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Global lung cancer burden, trends, and projections from 2010 to 2050: A population-level severity framework integrating DALYs-per-case and mortality-to-incidence ratio

Background Lung cancer remains the leading cause of cancer mortality worldwide. While incidence and mortality describe population burden, they do not fully capture disease severity at the level of the individual patient. This study quantified the contemporary global burden, temporal trends, and future trajectory of tracheal, bronchus, and lung (TBL) cancer, and applied a multidimensional severity framework integrating fatal and non-fatal outcomes. Methods A global ecological analysis was conducted across 185 countries and territories using harmonized data from GLOBOCAN 2022, the Global Burden of Disease (GBD) 2023 study, and the UN World Population Prospects 2024. Contemporary burden was assessed using incident cases, deaths, age-standardized incidence and mortality rates (ASIR/ASMR), disability-adjusted life years (DALYs), mortality-to-incidence ratio (MIR), and DALYs per incident case. Temporal trends in ASIR and ASMR (2010–2023) were estimated using log-linear regression to derive average annual percent change (AAPC). Projections to 2050 were generated under two scenarios: (1) constant 2022 rates reflecting demographic change only, and (2) trend-based projections extrapolating country-specific AAPCs. Disease severity was evaluated using a two-dimensional framework combining MIR and DALYs-per-case, which captures average lifetime health loss per diagnosed individual independent of population size or age structure. Results In 2022, an estimated 2.48 million new TBL cancer cases and 1.82 million deaths occurred globally, corresponding to ASIR and ASMR of 23.6 and 16.8 per 100,000, respectively. Global DALYs reached 46.7 million, yielding 18.8 DALYs per case, with substantially higher burden in males and in higher-SDI regions. From 2010-2023, age-standardized rates increased in most low- and middle-income countries and declined predominantly in high-income settings. By 2050, demographic change alone is projected to drive large increases in burden in many low-resource countries, with further amplification under trend-based scenarios. DALYs-per-case showed a moderate positive correlation with MIR (Spearman’s r_s = 0.46), revealing marked heterogeneity in severity profiles across countries. Conclusions Global lung cancer burden is projected to rise substantially in many regions despite declining rates in high-income settings. Integrating DALYs-per-case with MIR provides a complementary severity lens that highlights inequities not captured by incidence and mortality alone and supports more targeted prevention, treatment, and survivorship strategies.

Reducing Voltage Hysteresis of FeF ₂ via Oxygen Doping and Nano‐Disordering in Sulfide All‐Solid‐State Batteries

ABSTRACT Conversion‐type metal fluorides are promising cathode candidates for high‐energy‐density post‐lithium batteries. Unfortunately, their practical implementation has been severely impeded by pronounced voltage hysteresis (VH). Herein, we report a gas‐phase treatment strategy to realize oxygen doping and nano‐disordering of FeF 2 , which reduces the VH of FeF 2 to a record low level of 153 mV at 80°C when integrated into sulfide all‐solid‐state batteries. Specifically, crystalline FeF 2 is doped with oxygen and refined to nanocrystals dispersed in a disordered FeOF matrix, which narrows the band gap of FeF 2 from 1.84 to 1.36 eV, decreases the ionic migration energy barrier from 2.2 to 1.2 eV, enhances its electronic conductivity from 4.1 × 10 −6 mS/cm to 0.48 mS/cm, ionic conductivity from 1.1 × 10 −6 mS/cm to 4.8 × 10 −5 mS/cm. The dramatically increased electronic and ionic conductivity boosts the charge transport kinetics and reduces the charge transfer barrier, thus suppressing the VH. Notably, the oxygen doping strategy is not restricted to FeF 2 , but is valid for a broad class of metal fluorides. These results provide a versatile solution to the long‐standing VH bottleneck in metal fluorides and are expected to accelerate the industrial adoption of metal fluoride cathodes to enable high‐energy‐density lithium batteries.

Completeness of death registration in Ghana: An evaluation of multiple data sources and methods

Introduction The lack of a robust and comprehensive civil registration system undermines efforts to develop policies that address emerging health issues in a population. While Ghana has made significant strides in birth registration, progress in death registration has lagged despite the system’s introduction in 1888. Death records are dispersed across institutions and hampered by weak coordination and inconsistent data sharing. The study aims to evaluate the completeness of death registration using both demographic and empirical methods. Methods We assessed the quality of mortality data using demographic methods and further applied Death Distribution Methods (DDM) as well as the Empirical Completeness Method (ECM) to evaluate the completeness of death registration from the 2022 mortality register and two rounds of population and housing censuses. Findings Age reporting ranged between fairly accurate and rough, with noticeable under-reporting of under-five deaths. Death registration completeness was estimated at 28.7 percent and 56 percent using the ECM and DDM, respectively. DDM results reveal that male completeness was highest (101%) in the Volta Region and lowest (42%) in the Western Region, while female completeness was highest in Upper East (89%) and lowest in Western (35%) regions. Sub-national variations in completeness were further highlighted by the ECM, with completeness ranging from nearly 70 percent in Greater Accra to barely 8 percent in the Oti Region. Conclusions The study revealed that completeness of death registration remains low and incomplete, with minimal improvement over the past two decades. The findings underscore the urgent need to adopt innovative, targeted and coordinated approaches to improve completeness, ensuring Ghana can meet international commitments such as SDG 17.19.2.

A Hierarchical Plug‐and‐Supply Flap (PASF) for Instant Perfusion and Oxygen Delivery in Large Soft Tissue Repair

ABSTRACT Timely and spatially sufficient oxygen delivery remains a significant challenge in large‐volume soft tissue repair. Here, we present a novel plug‐and‐supply flap (PASF) system that integrates hierarchical vasculature and in situ endothelialization to achieve instantaneous perfusion within seconds and provide uniform metabolic support. We fabricated hierarchical vascular networks with high structural precision using a hydrogen‐bond reorientation technology, while biofunctionalizing the conduit surface to enable rapid endothelial adhesion via a unique galectin‐mediated mechanism, without needing prolonged pre‐culture. Computational modeling guided vascular geometry optimization by simulating oxygen diffusion and hemodynamic dynamics, thereby improving both metabolic support and perfusion stability. In a rabbit carotid artery anastomosis model, PASF restored immediate perfusion and enhanced oxidative metabolism, thereby promoting angiogenesis and establishing a pro‐regenerative niche. Together, these findings demonstrate a generalizable strategy for engineering perfusable scaffolds that actively modulate the post‐implantation niche in soft‐tissue reconstruction, where early metabolic support is vital.

Expression of Concern: How does social support influence autonomous physical learning in adolescents? Evidence from a chain mediation and latent profile analysis

Biocompatible Quaternized Chitosan‐Whey Protein Nanofibrous Porous Microspheres for Multi‐Functional Synergistic Regulation of the Gut‐Liver Axis in the Treatment of Metabolic Dysfunction‐Associated Steatotic Liver Disease

ABSTRACT Metabolic dysfunction‐associated steatotic liver disease (MASLD) has emerged as a major global health burden, yet effective pharmacological interventions remain limited. Dysregulation of the gut microbiota‐bile acid axis plays a pivotal role in MASLD pathogenesis; however, developing targeted therapies that address this complex interplay remains challenging. Here, we present a safe oral delivery system (QW) comprising in situ self‐assembled nanofibrous porous microspheres derived from whey protein and quaternized chitosan, which integrates physical adsorption with bio‐regulatory functions. In a murine MASLD model, oral QW administration reduced serum ALT (258.6 to 50.3 U/L) and AST (204.4 to 86.7 U/L) levels, and decreased hepatic triglyceride (0.54 to 0.18 mmol/g) and cholesterol (0.12 to 0.05 mmol/g) content. The NAS score decreased significantly, accompanied by marked histopathological improvements. Multi‐omics analysis revealed that QW reshaped gut microbial composition, doubled the relative abundance of Bacteroidetes, modulated bile acid metabolism, and preserved intestinal barrier integrity through reactivation of the hepatic FXR‐SHP signaling pathway. This biocompatible, multi‐functional oral system offers a promising therapeutic strategy for MASLD and advances the paradigm of gut‐liver axis‐based interventions for metabolic liver diseases.

Influence of salinity on growth, nutrient utilization, and gene expression of giant freshwater prawn (Macrobrachium rosenbergii)

Salinity is one of the most influential eco-hydrological factors that affect the molting, growth, and other physico-biochemical responses of crustaceans. A 56-day in vivo experiment was conducted to assess the effects of variable salinities on growth attributes, feed utilization, and gene expression profile of Macrobrachium rosenbergii. Juveniles of M. rosenbergii that were exposed to salinities of 0, 3, 6, 9, and 12 ppt in triplicate, and designated as control, T1, T2, T3, and T4, respectively. Higher weight gain (WG), %WG, specific growth rate (SGR), feed conversion ratio (FCR), and protein efficiency ratio (PER) were recorded at 3 ppt than at other salinities. A salinity of 3 ppt also showed higher values of condition factor (CF), and survival of M. rosenbergii . A polynomial regression analysis indicated that the optimal salinity for WG and SGR of M. rosenbergii were 3.12 and 3.80, respectively. A significant decrease in the molt-inhibiting hormone (MIH) and an increase in the chitinase (CHIT) gene expression were documented at 3 ppt compared to control. The mRNA transcripts of stress response genes were significantly downregulated, and immune-related genes were upregulated at 3 ppt salinity, compared to the other salinities. Although the expression of antioxidant-related genes was upregulated when rearing at 3 ppt salinity, no significant differences were found relative to other salinities. Our findings suggest that M. rosenbergii reared at 3 ppt salinity show promising improvements in growth attributes by modulating the expression profile of physico-biochemical response genes reared at low temperature.

Dual‐Solvent Supramolecular Assembly Enables Ampere‐Hour Halide All‐Solid‐State Pouch Cell

ABSTRACT Halide solid electrolytes (SSEs) hold promise for next‐generation all‐solid‐state batteries (ASSBs), yet scalable fabrication of halide SSE films and ampere‐hour‐scale all‐solid‐state pouch cells (ASSPCs) via slurry coating has not been demonstrated. Here, we introduce a dual‐solvent supramolecular assembly strategy that precisely regulates the chain organization of a multiblock copolymer binder (SEEPS), enabling low‐binder, high‐viscosity slurries for uniform halide SSE film formation. Methylcyclohexane and decane are identified as chemically compatible solvents that diminish InCl 3 surface precipitation in Li 3 InCl 6 , preserving ionic conductivity. The resulting Li 3 InCl 6 /Li 6− x PS 5− x Cl 1+ x bilayer SSE film exhibits high ionic conductivity (1.26 mS/cm), mechanical robustness, and electrochemical stability. ASSBs using NCM88 cathodes and micro‐silicon anodes retain 71.3% capacity after 600 cycles at 0.5 C, while the first ten‐layer ampere‐hour‐scale halide ASSPC delivers 1.45 Ah at 0.2 C with 95.1% capacity retention over 100 cycles. This approach establishes a practical and scalable pathway for fabricating halide ASSPCs, bridging laboratory innovations and commercial deployment.

Cardiometabolic risk pathways in adults with disabilities: A structural equation model of diet quality and functional ability

Background Adults with disabilities experience increased cardiometabolic risk, yet the pathways linking nutrition, functional ability, and environmental factors remain insufficiently defined. This study examined these relationships using a structural equation modeling framework. Methods A cross-sectional study was conducted among 123 adults with disabilities in Palestine (mean age 31.9 years). Data included anthropometric measures, two non‑consecutive 24-hour dietary recalls, disability severity (Disability Rating Scale), functional ability (Barthel Index), psychosocial environment, and socioeconomic indicators. Dietary quality and adequacy were assessed using the Diet Quality Index (DQI) and Mean Adequacy Ratio (MAR). Seven latent constructs were specified and tested using confirmatory factor analysis and structural equation modeling. Results Indicators of cardiometabolic risk were prevalent: 58.5% overweight/obese and 51.2% had inadequate intake. Disability severity correlated with reduced muscle mass and poorer diet quality. Nutritional adequacy positively predicted body composition (β = 0.274) and functional ability (β = 0.185). Functional ability and physical activity were inversely associated with adiposity, while sedentary behavior moderated the relationship between diet quality and waist circumference. Mental illness specifically impaired diet quality, but not caloric intake. Urban residence and lower education predicted poorer dietary outcomes. The model explained 63.7% of variance in body composition and 94.4% in functional ability. Conclusions Cardiometabolic risk in adults with disabilities is shaped by interrelated pathways involving disability severity, nutrition, functional capacity, and psychosocial factors. Lower anthropometric measures may reflect muscle loss rather than reduced risk. Interventions should focus on improving nutritional adequacy, supporting functional independence, addressing mental health, and reducing environmental barriers.

HLA-DRB1 and HLA-DQB1 genetic polymorphisms and susceptibility to coronary atherosclerosis in a Northeast Chinese Population: A case-control study

Atherosclerosis is a chronic inflammatory disease with increasing prevalence in Northeast China, where HLA class II molecules play an important immunoregulatory role. However, the contribution of specific HLA-DRB1 and HLA-DQB1 alleles to AS susceptibility in this population remains incompletely characterized, necessitating novel biomarkers for early detection. In this case-control study of 209 participants, HLA-DRB1 and HLA-DQB1 allele and phenotypic haplotype distributions were compared using odds ratios with 95% confidence intervals and Bonferroni correction for multiple comparisons. A total of 28 HLA-DRB1 and 12 HLA-DQB1 alleles were analyzed. The lowest P value for HLA-DRB1 was observed for DRB1*07:01 ( P  = 0.077, corrected P  = 1.000; OR = 1.994, 95% CI: 0.955–4.164), and that for HLA-DQB1 was observed for DQB1*02:02 ( P  = 0.150, corrected P  = 1.000; OR = 1.739, 95% CI: 0.850–3.558). Neither reached statistical significance, though both trended upward in the AS-susceptible group (DRB1*07:01: 12.59% vs. 6.76%; DQB1*02:02: 12.22% vs. 7.43%). The DRB1*07:01-DQB1*02:02 phenotypic haplotype was more frequent in the AS-susceptible group than in the control group (22.22% vs. 10.81%), with an OR of 2.357 (95% CI: 1.019–5.452). Although the association did not survive Bonferroni correction (corrected P  = 1.000), the effect size suggested the signal was unlikely to be a trivial statistical artifact. In conclusion, the DRB1*07:01-DQB1*02:02 phenotypic haplotype was identified as a candidate risk marker for AS in the Northeast Chinese population, warranting validation in larger cohorts.

Balancing adaptations and fidelity of implementation strategies to optimize primary healthcare in Ethiopia: Lessons from embedded implementation research

Background Optimizing Ethiopia’s Health Extension Program (HEP) has been critical to enhancing primary healthcare (PHC) service delivery, particularly in remote and underserved settings. Embedded implementation research (EIR) strengthens PHC systems by positioning implementers and local managers at the center of addressing operational bottlenecks, enabling adaptive, context-specific refinement of interventions and strategies while maintaining high fidelity to their core components. This study evaluates the implementation fidelity, adaptation of strategies, and lessons to address challenges in equitable access, quality, and accountability through the “Improve Primary Health Care Service Delivery” project. Method A participatory pragmatic EIR approach was applied to co-design and pressure test the implementation strategies to optimize the HEP roadmap (2020–2035). Fourteen woredas from agrarian and pastoral contexts were selected to pressure test HEP optimization strategies. Continuous adaptation tracking and fidelity monitoring were conducted throughout the project implementation period from April 2022 to September 2024. The HEP optimization implementation strategies, adaptations, and modifications were guided by frameworks such as Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies to ensure interventions fit local contexts. Results The adaptations of implementation strategies resulted in implementation fidelity, which improved maternal and child health service coverage, strengthened community health program units, enhanced referral systems through Networks of Care (NoCs), and contextualization of service delivery for pastoralist communities. While most strategies were retained and repackaged for scale, others—including performance-based incentives and governance restructuring—were deprioritized because of feasibility, policy, and sustainability considerations. Adaptations were guided through iterative learning and stakeholder engagement and clustered into four broad areas: contextualization of service delivery models, strengthening community engagement, streamlining quality improvement and NoCs approaches, and refining accountability mechanisms. Stakeholder engagement was pivotal in balancing fidelity with contextual adaptations, fostering trust and sustainability. Despite challenges such as resource constraints, sociocultural barriers, and infrastructure limitations, systematic monitoring and iterative learning processes facilitated the refinement of scale-up strategies. Conclusions Adaptive implementation science effectively optimizes health programs in complex and dynamic contexts. Participatory co-design, stakeholder engagement, and systematic frameworks facilitated the development and refinement of strategies that improved service quality, access, and accountability in diverse PHC settings.

Commensal-derived acetylcholine enhances mucosal immune education

Cone photoreceptor ablation in microglia-deficient larval zebrafish retina elicits a regenerative response alongside a compensatory immune cell response

Emerging evidence implicates retinal microglia and inflammation as important components impacting the outcome of retinal regeneration, which is spontaneously achieved in zebrafish retina following acute damage but is limited or blocked in mammals. Here we describe the regenerative response in the larval zebrafish retina following ablation of cone photoreceptors. To investigate the role of microglia in the regenerative response, we used irf8 st95 heterozygote (microglia-sufficient) and irf8 st95 homozygous mutant (microglia-deficient) zebrafish. We compared multiple aspects of the regenerative response in irf8  + /- and irf8 -/- larval retinas, including entry of the Müller glia (MG) into the cell cycle, the amplification of MG-derived progenitor cell (MGPC) proliferation, inflammatory and glial reactivity-associated gene expression, and the regeneration of cones. We found only modest impacts to early and late stages of MGPC proliferation and to inflammatory gene expression in irf8 mutants, with no obvious impacts to the regeneration of cones. Notably, we detected a population of immune cells in irf8 mutants that emerged following cone ablation, which expanded in number then were reduced over time, following a trajectory similar to microglia-sufficient siblings but at markedly reduced abundance. The immune cells detected in irf8 mutants included a subset with L-plastin/4C4 antibody staining patterns different than those in microglia-sufficient siblings, suggesting distinct origins and/or phenotype compared to resident microglia in controls. The presence of immune cells in irf8 mutants following cone ablation limited our ability to make strong conclusions about the role of microglia in regeneration of cones. However, our results are consistent with several reports that indicate a role for microglia in regulating MGPC proliferation in the regenerating retina. Collectively considered with other reports, our results further indicate that compensatory responses, which may include different immune cells and/or signaling from other retinal cell types such as Müller glia, may be elicited in microglia-deficient retinas upon neuronal damage.

Evaluation of outcomes in 201 child and youth survivors of Child Sexual Abuse (CSA) who participated in a one-year multimodal treatment program

Background and rationale Child sexual abuse (CSA) is a pervasive and prevalent form of early-life trauma that can increase the risk for PTSD, mood disorders, substance abuse, harmful behaviour, non-suicidal self-harm, suicidal ideation, and death by suicide. Preliminary research has shown positive impacts of multimodal treatment for youth survivors of CSA, but no ‘gold-standard’ currently exists for CSA treatment. The aim of this study was to provide a secondary analysis of data from a longitudinal, episodic, and multimodal treatment program specifically designed to treat child and adolescent survivors of CSA. Methods Child and youth survivors of CSA aged 8–17 completed a one-year multimodal treatment program at a dedicated facility known as the Little Warriors Be Brave Ranch. Participants completed self-report outcome measures for PTSD, depression, anxiety, self-esteem, quality of life, family functioning, and substance use at intake and graduation from the program. Changes in reported outcomes for child and youth participants were analyzed over the course of treatment. Results A total of 201 sequential individuals who completed the one-year treatment program between January 2022-January 2026, from an initial group of 253 participants, were included in this analysis. Most of the completers were biologically female (n = 166, 82.6%) and were adolescents aged 13–17 (n = 116), while the remainder were children aged 8–12 (n = 85). Overall, positive changes in all outcomes were reported in participants from both groups. The largest effect was reported in adolescent PTSD symptoms (d = 0.94, p < 0.001), depression (d = 0.88, p < 0.001), and anxiety (d = 0.86, p < 0.001). Large effect sizes were also reported in levels of PTSD (d = 0.72, p < 0.001), depression (d = 0.82, p < 0.001), and anxiety (d = 0.64, p < 0.001) in child participants. Participants whose PTSD scores remained above the clinical threshold at graduation had higher levels of family dysfunction, more complex histories of trauma, and lower resilience scores. Conclusion The findings of this study support the use of a multimodal treatment program for youth CSA survivors. The results suggest that this program design has the capacity to benefit CSA survivors across several domains of mental health and well-being. However, the findings of this study are limited by the lack of a control group. Future research should investigate the long-term effects of treatment, and include comparisons to a control sample, to further elucidate the sustainability of these positive therapeutic outcomes.

Trends in general practitioner dispensing of thickeners in the NHS England, 2019–24

Introduction Oropharyngeal dysphagia is common and often results in aspiration. Thickeners are widely used to thicken liquids to slow the liquid bolus and prevent aspiration and aspiration pneumonia, despite multiple concerns about their use. To date, there is little data on prescribing/dispensing practices. This study aims to provide the first overview of thickener dispensing practices, serve as foundational material for parties interested in research, practice and policy making, and guide further work in this area. Method We explored English general practitioner thickener dispensing practices for the five-year period 2019–2024 via the NHS Business Services Authority ePACT2 database and using descriptive statistics and linear regression to analyse the data. We hypothesized that with a large data set, it would be possible to detect trends in dispensing. Results Between 2019 and 2024, nearly three million thickening items were dispensed in primary care in England at a cost of nearly 90 million sterling. Thickened liquids is primarily an intervention for older people although there was a significant decreasing trend in dispensed thickener items in adult populations. Thickener dispensing has increased in the youngest age group (0–1-years-old). The cost of thickeners to the NHS has risen in the last year under study despite the significant decline in use observed for most age groups. Of dispensed items over the five-year period, the vast majority were gum-based. Conclusion While the data provided in this study is limited to GP dispensed thickeners in England, it provides researchers, clinicians and policy makers with initial information on dispensing practices. From the available data, a decreasing dispensing trend is seen in the context of rising costs, older people comprise the population who primarily receive thickeners and gum-based products dominate the market. This study raises a number of questions regarding the use of thickeners for people with swallowing problems.

Electric fields probe the symmetry of the ‘heavy hydrogen’ nucleus

Parents’ role as advocates for and against childhood vaccination: Findings from a nationally representative survey

Introduction In 2025, the US recorded the highest number of measles cases in 25 years, signaling an urgent need for renewed attention to increasing childhood vaccination coverage. To identify future intervention partners, we sought to understand parents’ role in advocating for and against childhood vaccines. Methods A nationally representative sample of 1,315 parents of children ages 9–12 years participated in our online survey about vaccine advocacy behaviors in 2025. Separate weighted logistic regression models identified correlates of encouraging or discouraging other parents from getting routine vaccines for their children. Results Over one-third of parents reported encouraging routine vaccines sometimes or more often (36%), while about one-tenth reported discouraging vaccines (12%). These estimates include a small proportion of parents (6%) who reported both behaviors. Parents with higher confidence in the importance of vaccines for their child’s health were more likely to be encouragers and less likely to be discouragers (both p  < .05). Encouragers ( n  = 477) most often advocated for measles (50%) or seasonal flu vaccines (44%). These parents most often engaged family members and close friends, using strategies such as sharing vaccine experiences (47%), information about vaccine effectiveness (38%), and advice or opinions about vaccines (35%). Discouragers ( n  = 151) most often advocated against Covid-19 (53%) or seasonal flu vaccines (41%), with relatively few focusing on measles vaccine (10%). Discouragers engaged similar audiences and strategies as encouragers. Conclusion Findings of our nationally representative study suggest that parents who encourage routine vaccination far outnumber those who discourage it. Given that encouragers often advocate for measles vaccine, future efforts to increase vaccination coverage should consider ways to partner with parent advocates to stem the alarming resurgence of this disease.

Efficacy and limitations of diffusion-weighted imaging with background suppression-based whole-body magnetic resonance imaging in high-risk prostate cancer staging: A retrospective study

Purpose To evaluate the diagnostic performance and limitations of whole-body magnetic resonance imaging (WB-MRI) using diffusion-weighted imaging with background body signal suppression (DWIBS) for staging high-risk prostate cancer (PCa) in comparison with conventional computed tomography (CT) and bone scintigraphy (BS). Materials and methods This retrospective study included 38 patients with newly diagnosed high-risk PCa who underwent CT, bone scintigraphy (BS), and DWIBS, all performed within two months prior to treatment initiation. DWIBS was performed with coverage from the skull base to the proximal femur. Pathological findings from extended pelvic lymph node dissection were available in 14 patients and were used as the reference standard for lymph node metastasis. For all remaining cases and metastatic sites, the reference standard was established by the best valuable comparator consensus of two radiologists and two urologists using imaging and clinical follow-up data. Results For lymph node metastases, both DWIBS and CT demonstrated a sensitivity of 64.3% and a specificity of 100.0%. For bone metastases, DWIBS showed a sensitivity of 88.9% and specificity of 100.0%, whereas BS showed a sensitivity of 100.0% and a specificity of 96.6%. Lung metastases were observed in three patients. Chest CT detected all lesions, whereas DWIBS detected two cases; these were confirmed on coronal T2-weighted images but not visualized on diffusion-weighted imaging alone. Conclusion DWIBS demonstrated acceptable diagnostic performance for staging high-risk PCa, comparable to CT and BS, while offering the advantage of radiation-free WB-MRI and avoidance of radioisotopes. When combined with chest CT, this approach may represent a practical and feasible alternative imaging strategy for initial PCa staging.

Service-oriented cloud manufacturing systems: Balancing profit, customer satisfaction, and resource fairness

The rapid growth of customized demand and geographically distributed manufacturing resources has increased the need for integrated decision-making in cloud manufacturing systems. In such environments, scheduling, logistics, pricing, and quality decisions are highly interrelated and significantly affect both system profitability and customer satisfaction. However, most existing studies address these decisions separately and pay limited attention to customer satisfaction and fairness. To address this gap, this paper proposes a multi-objective mixed-integer programming model that simultaneously integrates scheduling, logistics, pricing, and quality decisions while explicitly considering customer satisfaction and fairness among customers. The model pursues three objectives: maximizing cloud manufacturing system profit, maximizing customer satisfaction as a function of price and product quality, and minimizing unfairness among customers. An LP-metric approach is employed to aggregate the objectives, and the model is solved using CPLEX in GAMS. Computational experiments on small-, medium-, and large-scale instances demonstrate the effectiveness of the proposed framework. The results show that ignoring logistics decisions, customer satisfaction, or earliness/tardiness penalties leads to inferior solutions. Furthermore, a Genetic Algorithm is developed for large-scale instances, where the exact approach becomes computationally demanding. Comparative results indicate that the proposed heuristic provides high-quality solutions with significantly lower computational times for large-scale problems. The findings confirm the effectiveness and scalability of the proposed framework for integrated decision-making in cloud manufacturing systems.

A decade of progress and challenges in Water, Sanitation and Hygiene (WASH) coverage in Bangladesh: Insights from Bangladesh demographic and health survey 2011–2022

Background Access to safe water, sanitation, and hygiene (WASH) remains a critical global public health challenge, with an estimated 2 billion people lacking safe drinking water and basic hygiene services. In Bangladesh, disparities in WASH access persist across regions and socioeconomic groups. This study assesses decade-long changes in WASH coverage, examines its distribution across socio-demographic groups, identifies key associated factors, and highlights underserved regions and population subgroups. Methods Data from four rounds of the Bangladesh Demographic and Health Survey (BDHS) (2011–2022) were analyzed. WASH indicators were classified as improved or unimproved based on WHO–UNICEF Joint Monitoring Programme (JMP) 2017 guidelines and applied consistently across all survey rounds. Spatial mapping was used to assess regional disparities, while regression models identified factors associated with WASH facilities. A classification tree approach was used to explore interactions among predictors. Results Over the decade (2011–2022), access to improved drinking water remained high (above 98%), with improvements in sanitation (22 percentage points), hygiene (30.5 percentage points), and overall WASH facilities (28 percentage points). Classification tree analysis identified wealth index as the most important determinant. Regional disparities were evident, with higher coverage in Dhaka, Rajshahi, and Chattogram, and lower coverage in Barishal and Mymensingh. Wealthier households had higher odds of improved WASH facilities (AOR: 8.72 [6.74, 11.3] in 2011; 9.35 [8.31, 10.5] in 2022) compared to poorer households. Households with more higher educated heads also had higher odds (AOR: 7.10 [5.80, 8.69] in 2011; 3.44 [2.99, 3.96] in 2022) compared to those with no formal education. Other associated factors included family size, region, media access, and mobile ownership. Conclusion Key determinants of WASH access, including wealth, education, and regional disparities, remained largely unchanged over time. Achieving SDG 6 requires targeted subsidies for socioeconomically disadvantaged households, region-specific interventions in underserved areas such as Barishal and Mymensingh, and strengthened awareness programs.