Browse Articles

All-optical doubly resonant cavities for energy-efficient ReLU function in nanophotonic deep learning

This paper presents a novel approach to implementing all-optical Rectified Linear Unit (ReLU) activation functions using compact doubly-resonant cavities with dimensions of approximately 10 μ m. The proposed design leverages χ ( 2 ) nonlinear processes within carefully engineered photonic structures that simultaneously resonate at both fundamental and second-harmonic frequencies. By exploiting the phase-sensitive nature of second-harmonic generation, we demonstrate an optical analog to the ReLU function, achieving femtojoule-level activation energy—comparable to state-of-the-art approaches—while reducing device footprint by two orders of magnitude compared to previous implementations. The theoretical framework is developed using coupled-mode theory and validated through rigorous finite-difference time-domain simulations. Beyond ReLU, we show that the same physical structure can implement alternative activation functions such as ELU and GELU through simple adjustments to input conditions. Neural network simulations demonstrate that the proposed optical activation functions achieve classification accuracy within 0.4% of ideal electronic implementations while offering significant advantages in energy efficiency and processing speed. This work represents a significant advancement toward realizing energy-efficient, high-density optical neural networks for next-generation artificial intelligence hardware.

Comparative mediation analysis of dog and cat ownership and perceived stress

Companion animals, such as dogs and cats, are widely reported to be associated with lower stress, yet species-specific differences remain unclear. We conducted a comparative mediation analysis to examine how pet ownership type (dog vs. cat) relates to perceived stress, leveraging a large, balanced dataset (1,923 dog owners and 1,804 cat owners) collected throughout the COVID-19 pandemic. Investigated mediators included human-animal interaction, emotional closeness, perceived costs, behavior problems, and disease transmission concerns. We used a directed acyclic graph (DAG)-guided, bootstrap-based path modeling approach to estimate mediation-based associations. Dog and cat ownership differed only marginally in their overall association with perceived stress, with dog ownership associated with slightly lower stress levels. Comparative mediation analyses revealed the largest species-specific difference in human-animal interaction. This mediator showed a strong inverse association with perceived stress for dog ownership but only a minimal association for cat ownership. Accordingly, human-animal interaction emerged as the most influential mediator for dog ownership, whereas emotional closeness was most influential for cat ownership. Moreover, emotional closeness showed a positive association with perceived stress in both groups. Perceived costs and behavior problems showed the strongest associations with higher perceived stress across species, slightly more pronounced for dog ownership. Yet their mediation-based associations were weak, largely attributable to minimal differences in perceived costs and behavior problems between dog and cat ownership. Only 26% of the overall association between ownership type and perceived stress was accounted for by the study mediators, indicating the need to explore additional mediators. This study advances understanding of how the human-animal bond is associated with perceived stress and underscores species-specific differences in these associations. These findings can help generate hypotheses for future longitudinal studies and may help inform the development of species-tailored interventions.

Modeling the association between psychological capital and nurses’ job performance: The moderating role of intolerance of uncertainty

This cross-sectional analytical study aimed to examine the relationship between psychological capital (PsyCap) and nurses’ job performance, as well as the moderating role of intolerance of uncertainty (IU). A total of 212 nurses working in hospitals affiliated with Iran University of Medical Sciences participated. Verbal informed consent was obtained from all participants, as approved by the Ethics Committee of Iran University of Medical Sciences (IR.IUMS.REC.1401.561). Data collection tools included standardized questionnaires on PsyCap, IU, and job performance. Data were analyzed using structural equation modeling (SEM) with SmartPLS software. The measurement model was assessed for reliability and validity, and the structural model was tested for the study hypotheses. The findings indicated that PsyCap was positively and significantly associated with nurses’ job performance (β = 0.38, p < 0.001). IU was not significantly associated with job performance. However, IU negatively moderated the PsyCap–performance relationship (β = −0.16, p = 0.005). These findings suggest that PsyCap may be positively related to nurses’ job performance, although its positive effects may be attenuated under high IU. Interventions aimed at strengthening PsyCap alongside uncertainty-management strategies may help optimize performance in clinical settings.

Optimized detection of caspase-6 activation in a murine inflammation model to inform neurodegenerative disease therapies

Caspase-6 (casp-6), is a member of the apoptotic family of caspases (cysteine aspartic proteases) and has been shown to be involved in several neurodegenerative diseases, including Alzheimer’s disease. Drug discovery efforts have focused on specific inhibition of casp-6, and it is important that lead compounds demonstrate engagement and inhibition of the protease in vivo . A casp-6 overexpressing mouse model was reported, but is no longer available to the scientific community. We developed alternative means of activating casp-6 in commercially available mice as a platform to test potential casp-6 inhibitors. Lipopolysaccharides (LPS) from E. coli was used to stimulate an immunogenic response in WT C57BL/6NJ mice, which has been shown to activate the NLRP1 inflammasome, which activates casp-1 and subsequently, casp-6. Key tissues (brain, colon, and thymus) were sampled and evaluated for casp-6 activation by immunoblotting for both active casp-6 and a cleaved lamin A, a casp-6 substrate, and by directly measuring VEIDase activity in tissue lysates. Using in-house bred WT C57BL/6NJ mice, which had never been subjected to shipping, with a single intraperitoneal dose of LPS (5 mg/kg) and a 4-hour incubation, we observed robust casp-6 activation in the thymus. We also established VEIDase activity assays as a more reliable marker of casp-6 function than monitoring levels of casp-6 or cleaved substrates, and established the importance of using a non-immunogenic vehicle. We observed casp-6 activation in aged mice as a second useful model, which also further implicates casp-6 in age-related neurodegenerative pathways. These are new means to test the efficacy of casp-6 inhibitors using a simple in vivo assay that can robustly activate casp-6 in an easily accessible laboratory mouse strain. We foresee that these developments will drive drug discovery efforts aimed at identifying casp-6 inhibitors in various disease contexts, including neurodegeneration.

Comprehensive insights into the prescribing trends of carbamazepine, lamotrigine, lithium, and valproate in the UK Primary Care from 1995 to 2018

Background Mood stabilisers carbamazepine, lamotrigine and valproate remain the cornerstone medication in the treatment of epilepsy, and in the management of psychiatric disorders alongside lithium. Prescribing decisions are influenced by patient’s preference, clinical history, and risk. This study examines mood stabiliser initiation and prevalence prescribing trends in UK primary care (1995–2018), stratified by sex (male and females) and age (18–39, 40–59, 60–79 and 80–99 years), irrespective of diagnosis. Method Cohort studies using UK anonymised electronic primary care data from IQVIA Medical Research Data (IMRD) of individuals aged 18–99 years registered with participating General Practice. Results Carbamazepine prescribing declined sharply across ages and sexes since the early 2000s. In contrast, lamotrigine prescribing increased markedly from 2005, thus becoming most initiated among individuals aged 18–39 years by 2018. Carbamazepine initiation predominated in individuals aged 40–99 years, and more so in females than males. Valproate initiation decreased throughout study period: (2018 vs 1995) adjusted Incidence Rate Ratio (aIRR) ranged from 0.12–0.44. However, prevalence rose in males (18–79 years) with adjusted Prevalence Rate Ratio (aPRR) ranged from 1.14–1.60, and females (40–79 years) at aPRR 1.12–1.31. By 2018, valproate was still prevalent among 18–39 years males (3.40/1000 individuals [3.19–3.61]) compared to females (1.18/1000 individuals [1.06–1.30]). Carbamazepine, lamotrigine and valproate were almost equally prescribed by 2018, while lithium the least prescribed. Mood stabiliser prescribing was higher among socioeconomically deprived individuals, both in terms of initiation and prevalence: (Townsend 5 vs Townsend 1) aIRR ranged from 1.07–3.26, and aPRR 1.17–2.90. Conclusion Over the study period across demographics, carbamazepine prescribing declined while lamotrigine prescribing increased substantially. By 2018, carbamazepine was mainly initiated in males and females aged 40–99 years and lamotrigine dominated in 18–39 years. Valproate initiation fell but remained prevalent in 18–39 years males; lithium prescribing remained low. Mood stabilisers were frequently prescribed in socioeconomically deprived individuals.

Scrolling for science: Assessing the quality and accuracy of Crohn’s disease-related content on Instagram reels

Background There is a concerning trend of misinformation of healthcare related content on social media. Recent studies have examined themes and narratives about Crohn’s disease but have not quantitatively assessed the accuracy and quality of content on Instagram Reels. Our aim was to assess the quality and accuracy of Instagram Reels about Crohn’s disease and examine differences in content by type of creator, from medical professionals to lay individuals. Methods Seventy-eight top-viewed English-language Instagram Reels tagged with “#crohns” were evaluated. Videos were categorized by creator and content type. Two reviewers evaluated each video for accuracy and quality using an adapted harm/benefit score and the Journal of the American Medical Association (JAMA) benchmark criteria, respectively. Results Seventeen percent of videos were created by medical professionals and 83% by non-medical users. Educational content was significantly more common among medical professionals than other content creators (62% vs 23%; P  = 0.005). No significant correlation was found between engagement metrics and either JAMA or harm/benefit scores. Medical professionals had significantly higher JAMA scores than non-medical users (2.5 vs 2, P  < 0.001), but there was no significant difference in harm/benefit scores between groups (0 vs 0, P  = 0.9601). Videos offering medical advice had the lowest median harm/benefit score (−1), with frequent misinformation noted. Forty-two percent of harmful videos were created by medical professionals. Conclusions The average Instagram Reel about Crohn’s disease was of moderate quality and neutral impact. Accuracy or quality was unrelated to video popularity. While videos by medical professionals had higher JAMA scores, this did not correspond to greater accuracy. Medical advice videos by medical professionals were not more accurate than those by non-medical creators, and multiple harmful videos were created by medical professionals, underscoring the need for critical evaluation of Crohn’s disease-related social media content.

A path planning approach for ship collision avoidance integrating BRB reasoning and velocity obstacle algorithm

Reliable path planning for ship collision avoidance remains challenging in complex maritime environments with dense traffic. This study proposes a novel approach that integrates Belief-Rule-Based (BRB) reasoning with the Velocity Obstacle (VO) algorithm for multi-ship encounter scenarios. First, the BRB framework groups ships with similar movement trends and close proximity, reducing both the number of avoidance targets and decision-making complexity. Based on the grouping results, the safety domain radius for individual ships and ship groups is set proportionally to ship length. Subsequently, the VO algorithm generates safe and feasible avoidance trajectories toward the goal. The method was tested in two scenarios, showing improved navigational safety and operational efficiency in congested waters. This work provides a foundation for intelligent decision-making in maritime safety management and supports sustainable development in the shipping industry.

Robot-assisted reconstruction using ureteroureterostomy and Lich–Gregoir ureteral reimplantation for complicated duplex kidneys in children

Objective This study aimed to evaluate the efficacy of robot-assisted reconstruction using end-to-side ureteroureterostomy (UU) and Lich‒Gregoir ureterovesical reimplantation (UR) for complicated duplex kidneys in children. Methods A retrospective study was conducted on pediatric patients who underwent combined robotic UU and Lich‒Gregoir UR between January 1, 2021, and January 1, 2024. The inclusion criterion was the presence of concurrent upper- and lower-pole ureteral pathologies. Surgical time, postoperative length of stay, pre- and postoperative anteroposterior diameter of the renal pelvis (APD), ureteral diameter (UD), renal function (RF) of the affected kidney, and complications were analyzed. Results In total, 12 patients presented with urinary tract infections (UTI, n = 9), incontinence (n = 2), and abdominal pain (n = 1). Upper-pole pathologies included ectopic ureters (10 cases) and ureteroceles (2 cases). Lower-pole pathologies comprised ureteral stricture (n = 4) and vesicoureteral reflux (VUR, n = 8). The median surgical time was 177.5 minutes (range: 140–205 minutes), and the median hospital stay was 5 days (range: 3–7 days). Postoperative complications included two cases of UTI, both managed conservatively. At a median follow-up of 19 months (range: 12–31 months), no anastomotic stricture, urinary leakage, or ureteral stump syndrome occurred. Postoperative voiding cystourethrogram (VCUG) revealed no VUR in any patient. Pre- and postoperative APD (22.92 ± 9.07 mm vs. 7.33 ± 5.03 mm, p < 0.001) and UD (11.08 ± 3.15 vs. 5.83 ± 2.41 mm, p < 0.001) differed significantly in the upper pole system, as did the lower pole APD (14.00 ± 6.25 vs. 5.25 ± 3.02 mm, p < 0.001) and UD (7.75 ± 2.26 vs. 4.75 ± 1.36 mm, p = 0.003). The RF of the affected moiety improved significantly (36.58 ± 4.66% vs. 42.75% ± 3.10%, p < 0.001). Conclusions Robot-assisted reconstruction using UU and Lich–Gregoir UR is a safe and effective approach for complex duplex kidneys requiring concurrent upper- and lower-tract reconstruction, demonstrating durable resolution of obstruction and reflux as well as functional preservation.

Development and usability evaluation of HOPE: A patient-centered mHealth application for HTN self-management in Iran

Background Hypertension (HTN) is a major global health problem and a significant risk factor for cardiovascular disease. Mobile health (mHealth) applications offer an efficient, patient-centered approach to managing chronic conditions like HTN. Given the high prevalence of HTN in Iran, and a recognized lack of approved and scientifically-grounded mHealth applications, this study aimed to address this gap, particularly in Hormozgan Province. Objective This study aimed to design and evaluate a HTN self-care application, named HOPE, to facilitate self-management and enable patients to access health services outside of clinical settings. Materials and methods The research was conducted in four steps: (1) determination of data elements and functional requirements based on a systematic review of guidelines and feedback from 25 cardiologists and 50 patients using a Likert scale questionnaire; (2) content design based on national and international clinical and educational standards; (3) application development using Visual Studio, ASP.NET framework with MVC architecture, and C#; and (4) usability assessment. The final evaluation involved 46 participants with HTN from the Hormoz Clinic, who used the application for one month, followed by an assessment using the Mobile Application Usability Questionnaire (MAUQ). Results The HOPE application was designed with nine main tabs and 52 sub-tabs, covering key areas such as demographic information, comprehensive education, nutrition tracking, BP recording, medication management, and a dialogue panel for communication with the doctor. The overall usability evaluation for the application yielded an average score of 4.32 (on a 5-point Likert scale), which was categorized as a “very good” level. The highest average score (4.37) was assigned to the “User Interface and Satisfaction” dimension. A significant relationship was determined between satisfaction with the user interface and the participants’ level of education (P > 0.05). Conclusion The HOPE demonstrated very good usability across all evaluated dimensions—ease of use, interface quality, and usefulness. The strong usability performance suggests that the application is well-designed and has high potential to effectively enhance self-care practices and could be a valuable tool in digital health management programs for patients with HTN. Future research should explore the long-term impacts of using HOPE on clinical outcomes and patient adherence, as well as its integration into routine healthcare practice to optimize HTN management.

Mechanical properties of ECC connection plates in seamless Bridges

Seamless bridges require high-performance connection systems due to the elimination of expansion devices. This study investigates the flexural performance of ECC connection plates (ECP) for seamless RC bridge decks using finite element analysis. A three-dimensional ABAQUS model was developed and validated against available experimental results from the literature. Parametric analyses were performed to evaluate the effects of ECC thickness, reinforcement ratio, concrete strength, and ECC strength. The results show that ECP significantly improves flexural capacity and ductility compared with conventional RC connection plates. Under the same reinforcement ratio, the ultimate load and ductility coefficient increased by 35.1% and 31.3%, respectively. Increasing ECC thickness and ECC strength enhances both load-bearing capacity and deformation ability, while a higher reinforcement ratio increases ultimate load but reduces tensile strain capacity. A theoretical formula for predicting the flexural bearing capacity of ECP was derived and verified using numerical results. The findings provide a basis for the design and optimization of ECP in seamless bridge decks.

Retraction: Analysis of disease burden and future trends of ischemic heart disease in China and globally, 1990–2023

Spatial distribution of the proteome in the human body and in cancers

Abstract A detailed, spatially resolved quantitative map of the human proteome is essential for a deeper understanding of human biology and disease 1–4 . Here we present a comprehensive human proteomic landscape, generated by profiling more than 13,000 proteins across 2,856 samples using data-independent acquisition mass spectrometry. The dataset spans 58 major tissue types, 251 specific tissue subtypes and 25 distinct carcinomas. This resource enables the depiction of spatially resolved proteome trajectories across tissue types and physiological states, including fetal, tumour, adjacent non-tumour and healthy adult tissue, thereby providing insight into both developmental processes and oncogenic progression. Furthermore, quantitative proteomics comparisons across diverse tissue types and states facilitate the indication of organ-specific toxicity, the identification of repurposable anticancer drug candidates and the prioritization of therapeutic targets for cancers. This study establishes a quantitative resource for navigating the proteome in the human body and in common cancers.

Correction: Air pollution in the places of Betula pendula growth and development changes the physicochemical properties and the main allergen content of its pollen

Preventive spare parts supply strategy for large-scale equipment based on performance degradation

Timely replacement of spare parts can improve the reliability of large-scale equipment operation and is the critical link of preventive maintenance. This paper studies how to reasonably formulate spare parts supply strategy in large-scale equipment maintenance. Given the shortcomings of the conventional fixed cycle replacement method of equipment spare parts, a spare parts replacement method based on large-scale equipment performance degradation is proposed. The proposed method can shorten downtime and avoid waste. Firstly, by analyzing the large-scale equipment’s performance state characteristics, the performance evaluation model of the equipment is established using the interval evidential reasoning approach, and the envelope of performance degradation can be obtained. Weibull distribution is used to fit the performance degradation envelope, and the bisection method and maximum likelihood estimation method are combined to identify the model parameters. The health degree envelope of large-scale equipment performance is obtained. Then, the number of spare parts required is calculated based on health degree expectation. Considering the time required for ordering and transporting spare parts, the spare parts ordering strategy is formulated under the condition of large-scale equipment working simultaneously. Finally, the proposed method is applied to a type of large-scale equipment to verify the effectiveness of the proposed method.

LXNet: A lightweight CNN for lung disease classification from Chest X-ray with XAI-based interpretability

The diagnosis of lung diseases such as pneumonia and tuberculosis remains a major global health challenge, especially in resource-limited regions. Artificial Intelligence (AI) has shown strong potential in analyzing Chest X-Rays (CXR) for accurate and timely diagnosis, but most existing models are computationally heavy and lack interpretability, limiting their practical application. In this study, we present LXNet, a lightweight and explainable Convolutional Neural Network (CNN) for nine-class lung disease classification ( Normal , Pneumonia , Higher Density , Lower Density , Obstructive Pulmonary Diseases , Degenerative Infectious Diseases , Encapsulated Lesions , Mediastinal Changes and Chest Changes ). The model was evaluated on a diverse CXR dataset containing 6,743 images collected from a private imaging center (GRS Imagem, Brazil), enabling comprehensive multiclass assessment. LXNet contains only 0.35 million parameters and employs a no-pooling final block to preserve subtle diagnostic features while maintaining very low computational cost. Robustness was enhanced through adaptive Contrast Limited Adaptive Histogram Equalization (CLAHE), grayscale normalization and stratified class balancing. LXNet was benchmarked against pretrained CNNs (DenseNet201, ResNet50V2 and InceptionV3) under identical settings. Explainable AI (Grad-CAM, Score-CAM and LIME) provided meaningful visualizations. LXNet achieved 96.1% accuracy in 5-fold cross validation, outperforming the baselines (DenseNet201: 90.3%, InceptionV3: 88.9%) by 1–8%, with only 308 seconds of training on standard hardware. Statistical significance was confirmed using Wilcoxon signed-rank tests ( p  = 0.03125). These results demonstrate LXNet’s promising performance and interpretability; however, reduced external performance indicates limited generalizability and its clinical applicability requires further validation.

Discharge after coronary artery bypass grafting: A qualitative study highlighting the need for individualised, person-centred care

Background This study explores patient preparedness and support during discharge following coronary artery bypass graft (CABG) surgery. Despite the importance of effective discharge planning, many patients feel unprepared and unsupported, which can hinder recovery and increase readmission risk. Aim To examine patient experiences of the discharge process post-CABG, focusing on education received and perceptions of person-centred discharge planning. Methods A qualitative study using constructivist grounded theory was conducted with eleven participants, interviewed 4–6 weeks post-surgery at a UK Northern NHS hospital. Semi-structured interviews were digitally recorded, transcribed, and analysed using a constant comparative method. Recruitment, data collection, and analysis occurred concurrently. Despite the modest sample size, the study achieved strong information power as the research aim was narrow and clearly focused on exploring the lived experiences of patients who had had a coronary artery bypass graft. This allowed for in-depth engagement with each participant, with relevant experience, enhancing the relevance and the richness of the data. Thematic saturation was observed early in the analysis, indicating that the data sufficiently addressed the research questions. The use of a rigorous analytical approach further ensured that the insights drawn were both meaningful and robust, supporting the adequacy of the sample size. The COREQ checklist guided reporting. Results Four key themes emerged: Patients avoided seeking support or “making a fuss.” Many felt unprepared for discharge. The information booklet was a valuable resource. Lack of post-discharge contact and continuity caused concern. Some participants reported insufficient pre-discharge information and unclear pathways for post-discharge support. The booklet was often the primary source of guidance. The participants’ reluctance to seek support could reflect a pattern of self-management shaped by uncertainty, low confidence, a desire not to burden healthcare professionals or a belief that doctors know best. Yet many felt unprepared for discharge perhaps highlighting gaps in communication and discharge planning. There also seems a reliance on written materials, such as the information booklet. Limited post- discharge contact, created further anxiety, where patients were unsure where to turn for advice. These findings point to the need for clearer, more person‑centred discharge processes. Better communication, improved pre‑discharge education, and clear pathways for follow‑up support could strengthen patient confidence and safety. Although booklets are helpful, they should supplement and not replace ongoing contact and personalised guidance. Ensuring continuity of care and enabling patients to seek help without hesitation is essential for effective person‑centred discharge practice. Conclusion Findings highlight the importance of person-centred approaches in discharge planning. Tailored education and support could improve patient confidence and symptom management during recovery, potentially reducing readmission rates.

Quality assessment of endotoxin contamination in consumables used for assisted reproductive technology

Commercially available disposable products such as cell culture utensils and catheters do not necessarily possess sufficient quality for in vitro fertilization (IVF), from the perspective of pyrogen contamination. We aimed to comprehensively analyze the pyrogen contamination status, including bacterial endotoxins, of the products used for IVF in assisted reproductive technology (ART) and improve their cleanliness using a new sterilization technology. Pyrogen contamination levels were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike bacterial endotoxin tests. Pyrogen inactivation tests were performed using low-temperature ozone/hydrogen peroxide gas treatment. The residual hydrogen peroxide was colorimetrically quantified, and the effectiveness of its removal by drying treatment was evaluated using germ cell viability as an indicator. Significant amounts of pyrogen, from 0.014 to 1.110 EU/product, were detected in seven of the twenty products. Pyrogen contamination levels were reduced below the detection limit by ozone/hydrogen peroxide gas sterilization. Hydrogen peroxide remained on the surface of the GPS dish but was reduced to a level that did not affect human sperm viability and embryo development after drying at 80°C for 24 h following sterilization. These products may carry a potential risk of reducing ART success rates, and pyrogen contamination levels may exceed the previously reported allowable level of 0.01–0.02 EU/mL in human IVF during actual use. Our study suggests that the manufacturing of products free from pyrogens and without adverse effects on germ cells is possible using ozone/hydrogen peroxide gas sterilization and subsequent drying technologies.

Diet quality determinants among manufacturing workers in Brazil: Socio-demographic factors, food choices, and ultra-processed foods

This study evaluated the association between diet quality and socio-demographic factors, anthropometric measures, food choices, and consumption of processed foods in a low-income Brazilian manufacturing worker population, addressing gaps in evidence from low- and middle-income countries (LMICs). A cross-sectional study was conducted with 921 workers from 33 industries in Rio Grande do Norte, Brazil, selected via stratified proportional and multi-stage sampling. Diet quality was assessed using the Diet Quality Index-International (DQI-I), which evaluates variety, adequacy, moderation, and balance. Dietary intake was measured via 24-hour recalls, and foods were classified by processing level (NOVA system). Socio-demographic, anthropometric, and food choice data (using the Food Choice Questionnaire) were collected. Associations were analyzed using multilevel linear regression. Higher diet quality was associated with being male (p = 0.001). Among women, diet quality improved with age (p = 0.018) and participation in a food assistance program (p < 0.001), whereas those variables showed no association among men. Prioritizing natural food content predicted higher DQI-I scores in both sexes (p < 0.05), while weight control was significant only for women (p = 0.034). Unprocessed food intake showed a positive association (p < 0.001) with diet quality, whereas ultra-processed food consumption was inversely associated (p < 0.001), most notably with diet variety and adequacy in both sexes, and with moderation in women. Food choices also influence diet quality, with people who value health benefits, natural content, weight control, and familiar products being more likely to consume diets with better variety and adequacy. No significant associations were found between diet quality and anthropometric measures. Socio-demographic factors, food choices, and levels of food processing significantly influence diet quality in this low-income Brazilian population. Public health strategies targeting reductions in ultra-processed food consumption and supporting food assistance programs may improve dietary patterns, particularly among women. These findings highlight the need for context-specific interventions to address nutrition transitions in LMICs.

Suicide mortality in eastern and western Germany, 1952–2022: Construction and validation of time series using joinpoint models with jump detection

Suicide mortality is a significant public health problem. Retrospective analyses can be helpful in better understanding temporal trends of suicide mortality and thus derive clues about causal and associated factors for the course. For this paper, we compiled suicide mortality rates for eastern and western Germany from 1952 to 2022 from various data sources, stratified by sex. The period encompasses events that could substantially alter the statistically recorded rates, such as the changes in versions of the International Classification of Diseases (ICD) in 1978 and 1997, but also the integration of the statistical system of the German Democratic Republic (GDR) into that of the Federal Republic of Germany (FRG) in 1990/91. These could cause methodologically induced breaks in the compiled time series. Using Joinpoint-Jump models, we tested whether at these defined points a jump, i.e., an abrupt change in the level of the time series, can be statistically detected or rejected. The empirical results show a high dynamism of suicide mortality in both parts of Germany, with very frequent increases and decreases of suicide mortality rates. However, the analyses do not point to systematic and substantial methodologically induced structural breaks resulting from ICD version changes or from transferring of the GDR statistical system to that of the FRG. The analysis results support the conclusion that the compiled long time series for eastern and western German women and men are largely consistent. It is unlikely that analyses of trends in suicide rates in Germany during that period are distorted by methodological artefacts examined. Some caution is warranted for women during periods of ICD code changes, although any methodological effects are likely small and within the range of typical annual fluctuations.

Unveiling the psychological network of work alienation among nursing interns: A resource conservation perspective and network analysis

Background Clinical internship is critical for nursing students, but heavy workload and emotional demands increase the risk of work alienation. Traditional linear models fail to capture complex interrelationships among psychological factors. Objective To apply psychological network analysis to explore the associative structure of work alienation in nursing interns, identifying central and bridge nodes to generate hypothesis‑generating intervention priorities. Methods A cross-sectional survey was employed. Nursing interns from four tertiary hospitals in the Guanzhong region of Shaanxi Province were recruited via convenience sampling from January to August 2025. Data were collected using the Nurse Work Alienation Scale, Compassion Fatigue Scale, Moral Distress Scale, Ethical Sensitivity Questionnaire for Nursing Students, and NASA Task Load Index. A total of 934 valid responses were obtained. A regularized partial correlation network model was estimated using the EBICglasso method (γ = 0.5). Node strength and bridge strength were calculated, and stability was assessed via bootstrap. Results Node strength analysis identified personal responsibility (1.19), burnout (1.18), and failure to maintain patient’s best interest (1.13) as the three most central nodes. Bridge strength analysis revealed secondary traumatic stress (STS) as the strongest bridge (0.43, 95% CI [0.31, 0.55]), followed by perceived workload (0.38) and self‑evaluation (0.38). Subgroup network comparisons showed no significant structural differences by gender, age, or education (all p > 0.05). Stability analysis confirmed good robustness for centrality estimates. Conclusion Psychological network analysis mapped the associative structure of work alienation, identifying personal responsibility, burnout, and STS as key hub and bridge nodes. These findings offer hypothesis‑generating targets for future interventions (e.g., trauma‑informed care, workload management, self‑efficacy enhancement), pending validation in longitudinal studies.