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China's rapidly aging population and high burden of frailty make proactive preparation for future care increasingly urgent, yet few older adults engage in such preparation. Existing interventions often overlook the heterogeneity between prefrail and frail populations and lack precision-oriented digital strategies. Building on a series of prior empirical studies, this study aimed to develop and pilot-test a digital intervention to support preparation for future care among community-dwelling older adults with prefrailty and frailty. The "Yi Yang Plan," a WeChat mini-program, was developed through a rigorous multiphase process, including a scoping review, a convergent mixed methods study, and a structural equation model. These findings informed the design of a tailored, stage-specific intervention targeting the distinct needs of prefrail and frail older adults. An interdisciplinary team subsequently refined the intervention using an iterative design approach. The intervention modules comprised 4 processes: Awareness Enhancement, Care Resources, Care Decision-Making, and Care Planning. Pilot testing involved expert panel consultations and think-aloud tests. Expert characteristics, engagement, and authority coefficients were assessed, and feedback was synthesized using content analysis. Feasibility and acceptability among older adults and their family members were evaluated through task completion metrics, satisfaction surveys, think-aloud protocols, and semistructured interviews. Seven experts participated in the consultation, with an engagement coefficient of 100% and an authority coefficient of 0.88. Recommendations were synthesized into four key themes: (1) establishing mechanisms for care plan updating and review, (2) strengthening user-centered design, (3) implementing dynamic resource management and robust data security measures, and (4) enhancing integration with community care systems and policy frameworks. A total of 20 older adults and 20 family members were recruited. All participants successfully completed the assigned tasks, with a mean completion time of 20.7 (SD 5.2) minutes. Satisfaction ratings were generally favorable. The qualitative findings indicated that the intervention was perceived as useful and professionally designed, while also identifying several challenges, including variability in preparation for future care readiness and educational levels, limited interactivity, insufficient practical content, and reliance on support from adult children. Suggested improvements included enhanced personalization, additional supportive tools, improved usability, greater involvement of adult children, and stronger integration with offline services. The "Yi Yang Plan" demonstrated preliminary scientific validity, feasibility, and acceptability as a multidisciplinary, collaboratively developed digital intervention to support preparation for future care among older adults with prefrailty and frailty. By translating prior empirical and theoretical findings into a differentiated, precision-oriented digital strategy, this study advances interventions beyond conventional one-size-fits-all approaches. Future iterations should focus on optimizing system architecture, user interface design, platform functionality, and implementation strategies. Further research should conduct higher-quality randomized controlled trials to evaluate the platform's effectiveness.

The need for materials that have a limited impact on the environment has led to the development of engineered living materials (ELMs), which integrate living organisms and material applications to generate functional matter. Filamentous fungi offer a promising scaffold to design ELMs, which can be produced from the bottom up, but the possibilities for introducing dynamic functionalities are limited. To solve this, multispecies ELMs can be designed, using bacteria and algae to introduce biological functions in the material. The amenability of bacteria for synthetic biology offers a suitable platform to develop novel functions, while algae can endow the material with photosynthetic properties. Due to the preexisting natural interactions between these organisms and fungi, such as lichens and fungal highways, the establishment of a consortium-based bottom-up ELM becomes feasible. In this review, we summarize the natural mutualistic interactions between fungi, algae, and bacteria and how they can be harnessed for the design and implementation of engineered living materials, using filamentous fungi as their structural backbone. Furthermore, we review the role of such interactions in industrial processes, where they have been engineered for wastewater treatment and biotechnological production. Lastly, we discuss the current challenges of engineered living materials, the advantages of consortia-based solutions, and their future perspectives.

Developing advanced iridium (Ir)-based oxygen evolution reaction (OER) catalysts is critical for proton exchange membrane water electrolyzers (PEMWEs). Unfortunately, conventional adsorbate evolution mechanism (AEM) and lattice oxygen mechanism (LOM) pathways suffer from an activity-stability trade-off, posing substantial challenges for catalyst design. Here, we report a charge-redistribution-induced oxygen (O) spillover strategy by designing amorphous VOx-supported iridium-tin (IrSn) alloy OER catalysts, which can effectively transfer the poisoning oxygenated intermediates and maintain Ir valence stability (+2.5) during the dynamic OER to enhance activity and stability. In particular, the IrSn-VOx-based PEMWE anode can deliver a current density of 3.0 amperes per square centimeter @ 1.798 volts (0.4 milligrams of platinum and Ir per square centimeter), surpassing the US Department of Energy (DOE) 2026 targets. A 25-square centimeter PEMWE operates stably for 5000 hours at industrial currents (≥25 amperes) with an exceptionally low degradation rate of 5.6 microvolts per hour, representing one of the best OER catalysts reported for practical PEMWEs. Theoretical calculations predict that the charge redistribution within IrSn-VOx could reduce the kinetic energy barrier for *O spillover (from Ir to VOx) by 69% relative to O-O coupling, thus triggering the O spillover against the Ir overoxidation/dissolution. Consequently, IrSn-VOx follows a support-involved LOM pathway with a reduced rate-determining-step barrier (0.37 electron volts) relative to IrSn following AEM (0.66 electron volts). In addition, Sn doping in IrSn-VOx can further promote the regeneration of VOx lattice O and improve stability.

Background and objectives Timely transport of donor organs is a critical determinant of successful transplantation because organ viability is limited by cold ischaemic time (CIT). Unmanned aerial vehicles (UAVs), commonly referred to as drones, have recently emerged as promising tools for rapid medical logistics. The present study describes the design, engineering validation, and field evaluation of a drone-compatible organ transport container capable of maintaining cold-chain conditions during aerial transport. Methods A multidisciplinary engineering framework integrating biomedical engineering, materials science and transplant logistics consultation was used to design a lightweight crash-resistant container. The system incorporates carbon fibre reinforced polymer (CFRP) with aluminium reinforcement for structural stability, phase change materials (PCMs) for passive thermal regulation, and embedded sensors for monitoring temperature and mechanical shocks. Structural simulations, laboratory drop tests, thermal stability experiments, and pilot drone flight trials were conducted to evaluate mechanical resilience and preservation performance. Results Finite element simulations demonstrated that the composite container could withstand anticipated operational loads with adequate safety margins. Drop tests from heights up to 18.3 m resulted in minimal structural deformation while the internal payload chamber remained protected. Thermal experiments confirmed that PCM-based cooling maintained preservation temperatures within 0-4 °C for more than 18 h. Drone flight trials using a hexacopter UAV confirmed stable payload handling and maintenance of cold-chain conditions during simulated transport. Interpretation and conclusions The prototype demonstrates proof-of-concept feasibility for drone-compatible organ transport. UAV-enabled logistics may complement existing organ transport systems by reducing delays associated with traffic congestion and coordination challenges. Further clinical validation and regulatory approvals are required before routine deployment.

The line between tool and companion was once obvious, but conversational AI is blurring it in ways few researchers anticipated. Large language model chatbots and purpose-built AI companion agents are now used by millions of people every day. They are not being used to simply retrieve information but, instead, to offer emotional support, help process personal distress, and sustain what many describe as genuine relationships. Research puts the scale of this shift in sharp relief as nearly half (48.7%) of individuals with self-reported mental health concerns report having used a large language model for mental health support or therapy-related purposes. This Viewpoint argues that these uses are best understood through 3 unique but overlapping relational frames: AI as a therapist substitute, AI as a companion or confidant substitute, and AI as a romantic partner substitute. Drawing on empirical literature across digital mental health, psychology, communication, and human-computer interaction and grounded in the values of participatory medicine, this paper examines why people turn to AI for these intimate purposes; what they appear to gain; and what clinicians, designers, developers, and policymakers should examine more carefully as the practice evolves. The picture that emerges is neither straightforwardly optimistic nor dismissive. Therapeutic chatbots can produce real symptom reduction for users; AI companionship can ease loneliness in genuine, if bounded, ways; and the emotional relief some people experience in these interactions is not an artifact of naivety. But the same systems that lower the barriers to disclosure also lower the barriers to harm. AI chatbots regularly hallucinate clinical guidance, validate dysfunctional beliefs, handle crises without accountability, and may cultivate the very isolation they seek to relieve. Responsible integration requires something more demanding than a disclaimer. Instead, it requires transparent design, thoughtful escalation pathways, ongoing evaluation, and a commitment to the human connection that participatory medicine places at the center of good care.

There is an urgent and critical need to support the mental health of health care providers, given high rates of stress and burnout. Although the issues are complex, digital access to information and support can help address the needs, as technology can facilitate on-demand links to private, customized resources, including peer support. Beyond Silence (McMaster University) is an evidence-informed mobile health platform co-designed with health care workers and grounded in prior evidence that mental health literacy and peer support can reduce stigma and facilitate earlier help-seeking. This study aimed to (1) explore how health care workers across diverse health care settings use the app and (2) identify opportunities and barriers to implementation. A multiple-case study framework, informed by the Consolidated Framework for Implementation Research (CFIR), was applied to capture 4 months of implementation across a purposive sample of 7 diverse Canadian health care organizations. Implementation within each organization was led by designated organizational champions who leveraged existing communication channels and standardized promotional materials to invite employees to voluntarily download and use the app. Implementation outcomes were assessed using app analytics (downloads and feature use) and semistructured baseline and follow-up interviews with organizational champions to explore contextual influences on uptake. Approximately 1066 employees downloaded the app over the 4-month period, ranging from <2% to >45% of employees across the 7 organizations. Interviews with 28 organizational champions noted that there was good leadership support for the technology, aligning with their mission to address employee mental health. Barriers to use, however, included workplace culture surrounding mental health and help-seeking, lack of awareness about when and how to use the app, and infrastructure-related challenges, such as limited time and a lack of private spaces to download and use the technology. Effective implementation is a precondition for positive outcomes; therefore, strategies are needed to optimize technology implementation. Recommendations include evaluating organizational readiness, building mental health literacy, creating a multimodal communication and implementation plan, addressing technology requirements, and embedding the technology into organizational policies and practices. This study highlights key challenges in the implementation of the Beyond Silence peer support platform for health care workers, including slow adoption linked to mental health stigma, competing demands, and limited frontline engagement. Addressing these barriers will require innovative, trust-building strategies to support meaningful uptake and sustained use.

Nursing students often have limited opportunities to apply social determinants of health (SDOH) concepts to patient experiences and clinical reasoning. This study evaluated a facilitated, game-based learning intervention to reinforce person-centered, socially responsive care. A mixed-methods pretest-posttest design was used with junior-level undergraduate nursing students at a public university. Students participated in a structured board game during class. Matched pre/post surveys (n = 47) were analyzed using paired-samples t-tests, and open-ended reflections underwent content analysis. Significant improvements were found in endorsement of socioeconomic considerations in health care delivery (p = .020) and incorporating patient priorities into care plans (p = .026). Qualitative themes reflected increased awareness of SDOH, holistic thinking, engagement, and critical reflection. A brief, facilitated game-based intervention may strengthen application of SDOH concepts within person-centered care. Findings support continued refinement and further study with larger, multi-site, and longitudinal designs.

The objective was to examine the relationship between phonological processing skills and speech recognition outcomes after cochlear implantation in adults with acquired hearing loss, using both pre- and post-implantation measures. A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE, CINAHL, and EMBASE databases were searched for studies investigating phonological processing and cochlear implantation. Two reviewers independently screened studies according to predefined PICOST criteria. Eligible studies included randomized and non-randomized (cross-sectional or longitudinal) studies published in English or French between 1998 and 2024, involving adults (&#x2265;18 years) with acquired hearing loss who received at least a cochlear implant. Studies were required to assess phonological processing before and/or after implantation and report speech recognition outcomes. Methodological quality was also evaluated. Of 1649 records identified, 26 full-text articles were screened, and 9 studies met the inclusion criteria. Extracted data included study design, participant characteristics, hearing loss history, implant use duration, assessment methods, and performance on phonological, speech recognition outcomes, and cognitive measures. The available evidence was limited and highly heterogeneous in terms of study design, assessment tools, and outcome measures. Quality assessment revealed predominantly low-to-moderate levels of evidence, reflecting methodological limitations. Current evidence is low to support the hypothesis that stronger pre-implantation phonological processing skills predict speech recognition outcomes after cochlear implantation. Further studies using standardized assessments and more robust methodologies are needed to clarify the role of phonological processing in cochlear implant outcomes.

The N-terminal domain (NTD) of the SARS-CoV-2 spike (S) is a critical antibody target, yet its epitope organization, neutralization mechanisms, and immune evasion strategies remain incompletely resolved. Here, we classify NTD antibodies into nine spatially distinct classes (designated as NTD-1 to NTD-9), including a cryptic epitope defined here (NTD-8). Mechanistic studies reveal that NTD-5 and NTD-9 antibodies neutralize by inducing S1 shedding, thereby extending this mechanism to selected NTD-directed antibodies. Format profiling shows that while most NTD antibodies require bivalency, selected antibodies from NTD-3, NTD-5, and NTD-9 retain neutralizing activity in Fab form. Profiling 41 antibodies across prototype, Delta, and 17 Omicron subvariants defines an epitope-resolved escape landscape and enables dissection of three convergent evasion strategies: contact residue disruption, glycan shielding, and conformational remodeling. Notably, the KP.3.1.1 subvariant uses a dual escape mechanism in which &#x2206;S31 introduces N30 glycosylation and substantially remodels the S27-R34 region, undermining recognition by both NTD-5 and NTD-9 antibodies. These findings provide a structural and mechanistic framework for rational vaccine and antibody design resilient to antigenic drift.

Robots increasingly share spaces with people, supporting delivery services and mobility for the aging populations, yet their ability to share space comfortably lacks understanding and benchmarks for designers and policy-makers. We compared human-robot (HRI) and human-human (HHI) interactions across four real-world crowd datasets spanning Europe, North America, and Asia, using a unified pipeline to detect interactions, stratify by crowd density, and model pedestrian behavior. Local motion patterns (speed, acceleration, and jerk) remained closely matched between HRI and HHI across all densities. In contrast, proxemics diverged, with effects that grew approximately linearly with robot speed and weakened under higher crowding: In the dataset with the faster navigating robot, pedestrians maintained about 0.23&#xa0;meters more clearance around the robot than around other pedestrians under less crowded conditions and about 0.05&#xa0;meters more under more crowded conditions, while in the dataset with the predominantly stationary robot, the corresponding differences were small and inconsistent across crowding levels. The main conclusions were robust to parameter variations and remained stable across a broad range of motion-processing and interaction-labeling settings. Our findings provide density- and speed-aware benchmarks for proxemics in social robot navigation and empirically grounded targets for design, evaluation, and modeling across robotics and urban mobility.

Excessive melanin production that results in localized skin darkening is the hallmark of dermal hyperpigmentation, a frequent dermatological disorder. It is primarily induced by ultraviolet exposure, hormonal changes, and inflammatory processes. To develop targeted therapy, it is crucial to determine the exact role of biomarkers, encompassing pro-inflammatory cytokines, growth factors, enzymes, proteins, and genetic markers. With a focus on translational significance and dermal safety, this structured narrative review attempts to assess developments in etiology, biomarker identification, and treatment approaches for dermal hyperpigmentation. A structured narrative review was conducted using PubMed, Scopus, Web of Science, and Google Scholar to identify English-language literature published primarily from January 2005 to March 2026. Evidence was selected based on relevance to dermal hyperpigmentation, with emphasis on studies addressing pathogenesis, biomarkers, and therapeutic strategies. Findings were synthesized qualitatively, with clinical evidence prioritized for therapeutic conclusions and preclinical studies used to describe mechanistic insights and emerging drug delivery approaches. Emerging evidence highlights the involvement of pro-inflammatory cytokines, tyrosinase-related enzymes, and signaling mediators in the pathogenesis of dermal hyperpigmentation. Biomarker-guided therapeutic strategies remain largely supported by mechanistic and early translational evidence, with limited clinical validation. Nanotechnology-enabled drug delivery systems, including liposomes, nano-emulsions, and polymeric nanoparticles, have demonstrated improved skin delivery and therapeutic potential primarily in preclinical studies, while robust evidence demonstrating superior dermal targeting and clinical efficacy in humans remains limited. Current clinical evidence supports only a small number of nano-enabled formulations, emphasizing the need for further well-designed human studies. Current evidence supports the mechanistic relevance of several biomarkers and highlights the promise of nanotechnology-enabled delivery systems for dermal hyperpigmentation. However, both biomarker-guided therapeutic strategies and advanced nanocarrier platforms remain supported predominantly by preclinical and early translational evidence, with insufficient high-quality clinical validation. Future studies should prioritize standardized biomarker validation, rigorous dermal safety assessment, and well-designed clinical trials to facilitate successful clinical translation.

Cell line misidentification and cross-contamination remain persistent challenges in biomedical research, undermining experimental validity and contributing to irreproducible findings. Despite increased awareness and the availability of authentication technologies such as short tandem repeat (STR) profiling, problematic cell lines continue to appear in publications and commercial repositories. The International Cell Line Authentication Committee (ICLAC) maintains the Register of Misidentified Cell Lines, a curated and openly accessible resource designed to help researchers, reviewers, and funders identify cell lines that do not represent their claimed origin. The recently released Version 14 of the Register expands and updates this resource with new entries and revised information. Greater awareness and consistent consultation of this resource, together with routine authentication practices, can significantly improve the reliability and reproducibility of cell-based biomedical research. Investigators are encouraged to check the ICLAC Register before acquiring or using established cell lines, authenticate cultures at defined checkpoints, including upon receipt, during master-stock generation, after extended passaging, and before publication, and report authentication evidence transparently.

Self-assessment and peer assessment in nursing education promotes students' metacognition, clinical judgment skills, and communication. However, minimal research has examined the relationship between self-assessment and peer assessment of clinical judgment. An explanatory sequential mixed-methods design examined the relationship between self-assessment and peer assessment in simulation among senior undergraduate nursing students (N = 32). Pearson correlation and linear regression assessed score consistency, while qualitative thematic analysis identified factors influencing quantitative results. A small, nonsignificant positive correlation was found between self-assessment and peer assessment scores. Three themes emerged from the qualitative data: uncertainty, accountability, and communication. Findings indicated a modest alignment between self-assessment and peer assessment of clinical judgment, with uncertainty emerging as a barrier to assessments. Ongoing engagement with these strategies enhances familiarity with assessment processes and supports metacognition, accountability, and team communication, underscoring importance of their integration in nursing curriculum to promote practice readiness.

The catalytic enantioselective construction of acyclic quaternary stereocenters remains a central challenge in modern organic synthesis, with far-reaching implications for the design and synthesis of complex natural products and functional molecules. In particular, &#x3b3;-quaternary stereocenters are exceptionally difficult to access catalytically, as few methods enable precise stereochemical control at positions distal to an activating group. Although [3,3]-sigmatropic rearrangements provide a powerful means to reorganize molecular frameworks with high stereochemical fidelity, their strategic integration with asymmetric catalysis remains underdeveloped. Herein, we report a unified catalytic strategy that merges iridium-catalyzed enantioselective allylic alkylation of &#x3b1;,&#x3b2;-unsaturated malononitriles with a stereospecific Cope rearrangement to deliver &#x3b3;-quaternary nitrile derivatives with exceptional regio- and enantiocontrol (up to 96% ee). Density functional theory calculations demonstrate that the reaction proceeds via reversible &#x3b1;-allylation followed by a low-barrier, stereospecific Cope rearrangement, thereby establishing a stereochemical relay mechanism for remote stereocenter construction. This platform enables modular, scalable access to &#x3b1;-, &#x3b2;-, and &#x3b3;-quaternary stereocenters from a common intermediate without erosion of enantiomeric enrichment, establishing a unified strategy for the stereocontrolled construction of densely functionalized acyclic frameworks.

There is an increasing burden of neurodevelopmental disorders worldwide, with scarce data in low and middle-income countries, including Nigeria. Little is known about Fragile X disorders (Fragile X syndrome and Fragile X premutation-associated conditions) in developing countries and there is no national data in Nigeria. Advancing Mental Health and Well-being of Nigerian Children Through Public Health Screening for Fragile X Disorders (CHAMP-FX) is a multicentre public health screening initiative designed to estimate the prevalence of Fragile X disorders among children with neurodevelopmental disorders in Nigeria through targeted screening, strengthen diagnostic capacity and provide pathways to targeted treatments. This is a prospective multicentre screening study with longitudinal follow-up recruiting children aged 1-18 years with intellectual disability, autism spectrum disorder, and/or global developmental delay from six tertiary hospitals across Nigeria's six geopolitical zones. Using purposive sampling, 102 participants (17 per zone) will be enrolled. Sociodemographic data and clinical evaluation will be obtained using KoboToolbox. Blood samples will be collected as dried spots on quick-response coded filter cards, stored with desiccant, and transported to the coordinating molecular laboratory. Genetic testing will be performed using a long-range amplification workflow followed by long-read sequencing to determine repeat sizes and classify results using internationally accepted thresholds. The primary outcome is the proportion of participants with Fragile X full mutation and/or premutation in the selected cohort. Secondary outcomes include the distribution of repeat sizes and associations with sociodemographic and clinical variables. Screen-positive participants will receive structured result disclosure, genetic counselling, and referral for appropriate supportive interventions, with targeted therapy using metformin offered to participants diagnosed with Fragile X syndrome. Findings will be disseminated through peer-reviewed publication, conferences and stakeholder engagement.