This article explores the role of comics as a sustained pedagogical practice within medical education, presenting findings from a longitudinal qualitative study conducted at Penn State College of Medicine, United States. Over two pre-clinical years, a self-selected group of medical students-known as the Comics Cohort-were given comics-making assignments to integrate into their required Humanities curriculum. Through focus groups, individual interviews, and visual narrative analysis of students' drawings, the study investigated how engaging with comics over time shaped medical students' ways of seeing, learning, and becoming. We identified three main thematic domains: 1) students learn more deeply when they engage visually; 2) the personal reflection and vulnerability that arise from making comics can be challenging but are also tools for growth; and 3) making and sharing comics creates community and connection. Building on participants' accounts of repeated comics-based practices, this article conceptualizes drawing as a form of reflective engagement that shapes how students attend to clinical encounters. The act of drawing-repetitive, situated, and open-ended-functioned as a reflective tool through which students developed what we conceptualize as visual attunement: an ethically engaged perceptual stance that integrates attention to bodies, silences, emotions, and context. Rather than using art as an occasional creative supplement, this study found that drawing comics can serve as both a medium and method through which students cultivate professional identity, visual thinking, and critical reflection.
Despite rising socioeconomic inequalities most people see individualised merit as crucial for social success. Drawing on surveys such as the ISSP a wealth of research examines trends in subjective perceptions, the relative importance accorded to merit and non-merit factors for getting ahead in life and factors which influence lay perceptions. However, varied conclusions emerge from the literature. Further, puzzles ensue from the measurement of lay perceptions of (non-)merit factors as drivers of social success. Drawing on new qualitative data I argue that the specific, individualised, and binary framings of merit and non-merit beliefs in conventional accounts under-explore the varied ways in which people recognise structural processes. I also argue that explanation is hampered by over-stating lay misapprehensions, or what people don't see, when a greater focus on what people do see, and what they believe to have mattered in their biographical lived experience, would support a more nuanced sociological analysis of situatedness and complexity in lay apprehensions of social inequality.
The 2022 global mpox outbreak was the first to involve sustained community transmission outside endemic regions, disproportionately affecting gay, bisexual and other men who have sex with men (GBMSM). News media plays a critical role during outbreaks by disseminating information, shaping public perception and influencing health protection behaviours. This qualitative study examined how UK news media represented mpox during the 2022 outbreak, with a particular focus on public health messaging and the discursive framing of affected communities. Using the NexisUK® database, we retrieved UK print and online articles mentioning "mpox", "monkeypox", or "monkey pox" in headlines, published between May and December 2022. Five national newspapers were selected based on readership and political stance (The Times/Sunday Times, The Guardian, The Sun, The Daily Mail/Sunday Mail and the Daily Mirror/Sunday Mirror). Following deduplication and screening, we applied a rotating weekday sampling frame and analysed articles thematically in NVivo. We identified 746 articles in the five selected newspapers between May and December 2022. Coverage peaked in May 2022 (n = 223 articles) and then waned, despite incident cases rising in June (n = 1,185) and July (n = 1,453). We analysed 79 sampled articles. Key themes included communication of mpox characteristics, delivery of health promotion, and 'anchoring' mpox to other infectious diseases (e.g. COVID-19, chickenpox) to aid understanding. Articles described mpox's epidemiological origins in Africa, transmission routes, and epidemiological updates, often noting transmission during GBMSM events. Public health messaging focused on advice about transmission reduction, access to care/prevention services, and vaccine availability (including concerns over supply). GBMSM were frequently depicted as being at high risk, sometimes drawing upon stereotypes and language that potentially reinforced stigma. Notably, few articles included perspectives from individuals with lived experience of mpox. UK news media interest in mpox peaked early in the outbreak and waned despite rising cases. News media played a vital role in disseminating information and public health messaging (often drawing parallels with other familiar infections) but the framing of GBMSM may also have reinforced stigma. The absence of personal testimonies represents a missed opportunity for inclusive messaging. Future outbreak reporting should involve affected communities to co-produce and promote accurate, non-stigmatising communication.
Since the mid-1990s, combination antiretroviral therapy (ART) has transformed HIV from a fatal diagnosis into a manageable long-term condition. For the first time, a large cohort of people who once expected to die young are now growing old with HIV. This article examines how long-term survivors narrate and make sense of a life shaped by two linked turning points: First, a diagnosis that was widely understood as a death sentence; and second, the arrival of effective treatment, which abruptly reopened a future that had been foreclosed. Drawing on life-history interviews with 21 people living with HIV aged 50 and older in Norway the article shows that diagnosis was experienced as a terminal rupture that cancelled plans, relationships, and long-term commitments. The subsequent stabilisation of effective therapy did not simply restore what had been lost; it introduced a second upheaval, compelling participants to rebuild a life they had not expected to live. I propose the concept of prognostic horizon reversal to name this therapy-driven shift in expected life horizons and to clarify how it reshapes biography, responsibility and the practical work of planning for a future under conditions of ongoing treatment, clinical monitoring and the lingering traces of earlier crisis.
The existing body of research offers limited insight into the detrimental effects of incivility phenomena on proactive customer service performance (PCSP) from the customer's perspective. Drawing on the stressor-strain-outcome (SSO) framework and conservation of resources (COR) theory, this paper examines how customer incivility is associated with PCSP, with a particular focus on emotional exhaustion as a mediator and proactive personality as a moderator. Utilizing survey methodology, customer-contact employees in China were sampled with a time lag of three weeks in three waves. SPSS 27.0, the PROCESS macro (Model 59) and AMOS 27.0 were utilized to analyze the data. The results showed that customer incivility had a positive impact on emotional exhaustion and reduced PCSP. Additionally, the indirect effect of customer incivility on PCSP through emotional exhaustion was significant, indicating a significant mediating effect. The results also revealed that proactive personality significantly moderated the association between customer incivility and emotional exhaustion and the moderated mediation index was also significant. These findings indicate that proactive personality serves as a positive psychological resource, enhancing employees' capacity to mitigate the adverse effects of customer incivility (stressor) and emotional exhaustion (strain) while enabling them to consistently engage in proactive service behaviors (outcome), thereby breaking the vicious path of the SSO framework.
This study examined how digital interactivity and presence are associated with cultural inheritance behavior in the digital dissemination of the Morin Khuur, with particular attention to the mediating role of flow experience and the moderating role of prior cultural involvement. Drawing on flow theory and immersive media research, a structural model was developed to investigate how digital platform experiences relate to users' psychological engagement and behavioral intentions toward intangible cultural heritage dissemination. Data were collected through an online survey of individuals who had recently encountered Morin Khuur-related content on digital platforms. After applying screening criteria and data quality checks, 520 valid responses were retained for analysis. Partial least squares structural equation modeling was employed to test the proposed relationships. The results showed that both digital interactivity (β = 0.410, p < 0.001) and presence (β = 0.521, p < 0.001) were positively associated with flow experience. Flow experience was positively associated with cultural inheritance behavior (β = 0.551, p < 0.001) and significantly mediated the effects of interactivity and presence. Prior cultural involvement did not show a significant direct association with cultural inheritance behavior (β = -0.016, p = 0.720), but significantly strengthened the relationship between flow experience and cultural inheritance behavior (β = 0.083, p = 0.036). These findings suggest that immersive psychological engagement may play a central role in transforming digital cultural experiences into participatory cultural inheritance behaviors. The study extends flow-based digital engagement research into the context of intangible cultural heritage dissemination and provides empirical evidence from the digital dissemination of the Morin Khuur.
Digital twins in medicine are packaged as inevitable, disruptive technologies that will revolutionise healthcare, yet their integration into clinical practice remains slow. In this article, we extend current research on digital twins by shifting attention to the actors behind the technology and their visions. Drawing on multi-sited fieldwork, we identify from where and how the In Silico medicine community envisions the future of medicine and trace embedded ideas and logics. Our analysis reveals a friction between the narrowing of visions of medicine, the human body and clinicians and the technical features of digital twins, which are intended to open futures and possibilities through virtual interventions. We show how digital twins are developed at a distance from the very practices they seek to revolutionise and how the field attempts to navigate this distance through conversion and training. As with other digital health technologies, the burden of adjustment is placed on clinicians. By attending to how distance between modellers and clinical settings plays out in practice, we show how this "future-making from afar" constrains but also enables specific modes of engagement. It offers a starting point for demystifying digital twins in medicine and reflects on the kinds of futures the field promotes.
School is a key setting for a child's cognitive, social, and civic development and may therefore offer a promising space to open dialogue about death and dying. Yet awareness-raising practices on death and dying in schools can be difficult to identify within the abundance of scientific and practical writings. To support school staff and enrich curricula with coherent and context-sensitive approaches, we sought to map existing practices to better understand the levers, barriers, and conditions for success. To explore the current state of knowledge and practices on awareness about death and dying (ADD) in the school context, and answer these questions: 1) How is ADD addressed in school settings? 2) What are the views of young people, parents, and school personnel on raising ADD? 3) What factors influence such ADD? This scoping review followed Levac's methodology. Searches were performed in 17 scientific and grey literature databases, complemented by reference tracking and community partners' consultation. Data were charted by research questions and analyzed using content analysis. 35 writings (2010-2023) were included. Various awareness-raising practices combining multiple activities were identified, emphasizing the value of multimodal approaches that engage cognitive, emotional, and creative dimensions. Interdisciplinary collaboration with community organizations was frequently requested to support ADD practices. Perceptions of ADD were generally positive, though nuances emerged among young people, school personnel and parents. Our results identify numerous factors that influence ADD, span between individual, family, school, and sociocultural levels, showing the multidimensionality and systemic nature of this phenomenon. ADD in schools is shaped by its context, such as collaboration between interested parties, teacher training, sensitive practices, and supportive policy frameworks enabling meaningful curricula integration. Without clear political and institutional support, initiatives remain fragile and dependent on isolated actors. Death is part of life, yet many children say it is rarely spoken about at school. We reviewed recent publications to better understand how awareness about death and dying (ADD) in school settings was viewed and practised. We found 35 sources published between 2010 and 2023. 1) How do we raise ADD? A range of activities can be used in school settings: guided class discussions, short talks by nurses, psychologists, or community workers, creative projects like drawing or storytelling, films or books to start a conversation, and, in some cases, visits to hospices or community spaces. In the reviewed writings, combining activities was found to help children think, feel, and express themselves. 2) What are the views of children, parents, and school staff on raising ADD? In the included writings, children often described death as being everywhere but not openly discussed. In most of the writings that reported on parents’ and school staff’s perspectives, they were supportive, even if they expressed some nuances and concerns. 3) What factors influence ADD? The writings reviewed suggest that ADD is influenced by the child’s age, cognitive development and grief experiences, family’s willingness to talk about death, school environment, curriculum, as well as teachers’ confidence, and more broadly culture, religion, media, and local policies. Because of these different factors, the integration of ADD in school requires clear guidance and teacher training, and cooperation with communities can make a real difference. In short, the writings suggest that school settings can provide safe opportunities for children to find words, ask questions, and build “death literacy”. When thoughtfully integrated, such practices may help young people face end-of-life realities with greater understanding and for themselves and others.
Zinc-based biodegradable stents offer a promising solution for temporary vascular support, aiding in vessel healing while reducing long-term complications such as thrombosis and restenosis. This study examined three zinc-based alloys: AMZ (Zn-4.0Ag-0.6Mn-0.1Zr), ACMZ (Zn-3.5Ag-0.5Cu-0.7Mn-0.1Zr), and CMM (Zn-1.0Cu-0.6Mn-0.05 Mg), all featuring reduced wire diameters of 0.12 mm. The focus was on their microstructure, mechanical performance, thrombogenicity, and in vivo biocompatibility. The alloys were processed through cold drawing and heat treatment, resulting in ultra-fine-grained structures measuring less than 1 μm. Energy dispersive spectroscopy (EDS) and x-ray diffraction (XRD) analyses confirmed the presence of strengthening intermetallic phases (AgZn3, CuZn4, and MnZn13), while a uniform elemental distribution indicated solid solution strengthening. Heat treatment enhanced ductility, especially in the AMZ and ACMZ alloys, without compromising tensile strength. In vitro hemocompatibility assays showed low thrombogenicity for these alloys, with lower fibrin and FXIIa generation compared to clinical control materials. Ex vivo assessments of platelet and fibrin attachment revealed similar results to those observed with pure zinc controls. In vivo implantation of the stent materials into the abdominal aortas of mice and rats produced distinct species-specific immune responses. Mice exhibited significant inflammation, extracellular matrix degradation, and necrosis, raising potential concerns about their biocompatibility in this model. In contrast, implants in rats resulted in only mild inflammation and limited neointimal growth, with no signs of necrosis. This suggests a more favorable and controlled healing response in rats. Morphometric analysis of Verhoeff-Van Gieson-stained cross-sections indicated that the 0.12 mm wires produced significantly less neointimal growth compared to previously tested 0.25 mm implants in rats, highlighting the advantages of smaller implant dimensions. Overall, these findings support the use of refined zinc-based alloys with smaller struts for next-generation biodegradable stents. However, the inflammatory response observed in mice emphasizes the necessity for careful selection of models in preclinical testing.
This study examines how students psychologically adapt to scaffolded generative artificial intelligence (GenAI) use in higher education. Drawing on the Technology Acceptance Model (TAM) and the Unified Theory of Acceptance and Use of Technology (UTAUT), we investigated how acceptance-related beliefs and behavioral intention (BI) were associated with learning engagement (ENG) and student-perceived instructional innovation (PPI) in a New Media Marketing course at a private Thai university. Using an explanatory sequential mixed-methods design, quantitative survey data from 207 students were analyzed using covariance-based structural equation modeling (SEM), and qualitative data from semi-structured interviews with 10 students and the course instructor, complemented by classroom artifacts, were examined thematically. The SEM results indicated that BI was positively associated with ENG and PPI, with ENG carrying much of the association between BI and PPI. Upstream beliefs, including digital self-efficacy, perceived ease of use, perceived usefulness, and general attitudes toward AI, were linked to PPI primarily through a serial sequence involving attitudes, intention, and engagement. Qualitative findings identified an explain-verify-revise routine, supported by prompt templates, verification checklists, and process-visible rubrics, as a key mechanism through which scaffolded GenAI use was associated with evaluative judgment, cautious trust, and more deliberate engagement. Taken together, the findings suggest that positive appraisal of scaffolded GenAI in this context depended less on technological familiarity alone than on structured use. Implications are discussed for AI-supported learning design and faculty development, particularly in relation to supporting students' judgment, agency, and accountability when working with GenAI tools.
Early human development is characterized by sensitive periods which impact long-term cognitive and behavioral outcomes. While these windows of heightened plasticity are well documented, the cellular mechanisms that enable and regulate them remain incompletely understood. In this conceptual article, I propose that early-life shifts in cortical inhibitory-excitatory balance, driven by prolonged neurogenesis, migration, and maturation of GABAergic interneurons, play a central role in opening, shaping, and closing sensitive periods and thereby guide skill development. Drawing on evidence from human and animal studies, I synthesize findings showing that inhibitory interneurons are integrated into cortical circuits well into postnatal life, where they regulate intrinsic and sensory-driven activity, sculpt synaptic connectivity, coordinate interactions with glial cells, and progressively refine network dynamics. The developmental strengthening of inhibition alters excitation-inhibition ratios, drives the transition from highly synchronous early activity to decorrelated and efficient adult-like firing patterns, and gates critical period plasticity across cortical regions. I argue that these inhibitory processes are not merely stabilizing but actively facilitate learning by suppressing non-relevant activity and enabling the emergence of specialized functional networks. This framework highlights fundamental differences between infant and adult learning mechanisms and suggests that individual variability in inhibitory circuit development may underlie differences in cognitive trajectories and vulnerability to neurodevelopmental disorders. Together, this synthesis positions early inhibitory interneuron development as a key mechanistic substrate linking sensitive periods to lifelong skill acquisition and behavioral individuality.
Critical scholarship documents how health communication campaigns reinforce inequalities by promoting individualized behavior change while erasing structural contexts. Drawing on the culture-centered approach (CCA), this study inverts dominant campaign logic by examining how households negotiating poverty in Singapore interpret and respond to the state-led "Let's Beat Diabetes" campaign. Through in-depth interviews with 39 low-income residents, we document how marginalized voices render visible the gaps, erasures, and structural barriers embedded in technocratic campaign design. Findings reveal two key dynamics. First, structural conditions-illiteracy, food insecurity, healthcare costs, and digital divides-determine who can access and interpret campaign messaging, creating systematic exclusion despite campaign claims of universal reach. Participants identify contradictions between campaign advice (eat healthy food) and structural realities (food charity systems delivering predominantly unhealthy processed foods). Second, communicative infrastructure gaps manifest in lack of campaign awareness, perceived irrelevance of messages, inaccessibility of digital platforms, and absence of structural solutions in campaign content. The technocratic rationality celebrated as efficient systematically misses those most affected by diabetes risk. This study makes three contributions to CCA. Methodologically, it demonstrates how marginalized communities can interrogate hegemonic campaigns, inverting traditional formative/evaluative research. Substantively, it documents how communicative infrastructure itself becomes a structural barrier in technocratic governance. Theoretically, it extends CCA by foregrounding communicative inequality as a dimension of structural violence. Ultimately, voices from the margins teach that addressing diabetes among the poor requires confronting the structural conditions that produce health inequalities, not nudging individuals to make better choices.
The ethical terrain surrounding feeding at the end-of-life is emotionally charged and complex. In the literature, the recently introduced notion of "minimal comfort feeding" (MCF), defined as deliberate limitation of feeding or hydration, given only in response to visible signs of hunger or thirst, for a patient with a longer prognosis, has been proposed as a comfort measure at the end of life and as an alternative to voluntarily stopping eating and drinking (VSED) in advance care planning. However, the same term may be applied to two morally distinct acts: 1) providing comfort in the context of active dying, and 2) a hastening death. In this paper, we argue for conceptual clarity around these two practices and their ethical valence, drawing on an Anscombean-Thomistic virtue ethics framework that deals with moral evaluation of human action and the doctrine of double effect. We present two clinical cases highlighting each of these ethical scenarios. Through the cases, we show how intentionality and some circumstances such as timing critically shape the morality of the act. We propose a new nomenclature with the aim of fostering ethical clarity of the morally distinct acts: "proportionate comfort feeding" (PCF) for MCF where nutrition and hydration is provided for comfort with the understanding that it may hasten death but is its foreseen, unintended outcome, and "minimal feeding to hasten death" (MFHD) for cases where MCF is chosen with the specific intention to hasten death.
Understanding continuous participation intention in emerging leisure sports such as Ultimate Frisbee is important for promoting leisure-time physical activity. Drawing on leisure motivation theory and Social Information Processing theory, this study examines the relationships among leisure motivation, leisure involvement, information acquisition, and continuous participation intention among Chinese Ultimate Frisbee participants. The research aims to provide a clearer explanatory perspective for understanding sustained participation in emerging leisure sports and to offer practical implications for promoting participation in community-oriented leisure sports. Using snowball sampling, an online questionnaire survey was conducted with 724 Ultimate Frisbee participants from multiple regions in China. Data were analyzed using SPSS 27.0. Regression analyses were first conducted to examine the relationships among the study variables. PROCESS Model 6 with 5,000 bootstrap resamples was then used to test the indirect associations. The results showed that leisure motivation was positively associated with continuous participation intention. Leisure involvement and information acquisition each showed significant indirect associations in the relationship between leisure motivation and continuous participation intention. In addition, a significant serial indirect association through leisure involvement and information acquisition was observed. Overall, a substantial proportion of the relationship between leisure motivation and continuous participation intention was reflected in these indirect associations. The findings provide empirical evidence for understanding continuous participation intention in Ultimate Frisbee and also highlight the importance of leisure involvement and information acquisition in community-oriented leisure sports. In the context of the internet era, further improving the accessibility and effectiveness of Ultimate Frisbee-related information will help enhance individuals' continuous participation intention.
This study aims to investigate the awareness, practices, needs, and challenges of hospital-based health technology assessment (HB-HTA) in China's tertiary public hospitals, drawing on perspectives from both hospital management and clinical practice. Semi-structured interviews were conducted with seventeen participants representing six major tertiary public hospitals in China. Respondents included vice presidents, clinical department directors, and heads of pharmacy. The questionnaire explored four dimensions consistent with China's national performance appraisal framework: medical quality, operational efficiency, sustainable development, and satisfaction. Data were analyzed using NVivo 14 for qualitative responses and Excel 2021 for quantitative metrics. The findings revealed that 82.35 percent (14/17) of hospitals lacked dedicated HB-HTA teams, with decisions made primarily by coordination between Medical Affairs Offices (28.89 percent, 13/45) and Pharmacy Departments (22.22 percent, 10/45). Safety (28.26 percent, 13/46), effectiveness (23.91 percent, 11/46), and cost-effectiveness (19.57 percent, 9/46) were prioritized criteria, yet only 29.41 percent (5/17) of institutions used formal HB-HTA tools. Divergence persisted between administrators' organizational priorities and clinicians' patient-centered perspectives. Despite barriers reported by 62.8 percent (27/43) of respondents' institutions, 88.24 percent (15/17) expressed an urgent or recognized need for HB-HTA implementation. For effective HB-HTA implementation in China, addressing capacity deficits and reconciling stakeholder perspectives is essential. A project-based strategy, supported by government real-world data platforms and interdisciplinary teams, is recommended for contextually-appropriate evaluation frameworks.
This study advances understanding of teacher wellbeing by examining how pre- and in-service English Language Teaching (ELT) student teachers in Iran's private sector experience flourishing amid systemic precarity. Drawing on Bronfenbrenner's Ecological Systems Theory and using interpretative phenomenological analysis of semi-structured interviews with ten Iranian ELT student teachers, wellbeing is traced across microsystem, mesosystem, exosystem, macrosystem, and chronosystem layers. Findings show that immediate classroom interactions, pedagogical confidence, student rapport, and skill cultivation, co-construct hedonic joy and eudaimonic purpose, while mentorship, familial support, institutional autonomy, and resource equity function as key resilience resources at the meso- and exosystem levels. At the macro- and chronosystem levels, socio-economic instability, COVID-19 disruptions, and AI-related anxieties intensify vulnerabilities to classroom monotony, work-life spillover, and market-driven employment uncertainty, particularly for novice teachers. Theoretically, the study extends ecological and wellbeing frameworks by demonstrating how hedonic and eudaimonic dimensions are jointly produced across nested systems in a commercialized ELT context, thereby contributing to contemporary positive psychology. Practically, it identifies multilevel leverage points, such as diversified practicum assignments, structured cross-institute mentorship, fair contractual and policy arrangements, and public campaigns that revalue teaching, that can support more sustainable wellbeing trajectories for ELT student teachers in private-sector settings.
Mainstream global mental health continues to privilege individual-level risk factors and biomedical approaches and treatments while sidelining the structural forces that shape mental distress. Despite calls for more socially embedded and decolonial approaches, policy and research too often neglect how structural phenomena such as globalization, colonialism, and neoliberal reforms directly drive mental health inequities. Drawing on Latin American traditions of social medicine-particularly Jaime Breilh's paradigm of social determination of health-this debate article critiques reductionist frameworks that fragment structural causation into depoliticized lists of risk factors. We articulate a social determination approach for mental health research and practice, emphasizing the multi-level embodiment of power relations, the historical-political organization of social life, structural drivers embedded in institutions and policies, and the role of collective agency and praxis. Illustrative vignettes from Latin America (employment, discrimination, and environment) demonstrate how historically structured processes linking global political economy, institutional arrangements, and everyday social relations become embodied as mental distress, and how participatory and mixed-method research can help document these dynamics while supporting transformative, community-led responses. We argue that adopting a social determination lens can reorient global mental health policy and scholarship toward structural justice, in line with recent international calls to decolonize and politicize mental health research. Not applicable.
Multidisciplinary team meetings (MDTMs) are central to cancer treatment planning in the UK, but increasing caseloads, growing clinical complexity, and workforce constraints have raised concerns about the sustainability of a "discuss-every-case" model. National guidance in England now promotes MDT streamlining, using Standards of Care (SoCs) to stratify cases requiring full multidisciplinary discussion from those suitable for standardised pathways. However, there remains limited clarity on how SoCs should be specified and governed to ensure safety, consistency, and clinical accountability in routine practice. This mini-review synthesises national policy, emerging empirical literature on MDT streamlining, and evidence from complexity research to examine SoCs as a mechanism for operationalising MDT reform. We highlight that empirical evaluations of streamlining remain limited and heterogeneous, and that reported effects depend less on caseload reduction than on information readiness, organisational context, and explicit escalation criteria. Drawing on NHS England guidance, specialty recommendations from the British Association of Urological Surgeons (BAUS), and the Measure of case-Discussion Complexity (MeDiC), we present a structured framework to support SoC development. The framework specifies parameters across patient, pathology, and treatment domains (in line with the MeDiC tool), alongside explicit eligibility, exception, and escalation logic, and interfaces with governance requirements for triage, data completeness, and audit. By making decision boundaries transparent and multidimensional, this approach addresses key risks associated with oversimplification and inappropriate exclusion while preserving clinical judgement and patient-centred care. Structured approaches to SoC development provide a defensible foundation for focusing MDT discussion where it adds greatest value under increasing service pressures.
Laboratory medicine remains the cornerstone of disease detection, clinical management, monitoring, and public health surveillance. Increasing population needs and rising disease burdens, particularly in low- and middle-income countries (LMICs), continue to expand the volume of diagnostic testing, resulting in substantial generation of biomedical waste. Effective laboratory waste management is therefore essential for protecting personnel, maintaining high-quality service delivery, and minimizing environmental harm. However, many LMICs face persistent challenges due to inadequate infrastructure, insufficient training, limited financial resources, and weak regulatory enforcement - that compromise safe and efficient waste handling. This review explores affordable, scalable and sustainable measures to strengthen laboratory waste management in resource-constrained settings. It categorizes the main types of laboratory waste - infectious/biological, chemical, sharps, and general waste - and examines common barriers to appropriate disposal. Guided by various international standards including International Organization for Standardization (ISO) 15189 and 14001, Eco-Management and Audit Scheme (EMAS) and World Health Organization (WHO) recommendations, and drawing on experiences from other LMICs, the review discusses practical, low-cost interventions such as improved test utilization, workflow optimisation, Artificial Intelligence (AI)-supported waste classification and digital tracking systems. The importance of workforce training, government engagement, public-private partnerships, and involvement of non-governmental organisations is also emphasised. To foster a culture of responsible waste management, the review proposes behavioural and accountability mechanisms including linking efficiency to key performance indicators, providing institutional recognition, documenting non-conformances, and applying consequence management where necessary. Sustainable and cost-effective waste management is achievable in resource-limited settings when supported by committed leadership, coordinated stakeholder action, and continuous quality improvement. Corporate bodies can play a pivotal role by providing strategic leadership, mobilising resources and strengthening workforce capacity.
This study investigates the nonlinear relationship between faculty mentoring and undergraduate innovation capacity within a universal tutorial system. Drawing on survey data from 1066 students at a Chinese provincial university, and grounded in motivational synergy theory and self-determination theory, we examine an inverted U-shaped effect of mentoring frequency, with an estimated inflection point of 13.35 sessions per semester. Bootstrap-based conditional indirect effects suggest that this pattern is consistent with both extrinsic (mentor pressure, peer influence) and intrinsic (academic identity, self-efficacy) motivational pathways, with the indirect effects themselves shifting from positive to negative as mentoring intensifies. Furthermore, the curvilinear pattern is more pronounced under low mentor-student research alignment, in smaller meeting cohorts, and within STEM disciplines. The mentoring benefits concentrate among students with moderate innovation capacity, suggesting an "expanding the middle" effect. These findings provide convergent evidence that the synergy-versus-crowding-out logic operates across mentoring intensity, motivational pathways, and student capacity, offering a more differentiated and mechanism-based understanding of how faculty mentoring shapes undergraduate innovation.