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Plants are constantly exposed to diverse abiotic stresses, including drought, salinity, and extreme temperatures, which severely limit growth, development, and crop productivity. These stresses disrupt physiological, biochemical, and molecular processes, leading to reduced photosynthesis, altered water and ion homeostasis, and accumulation of reactive oxygen species (ROS). Plants have evolved sophisticated sensing and signaling mechanisms to perceive these stresses, with phytohormones playing central roles in mediating adaptive responses. Key hormones, including abscisic acid (ABA), salicylic acid (SA), jasmonates (JAs), gibberellins (GAs), auxin (IAA), ethylene (ET), melatonin, and strigolactones (SLs), regulate stress tolerance by controlling stomatal behavior, root architecture, antioxidant systems, osmolyte accumulation, and stress-responsive gene expression. Importantly, these hormones operate within an intricate network of crosstalk, integrating multiple signaling pathways to balance growth and stress adaptation. Interactions among ABA, GA, JA, SA, auxin, ET, SLs, and melatonin enable plants to coordinate transcriptional regulation, protein phosphorylation, and ROS signaling, optimizing survival under fluctuating environmental conditions. Understanding the molecular mechanisms underlying hormonal crosstalk and their roles in abiotic stress tolerance provides valuable insights for developing resilient crops in the face of climate change.

Socio-economic inequalities in life expectancy are generally higher among men than among women. We formally estimated the contribution of smoking, alcohol, and obesity to the sex gap in educational inequalities in remaining life expectancy at age 30 (e30_ineq) in England and Wales (E&W), Finland and Italy (Turin), from 1992 to 2017. We compared the sex gap in e30_ineq (high versus low educated) with and without 'lifestyle-attributable mortality' (LAM) by extended cause-deletion lifetable calculations. We estimated LAM by multiplicatively aggregating estimates of smoking-, alcohol- and obesity-attributable mortality by educational level (low, middle, high), sex and five-year age groups (30 +). Males experienced almost constantly higher e30_ineq than females. In 1992-2017, LAM contributed respectively 57%, 70%, and 92% to the observed sex gap of 1.1 years in E&W, 2.6 years in Finland, and 2.4 years in Italy (Turin), driven predominantly by smoking-attributable mortality. LAM, driven by alcohol-attributable mortality, determined the reversal from increase to decline in the sex difference in e30_ineq in Finland in 2007. Smoking and excessive alcohol consumption, thus, largely determined the larger educational inequalities in e30 among men in all three countries, the observed country differences therein, and the time trends in the sex gap for Finland.

Mitochondria act as dynamic signaling hubs, constantly adapting to tissue-specific metabolic demands to ensure cell homeostasis. Central to this role is their capacity to take up calcium (Ca2+) into the matrix, a process that regulates energy production, cell death pathways, and broader cellular signaling. For decades, mitochondrial Ca2+ (mt-Ca2+) uptake was firmly established at the physiological level, yet the identity of the proteins involved remained elusive. The breakthrough discovery of the mitochondrial calcium uniporter complex (MCUC) has finally enabled genetic dissection of mt-Ca2+ fluxes and revealed its pivotal role in health and disease. Here, we retrace the trajectory of the field from the pioneering observations of the 1960s to the molecular era of the MCUC, emphasizing the latest advances in its regulation, integration into cellular networks, and pharmacological targeting.

Today, patients with intermediate high-risk pulmonary embolism are usually treated by a pulmonary embolism response team (PERT) and often EKOS lysis. We investigated whether this approach leads to a reduction in the hospital stay duration. A retrospective analysis of patients with intermediate high-risk pulmonary embolism clinically assessed by PERT and treated with EKOS lysis in a medical intensive care unit (ICU) between 01 October 2021 and 21 August 2024 was undertaken. The control group comprised patients suffering from intermediate high-risk pulmonary embolism, treated with medication alone (without assessment by PERT) in the ICU between 01 January 2010 and 31 December 2021. The economic/process-associated endpoint of the study was duration of hospital stay (days in hospital). A total of 45 patients were treated in the EKOS and PERT group and 31 in the control group. No differences regarding sex, vital signs, and laboratory parameters were observed. Despite the higher age of patients in the group treated by PERT and EKOS (64.7 years [53.4-71.6] vs. 54.0 years [38.6-63.1], *p = 0.03), the duration of hospital stay was significantly shorter (7.8 days [5.2-13.2] vs. 12.9 days [7.1-22.1], *p = 0.003). Time in the ICU was also significantly shorter (0.9 days for PERT and EKOS [0.5-1.5] vs. 2.0 days [0.9-6.2], *p = 0.01). In addition to being advantageous in situations where there is a shortage of acute care beds, a reduction of hospital stay may also potentially reduce treatment costs. This is especially important in ageing societies like Germany suffering from constantly increasing healthcare costs. HINTERGRUND UND FRAGESTELLUNG: Inwieweit eine Evaluation von Intermediate-high-risk-Lungenembolie-Patienten durch ein „Pulmonary Embolism Response Team“ (PERT) und eine EKOS-Lysetherapie zu einer Reduktion des Krankenhausaufenthalts führt, ist nur unzureichend untersucht. Untersucht wurden Patienten mit Intermediate-high-risk-Lungenembolie, die im Zeitraum vom 1. Oktober 2021 bis zum 31. August 2024 mittels PERT und EKOS-Lysetherapie auf der internistischen Intensivstation behandelt wurden. Als Kontrollgruppe wurde ein rein medikamentös behandeltes Vergleichskollektiv (ohne PERT) aus dem Zeitraum vom 01. Januar 2010 bis zum 31. Dezember 2021 untersucht. Als ökonomisch/prozessualer Endpunkt wurde die Aufenthaltsdauer im Krankenhaus gewählt. Insgesamt wurden in diese Analyse 76 Patienten eingeschlossen. Hiervon wurden 45 Patienten mit PERT und EKOS-Lysetherapie und 31 Patienten als Vergleichskollektiv ausgewertet. Im Hinblick auf die Geschlechtsverteilung, Vitalparameter und laborchemischen Parameter sahen wir keine Unterschiede zwischen den beiden Gruppen. Trotz des höheren Patientenalters der PERT- und EKOS-behandelten Patienten (64,7 Jahre [53,4–71,6] vs. 54,0 Jahre [38,6–63,1], *p = 0,03) konnten wir eine signifikante Abnahme der Aufenthaltsdauer beobachten (7,8 Tage für PERT und EKOS [5,2–13,2] vs. 12,9 Tage [7,1–22,1] in der Vergleichsgruppe, *p = 0,003). Darüber hinaus war auch der Aufenthalt auf der Intensivstation signifikant kürzer (PERT und EKOS 0,9 Tage [0,5–1,5] vs. 2,0 Tage [0,9–6,2] im Vergleichskollektiv, *p = 0,01). Durch die Abnahme der Behandlungsdauer könnten sich ökonomische Vorteile und positive Effekte auf Kapazitätsengpässe in Akutkrankenhäusern ergeben, was insbesondere in demografisch alternden Gesellschaften wie in Deutschland relevant ist.

Photoreceptor cells in the retina are highly specialized sensory cells that function as light receptors. During the conversion of light into neural signals, photoreceptors are constantly exposed to oxidative stress. Although environmental stressors, such as excessive light exposure, have been implicated in the progression of various retinal diseases, including dry age-related macular degeneration (AMD), the molecular mechanisms underlying the light-induced stress response remain incompletely elucidated. Excessive light exposure triggers the endoplasmic reticulum (ER) stress response in cells and also induces mitochondrial dysfunction characterized by depolarization and fragmentation, ultimately leading to cell death. We have shown that compounds derived from natural products, such as delphinidins and pentadecyl, exert protective effects against blue light-induced cellular damage. Furthermore, crocetin, a natural carotenoid pigment, has been shown to suppress ultraviolet-A (UV-A)-induced mitochondrial fragmentation in corneal epithelial cells. In this review, we provide an overview of light stress-induced injuries to intracellular membrane organelles, particularly mitochondria and the ER, and the cellular response mechanisms that are mediated through these organelles. These findings suggest that maintaining the homeostasis of intracellular membrane organelles represents an important therapeutic target for the prevention and treatment of retinal degenerative diseases.

Extracting knowledge from biomedical data is crucial for advancing our understanding of biological systems and developing novel therapeutics. The quantity, quality, and resolution of biomedical data constantly evolves, requiring the automation of biomedical machine learning (ML). Existing Automated ML tools lack flexibility, while large language models (LLMs) struggle to consistently deliver reproducible machine learning codebases, and existing LLM Agent-powered solutions lag behind human-engineered ML models. Here, we introduce Agentomics, an autonomous LLM-powered agentic system for end-to-end ML experimentation. Given a biomedical dataset, Agentomics implements various ML modeling strategies, and produces a ready-to-use ML model. Agentomics introduces strict validation checkpoints for standard ML development steps, allowing gradual development on top of working code with defined interfaces and validated artifacts. Further, it offers native support for biomedical foundation models that can be leveraged during experimentation. The generic nature of Agentomics allows the user to create ML solutions for a large variety of datasets and use various LLMs. We evaluate Agentomics across 20 datasets from the domains of Protein Engineering, Drug Discovery, and Regulatory Genomics. When benchmarked against other agentic systems, Agentomics outperformed them in all tested domains. When benchmarked against human expert solutions, Agentomics generated novel state-of-the-art models for 11/20 established benchmark datasets. Agentomics is implemented in Python. Source code and documentation are freely available at: https://github.com/BioGeMT/Agentomics-ML.

Plants are constantly challenged by environmental stressors, yet their sessile nature demands highly flexible developmental programs to maintain growth and survival. With the advent of single-cell technologies, developmental plasticity can now be dissected at cellular resolution. Two recent Populus studies show that both mechanical and drought stress induce xylem remodeling by shifting cell-type ratios or altering differentiation speed, while preserving the underlying developmental lineages. Highly similar patterns have been recently observed in Arabidopsis and cabbage, in which osmotic and salt stress alter the tempo of root hair differentiation without changing lineage identity. The recurrence of this developmental program across woody and herbaceous species, spanning distinct taxonomic orders, suggests that lineage-stable yet flexible stress responses are evolutionarily conserved in plants. Moreover, these insights were enabled by the application of advanced single-cell and spatially resolved approaches, with several of these studies incorporating single-cell/nucleus transcriptomics with spatial multi-omics analyses to link developmental dynamics with tissue context. This balance between flexibility and developmental order may represent a fundamental principle by which plants maintain resilience under diverse environmental challenges and may offer a valid framework for this field of study. 植物在生長過程中持續面臨各種環境逆境挑戰；然而，由於其固著性的生長特性，植物必須仰賴高度可塑性的發育調控，以維持生存與適應環境變化。隨著單細胞技術的快速發展，植物發育可塑性如今已能在單細胞層級被深入解析。近期兩篇以楊樹為研究對象的研究顯示，機械應力與乾旱逆境皆可透過改變細胞類型比例，或調節細胞分化速度，誘導木質部發育重塑；然而，這些變化仍維持既有的發育譜系結構。類似現象近期亦在阿拉伯芥與不結球白菜中被觀察到，分別顯示滲透壓與鹽逆境可改變根毛分化的發育節奏，但不改變其原有細胞譜系。此類現象同時出現在木本與草本植物中，且橫跨不同演化類群，顯示「維持細胞譜系穩定、同時保有發育可塑性」的逆境反應模式，為植物適應環境變化時的一種演化保守策略。此觀點的建立亦有賴於先進單細胞與空間解析技術的應用；透過結合單細胞/細胞核及空間轉錄體學，或是應用質譜多體學於獲取空間分子資訊，得以將發育動態與組織空間脈絡相互連結，進一步理解植物如何在逆境下維持發育進程與生長韌性。.

The lined sole, Achirus lineatus, is a widely distributed species in the Gulf of Mexico. This basin is constantly exposed to hydrocarbon contamination due to natural oil seeps, oil extraction and oil spills. Previous studies suggest the line sole A. lineatus as a possible sentinel species for oil spills; but the overall landscape of xenobiotic metabolism in this species remains poorly understood. Access to high-quality reference genomes will improve this situation. Here, we report the first whole-genome sequence, assembly, and annotation of the lined sole A. lineatus. We generated 132 Gb of PacBio High-Fidelity (HiFi) reads, which were filtered to retain 93 Gb of ultra-high-quality data. The assembly resulted in a mitogenome of 16,579 bp and a nuclear genome of 486.3 Mb distributed across 199 contigs, with a contig N50 of 9.87 Mb. Benchmarking Universal Single-Copy Orthologs (BUSCO) analysis based on the actinopterygii_odb10 database (3,640 orthologs) identified 3,611 (99.2%) complete BUSCOs. Genome annotation strategy resulted in the identification of 22,412 protein-coding genes with a high percentage (95.94%) of functional annotation. The genome of A. lineatus revealed 693 expanded and 3349 contracted gene families. We also identified 123 genes involved in the xenobiotics biodegradation and metabolism pathways, as well as neuroplasticity-related genes that may be associated with responses to environmental toxicants, providing baseline genomic information that suggests an integrated adaptive strategy involving both metabolic and nervous system processes. This assembly represents a valuable genomic resource for future toxicological and ecological studies of this species.

Drug resistance is a constantly evolving challenge. The allosteric inhibitor asciminib is a novel therapy for chronic myelogenous leukemia (CML) that targets the myristoyl pocket of the BCR::ABL1 kinase. While it can overcome resistance to active-site inhibitors like imatinib, new resistance mutations to asciminib are emerging. The complete landscape of these mutations, particularly those outside the kinase domain or those arising from epistatic interactions between mutations, are not well understood. This study employed a dual functional genomics approach in CML cell line models. A high-throughput adenosine base editing (ABE) screen was used to identify broad hotspots of asciminib resistance across the entire BCR::ABL1 protein. Deep mutational scanning (DMS) was then used to create a high-resolution map of all possible amino acid changes within these hotspots. An "edit-on-edit" screen was performed to investigate epistasis by introducing a library of mutations into a cell line that was pre-edited to incorporate the common imatinib-resistance mutation, Y253H. Finally, a novel Förster resonance energy transfer (FRET) biosensor was developed to measure the conformational state of BCR::ABL1 in live cells and link it to drug sensitivity. The screens identified 279 asciminib resistance mutations and revealed resistance hotspots distributed across the SH3, SH2, and kinase domains, in contrast to imatinib resistance, which is largely confined to the kinase domain. The study uncovered a potent epistatic interaction between a mutation in the SH3 domain (V73A) and a mutation in the kinase domain P-loop (Y253H), which synergistically conferred high-level resistance. The FRET biosensor demonstrated that asciminib resistance mutations tend to destabilize the "closed" inactive conformation of the ABL1 kinase. The landscape of asciminib resistance is broader and more complex than previously appreciated, involving mutations across multiple domains that disrupt ABL1 autoinhibition. Epistasis between mutations acquired during sequential therapies can create unexpected and potent resistance. However, these diverse genetic resistance mechanisms converge on a single biophysical measurement of the openness of the active ABL1 conformation. This provides a unified framework for understanding asciminib resistance and underscores the need for routine clinical resistance monitoring to include the SH3 and SH2 domains in first line and later line therapy.

Anterior cruciate ligament reconstruction is a constantly evolving procedure, and we continue to push the limits to improve outcomes for our patients. As rates of reinjury continue to be higher than we desire, we have consistently sought methods to improve postoperative outcomes and reduce the rates of revision surgeries. The rebirth of lateral extra-articular augmentation procedures has given us a strong tool to leverage to achieve these goals. It is essential that we continue to appreciate the price of this progress and fully understand the risks of augmenting our existing surgical techniques. Finding the optimal patients on whom to utilize these techniques is the key to balancing our success in this challenging patient population.

To identify latent profiles of change fatigue among nurses in Southwestern China and explore factors associated with distinct profiles. Healthcare resources in Southwestern China are unevenly distributed, and the region features considerable ethnic diversity. Against the backdrop of ongoing reforms in the healthcare system, nurses-as frontline implementers-are constantly exposed to intensive and frequent updates in policies, technologies, and workflows, making them susceptible to change fatigue. This sustained exposure precipitates "change fatigue," a syndrome that erodes psychological resilience and professional identity, and is prospectively linked to heightened turnover intention, measurable deterioration in nursing quality and an increased incidence of patient-safety events. From July to September 2025, we recruited nurses from various tiers and types of medical institutions across Southwestern China. Data were collected using a general information questionnaire, the Change-Related Stress Scale, the Grandey Emotional Labor Strategy Scale, the Connor-Davidson Resilience Scale (CD-RISC), and the Chinese Nurse Job Stressors Scale. Latent profile analysis (LPA) was employed to identify subgroups of change fatigue. Univariate analysis and multinomial logistic regression with Firth's penalized likelihood estimation were used to examine factors associated with profile membership. A total of 1383 valid questionnaires were included. LPA revealed three distinct profiles of change fatigue: low fatigue (17.5%, n&#x2009;=&#x2009;242), moderate fatigue (61.6%, n&#x2009;=&#x2009;852), and high fatigue (20.9%, n&#x2009;=&#x2009;289). Multinomial logistic regression showed that nurses in the high fatigue group were significantly more likely to work in the intensive care unit (OR&#x2009;=&#x2009;2.31, 95% CI: 1.40-3.85, p = 0.001) and internal medicine (OR&#x2009;=&#x2009;2.12, 95% CI: 1.26-3.61, p = 0.005). Working 1-2 night shifts per week increased odds of high fatigue by 53% (OR&#x2009;=&#x2009;1.53, 95% CI: 1.03-2.27, p = 0.034). Compared with minimal emotional labor (Level 1, 14-30 points), both moderate (Level 2, 31-50 points: OR&#x2009;=&#x2009;0.14, p = 0.030) and high (Level 3, 51-70 points: OR&#x2009;=&#x2009;0.09, p = 0.010) emotional labor levels were associated with significantly lower odds of high fatigue, suggesting that deficient emotional labor engagement may represent a risk configuration. Work stress Level 3 increased odds of high fatigue 33-fold (OR&#x2009;=&#x2009;32.71, 95% CI: 13.27-103.37, p < 0.001). Psychological resilience showed no independent significant association with profile membership in multivariate models. Change fatigue exhibits a heterogeneous tripartite structure. Minimal emotional labor engagement (Level 1) was associated with higher odds of high fatigue compared with moderate and high levels, suggesting that deficient emotional labor may represent a distinct risk configuration. Both modifiable workplace factors (ICU/internal medicine placement, night shifts, and job stress) and emotional labor patterns were associated with profile membership, supporting the potential value of organizational interventions and targeted emotional labor training. These findings provide an evidence-based foundation for precision prevention. Nursing leaders should integrate the six-item Change Fatigue Measurement Scale into routine occupational health surveillance to enable profile-based risk stratification. High-fatigue nurses (20.9%) require immediate workload relief and mental health referral; moderate-fatigue nurses (61.6%) represent a critical prevention window for resilience training and peer support; low-fatigue nurses (17.5%) should serve as peer mentors and change champions. Priority interventions should target ICU and internal medicine units given the 2- to 2.3-fold increased high-fatigue risk. Leaders should limit consecutive night duties to &#x2264;&#x2009;2 shifts, ensure &#x2265;&#x2009;11&#x2009;h rest between shifts, and enforce weekly overtime caps (&#x2264;&#x2009;8&#x2009;h). Differentiated emotional labor training is essential: Nurses with minimal engagement need professional identity strengthening and authentic expression workshops, while those with excessive engagement require boundary-setting training and mindfulness-based stress reduction. Resilience-building interventions must be embedded within organizational support initiatives rather than implemented as standalone programs. In ethnically diverse, resource-constrained contexts, culturally tailored change communications and phased implementation timelines are critical to avoid "reform stacking."

The number of unimodal molecule representation constantly increases, and researchers investigate how to combine them. Intuitively, multimodal representations may provide complementary information and combining them promises better performance. In this work, we systematically explore how combining multiple molecular modalities affects the performance of downstream prediction tasks, providing a baseline for informed decision making. Our study covers 7 molecular modalities and combines them using intermediate and late fusion, and 2 neural network architectures (with or without using knowledge graphs). We conduct experiments with 3 benchmarks for drug-target binding affinity, and 22 molecule property prediction. In total, we train and evaluate over 1400 models. In summary, our results show that combining multiple modalities improve the performance provided that effective fusion strategies are chosen. Knowledge-enhanced representation learning further boosts model performance. Notably, we find that even the use of simple late-fusion approaches establishes state-of-the-art results for some tasks.

The clinical dilemmas in this 6 year analysis, with this single woman in her 30s, (whom I saw mostly in candidacy), unfolded into a dramatic, yet simultaneously stalled analysis that remained intrapsychically frozen. My conceptualization of the interaction was of the patient and me as Echo and Narcissus. The best I felt I could do for her, and for the analysis, was to explore those dimensions - yet always the enactment seemed more of a self-exploration than a meaningful communication with her. I include some ideas of how I might proceed somewhat differently, many years later. The despair in the contact led me to a more empathic view of the yearning of Narcissus, which has classically been interpreted as his cruel failure to appreciate Echo's beauty and love for him, due to his self-absorbed love of himself. I introduce his deeper yearning as a constantly frustrated desire to contact the mind of the other. The punishment of Echo, reduced to echolalia, deprived her of an intercommunicative mind, except for a sound suggesting a craven dependency. This was frustratingly far from her intention too, and confined her to her physicality alone. Their stall led to emotional death. Did ours?

Novel psychoactive substances (NPS) are compounds emerging as alternatives to more established drugs of abuse. They are constantly changing and being modified, which makes their detection difficult. The study objective was to determine the prevalence of NPS in selected clinical specimens. Deidentified urine specimen remnants were analyzed that had previously been submitted for testing from six different regions in the United States and representing three different clinical categories: specimens submitted for smaller legacy LC-MS/MS NPS panels (ie, NPS-targeted, negative test results), immunoassay-positive but LC-MS/MS-negative traditional benzodiazepine and opiate specimens, and fentanyl/norfentanyl LC-MS/MS-positive specimens. A new, validated, large-panel LC-MS/MS method analyzed for 88 NPS including designer fentanyl analogs, designer benzodiazepines, designer opioids, designer stimulants and hallucinogens, synthetic cannabinoids, and other additives (e.g., xylazine). In total, 3753 deidentified remnant specimens were analyzed between March and July 2023 with 13.3% of specimens testing positive for &#x2265;1 NPS, with 30 different NPS detected; most of which were from the Eastern part of the United States. Xylazine was the most prevalent NPS and was detected in all regions and specimen categories, but the other analytes were not consistently observed across the six regions. In terms of specimen remnant categories, NPS positivity was 5.5% for the NPS-targeted specimens, 10.7% for opiate/benzodiazepine specimens, and 43.7% for fentanyl/norfentanyl specimens. Our data demonstrate variability in the NPS landscape and that testing for NPS in clinical urine specimens can help give clinicians a better awareness of drug misuse among their patients.

The collection and analysis of biological samples for DNA profiling have become indispensable tools in forensic investigations, facilitating both the incrimination and exoneration of individuals implicated in criminal activities. Every individual constantly release traces of their DNA into their surroundings, depositing genetic material in the environment. Recent advancements in DNA technology have enabled the detection and profiling of these trace samples containing minimal cellular material. These evidences expand the scope of forensic analysis to a new concept of environmental DNA (eDNA) which refers to genetic material recovered from environmental matrices such as water, soil, and air. While eDNA has traditionally been utilized in ecological contexts-such as non-invasive species monitoring and population genetics-its forensic applications are now garnering significant attention. Between 2005 and 14th February, 2026 different keyword searches in Google Scholar, Scopus and PubMed revealed that about 25% of eDNA studies focused on biodiversity, 27% on conservation, and only 10% on forensic applications-with a mere 0.08% dedicated to human eDNA. This review, therefore, concentrates on human eDNA analysis from environmental sources such as water, air, and soil, along with their downstream applications. The approach offers a promising, non-invasive avenue for collecting biological evidence, potentially transforming forensic investigation methods. At the same time where eDNA research grows, it must also address key legal and ethical issues such as consent, data ownership, and privacy. This review summarizes recent advances and future directions in forensic eDNA, emphasizing the need for strong ethical and regulatory frameworks for its responsible use.

New evidence relevant to the management of kidney disease is constantly being generated, underscoring the need for timely, rigorous, and trustworthy clinical practice guidelines that translate evidence into improved patient outcomes. The accelerating pace of innovation presents a challenge as well as an opportunity for rapid and seamless translation. This paper extends the work of earlier papers in the methodology series by describing the methods that Kidney Disease: Improving Global Outcomes (KDIGO) uses to prioritize topics and update existing guidelines and recommendations. Finally, we examine a living guideline framework, balancing the promise of more agile, up-to-date recommendations with the practical and methodological challenges inherent to continuous evidence integration.

The intestine, consisting of the small and large intestines, is a functional and immunologically active organ in which digestion, absorption, and defence are closely intertwined. Immediately following the stomach is the duodenum, where the food chyme comes into contact with pancreatic digestive juices and bile, enabling further nutrient breakdown. The primary function of the small intestine is the absorption of nutrients through the intestinal mucosa. The large intestine is responsible for the reabsorption of water and electrolytes and is home to a diverse microbiome, consisting of various microorganisms involved in the digestion of complex carbohydrates. This microbiome is constantly interacting with the intestinal immune system, maintaining a delicate balance between tolerance and immune activation. Disruption of this balance can lead to or contribute to various conditions, some of which are discussed in this overview. De darm, bestaande uit de dunne en dikke darm, is een functioneel en immunologisch actief orgaan waarin vertering, absorptie en afweer nauw met elkaar verweven zijn. Direct na de maag bevindt zich de twaalfvingerige darm, waar de voedselbrij in contact komt met verteringssappen van de alvleesklier en met gal, waardoor verdere afbraak van nutri&#xeb;nten mogelijk wordt. De primaire functie van de dunne darm is de opname van nutri&#xeb;nten via het darmslijmvlies. De dikke darm is verantwoordelijk voor de resorptie van water en elektrolyten en herbergt een uitgebreid microbioom, bestaande uit verschillende micro-organismen die betrokken zijn bij de vertering van complexe koolhydraten. Dit microbioom staat in voortdurende interactie met het afweersysteem van de darm, waarbij een delicate balans bestaat tussen tolerantie en immuunactivatie. Verstoring van deze balans kan leiden tot of bijdragen aan verschillende ziektebeelden met orale manifestaties waarvan een aantal in dit overzicht worden besproken.

Dear Readers, Welcome to this new issue of the International Maritime Health Magazine. Maritime medicine often advances not in times of stability but through the careful analysis of events that test existing systems. Whether we are managing a complicated medical repatriation, responding to an infectious disease outbreak, or striking a balance between clinical requirements and operational realities, dealing with a difficult situation will provide us with a lesson. This issue reflects that principle. An analysis of the outbreak onboard the MV Hondius included in this issue goes beyond the clinical aspects of infectious disease to examine the more general issues of operational decision-making, international coordination, communication, and public health responsibility at sea. Events such as this one remind us that, at times, the effectiveness of international frameworks depends not only on their existence, but also on how they perform under the pressures of real-world operations. This issue also marks the introduction of our new The Decision Deck section. The aim of this section is to encourage reflection and clinical reasoning, particularly in situations where decisions must be made with limited resources or conflicting operational priorities. In many respects, both the analysis of the MV Hondius and the case presented in The Decision Deck reflect the same principle: maritime medicine evolves through the continuous examination of difficult situations. Through this process of reflection and debate, our field continues to strengthen and adapt to a complex and constantly evolving maritime environment. We hope that this issue will foster an ongoing dialogue among the various disciplines that contribute to our maritime and hyperbaric medicine community.

Flooding is a recurrent and worsening public health threat in Indonesia, disproportionately affecting women and children in low-elevation urban areas. Pregnant and postpartum women in Indonesia experience unique physical and emotional burdens during floods, yet their lived experiences remain underexplored. Understanding how mothers adapt to recurrent flooding is critical for developing context-relevant interventions to improve maternal and child outcomes. This study aimed to explore (1) how recurrent flooding shapes the daily lived experiences and caregiving responsibilities of pregnant and postpartum women, (2) how flooding affects access to food, water, and healthcare, and (3) what community-informed interventions mothers identify as most impactful. We conducted a qualitative descriptive study using in-depth interviews with 20 women who gave birth within the past three years and reported prior flood experience in the Tallo District of Makassar. They were randomly selected from a mother-child cohort based out of Hasanuddin University. Sample size was determined by data saturation. Interviews were transcribed and translated from Makassarese into English. They were then coded and analyzed thematically using MAXQDA. Flooding occurs annually, with severity differing between years. Mothers bore primary responsibility for lifting furniture, protecting children, and cleaning contaminated homes. Recurrent floods disrupted food preparation and reduced meal variety. Floodwater contaminated government-owned piped water and borehole well water. Toilets overflowed and bathing was often skipped to conserve clean water. Prenatal and routine health visits were frequently postponed until floodwaters receded; however, many mothers reported wading through deep water to attend scheduled appointments. The distress of these burdens was worsened by lost income from disrupted work. Mothers identified food distribution, drain maintenance, and improved housing infrastructure as the most impactful interventions. These findings provide translatable insights for flood-prone coastal urban communities. Educating households about water preparation and implementing timely food staple distribution through existing community networks can reduce illness and hunger during flooding. Supporting neighborhood-based drainage maintenance and subsidizing incremental home elevation with locally available materials can address the burdens placed on mothers during flooding. Flooding is becoming more frequent and severe in many parts of the world, yet its effects on women&#x2019;s daily lives and health are often overlooked. This study explores how recurrent flooding impacts mothers and their families living in the Tallo subdistrict of Makassar, Indonesia, a flood-prone community.We conducted in-depth interviews with mothers and found that flooding was often seen as a normal part of life, even though it caused repeated damage to homes, belongings, and routines. Many women described how their houses flooded every year, forcing them to constantly clean, repair, and adapt their living spaces. These repeated disruptions created ongoing stress, worry, and exhaustion.Mothers carried most of the responsibility for preparing for floods and recovering afterward. This included moving furniture and food to higher ground, protecting children&#x2019;s belongings, cooking in unsafe conditions, and cleaning homes after floodwaters receded. During floods, families often struggled to access fresh food, clean water, toilets, and bathing facilities, increasing the risk of illness, especially for children.Flooding also made it harder for women to access healthcare, including prenatal and postpartum care. Some delayed or missed appointments, while others walked through floodwater despite fear of falling or harming their pregnancy. Mothers expressed strong concerns about keeping their children healthy and safe, particularly when floodwater was dirty or contaminated. Addressing flooding risks requires not only infrastructure improvements, but also greater attention to women&#x2019;s health, caregiving responsibilities, and access to essential services.