Abstract: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal human malignancies, characterized by late diagnosis, aggressive metastatic behavior, and profound resistance to current therapies. Ion channels are increasingly recognized as active participants in oncogenesis, challenging the historic view of cancer as solely a genetic and biochemical disease. Emerging evidence has established that potassium (K+) channels, a structurally and functionally diverse superfamily of ion-conducting proteins, are systematically dysregulated in PDAC and play active roles in virtually every hallmark of this cancer, including uncontrolled proliferation, resistance to apoptosis, enhanced cell migration and invasion, metabolic reprogramming, and immunosuppressive tumor microenvironment remodeling. Potassium channels deregulation form part of a major deregulation frame, that is the electrochemical network deregulation (ECND). ECND is a neglected player in PDAC that is just recently being recognized as an interesting opportunity for therapeutic interventions. Potassium channels play an important role in ECND because they participate directly or indirectly in all the main manifestations of ECND, that is intracellular alkalosis, extracellular acidosis, plasmatic and mitochondrial membranes voltage, ROS homeostasis, calcium ion signaling, and pseudosynapsis. The lack of success of all pharmacological treatments attempted so far compels us to explore new therapeutic avenues. The deregulation of the electrochemical network in cancer, and in particular of the potassium channels that are an integral part of this network, are poorly recognized and investigated potential targeting areas. Furthermore, there are existing and developing drugs in this regard. This review provides a comprehensive analysis of the major K+ channel families involved in PDAC: voltage-gated (Kv) channels, inward rectifier (Kir) channels, two-pore domain (K2P) channels, and calcium-activated (KCa) channels. We examine the molecular mechanisms by which each channel subfamily contributes to oncogenic signaling, discuss their crosstalk with key PDAC driver pathways including KRAS, PI3K/AKT, and Wnt/β-catenin, and evaluate their potential as diagnostic biomarkers and therapeutic targets. Special attention is paid to the pharmacological landscape, including repurposed drugs and novel channel-targeting strategies. Collectively, the literature supports a model in which K+ channel dysregulation is not an epiphenomenon but a mechanistically integral feature of PDAC physiopathology, warranting prioritized investigation in preclinical and clinical settings.

Abstract: Objective: To evaluate the efficacy of a black raspberry extract-containing composite gel in treating persistent cervical high-risk human papillomavirus (hrHPV) infection and to analyze the clinical factors influencing treatment outcomes, with the goal of informing precision treatment strategies for this population.Methods: This was a prospective cohort study that enrolled 161 patients with persistent hrHPV infection. Participants received vaginal applications of a black raspberry gel every other day (discontinued during menstruation) for three consecutive months, followed by a three-month off-treatment period before re-examination. The primary efficacy endpoint was the viral clearance rate, defined as the clearance of any high-risk HPV subtype that was positive at baseline. Univariate analysis was performed to evaluate the correlation between clinical characteristics and efficacy. Additionally, data from 121 contemporaneous patients who received other treatments were retrospectively collected, and after propensity score matching, the efficacy was compared between the two groups.Results: The response rate among 161 patients who received black raspberry gel intervention was 50.9% (82/161). Univariate analysis showed that significantly higher response rates were observed in younger patients (P=0.011) and those who were premenopausal (P=0.003). Patients with multiple HPV infections had a significantly higher response rate compared to those with single infections (P=0.043). The clearance rates for HPV16 and HPV18 were 66.7% and 70.0%, respectively. No serious adverse events were reported during the intervention period. After propensity score matching, 99 patients were matched in the black raspberry gel group and 99 in the concurrent alternative treatment group. The response rate in the black raspberry gel group (57.6%, 57/99) was non-inferior to that in the concurrent alternative treatment group (55.6%, 55/99). Subtype analysis revealed that the black raspberry gel achieved a significantly higher clearance rate for hrHPV types 16, 18, 33, 39, 51, and 59 compared to the concurrent alternative treatment group (61.5% vs. 31.3%, P=0.011). For hrHPV types 52, 53, 58, and 68, the overall clearance rate was comparable between the black raspberry gel group and the concurrent alternative treatment group (51.0% vs. 50.0%, P=1.000). However, for hrHPV types 31, 35, 56, 66, and 73, the overall clearance rate was significantly lower in the black raspberry gel group than in the concurrent alternative treatment group (39.1% vs. 69.6%, P=0.038).Conclusion: The black raspberry extract-containing composite gel demonstrated a favorable safety profile and certain clinical efficacy in patients with persistent hrHPV infection, particularly showing enhanced effectiveness in younger, premenopausal women and exhibiting potential advantages in clearing high-risk subtypes such as HPV16/18. This study provides new real-world evidence for topical pharmacotherapy in persistent hrHPV infection and offers a preliminary theoretical basis for developing individualized, subtype-specific precision intervention strategies in the future.

Abstract: This study investigates the provenance, weathering history, and tectono-sedimentary evolution of Lower Ediacaran siliciclastic rocks of the Imiter Formation (Saghro Group, Imiter Sub-inlier, Anti-Atlas, Morocco) deposited along the northern margin of Gondwana. An integrated approach combining petrography, whole-rock major and trace element geochemistry, rare earth elements (REE), Sm–Nd isotopes, and organic geochemistry (TOC and δ¹³Cₒᵣg) was used to constrain sediment sources and deposi-tional conditions. Geochemical proxies, including Th/Sc, La/Sc, and Zr/Sc ratios, to-gether with REE distribution patterns, indicate that the sediments were mainly derived from felsic to intermediate rocks of the upper continental crust, with only minor sedi-ment recycling. The negative εNd(t) values (−8.5 to −6.2) and Paleoproterozoic Nd model ages (1.6–2.1 Ga) further suggest erosion of evolved crustal sources related to the West African Craton. Weathering indices (CIA, CIW, PIA) suggest weak to moder-ate chemical weathering under predominantly arid conditions. Redox-sensitive proxies (V–Ni, V/Cr, V/(V+Ni)) and low TOC contents (0.1–0.3 wt.%) indicate deposition under mainly oxic to dysoxic conditions with only transient reducing episodes. Tectonic dis-crimination diagrams, supported by regional magmatism, point to sedimentation within an extensional basin evolving from active margin to continental rift conditions during the late Pan-African orogeny. The Imiter Formation records a system dominat-ed by crustal recycling, syn-rift tectonics, and dynamic redox conditions in a shallow marine environment.

Abstract: Cloud computing and mobile edge computing address the growing demand for computing power driven by the rise in data-intensive applications, but they are prone to creating computing silos, resulting in unbalanced resource utilization. To address this issue, the Computing Power Network (CPN) has been introduced to enable the centralized management and scheduling of resources across the entire network. However, task scheduling in the CPN requires joint selection of computation nodes and routing paths, which greatly increases the complexity of scheduling problem. In existing studies, heuristic methods are difficult to satisfy real-time requirements, whereas deep reinforcement learning methods ignore the collaborative optimization of network resources, making them difficult to adapt to complex CPN scenarios. To this end, we propose a task scheduling method for the CPN, called TS-DQNF. First, the method uses the Deep Q-Network (DQN) to determine the computation node for computation task. Then, it introduces a dynamic congestion-aware mechanism to determine the shortest routing path. Finally, it gradually obtains the optimal task scheduling scheme through multiple rounds of alternating iterations. Simulation results show that the TS-DQNF achieves good performance and good convergence performance under different scenarios and scales.

Abstract: Background: Registered nurses (RNs) working in Primary Health Care (PHC) settings in South Africa (SA) are experiencing burnout, and it is a growing concern. Early recognition of signs and support methods is vital for effective prevention strategies. If burnout is left unattended, it will negatively impact the well-being of RNs, and patient care will be compromised. Aim: The study aims to explore early detection of burnout and the available support systems for RNs working in PHC settings in a district based in Gauteng Province, South Africa.Objectives: To identify signs and symptoms of burnout among RNs, examine contributing organisational stressors, assess awareness and recognition of burnout, and explore existing mitigation and support strategies. Methods: The study followed an exploratory qualitative design approach. In-depth face-to-face semi-structured interviews were conducted with 17 participants, with data saturation reached after the 12 interviews. The data was coded and analyzed using thematic content analysis, which included five interrelated steps. Results: The results revealed that RNs are experiencing burnout. Four main themes emerged: manifestations of burnout among registered nurses, organizational stressors, poor recognition and awareness of burnout, and mitigation and organizational support. Conclusion: Burnout is a reality among RNs in a District in Gauteng Province, South Africa, and it is often neglected until symptoms worsen. Promoting early detection through screening RNs and providing burnout education and awareness, coupled with organizational changes, will benefit RNs' well-being and the quality of care for patients.

Abstract: We investigate a possible connection between early central activity in galaxies and present-day large-scale stellar kinematics. Recent observations from the James Webb Space Telescope have revealed both a population of apparently massive galaxies at high redshift and compact luminous sources (“little red dots”, LRDs), challenging standard hierarchical formation scenarios. While the former suggest rapid early mass assembly, the latter are commonly interpreted as systems dominated by intense nuclear activity. At the same time, analysis of Gaia DR3 data reveals non-zero Galactocentric radial velocity components in the Milky Way, indicating large-scale non-equilibrium motions. We develop a phenomenological framework linking AGN-driven outflows, star formation, and stellar kinematics, in which stars form in dense clumps within multiphase outflows and inherit a small fraction of the outward velocity. Using characteristic values v_out∼10³kms⁻¹ and v_R∼1–10kms⁻¹, we derive a coupling factor f∼10⁻³–10⁻², consistent with Gaia DR3 observations. The model predicts star formation rates of 1–100M_⊙yr⁻¹ and growth timescales of 10⁷–10⁹yr, consistent with JWST constraints. Within this framework, LRDs may represent an early phase of centrally driven evolution, while present-day radial motions may reflect a long-term kinematic imprint of similar processes.

Abstract: Since 2020, the Swiss Personalized Health Network has adopted Semantic Web technologies to standardize health-related data for research in Switzerland. The SPHN Semantic Interoperability Framework promotes semantic interoperability, following the FAIR principles. Within this framework, the SPHN RDF Schema has evolved over five years to define more than 200 concepts across domains such as patient demographics, diagnoses, and laboratory results, enabling the representation of structured and machine-interpretable datasets. This study evaluates the evolution of schema versions from 2021 to 2025 and their adoption, examining structural and semantic changes, and analyzing quantitative metadata from projects in the SPHN Metadata Catalog. Results show consistent reuse of core concepts, especially demographics, diagnoses, and laboratory-related concepts, with 67% of SPHN concepts used in projects. The SPHN framework has proven to be a viable national standard for FAIR health data representation. Nonetheless, semantic modeling alone does not guarantee full interoperability. Future efforts must enhance data structuring and quality at the source, promote RDF adoption in research workflows, and develop user-friendly tools for querying and visualizing data.

Abstract: Background: The Toscana Virus is a little-known virus, present in Italy, transmitted by sandflies and associated with cases of meningitis and meningoencephalitis in humans. this study compared three statistical models (SARIMA, Poisson, and Negative Binomial) to forecast monthly Toscana virus (TOSV) cases in Italy for the period 2023–2024. Materials and Methods: data were extracted from the epidemiological bulletins of the Italian National Institute of Health for the period January 2016–December 2024. The 2016–2022 training set was used to estimate the models, while the 2023–2024 test set validated the predictions. Results: in the model comparison, SARIMA showed the best predictive ability, with the lowest MAE (3.46) and RMSE (5.05), demonstrating that seasonality and temporal de-pendence were well captured. The Poisson and Negative Binomial models, although use-ful, showed lower performance in terms of accuracy (higher RMSE). Conclusions: the results indicate that the SARIMA model is the best suited for forecasting monthly TOSV cases, but it is not perfect, highlighting the need for more complex ap-proaches that also integrate exogenous variables to improve forecast quality.

Abstract: The digitalisation of Indigenous medicinal knowledge constitutes a qualitatively new form of bioprospecting — one that operates through artificial intelligence, open-access repositories, genomic databases, and state-led data infrastructure rather than field collection alone. This article examines this transformation through the Rakhain community of Bangladesh, whose plant-based and non-plant healing heritage occupies a structurally vulnerable position at the intersection of biodiversity law, data governance, and digital capitalism. Drawing on long-term ethnographic engagement with the Rakhain community (2004–2024), Indigenous Gnoseology (Chowdhury, 2026a), reciprocal methodology (Chowdhury, 2026b), and the CARE Principles for Indigenous Data Governance (Carroll et al., 2020), the article argues that existing legal regimes are insufficient without community-centred digital sovereignty. A Rakhain Digital Healing Sovereignty Framework is proposed, grounded in collective consent, tiered knowledge classification, sacred secrecy, reciprocal benefit sharing, and post-research accountability.

Abstract: Tear film instability and dry eye disease (DED) are among the most common postoper-ative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all alter ocular surface homeostasis through mechanisms including corneal denervation, inflammation, loss of goblet cells, and meibomian gland dysfunction. However, the severity and duration of postoperative dry eye vary significantly depending on the procedure performed. This comprehensive review of the literature summarises current evidence on pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Proce-dure-specific recovery trajectories are compared, distinguishing transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy are also reviewed. Understanding these distinct re-covery patterns allows for better surgical planning, improved patient counselling, and earlier intervention to reduce chronic postoperative dry eye and improve visual outcomes and patient satisfaction.

Abstract: The building renovation sector is under growing pressure to balance environmental responsibility, economic efficiency, and occupant well-being simultaneously. Existing evaluation approaches remain predominantly finance-driven, marginalising ecological and social dimensions. This study develops and validates a parametric multi-criteria assessment framework for building renovation elements, structured around the three pillars of sustainability: environmental, economic, and social. A dataset of 33 renovation elements — encompassing green façade systems, extensive and intensive green roofs, interior wall, floor, and ceiling solutions, and exterior envelope and site components — was compiled and digitised as BIM objects in ArchiCAD 26, enriched with non-graphic parameters including cost, lifespan, recyclability, eco-index, maintenance effort, and qualitative social descriptors. Parameters were aggregated using type-specific logic: additive for economic indicators, minimum-value for lifespan, arithmetic mean for environmental indicators, and descriptive aggregation for social attributes. Five renovation scenarios (A–E), each composed of nine elements, were evaluated to demonstrate how the sustainability profile changes with selection priorities. Scenarios A, B, and C confirmed single-dimension dominance (environmental, economic, and social, respectively), Scenario D achieved a balanced three-pillar profile, and Scenario E revealed a latent economic bias in an apparently random element selection. The framework is scalable, extensible, and designed for future integration with BIM environments, mixed reality platforms, and AI-driven decision-support tools.

Abstract: In oral surgery, the classification of the proximity of the mandibular third molar to the mandibular canal, typically performed on panoramic radiographs, is essential for surgical planning. While artificial intelligence (AI) tools have been explored for this task, their performance is limited due to data scarcity and class imbalance. In this work, we study the potential of synthetic data generation for this task using Denoising Diffusion Probabilistic Models (DDPMs) and Generative Adversarial Networks (GANs), both unconditional and conditioned to the tooth-canal relationship. We used public datasets to create and label a training dataset of 5416 images. The results show the lowest Fréchet inception distance (FID) / second-highest Inception Score (IS) for the unconditional GAN (32.48 / 2.14). The unconditional DDPM showed an FID of 34.28 and IS of 1.95. Conditional models showed similar IS but a worse overall FID of 68.19 and 219.11 for DDPM and GAN, respectively. In a paired observer study between the two unconditional models, clinical observers found the DDPM image to be more realistic in 69.6% of cases. Future work should investigate downstream effects of GANs and DDPMs used in data augmentation for the training of an AI classifier.

Abstract: Background/Objectives: This study aimed to examine the associations between diet-related quality of life (DRQOL) and psychological distress, autonomic dysfunction, and migraine in patients with dizziness and balance disorders. Methods: In this retrospective cross-sectional study, 122 patients (56 men, 66 women; mean age 40.4 ± 12.8 years, minimum 14, maximum 65) from the vertigo outpatient clinic at JR Tokyo General Hospital completed self-reported questionnaires. These included the DRQOL scale, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Self-rating Depression Scale (SDS), Orthostatic Dysregulation (OD) checklist, and migraine assessments (POUNDing [Pulsating, duration of 4–72 h, Unilateral, Nausea, Disabling], MIDAS, migraine screener). Correlational analyses, group comparisons, and receiver operating characteristic (ROC) analyses were conducted. Results: DRQOL scores showed positive correlations with psychological distress (SDS: ρ = 0.58; HADS-A: ρ = 0.50; HADS-D: ρ = 0.52; all p <  0.001) and OD severity (ρ = 0.48, p <  0.001), but not with age, DHI, or individual migraine indices. Migraine screener-positive patients had significantly higher DRQOL scores (p <  0.01). DRQOL alone modestly discriminated positive migraine screener (AUC = 0.65), improving to AUC = 0.77 in a multivariable model including age and sex. Conclusions: DRQOL can capture psychological and autonomic symptom burden rather than vestibular or headache severity, suggesting that it may serve as a complementary, patient-centered metric in the holistic assessment of dizziness patients.

Abstract: Primary hepatic masses in dogs represent a heterogeneous group of lesions with variable biological behavior and challenging preoperative characterization. The objective of this retrospective study was to describe the clinical presentation, diagnostic findings, surgical management, and outcome of dogs with primary hepatic masses treated surgically. Ten dogs with resectable hepatic lesions and no evidence of extrahepatic metastasis were included. Clinical records, imaging findings, histopathological diagnoses, treatment, and follow-up data were reviewed. Histopathological diagnoses included hepatocellular carcinoma (n=3), nodular hyperplasia (n=2), lobular hyperplasia (n=1), hepatocellular adenoma (n=1), undifferentiated sarcoma (n=1), osteosarcoma (n=1), and one case without definitive histological diagnosis. Tumor size ranged from 3.3 to 18 cm and was not associated with biological behavior. Preoperative cytology showed poor concordance with final histopathological diagnosis in all sampled cases. Abdominal ultrasound identified solitary lesions in all evaluated dogs, although surgery revealed previously undetected multifocal disease in two cases. Most lesions were located in the right hepatic lobes, differing from the predominance of left-sided lesions commonly reported in the literature. All dogs underwent surgical resection. Two perioperative deaths occurred secondary to postoperative renal failure. In the remaining dogs, surgery resulted in complete remission of clinical signs and prolonged survival, including dogs with malignant tumors. Four dogs remained alive and disease-free at the end of the follow-up period (>730 days). These findings highlight the limitations of preoperative diagnostic techniques for predicting the biological behavior and extent of canine hepatic masses. Surgical resection provided substantial clinical benefit and prolonged survival in most cases, supporting its consideration whenever complete excision is technically feasible.

Abstract: The objective of this study was to evaluate the effects of partially replacing wheat bran with poplar wood composite fiber (PWCF) on growth performance, immune status, apparent total tract digestibility (ATTD), and gut microbial composition in growing pigs. A total of 140 healthy crossbred (Duroc × Landrace × Yorkshire) growing pigs with an initial body weight of 47.25 ± 0.49 kg were randomly assigned to two dietary treatments, with five replicates per treatment and fourteen pigs per replicate. The control (CT) group was fed a corn–soybean meal–based diet, whereas the experimental group re-ceived the same diet in which 2% wheat bran was replaced by PWCF. The experiment lasted for 60 days. Compared with the CT group, replacing wheat bran with PWCF did not affect body weight, average daily feed intake, feed conversion ratio, or average daily gain on days 30 or 60 (P > 0.05). In addition, no negative effects were observed on ATTD of nutrients and serum immunoglobulin A (IgA), IgG, and IgM levels at either time point, indicating that PWCF can serve as a suitable partial substitute for wheat bran in growing pig diets. However, it could regulate nitrogen metabolism by reducing blood urea nitrogen (BUN) concentration and the BUN/creatinine ratio, as well as decreasing total free amino acids in serum (P < 0.05). In addition, the antioxidant capacity can be improved by increasing catalase activity. Gut microbiota analysis showed that the re-placement significantly increased the relative abundances of Treponema, Lachnospi-raceae_XPB1014_group, Prevotellaceae_UCG-001, Prevotellaceae_UCG-003, Prevotel-laceae_UCG-004, and norank_f_Oscillospiraceae (P < 0.05). These changes suggest that PWCF modulates gut microbiota and enriches fiber-degrading bacterial populations. Overall, substituting wheat bran with PWCF did not impair growth performance, im-munity, or digestibility, while altering microbial community composition. These find-ings support the potential application of PWCF as an alternative fiber source, contrib-uting to greater diversity in feed formulation.

Abstract: Transcatheter edge-to-edge repair (TEER) is a recent minimally invasive method of managing mitral regurgitation (MR) in dogs with myxomatous mitral valve disease (MMVD). The goal of interventions is to minimize MR severity. The objective of this study was to determine the association between reduced MR and changes in myocardial work indices after TEER in dogs. Client-owned dogs with moderate-to-severe MR were enrolled in the study. TEER performance was completed with multimodal imaging guidance in all 10 dogs. Before and after the procedure, myocardial work was analyzed. MR severity, transmitral pressure gradients, left atrial and ventricular measurements, and index of myocardial work (GWI, GCW, GWW, and GWE) were calculated. TEER significantly reduced MR severity in the majority of dogs. MR decrease was associated with a greater efficiency of myocardial work, more constructive work, and less wasted energy. No significant negative associations of moderate post-procedure gradients with short-term clinical outcomes emerged. TEER-mediated reduction of MR improves myocardial function in dogs. However, long-term studies are also needed to examine the effects of residual MR and transmitral gradients on cardiac function and clinical outcome.

Abstract: This paper examines the datafication of migrant labor governance in Malaysia, arguing that the growing digital infrastructure surrounding migration — biometric registration, employer-tied databases, algorithmic productivity monitoring, and cross-border recruitment platforms — constitutes a regime of digital dispossession that is legally unaddressed and politically uncontested. Drawing on critical data studies, decolonial political economy, and the emerging field of digital migration studies, the paper interrogates how migrant workers in Malaysia are rendered exhaustively visible to state and capital through data, while remaining structurally invisible to the law that is supposed to protect them. Anchored in Chowdhury's (2022, 2023, 2026a, 2026b) frameworks of reciprocal methodology and Indigenous Gnoseology, and engaging with Couldry and Mejias's (2019) concept of data colonialism, Spanger and Andersen's (2023) analysis of convoluted mobility, Leurs and Smets's (2018) digital migration studies framework, and Beduschi's (2021) international human rights analysis of AI-driven migration management, the paper develops a concept of relational data sovereignty as an alternative governance foundation. It proposes five institutional reforms for Malaysia and ASEAN and argues that the reform of digital governance in migration contexts requires both epistemological and institutional transformation — centering the knowledge, agency, and rights of those most governed by data and least protected by law.

Abstract: Accurate donor-recipient allograft size matching remains a critical determinant of outcomes in lung transplantation, yet current approaches rely predominantly on predicted total lung capacity (pTLC) and height-based metrics derived from population-based equations. These simplified surrogates fail to capture individual anatomical variability, disease-specific alterations in thoracic geometry, and the spatial relationship between donor lungs and recipient chest cavities. In this review, we examine the limitations of conventional size matching and synthesize emerging evidence supporting imaging-based approaches, including computed tomography (CT) volumetry, radiomics, and machine learning. CT-derived volumetric analysis enables individualized anatomical assessment and has been associated with clinically relevant prediction of primary graft dysfunction and mortality. Advanced computational methods may further support extraction of imaging-derived features and integration with clinical data, although these approaches remain investigational. Collectively, these developments signal a paradigm shift from crude population-based metrics toward imaging-driven and computational approaches in the modern era. With rigorous validation and careful clinical integration, imaging-based approaches may complement conventional size metrics and support more individualized donor-recipient assessment.

Abstract: Background:Chronic musculoskeletal pain is a common condition, for which pain self-management is recommended. Digital tools offer potential to support individuals with chronic pain, but it is unknown to what extent existing tools are responsive to the social context of Pakistanis living with chronic pain and are engaging for them. Objective: This study aimed to explore strategies to enhance engagement with digitally enabled pain self-management tools among people with chronic musculoskeletal pain.Methods: A mixed-methods sequential explanatory design was used. We first reviewed Android app store and published literature to identify content and engagement strategies incorporated in digital tools. Following this, we conducted a narrative study involving adults with chronic musculoskeletal pain to capture their lived experiences and requirements for pain self-management. Review findings were synthesised descriptively, qualitative data were analysed thematically, and overall findings were combined to generate design and content recommendations.Results: Literature and app reviews revealed that digital tools commonly included components related to patient education and physical or mental therapy. They often included engagement features such as personalization and reminders. Dietary advice and peer or social support were less commonly included in digital tools but were commonly discussed during group discussions by individuals living with chronic pain. Nineteen individuals with chronic pain participated in group discussions and described how their pain self-management practices were shaped by cultural beliefs and perceptions and digital health information. These factors also influenced their decision making related to treatment choices and adoption of non-pharmacological strategies. Although participants trusted healthcare professionals but expressed concerns about limited guidance on how to apply clinical advice in their daily lives. Moreover, they identified several requirements for pain self-management tools, including evidence based audio-visual content and incorporating aspects related to symptom monitoring, symptom relief and physical rehabilitation, psychological wellbeing, lifestyle management, social support, patient education. Conclusion:Existing pain self-management tools rarely address the social context of South Asians. While pain self-management is shaped by digital information and cultural beliefs and perceptions, participants valued evidence-based digital resources. Therefore, future research should focus on co-developing these resources to ensure they are clinically meaningful, culturally responsive, and supportive of patient-centred and equitable pain self-management.

Abstract: Objective: To characterize the structural fragility of installed health-service capacity in Barranquilla, Atlántico, Colombia, using absolute capacity, supply concentration, reserve or transitory capacity, and service-line clinical sensitivity as structural-risk dimensions. Methods: An ecological health-services study was conducted using a local installed-capacity dataset traceable to the Colombian Special Registry of Health Service Providers and SISPRO, together with two contextual World Bank series for Colombia: physicians per 1,000 population and premature mortality from noncommunicable diseases. Traceable data cleaning, functional normalization, separation of baseline versus transitory capacity when allowed by the source fields, and exploratory estimation of a relative structural fragility proxy index using a normalized Poisson-type transformation were performed. This index was interpreted exclusively as a comparative structural-fragility ranking and not as an observed probability of saturation. Results: The analytical capacity of the Barranquilla node included 5,397 installed capacity slots. Adult ICU accounted for 707 slots and neonatal ICU for 160. Reserve capacity was low in neonatal ICU (2.5%) and higher in adult ICU (32.2%). The largest service lines were adult general hospitalization, adult ICU, and pediatric general hospitalization, whereas the highest relative structural fragility was observed in low-scale and highly concentrated services, including burn care, acute mental health, and selected highly specialized lines. Conclusion: Barranquilla has a broad but markedly heterogeneous structural health-service capacity network. The critical pattern is not determined only by the absolute number of slots, but by the interaction between limited capacity, high concentration, low stable reserve, and clinical sensitivity. The evidence generated is structural and should not be interpreted as observed occupancy, real-time saturation, or operational collapse.