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The health effects of extreme heat have gained attention rapidly, as rising global temperatures cause more frequent and severe heat waves. More attention is needed, however, to the myriad pathways by which the financial and physical tolls of extreme heat are ultimately borne by the most disadvantaged members of society. These tolls include direct impacts on health and indirect impacts on income as costs incurred by industry, government, and other entities are passed on to individuals as increased prices or decreased earnings. Strained household finances in turn affect individuals' ability to pursue a healthy lifestyle and seek medical care. Existing research says little about transmission of these effects between individuals and organizations, however. We explore current evidence, identify gaps in this research, and recommend priorities for future work to promote more comprehensive understanding of the direct and indirect impacts of rising temperatures on health and financial well-being.
An amoebic liver abscess (ALA) caused by Entamoeba histolytica remains a significant cause of morbidity and mortality in tropical regions. Although hepatic rupture into adjacent thoracic structures is a recognised but rare complication, it can be fatal if undiagnosed or untreated. Hepatic abscesses can rupture and spread the infection to the thoracic cavity, resulting in the formation of a hepato-thoracic fistula, rarely. We report an autopsy case of a middle-aged female who died suddenly following nonspecific systemic symptoms. Postmortem examination revealed a large ALA that had ruptured through the diaphragm, leading to massive pleural empyema. This autopsy case report underscores the importance of early clinical suspicion, imaging, and surgical management to prevent such catastrophic outcomes.
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The US pays higher drug prices than do peer nations, thereby financing a disproportionate share of global pharmaceutical research and development. President Donald Trump has announced himself willing to do "whatever it takes" to compress, if not eliminate, the global disparity. In response, major drug firms have hurried to announce price reductions for at least some patients and some products. "Most favored nation" drug pricing as a formal policy faces many political and administrative challenges, but the threat has been effective in driving behavior change by pharmaceutical firms and payers in other nations. This Commentary takes the president seriously, if not literally. It describes the range of instruments available to the administration to pursue its price goals and assesses the tools' potential impact on the rate of investment and innovation in pharmaceuticals. Most favored nation pricing will reduce the revenues available to the industry for research and development, but its impact may be moderated by improved prioritizing of investments and improved efficiency in translating investments into innovation.
Erythropoietin (EPO) is essential for erythropoiesis, with production shifting from the foetal liver to the kidney after birth. This hepatic-to-renal transition is a hallmark of neonatal adaptation, but the relative contribution of oxygen exposure versus intrinsic developmental processes remains unclear. We studied plasma EPO isoform profiles in 89 neonates (developmental age 29-56 weeks; chronological age 1-92 days). Isoforms were classified as hepatic-like or renal-like based on isoelectric focusing patterns. Profiles were correlated with developmental and chronological age to assess the influence of oxygen exposure versus maturation. In parallel, human induced pluripotent stem cells (hiPSCs) were differentiated into liver organoids and cultured under hypoxic or normoxic conditions. Transcriptome and EPO mRNA expression were measured throughout differentiation to evaluate developmental and oxygen-dependent regulation. Neonatal EPO profiles shifted progressively from hepatic-like to renal-like with increasing developmental age. This transition was independent of time spent in atmospheric oxygen; preterm infants retained hepatic-like profiles for weeks after birth despite continuous oxygen exposure. In cellulo, immature hepatocytes expressed EPO robustly under hypoxia, but expression declined sharply as hepatocyte maturation advanced and was absent at later stages, regardless of oxygen tension. Maintaining the immature state of hepatic cells may be critical for responsiveness to hypoxia and for EPO production. These findings indicate that intrinsic hepatic maturation, rather than oxygenation, governs the silencing of hepatic-derived EPO after birth. Clarifying this process could support novel therapeutic strategies aimed at reactivating foetal-like hepatic EPO production to treat anaemia, particularly in preterm infants and in conditions associated with insufficient renal EPO production, such as chronic kidney disease. This study was mainly supported by the Région des Pays de la Loire, The French National Agency for Research (ANR), the Fonds Européen de Développement Régional Bourgogne Franche Comté, the Marie Skłodowska-Curie action, and the Fondation Génavie.
Worldwide, Road Traffic Accidents (RTAs) are the 8th leading cause of death, and leading killer of children and young adults. An additional 50 million people are seriously injured annually. We argue here that RTAs are also a leading - although rarely acknowledged - cause of preventable disability in low and middle-income countries. The Road Traffic Safety community pays little attention to people disabled in an RTA once they leave medical or rehabilitative care. Disability policy, advocacy and research groups rarely consider people disabled in RTAs as a discrete subgroup within the disability community. Furthermore, the costs and consequences of RTA-related disability are greatly underestimated. A scoping review and interviews with prominent road traffic safety and disability experts identified major conceptual gaps between the fields of Road Traffic Safety and Disability, including how people disabled in RTAs are identified, followed and provided with needed services and support. The current lack of 'joined up' thinking around those who survive an RTA with a disability represents a lost opportunity to more systemically address this major global health concern.
PICK charts are Lean Six Sigma tools used to prioritize improvements based on effort required and potential impact. Our purpose was to conduct PICK chart prioritization exercises with a low income, diverse community advisory group to identify and prioritize patient and community centered interventions to reduce mammography screening disparities. Community advisory focus group was composed of 22 adults from low-income neighborhoods in Madison, Wisconsin. Included participants were from the Wisconsin Network for Research Support Community Advisory on Research Design and Strategies, recruited from community centers and food banks that serve individuals from diverse racial, socioeconomic, and educational backgrounds. Structured, divergent thinking brainstorming sessions were conducted to identify interventions to improve the mammography screening process. The idea generation process revealed 52 unique ideas across 7 process map domains. Among participants, the most highly cited ideas that were classified as high impact, low effort ideas included: reminders, sharing positive stories about mammography experiences, offering reassurance during mammograms, and reducing co-pays. Community centered prioritization exercises identify patient-centered, contextually relevant interventions to improve cancer screening percentages in medically underserved patient populations, including high-quality, patient centered communication about the mammography screening process and reduced costs.
This study provides a systematic review of research hotspots and trends in the field of parent-child reading, covering the period from 2005 to 2024, based on data retrieved from the China National Knowledge Infrastructure (CNKI) and the Web of Science (WOS). The results indicate that both Chinese- and English-context research on parent-child reading focus on the family literacy environment, the impact of parent-child reading on child development, social support systems, and educational equity. Chinese research places greater emphasis on family reading, family-kindergarten collaboration, and father involvement. This research mainly examines parental guidance strategies and pays particular attention to current practices, especially in rural areas. It highlights the role of fathers in reading, with picture books being the most commonly used reading materials. In contrast, English-context research focuses more on language development and early literacy, with particular emphasis on the development of children's literacy skills and school readiness. Greater attention is also given to multicultural and minority groups, the role of mothers in reading is more frequently emphasized, and the reading materials are predominantly storybooks and wordless books. Research in both Chinese and English contexts reveals that parent-child reading interactions serve as a channel for the transmission of cultural values, leading to distinct developmental priorities for children. These differences profoundly reflect the systematic influence of sociocultural logics on parental reading behaviors and related research. This analysis provides an empirical foundation for future international collaboration in cross-cultural research.
Liver diseases, including hepatocellular carcinoma (HCC), non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease (ALD), impose a significant global health burden, with over 2 million deaths annually and substantial economic losses. Current treatments, primarily pharmacological, face challenges such as insufficient efficacy, poor absorption, and drug resistance. The liver-gut axis, a critical pathway linking the liver and intestines, offers a therapeutic target for these diseases. Engineered live bacteria, modified through genetic engineering and synthetic biology, have emerged as a promising alternative. These bacteria can be designed to deliver therapeutic agents directly to the liver or gut, enhancing efficacy and reducing systemic side effects. This review explores the application of engineered live bacteria in treating liver diseases, focusing on strains such as Bifidobacterium, Escherichia coli Nissle 1917 (EcN), Bacillus subtilis (B. subtilis), Saccharomyces boulardii (S. boulardii), and Lactobacillus reuteri (L. reuteri). It also pays attention to the internal genetic modification and external covalent connection of the original live bacteria. We discuss the design of dosage forms, including capsule formulations, microencapsulation, and nanopreparations, and administration methods like oral and in situ injection. Additionally, we address the challenges and future prospects of using engineered live bacteria to target liver diseases and related conditions, aiming to advance their clinical application and reduce the global burden of liver diseases.
South Korean policymakers are weighing tobacco control and financing options amid rising health-care costs. This study estimates the direct medical expenditure attributable to active and second-hand smoking (SHS) using Korea's National Health Insurance Service (NHIS) claims data (2014-2024) and quantifies the fiscal burden borne by the public insurer vs. households. Annual NHIS claims data for all beneficiaries for the period 2014-2024 were linked with disease-specific Population Attributable Fractions (PAFs) derived from the Global Burden of Disease (GBD) study. Costs were stratified by sex, age, income group, and payer (NHIS vs. out-of-pocket) and expressed in 2024 US dollars. Smoking-attributable medical spending totaled USD 29.86 billion over the period from 2014 to 2024. In 2024 alone, costs reached USD 3.38 billion, representing 19.7% of expenditure for the analyzed conditions and approximately 4.0% of national health expenditure. The fiscal burden was shared between the public insurers (82.5%) and households (17.5% out-of-pocket). Costs were highest among men (80.1%) and adults aged 50-79 (80.7%), reflecting a "lagged epidemic" driven by historical exposure. The top 10 conditions accounted for 88.2% of total smoking-attributable spending, with cancers absorbing 35.2% and cardiometabolic diseases absorbing 53.1%. Costs for men were driven by active smoking (∼90%), while costs for women were largely attributable to SHS, which accounted for 48% of their total costs compared to 9% for men. Past smoking choices of South Koreans have left a legacy of current medical costs that many non-smokers are now facing. Women and men who never chose to smoke are succumbing to illness due to SHS which accounts for 16.5% of overall costs. New generations of workers must bear these costs through taxation and premiums to finance South Korea's health care system. The current decline in smoking prevalence is insufficient to arrest the rising financial momentum of historical exposure. These findings provide evidence for a way out of the cycle by correcting prices of tobacco to include the social costs. A polluter-pays framework would recover public health expenditures and deter new generations from imposing consequences of their personal choices on others. None.
The United States pays some of the highest prices for prescription drugs in the world, with drug prices and overall spending increasing year-over-year. Ballooning prescription drug costs can result in low rates of medication adherence, negatively affecting public health and straining national health care systems and resources. The 340B Drug Pricing Program (340B Program), which allows health care safety-net settings to purchase prescription drugs at deep discounts, has long sought to function as a bulwark against increasing drug prices for institutions serving those most vulnerable in society. Savings from the program have facilitated expanded access to health care services for low-income and uninsured patients. However, shortcomings in the program's design, implementation, and oversight obscure to what degree low-income and uninsured patients are realizing program benefits and create incentives for institutions to undertake profit-seeking behaviors at the expense of patients. To strengthen the 340B Program and ensure it is best serving its intended audience, reforms are needed within the program to promote transparency in how drug savings are reinvested into patient care and mandate demonstrated benefit to low-income and uninsured populations. Access to contract pharmacies-that is, the specialty or community-based pharmacies that 340B Program "covered entities" have an agreement with to distribute medications to patients-should be preserved, with appropriate guardrails to prevent unauthorized diversion. Federal regulators should be empowered with the resources and clear statutory authority necessary to engage in meaningful oversight of all program participants.
Noise-induced hearing Loss (NIHL) is a major public health issue, especially in areas of conflict where civilians are exposed to acute and prolonged loud noise from, for example, sonic booms and explosions. A lot of civilians in Lebanon suffered from severe auditory trauma during the 2024 war. Although there have been a few instruments for the assessment of NIHL, none had been previously culturally adapted and validated into Arabic. The study aimed to test the psychometric properties of the Arabic version of the Noise-Induced Hearing Loss-Symptoms (NIHL-S) Scale in a Lebanese population experiencing noise pollution due to war activity. Lebanese individuals (N = 536, average age = 27.29 ± 11.79 years) exposed to loud blasts during the 2024 Lebanese responded to a self-administered online survey. NIHL-S was translated by forward-backward translation methodology and was culturally adapted. A one-factor model of the Arabic NIHL-S was supported by CFA (χ²/df = 4.01; RMSEA = 0.075; CFI = 0.931; TLI = 0.911). Internal reliability was acceptable (ω = 0.85; α = 0.85). Configural, metric, and scalar measurements invariance across sex were established. No significant gender differences were found for NIHL-S scores (p = 0.726). Moreover, there were significant positive correlations between NIHL-S scores and stress (r =  0.10; p = 0.027) and Patient Health Questionnaire-4 scores (r = 0.35; p < 0.001). The Arabic version of the NIHL-S has good psychometric properties, indicating that it is a reliable and valid tool to be used to screen for NIHL symptoms in Arabic-speaking populations subjected to war-related noise exposure. Its presence addresses a crucial need for clinical practice and research in conflict settings.
Microbial mercury (Hg) methylation drives the formation of methylmercury (MeHg) hotspots in natural environments, but the cellular pathways that determine MeHg fate and isotopic signatures remain largely unresolved. In this study, we cultured the model sulfate-reducing bacterium Pseudodesulfovibrio hydrargyri BerOc1 anaerobically under fumarate respiration for 30 h and quantified Hg speciation and fraction- and species-specific Hg isotopic compositions. The results showed that intracellular MeHg was rapidly exported and dominated the extracellular pool by 30 h (> 80%). Exported MeHg bound to specific bioligands across size fractions, likely associated with its export mechanisms. Mass-dependent Hg isotope fractionation revealed temporal shifts in extracellular MeHg isotopic signatures (δ202HgMeHg= -1.10‰ to -0.82‰, 4-30 h), suggesting demethylation of bioligand-bound MeHg upon export. This isotopic observation refines previously reported suppressed mass-dependent fractionation signatures of MeHg in bulk bacterial cultures. Our results demonstrate that bacterially produced MeHg is rapidly exported from cells, potentially bound to specific biomolecules, and subsequently undergoes extracellular demethylation, thereby shaping aqueous MeHg isotopic signatures. These findings provide insight into the key factors that govern MeHg fate and accumulation during bacterial Hg methylation in aquatic ecosystems.
Yersinopine, a nicotianamine-like metallophore, was recently identified through biochemical analyses, but its in vivo production and functional role remain uncharacterized. In Yersinia pseudotuberculosis and its recent descendant Yersinia pestis, the cnt operon (cntPQRLMI) putatively encodes the biosynthesis and transport of yersinopine. In Y. pestis, however, two frameshift mutations disrupt cntQ, which encodes the predicted permease for yersinopine-metal complexes. This pseudogenization raises critical questions about the functional relevance of yersinopine in these closely related species. Here, we show that cnt operon expression is repressed by the zinc uptake regulator Zur and that both Y. pestis and Y. pseudotuberculosis secrete yersinopine under zinc-limited conditions. Unexpectedly, the operon mediates iron uptake in Y. pseudotuberculosis but supports zinc acquisition in Y. pestis. Moreover, targeted disruption of cntQ in Y. pseudotuberculosis shifts metal specificity from iron to zinc, mimicking the Y. pestis phenotype. Collectively, our results suggest that a single pseudogenization event could rewire metal uptake specificity. Our findings illustrate how evolutionary genome reduction can reshape bacterial physiology.
Carbon nanostructures (e.g., graphene, CNTs, MXenes) offer high strength and conductivity but suffer from severe agglomeration, instability, and complex synthesis, which hinder their scalable assembly into robust carbon networks. Meanwhile, the current methods for constructing nano carbon-mesh (NCM) show enormous limitations, e.g., complex processes and enormous energy consumption, etc., making it difficult to achieve green, low-carbon, and large-scale applications. Here, an efficient NCM preparation method of hydro-cage de-shielding strategy to implement instantaneous carbonization-polymerization was conceptualized. During the initial stage of hot-pressing, cellulose-based film (CF) carbonized into quasi-spherical carbonized polymer dots (CPDs), where the system is containing enormous water, existed hydro-cage shielding effect, which formed a huge barrier between CPDs, preventing CPDs from further polymerization. As the hot-pressing progresses, water continuously evaporated or transformed from the free water state to the bound water state, the hydro-cage shielding effect gradually weakened, the system formed a core of CPDs and further underwent polymerization and growth through its surface functional groups, gradually forming NCM similar to a dragonfly's wing with excellent toughness and load-bearing capacity. As a result, the final NCM-plywood achieved a wet shear strength of 1.24 ± 0.05 MPa under 63°C, exceeding the Class II plywood requirement (≥ 0.7 MPa).
The synthesis of colloidal imine-linked Covalent Organic Framework nanoparticles using a polymeric growth-blocking agent that facilitates both in situ colloidal stabilization and size control. This new surfactant-free method, called Self-Assembly-Induced Colloidal Covalent Organic Frameworks (SAI2COF), is inspired by Polymerization-Induced Self-Assembly (PISA), largely used to generate colloidal emulsions. The optimized formulation, I-COF-Poly-0.5, shows excellent colloidal stability in aqueous media under neutral and acidic conditions, along with enhanced light absorption and π-conjugation. Photocatalytic hydrogen evolution demonstrates that I-COF-Poly-0.5 is an efficient light-driven catalyst for at least 24 h, with performance strongly influenced by the sacrificial electron donor (SED), photocatalyst concentration, and metal cocatalyst. Sodium ascorbate is identified as the most effective SED for sustained H2 production, whereas triethanolamine induces rapid deactivation. An optimal COF concentration of 0.1 g L-1 provides the best balance between light penetration and catalytic efficiency. Among tested cocatalysts, platinum salts (H2PtCl6, K2PtCl6) significantly outperform AgNO3, which forms less active silver nanoparticles. Single-particle induced coupled plasma mass spectrometry confirms the formation of hybrid colloidal COF particles containing in situ photo-generated metal nanoparticles. Overall, this surfactant-free approach affords stable, dispersed COF photocatalysts for clean hydrogen production over 24 h without aggregation and paves the way for further optimization.
Acute otitis media (AOM) is associated with the development of permanent sensorineural hearing loss (SNHL). The potential role of steroids in preventing cochlear damage secondary to AOM has been discussed. To critically analyze the current evidence on the use of steroids to prevent AOM-associated SNHL. A total of 15 studies was categorized into 3 groups: 1) studies on histopathological changes in the inner ear secondary to AOM (n 5); 2) those on the relationship between AOM and hearing outcomes (n = 5); and 3) studies on the (hearing or histological) outcomes of AOM treatment using steroids (n = 5). Experimental studies in animals and human temporal bones revealed that AOM is associated with the upregulation of proinflammatory cytokines in the middle and inner ears, resulting in an inflammatory process. Inflammatory cytokines and bacterial toxins translocate from the middle to the inner ears through the semipermeable round window membrane, causing structural damage to the neuroepithelium, mainly in the cochlear basal turn. In experimental studies, the use of steroids has been shown to reduce the expression of inflammatory cells and cytokines and the structural damage affecting the stria vascularis and hair cells. One study clinically evaluated the effects of steroids on AOM patients with SNHL, and it demonstrated significant improvements in hearing thresholds. Experimental data demonstrate that steroids can reduce the expression of inflammatory cytokines and reduce structural damage to the cochlear neurosensory epithelium. However, these findings have yet to be translated to a clinical setting due to the lack of high-level evidence.
The structural, electronic, and magnetic properties of the KCrF3 perovskite have been investigated using an all-electron Gaussian-type basis set and various functionals, including full-range and range-separated hybrids, as implemented in the crystal code. Structural optimizations were performed by imposing tetragonal (I4/mcm) and monoclinic (I112/m) space-group symmetries, corresponding to the experimentally observed phases above and below 250 K, respectively. Three AFM arrangements were considered and compared with the FM one: the AFMA phase (spin inversion between first-neighbor Cr ions along the c-axis) is more stable than the FM phase, in agreement with experimental evidence. The monoclinic I112/m structure is energetically favored over the tetragonal I4/mcm phase by 5.9 meV per transition-metal ion with the B3LYP functional, and by 3.4 meV when using PBE0 or HSE06. This small energy difference is associated with only minor changes in structural and electronic properties, including a slight volume contraction (-0.4%) and increase in the band gap (+2%). Mulliken population analysis indicates a Cr d-shell occupation of 3.907 |e|, which is very close to the formal d4 configuration. Nearly exactly three electrons populate the t2g manifold (0.974 |e| each), while the remaining electron is distributed between the dz2 (0.360 |e|) and dx2-y2 (0.624 |e|) orbitals. Spin-density maps clearly show the orbital ordering within the ab plane and provide insight into the stabilization mechanism of the AFMA phase, which is mediated by the polarization of the fluorine valence shell.
Eating disorders (ED) are disabling conditions increasingly conceptualized as addictive disorders. While food addiction (FA) is well documented in bulimia nervosa (BN) and binge-eating disorder (BED), its mechanisms in anorexia nervosa (AN) remain unclear. The triadic model of addiction-encompassing reflexive, affective, and interoceptive systems-offers a relevant framework to investigate FA across EDs. The current study aimed to test to what extent these three components of addiction contribute to FA in patients with ED. The sample included 115 patients (mean age = 28.41 years, SD = 11.64; 91% female) diagnosed with either AN (restrictive: n = 38; binge-eating/purging type: n = 32), BN (n = 29), or BED (n = 16). Participants completed the Emotional Appetite Questionnaire, the interoceptive subscale of the Eating Disorder Inventory-2, the Detail and Flexibility Questionnaire, and the Yale Food Addiction Scale 2.0. In the present analyses, FA was operationalized using the continuous total score reflecting FA symptom severity. Additional analyses using the symptom-count and diagnostic scoring procedures yielded comparable results. Linear and multinomial logistic regressions were used to test the associations between FA and the three systems, and their ability to distinguish diagnostic groups. When considered separately, interoceptive difficulties (r = .54), negative emotions (r = .47), and cognitive inflexibility (r = .33) were all associated with higher FA (all ps < 0.001). However, in the joint model, only interoception (β = 0.39, p < .001) and negative emotions (β = 0.33, p = .005) remained significant predictors, whereas cognitive flexibility had no significant effect. These effects did not differ significantly between diagnostic groups. The affective system predicted diagnostic (χ²(3) = 21.78, p < .001), but the effect was inconsistent and the overall predictive value was modest (McFadden's R² = 0.11, classification accuracy = 50%). Interoceptive and affective systems appear to significantly predict FA across various ED; the reflexive system, as currently measured, seems to play a more limited role. These results highlight the need for more sensitive assessment tools and refined models of ED-related addictive dimensions. Trial Registration NCT03160443, first post 2017-05-03. Management and care for eating disorders (ED) remain difficult, and the success rate for anorexia nervosa remains low. One of the reasons given for this difficulty is the substantial variability in the profile of individuals. Therefore, a major challenge is to better characterize these disorders. A growing body of evidence points toward addictive behavior patterns among patients with eating disorders, encouraging further research to explore how psychological and cognitive processes involved in addictive behaviors can influence ED behaviors. In this perspective, the current study tested, in a population of 115 patients with ED, a triadic model that is increasingly used to help understand addictive processes. The aim was to understand the articulation between the cognitive control, emotional, and interoceptive systems. The findings showed that interoceptive and emotional difficulties are the strongest and most consistent predictors of food addiction. By contrast, cognitive flexibility did not retain predictive value when these factors were accounted for. Moreover, the model’s ability to differentiate diagnostic categories was limited, further supporting a transdiagnostic perspective. These results reinforce the hypothesis that processes involved in addictive behaviors can be central to ED and suggest the need to refine both our conceptual frameworks and assessment tools. This work can be seen as preliminary groundwork for future longitudinal and transdiagnostic studies investigating the triadic model in ED.
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