Young people around the world are threatened by increasing chaos and danger from armed conflicts, natural disasters, climate change, forced displacement, disease epidemics, and related adversities. This perilous situation raises a critical question: Are we doing enough to protect and prepare young people to adapt and thrive? Developmental research on risk and resilience suggests that the answer to this question is no, but there is considerable evidence to guide practice and policy going forward. Both reducing risk and bolstering resilience are essential strategies for promoting positive outcomes in a generation of young people contending with rising global chaos. Moreover, evidence suggests that the resilience of children depends on the operations and interactions of many systems within and around them that are amenable to change. These include neurobiological and psychological adaptive systems and supportive relationships, as well as safe and effective schools and communities. Building resilience for the younger generation is an investment in the future resilience of societies.
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Hydrophilic polymer embolism (HPE) is a rare complication of endovascular procedures caused by embolization of polymer coatings from vascular devices. We report a 72-year-old man with peripheral artery disease, diabetes, and chronic kidney disease who developed painful, nonhealing lower-extremity ulcers presenting shortly after vascular stenting. Initial biopsies and an extensive infectious and autoimmune workup were nondiagnostic, and the patient failed treatment for presumed pyoderma gangrenosum. Repeat biopsies later revealed amorphous blue material in dermal vessels, highlighted by Alcian blue staining, confirming HPE. Despite treatment with pentoxifylline and wound care, disease progression led to bilateral below-the-knee amputations. This case highlights the diagnostic challenge of HPE, which can present months after endovascular intervention and mimic other ulcerative disorders. Histologic findings are subtle, and early coordination with dermatopathology is key. Clinicians should maintain high suspicion for HPE in patients with unexplained ulcers and vascular procedure history, as early recognition may reduce morbidity. A temporal association between endovascular procedures and rapid onset of nonhealing ulcerations should raise suspicion for iatrogenic embolic phenomena. Early recognition of hydrophilic polymer embolism (HPE) is essential to avoid inappropriate treatment and reduce the risk of severe outcomes such as limb loss.Initial misdiagnosis of pyoderma gangrenosum led to prolonged, ineffective immunosuppressive therapy.HPE can mimic neutrophilic dermatoses both clinically and histologically, highlighting the need for repeat biopsy and special stains when ulcers do not respond to standard treatments.The histopathologic hallmark of HPE is amorphous Alcian blue-positive material within dermal vessels.
Hepatitis A, a highly contagious and perilous viral liver infection, is globally widespread, with its data collected across spatial and temporal domains. Also, demographic and socioeconomic covariates, such as population density and per capita income, are gathered over space and time units. As a result, the association between infectious disease outcomes and risk factors may differ across space and time. Some sub-regions may have a heterogeneous association with others, while a homogeneous temporal structure may exist within certain sub-regions. Acknowledging the potential variability in these associations, this study focused on comprehending the spatio-temporal dynamics of hepatitis A through a statistical model. In this paper, we analyzed monthly hepatitis A infection counts in the Republic of Korea from January 2020 to December 2021 using a Bayesian spatio-temporal model. Specifically, we employed a Bayesian spatially-clustered coefficient model with temporal structures to estimate sub-regions with the temporally varying risk effects associated with hepatitis A. Our focus lies in utilizing the Bayesian spatio-temporal model to uncover insights into the spatio-temporally varying relationships between covariates and hepatitis A outcomes. Furthermore, we addressed the spatial confounding bias prevalent in common spatial models with space-time random components by incorporating two-stage framework within our analysis.
Wireless Sensor Networks (WSNs) play a perilous role in the IoT environment and other applications, where reliable sensing and timely fault diagnosis are essential for system stability. However, fault behavior in WSNs is inherently complex because of the coexistence of multiple fault types, their spatial propagation across the network topology, temporal evolution over time, and varying levels of severity. Existing fault diagnosis approaches largely focus on binary or single-fault detection and fail to jointly model network topology, long-range temporal dependencies, class imbalance, and fault severity estimation. To address these limitations, this study proposes a GNN-Transformer, a dual-stream Graph Neural Network-Transformer framework for multi-fault classification and severity-aware fault diagnosis in WSNs. The proposed model integrates a GNN stream to capture spatial correlations and fault propagation among neighbouring sensor nodes, and a Transformer-based temporal stream to model long-term temporal dependencies in multivariate temperature-humidity sensor data. To mitigate the severe class imbalance intrinsic in real-world WSN datasets, Conditional Tabular Generative Adversarial Network (CTGAN) is employed to generate realistic minority fault samples, which are further enhanced using SMOTE and Borderline SMOTE techniques. A graph-temporal fusion module with attention-based multi-scale aggregation adaptively combines spatial and temporal representations for robust fault characterization. The proposed GNN-Transformer achieves 86.79% accuracy and an F1-score of 87.1% for multi-fault classification, along with a 62.4% F1-score for fault severity estimation. These results confirm the effectiveness of the proposed topology-aware, severity-conscious framework for reliable and scalable fault diagnosis (FD) in WSNs.
Unaccompanied immigrant children (UIC) are minors under 18 who arrive alone in the United States, often after experiencing cumulative trauma related to premigration adversity, family separation, and perilous journeys. These exposures increase risk for abuse, neglect, trafficking, and adverse physical and mental health outcomes. Trauma-informed care (TIC) offers an evidence-based, child-centered framework for nursing practice across the migration continuum by promoting safety, preventing retraumatization, and supporting continuity of care. Policies must prioritize children's best interests while equipping nurses, health professionals, and Customs and Border Protection personnel to deliver developmentally appropriate, compassionate care during screening, entry, release, and resettlement. An urgent, ethical, trauma-informed policy response is needed to safeguard UIC well-being. Providing TIC to UIC is both a moral imperative and a strategic investment in health equity and national well-being. The American Academy of Nursing supports integrating TIC across UIC services and minimizing detention to improve health outcomes.
Spinal cord maladies occupy a uniquely perilous corner of emergency medicine. The challenge is that spinal cord pathologies often present subtly, with nonspecific and evolving symptoms such as atraumatic back pain, urinary retention, minimal leg weakness, or imbalance, all of which can easily be dismissed or attributed to an alternative diagnosis at initial presentation. Because early symptoms are often not pronounced or yet definitive, it is essential to recognize deviations from expected patterns of more benign disease, perform detailed history and physical examination, and act on atypical findings to minimize diagnostic errors.
The transition from an immature oocyte to a normally fertilized zygote is a perilous bridge between gamete and embryo life. Failure can occur during oocyte maturation or in the multiple steps required for fertilization. In assisted reproduction cycles, a proportion of retrieved oocytes are found at the prophase I or metaphase I (MI) stages. These oocytes can be cultured in the attempt to assist the progression to metaphase II (MII) stage, and therefore achievement of meiotic maturation, in vitro. However, the absence of robust culture systems considerably limits the rates of oocyte maturation in vitro and the full acquisition of developmental potential of rescued oocytes. Developmental failure can also occur during the sperm-oocyte interactions that lead to the formation of the zygote. Fertilization can fail entirely; in such cases failed fertilized oocytes can be treated by ICSI during the first 24 hours from the initial insemination. Fertilization and developmental rates of re-inseminated oocytes are sub-optimal, but clinically significant outcome rates can be achieved. Fertilization can also occur atypically, generating - not bipronuclear (2PN) - but monopronuclear (1PN) and tripronuclear (3PN) zygotes. Especially 1PN zygotes, if capable to develop to the blastocyst stage, have notable chances to be biparental diploid. Therefore, They can be cultured at the blastocyst stage and, ideally, undergo chromosomal testing to assess their suitability for clinical use. This range of possibilities for oocyte and zygote rescue are attracting increasing interest, especially for the treatment of cases in which one extra embryo can have a significant impact on clinical outcome.
Coral reefs face a perilous future due to global climate change compounded by the increasing prevalence of local stressors. Prominent among these is nutrient pollution, particularly nitrate eutrophication, which disrupts the coral-algal symbiosis and escalates reef degradation. While microbial denitrification is hypothesized to mitigate nitrate stress, the mechanisms underlying coral resilience remain unknown. Studying Hong Kong's coral "reef oases" that persist under chronic hyper-eutrophication, we discovered that resilience is not mediated by diversity or abundance shifts in denitrifier genera but by the association with specific, hyper-efficient denitrifying populations within the dominant denitrifier genus Ruegeria. By integrating population genomics, subspecies-resolution metabarcoding (resolving both the entire Ruegeria community and the denitrifying sub-community), and direct isotope-based activity assays, we identified and validated putative denitrifying "specialist" populations. These specialists were significantly enriched in corals from high-nitrate waters and exhibited 10-fold higher denitrification rates in low-oxygen incubations, converting nitrate to inert N2 with superior efficiency compared to non-specialists. Our findings reveal that critical ecosystem-scale adaptations to anthropogenic change can occur through a unique association with specialized sub-genus populations, which may be missed in conventional microbiome surveys. As such, our work sheds light into why dominant denitrifying genera are ubiquitous, yet only certain corals thrive in eutrophic conditions. It also provides a framework for future studies delineating ecologically important host-associated microbes.
Cryptosporidium parvum is a water and foodborne apicomplexan pathogen that vigorously disrupts host signaling networks to enable intracellular colonization. However, the parasite-encoded effectors responsible for this modulation and the specific host signaling cascades they involve is still unexplored. In this study, we identify CpCML, a calmodulin-like protein encoded by C. parvum, as a perilous virulence effector that modulates host PI3K-NF-κB signaling and autophagic flux through direct interaction with the host protein SUGT1. Biochemical and cellular analyses reveal that CpCML binds SUGT1 with high specificity, inducing its redistribution from the cytoplasm to the nucleus, a shift that fundamentally reprograms host signaling, and thereby promoting nuclear enrichment. Expression of CpCML enhances phosphorylation of AKT and subsequent activation of NF-κB without changing total NF-κB or AKT protein levels, indicative of post-translational modulation of signaling activity rather than changes in protein expression. Inhibition of PI3K abrogates CpCML-induced NF-κB activation and autophagy-related responses, establishing a functional dependency of these outcomes on PI3K signaling. Mechanistic dissection further reveals that SUGT1 serves as a pivotal node: siRNA-mediated depletion of SUGT1 assists NF-κB activation and promotes the accumulation of autophagy-associated markers (LC3-II and p62), indicative of impaired autophagic flux, which in turn helps intracellular parasite survival; on the contrary, SUGT1 overexpression restores autophagic flux and significantly diminishes parasite burden. Together, these findings outline a CpCML-SUGT1-PI3K-NF-κB signaling axis that integrates host signaling and autophagy responses during C. parvum infection, presents a mechanistic framework for understanding how this obligate intracellular parasite preserved conserved cellular pathways to confirm its survival and replication.
Methotrexate (MTX) is a pivotal chemotherapeutic drug which is also used to treat serious chronic inflammatory disorders. However, it causes perilous pulmonary injury. This study aimed to explore the protective effects of CGA and ω-3 on MTX-induced pulmonary toxicity in rats via modulation of SIRT1/PGC-1α/ NF-κB signaling axis. Twenty-four male Sprague-Dawley rats were randomly divided into four groups; normal, MTX, MTX + CGA, and MTX + ω-3, rats were injected with MTX single dose intraperitoneally (20 mg/kg) followed by an oral administration of CGA (100 mg/kg) or ω-3 (400 mg/kg) for seven days. Both CGA and ω-3 relieved MTX-induced-pulmonary histopathological changes by decreasing alveolar epithelial loss and inflammatory cell infiltration. Also, CGA and ω-3 markedly ameliorated the oxidative stress by lowering pulmonary MDA content along with significant increment in pulmonary GSH content. Moreover, both CGA and ω-3 suppressed pulmonary inflammation as proved by marked lowering of serum CRP level via downregulation of pulmonary NF-κB, TNF-α and MPO levels along with upregulation of pulmonary SIRT1/PGC-1α expression and IL-10 level. Additionally, the antioxidant and anti-inflammatory activities of CGA and ω-3 promote pulmonary Bcl-2 expression and inhibit pulmonary caspase 3 expression which in turn suppress apoptotic cell death in the lungs of MTX-intoxicated rats. These protective effects of CGA and ω-3 suggest the potentiality of using them in conjunction with MTX treatment protocols to diminish their undesirable lung toxicity.
The transition from hospital to home represents a critical and often perilous period for preterm infants. Inadequate discharge preparation frequently leads to adverse outcomes and preventable readmissions. This study aimed to develop and evaluate a robust management indicator system to standardize and enhance the quality of transitional care for this vulnerable population. A sequential multiphase study was conducted, beginning with a systematic literature review to establish a preliminary indicator pool. A two-round Delphi survey involving 21 neonatal care experts was then used to refine the indicators and achieve consensus. Finally, the analytic hierarchy process (AHP) was employed to determine the relative weight of each indicator. The response rate for both Delphi rounds was 100%. The expert consensus reliability (Cr) was 0.967 and 0.964 for the two rounds, respectively, with consensus scores (Cs) of 0.971 for both. Kendall's W coefficients were 0.385 and 0.187 (both p < 0.05), indicating statistically significant agreement among experts across both rounds. The finalized management indicator system comprises 3 equally weighted primary indicators (0.333 each), 17 secondary indicators, and 42 tertiary indicators. Notably, at the secondary level, "Transitional care readiness" (0.234) received the highest weight. Among the tertiary indicators, the highest weight was assigned to "Emergency preparedness skills" (0.162), followed by "Medication administration guidance" (0.054). The management indicator system developed in this study demonstrates methodological rigor and expert consensus, offering a standardized, weighted framework for assessing transitional care readiness, guiding transitional care processes, and informing evidence-based management practices for preterm infants. The system's emphasis on emergency preparedness and family capability assessment highlights areas that may warrant greater attention in current discharge planning approaches, pending further empirical validation.
Drug hypersensitivity reactions are a clinically significant and potentially preventable cause of hospital admission, treatment interruption, and drug-related mortality worldwide. Within severe cutaneous adverse reactions (SCARs), a group that includes Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS), DRESS stands out because of its delayed onset, multi-organ involvement, and frequent diagnostic uncertainty. Allopurinol is a commonly prescribed medication for hyperuricemia, but in rare cases, it can trigger DRESS. This systematic review was conducted to comprehensively summarize the demographic characteristics, clinical manifestations, diagnostic features, management strategies, and outcomes of reported cases of allopurinol-induced DRESS syndrome. Available case reports and case series were analyzed to consolidate patient characteristics, patterns of organ involvement, treatment approaches, and clinical outcomes. The findings indicate that allopurinol-induced DRESS most often presents with cutaneous manifestations and systemic involvement, most commonly affecting the liver and kidneys, and is associated with considerable morbidity and mortality despite treatment. These results emphasize the importance of early recognition, prompt drug discontinuation, and cautious prescribing of allopurinol, particularly in high-risk populations.
Enzyme inhibition has become a cornerstone of modern therapeutics, targeting key molecular pathways implicated in cancer, metabolic disorders, and infectious diseases. This review explores diverse strategies of enzyme inhibition from classical active site-directed inhibitors to innovative biofilm-targeting enzymatic cocktails, emphasising their clinical utility. Beyond medicine, enzyme inhibitors are routinely employed to modulate nitrogen fixation, methanogenesis, and microbial dynamics in industrial and environmental settings. However, this dual-edged sword reveals its paradox: the very agent that heals can also harm. Their ecological persistence and bioaccumulation risks disrupt microbial ecosystems, foster antibiotic resistance, and affect non-target organisms. This review navigates the fine line between pharmaco-logical promise and environmental peril, evaluating risk assessment frameworks, mitigation strategies, and forward-looking approaches such as high-throughput screening, machine learning, and enzyme engineering. Ultimately, it advocates for a symbiotic integration of pharmaceutical innovation and environmental stewardship to create eco-friendly strategies that can enhance therapeutic efficacy without compromising ecological balance.
Paraquat (PQ) dichloride is a commonly used herbicide across agricultural sectors worldwide. Despite being banned in over 70 countries, PQ is still frequently misused in India for suicidal and homicidal poisoning. The study aims to evaluate the clinical and laboratory predictors of survival and to estimate time-to-event outcomes of patients admitted to a quaternary care center in South India with a history of PQ poisoning. This retrospective study included patients aged 16 and above who presented with PQ poisoning over 10 years (January 2015 to October 2024). Data were collected from the emergency department (ED) triage registry and hospital electronic database. Statistical analyses were conducted to identify factors predicting survival. During the study period, 166 patients with PQ poisoning were included. The majority were young males, with 79.5% experiencing poor outcomes. Acute kidney injury (AKI) (92.2%) and lung injury (57.6%) were common complications. The overall survival rate was 20.5%, with a median survival time of 5 days. Multivariate Cox regression analysis identified N-acetylcysteine, ascorbic acid, cyclophosphamide, and steroids (NACS) combination therapy, a low acute physiology and chronic health evaluation (APACHE) II score, and activated charcoal as independent predictors of survival. A meta-analysis of 15 Indian studies revealed a pooled bad outcome rate of 79%. High morbidity and mortality associated with PQ poisoning in India have been highlighted in our study. The authors suggest that a combination therapy using NACS may improve survival; however, this needs to be explored further. Despite these interventions, delayed presentation with multiorgan system involvement points toward a poor prognosis. Further research is needed to standardize treatment protocols and guide policy interventions to limit PQ use and enhance outcomes. Neeraj GPP, Philip AJ, Prakash G, Praneeth CS, Chandiraseharan VK, Zachariah A, et al. Paraquat Peril: A Retrospective Study from the Frontlines of a Quaternary Care Hospital in South India. Indian J Crit Care Med 2026;30(2):107-116.
Doctors, nurses, and midwives are key providers of abortion care for women in Australia. Providing abortion care is a challenging, contentious, and sometimes perilous occupation. Recent changes in the Australian abortion care landscape mean that it is essential to consider the experiences and perceptions of the abortion workforce and to identify future needs. The aim of this review was to collate and report the experiences and perceptions of doctors, nurses, and midwives who provide abortion care in Australia. A scoping review was utilised to address this question, applying Arksey and O'Malley's framework with enhancements by Levac et al. Research question development and reporting approaches were informed by Joanna Briggs Institute (JBI) Health. In total, 19 articles were included in the review. Studies were predominantly qualitative in nature and encompassed all three clinical groups. Most studies included participants from multiple Australian sites, with five focusing specifically on Victorian participants. Overarching themes included: clinical care provision; person-centred care; social and system-based factors; provider education, training and networks; abortion and the law; ethical challenges; emotional responses; abortion stigma; and conscientious objection. The experiences of Australian abortion providers reflect shared challenges relating to: training access; ethical and emotional impacts; abortion stigma; and conscientious objection. Navigating changing system, regulatory, and legal frameworks compounds this complexity. Further research into the experiences of abortion providers will inform support interventions. Legislators, regulators, and health service executives must listen to the needs of providers to ensure service sustainability into the future.
An involuntary commitment is a rights-restrictive procedure that is rarely afforded visibility through useful data. Pennsylvania is a nationally relevant case study on the promises, perils, and misconceptions surrounding involuntary commitment data. In this study, we survey the minimal available Pennsylvania data and then contextualize our results within state laws and norms by (1) framing involuntary commitment data within the state's gun control agenda, (2) implementing the language of undone science, agnotology, and visibility, and (3) discussing the rights and social obligations surrounding privacy, confidentiality, and dangerousness. We find that sensitive administrative data is collected at several points during the involuntary commitment process but is rarely available in a useful, de-identified form. Improved access to useful data about the commitment population would close a major gap in state and national healthcare delivery, policy, and accountability.
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Marine heat waves detrimentally affect a range of marine species, including seabirds, and are increasing in frequency and severity. When thousands of dead seabirds wash up on beaches, the public becomes concerned. However, the number of dead birds recorded on beaches is only a fraction of the total mortality; most birds perish at sea. As a result, estimates of total mortality are scarce, and this impedes the ability to determine how such mortality events affect populations. Community science programs can greatly enhance the geographic or temporal scale of studies, which can be critical when mortalities or changes take place over large distances or many months. Using three community science data repositories, we examined the number and composition of seabirds found dead on beaches in eastern Australia during the 2023-2024 marine heat wave. Mortality estimation models developed for other sectors were refined using measures of searcher efficiency and carcass persistence for beach-washed birds. Total mortality of sable shearwaters (Ardenna carneipes) and short-tailed shearwaters (Ardenna tenuirostris) was >13,900 and >608,000, respectively. The loss of these birds, in total more than 629,000 individuals, highlights the increasingly perilous marine environment in which many marine species now exist. Estimación de la mortalidad total de aves marina después de una onda de calor oceánica Resumen Las olas de calor oceánico dañan a diversas especies marinas, incluidas las aves, y su frecuencia y gravedad van en aumento. Cuando miles de aves marinas muertas aparecen en las playas, la población se alarma. Sin embargo, el número de aves muertas registradas en las playas es solo una fracción de la mortalidad total ya que la mayoría de las aves mueren en el mar. Por esto, son pocas las estimaciones de la mortalidad total, lo que dificulta la capacidad de determinar cómo afectan estos episodios de mortalidad a las poblaciones. Los programas de ciencia ciudadana pueden ampliar considerablemente la escala geográfica o temporal de los estudios, lo que es fundamental cuando las muertes o los cambios se producen a lo largo de grandes distancias o durante muchos meses. Utilizamos tres repositorios de datos de ciencia ciudadana para analizar el número y la composición de las aves marinas encontradas muertas en las playas del este de Australia durante la ola de calor oceánico de 2023‐2024. Los modelos de estimación de mortalidad desarrollados para otros sectores se perfeccionaron con medidas de la eficiencia de los buscadores y la persistencia de los cadáveres de las aves arrastradas a la playa. La mortalidad total de las pardelas sombrías (Ardenna carneipes) y las pardelas de cola corta (A. tenuirostris) fue de >13 900 y >608 000, respectivamente. La pérdida de estas aves, en total más de 629 000 individuos, resalta el entorno cada vez más peligroso en el que viven actualmente muchas especies marinas. 海洋热浪对包括海鸟在内的许多海洋物种造成了负面影响, 且其发生频率和严重程度正在加剧。当数千只死亡海鸟被冲上岸时, 公众会感到担忧。然而, 在海滩上记录到的死亡鸟类数量仅占总死亡量的一小部分;大多数鸟类是在海上死亡的。因此, 关于鸟类死亡总数的估计数据十分匮乏, 阻碍了研究者确定此类死亡事件对种群的影响。公民科学项目可以极大地扩展研究的地理和时间尺度, 当死亡事件或种群变化发生在广阔的地理范围或长达数月的时间内时, 公民科学的贡献至关重要。我们利用三个公民科学数据集, 分析了2023‐2024年澳大利亚东部发生海洋热浪期间, 海滩上发现的死亡海鸟数量及其组成。我们结合搜寻效率指标和海滩冲上岸鸟类尸体的残留时间数据, 对其他领域开发的死亡率估计模型进行了优化调整。研究发现, 淡足鹱(Ardenna carneipes)和短尾鹱(A. tenuirostris)的死亡总量分别超过13,900只和608,000只。这些鸟类的死亡总量超过了629,000只, 强调了当前许多海洋物种所处的海洋环境正变得日益危险。【翻译:胡怡思;审校:聂永刚】.