Interstitial lung diseases (ILDs) are a heterogeneous group of diffuse parenchymal lung disorders, including idiopathic interstitial pneumonias, connective-tissue-disease-associated ILD and sarcoidosis. Patients often experience prolonged diagnostic delays and non-specific symptom profiles that overlap with more prevalent conditions. While these delays are well documented, the contribution of low public awareness to these delays is not well described in the Middle East. We aimed to determine the prevalence of ILD awareness in Saudi Arabia and evaluate its independent association with knowledge, attitudes, and care-seeking practices. We conducted a cross-sectional study of adults (≥18 years) across Saudi Arabia between May and October 2025. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guideline (STROBE). Data were collected using a validated knowledge, attitudes, and practices questionnaire, developed with reference to World Health Organisation guidance and the Theory of Planned Behaviour. Factors associated with prior ILD awareness were assessed using multivariable logistic regression. KAP domain scores, Knowledge (0-8), Attitude (1-5), and Practice (1-5) were compared between awareness groups using Mann-Whitney U tests and analysed using multivariable linear regression with standard errors, adjusting for demographics and healthcare background. p Values were adjusted for multiple comparisons using the Benjamini Hochberg false discovery rate procedure. Ethical approval was obtained from King Abdulaziz University. Of 830 individuals who initiated the survey, 628 (75.7%) provided complete responses and were included in the analysis. Of 628 participants, 116 (18.5%) reported prior ILD awareness. Healthcare providers had 6.45-fold higher odds of awareness (95% CI 3.12-13.32; p < 0.001), and other demographic factors showed no independent association. After adjustment, prior awareness was associated with higher knowledge (β = 3.27, 95% CI 2.77-3.77; p < 0.001) and higher practice scores (p < 0.001). Attitude differences were small and were not statistically significant after full adjustment (p = 0.051). Lack of awareness was reported as a care-seeking barrier by 81% (413/512) of unaware and even by 78% (90/116) of aware participants. Unaware participants prioritised symptom information (65% vs. 53%), whereas aware participants prioritised specialist centre access (53% vs. 43%). ILD awareness in Saudi Arabia is low (18.5%), concentrated among healthcare providers, with knowledge gaps across both the public and healthcare professionals. The persistence of perceived knowledge deficits, even among those aware demonstrates unmet educational needs. Findings support targeted public campaigns emphasising symptom recognition and primary care education to support earlier recognition, diagnosis, and timely specialist referral.
Seafood provides essential nutritional benefits but represents the primary dietary route of exposure to methylmercury (MeHg). Population-level evidence linking adult seafood consumption behavior to MeHg risk awareness in Saudi Arabia remains absent. This study aimed to characterize seafood consumption patterns, estimate MeHg hazard recognition, and identify independent predictors of high-risk consumption and mercury risk awareness among Saudi adults. This nationwide cross-sectional survey enrolled 1,021 adults across all 13 Saudi administrative regions (January-April 2026) and used two pre-specified binary logistic regression models-one examining predictors of high-risk seafood consumption (Model 1) and one examining predictors of mercury risk awareness (Model 2). Regular seafood consumption was reported by 47.4% of participants; only 19.7% identified mercury as a health concern. High-risk consumption, operationalized using FDA/U.S. EPA advisory thresholds and Gulf-region contamination data, was identified in 53.3% of participants (sensitivity range across five alternative definitions: 24.9-70.4%). Women demonstrated higher MeHg-specific awareness (23.6% vs. 16.5%; p = 0.005) and greater food-safety knowledge (1.29 ± 1.91 vs. 0.71 ± 1.42; p < 0.001). Food-safety knowledge strongly predicted mercury awareness (OR = 4.000, 95% CI [3.350-4.777]) but was not associated with consumption behavior (OR = 0.997; p = 0.950). Coastal residence (OR = 3.019), older age (≥50 years: OR = 3.494), female sex (OR = 0.534), and lower educational attainment independently predicted high-risk consumption. Consistent with our objective of evaluating whether food-safety knowledge translates into safer seafood choices, this knowledge-behavior gap was robust across all five sensitivity specifications, confirming a structural-rather than informational-dissociation between awareness and behavior. Species-specific, geographically targeted interventions, rather than general knowledge-based campaigns, are therefore required to reduce the risk of MeHg exposure among Saudi adults.
Emergency physicians are among the first healthcare professionals to manage traumatic dental injuries, yet knowledge deficiencies may compromise early care. This study evaluated emergency physicians' knowledge of traumatic dental injury management, ToothSOS awareness, and factors independently associated with overall knowledge. This questionnaire-based cross-sectional study was conducted among emergency physicians in Turkey between April 2 and May 19, 2026. The survey assessed demographic and professional characteristics, traumatic dental injury knowledge, ToothSOS awareness, and willingness to use the application. Item-level associations were analyzed using chi-squared or Fisher's exact tests. An overall knowledge score, ranging from 0 to 8, was analyzed using univariable comparisons and multivariable linear regression. Factors associated with willingness to use ToothSOS were evaluated using multivariable logistic regression. A total of 208 emergency physicians were included. Correct-response rates ranged from 47.1% for the first intervention for an avulsed permanent tooth to 91.8% for identifying the most commonly affected teeth. ToothSOS awareness was 1.0%, although 79.6% of unaware participants stated they would consider using the application. The mean overall knowledge score was 5.23 ± 1.48. Previous dental trauma training and clinical exposure to traumatic dental injury cases were associated with higher scores in univariable analyses; only clinical exposure remained an independent predictor after adjustment. No factor independently predicted willingness to use ToothSOS. Emergency physicians demonstrated moderate overall traumatic dental injury knowledge, with deficiencies in avulsion management and referral decisions. Previous clinical exposure to such cases was the only independent predictor of higher knowledge scores, supporting structured training rather than reliance on incidental experience. Low ToothSOS awareness, despite high willingness to use it, supports integrating dental trauma education and digital decision-support tools into emergency medicine training and clinical protocols.
Stroke incidence and mortality are higher among adults in northern and western China, commonly referred to as the "Stroke Belt." However, few studies have compared stroke action awareness between Stroke Belt and non-Stroke Belt regions at the national level. This study aimed to evaluate stroke action awareness-including recognition of symptoms and appropriate emergency responses-among community residents in China, with comparisons between Stroke Belt and non-Stroke Belt regions. We conducted a cross-sectional, questionnaire-based survey of community residents across China to assess knowledge of stroke symptoms and appropriate responses to suspected stroke events. A total of 6181 residents were included in the final analysis, with 2037 living in Stroke Belt regions and 4144 in non-Stroke Belt regions. Overall, 19.07% (n = 1179) were unaware of any stroke symptoms, 17.96% (n = 1110) recognized one symptom, 11.97% (n = 740) recognized two symptoms, and 50.99% (n = 3152) recognized all three. Additionally, 77.59% (n = 4796) identified calling emergency medical services (EMS) as the correct response. Multivariable logistic regression showed that residents of the Stroke Belt had significantly lower odds of recognizing all three symptoms (adjusted odds ratio [aOR]: 0.50; 95% CI: 0.44-0.56; p < 0.001), calling EMS (aOR: 0.62; 95% CI: 0.54-0.70; p < 0.001), and both recognizing all three symptoms and calling EMS (aOR: 0.51; 95% CI: 0.45-0.58; p < 0.001). Stroke action awareness remains notably low among community residents in China, with the lowest levels observed in the Stroke Belt. Targeted public health interventions are urgently needed to improve symptom recognition and promote timely action for emergency stroke care, especially in high-risk regions such as the Stroke Belt.
A rank-aware determinant evaluation scheme is presented to improve the non-dimensional dynamic influence function (NDIF) method for accurate eigenvalue and eigenmode analyses of arbitrarily shaped two-dimensional acoustic cavities. In the conventional NDIF method, lower-order eigenvalues in the low-frequency range may be missed when the number of boundary nodes is increased to enhance higher-order accuracy. This study first shows that this limitation originates from ill-conditioning and rank deficiency of the system matrix in the low-frequency region, which makes direct determinant evaluation unreliable. To address this issue, a practical determinant-evaluation scheme is developed by incorporating the rank information of the acoustic-cavity system matrix together with that of the corresponding membrane system matrix. In addition, a discontinuity-removal procedure is introduced to eliminate stepwise discontinuities in the determinant curve caused by discontinuous rank variations, thereby enabling robust identification of eigenvalues. The proposed method is validated using three example studies: a circular cavity with an exact solution and two arbitrarily shaped cavities. The extracted eigenvalues and mode shapes show exact agreement with the analytical solutions for the circular cavity and close agreement with finite-element method results for the arbitrarily shaped cavities.
The present study aimed to explore how healthcare professionals in Slovak hospitals perceive patient safety concerns and how these perceptions shape their actions. The study employed a qualitative research design using individual semi-structured interviews. The data were analysed using reflexive thematic analysis. A total of 32 healthcare professionals with prior or current work experience in various departments of Slovak hospitals participated. The authors identified two themes: (1) patient health and safety as a core professional value closely linked to emotional experiences and fear of professional failure, and (2) context-dependent decision-making in response to patient safety concerns, with internal conflict when witnessing suboptimal care and efforts to protect patients through speaking up, intervening, or taking preventive measures. The findings indicated that healthcare professionals conceptualised patient safety concerns not only as discrete patient safety issues, but also in relation to general health concerns, with a focus on ensuring safe and appropriate care. However, barriers to providing high-quality healthcare were also present, highlighting opportunities to improve safety culture and promote teamwork, shared responsibility, and open communication within hospital teams in Slovakia. The findings of this study may have relevance beyond the Slovak context, particularly in hospital settings in other post-socialist countries.
An understanding of the relations between psychological flexibility processes and quality of life among autistic adults could help inform treatment development to improve the acceptability of mental healthcare among autistic adults. This pre-registered (https://osf.io/t3pws) secondary analysis of a mixed-methods pilot open trial provides a preliminary test of which subprocesses of psychological flexibility are associated with improvements in quality of life among a sample of 56 autistic adults who received a 6-week digital self-help acceptance and commitment therapy (ACT) intervention. Online self-report assessments were collected at pre-treatment, 6 weeks (post-treatment), and 10 weeks (1-month follow-up). Pre- to post-treatment improvements in values progress and valued action, but not openness to experience, behavioral awareness, or values obstruction, were associated with pre- to follow-up improvements in quality of life. Qualitative themes suggested that psychological flexibility with thoughts, emotions, and behaviors may be experienced as impacting quality of life. An exploratory analysis found that greater adherence to the digital ACT program was associated with greater pre- to post-treatment improvements in awareness and values obstruction, but not other psychological flexibility subprocesses. Although these are preliminary associative findings limited by a single-arm design, they suggest psychological flexibility, especially values, is a promising candidate for future research on mechanisms for improving quality of life among autistic adults.
Physician compensation models increasingly rely on productivity metrics, with current procedural terminology (CPT) codes and relative value unit (RVU) assignments standardizing procedure complexity and informing reimbursement. Pediatric neurosurgery receives lower RVU assignments than adult counterparts, with many procedures lacking assigned codes despite yearly evaluations. Understanding current coding knowledge, patterns, and interest in change among pediatric neurosurgeons is essential for accurate CPT and RVU alignment with procedure complexity. The Pediatric Coding and Reimbursement Committee developed a 24-question survey using Modified Delphi methodology to assess coding habits, knowledge, training, resources, and perceptions within pediatric neurosurgery. The American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Pediatric Section distributed the survey to members in Spring 2024, collecting 119 responses. Response rate for the survey was 21.6%. Overall, 94.2% of the respondents were full-time attendings and the remainder were fellows (3.3%) and residents (2.5%). Although 55.6% code independently or with billing departments, others rely solely on billing assistance. Self-reported coding knowledge was poor, with only 15.7% feeling confident coding without billing support. Notably, 59.3% have never performed formal coding training postresidency, and 30.6% do not know how to find formal training. In addition, 41.6% were unfamiliar with American Association of Neurological Surgeons coding resources. However, 68.6% considered coding "very" important for training incorporation, and 90.2% believed a Pediatric Neurosurgery Coding Manual would be beneficial. Clinical scenarios with unclear coding guidance showed significant practice variability. The pediatric coding landscape features predominantly large academic practices with RVU-based compensation, yet individual surgeons report disparities between coding importance and abilities. Despite expressing poor coding knowledge and limited awareness of formal training resources, pediatric neurosurgeons demonstrate high interest in coding education while simultaneously expressing poor coding knowledge and lack of awareness of formal training or online resources. These findings highlight significant opportunities for coding education and standardization within existing CPT architecture, enabling better protection of the field's financial viability through improved reimbursement understanding.
To compare the patterns of domestic violence among pregnant women residing in rural and urban areas of Khyber Pakhtunkhwa, Pakistan. This cross-sectional comparative study included 500 pregnant women (250 rural, 250 urban) attending the Department of Gynecology and Obstetrics in Khyber Pakhtunkhwa, Pakistan. Domestic violence was measured using the 25-item Domestic Violence Scale, covering seven domains: neglect, psychological, spiritual, verbal, economic, physical, and sexual violence. Independent variables included residence, age, education, occupation, socioeconomic status, trimester, and awareness of support services. Group comparisons were performed using the Chi-square and the Mann-Whitney U tests. Linear regression analysis identified factors independently associated with domestic violence. Rural women had significantly higher domestic violence scores than urban women (p < 0.001), with lower awareness of support services (22.0% vs. 70.6%; p = 0.001). All violence domains were significantly higher in rural participants (p < 0.001). Regression analysis showed urban residence was associated with lower violence scores (β = -7.04; p < 0.001), while the third trimester was associated with higher scores (β = 2.58; p = 0.039); other variables were not significant after adjustment. Pregnant women residing in rural areas demonstrated greater vulnerability to domestic violence. In the adjusted analysis, urban residence was associated with lower violence scores, whereas the third trimester was associated with increased scores. N/A.
The impact of ionising radiation (IR) from environmental and therapeutic sources is complex and extends beyond the damage to DNA. These perturbations are conveyed by regulatory networks, such as transcription factors, microRNAs, long non-coding RNA, and signaling cascades, which in the end affect the susceptibility, progression, and treatment response to cancer. The traditional reductionist approaches, which are very useful, are not enough to explain emergent properties of these dynamic systems. The system's biology paradigm has a great potential of providing the explanation of the rewiring of cellular networks by radiation and identify novel targets to be targeted in precision oncology. The review summarizes the current literature on radiation-induced alterations of network patterns and on the remodelling of the molecular landscape of cancer cells due to exposure to environmental radioactivity and therapeutic radiation exposure. We create awareness of methodological progress in the development and analysis of radiation-responsive regulatory networks, identify key hub molecules and pathways, and discuss the translation potential of using radiation-responsive regulatory networks in individual radiotherapy. This review is different from previous reviews that have concentrated on single mechanisms in single-omics viewpoints or focused on a single radiation type as environmental or therapeutic, since it brings together network topology analysis, multi-omics data and clinical translatability in the context of both types of radiation exposure. We explore how weaknesses in radiation-sensitive components of a tumor can be used to target radiation-resistant ones while at the same time, radiation-induced damage to normal tissues can be reduced by network-aware approaches.
Intertemporal decision-making ability is critical for behavior change and maintenance. While a conceptual model of this ability exists for chronic patients, how it manifests in the physical activity (PA) context among young and middle-aged stroke patients is unclear. Therefore, this study aimed to contextually validate and extend the generic conceptual model, and to explore its applicability to PA among young and middle-aged stroke patients. This qualitative study employed semi-structured interviews with 16 stroke patients, who were purposively sampled from a hospital in Nanchang. Data were analyzed using directed content analysis. The conceptual model comprises four dimensions: (1) impulse control (including impulse awareness and inhibition of immediate impulses); (2) emotional self-regulation (including emotional awareness and application of emotion regulation strategies); (3) future health valuation (including perceived long-term benefits of PA and the value attributed to family roles and social responsibilities); (4) future-oriented thinking and planning (including future scenario imagination, construction of causal chains, and shortening of temporal distance). The intertemporal decision-making ability of young and middle-aged stroke patients during PA exhibits multidimensional characteristics, including impulse control, emotional self-regulation, future health valuation, and future-oriented thinking and planning. Family and social responsibilities, along with warning imagery, endow these dimensions with unique connotations that extend beyond the general model. Future research should develop specific measurement tools based on the dimensional structure of this ability and design personalized intervention programs.
 Diabetic retinopathy (DR) is a major cause of avoidable vision loss, yet public awareness is low, hindering early detection and treatment. Many people living with diabetes are unaware of their risk for DR and the need for screening.  To assess the knowledge, attitudes and practices of people living with diabetes regarding DR prevention.  Ten primary health care clinics in the Maruleng sub-district in Limpopo province of South Africa.  A cross-sectional study utilised a self-reported questionnaire with yes/no questions to measure knowledge and practices, and attitudes were assessed with a 5-point Likert scale. Scores above the median for knowledge, attitudes and practices were indicative of good knowledge and practices and positive attitudes.  Almost two-thirds of participants (n = 255; 65.6%) were female. Approximately 268 participants (61.2%) knew that uncontrolled high blood sugar can lead to DR. The majority (n = 355; 86.1%) showed positive attitudes towards their eye health, while 216 (55.8%) had good practices towards DR prevention. Higher education and duration of diabetes were associated with good knowledge (adjusted odds ratio [AOR]: 2.2; 95% confidence interval [CI]: 1.3-3.9; p  0.05) and (AOR: 1.9; 95% CI: 1.2-2.9; p  0.05), respectively, while good knowledge about diabetic eye complications was associated with positive attitudes (AOR: 2.0; 95% CI: 1.3-3.1; p  0.05). Patients diagnosed with diabetes mellitus for more than five years were more likely to attend regular eye exams (AOR: 2.3; 95% CI: 1.5-3.6; p  0.05).  Although participants had high median scores for knowledge and attitudes, important deficiencies were noted that could hinder effective DR screening.Contribution: These findings provide the baseline evidence on the need for ongoing patient education in primary care to enhance DR prevention.
Esherishia coli (E. coli) and Salmonella species (spp.) pose serious public health threats because of their ability to contaminate poultry products and spread through farm environments. This study assessed the prevalence, antimicrobial resistance, and virulence gene profiles of E. coli and Salmonella spp. A cross-sectional study was conducted, involving the random collection of 400 samples from broilers, drinker's water, feedstuff, broiler litter, and poultry workers in broiler farms. Furthermore, a structural questionnaire was administered to poultry workers to identify potential risk factors and assess the public health implications associated with pathogen transmission. The antimicrobial and anti-virulence activities of melanin against E. coli and Salmonella enteritidis (S. enteritidis) were also assessed. E. coli and Salmonella spp. were frequently isolated from broiler farms, with a predominance of. E. coli serotype O111:H2 (25.64%) and S. enteritidis strains (30.4%) among the total examined samples. Multivariate analysis revealed that poultry workers, who had symptoms worsened after starting farm work and those did not use of personal protective equipment (PPE) were strongly associated with E. coli positivity. E. coli isolates exhibited full resistance to ampicillin (AMP) and tetracycline (TET), whereas Salmonella spp. isolates showed full resistance to AMP. Most of the examined E. coli isolates (71.8%) and the Salmonella spp. isolates (60.9%) were multidrug resistant (MDR) strains. In addition, 28.2% of E. coli isolates and 30.4% of Salmonella spp. isolates were -XDR. The stx1, stx2, and hylA virulence genes were respectively detected in 69.2%, 69.2%, and 74.4% of the examined E. coli isolates, whereas the sopB and hilA virulence genes were identified in all Salmonella spp. isolates. One-way repeated-measures analysis of variance (ANOVA) showed that natural melanin treatment significantly reduced the expression of virulence genes in both E. coli and S. enteritidis isolates. The predominance of E. coli serotypes O111 and S. enteritidis highlights the need for improved hygiene practices and zoonotic diseases awareness to limit pathogen transmission in poultry farms. The detection of MDR and XDR strains e emphasizes the consequences of antimicrobial misuse and its implications for public health. Melanin has potential antimicrobial and anti-virulence activities against E. coli and S. enteritidis.
Overuse and misuse of chemical pesticides remain a major threat to public health in agricultural communities of the least developed and low-income countries. Gender-based differences in agricultural settings, access to agricultural information, and decision-making play a crucial role in influencing farmers' knowledge, perceptions, and behaviors related to the application of pesticides. However, gender-disaggregated evidence from Nepal is scarce. A cross-sectional mixed-methods study was conducted among 244 vegetable farmers in Palpa district, Nepal. Data were collected through household surveys using a semi-structured questionnaire assessing knowledge, perceptions, and behaviors related to the application of pesticides. Additional data were obtained through focus group discussions, key informant interviews, and field visits. Gender-based differences were analyzed using χ 2 tests, Mann-Whitney U tests, Spearman's correlation and principal component analysis. A significant gender difference was observed in relation to pesticide knowledge, particularly regarding safe application intervals/waiting periods, pesticide dosages, toxicity labels, and regulatory awareness, with women demonstrating comparatively poor knowledge levels. Both men and women perceived pesticides as deleterious to human health and the environment; however, many recognized pesticides are essential substance for preventing, destroying, and mitigating pests and plant diseases, thereby maintaining crop yield. Pesticide retailers were the key source of pesticide information for most farmers, especially women, while formal extension service providers played a negligible role. Unsafe handling and improper disposal practices, including burning pesticide packets/containers and storing leftover pesticides, were common. Although self-reported adoption of basic safety measures was high, our analysis revealed gaps between reported and actual practices due to budget, comfort, and limited access. This study highlighted critical gender-based disparities in pesticide use knowledge and safety practices among vegetable farmers in the hills of Nepal. Addressing these gaps requires gender-responsive education and training, strengthened rules and regulations of pesticide retailers, improved access to high-quality protective equipment, and broader promotion of integrated pest management to reduce pesticide use and pesticide-related exposures and health risks. Illegal imports and sales of banned pesticides warrant severe punishment as per the rules and regulations of the government authorities.
This study aimed to develop and validate the Thai AI Literacy Scale for Nursing Students (TAILS-NS). A cross-sectional study was conducted across multiple nursing institutions in Thailand from March to May 2026 to address the absence of a validated artificial intelligence (AI) literacy instrument for nursing students in Thai or Southeast Asian contexts. A total of 410 nursing students participated, yielding a response rate of 94.5%. The TAILS-NS was developed through item generation, expert content-validity assessment using the item-objective congruence index, and a 2-phase pilot study, resulting in a 40-item instrument comprising a 15-item knowledge test and 25 Likert-scale items across 6 domains. Exploratory factor analysis using maximum likelihood estimation and confirmatory factor analysis using the weighted least squares mean and variance-adjusted estimator, as well as internal consistency, convergent validity, and discriminant validity, were assessed. An independent validation sample (n=157) was recruited for cross-validation confirmatory factor analysis. Raw data are available as a supplement. Exploratory factor analysis supported a 6-factor structure: AI awareness, skills, ethics and professionalism, positive attitude, AI anxiety, and readiness. Confirmatory factor analysis showed acceptable model fit, although the root mean square error of approximation (RMSEA) indicated marginal fit (comparative fit index [CFI]=0.919, Tucker-Lewis index [TLI]=0.906, RMSEA=0.090). Reliability of the knowledge subscale was acceptable (Kuder-Richardson Formula 20=0.758). Internal consistency was excellent (α=0.810-0.934; total α=0.974; ω=0.989). Average variance extracted exceeded 0.50 for all factors, supporting convergent validity. Most heterotrait-monotrait ratios were below 0.90, supporting discriminant validity. Cross-validation confirmed factorial replicability (CFI=0.917, TLI=0.904). The TAILS-NS provides evidence of validity and reliability for measuring AI literacy among Thai nursing students and may serve as a standardized tool for curriculum evaluation. Future studies should expand the AI anxiety subscale and explore cross-cultural applicability in Southeast Asian nursing contexts.
Meta-analysis is fundamental to evidence-based medicine, yet traditional workflows remain labor-intensive and susceptible to bias. Although LLM-based research agents offer opportunities for workflow automation, they often lack the data fidelity and methodological traceability required for rigorous quantitative evidence synthesis, particularly when parsing multimodal scientific charts. To address this challenge, we introduce MacAma, a semi-automated multi-agent framework for protocol-constrained and human-verifiable meta-analysis. MacAma operationalizes selected PRISMA 2020 reporting items, PICOS-based eligibility logic, and SYRCLE risk-of-bias domains as structured prompts, decision rules, output fields, and audit records. Critically, MacAma adopts a risk-aware automation strategy: Lower risk, repetitive, and protocol-driven tasks, such as literature screening and drafting, are delegated to AI agents, whereas high-impact steps that directly affect effect-size estimation and statistical conclusions, such as quantitative chart-data extraction, remain subject to expert verification. In a preclinical radiotherapy case study evaluating tumor-related immune outcomes and metastatic potential mediated by circulating tumor cells, MacAma achieved competitive screening performance in the evaluated benchmark and reduced the manual screening burden by over 80% within the current workflow. The case study further demonstrates how structured agent outputs, predefined criteria, and audit records can support transparent screening, data extraction, statistical synthesis, and manuscript drafting. These results suggest that MacAma may provide a scalable and auditable framework for AI-assisted meta-analysis, although important limitations remain in full-text access, quantitative chart data extraction, and expert interpretation of heterogeneity. MacAma is open-source and available at https://github.com/YilinYuan/MacAma.
Gynaecological health requires a health systems approach through the life course to address the interlinked nature of common gynaecological conditions or symptoms. This narrative review, following the READ approach, examined how the public health system in India addresses gynaecological health, as reflected in policies, services and data. A multi-disciplinary team searched government policies, service guidelines and standards across relevant Ministries and national institutions, Parliamentary Questions, government surveys and administrative data sources between 2005 and 2025. The extraction of 34 documents examined whether a condition/symptom was covered in policy and included in guidelines for community awareness/outreach and facility-based treatment. The analysis assessed the extent of policy guidelines and data available for different gynaecological conditions and across the life course, along with an in-depth analysis of heavy menstrual bleeding across five health system building blocks. India's health policies cover most gynaecological conditions, to varying degrees. Cancers and reproductive tract infections have comprehensive policies and guidelines for community-based outreach and services, while outreach and services for menstrual disorders, sexual health, infertility and menopause remain limited. Injuries from gender-based violence are a priority policy area. Heavy menstrual bleeding has comprehensive service guidelines, but gaps remain in community-based outreach and access to conservative treatment options. Nationally representative surveys currently collect data on some gynaecological conditions, but there are limited population-level data on the prevalence of and treatment for menstrual disorders, infertility and sexual health. Advacing women's health will will require policy and service guidelines that address the range of gynaecological conditions in an integrated approach, including community outreach, facility-based management and national, routine data colleciton.
Antibiotic resistance remains one of the most pressing challenges in modern microbiology. Decades of research have focused on identifying resistance genes and molecular mechanisms in opportunistic pathogens. Yet bacterial survival under antibiotic stress is often shaped by broader physiological processes that are not always considered within the conventional frameworks associated with antibiotic resistance. In this perspective, I argue that bacterial metabolism plays a broader and more integrative role in shaping antibiotic resistance than is often appreciated. I discuss how metabolic networks and core housekeeping genes may serve as underlying drivers of bacterial survival and adaptation during antibiotic exposure. Integrating metabolic context into resistance research may reveal new evolutionary insights and highlight previously unrecognized vulnerabilities in bacterial physiology. Indeed, viewing antibiotic resistance through the lens of metabolism may ultimately help guide the development of more effective, 'metabolism-aware' antimicrobial strategies.
The aim of this study was to investigate enabling factors of bullying and harassment in the work environment on board ships. This qualitative study was based on semi-structured interviews with seafarers and industry experts. The study also used free-text responses to open-ended questions from a large population-based cross-sectional survey on the prevalence of bullying and harassment on ships in the Danish merchant fleet. The data were imported into NVivo and analyzed thematically. Four themes emerged as enabling factors specific to the work environment on a ship. The first theme, Isolation, covers how the crew - as a group - is physically isolated from the world outside the vessel, but also how new crew members can face challenges when trying to become established within the groups on board. The second theme, Hierarchy, encompasses how challenging the existing rank-based hierarchy is not tolerated and how the hierarchy itself is often maintained through bullying and harassment. The third theme, Crewing, includes how diversity related to, for example, culture, language, gender, or age/experience may create another form of hierarchy, with the same negative consequences as the hierarchy based on formal rank. The fourth theme, Leadership, covers how leadership can enable both good and unacceptable work environment related to bullying and harassment. Bullying and harassment pose serious challenges to the work environment on ships. Four themes were identified as enabling factors of bullying and harassment. Some are inherent conditions, whereas others may be improved through continued awareness and focused educational initiatives.