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Ensuring equitable access to health care facilities for older adults is an increasingly important concern for academic researchers and policymakers in building age-friendly cities and communities. Previous studies have seldom explored the spatial equity in the distribution of geographic access to multi-tiered and multi-type health care facilities in China, especially community-based care for older adults. To compensate for this gap, this article adopted the two-step floating catchment area (2SFCA) method to systematically and dynamically evaluate equity in spatial accessibility by accounting for the category and hierarchy of health care facilities in Guangzhou by investigating the accessibility among 176 towns/districts and 973 health care facilities that were classified by municipal and community levels as well as medical facilities and nursing facilities in six different years. The results suggested that the supply-demand relationships were regionally unbalanced in Guangzhou. The supply of all types of health care facilities in the suburban area was optimistic, whereas that in the central city was inadequate considering its high density of older adults. Accessibility on the outskirts was complex, and areas with insufficient supply. Moreover, community-level and nursing facilities had lower accessibility than municipal-level and medical facilities. Along with aging in the coming three decades, the supply-demand relationships of all health care facilities will lag in terms of supply. These findings may provide helpful insights for urban planners, and public officials with respect to the equal provision of health care resources and site allocations for older adults.

Amyrins arе pеntacyclic tritеrpеnoids with valuablе pharmacеutical and cosmеtic applications; howеvеr, thеir low abundancе in plants and complеx еxtraction procеssеs hindеr sustainablе supply. Hеrе, Yarrowia lipolytica was еnginееrеd to еnhancе α- and β-amyrin biosynthеsis using mеtabolic and еnzymе еnginееring stratеgiеs. First, thе multifunctional amyrin synthasе gеnе (CrMAS) from Catharanthus rosеus was intеgratеd into a superior squalene-producing chassis, еstablishing α-amyrin and β-amyrin production. Squalene epoxidase (ERG1) displayed low native activity and represented a major rate-limiting step in squalene conversion. Structure-guided engineering identified key activity-regulating residues, where T202V improved hydrophobic complementarity and substrate stabilization, and M308L relieved steric constraints at the substrate access tunnel. The T202V/M308L mutant enhanced catalytic efficiency, increasing squalene conversion and reducing its accumulation. Sеcond, thе copy numbеrs of ERG1 and CrMAS wеrе optimizеd, and еnhancеd NADPH supply increased α- and β-amyrin production, while decreasing squalene accumulation. Finally, thе glucosе ratio was optimizеd, and rеstoration of auxotrophic markеrs lеd to improvеd α-amyrin and β-amyrin titеrs of 220.81 ± 6.74 mg/L and 85.41 ± 2.61 mg/L, rеspеctivеly, through fed-batch fermentation in a 5 L fermenter, the titer 1.7 g/L α-amyrin and 0.5 g/L β-amyrin, which is the highest reported to date in Y. lipolytica. This study provides an effective framework for overcoming enzymatic bottlenecks and achieving sustainable microbial production of high-value pentacyclic triterpenoids.

The dual-energy lattice-tip catheter delivering radiofrequency (RF) or pulsed field ablation (PFA) has experienced rapid uptake in atrial fibrillation (AF) ablation, with potential trade-offs between efficiency and cost. Real-world data on clinical, operational, and economic impact remain limited. To report a real-world, single-center experience with the Sphere-9 catheter for AF ablation, focusing on clinical, practice management, and financial outcomes. Consecutive patients undergoing AF ablation were prospectively enrolled between December 2024 and January 2026. Procedural characteristics, acute outcomes, safety events, discharge status, and early follow-up were analyzed. Procedural volume, efficiency, and supply-related costs and charges were compared with a pre-implementation cohort. A total of 985 patients underwent 1008 procedures (53.3% paroxysmal; 66.5% first ablation). Pulmonary vein isolation was achieved in all cases, with adjunctive lesion sets performed as indicated. Acute safety events occurred in 2.4%, including coronary vasospasm (n=1), ventricular fibrillation during mitral PFA (n=1), persistent atrioventricular block (n=2), and device-related complications (n=3). There were no deaths, strokes, tamponades, atrio-esophageal fistulas, or phrenic nerve injuries. Same-day discharge was achieved in 83.5%. Compared with pre-implementation, annual AF ablation volume increased by 26.8%, and median procedure time decreased (69 vs 116 minutes; p<0.001). Supply costs and charges increased by 37% and 43%, respectively (p<0.001). AF ablation with the Sphere-9 catheter was associated with improved procedural efficiency, low complication rates, high same-day discharge, and favorable early effectiveness. These gains were offset by substantial increases in supply costs.

The 2026 closure of the Strait of Hormuz has disrupted approximately one-fifth of global petroleum transit, sending oil prices sharply upward and exposing medicine's structural dependence on petrochemicals, helium, and globalized manufacturing. This article examines how medicine's reliance on globalized commodities exposes patients to medication and device shortages during sustained supply disruption. Prior crises, including the 1973 oil embargo and the 2021 Suez blockage, revealed vulnerabilities that current just in time supply chains have deepened. We urge practice leaders, hospital administrators, and clinicians to establish supply continuity frameworks now, before scarcity forces improvised rationing and reactive procurement.

The sluggish cathode oxygen reduction reaction (ORR) kinetics and insufficient supply of electron acceptors are the critical bottlenecks limiting the power generation performance of microbial fuel cells (MFCs), particularly photosynthetic algal microbial fuel cells (PAMFCs). This study constructed a cathode optimization strategy integration of polypyrrole (PPy) modification and electron acceptor regulation, aiming to elucidate the working mechanism of bioelectrochemical coupling in biocathodes. The performance of PPy-modified carbon felt cathodes was systematically investigated in both conventional MFC and PAMFC systems, and the cathode electron acceptor supply levels were modulated via the dosage of ammonium chloride (NH4Cl) and sodium nitrate (NaNO3). The results indicated that an optimal PPy loading effectively enhanced electrode conductivity and upgraded ORR activity. Notably, the optimal PPy loading in the PAMFC shifted compared to that in the conventional MFC. This shift demonstrated that the performance of the algal biocathode is not dictated solely by the electrocatalytic activity of the electrode, but is co-regulated by the dynamic matching between biological oxygen evolution and electrochemical oxygen consumption. Further evaluation of electron acceptor supplementation revealed that NaNO3 exerted a more pronounced promotion effect than NH4Cl, with a maximum power density of 422.5&#x202f;mW/m2 achieved at 2.0&#x202f;g/L NaNO3. This enhancement was attributed not only to the provision of auxiliary electron acceptors but also to the stimulation of algal nitrogen metabolism, which bolstered photosynthetic oxygen evolution and effectively mitigated the oxygen consumption pressure imposed by the biocathode reaction. The bioelectrochemical coupling developed in this study enhances PAMFC power generation and carbon sequestration potential.

Policies in sub-Saharan Africa are constrained by a limited knowledge of climate change extremes and a focus on agricultural production rather than nutrition supply. Here we model the impacts of future extremes on national-level calorie and nutrient supply in Zambia for production and nutrition focused policy scenarios. We identify the specific cropland, yield and import increases required to achieve climate-resilient nutrition security and highlight policy options.

Community pharmacies fulfill a pivotal function in maintaining the uninterrupted delivery of health care services and safeguarding the medication supply chain during disaster situations. However, the extant evidence regarding the disaster preparedness levels of pharmacies is limited, particularly in regions with high seismic risk. The objective of this study was to assess the disaster preparedness levels of community pharmacies in Istanbul and to examine factors associated with their preparedness status. In this descriptive cross-sectional study, conducted between December 2024 and April 2025, researchers collected data from 360 pharmacies. These pharmacies were selected using a systematic sampling method. The researchers developed a structured questionnaire to collect the data. The investigation revealed that only 32.8% of pharmacies had a disaster plan, 91.7% had not conducted drills, 85.6% lacked smoke detectors, and 71.4% lacked fire alarms. Conversely, 87.5% of pharmacies reported collaborating with neighboring pharmacies or regional representatives during disaster situations. The findings of the study indicated that pharmacies that had undergone disaster training exhibited significantly higher levels of safety equipment, planning, and material stockpiles (P < 0.05). The findings indicate that pharmacies in Istanbul demonstrate proficiency in collaboration and fundamental supply procurement. However, deficiencies are observed in drills, fire safety measures, data backup protocols, and strategic planning. In order to enhance the disaster resilience of pharmacies, it is imperative that training programs be expanded, drills be made mandatory, and institutional governance be strengthened.

Small-scale artisanal fisheries and aquaculture contribute significantly to seafood supply for coastal communities in Viet Nam. However, persistent organochlorine pesticides (OCPs) remain a potential threat to marine ecosystems and seafood safety. This study investigated the occurrence, distribution, and human health risks of OCPs in 532 samples representing 59 marine species collected from lagoon and open sea habitats along the central coast of Viet Nam. OCP residues, including HCHs, DDTs, DRINs, heptachlors, and endosulfans, were generally higher in organisms from lagoon habitats than in those from the open sea, whereas differences between trophic levels were relatively small, indicating that habitat characteristics had a greater influence on OCP accumulation than trophic position. Diagnostic isomer ratios suggested recent &#x3b3;-HCH inputs, predominantly historical DDT contamination with localized recent inputs, and no recent application of technical endosulfan. Estimated daily intakes of all OCPs were below the acceptable daily intake values. However, hazard quotient values for heptachlor epoxide and carcinogenic risk values for aldrin, dieldrin, and heptachlor epoxide exceeded acceptable thresholds in several lagoon species, indicating potential health concerns associated with long-term seafood consumption. These findings identify coastal lagoons as important hotspots of OCP contamination and emphasize the need for continued monitoring and source identification to protect seafood safety and public health.

To determine the effects of lower dietary protein (CP) on lactation and metabolism in lactating cows, 274 primiparous (37.8 &#xb1; 3.98 kg/d milk, 141 &#xb1; 24.1 DIM) and 260 multiparous cows (44.6 &#xb1; 7.13 kg/d milk, 134 &#xb1; 21.0 DIM, 3.21&#xb1;1.26 of parity) were randomly assigned to one of 2 diets: 170 g CP/kg DM (CON) or 162 g CP/kg DM (LCP) for 10 weeks. In primiparous cows, LCP has no effect on milk yield and most other parameters (P > 0.10) except for tendency of decreasing milk urea nitrogen (MUN) (P = 0.08). In multiparous cows, LCP show no effect on milk yield and other parameters (P > 0.10) for cows with milk yield < 50 kg/d, while high-yield cows (50-60 kg/d) exhibited 1.37 kg/d milk yield reduction (P < 0.01), along with higher content of fat (P < 0.05) and total solids (P < 0.01) and lower MUN (P < 0.01). LCP decreased blood urea nitrogen (P < 0.01), albumin (P < 0.05) and NEFA (P < 0.05), tended to increase rumen total volatile fatty acids (VFA) concentration (P = 0.09), decreased molar proportion of isobutyrate (P < 0.05) and total branched-chain VFA (P < 0.05). In conclusions, 162 g CP/kg DM of diet has no impact on lactation performance in primiparous cows or multiparous cows producing < 50 kg/d, but induced milk depression (-1.37 kg/d) in high-yielding multiparous cows (50-60 kg/d) coupled with enhanced milk fat and total solids content, suggesting yield-dependent trade-offs between diet protein supply and dairy cows requirement.

This study establishes a three-layer porosity gradient optimization framework for the cathode gas diffusion layer (GDL) of proton exchange membrane fuel cells (PEMFCs), concurrently considering mass transport, electrical conductivity, and permeability, and systematically investigates its performance under different mass flow rate (stoichiometric ratio) conditions in serpentine and sinusoidal flow fields. The results reveal a pronounced operating-condition dependence of the optimal porosity gradient. At high mass flow rates, where oxygen supply is sufficient and liquid water accumulation becomes the dominant constraint, a mild decreasing porosity distribution (0.6/0.5/0.4) effectively balances oxygen diffusion and water removal. However, as the mass flow rate decreases, oxygen transport resistance gradually becomes the controlling factor in the electrode, requiring enhanced diffusivity and permeability near the catalyst layer. Consequently, a steeper porosity gradient (0.7/0.4/0.4) leads to improved current density. Performance comparisons further demonstrate that applying the optimized three-layer porosity distribution to a serpentine flow field yields a current density enhancement nearly equivalent to that achieved by a sinusoidal serpentine channel with a 0.15 mm amplitude, without requiring structural modifications to the flow channel. This significantly reduces manufacturing complexity and cost while enhancing engineering feasibility. When the optimized porosity is further coupled with the sinusoidal flow field, a synergistic enhancement occurs, where transverse mixing and vertical drainage effects are jointly strengthened, achieving an additional 5-6% increase in current density compared with the conventional uniform GDL. Contour-based analyses confirm that porosity optimization enhances oxygen penetration, promotes liquid water removal, and improves drainage pathways near the catalyst layer, which constitute the key physical mechanisms underlying the performance improvement. Overall, this study proposes a mass-flow-dependent porosity gradient design principle and demonstrates that material-level optimization can partially substitute geometric flow-field redesign under certain conditions, providing a low-cost and highly manufacturable pathway for PEMFC structural optimization.

The World Economic Forum Annual Report 2023-2024 warned of the devastating impact that climate change will have on human health by 2025, claiming that 14.5 million deaths by 2050 are likely to occur because of weather-induced catastrophes such as droughts, floods, extreme heat, heatwaves, wildfires, and tropical storms. Regions of the world, whether in the Global North or Global South, are experiencing different, if not multiple, forms of these climate-driven events. In the Global South, home to many sport-for-development non-governmental organisations (SDP NGOs), community actors are responding to the call for environmental stewardship. The El Nino-induced drought in Zambia has destabilised the operation of SDP NGOs as organisations and participants experience water shortages, erratic electricity supply, and limited engagement time with participants. This study purposed to advance environmental research among some of Zambia's SDP sector actors by demonstrating their engagement in national climate adaptation programmes. The study explored how the SDP sector is responding to environmental matters such as the prolonged drought in Southern Africa and its implications on the operations of the SDP sector. Drawing upon John Child and Richard Whittington's theories of strategic choice, the study analysed the structural constraints and agency of SDP NGOs regarding climate education and practical adaptations to external forces. This study utilised a survey questionnaire which was administered among SDP actors and semi-structured interviews with purposively selected SDP actors to highlight organisational responses to climate change impacts. Using a realist lens, this study examined how agency and structure interact through SDP actions. The study reveals that SDP actors have responded through climate adaptation actions in efforts to transform their context amid the harsh local realities of climate change. It further reveals that SDP NGOs' climate education continue to be constrained by environment and economic determinants.

Globally, potato (Solanum tuberosum) is an important food crop. Due to an expanding potato&#x2011;chip processing market, it is increasingly essential that high-quality raw tubers are maintained and available year-round. Cold storage at temperatures below 10&#xb0;C greatly increases the duration of potato tuber storage, however, potatoes are susceptible to cold-induced sweetening (CIS). At these temperatures, potato starch stored in the tuber converts to reducing sugars, leading to a dark, bitter-tasting potato chip. Kalkaska is a potato variety with high yield and a highly desirable scab resistance; however, it is unreliable in managing reducing sugars in commercial storage. In this study, we report a comprehensive characterization and analysis of a genetically engineered potato line Kal91.3, utilizing VInv RNAi suppression to correct the reducing sugar management in Kalkaska. A full molecular characterization analysis was completed on Kal91.3, which demonstrated that there are two independent and stable T-DNA insertions. RNA analysis reported suppression of the VInv transcripts, which was further shown during a prolonged tuber storage period. Kalkaska and Kal91.3 tubers were stored at 4&#xb0;C for up to 8&#x2009;months. Kal91.3 produced chips light in color, and the Kalkaska control produced dark chips typical of the CIS darkening response. Kal91.3 is the first genetically engineered field&#x2011;crop product developed by a non-industry organization and to have received regulatory clearance in the United States. Kal91.3 is expected to provide significant benefits to growers, processors, and consumers by producing high-quality potato chips from long-term, lower-temperature storage, improving supply&#x2011;chain stability, and waste reduction.

Postoperative complications contribute significantly to patient morbidity and mortality. Early prediction of such complications could enable the care team to intervene promptly and improve patient outcomes. Existing surgical risk scores are easy to use but lack accuracy and do not provide individualized risk or guidance for clinical decision-making. This study aimed to develop and evaluate machine learning models using the INSPIRE perioperative dataset to predict whether an individual patient will require critical postoperative interventions-ventilatory support, extracorporeal membrane oxygenation (ECMO), an intra-aortic balloon pump (IABP), or continuous renal replacement therapy (CRRT). Four artificial neural network models and 4 random forest classifiers were trained and tested using the publicly available INSPIRE dataset (131,000 surgical cases). Preoperative laboratory data, medication use, surgery type, and intraoperative vital signs were used as inputs. The dataset was randomly divided into a 70% training set (91,000 cases) and a 30% test set (38,998 cases), with a temporal split to prevent leakage. Model performance was assessed using accuracy, sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC). The artificial neural network models achieved high predictive performance for ECMO (accuracy 98.9%; AUC 0.992), ventilatory support (accuracy 97.7%; AUC 0.995), IABP (accuracy 98.0%; AUC 0.992), and CRRT (accuracy 94.9%; AUC 0.983). In the test set of 38,998 patients, the neural network models correctly classified 38,569 cases for ECMO, 38,097 for ventilatory support, 38,230 for IABP, and 37,021 for CRRT, corresponding to accuracies of 98.9%, 97.7%, 98.0%, and 94.9%, respectively. The corresponding random forest classifiers achieved accuracies of 98.0%, 99.0%, 98.2%, and 96.5%, respectively, with similar AUC values. These results indicate that the models can reliably identify patients who will or will not require lifesaving postoperative interventions despite the marked class imbalance. Our work began in April&#x202f;2023, with the research concept taking shape over the following 1 to 2 months. Model development spanned approximately 3 to 4 months and was followed by 1 month of testing and validation conducted by other computer scientists. Machine learning models trained and tested on the INSPIRE dataset can provide individualized risk estimates for critical postoperative interventions. By supplying accurate predictions before or during surgery, these models can support proactive perioperative planning (eg, intensive care unit bed allocation and device readiness).

Primary health care (PHC) systems across many low- and middle-income countries increasingly rely on mixed provider environments involving public, private, and mission-based actors. Public-private partnerships (PPPs) are often promoted as a way of improving coordination and expanding access to care. However, many PHC partnerships continue to be governed through highly centralized and compliance-oriented arrangements that may limit flexibility, trust, and long-term collaboration. Botswana provides a useful case for examining how PPPs are governed within a health system experiencing fiscal pressure, medicines supply challenges and ongoing PHC restructuring. This study relies on a theory-based qualitative documentary analysis of policy documents, government reports, gray literature, and peer-reviewed research relevant to PHC governance and PPP implementation in Botswana and comparable low- and middle-income country settings. Concepts such as health systems governance, stewardship and systems thinking guided the analysis with due attention to financing arrangements, accountability systems, provider relationships and implementation dynamics within mixed health systems. Four recurring governance barriers were identified as factors affecting PPP implementation in PHC. These included hierarchical administrative approaches that limit collaboration and local adaptation; weak financing credibility and purchasing uncertainty; limited community-facing accountability; and gaps between national policy ambition and district-level implementation capacity. The analysis also identified emerging opportunities related to digital health systems, integrated service delivery approaches, and more flexible partnership practices that may strengthen coordination across providers. The findings suggest that PPP performance in PHC depends less on formal contracts alone and more on the wider governance conditions shaping relationships between public institutions, providers, and communities. In Botswana, partnership arrangements are more likely to function effectively when financing systems are credible, accountability extends beyond administrative reporting, and local implementation systems are adequately supported. The study contributes to wider debates on PHC governance by highlighting the importance of stewardship, coordination, and institutional trust in sustaining partnerships within mixed health systems.