Beyond borders:Assessing global sustainability through interconnected systems

The many complex interconnections among countries driven by natural and socio-economic processes have a crucial impact on regional and global sustainability, yet a robust and systematic way to quantify this impact is lacking. Here we introduce two complementary approaches to bridge this key methodological gap. The first entails constructing a new sustainability index capable of systematically considering pertinent indicators of interdependencies and spillovers between countries. To minimize ambiguities associated with the aggregated index, the second approach establishes a spatial analysis framework, one designed to explicitly incorporate dimensions of interdependence and spillovers, along with buffer and multiplier effects, enabling us to distinguish and gage the impact of spatial interconnections on regional and global sustainability. Overall, the two approaches applied in tandem reinforce the joint principles of ‘one Earth’ and ‘leaving no one behind’, and can help to clarify countries' responsibilities in respect of global sustainable development.</p

5-Aminolevulinic acid (5-ALA) in paediatric brain tumour surgery—a systematic review and exploration of fluorophore alternatives

Purpose: Paediatric brain tumours represent the most common solid malignancies in children, with extent of resection being a critical prognostic factor. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is well-established for adult high-grade gliomas, but its efficacy and safety in paediatric populations remain unclear. This systematic review evaluates the utility of 5-ALA fluorescence-guided surgery in paediatric brain tumours and explores alternative fluorophores. Methods: A systematic review was conducted according to PRISMA guidelines, analysing studies from MEDLINE and EMBASE published up to October 2024. Data on patient demographics, tumour fluorescence patterns, surgical outcomes, and adverse effects were extracted. Statistical analyses assessed fluorescence differences across tumour types and administration parameters. Results: Twenty-three studies, including 281 paediatric patients (mean age, 10 years), were analysed. The most common tumours included pilocytic astrocytomas (n = 45), medulloblastomas (n = 45), glioblastomas (n = 35), and ependymomas (n = 27). Strong fluorescence was observed more frequently in high-grade gliomas compared to low-grade gliomas (p &lt; 0.00001), non-glioma tumours (p &lt; 0.00001), and high-grade non-glioma tumours (p = 0.000485). Adverse effects were mostly transient; rare complications included transaminitis and dermatologic reactions. Conclusion: 5-ALA fluorescence-guided surgery shows promise in the resection of high-grade gliomas in paediatric patients, improving intraoperative visualisation. However, limited fluorescence in low-grade and non-glioma tumours underscores the need for tumour-specific approaches. Emerging alternatives, such as fluorescein sodium and tozuleristide, offer potential advantages. Future research should focus on optimising 5-ALA dosing, refining timing protocols, and conducting robust prospective trials to establish efficacy and safety in paediatric populations.</p

Complex dynamics in a delayed diffusive cell population model of hepatitis b with capsids, mitotic transmission, and non-cytopathic antiviral mechanisms

Hepatitis B virus (HBV) infection remains one of the most serious global health challenges of our time. It causes liver diseases such as hepatocellular carcinoma, cirrhosis, and liver failure. Understanding the host-virus interactions involved in the pathogenesis of HBV is crucial for designing more effective preventive and therapeutic strategies. In this paper, we investigate the viral dynamics of an HBV mathematical model governed by partial differential equations (PDEs), incorporating mitotic transmission, the cure of infected hepatocytes, a saturated infection functional response rate, HBV DNA-containing capsids, and three distinct delays representing intracellular delay, intracellular capsid production delay, and virus replication delay. We establish the existence, uniqueness, positivity, and uniform boundedness of solutions. By conducting a qualitative analysis and employing Lyapunov functionals, we study the global asymptotic stability of both the infection-free equilibrium and the unique endemic equilibrium under suitable conditions and threshold parameters. Furthermore, we perform numerical simulations, utilizing biologically relevant parameter values, to illustrate the analytical results and to demonstrate the model's capability to provide deeper insights into HBV infection dynamics. Our findings reveal rich and complex patterns, including both regular and irregular periodic oscillations. Notably, irregular oscillations may indicate disruptions in hepatocyte regulation and subsequent deterioration of functional activity. A comparison with existing models in the literature highlights that our model avoids the overestimations present in models that neglect certain compartments and delays

Spiritual Midwifery:Lessons for Our Future

For many midwives, Ina May Gaskin’s classic Work, Spiritual Midwifery, 1 offered an insight into ways of knowing and practising outside of the boundaries of medicalised maternity care. The book was radical in its time, being an exploration, primer and guidebook for practitioners that focused on out-of-hospital, holistic and spiritual birthing care, driven by a message of love. In this article, three midwives discuss the impact and messages of the book, and its relevance today.</p

Interprofessional Co-Debriefing in Simulation—Role Modeling Collaboration:A Qualitative Study

Introduction: Effective debriefing is a key element of simulation-based learning, providing an opportunity to facilitate critical reflection and promote constructive conversations, with generalization of the learning experience to real-life health care and collaborative practice. Co-debriefing, meaning a debrief involving more than 1 simulation facilitator, has potential benefits as well as challenges. Interprofessional co-debriefing, where 2 or more members of different professional groups debrief together, has not yet been fully explored in the literature. Methods: A qualitative approach was used to explore the benefits and challenges of interprofessional co-debriefing from a simulation faculty perspective. Individual semistructured interviews were recorded and transcribed, with data analyzed using reflexive thematic analysis. Results: Ten interviews were conducted with health care professionals in Christchurch, New Zealand, who co-debrief simulation with faculty from other professions. Three major themes were identified: 1. Developing Debriefers—simulation faculty require opportunities to develop interprofessional co-debriefing skills; 2. Teaming and Collaboration —bringing co-debriefing teams together, role modeling interprofessional collaboration; 3. Logistics and Sustainability—top-down institutional/bottom-up champion support is required to overcome logistical barriers of bringing together multiple professional groups. The reported benefits and challenges of interprofessional co-debriefing were linked to these themes. Conclusions: This interprofessional group of simulation debriefers identified a number of benefits to interprofessional co-debriefing, along with several challenges. Debriefers require support to develop as role models of interprofessional collaboration. Peer mentoring and faculty development opportunities, along with consideration of the logistics that make this model of debriefing sustainable are needed for this nascent field of simulation-based education practice to evolve and mature.</p

Clinical trials reimagined:Integrating community engagement and artificial intelligence

In celebration of Clinical Trials Day, May 20, this collection of Voices highlights visionary perspectives on the evolving landscape of clinical research. It explores decentralized clinical trials, which bring research into participants' homes, enhancing diversity and convenience. It also emphasizes the imperative of community engagement to address health disparities and build trust. Finally, it showcases how generative AI promises to revolutionize drug discovery and clinical development through end-to-end automation and precision. Together, these insights underscore transformative shifts where innovation, inclusivity, and technology converge to accelerate the delivery of effective therapies for all.</p

Barriers to mental health support among Canadian Veterans:Complicating factors of confidentiality and moral injury

Introduction: Military members often encounter high-stakes, morally challenging situations during their service (also known as potentially morally injurious events; PMIEs). Such experiences put military members at a higher risk of developing mental health concerns. Additionally, in response to PMIEs, some individuals may experience moral injury (MI)—profound and long-lasting psychosocial, spiritual, and functional impairments. There is concern that individuals with MI may be particularly hesitant to seek mental health services. This hesitancy may stem from the socially withdrawing nature of moral emotions and apprehensions about confidentiality during treatment seeking, as some PMIEs may be perceived as immoral, unethical, or illegal, depending on the context. Methods: Qualitative interviews (n = 20) were conducted to explore the barriers to mental health support-seeking experienced by Canadian Armed Forces Veterans, placing an emphasis on the nuanced challenges of MI, including perceived confidentiality concerns and whether PMIEs impact the decision to seek care. Results: Eleven barriers were found; concerns related to confidentiality, career, stigma, trust, legal, relationships, shame and guilt, and accessibility to and adequacy of support. Discussion: While numerous barriers to mental health support are common across various mental health issues, this study revealed that specific barriers, notably guilt, shame, and fear of reprimand, are uniquely pronounced in MI. There is a need to demarcate MI from other mental health challenges when considering treatment-seeking barriers. Effective communication and review of confidentiality assurances are recommended as viable approaches to reducing barriers to treatment and ensuring that Veterans are adequately supported in their mental health journeys

Intraepithelial T cells move from gut to breast to shape lactation

During late gestation, unconventional intraepithelial αβ T cells migrate from the gut to the mammary gland to remodel the tissue for lactation and enhance its mucosal barrier state

Should EU public procurement law integrate sustainability due diligence requirements?

Globally, expectations on businesses to manage human rights and other sustainability risks are becoming increasingly ‘more detailed, demanding and widespread’ (Methven O'Brien &amp; Martin-Ortega, 2019c). Since 2011, taking point of departure in the UN Guiding Principles on Human Rights (UN Human Rights Council, 2011) and related ‘responsible business conduct’ standards (OECD, 2011, 2018, 2023), the European Union (EU) and other policy actors have contributed to this trend by adopting a range of instruments encouraging businesses to implement sustainability ‘due diligence’ to give effect to their ‘corporate responsibility to respect’ human rights (EC, 2011b; Council of Europe, 2016; Methven O'Brien, 2021; Methven O'Brien &amp; Botta, 2023; Methven O'Brien &amp; Caranta, 2024). Due diligence processes, so understood, entail that businesses should identify, assess, prevent, cease, or mitigate and remediate harms to human rights and the environment resulting from their own activities or to which they are directly linked via business partners. The scope of corporate human rights due diligence, correspondingly, extends to procurement activities

Ligand Hole Driven Metal–Insulator Transition Exemplified in a Layered Transition Metal Oxide

The interplay of cooperative Jahn–Teller (JT) distortions and charge-disproportionation (CD) with a strong electronic correlation in transition metal oxides leads to structural symmetry breaking. Both JT and CD often manifest in the form of significant modifications in electronic and structural properties such as band splitting, metal–insulator transitions (MIT), and enhanced electron lattice interactions. Notably, the charge-disproportionation is a key electronic feature that drives the MIT. We demonstrate and quantify it using first-principles calculations combining density-functional theory, dynamical mean-field theory, and spin–lattice Monte Carlo simulations. Taking Ca2FeMnO6 as a prototypical example of a correlated oxide, our ab initio study shows that MIT in Ca2FeMnO6 arises from the partial localization of oxygen ligand holes at alternate Fe sites that control both charge and magnetic ordering. Interestingly, the band gap was found to be fundamentally controlled by the strength of the charge-transfer energy and not by the Mott–Hubbard interactions. The novel physics and insights presented in this work reveal promising routes for tuning the electronic functionality in transition-metal oxides