Domestic abuse and suicidal ideation are highly prevalent and often co-occur. These issues are distressing and put people in danger from themselves or others. Numerous practical and psycho-social barriers inhibit help-seeking. Community pharmacies are accessible healthcare environments that deliver various public health functions. However, no studies have yet developed and tested a robust intervention for responding to domestic abuse and suicidal ideation in community pharmacy. To co-develop a domestic abuse and suicidal ideation response service in community pharmacy; and to test whether the co-developed intervention and a future trial to evaluate it would be feasible and acceptable in community pharmacies. Service scope and resources were co-developed with 36 people (lay and professional) who participated in focus groups, interviews and/or workshops. A randomised feasibility trial tested the deliverability and feasibility of consenting clients and collecting study data, including data for a future economic evaluation. A nested process evaluation, comprising staff focus groups, customer interviews and a wider public survey, assessed the fidelity, acceptability and accessibility. A final feasibility workshop reviewed all feasibility objectives. The service was tested for 6 months in eight intervention pharmacies in Lincolnshire. Four more pharmacies acted as controls, providing usual care. In intervention pharmacies, trained staff provided triage assessment and structured signposting to those identified at risk of domestic abuse and/or suicidal ideation. Data were collected on the number and type of relevant patient contacts from intervention and control pharmacies. Staff training was evaluated using the Continuing Professional Development-Reaction questionnaire, with before-and-after data analysed via paired t-tests. Feasibility objectives were assessed in a multistakeholder workshop. Qualitative process evaluation data were thematically analysed. Co-development participants considered community pharmacies to be an ideal service setting. Their recommendations for safety, equity, empowerment and discretion were incorporated into service design. Following training, staff showed statistically significant improvements in their perceived ability and confidence in responding to people in need of help for suicidal ideation and/or domestic abuse. The public and pharmacy customers showed positive support and acceptability. During the intervention period, 24 patients needing support were identified in the intervention pharmacies compared to two in the control pharmacies. Stakeholder workshop findings confirmed community pharmacy as an appropriate setting for a staff-initiated intervention and the dual focus on domestic abuse and suicidal ideation. The findings do not support a client-initiated service at this stage due to challenges related to marketing and ensuring sufficient staffing capacity to deliver a safe, high-quality service. Limited participant diversity and significant gaps in data collection from clients due to complexities of gaining consent in a pharmacy setting for this type of intervention. A co-developed, staff-initiated response service for suicidal ideation and/or domestic abuse in community pharmacy was found to be feasible to deliver and acceptable to patients and staff. An implementation study to scale-up service roll-out, evaluate it in diverse settings and streamline operational processes across more organisations is required. Further work is needed to determine how to collect outcome and cost-effectiveness data from people receiving a rapid intervention and/or in distress. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133132. We wanted to find out whether we could develop and test a new service in pharmacies for people in danger from either domestic abuse and/or suicide. People experiencing suicidal thoughts and/or domestic abuse can find it difficult to reach out and ask for help. These issues are distressing and can be fatal. However, harm can be minimised if people can access appropriate help when they need it. Community pharmacies are highly accessible, with long opening hours and no need for an appointment. When we spoke to people with lived experience before the project, they thought that pharmacies could be a suitable place to access support. The new service was co-developed with 36 people who contributed at least once to a series of focus groups, interviews and/or workshops to design the service components. The people were a mix of those with lived experience of suicidal thoughts or domestic abuse, professionals from relevant organisations and pharmacy staff. The service was then tested in eight community pharmacies. Four pharmacies acted as controls by continuing their business as usual. Twenty-seven pharmacy staff gave feedback at focus groups. A multi-stakeholder evaluation workshop was held with 42 people, 13 customers were interviewed about their views and 501 members of the public shared their views in a survey. Introducing this new service and providing training, support and resources enabled pharmacy staff to identify and assist 24 people who were experiencing suicidal thoughts and/or domestic abuse. There was strong support for the service as a staff-initiated service but not at this stage for a client-initiated service. Further development on an appropriate tone for the marketing material and assurances about quality standards and minimum staffing levels would be needed for a client-initiated service.
Women who are impacted by diverse forms of violence and structural disadvantage such as poverty, health inequities, and precarious housing experience significant barriers to health care. Outreach is a promising strategy to mitigate barriers to care. Until recently, outreach has focused on women's behaviors, with less attention paid to the intersecting systemic inequities inclusive of stigma and discrimination, poverty, and compartmentalized health service delivery models that impact care engagement and access. The research study aims to (1) describe the demographic characteristics, baseline health status, and care access among diverse women impacted by gender-based violence; (2) explore preliminary changes in trust in the outreach program over time; (3) explore trends in participants' access to health and social care services and safety planning over time; and (4) explore the contextual factors impacting trends in trust, service access, and safety. An exploratory outreach intervention will be conducted in 2 Canadian cities in partnership with community-based service organizations focused on housing security and victim support. Participants will be women eligible for these services who are experiencing barriers to timely and appropriate health and social services commensurate with their self-identified needs. The analysis will adopt a convergent mixed methods design in which quantitative and qualitative data will be collected concurrently and subsequently analyzed in parallel and then merged for data integration to fully contextualize study findings. Data will include surveys conducted at up to 4 time points to assess service access, trust and safety planning, and qualitative interviews with participants detailing sociostructural and individual factors impacting service access and trust and safety planning. Case notes will be recorded for all outreach engagement with participants. Descriptive statistics and data visualization analytic techniques will be used to document demographic characteristics and trends in trust, safety planning, and access to and engagement with care over time. Interview data will be thematically analyzed to note contextual factors associated with safety, engagement, and trust. Data integration will be carried out to examine how observed trends are influenced by contextual features and to identify nuance in variation over time. The study was funded in April 2019. Intervention implementation began in the first of 2 study hubs in October 2023 and in the second hub in October 2024, and participant enrollment was open from November 2023 to June 2025. A total of 86 women were enrolled during that time; though enrollment has now closed, data collection is ongoing and is expected to continue through January 2026. Data analysis will commence in February 2026. Results are expected in late spring 2026. Study results will be presented at community forums within study settings and at international conferences and will be submitted for publication in relevant journals. This study is expected to generate insight into interpersonal and structural factors shaping trends observed, extending beyond behavioral investigation with new insights into how intersecting inequities can impact trust, engagement in care, and women's safety.
International expansion has been identified as a pivotal strategy for SMEs seeking to achieve internationalisation and growth within the global market. However, as evidenced by extant literature, SMEs encounter numerous obstacles that impede their ability to access foreign markets, including a dearth of resources and experience, fierce competition from large and sustainable global companies. Therefore, the study seeks to identify the Business Intelligence factors that affect the export competitiveness of SMEs in a region of northern Peru. The research had a quantitative, non-experimental and explanatory approach; being basic research focusing on the generation of theoretical knowledge about the factors that affect competitiveness through business intelligence strategies, for which 51 SMEs, economic units that currently maintain trade relations with international markets, were studied and the Logit model was used to identify those factors. The findings indicate that the binary logistic regression model demonstrates the significance of the market research and business management dimensions. The assertiveness matrix demonstrates a higher capacity to predict the 'No' response (76.5%) in comparison to the 'Yes' response (23.5%). It is noteworthy that the relative probability of enhancing competitiveness is estimated at 0.98 times when market identification, target market segment analysis and market research development are requested, as opposed to 0.95 times when external advice or assistance is obtained to formulate an alternative value proposition for the exportable product. The market research and business management dimensions of Business Intelligence have a significant impact on the export competitiveness of SMEs in northern Peru, with market research being the factor with the greatest influence on the export competitiveness of SMEs. This finding highlights the importance of collecting and analysing accurate information on international markets in order to identify opportunities, reduce uncertainties and adapt products to the demands of global customers.
Underdiagnosis of asthma in children and adolescents is a major challenge, particularly in low-resource settings. We aim to assess the clinical and cost-effectiveness of screening for asthma symptoms among children and adolescents with respiratory symptoms presenting at primary care health facilities in Uganda. The feasibility and acceptability of routine screening will also be explored. A cluster-randomised trial, using screening for asthma symptoms as the intervention, will be conducted in health centres in Jinja region, Eastern Uganda. We hypothesise that screening for asthma symptoms at clinical care points will lead to an increase in the proportion of children diagnosed with asthma. The health centres will be randomised into intervention and control arms. In the intervention sites, 1050 children aged 2 months to 17 years with respiratory symptoms will be screened for asthma symptoms using the International Study on Asthma and Allergies in Children verbal questionnaire. History and physical examination will be conducted among the screen positives to identify those with asthma. Data on asthma diagnoses 12 months before the intervention and during the intervention will be collected from both the control and intervention health centres. Data on direct and indirect costs of screening will be collected prospectively. Focus group discussions (FGDs) will be conducted among health workers and key informant interviews (KII) among facility in-charges at the intervention sites to assess the feasibility and acceptability of the intervention. The primary outcome will be the proportion of asthma diagnoses. A random-effects logistic regression model, adjusting for baseline data while accounting for facility level clustering, will be used to assess the effectiveness of screening. Cost-effectiveness will be assessed by computing the incremental cost-effectiveness ratio. Framework analysis will be used to analyse data from the FGDs and KIIs. Ethics approval was obtained from Makerere University School of Public Health Research and Ethics Committee (SPH-2024-552), Uganda National Council for Science and Technology (HS4136ES) and the Queen Mary University of London Research Ethics Committee in the UK (QME24.0514). All participants will provide written informed consent. Children aged 8 years and above will provide assent, in addition to consent by their parents/caregivers. The study results will be disseminated through publications in peer reviewed journals, conferences, participant feedback meetings and Makerere University Lung Institute website. Policy briefs will be shared with key stakeholders including the Ministry of Health and Jinja District/City administrators. ISRCTN16018011.
Sugar-sweetened beverages (SSBs) are a major source of added sugars and an important focus for fiscal policies aimed at preventing obesity, type 2 diabetes, and other non-communicable diseases (NCDs). We aimed to assess trends in sugar-sweetened beverage sales and inflation-adjusted prices and to estimate the price elasticity of demand across World Health Organization (WHO) regions from 2010 to 2024, providing evidence to support fiscal policies for health. Annual country-level data on sugar-sweetened beverage sales volumes and values for 93 geographic locations, representing 81.74% of the 2024 global population, were obtained from the Euromonitor International Passport database and grouped into six WHO regions. Sales values were converted to international dollars using purchasing power parity and adjusted for inflation, and regional average real prices were calculated. Trends in sales volumes, sales values, and prices were analysed using joinpoint regression. Price elasticities of demand were estimated using a baseline panel regression model of the log of sales volume per capita on the log of real price, controlling for macroeconomic indicators, with regional elasticities derived from the model's marginal effects, and an instrumental variables specification was used for robustness. Between 2010 and 2024, the global sugar-sweetened beverage sales volume increased by 16.9%, with the largest rises in Southeast Asia (101.6%) and Africa (81.5%) and smaller increases in the Americas, the Western Pacific Region, the Eastern Mediterranean, and Europe. The global price elasticity of demand was -0.423 (p < 0.01). It was highest in Europe (-0.828, p < 0.01) and the Americas (-0.509, p < 0.05), while elasticities in other regions were not statistically significant. The substantial increase in SSB sales in emerging markets, such as Southeast Asia and Africa, along with a moderate increase in other regions, indicates the need for comprehensive SSB control policies and the implementation of WHO SSB taxation policies (2022). The divergent regional trajectories highlight the need for comprehensive fiscal and regulatory policies to curb the growth in SSB consumption and encourage shifts towards healthier options.
Companion animals are more and more mobile and global translocation of parasites and other pathogens is increasingly recognized as a risk to animal and human health, as well as to international trade. Canadian regulations for importation of pets are lax, with only rabies vaccination and basic health documentation required. Pathogens, including the zoonotic parasites Echinococcus and Leishmania, as well as drug-resistant strains of parasites currently at low prevalence in Canada, such as canine heartworm (Dirofilaria immitis) and hookworm (Ancylostoma caninum), are inadvertently imported along with pets. The objective of this article is to provide a timely review of the current regulatory situation in Canada, describe recent examples of foreign animal pathogens, including drug-resistant parasites, being brought into Canada, and provide expert opinions on both risks and mitigation measures associated with the introduction of non-endemic companion animal parasites. There is now a higher risk of establishment due to climate change, which endangers local domestic and wild animals and triggers costly, long-term public and animal health interventions. Canadian veterinarians are increasingly faced with new challenges due to imported animals, including diagnosis and management of non-endemic diseases. We call for tighter mandates for importation of companion animals to Canada, including pre-travel screening of pets for local diseases of concern, treatment with a broad-spectrum antiparasitic just prior to relocation, and follow-up testing to detect drug resistance, as well as improved traceability of imported animals, and educational campaigns for owners and rescue organizations. These measures will ultimately reduce the burden on veterinarians, responsible pet owners, and reputable rescue organizations. Les animaux de compagnie sont de plus en plus mobiles et la translocation mondiale de parasites et autres agents pathogènes est de plus en plus reconnue comme un risque pour la santé animale et humaine, ainsi que pour le commerce international. La réglementation canadienne sur l’importation d’animaux de compagnie est peu contraignante, car seuls la vaccination antirabique et les documents sanitaires de base sont requis. Des agents pathogènes, notamment les parasites zoonotiques Echinococcus et Leishmania, ainsi que des souches de parasites résistantes aux médicaments, actuellement peu répandues au Canada, comme la dirofilariose canine (Dirofilaria immitis) et vers en crochet (Ankylostoma caninum), sont importés par inadvertance avec les animaux de compagnie. Cet article vise à dresser un bilan actuel de la réglementation en vigueur au Canada, à décrire des exemples récents d’agents pathogènes animaux étrangers, y compris des parasites résistants aux médicaments, introduits au Canada, et à fournir l’avis d’experts sur les risques et les mesures d’atténuation associés à l’introduction de parasites non endémiques chez les animaux de compagnie. Le risque d’établissement est aujourd’hui plus élevé en raison des changements climatiques, qui mettent en danger les animaux domestiques et sauvages locaux et entraînent des interventions coûteuses et à long terme en matière de santé publique et animale. Les vétérinaires canadiens sont de plus en plus confrontés à de nouveaux défis liés à l’importation d’animaux, notamment le diagnostic et la prise en charge des maladies non endémiques. Nous demandons un renforcement des exigences relatives à l’importation d’animaux de compagnie au Canada, incluant un dépistage préventif des maladies locales préoccupantes avant le voyage, un traitement antiparasitaire à large spectre juste avant le départ et des tests de suivi pour détecter la résistance aux médicaments, ainsi qu’une meilleure traçabilité des animaux importés et des campagnes de sensibilisation auprès des propriétaires et des organismes de sauvetage. Ces mesures permettront à terme d’alléger la charge de travail des vétérinaires, des propriétaires responsables et des organismes de sauvetage reconnus.(Traduit par Docteur Serge Messier).
International Student-Athletes (ISAs) represent a unique population in collegiate sports, facing distinct challenges that may impact their mental health beyond those experienced by domestic athletes. While ISAs contribute significantly to NCAA programs, limited quantitative research exists on their specific risk factors, stressors, and mental health needs. This study examined factors affecting ISAs' wellbeing and their utilization of mental health resources. A cross-sectional survey was distributed to ISAs at Division I and II universities through athletic directors and coaches. The anonymous online questionnaire assessed demographics, depressive symptoms (PHQ-2), anxiety symptoms (GAD-2), relationship satisfaction with coaches/teammates/staff, life domain satisfaction, homesickness, discrimination experiences, and mental health service utilization. Chi-square analyses examined associations between variables and mental health symptoms. Among 207 participants (87% female and 83% European origin), 18% reported depressive symptoms and 25% reported anxiety in the previous 2 weeks. Mental health service utilization was 41%. Significant associations emerged between mental health symptoms and dissatisfaction with coaches, teammates, staff, diet, sleep, and social life. Homesickness affected 63% and was linked to higher depression and anxiety rates. Twenty percent experienced discrimination and 27% reported food insecurity. ISAs face substantial mental health challenges, with relationship quality emerging as a critical factor. The findings highlight the importance of supportive coach-athlete and teammate relationships for ISA wellbeing. Future research should explore cultural and gender variations while institutions should consider specialized mental health support and culturally informed training for athletic staff working with this population.
Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline. Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour. Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD. The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.
Parkinson's Disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms, alongside non-motor manifestations. In advanced stages, people with PD (PwP) require extensive support to maintain mobility and quality of life, creating substantial demand on healthcare and reimbursement systems. Reported prevalence varies across Europe, with Germany at 350 per 100,000, Estonia at 314 per 100,000, Lithuania at 265 per 100,000, and Latvia at 217 per 100,000. This study applies a structured, qualitative comparative policy mapping approach (a subtype of comparative policy analysis) to describe and compare how national reimbursement and service-delivery rules shape access to PD treatments in Latvia, Lithuania, and Estonia, using Germany as a high-resource comparator. Key constructs, including availability, accessibility, affordability, and reimbursement, were defined a priori and operationalized into extractable indicators (e.g., formulary inclusion, reimbursement rate, cost-sharing, authorization requirements, and service-capacity proxies). Data sources included reimbursement agency databases, national formularies, policy documents, and expert input. Analysis was structured across three domains: pharmacological therapy, device-assisted therapies (DATs), and rehabilitation and supportive therapies. Findings show that Germany ensures broad access to all treatment domains, including newer pharmacological options, reimbursed DATs, and structured multidisciplinary rehabilitation. Estonia and Lithuania provide full reimbursement for standard medications but limited access to DATs and variable rehabilitation services. Latvia remains most constrained, with partial reimbursement for medications, no reimbursed DATs, and underdeveloped supportive therapies. Differences in reimbursement design (including cost-sharing and eligibility rules) and service capacity co-occur with broader system financing differences (total health expenditure: 12.6% of GDP in Germany vs. 7.6% in Latvia, 7.2% in Lithuania, and 7.0% in Estonia; government-funded expenditure: 10.1%, 4.9%, 4.7%, and 5.2%, respectively). These findings are descriptive and intended to clarify where policy design and implementation may plausibly contribute to cross-country variation in access.
In Uganda, 150,000 young people were living with HIV by the end of 2023. While Antiretroviral therapy (ART) is effective in reducing HIV transmission, youth in SSA, including in Uganda, face greater challenges with ART adherence compared to adults. Poverty-focused interventions have been recommended to improve adherence and viral load suppression. In this manuscript from Suubi+Adherence-Round 2 study, we explored the acceptability of Suubi+Adherence, a combination intervention aimed at improving ART adherence among adolescents living with HIV in Uganda that was tested in a six-year longitudinal study called Suubi+Adherence (2012-2018). We conducted semi-structured in-depth interviews with 36 youths who participated in the Suubi+Adherence intervention, which comprised matched savings accounts, mentorship, financial management, and business development training. Interviews explored participants' motivations for joining, their experiences with the intervention, and the facilitators and barriers to intervention attendance. Informed by the Theoretical Framework of Acceptability, data were analyzed using thematic analysis and Dedoose software. Our results showed that the primary motivation for participation was the opportunity to learn about savings and income-generating activities. Participants also appreciated the Wisepill -an Electronic Monitoring Device, which reminded them to take their medication. Key facilitators for intervention attendance included transport reimbursements, family support, and content relevance. Challenges included long travel distances and associated costs, session timing conflicts with household responsibilities, and other personal obligations. Despite these challenges, participants highlighted the practical relevance of the intervention content, which aligned with their real-life experiences and needs. Our findings offer valuable insights into the acceptability of a combination intervention aimed at improving ART adherence among youth. These results have important implications for HIV treatment programs and policy in Uganda, particularly given the country's high HIV prevalence. The parent randomized clinical trial is registered in the clinical trials database (NCT03307226).
The environmental effect of foreign direct investment is a much-discussed topic. Nevertheless, how foreign direct investment's country of origin can affect is a topic of salience for international business managers, policymakers, and researchers. Thus, this study focuses on environmental performance of disaggregated foreign direct investment originating from high-income, middle-income countries, and China in Pakistan from 1995 to 2024. The research assesses (1) the direct impacts of disaggregated foreign direct investment on Pakistan's environmental performance, (2) the mediating role of digital financial inclusion, and (3) time-varying and heterogenous effects of geopolitical risks and the China-Pakistan Economic Corridor (CPEC). The empirical framework employed novel machine learning techniques and constructed composite indices from country-specific indicators to evaluate environmental performance and digital financial inclusion. The results show heterogeneous environmental effects of disaggregated foreign direct investment. Chinese investment directly intensified environmental stress, which is further exacerbated indirectly by digital financial inclusion. Conversely, the high-income and middle-income countries FDI directly mitigate environmental degradation, whereas indirect effects via digital financial inclusion exacerbate it. This indicates that digital financial inclusion predominantly promotes capital inflow towards resource-intensive industries rather than in ecologically sustainable sectors. Temporal and regime-specific analysis demonstrates that the impact of disaggregated foreign direct investment on environment is contingent upon structural and geopolitical factors in Pakistan. Robustness tests using alternative specifications, bootstrapping, and placebo testing confirm the validity of main results. The findings provide comprehensive evaluations of how the origin of foreign investment, digital financial inclusion, and geo-economics jointly impact Pakistan's environmental landscape.
This study examines the relationships among job satisfaction, work-family conflict, psychological distress, and turnover intention among nursing assistants in China, with a particular focus on the mediating role of psychological distress. A cross-sectional survey was conducted among 240 nursing assistants from Jiangsu and Fujian provinces between December 2023 and March 2024. Standardized instruments measured job satisfaction, work-family conflict, psychological distress (K10), and turnover intention. Pearson correlation and mediation analyses were performed using PROCESS Macro (Model 4) to assess relationships and mediating effects. Job satisfaction was negatively associated with turnover intention (r=-0.30, p < 0.01) and psychological distress (r=-0.23, p < 0.01). Work-family conflict was positively correlated with psychological distress (r = 0.52, p < 0.01) and turnover intention (r = 0.48, p < 0.01). Mediation analyses indicated that psychological distress partially explained the associations of job satisfaction and work-family conflict with turnover intention, accounting for 17.64% and 27.22% of the total effects, respectively. Job satisfaction and work-family conflict demonstrate both direct associations with turnover intention and indirect associations through psychological distress. These findings suggest that integrating psychological health protection into workforce management strategies, alongside reducing work-family conflict and strengthening organizational resources, may represent a viable approach to improving retention in China's long-term care sector. Not applicable.
Telecommuting is recognized as a sustainable urban mobility strategy; however, its quantitative impacts on network performance and air quality remains insufficiently understood, particularly in developing countries. This study develops an integrated spatial framework that directly links a travel demand forecasting model (EMME/2) with the International Vehicle Emissions (IVE) model to empirically evaluate the effect of telecommuting on network performance and emission hotspots in Tehran. Two scenarios-Business-As-Usual (BAU) and Telecommuting (TELE)-are simulated within EMME/2. The outputs, including vehicle kilometers traveled and speed are employed as primary inputs for the IVE model in order to estimate on-road emissions of major pollutants. The results show that implementation of a 20% telecommuting scenario might decrease total Vehicle Kilometers Traveled (VKT) and Vehicle Hours Traveled (VHT) by 4.6% and 10.9%, respectively; furthermore, the results indicate reductions in emissions of CO, VOCs, NOx, SOx, and PM by up to 7.9%, 7.9%, 5.9%, 4.5%, and 4.4% respectively during the morning peak hour. It's worth mentioning that spatial analysis highlights important emission reduction within the Low-Emission Zone (LEZ) and Restricted-Traffic Zone (RTZ) of Tehran, where most daily business trips are concentrated. The findings provide novel empirical evidence from a developing-country context, demonstrating that even moderate levels of telecommuting adoption can substantially enhance both transportation network efficiency and urban air quality. The framework proposed in this study provides policymakers with a robust, data-driven tool for evaluating travel demand management (TDM) strategies aimed at supporting sustainable urban development.
Globally, researchers have documented an emergence of public health approaches within palliative care, leading to the development of compassionate communities, a movement that seeks to build community capacity to support individuals at the end of life and those affected by death and loss. Compassionate communities emphasize a social model of care that complements formal palliative services by reducing suffering, enhancing well-being, and empowering community members through collective action. The Compassionate City Charter broadens this scope to include civic institutions, outlining recommendations for adoption within workplaces and educational settings. However, empirical evidence examining the adoption of compassionate practices within workplace contexts remains limited. This study aims to systematically map and explore international evidence regarding compassionate workplace interventions for employees in a workplace or organizational setting who are experiencing serious illness or are affected by caregiving, death, or bereavement. The Joanna Briggs Institute (JBI) framework will guide this review to systematically search and locate published articles reporting primary research. The following five stages will be conducted: (1) research question and objectives development; (2) search strategy development; (3) study and gray literature search and selection across 7 databases, including CINAHL Ultimate (EBSCO), Scopus, PsycINFO (OVID), Web of Science, ABI/INFORM (ProQuest), Business Source Ultimate (EBSCO), and MEDLINE (ProQuest); (4) data extraction and charting; and (5) data analysis and presentation. The JBI 3-step strategy will be applied to determine the search method and article selection. Articles will be assessed for inclusion by two reviewers independently and included if they describe a compassionate approach to supporting employees navigating serious illness, caregiving, grief, or bereavement. The review will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to present the results. Data collection for this scoping review was conducted between July and August 2025. The extracted data are currently being organized and analyzed, with submission of the final manuscript anticipated in May 2026. This protocol outlines a scoping review that will represent the first comprehensive review to explore the international evidence on compassionate workplace interventions for employees navigating serious illness, caregiving, death, or bereavement.
Functional bionanomaterials have enabled major advances in nanomedicine through their tunable physicochemical properties, multifunctionality, and ability to interact with biological systems in a controlled manner. Despite sustained progress in materials design and preclinical validation, the clinical translation of bionanomaterials remains limited, with only a small fraction achieving regulatory approval and routine clinical use. While technical performance, safety, manufacturing scalability, and regulatory complexity are widely recognized as key translational barriers, the role of strategic communication in shaping stakeholder understanding, trust, and adoption has received comparatively little attention. In this Perspective, we argue that strategic communication should be considered a core translational enabler for functional bionanomaterials rather than a downstream dissemination activity, as in current trends. We identify recurrent communication gaps between bionanomaterial developers and key stakeholders, including clinicians, patients, regulators, and investors, that contribute to misaligned expectations, heightened risk perception, and delayed clinical adoption. Drawing on examples from nanomedicine translation, we discuss how differences in language, decision-making frameworks, and perceived value across stakeholder groups, can impede progress even for technically mature platforms. Building on insights from translational medicine, behavioral science, and innovation studies, we propose a structured communication framework tailored to the specific challenges of functional bionanomaterials. This framework emphasizes early integration of communication planning, stakeholder-specific narrative framing, visual and digital tools to reduce cognitive complexity, and iterative feedback mechanisms. We further discuss practical approaches for evaluating communication impact using measurable indicators such as stakeholder awareness, trust, regulatory feedback, and clinical uptake. By reframing communication as a bidirectional and designable component of the translational pipeline, this Perspective aims to support more efficient pathways for bringing functional bionanomaterials from the laboratory to the clinic.
Depression is a pervasive global mental health issue, yet access to trained professionals remains severely limited. With the rapid advancement of artificial intelligence (AI), digital tools are increasingly seen as a viable way to address this shortage. However, questions remain about how digital platforms for mental health care can be effectively designed. This study aimed to investigate, from an end user's (patient's) perspective, the potential use scenarios, desired features, and perceived risks of AI psychotherapists in depression treatment, providing design guidelines for their development. A grounded theory approach was applied to analyze qualitative responses from 452 individuals recruited via Amazon Mechanical Turk. Data were collected through a scenario-based online survey on AI-assisted depression treatment administered between March 2023 and May 2023. Participants responded to 3 open-ended questions regarding the potential use of AI in treating depression, the characteristics expected from an AI psychotherapist, and the associated perceived risks, along with demographic, control, and contextual measures. The open-ended responses were inductively coded into themes, with intercoder reliability established (Cohen κ=0.80). In addition, variations in themes were further examined across participant profiles, including social stigma, current depression severity, trust in an AI psychotherapist, and privacy awareness. Participants envisioned AI psychotherapists across 5 primary scenarios: diagnosis, treatment, consultation, self-management, and companionship. Key desired features include professionalism, warmth, precision care, empathy, remote services, active listener, personalization, flexible treatment options, patience, trustworthiness, and basic treatment alternative, while critical concerns include diagnostic inaccuracy, treatment errors, privacy breach, lack of human interaction, technical malfunctions, and lack of emotional engagement. Based on these findings, a general MoSCoW (must have, should have, could have, and won't have) prioritization framework was proposed to serve as a conceptual starting point for future AI system design and empirical validation in mental health care. Notably, feature prioritization varied across user profiles: individuals with higher stigma placed greater emphasis on privacy protection, those with more severe depression prioritized precision care and timely access, low-trust users de-emphasized remote services, and privacy-sensitive individuals showed reduced preference for features requiring extensive data disclosure. These patterns highlight the need for context-sensitive design. This study provides a patient-centered framework for designing AI psychotherapists and complements the existing literature by highlighting the importance of balancing clinical effectiveness with relational considerations. The findings offer actionable guidelines for designing AI mental health care tools that are aligned with user expectations and sensitive to individual differences.
Smart city programs are increasingly used by governments to manage public services through digital and automated systems, and this development is closely linked with questions of administrative power, fairness, and accountability. Existing public law doctrines in common law systems were shaped for human decision-making and have not been fully adapted to administrative action carried out through algorithmic systems, which creates a clear gap in current legal thinking. The research is motivated by the growing use of algorithmic systems as effective decision-makers in areas such as utilities, mobility, welfare, and digital identity, especially in contexts marked by limited state capacity and prolonged emergency conditions. The study aims to examine how judicial review should respond to algorithmic administrative systems so that legality, fairness, and accountability remain protected while legitimate administrative goals are still met. Methodologically, the article adopts a doctrinal and normative legal research design based on structured analysis of public law doctrine, relevant judicial and administrative materials, and governance instruments on automated decision-making. The focus is on developing a doctrinal framework that treats algorithmic systems as legally reviewable decision infrastructures rather than neutral technical tools. The study highlights the importance of reviewing not only final automated outcomes but also earlier design choices, including data use, system objectives, and oversight mechanisms. The research is important because it offers courts and lawmakers clearer legal tools to assess algorithmic administration, with particular attention to settings where oversight is weak and emergency powers risk becoming normalized, increasing the danger of opacity, discrimination, and unchecked security repurposing.
In this review we investigate how strategic thinking and entrepreneurial orientation jointly foster adaptive resilience in manufacturing SMEs, addressing a critical knowledge gap regarding their integrated role across sensing, seizing, reconfiguring, learning, and strategic renewal capabilities in diverse institutional contexts. Our review aims to synthesise recent evidence on mechanisms of adaptive resilience, identify persistent challenges, and inform both theory and policy. Anchored in Dynamic Capabilities Theory and Organisational Resilience Theory, the review employs a qualitative thematic analysis of literature from major electronic databases spanning 2020 to 2025, focusing on empirical and conceptual studies of global manufacturing SMEs. Our findings indicate that strategic thinking and entrepreneurial orientation enable early recognition of environmental signals, disciplined opportunity prioritisation, resource reconfiguration, experiential learning, and continuous strategic renewal. Persistent challenges comprise resource constraints in emerging economies, institutional barriers, variability in strategic adoption, and limited longitudinal evidence on resilience outcomes. The review concludes that adaptive resilience is a dynamic, context-sensitive process requiring deliberate strategic design and proactive entrepreneurial action. Its contribution is twofold: empirically, by consolidating contemporary insights into SME resilience mechanisms, and theoretically, by extending dynamic capabilities and organisational resilience frameworks to complex, small-scale manufacturing contexts. For policymakers, the findings underscore the importance of creating enabling ecosystems, targeted innovation financing, capability development programmes, and context-specific interventions to strengthen SME resilience, competitiveness, and long-term strategic adaptability.
Prescription drug list prices in the United States far exceed those in peer nations, averaging 278% of non-US prices and 422% for branded products. The Inflation Reduction Act authorized Medicare to negotiate net prices for high-expenditure drugs, resulting in maximum fair prices (MFPs) for 15 Part D products effective in 2027. Subsequently, Centers for Medicare and Medicaid Services (CMS) introduced the GLOBE and GUARD models, which propose a most-favored nation (MFN) pricing framework for both Part B and Part D, respectively, that is tied to international prices in 19 countries. CMS also introduced the GENEROUS model for Medicaid, which uses an 8-country subset of the GLOBE/GUARD reference nations. To evaluate the performance of the Medicare Drug Price Negotiation Program by comparing negotiated net prices with domestic and international list price benchmarks. We identified negotiated drugs using CMS publications and estimated initial US net prices and CMS price benchmarks for negotiation including statutory discounts. International list prices from the 19 countries that will be used as reference for the GUARD and GLOBE models were extracted from Eversana's NAVLIN database and converted to US dollars using 2025 exchange rates. Prices were adjusted using purchasing power parity. All prices were standardized to a 30-day equivalent supply following CMS methods. For drugs with multiple brands or strengths, weighted average per-unit prices were estimated using Medicare Part D utilization data. Postnegotiation MFPs were 15% to 60% (median: 38%) lower than estimated US net prices with greater reductions for drugs whose ceiling price was determined by the net price. However, MFPs remained 17% to 755% (median: 108%) higher than the average purchasing power parity-adjusted published list price in MFN reference countries. The mean US-to-international price ratio declined from 5.8 before negotiation to 3.3 afterward. Twelve of 14 drugs had MFPs below their estimated ceilings, whereas the 15th drug had an inestimable ceiling. There is not enough information about the proposed GLOBE and GUARD models to project MFN prices for Part B or D at this time. Discounts varied by therapeutic class and were larger for drugs with prior negotiated comparators. The 2025 Medicare drug negotiations will generate meaningful reductions in domestic drug prices when they take effect in 2027 but left substantial disparities relative to peer nations. Upcoming MFN-based pricing models may exert further downward pressure, although their implementation and international effects warrant careful monitoring.
Objective: This study was administrated with the goal of examining the efficacy of acceptance and commitment therapy (ACT) on cognitive functions of patients with systemic lupus erythematosus. Method : In a single-blind experimental research, 90 adult patients with lupus were randomly divided into the three ACT (n = 30), general health education (GHE) (n = 30) and waitlist (n = 30) groups. Both treatment groups received individual treatment with a specific protocol for four weeks. Before and after treatment, all participants were assessed using the Wisconsin Card Sorting Test (WCST) and the Stroop Color Word Test (SCWT). Results: Both ACT and GHE groups had a significantly better post-intervention cognitive performance compared to the waitlist group in terms of WCST and SCWT scores (P < 0.05). Cohen's d for the effects of ACT on WCST total errors and completed categories were 0.86 and 0.80, respectively. Cohen's d for the effect of ACT on SCWT was 0.70. Furthermore, Cohen's d for the effects of GHE on WCST total errors and completed categories were 0.65 and 0.58, respectively. Also, Cohen's d for the effect of GHE on SCWT was 0.55. The ACT and GHE interventions differed significantly only in total errors on WCST, with the ACT group demonstrating significantly better cognitive functioning at post-intervention (P = 0.04). Conclusion: The ACT approach has a large effect on the cognitive performance of lupus patients, while the GHE has a moderate effect on these functions. Therefore, these intervention methods, especially ACT, could be considered alongside usual treatment methods as suitable options to improve the daily affairs of people with lupus.