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Sodium Bicarbonate versus N-Acetylcysteine plus hydration versus hydration alone for preventing contrast-associated acute kidney injury: A single-center retrospective analysis with propensity score matching

Background Contrast-associated acute kidney injury (CA-AKI, historically termed contrast-induced nephropathy, CIN) is a leading cause of iatrogenic acute kidney injury (AKI) following iodinated contrast administration; yet the optimal preventive strategy remains controversial, especially in mild-to-moderate-risk patients. Methods This single-center retrospective observational study was conducted in strict accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. We consecutively screened adult patients undergoing contrast-enhanced computed tomography (CT) or angiography at a tertiary hospital in China between June 2022 and January 2025. After propensity score matching (PSM), 240 adult patients were included in the final analysis, allocated 1:1:1 into three groups: conventional hydration alone (control), hydration plus N-acetylcysteine (NAC), and hydration plus sodium bicarbonate. 1:1:1 nearest-neighbor PSM was performed to minimize confounding bias, with a caliper of 0.05. The primary endpoint was the incidence of CA-AKI within 72 hours after contrast exposure, defined per the 2024 European Society of Urogenital Radiology (ESUR) guidelines. Secondary endpoints included dynamic changes in renal function, renal replacement therapy (RRT) requirement, hospital stay duration, adverse events, and subgroup analyses by comorbidities and contrast modalities. Results After PSM, 240 patients (80 per group) were included in the final analysis, with well-balanced baseline characteristics across groups (all standardized mean differences <0.1, all P > 0.05). The overall incidence of CA-AKI was 15.00% in the control group, 2.50% in the NAC group, and 7.50% in the sodium bicarbonate group. Hydration plus NAC significantly reduced CA-AKI risk compared with hydration alone (RR = 0.17, 95% CI: 0.04–0.74, Bonferroni-adjusted P = 0.004). Sodium bicarbonate showed a numerically lower CA-AKI incidence than control, but the difference did not reach statistical significance after correction (RR = 0.50, 95% CI: 0.19–1.31, adjusted P = 0.121). Repeated-measures ANOVA revealed significant group, time, and group × time interaction effects on serum creatinine (Scr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) (all P < 0.001), with the mildest renal function fluctuations in the NAC group. The renoprotective efficacy of NAC was consistent across contrast-enhanced CT and angiography modalities. Advanced age, comorbid diabetes, comorbid hypertension, higher baseline Scr, and lower baseline eGFR were independent risk factors for CA-AKI [5,6,28] (all P < 0.05). No patients required RRT in any group, with no significant difference in hospital stay duration or mild adverse event incidence across groups (all P > 0.05). Conclusions For patients with eGFR ≥ 30 mL·min ⁻ ¹·(1.73 m² ⁻ ¹), hydration combined with high-dose intravenous NAC significantly reduces the short-term incidence of CA-AKI compared with hydration alone, with a favorable safety profile and consistent efficacy across contrast modalities. Hydration plus sodium bicarbonate is a safe alternative for patients intolerant to NAC. These findings are hypothesis-generating and require verification in large-sample, multicenter prospective trials.

Interactions between self-help and hospice and palliative care – Opportunities, barriers and needs (Self-Pall): A study protocol

Introduction A progressive and life-limiting disease can cause enormous psychological distress for patients and family caregivers. Health-related collective self-help could be a coping strategy by facilitating interaction with others in similar situations. Scarce literature is available on how those patients and their caregivers could benefit from self-help activities, how self-help groups deal with death and grief, and whether there are interactions between self-help and hospice and palliative care. The Self-Pall project aims at developing recommendations tailored at different actor groups to support the interactions between self-help and hospice and palliative care. Methods We will use a qualitative, multi-method, sequential research design. The project started in 07/2025 and will end in 06/2027. Semi-structured interviews will be conducted with patients, family caregivers, and representatives of hospice and palliative care and of self-help to explore personal and professional experiences focussed on opportunities, barriers, and needs. A draft of recommendations will be derived, which will then be confirmed and expanded upon within focus groups. A representative expert panel will refine and agree upon the recommendations through an iterative, multi-level Delphi process. The engagement of a Patient and Public Involvement group will ensure the relevance of our research to the public and provide transparency. Discussion We will explore awareness, needs, and factors that promote or hinder self-help activities from the perspective of patients, caregivers, and professionals. From a self-help perspective, we will assess how to deal with dying, death, and grief, as well as knowledge and use of hospice and palliative care services, any barriers and how to overcome them. We are the first to explore interactions between self-help and hospice and palliative care bilaterally to develop practical recommendations and key principles with significant implications for practice.

Amyloid-bodies in the evolution of malignancies

Tumorigenesis depends on the capacity for cancer cells to survive in the presence of various environmental stressors. An emerging paradigm in the study of cancer cell stress responses is their regulation by membrane-less intracellular compartments known as biomolecular condensates. While there has been considerable progress in our understanding of biomolecular condensates in cancer in vitro , a paucity of evidence remains for their presence and function in settings which more closely reflect in vivo tumor physiology. In this study, we use human tissues and an in vivo orthotopic mouse model to study the role of the Amyloid-body, a stress-induced condensate, in tumorigenesis. We present methodology to visualize Amyloid-bodies in tumors by multiple immunohistochemical approaches in addition to a semi-automated analysis pipeline. Analysis of multiple tumor types reveals that Amyloid-bodies are detectable at all tumor grades and stages, to varying degrees, and negatively correlate with the cell proliferation marker Ki-67. Finally, in an orthotopic mouse model of breast cancer, we show that silencing long noncoding ribosomal intergenic spacer RNA (rIGSRNA) involved in Amyloid-body formation accelerates tumorigenesis in vivo . Together, these results suggest that Amyloid-body formation occurs in human cancers, further establishing the physiological relevance of biomolecular condensates.

Air-permeable hydrogels through viscoelastic phase separation of aerogels

Contextual image caption creation using object positional embedding and generative models

Automated image captioning remains a challenge, as it enables machines to generate context-aware textual descriptions of visual content. Traditional deep learning approaches often rely on lexical overlap and fail to capture semantic relationships among objects, leading to captions that lack contextual richness. This study proposes an encoder–decoder framework that integrates YOLOv5 with a generative transformer to generate descriptive image captions. The proposed model was evaluated against two baselines: CNN-LSTM (M1) and a BERT-based transformer model (M2). M1 achieves BLEU-1 (0.45) and ROUGE-L (0.42) but demonstrates limited semantic understanding with METEOR (0.18) and SPICE (0.07). M2 improves with higher METEOR (0.24) and CIDEr (0.62), although its BLEU scores remain low. The proposed model achieves the highest CIDEr (1.10) and SPICE (0.25), reflecting superior semantic understanding and better capture of object relationships. Despite a lower BLEU (0.40), it significantly outperforms traditional methods in caption quality. To further validate these results, we conducted an expert-based evaluation to assess semantic accuracy, visual grounding, and caption usefulness. The proposed model achieved 93% accuracy in expert evaluations across 500 images, indicating strong contextual alignment with human interpretation. Additionally, we employed exploratory data analysis to examine and visualize the text captions, aiming to gain a deeper understanding of the optimal caption.

Serological evidence of SARS-CoV-2 exposure in marine mammals in the United States between 2020 and 2025

Natural infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been documented in over 60 animal species, some distantly related. Several marine mammals have been predicted as highly susceptible to SARS-CoV-2 infection based on the homology of their ACE2 receptors to those of humans. To assess potential exposure of marine mammals to SARS-CoV-2, we conducted an opportunistic survey from 2020 to 2025 and tested 1,808 swabs and 378 serum samples from 21 marine mammal species in the United States. All the swabs tested by RT-qPCR were negative, indicating the absence of active infection. A low level of SARS-CoV-2 neutralizing antibodies was detected in three pinniped species, including Phoca vitulina (harbor seal, 13.6%, 95% CI: 5.2–27.4%), Zalophus californianus (California sea lion, 7%, 95% CI: 1.9–17.0%), and Halichoerus grypus (grey seal, 3.7%, 95% CI: 0.5–12.7%). These findings represent the first serological evidence of SARS-CoV-2 exposure in marine mammals in the United States, highlighting the need for continued monitoring of these populations and further research on SARS-CoV-2 transmission dynamics in wildlife.

Modelling and simulation of smart city drainage system based on digital twin five-dimensional models

The construction of smart cities has entered a new stage of industrial development in light of the industrial revolution. The aim is to create digital twin cities that integrate the dual systems of physical and digital bodies. The drainage system of a city forms the foundation and core of its digital twin, hence the need for a construction and simulation study proposed in this research. The study is based on the five-dimensional model of the digital twin. First, the research aims to develop a five-dimensional digital twin model that incorporates twin data and connections, building upon a three-dimensional model to improve its applicability. Second, the research looks to create a digital twin drainage system model using a lightweight framework, employing a dynamic scheduling algorithm and model-view-controller to facilitate intelligent scheduling of the drainage system and enable real-time data collection and transmission. The experimental outcomes indicate that in normal conditions, the overflow loss of the mathematical twin drainage system was 30m 3 /s, 34m 3 /s, and 25m 3 /s under the conventional fixed-priority scheduling algorithm and dynamic scheduling digital twin drainage system algorithm, respectively. Due to the ratio of the improved overflow loss to the pre improved overflow loss being called the improvement ratio, the improvement ratios generated by the mathematical twin drainage system in different situations were 48.67%, 48.1%, and 48.57%, respectively, which significantly enhanced the performance and durability of the urban drainage system. The model effectively transforms and enhances the current urban drainage system by increasing the efficiency of scheduling pumping station clusters. It also offers valuable reference for the implementation of digital twin concept and technology.

Mycobacterial lipoarabinomannan negatively interferes with macrophage responses to Aspergillus fumigatus in-vitro

Over 1 million people have chronic pulmonary aspergillosis (CPA) secondary to pulmonary tuberculosis. Additionally, Aspergillus fumigatus ( Af ) has been reported as one of the most common pathogens associated with mycobacteria in patients with cystic fibrosis. Mycobacterial virulence factors, like lipoarabinomannan, have been shown to interfere with host’s intracellular pathways required for an effective immune response, however, the immunological basis for mycobacterial-fungal coinfection is still unknown. We therefore investigated the effect of lipoarabinomannan on macrophage responses against Af . Bone marrow-derived macrophages (BMDMs) were stimulated with non-mannose-capped lipoarabinomannan (LAM) from Mycobacterium smegmatis or mannose-capped lipoarabinomannan (ManLAM) from Mycobacterium tuberculosis for 2 hours and then infected with swollen Af conidia. Cell death was assessed by lactate dehydrogenase release. Cytokine release was measured in supernatant using Enzyme Linked Immuno-Sorbent Assay (ELISA). Colony forming units counting and time-lapse fluorescence microscopy was performed for studying conidia killing by macrophages. BMDMs stimulated with LAM showed increased cell death and inflammatory cytokine release in a dose-dependent manner, characterised by a significant increase of IL-1β release. Time-lapse fluorescence microscopy and CFUs revealed that both LAM and ManLAM significantly decrease the capacity of macrophages to kill Af conidia within the first 6 hours of infection. The mycobacterial virulence factor, lipoarabinomannan, disrupts macrophage capacity to efficiently clear Af at early stages of infection in-vitro .

A practical inflammatory blood-cell marker for cardiovascular risk stratification in psoriasis: Development of the Platelet-Leukocyte Adjusted Cardiovascular (PLAC) score

Background Psoriasis is an inflammatory disease associated with atherosclerotic cardiovascular disease (ASCVD). Although blood-cell markers predict ASCVD in the general population, the utility of these markers in cardiovascular risk stratification in psoriasis remains unclear given heightened inflammatory burdens among these patients. Objectives We aimed to develop a composite ASCVD risk score for psoriasis and evaluate its performance by integrating a novel inflammatory blood-cell marker with traditional cardiovascular risk factors. Methods We conducted a retrospective cohort study using All of Us (enrollment:May 2018-October 2023). ASCVD included acute coronary syndrome, cerebrovascular accident, or coronary artery disease. Independent predictors of ASCVD in Cox regression informed the Platelet-Leukocyte Adjusted Cardiovascular (PLAC) score, incorporating the Neutrophil-to-Platelet-to-Monocyte Ratio (NuPMoR=neutrophils/[platelets x monocytes]), age ≥ 65, male sex, hypertension, and diabetes. Results Among 1,572 psoriasis patients (median follow-up 7.2 years), the PLAC score (AUC 0.69, 95% CI 0.65–0.74), which incorporates NuPMoR, stratified patients into low-, medium-, and high-risk groups with corresponding 10-year ASCVD incidences of 4.9%, 11.8%, and 39.9%. Compared with the low-risk group, medium- (HR 2.27, 95% CI 1.53–3.39) and high-risk (HR 6.40, 95% CI 3.97–10.33) groups had significantly higher ASCVD hazard. The PLAC score demonstrated similar or numerically higher discrimination than the Framingham and PCE models in limited samples. Conclusions The PLAC score is a practical, psoriasis-specific ASCVD risk tool that integrates a novel inflammatory marker with traditional risk factors. It enables clinically meaningful ASCVD risk stratification using routine laboratory values in a high-risk population and may help identify psoriasis patients warranting closer cardiovascular monitoring.

Full blood count dynamics in immunologically naïve individuals with mild COVID-19: A prospective community cohort study

Purpose Full blood count (FBC) provides a range of cellular haematological parameters and serves as a routinely available basic immune profile. While FBC has been widely used to monitor moderate-to-severe COVID-19 in hospitalised settings, its temporal dynamics in mild, community-managed cases remain poorly characterised, despite these constituting the majority of global infections. Methods In a prospective cohort study, we tracked the cellular haematological profiles of 93 recently exposed, immunologically naïve individuals with mild COVID-19 and no underlying co-morbidities, recruited to the Integrated Network for Surveillance, Trials and Investigations into COVID-19 Transmission (INSTINCT) study. Blood samples were collected on D0, D7, D14 and D28 and subsequently aligned to infection-timepoints based on the day of first detected PCR positivity, and analysed using mixed-effects models. Results Over 30% of cases exhibited transient, clinically defined neutropenia (mean (95% CI): First PCR-Positive (FP) 2.47x10 9 /L (2.26–2.68) vs convalescence 3.34 x10 9 /L (2.98–3.7); p = 0.0013). Over 20% exhibited lymphopenia (FP 1.38x10 9 /L (1.28–1.48) vs convalescence 1.79x10 9 /L (1.79–2.01); p = 0.0013). Additionally, we observed a notable elevation in platelet count, peaking approximately two weeks after initial infection (mean (95% CI): FP + 14 283x10 9 /L (254–311) vs convalescence 237x10 9 /L (222–252); p = 0.0013). Conclusions Transient neutropenia and lymphopenia occurred in approximately one-third and one-fifth of mild COVID-19 cases, respectively, and were followed by a delayed increase in platelet count. This study provides a descriptive, prospective dataset of full blood count parameters spanning early infection to convalescence in immunologically naïve individuals with mild SARS-CoV-2 infection. These data may support mathematical modelling of within-host cellular haematological dynamics and have potential clinical relevance for understanding typical trajectories of routine blood parameters during mild disease.

Self-positioning in space science communication: A corpus-assisted discourse study

This study incorporates text mining into critical discourse analysis to examine how government science agencies in China and the United States position themselves in space science communication on social media. Two specialized corpora have been built by collecting posts from government science agencies on Weibo from China and X (formerly Twitter) from the U.S. With the help of the text mining tool KH Coder, this study gives a corpus-assisted discourse analysis of the particular ways of positioning at different levels of discourse: (1) topics/themes, (2) addressing terms, and (3) those words that co-occur with self-addressing terms in a sentence. The findings reveal significant differences in their preferential ways of positioning. Chinese government science agencies present themselves as state-affiliated yet approachable institutions, blending achievements and operational efficiency with patriotism and collective pride. Their use of diverse addressing terms and co-occurrence patterns portrays them as experienced, supportive guides, balancing national identity with interpersonal closeness. In contrast, U.S. government science agencies emphasize professionalism, focusing on research, space exploration, mission execution, and audience engagement, with minimal reference to state affiliation. Their addressing terms are formal and standardized, with pride centred on mission success and discovery, highlighting expertise and scientific leadership. Their preferential ways of positioning are further explained in their respective contexts in order to present a proper understanding of these differences.

Early life stress enhances the association between residential nature exposure and fasting blood glucose

Background Emerging epidemiological evidence indicates that groups in low socioeconomic positions exhibit more pronounced health benefits from nature exposure compared to more privileged groups. We have previously posited one possible mechanism underlying this phenomenon through our framework: (susceptibility to stress) groups in low socioeconomic positions are often exposed to more early-life stressors, which can induce a lifelong susceptibility to stress through various neurobiological pathways; (environmental sensitivity) susceptibility to stress, traditionally understood as heightened reactivity to stressors, could also encompass enhanced responsivity to health-protective exposures, inducing greater risks in adverse environments, but also greater benefits in protective environments. Objective Examine the moderation effect of early life stress on the association between residential nature exposure and fasting glucose. Methods We assessed the impact of residential nature exposure (Normalized Difference Vegetation Index) on glucose dysregulation (elevated levels of fasting blood glucose) with a specific focus on the moderation effect of early life stress (Stress and Adversity Inventory for Adults) using baseline data from a cohort of 340 nursing students. Results An initial analysis did not support our linear dose-response hypothesis. However, a theory-guided exploration revealed a significant curvilinear trend wherein participants with higher but also lower exposure to early-life stressors both exhibited lower levels of fasting glucose when living in greener neighborhoods. By contrast, for participants with relatively moderate early-life stressor exposure, there was no association between neighborhood greenness and fasting glucose. Discussion Our findings contribute to growing evidence and further support the idea that increasing access to nature within disadvantaged neighborhoods could be an effective strategy to mitigate metabolic risks and attenuate health disparities among vulnerable populations. As the evidence for this framework expands, it could inform more targeted interventions that leverage individual differences in environmental sensitivity to promote health equity, ultimately providing more nuanced and socioeconomically attuned approaches to public health.

Metataxonomic insights into lactic acid bacteria diversity in artisanal coalho cheese from the Caatinga biome

Artisanal raw-milk cheeses are complex microbial ecosystems that reflect local environments through spontaneous fermentation driven by lactic acid bacteria (LAB), processing practices, and the quality of raw materials. The Caatinga biome, a unique semi-arid ecosystem in Northeastern Brazil, presents distinctive environmental and cultural conditions which can significantly influence the microbial composition of traditional dairy products. This study aimed This study aimed to characterize the bacterial community, with emphasis on lactic acid bacteria (LAB), in artisanal Coalho cheese produced in the Seridó region using 16S rRNA gene-based metataxonomic analysis. A total of 32 cheese samples from eight municipalities were collected and homogenized into a representative composite sample. DNA was extracted and the V3–V4 region of the 16S rRNA gene was sequenced using the Illumina MiSeq platform (paired-end 2 × 300 bp). The microbial community was dominated by LAB, particularly Enterococcus (~25%), followed by Lactococcus, Streptococcus, and Leuconostoc. The predominance of these genera reflects the spontaneous fermentation process typical of artisanal raw-milk cheeses and highlights their role in acidification, flavor development, and microbial stability. The microbial community was dominated by LAB, particularly Enterococcus (~25%), followed by Lactococcus , Streptococcus , and Leuconostoc . The predominance of these genera reflects the spontaneous fermentation process typical of artisanal raw-milk cheeses and highlights their role in acidification, flavor development, and microbial stability. This study provides the first metataxonomic insight into the microbiota of artisanal Coalho cheese produced in the Seridó region of the state of Rio Grande do Norte, highlighting its microbial richness and biotechnological potential, and supporting its valorisation and the sustainable development of regional cheese production. Although the use of pooled samples limits the assessment of intra-regional variability, the results establish a foundational understanding of the microbial community structure and support future investigations focused on functional characterization, food safety, and process standardization.

Parental knowledge, vaccine hesitancy, and practices regarding seasonal influenza vaccination for preschool-aged children in Shenzhen, China: Insights from a cross-sectional survey

Background Seasonal influenza poses a substantial health threat to children under 5 years of age. Despite recommendations for annual seasonal influenza vaccination (SIV), coverage among preschool-aged children in China remains low. Vaccine hesitancy is an important barrier to vaccine uptake. This study assessed parental knowledge, vaccine hesitancy, and practices regarding SIV for preschool-aged children in Shenzhen, China, and identified factors associated with hesitancy. Methods A cross-sectional online survey was conducted from September to December 2025 using a multistage sampling strategy across six administrative districts of Shenzhen. Parents of children aged 0–5 years were recruited from community health service centers and kindergartens/childcare institutions. An adapted Chinese version of the Parental Attitudes toward Childhood Vaccines (PACV) scale was used to assess hesitancy toward SIV. Parents’ knowledge regarding influenza and SIV, as well as SIV practices, were assessed and scored. Independent factors associated with hesitancy scores were identified using multivariable linear regression, and factors associated with binary hesitancy outcomes were conducted using multivariable logistic regression. Sensitivity analyses excluding the behavioral PACV items were also performed. Results A total of 17,955 parents were included in the final analysis, and 19.16% reported that their child had received SIV in the past year. The mean PACV hesitancy score was 32.26 ± 18.50, and 19.42% of parents (3,487/17,955) were classified as vaccine hesitant. The highest proportions of hesitant responses were related to concerns about serious adverse reactions (69.47%), the safety of repeated annual vaccination (55.61%), and doubts regarding vaccine effectiveness (52.68%). Higher knowledge and vaccination practice scores were independently associated with lower levels of vaccine hesitancy in both multivariable linear and logistic regression analyses (both P  < 0.001). Additionally, older parental age, Shenzhen household registration, employment in enterprises/public institutions, middle-level household income, kindergarten attendance, obtaining vaccine information from kindergartens and relatives/friends were negatively associated with vaccine hesitancy in multivariable logistic regression analyses (all P  < 0.05). Sensitivity analyses yielded generally consistent findings. Conclusion Parental hesitancy toward SIV among preschool-aged children in Shenzhen was low-to-moderate and was associated with knowledge, prior vaccination behaviors, and sociodemographic characteristics. Concerns about vaccine safety and effectiveness were the most frequently cited reasons for hesitancy. Targeted communication strategies delivered through multiple channels, together with consideration of free SIV for preschool-aged children may help improve vaccine uptake in this high-burden population.

Prevalence, diagnostic methods, and clinical outcomes of wasting among paediatric cancer patients in Africa: A systematic review and meta-analysis

Background Malnutrition is a prevalent and modifiable co-morbidity in paediatric oncology, yet no comprehensive pan-African synthesis of its burden has been conducted. This systematic review and meta-analysis estimated the pooled prevalence of wasting and acute malnutrition among paediatric cancer patients in Africa, evaluated the impact of diagnostic assessment methods on reported prevalence, and characterised associations with adverse clinical outcomes. Methods We searched PubMed/MEDLINE, EMBASE and Web of Science for observational studies published from January 2000 to December 2025 reporting wasting or acute malnutrition among children and adolescents (0–19 years) with confirmed malignancies in African healthcare settings. Two independent reviewers screened studies, extracted data, and appraised quality using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled prevalence was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I ² statistic and Cochran’s Q test. Publication bias was evaluated with Egger’s regression test. Certainty of evidence was assessed using the GRADE framework. Results Sixteen independent cohorts comprising 2,419 paediatric cancer patients across eight African countries were included. The pooled prevalence of wasting or acute malnutrition was 39.7% (95% CI: 30.7%–49.1%), with individual study estimates ranging from 11.7% to 67.6%. Between-study heterogeneity was substantial ( I ² = 95.3%; 95% CI: 92.7%–96.1%, p < 0.001). Studies using mid-upper arm circumference (MUAC) consistently detected substantially higher rates of malnutrition than those relying on weight-for-height or body mass index criteria from the same patient populations. No significant publication bias was detected (Egger’s test p = 0.503). GRADE certainty of evidence was very low, primarily due to heterogeneity. Wasting was independently associated with higher chemotherapy toxicity, treatment-related neutropenia, sepsis, and reduced overall survival across two of the included cohorts. Conclusions Wasting and malnutrition affects about two in five children with cancer in the African countries studied. The diagnostic tool employed is the single most consequential determinant of detected prevalence, and weight-based metrics alone are inadequate in populations with large solid tumours. Universal adoption of MUAC-based screening, structured algorithm-guided nutritional intervention, and integration of socioeconomic vulnerability assessment into routine oncological care are evidence-based priorities for improving treatment tolerability and survival in this population.

Epidemiology and healthcare burden of non-fatal maxillofacial injuries in Bangladesh: Evidence from Bangladesh Health and Injury Survey (BHIS), 2016

Background Maxillofacial injuries cause significant morbidity and contribute greatly to the global healthcare burden, yet epidemiological estimates from Bangladesh are lacking. This is the first population-level study to provide nationally representative estimates of the epidemiology, healthcare burden, and economic impact of such injuries in Bangladesh. Methods A secondary analysis was conducted using data from the Bangladesh Health and Injury Survey 2016, a national cross-sectional survey that utilised multistage cluster sampling to collect data from 292,217 individuals across all age groups with a six-month recall period. Annualised incidence rates (IRs) and incidence rate ratios (IRRs), with 95% confidence intervals (CIs), were estimated and stratified by sociodemographic, injury, and healthcare-related characteristics. Results The annual IR of non-fatal maxillofacial injuries was 793 (95% CI 760.3–824.8) per 100,000 population in 2016. Males (IR 989.1 per 100,000; 95% CI 938.1–1040.2), children aged 0–4 years (IR 1577.9 per 100,000; 95% CI 1414.9–1740.9), urban residents (IR 826.1 per 100,000; 95% CI 748.1–904.2), and auto-rickshaw/bus/truck drivers (IR 1632.7 per 100,000; 95% CI 1205.0–2060.3) experienced higher rates. Falls and road traffic accidents accounted for most cases, and 56.9% of injured individuals sustained concomitant injuries. Moreover, 47.4% of the injured did not receive any treatment, while 15.1% required hospital admission. The mean inpatient out-of-pocket (OOP) expenditure was USD 470.5 [standard deviation (SD) 1497.1]. Extrapolating the BHIS 2016 estimates to the 2026 national population projected an increase in non-fatal maxillofacial injury cases from 1.27 to 1.41 million. Conclusion A high incidence rate, a substantial treatment gap, and significant OOP costs underscore critical gaps in maxillofacial injury care in Bangladesh. Alongside reinforcing the country’s infrastructure, we call for targeted policy reforms to strengthen injury prevention, treatment, rehabilitation, and financial protection.

Research on the evaluation and spatial layout of high quality development of higher education in China

As a social subsystem, the layout of higher education is related to the degree of harmony in the economy and society. Based on the panel data from the “China Statistical Yearbook”, “China Education Statistical Yearbook” and the “Education Statistical Yearbook” of China’s provincial administrative regions from 2000 to 2022, considering factors such as sustainable economic and social development capacity, regional scientific and technological cultural development level, and spatial layout of higher education, this study determines the degree of harmonic development among the three subsystems. This paper constructs an indicator system for harmonious development of China’s higher education, and uses the method of “single indicator quantification-multi indicator synthesis-multi criteria integration” (SMI-P) to determine the harmonious development index of China’s higher education. The ArcGIS spatial analysis method is used to study the spatial distribution changes of higher education harmonious development in China’s 31 provincial administrative regions. Then, the Tobit model is used to analyze the impact of various economic and social factors, scientific and cultural factors or layout of higher education factors on the harmonious development of higher education, in order to optimize the spatial layout of China’s higher education resources, balance education development, narrow regional disparities, promote regional coordination, and enhance the overall competitiveness of higher education. Research has found that: (1) The development of higher education subsystems shows a trend of convergence; (2) Over the past 23 years (from 2000 to 2023), the spatial centroid of harmonious development of higher education (HDHE) in China shifted southward; (3) There is a strong spatial interaction between 3 subsystems of harmonious development of higher education in China(economic society subsystem, technology and culture subsystem, and higher education subsystem); (4) The main factors affecting HDHE in China include the degree of regional ecological civilization, the ratio of university students to teachers and the per capita domestic patent application authorization.

Continuity or change in the transition to Islam? A diachronic assessment of agricultural production at Old Dongola, Northern Sudan (14th–18th centuries CE)

In this paper, we present an archaeobotanical study from Old Dongola, northern Sudan, examining agricultural dynamics and subsistence strategies from the Late Christian to the Islamic period. Old Dongola, established in the 5th century, served as the capital of the Kingdom of Makuria, one of the three medieval Nubian kingdoms. Following the collapse of Makuria in the 14 th century, the city underwent significant cultural and social transformations, marked by the migration of Arab tribes and the rise of new power structures. From the 14 th to the 18 th century, Old Dongola served as the seat of a local ruler who became subordinate to the Funj Sultanate in the 16 th century, a period that witnessed religious conversion, migration, and political reorganisation associated with the gradual conversion to Islam in the region. This study is distinguished by a systematic sampling strategy, with sediments collected from every excavated context in the citadel of Old Dongola. The archaeobotanical results, spanning the Kingdom of Dongola and Funj periods (14 th –18 th centuries), shed light on the dietary habits of the site's inhabitants. The evidence indicates an increasing reliance on sorghum, alongside a gradual decline of bread wheat and hulled barley. The introduction of crops such as tobacco and eggplant from the 16 th century onwards may reflect broader economic and cultural shifts occurring during this period of religious and demographic change, though a direct causal link between these crop introductions and processes of demographic change or conversion to Islam cannot be established from archaeobotanical evidence alone. This study contributes to our understanding of agricultural change in early modern Sudan, adding to an understudied archaeobotanical record at a time of significant socio-political transition.

Evaluating a sexual violence primary prevention program in Australian secondary schools: A protocol for a pilot cluster randomised controlled trial

Background Sexual violence is a global human rights issue and a significant public health concern. Prevention of sexual violence requires addressing the structural and social norms that perpetuate it. Schools are promising settings for primary prevention interventions, as early socialisation experiences can shape attitudes and behaviours that enable sexual violence. However, evidence on effective school-based interventions is limited. The objective of this pilot study is to assess the feasibility and preliminary effectiveness of an Australian sexual violence primary prevention program, the Schools Education Program, on student sexual violence knowledge, attitudes and behavioural intentions. Methods/design A two-arm, parallel pilot cluster randomised controlled trial will be conducted with Year 9 students (aged 13–15) in 12 secondary schools across one Australian state. Ten schools will be randomly allocated to the SEP intervention (n = 6) or a waitlist control (n = 4); an additional two schools are pre-assigned to the waitlist control group. The SEP comprises three student education modules, parent and staff education, and the recruitment of School Student Champions. The primary outcome is sexual violence knowledge. Secondary outcomes include attitudes, behavioural intentions, and implementation factors. Quantitative data will be collected at baseline, immediately post-intervention, and at 6-month follow-up. Analysis will use linear mixed-effects models to provide preliminary estimates of effect and estimate key parameters for a future definitive trial. The trial is embedded within a concurrent realist evaluation that includes qualitative methods to explore the mechanisms and contextual conditions shaping these outcomes. Discussion This study is the first pilot trial to evaluate a sexual violence primary prevention intervention in Australian secondary schools. In addition to the trial focused on sexual violence prevention outcomes, its integration with realist evaluation methodology will advance knowledge about how, when, and for whom these outcomes occur. The study findings will inform adaptability and scalability for secondary schools nationally and internationally. Trial registration The trial is prospectively registered with the Australian and New Zealand Clinical Trials Registry (reference: ACTRN12625000409471p). Registered 6 May 2025. Protocol version v.1.0, 20/05/2025

Improving the care of people affected by post-COVID syndrome (LCovB):study protocol of a mixed-methods study

Background The COVID-19 pandemic has resulted in a large number of individuals affected by post-COVID syndrome (PCS) and poses significant challenges to healthcare provision. Many PCS patients are left to manage their condition without adequate support. The aim of the LCovB study is to collect data on symptoms (including pre-existing conditions and comorbidities) and the care situation and trajectories of PCS patients. The results will serve to identify key measures for optimizing care. Methods Using a mixed-methods approach, the study includes secondary data analyses of routine data of PCS patients from 44 German statutory health insurance companies, a primary survey and semi-structured interviews with selected PCS patients. In addition, the situation of severely ill patients will be assessed through a physician’s visit and questionnaires. Finally, an expert panel with stakeholders from the healthcare sector will examine the study results using the Delphi method to derive recommendations for treatment and optimized care pathways. Discussion The LCovB study examines care trajectories to identify gaps and barriers for patients with PCS, aiming to develop evidence-based recommendations and guidelines for care and disease management, supported by an expert panel. Trial registration In August 2025, the study was prospectively registered in the German Clinical Trials Register: Module 1 (DRKS00037341), Module 2 (DRKS00037343), Module 3 (DRKS00037344), Module 4 (DRKS00037345).