΔGpbx-guided design framework for acid-stable and high-performance OER catalysts, providing a generalizable strategy for next-generation energy conversion materials.

New RSV prevention products show strong potential, but their success depends on wide acceptance and use. We assessed Ontario pediatricians' knowledge and attitudes about these products before their introduction to highlight opportunities and barriers. In March-April 2024, Pediatricians Alliance of Ontario newsletter subscribers (n = 1566) were invited to complete an online survey on RSV knowledge and attitudes. Descriptive analyses with a complete-case approach assessed responses. Of 117 responses (7% response rate), we retained 104 confirmed as from pediatricians with complete demographic data, including 81% (84/104) general pediatricians and 19% (20/104) subspecialists. Most worked in primary care (40%; 42/104), community hospitals (32%; 33/104), and urban centers (63%; 65/104), and had ≥ 10 years' experience (81%; 83/104). They had high awareness of provincial recommendations (91%; 94/103) and knowledge of severe RSV disease risk factors (Figure 2). While 83% (82/99) always recommended palivizumab to eligible patients, only 34% (34/99) reported that all eligible patients always received it. Over 90% were likely to recommend nirsevimab (91%; 89/98), but 66% (65/98) expected to administer it. Top anticipated barriers included the introduction of a new product (69%; 25/36) and concern for adverse effects (69%; 41/59). The likelihood of recommending a maternal vaccine over nirsevimab was 45% (44/98), while 44% (43/98) were neutral. Ontario pediatricians were knowledgeable and supportive of RSV prevention products. However, they have experienced barriers with palivizumab, and they anticipated barriers with nirsevimab and the maternal RSV vaccine. As other jurisdictions look to implement new RSV prevention products, acknowledging and addressing anticipated barriers may promote acceptance and use.

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Guidelines play a critical role in translating evidence into consistent, transparent, and actionable recommendations to inform clinical practice, policy, and decision-making. Nevertheless, heterogeneity in guideline development methodology has raised concerns regarding applicability and implementation. In this paper, we describe the structured and systematic guideline development process employed by Kidney Disease: Improving Global Outcomes (KDIGO), which is designed to enhance methodological rigor, transparency, and stakeholder confidence. This paper outlines the process from initiating a guideline and appointing Guideline Work Group Co-Chairs to assembling the full team, including Guideline Work Group members, the Evidence Review team, Methods Committee representatives, and the KDIGO Guideline team. We also outline the guideline development timeline until publication and dissemination, public review opportunities, and the rigorous disclosure of interest management process. By delineating a transparent and reproducible guideline development process, this paper aims to support the production of high-quality KDIGO guidelines that are evidence-based, credible, and implementable across diverse settings.

Expanding access to voluntary family planning is a global health priority, yet progress has been uneven across low-income and middle-income countries. Despite being a fragile state with historically high fertility and limited health resources, Sierra Leone has achieved one of the fastest increases in modern contraceptive prevalence in sub-Saharan Africa. This study explores the drivers of this progress through a mixed-methods case study. We analysed national-level data from urban and rural settings, and engaged diverse stakeholders including family planning professionals, healthcare providers, community leaders and service users. Quantitative data were drawn from Demographic and Health Surveys (DHS 2008, 2013 and 2019), and United Nations (UN) Population Division estimates (1990-2022). Qualitative insights were obtained through 33 key informant interviews and 12 focus group discussions. A systematic review of peer-reviewed articles, policies and programme documents was conducted to assess the broader implementation context. Between 2008 and 2019, modern contraceptive prevalence among women aged 15-49 rose from 8.2% to 23.9% (+15.7 percentage points). Among married women, gains were larger in those aged 15-24 years (+12.6) than in women aged 25-49 years (+10.0). Unmarried women maintained substantially higher use, with gains of +19.5 and +16.9 points, respectively. Key drivers included expanded knowledge, higher education, delayed marriage and outreach by fieldworkers. Political commitment-particularly integration into the Free Health Care Initiative (FHCI)-together with women's empowerment policies, donor and non-governmental organisation (NGO) support, media and community engagement improved access, awareness and autonomy. Sierra Leone's progress demonstrates the importance of holistic approaches combining political commitment, external financing, cross-sector partnerships and community engagement. Government leadership was most evident in integrating family planning into the Free Health Care Initiative, while educational and gender-sensitive strategies proved particularly effective. These drivers consolidated gains and offer lessons for fragile, high-fertility settings.

The growth of musculoskeletal ultrasound (US) has led to an increasing trend of US-guided interventions also/sometimes being performed by allied health professionals who lack formal comprehensive medical training. This international expert opinion - developed through structured consultation among 20 Physical and Rehabilitation Medicine (PRM) physicians from 14 countries across five continents - addresses the patient safety, ethical, and medicolegal concerns arising from non-physicians performing such interventions. A narrative literature synthesis was conducted and iteratively reviewed by all contributing authors whereas formal consensus methodology was not employed. Having reviewed the international regulatory landscape, including regulations from the United States, Europe (Germany, France, Italy, Spain, Scandinavian countries, and the United Kingdom), and the Asia-Pacific region; we highlight inconsistencies that may compromise patient welfare. We call upon PRM associations to develop unified position statements establishing minimum competency standards. Policy recommendations would include establishing international complication registries, implementing enforceable supervision protocols, strengthening informed consent requirements, and ensuring transparent provider identification. Through these measures, professional organizations, regulators, and healthcare institutions can promote patient safety, transparency, and consistent standards worldwide.

This cohort study examines emergency department visits and hospitalizations for cold-related illness among older adults experiencing homelessness compared with socioeconomically disadvantaged adults with housing in Ontario, Canada.

Family caregivers in low- and middle-income countries (LMICs) provide the lion's share of care for their relatives with severe mental health conditions amid vast treatment gaps. Yet, their lived experiences are not adequately explored. This systematic review synthesizes evidence on the lived experiences, priorities and needs of these caregivers across diverse LMIC settings. We analyzed 76 articles identified across nine databases. Data were synthesized using thematic analysis. The synthesis identified five themes: (1) the journey to understanding, (2) familial commitment to care, (3) the unrelenting burden of caregiving, (4) Forging resilience: strategies of enduring care and (5) voiced needs and priorities. The early attempts to understand the illness take the family on a journey from initial uncertainty to experiential learning. Familial commitment to care is often rooted in moral obligation and system neglect, but this sustained effort leads to an immense caregiving toll. The burden is profoundly gendered, disproportionately affecting women, who commonly face isolation and burnout. Caregivers often navigate pervasive, multidimensional stigma that restricts the entire family's social and economic future. Despite these challenges, resilience is fostered through faith, peer support and active inclusion of the person in family routines. Caregivers urgently prioritized mental health services that offer knowledge about the illness, active and respectful involvement in treatment planning, practical caregiving skills and support groups. The pressing need for economic support was also expressed. This review underscores the need for global mental health endeavors to recognize and respond to unsupported family caregiving. Family focused interventions have the potential to modify the home environment in ways that support recovery for the person and alleviate many of the caregiving challenges faced by the family. Alongside this, initiatives are needed to address economic precarity and facilitate social inclusion of the family unit.

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Generative Artificial Intelligence (GenAI) tools are reshaping professional education by enabling tailored content generation, automating tasks, and enhancing creative output. While widely studied in undergraduate and postgraduate education, little is known about their role in Continuing Professional Development (CPD), where professionals function as system-level educational leaders rather than learners. A cross-sectional international survey (March-June 2025) explored GenAI adoption among CPD professionals. Using the validated Generative Artificial Intelligence Acceptance Scale and the Artificial Intelligence Attitude Scale, the study examined performance expectancy, effort expectancy, facilitating conditions, social influence, and general attitudes toward Artificial Intelligence. Quantitative data were analyzed descriptively and inferentially, and qualitative open-ended responses were analyzed using reflexive thematic analysis. A total of 110 respondents from 14 countries participated. Most reported moderate to high familiarity and comfort with GenAI, with frequent users demonstrating significantly greater confidence and perceived proficiency. Performance expectancy was high, particularly regarding efficiency and productivity, but lower for complex problem-solving. A proportion of respondents expressed undecided positions, indicating transitional stages of adoption. Qualitative analysis revealed three overarching themes: (1) adoption and utilization, (2) personal perspectives, and (3) perceived challenges and benefits. CPD professionals view GenAI as an augmentative tool that enhances efficiency and creativity rather than replacing human expertise. While individual readiness is high, sustainable adoption depends on institutional support, structured training, and ethical integration. This study provides novel insights into GenAI adoption at the CPD system level and highlights the importance of engaging the "undecided" to move from incremental use to meaningful transformation.

Coronary angiography remains the principal imaging modality guiding coronary revascularization, but it provides only an anatomic representation of disease and does not reliably identify lesion-specific ischemia. This review summarizes contemporary evidence on coronary physiology and intravascular imaging in percutaneous and surgical revascularization. Physiology-guided percutaneous coronary intervention (PCI) improves clinical outcomes by refining lesion selection and supporting safe deferral of nonflow-limiting stenoses. Fractional flow reserve and instantaneous wave-free ratio are supported by long-term randomized data, while angiography-derived quantitative flow ratio has shown favorable outcomes compared with angiography-guided PCI, although equivalence to pressure-wire-based strategies remains unsettled. In parallel, intravascular ultrasound and optical coherence tomography enhance procedural optimization by improving stent sizing, expansion, and detection of mechanical complications, with the strongest benefit observed in anatomically complex lesions. Postprocedural physiologic testing frequently reveals residual ischemia despite acceptable angiographic results. In coronary bypass surgery, physiologic assessment may refine target selection and clarify mechanisms of competitive flow, and postoperative quantitative flow ratio has been explored in assessing functional completeness; however, consistent improvement in clinical outcomes has not been demonstrated. Current evidence strongly supports integration of coronary physiology and intravascular imaging in PCI, whereas their role in coronary artery bypass grafting remains investigational.

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Algal blooms in shallow lakes have attracting increasing attention owing to their high frequency and severe ecological harm. Previous studies, which primarily focused on single influencing factors such as nutrient input or toxins released by phytoplankton, have demonstrated that excessive nutrient input can increase the incidence of algal blooms, while high toxin levels exert an inhibitory effect. This study proposes a general analytical framework for exploring zooplankton grazing responses to phytoplankton-derived toxins and nutrient uptake, with a focus on zooplankton immunity to such toxins. A novel nutrient-phytoplankton-zooplankton model is adopted to investigate the combined impacts of nutrient input and phytoplankton-derived toxins on algal blooms, considering zooplankton immunity. We conduct analyses on the existence, stability, and bifurcations of the model to explore its complex dynamic behaviors, including Hopf bifurcation and Bogdanov-Takens bifurcation of codimension 2 and a degenerate case with a nilpotent cusp of codimension at least 3. Specific forms of nutrient uptake and zooplankton grazing functions are employed to validate the relevant theoretical results and perform numerical simulations. Beyond existing findings, this study reveals that oscillation periods tend to lengthen under lower toxin levels or higher nutrient input when oscillations occur.

To assess prospective associations between media parenting practices and screen time and problematic screen use in early adolescents. We used data from the Adolescent Brain Cognitive Development Study, a prospective cohort of 7947 adolescents [Mage 12.9 years]. Media parenting practices from Year 3 (2019-2021) and adolescent-reported screen time, app-reported smartphone time (subsample N = 840), and problematic screen use from Year 4 were analyzed using linear regression models adjusted for potential confounders. Use of screens to control behaviour (e.g., as a reward or punishment) and adolescent bedroom screen use were associated with greater screen and smartphone time. Parental screen time modelling and family mealtime screen use were associated with greater screen time. Parental monitoring and limiting of screen time were associated with lower adolescent screen time. Parental monitoring was also associated with lower smartphone time. Parental screen time modelling and use of screens to control behaviour were associated with problematic social media use, while family mealtime screen use, adolescent bedroom screen use, and use of screens to control behaviour were associated with problematic mobile phone use. These findings suggest that counselling families on specific media parenting practices may help reduce adolescent screen exposure and problematic screen use.

Family planning (FP) is a critical component of reproductive health, enabling individuals to plan the number and timing of children through various contraceptive methods.We outline the conceptual framework and country case study methodology used by the Exemplars in Family Planning (EFP) project. This was based on the wider Exemplars in Global Health programme, which uses mixed-methods to examine determinants of FP progress in countries that exceed expectations for health outcomes. The EFP project integrates findings from case studies on six such countries, including quantitative analyses of trends and drivers of modern contraceptive prevalence, systematic reviews, policy, programme and financing assessments, and qualitative data collection with policymakers, providers and community actors. Data triangulation across these methods, complemented by consortium input and country workshops, enabled robust validation of findings and identification of cross-cutting themes. This approach produced a nuanced understanding of FP progress by capturing interactions between government programmes (demand and supply), service delivery mechanisms, subnational contexts and individual determinants. Quantitative decomposition and trend analyses quantified the contributions of population characteristics, behavioural factors and interventions, while qualitative and stakeholder data contextualised these findings within local sociocultural, health system and policy environments.This multicountry, mixed-methods analysis led by local researchers and supported by a global consortium enhanced methodological rigour, contextualised findings and enabled cross-country learning on FP progress. It identified key cross-cutting drivers and offers evidence-informed guidance to improve contraceptive uptake and demand satisified, while highlighting the need for context-specific interventions and further longitudinal, multicountry research.

Factors influencing unrelated donor selection for allogeneic hematopoietic cell transplantation (HCT) continue to shift. To understand current priorities in step-wise donor selection and guide optimal recruitment for the Canadian Blood Services Stem Cell Registry, we examined changes in donor usage for Canadian patients in 2023. A retrospective cohort study was conducted of unrelated allogeneic donor transplants in Canada (excluding Quebec) in 2023 with comparison to previous usage and to survey results of transplant center donor selection algorithms. Five hundred patients (mean age 51.7 years; 62% male) underwent first transplantation with unrelated human leukocyte antigen (HLA-matched (n = 416, 83%) or mismatched adult donors in 2023. Mean donor age was 28.7 years. cytomegalovirus (CMV) concordance in 73% and avoidance of major ABO mismatch in 62% was observed. Selection of Canadian (CDN) donors for CDN patients (n = 50, 10%) is characterized by a preference for HLA-matched, young (≤ 30 years old), male registrants and is positively influenced by availability of donor CMV serostatus and ABO blood group typing at time of initial donor search. When an international donor was used despite the presence of an HLA-matched CDN option, young donor age (≤ 30 years), male sex, and CMV-matching were prioritized. Greater use of HLA-matched donors is observed compared with 2013 and donor factors influencing selection align with survey responses of Canadian transplant centers. To best serve our patients, HLA-matched CDN stem cell registrants should be young (≤ 30 years), and with CMV and ABO results available at search to facilitate timely selection.

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Out-of-hospital blood transfusion (OHBT) trials in trauma face unique ethical and operational challenges. Patients are often incapacitated, time-critical interventions preclude traditional consent, and surrogate decision-makers are rarely accessible in the out-of-hospital environment. The Canadian Prehospital and Transport Transfusion Network (CAN-PATT) supports the use of alternative models of consent to enable rigorous evaluation of OHBT strategies. This position statement outlines the ethical and regulatory justification for an exception from prospective consent with opt-out notification model used in the SWiFT Canada (Study of Whole Blood in Frontline Trauma) pilot randomized controlled trial. Grounded in the Tri-Council Policy Statement 2 (TCPS2) Article 3.8 governing research in medical emergencies, the SWiFT Canada model uses multi-modal notification and post-enrollment withdrawal options to balance feasibility with respect for autonomy. We argue this approach is essential to advance evidence-based transfusion practice in Canadian out-of-hospital care and serves as a national template for emergency research.