Public health crises like the COVID-19 pandemic and major wildfires have exposed significant confusion about how members of the public can effectively protect themselves from inhaling harmful airborne particles. Unlike many other nations, no single federal agency oversees respiratory protective devices (RPDs) designed for public use against inhaled contaminants. The National Institute for Occupational Safety and Health (NIOSH) currently holds the authority for establishing standards and approving respirators used in workplaces; however, for public sector use, there is a lack of standards for their design and construction, conformity assessment to ensure conformance, risk assessment in selecting devices, and guidance for proper use and maintenance. Without RPDs specifically designed for public use, individuals are left to purchase industrial products intended for workplaces, which do not generally suit the needs of the public, or to rely on domestic and foreign products that have uncertain quality and effectiveness. The development of specific standards for public-use devices, robust conformity assessment practices, and clear guidance on their selection, use, and care is needed. A risk assessment framework for selecting devices for common hazards like wildfire smoke, general air pollution (including pollens and allergens), and infectious particles is presented. Respiratory protection for the public must consider those with physical and mental disabilities and is discussed. Given that nearly all governmental expertise in RPD testing, efficacy determination, and systems oversight resides within NIOSH, its authority could be expanded to assist in developing public-specific standards and conformity assessments. This expansion would enable the public to have confidence that the RPDs they purchase are effective for the protections manufacturers claim.
Case definitions are essential for effectively communicating public health threats. However, the absence of a standardized, machine-readable format poses significant challenges to interoperability, epidemiological research, data sharing, and the application of computational methods, including artificial intelligence. These barriers complicate collaboration across regions and organizations and hinder technological progress in public health. This study aims to propose and release the first open, machine-readable format for representing case and syndrome definitions, together with tools and resources that enable their standardized and scalable use. We developed the Open Syndrome Definition, a structured, machine-readable schema for representing case and syndrome definitions. We compiled official public health case definitions from multiple institutions and converted them into standardized, machine-readable representations using open-source tools. These tools, available through GitHub under the Massachusetts Institute of Technology license, automate the translation of narrative definitions into structured data. We also created a platform for browsing, analyzing, and contributing new definitions on our initiative website. The Open Syndrome Definition format enabled consistent, automated representation of case definitions across different diseases and jurisdictions. The conversion tools achieved high semantic fidelity, as assessed by qualitative expert review, between narrative and structured representations, supporting human verification and automated analysis. The dataset and accompanying tools demonstrated structural and semantic interoperability by standardizing definitions from various health systems into a unified format and integrating existing medical ontologies through JSON for Linked Data. To further illustrate practical applicability and downstream usage, we introduced a data filtering prototype that allows users to upload their own datasets and verify the results against the standardized definitions. The Open Syndrome Definition establishes a foundation for consistent and machine-readable public health definitions, facilitating reproducible research and interoperability at scale. By enabling systematic data exchange and artificial intelligence-driven analysis, it strengthens public health preparedness and supports more rapid, coordinated responses to emerging health threats.
During the COVID-19 pandemic, Alert Level Systems (ALS) were widely implemented as public health tools to communicate risk levels and recommend public health and social measures (PHSMs). However, the efficacy of ALS in mitigating disease spread and their impact on public health responses have not been systematically evaluated. This study aims to assess perceptions of ALS implementation across diverse jurisdictions and derive lessons for future public health emergencies. Key informant interviews were conducted remotely between December 2023 and March 2024 with senior stakeholders who were involved in ALS development and implementation during the COVID-19 pandemic, from eight jurisdictions: California (US), New Zealand, the Philippines, Rio Grande do Sul (Brazil), Singapore, South Africa, the United Kingdom, and the United States. A thematic analysis approach was applied to synthesize insights, focusing on the strengths, challenges, and key lessons from ALS implementation. ALS were generally perceived by key informants as useful tools for communicating risk and supporting adherence to PHSMs due to their simplicity and transparency. However, significant challenges were identified, including difficulties in accessing reliable data, lack of clear ALS objectives, and insufficient community engagement. The study highlights the need for ALS to integrate social, economic, and epidemiological data in decision-making processes. Jurisdictions also reported that pre-existing ALS governance structures and stronger community feedback mechanisms could have improved implementation outcomes. ALS can serve as valuable public health communication tools in future epidemics, but their success depends on clear objectives, evidence-based PHSMs, and robust community engagement. Pre-emptive development of ALS structures and governance will improve preparedness for future epidemics. Transparent and flexible decision-making processes will be crucial for sustaining public trust.
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Assistive technology (AT) is widely promoted as a means of supporting equitable participation in higher education; however, little is known about how students with visual impairment (SWVI) in Gulf higher education experience AT in everyday academic life. This study explored how SWVI at one public university in the United Arab Emirates (UAE) perceived the affordances and constraints of AT in academic activities. A qualitative interpretive phenomenological design was used. Ten Emirati SWVI enrolled in undergraduate or postgraduate programmes and regularly using AT for academic purposes were recruited through the university's disability support unit. In-depth- semi-structured interviews were conducted and analysed using reflexive thematic analysis. Four interrelated themes were identified in the study. AT functions as a catalyst for academic and social autonomy, enabling students to manage core tasks and participate more fully in university life. However, these affordances were often curtailed by inaccessible digital platforms, incompatible course materials, bureaucratic hurdles and limited technical support. Institutional and peer awareness acted as conditional enablers of AT use, while a pervasive lack of specialised and continuous training for both students and staff constrained the realisation of AT's potential for enhancing learning. In this single-institution study, AT's educational affordances of AT were situational and emerged from interactions among students, technologies and institutional systems. Improving digital accessibility, centralising AT support and providing structured AT training for students and staff may help advance the UAE's inclusive education goals and strengthen equitable participation in comparable higher-education settings. Assistive technology can substantially enhance academic independence, confidence and social participation for university students with visual impairment, but its benefits are contingent on accessible learning management and assessment systems.Inaccessible digital platforms, image-based- course materials and restrictive exam software can negate AT’s intended affordances, making students reliant on others at critical moments.Centralised assistive technology and digital accessibility support, including structured training for students and staff, are essential for sustaining effective AT use in higher education.Rehabilitation and education professionals should collaborate to embed AT training, digital accessibility and universal design principles within institutional policies and teaching practices.
Objectives. To examine the associations between paternal leave status and mental health symptoms in a large population-representative study of fathers after the birth of a child. Methods. We used data from the 2022-2023 Ohio Fatherhood Survey (OFS) to model the relationship between paid work leave factors and mental health (Patient Health Questionnaire-2 [PHQ-2] and Generalized Anxiety Disorder-2 [GAD-2]) by using weighted descriptive analyses and adjusted logistic regression modeling. Results. Fathers with unpaid leave were more likely to report anxiety symptoms (adjusted odds ratio [AOR] = 1.58; 95% confidence interval [CI] = 1.00, 2.48) compared with fathers with paid leave, while unmet needs were associated with increased depression (AOR = 3.21; 95% CI = 1.92, 5.37) and anxiety (AOR = 3.12; 95% CI = 2.02, 4.83) symptoms. Furthermore, barriers to work leave, including financial barriers (PHQ-2 = 74.6%; GAD-2 = 71.2%) were more prevalent among fathers who reported recent mental health symptoms. Conclusions. Paid paternal leave status and leave barriers are associated with mental health symptoms. Public Health Implications. Equitable paid paternal leave may strengthen mental health, highlighting a public health pathway toward improving father and family well-being. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308554).
Learning from medical errors prevents their recurrence. This study examined the management of safety incidents and medical errors, as well as the learning process. A semi-structured interview was conducted with NHS practitioners involved in invasive procedures. An inductive thematic analysis was followed to create descriptive themes. Analytical themes have been identified based on the descriptive themes. The interviews included 15 participants (11 consultants, two senior trainees, and two senior theatre nurses). Many are unfamiliar with the definitions and classification of medical errors. Concerns are raised about under-reporting important incidents and over-reporting futile incidents. There was a clear division in reporting near misses. The majority have a pathway for managing medical errors in their organisations. However, the main concern was the lack of feedback. The majority believe M&M meetings provide the best platform to discuss medical errors, though there are concerns about the meetings' length, case selection, and the absence of anonymised discussions. The participants believe central reporting could lead to change, but the lack of horizontal dissemination of lessons learned is a significant defect. Confidentiality, the reputation of trust, fear of public opinion and politicians, and the negative role of the media all hinder the publication of medical errors and the learning of lessons. There is a lack of formal support for the second victim and a prevalence of defensive medicine. There are concerns related to the process and purpose of incident reporting. M&M meetings are the preferred forum for clinicians to discuss and learn from errors. The main problems are the lack of feedback and the horizontal dissemination of learning lessons. Publishing about medical errors is a sensitive subject influenced by many factors. There is a need for a formal programme across the NHS to support the second victim. Defensive medicine is the new norm.
There are significant opportunities for speech-language pathologists (SLPs) to play important roles in the primary and secondary prevention of Alzheimer's disease and related dementias (ADRD) beyond current practices. This tutorial, developed by members of the Joint Committee on Interprofessional Relations between the American Psychological Association and the American Speech-Language-Hearing Association, is intended to support SLPs in these efforts and to facilitate collaboration between SLPs and neuropsychologists. This tutorial synthesizes interdisciplinary literature on cognitive aging, ADRD, public health, clinical psychology, speech-language pathology, and motivational interviewing. We provide an evidence-based overview of cognitive aging, ADRD, modifiable aspects of brain health, and practical strategies for engaging with middle-age and older adults to promote brain health across the lifespan. While discussions about cognitive aging, Alzheimer's disease, and dementia have long been avoided, stigmatized, and demoralizing, there is much more to be positive about than in the past. Forty-five percent or more cases of dementia can be delayed or prevented by addressing modifiable risk factors across the lifespan, and brain health and resilience can be improved at any age. As the population ages worldwide, it will require SLPs and neuropsychologists working together and with other helping professions to raise awareness, contribute to public health initiatives, advocate for reimbursement for efficacious services, and educate and motivate their clients to improve brain health. Even small effects in the primary and secondary prevention of dementia can translate into significant personal and societal outcomes.
Objectives. To examine whether paternal leave duration is associated with fathers' depression. Methods. Data from 746 Swedish fathers of children aged 0 to 24 months participated in a national cohort during December 2021 through February 2022 and were followed up 18 months later (July 2023 to January 2024). Fathers reported their depression at both waves and leave duration at follow-up. Logistic regression models were used to estimate associations between leave duration and depression at follow-up after adjustment for baseline depression, maternal leave, sociodemographic factors, coparenting, bonding, and child health care engagement. Results. Fathers taking 14 to 40 weeks of parental leave had lower odds of depression (adjusted odds ratio = 0.42; 95% confidence interval [CI] = 0.22, 0.82) than fathers taking 0 to 4 weeks of leave; predicted probabilities were 0.25 (95% CI = 0.15, 0.37) versus 0.12 (95% CI = 0.09, 0.16). No significant benefit was observed for 5 to 13 or 41 or more weeks of leave. Conclusions. Taking parental leave beyond the reserved 90 days appears to protect fathers' mental health, positioning leave duration as a structural determinant of men's health. Public Health Implications. Encouraging fathers to take longer parental leave could be a population-level strategy to reduce depression risk and promote family well-being. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308589).
Objectives. To assess US patterns of distribution for all naloxone products. Methods. We conducted a retrospective, cross-sectional study using manufacturer reports (total US naloxone distribution) and IQVIA National Sales Perspectives (estimated sales to US health care settings) to assess naloxone distribution quantity and patterns from 2018 to 2023. Results. Aggregated manufacturer-reported data showed that total US distribution of naloxone increased from 7.65 million units (vials, syringes, devices) to 29.7 million units from 2018 to 2023; the largest increase was in distribution of nasal spray devices (2.9 million to 23.4 million devices). Although sales to health care settings doubled (6.3 million units in 2018 and 13.6 million units in 2023), we infer that naloxone distributed to non-health care settings increased from 1.39 million units in 2018 to 16.1 million in 2023, accounting for 54% of total naloxone distributed in the United States by 2023. Conclusions. Distribution of naloxone markedly increased between 2018 and 2023, with the largest increases in distribution to non-health care settings and for nasal spray devices. Public Health Implications. This comprehensive overview of the naloxone supply, with insights into changes in distribution for community use, may help inform assessments, including those involving factors contributing to recent declines in opioid overdose deaths. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308541).
Objectives. To compare 7-day readmission among patients with a non-English primary language in language-serving versus non-language-serving hospitals. Methods. We conducted a retrospective cohort study using the New Jersey State Inpatient Database (2010-2022). We identified 578 030 inpatient discharges home among patients with a non-English primary language. We used generalized linear mixed models to compare 7-day readmission between language-serving hospitals-defined as those with a higher proportion of patients with a non-English primary language-and non-language-serving hospitals. Results. Patients with a non-English primary language were less likely to be readmitted within 7 days at language-serving versus non-language-serving hospitals (4.8% vs 9.8%; adjusted odds ratio = 0.49; 95% confidence interval = 0.25, 0.96). This trend persisted when stratified into Spanish (5.5% vs 9.7%), common (4.0% vs 14.6%) and rare non-English primary languages (4.0% vs 8.8%). Conclusions. Patients with a non-English primary language discharged from language-serving hospitals were less likely to be readmitted within 7 days. Public Health Implications. To improve care for patients with a non-English primary language, future research should identify the hospital- and state-level language access policies that underpin these findings. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308470).
This study examines the use of Social Network Sites for public institutional communication through a sociological, data-driven lens, focusing on the challenges and potential of automated classification tools for data analysis. Although Large Language Models are increasingly used to process social media data, a key research gap remains: few studies systematically assess whether AI-based categorizations are as reliable as human coding, especially when categories are semantically ambiguous. The research addresses the following questions: How reliable are AI-generated classifications compared to those made by human experts? Is human-machine agreement comparable to the level of agreement observed among human coders? To experimentally test this approach, we conducted a case study on Facebook posts published by two Italian universities (March 2020-March 2023), classified into eight categories of public institutional communication. Three researchers independently annotated the dataset. Human annotations are used as a benchmark to assess agreement patterns and to compare them with classifications produced by AI-based systems. Results show substantial interpretive ambiguity across several categories, mirrored by variability among human coders. Nonetheless, automated models achieve agreement with human classifications that is broadly comparable to inter-coder agreement. Overall, the findings support integrating AI as an additional coder within hybrid workflows to enable scalable and transparent sociological analysis of complex social media data.
Georgescu-Roegen is known both for his proposal of a paradigmatic shift in economics and for the difficult acceptance of his thermodynamic view among his peers. It was only with the development of modern ecological economics that his view became a foundational element of an economic approach. In Latin America, where economics was more pluralistic than in core countries, one might expect his ideas to have circulated more freely, even before ecological economics became institutionalized in the region. This article explores the reception of Georgescu-Roegen's thermodynamic view of the economic process within Latin American thought during the two decades following the publication of The Entropy Law and the Economic Process (1971). His perspective found only limited resonance among Latin American developmentalists, including within the Economic Commission for Latin America and the Caribbean (ECLAC), where references to thermodynamics did not generally result in a new biophysical view of development. By contrast, Georgescu-Roegen's ideas were more deeply integrated into the study of regional development in the Amazon, where they gave rise to an original formulation of regional development and ecologically unequal exchange based on the Entropy Law.
Emissive metal halide perovskites (MHPs) have emerged as candidates for next-generation optoelectronics due to their sharp color purity, inexpensive processing, and bandgap tunability. However, the development of violet and ultraviolet light-emitting MHPs has lagged behind due to challenges related to material and device stability, charge carrier transport, tunability into the ultraviolet spectrum, toxicity, and scalability. Here, we review the progress of both violet and ultraviolet MHP nanomaterials and light-emitting diodes, including materials synthesis and device fabrication across various crystal structures and dimensions (e.g., bulk thin films, 2D thin films, nanoplatelets, colloidal nanocrystals, and more) as well as lead-free platforms (e.g., rare-earth metal halide perovskites). By highlighting several pathways to continue the development of violet and ultraviolet light-emitting MHPs while also proposing tactics to overcome their outstanding challenges, we demonstrate the potential of violet and ultraviolet MHP materials and devices for important applications in public health, 3D printing, nanofabrication, and more.
Low-grade urothelial carcinoma of the bladder with an atypical stromal reaction and accumulation of osteoclast-like giant cells is a rare form of urothelial cancer. A meta-analysis of literature data over the past 53 years revealed 30 publications containing a total of 50 cases of this form of urothelial cancer. In 2/3 of the cases, the primary tumor was located in the bladder, while the remaining cases were located in the renal pelvis. The disease is extremely aggressive: the median survival time is 12 months, and distant metastases are detected in 65% of cases. The article describes a clinical case of a patient with primary multiple synchronous cancers, including poorly differentiated urothelial carcinoma with osteoclast-like differentiation of the bladder, papillary renal carcinoma, and acinar adenocarcinoma of the prostate. Низкодифференцированная уротелиальная карцинома мочевого пузыря с нетипичной стромальной реакцией в виде накопления остеокластоподобных гигантских клеток является редкой формой уротелиального рака. Проведен метаанализ данных литературы за последние 53 года в базах Scopus, Web of Science, Elibrary, PubMed, Google Scholar. Найдены 30 публикаций, суммарно содержащие сведения о 50 случаях данной формы уротелиального рака. В 2/3 случаев первичная опухоль была локализована в мочевом пузыре, остальные — в почечной лоханке. Установлено, что заболевание протекает чрезвычайно агрессивно: медиана выживаемости составляет 12 мес, в 65% обнаруживаются отдаленные метастазы. В данной статье описан клинический случай наблюдения пациента с первично-множественным синхронным раком, включающим низкодифференцированную уротелиальную карциному мочевого пузыря с остеокластоподобной дифференцировкой, папиллярную карциному почки и ацинарную аденокарциному простаты.
Biosecurity is a cornerstone of infectious disease prevention in cattle farming, yet its implementation remains suboptimal. This study aimed to identify psychosocial and socio-technical factors significantly associated with the adoption of biosecurity measures among French cattle farmers. An online survey collected data on practices and perceptions from 412 respondents, and multivariable logistic regression models were employed to evaluate four key domains: inter-herd contact, animal introduction, visitor management, and the wildlife-livestock interface. The results identified risk perception as the most consistent driver across all themes; farmers acknowledging a real risk were significantly more likely to implement protective measures. A major catalyst for behavioural change was the biosecurity audit, which increased the likelihood of performing pre-purchase blood tests at the seller's farm. Furthermore, a spillover effect was observed, where multi-species farming (including swine or poultry) acted as a protective factor for visitor protocols and sourcing. Conversely, infrastructural constraints, such as unsuitable building layouts, were major barriers to quarantine. A strictly regulatory mindset also significantly hindered proactive prevention, particularly for wildlife-related measures. These findings demonstrate that biosecurity adoption depends more on individualised technical support and structural feasibility than on general awareness. Public policies should therefore prioritise participatory approaches, such as tailored audits, to effectively enhance on-farm biosecurity.
Objectives. To examine geospatial polysubstance use overdose typologies and socio-structural determinants among overdose decedents in Cook County, Illinois, from 2017 to 2022. Methods. Decedents' addresses were geocoded and aggregated to census tract level (n = 1331). We conducted latent profile analysis to identify census tract profiles based on overdose fatality rates per 1000 census tract population across 9 drug types (alcohol, fentanyl, prescription opioids, heroin, cocaine, benzodiazepines, xylazine, methamphetamine/amphetamine, and other drugs). We used Bayesian spatial multinomial logistic regression to determine what census tract socio-structural determinants could predict polysubstance profile membership. Results. Three clusters of polysubstance use-low, moderate, and high-emerged with fentanyl, cocaine, and heroin dominating all clusters. In the adjusted model, census tracts with lower median household income were associated with increased odds of belonging to the moderate polysubstance use profile (odds ratio [OR] = 0.90; 95% Bayesian credible interval [CrI] = 0.85, 0.96) compared with the referent group. Also, census tracts with high Black isolation (quartile 4: OR = 2.93; 95% CrI = 1.44, 6.02) and higher population density (OR = 1.24; 95% CrI = 1.13, 1.37) were more likely to belong in the high polysubstance use profiles. Conclusions. Findings support the need for targeted resources tailored for particular neighborhoods. (Am J Public Health. Published online ahead of print June 18, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308446).
Promoting early HIV testing and patient detection is an important public health goal. In Japan, approximately 30% of the population is diagnosed with AIDS. Several studies have investigated the challenges related to HIV diagnosis; however, there are limitations in understanding the characteristics and barriers faced by individuals who are at high risk of HIV but have not yet been tested or have not sought medical consultation. This study aimed to examine the factors associated with medical consultation and HIV-testing behaviors, explore the reasons for not undergoing HIV testing, and evaluate the effectiveness of HIV-related awareness efforts among respondents to a revisit survey conducted via an artificial intelligence (AI)-based symptom search engine. This retrospective cohort study used data obtained from the AI-based symptom search engine, Ubie. Episodes involving individuals who used the AI-based symptom checker to search for their symptoms, which were subsequently suggested as HIV/AIDS/sexually transmitted infection (STI)-related conditions, were included. Those who answered the first and revisit survey questionnaires were included in the analysis. Multivariable logistic regression analyses were conducted to explore the factors associated with medical consultation in both the overall suggested HIV/AIDS/STI-related condition group and the suggested STI-related condition subgroup. Factors associated with HIV testing in individuals who underwent medical consultations were also explored using multivariable logistic regression analysis. The reasons for not undergoing HIV testing and the future intention to undergo testing were described. The number of eligible episodes was 424,893 for 332,976 individuals. Of these, medical consultations were performed in 105,365 cases and HIV testing in 394 cases. Compared with individuals in their 20s, older age groups were associated with a higher tendency to seek medical consultations. The provision of awareness information through the AI-based symptom checker was associated with medical consultation behavior, and 29% (280/964) of people who initially had no intention of undergoing HIV testing responded that they would undergo HIV testing after using the AI-based symptom checker. Compared with the internal medicine department, the gynecology department was significantly associated with HIV testing; however, the HIV testing rates were low in the suggested STI-related condition subgroup across major departments. These results suggest that HIV-related information delivered via an AI-based symptom checker may raise awareness or consideration of medical consultation among individuals actively searching for symptoms potentially associated with HIV. To further promote HIV testing, it may be necessary to refine the content and delivery of educational materials and enhance HIV testing literacy among physicians who encounter patients with STIs.