Abstract: Bioidentical hormone replacement therapy (BHRT) traditionally operates within a triad consisting of sex hormones, thyroid hormones, and adrenal glucocorticoids. Despite widespread adoption, a substantial proportion of patients experience persistent dysglycemia, adrenal instability, fluctuations in symptom control, and inconsistent responses to therapy even when laboratory values appear biochemically normalized. These clinical patterns suggest that an essential regulatory element is missing from the current BHRT conceptual model. This narrative review proposes the Insulin–Cortisol–Vitamin C (ICV) Axis as a previously unrecognized hormonal network central to metabolic and endocrine homeostasis. Insulin profoundly influences sex-hormone binding globulin (SHBG), estradiol and testosterone bioavailability, progesterone responsiveness, thyroid hormone conversion, mitochondrial ATP production, and cortisol reactivity—yet insulin is rarely evaluated in BHRT. Cortisol, in turn, directly modulates insulin sensitivity and metabolic function, while vitamin C is required for cortisol synthesis, adrenal recovery, endothelial nitric oxide signaling, mitochondrial redox regulation, and antioxidant defense. Together, disturbances in these three components can generate characteristic clinical presentations frequently encountered in BHRT practice. In parallel, emerging evidence—including metabolic insights from GLP-1 receptor agonist therapy—indicates that vitamin C status and oxidative stress modulation play broader roles in insulin sensitivity and hormonal signaling than previously recognized. Integrating these findings, the ICV Axis provides a systems-level framework capable of explaining BHRT treatment failures, variable patient responses, and persistent symptomatology despite standard hormone optimization. The purpose of this review is to synthesize biochemical, endocrine, and nutritional evidence supporting this new axis, and to outline a clinically actionable update to BHRT incorporating insulin dynamics and vitamin C sufficiency. Recognition of the ICV Axis represents a conceptual advancement that can improve therapeutic outcomes across metabolic, endocrine, and integrative medical practice.

Abstract: The reconstruction of Mosul after 2017 has produced a residential landscape in which design intent systematically fails to survive construction. While existing scholarship examines the materiality and symbolism of post-conflict façades, it neglects the process conditions under which aesthetic specifications are overridden. This study examines the relationship between form and materiality in contemporary Mosul residential architecture through a mixed-methods design: formal visual analysis of twelve recently completed façades and a structured survey of forty-five practising architects. Visual analysis reveals a sophisticated design language of controlled complexity (orthogonal massing articulated through contrasting materials) that is rarely realised in built form. Survey data show that architects are excluded from construction supervision in seventy-six per cent of projects, with client intervention affecting seventy per cent. Architectural oversight emerges as the primary determinant of aesthetic integrity: projects most consistently achieve material–form coherence where architects retain supervisory authority, whereas exclusion produces four distinct pathologies: material substitution, execution degradation, language override, and ornamental hollowing. The study advances the concept of an aesthetics of interruption, understood as the systematic degradation of designed form–material relationships through the fragmentation of professional authority. It demonstrates that aesthetic degradation in post-conflict reconstruction stems not from design incapacity but from broken process structures. Preserving architectural quality requires contractual frameworks mandating designer supervision and material-substitution protocols that protect design intent.

Abstract: Commercial aluminum (Al) metals contain unavoidably iron (Fe) and silicon (Si) as impurities. Due to its low solubility and high chemical affinity to Al, Fe exists in the form of Fe-containing intermetallic compounds (Fe-IMCs) which act crucially in solidification processes, determining the micro-structure and consequently the mechanical performance of the cast parts. Meanwhile, Si as impurity or addition may join the binary Fe-IMCs. Here, we investigate the Si stabilization effects on the frequently observed Al-rich Fe-IMCs in a comprehensive and systematical way using a first-principles density-functional theory (DFT) approach. The study revealed different Si stabilization effects on the cubic α- and hexagonal αʹ-phase, as well as other binaries: Al₁₂Fe, η-Al₆Fe, τ₄-, β- and θ-phases. The enhancement of stability for the α-phase is moderate while it is strong for the αʹ-phase. For the stability series (from higher to lower) is θ-Al₁₃Fe4 > η-Al₆Fe >α-Al_4.75Fe in the binary system, while it becomes τ₄-(Al,Si)₅Fe>β-Al_4.5SiFe >αʹ-(Al,Si)_4.174Fe for the ternary Fe-IMCs. The information obtained here helps understand the formation of Fe-IMCs particles during casting of Al-Si alloys, and design of novel Al alloys of fine micro-structures and desired mechanical performances of the products from the primary Al and the scraps and wastes.

Abstract: Floodplain wetlands are dynamic and biodiverse environments that provide important ecosystem services. This study analyzes the temporal and spatial dynamics of hydrogeomorphological attributes, vegetation, and water in floodplain wetlands. The methodology consisted of applying PCA in temporal (T) and spatial (S) modes, decomposing spectral indices (NDVI, NDMI, MNDWI) to identify variability patterns associated with ENSO events. The results revealed that C2 was the main descriptor of hydrological anomalies, with strong temporal synchrony between vegetation vigor (NDVI) and the expansion of the water surface (MNDWI), contrasting with the water stress response captured by NDMI. PCA highlighted environmental heterogeneity within the floodplain, with peatland areas standing out as zones of high spatial complexity and greater water retention capacity. Temporal variability responded primarily to climatic extremes, whereas spatial variability was modulated by hydrogeomorphology.

Abstract: ntroduction: Despite multi-decade reforms aimed at Universal Health Coverage (UHC), out-of-pocket (OOP) expenditure remains a primary barrier to healthcare access in Sub-Saharan Africa (SSA). While macro-level financing policies are well-documented, the agency of the "street-level" health workforce in navigating these policies at the point of care is under-researched. This scoping review aims to map the perceptions, experiences, and discretionary practices of primary care workers that mitigate or exacerbate OOP payments in Sub-Saharan Africa. Methods: Following the Arksey and O'Malley (2005) framework, a comprehensive search of PubMed, Scopus, and Google Scholar will be conducted for studies published between 2012 and 2025. Data extraction will focus on the frontline practices of primary care staff. Analysis will be guided by Street-Level Bureaucrat Theory, examining how worker discretion, resource scarcity, and client interactions shape the implementation of financial risk protection. Discussion: The findings will provide a critical lens on the "implementation gap" in health financing, shifting the focus from top-down policy design to the frontline actors who ultimately determine the financial burden faced by patients.

Abstract: Tropospheric ozone (O³) is a phytotoxic air pollutant that can impair visible foliar injury (O³ VFI) and reduces photosynthesis in sensitive forest species. Viburnum lantana L. has been widely used as an in situ bioindicator of O³ pollution in mountainous areas of Europe; however, field-observed O³-induced VFI as well as critical levels (CLs) established to protect forests, have not been validated. This study validated field-observed O³ effects in V. lantana through experiments carried out in a Free-air O³ eXposure infrastructure (FO₃X) and determined which O³ metric (exposure-based—AOT40 or flux-based—POD₁) best explains O³ effect on leaf physiology and VFI. V. lantana saplings were subjected to ambient air (AA) conditions and elevated O³ levels at 1.5× and 2.0× AA. Throughout the experimental period (T1: 2-month and T2: 3.5-month O³ exposure) measurements were taken for the Plant Injury Index (PII), light-saturated net photosynthetic rate (A_sat), stomatal conductance (g_s), leaf color index (SPAD), and the maximum photochemical efficiency of photosystem II (Fv/Fm). O³ VFI was first observed in 2.0× after 16 days. As a result, O³ treatment influenced PII, which was significantly higher in the 2.0× (9.06 ± 3.24) than in the 1.5× and AA treatments (1.31 ± 0.62 and 1.29 ± 0.71) at T2. The A_sat, SPAD, and Fv/Fm were significantly affected by O³ treatments; no significant difference in g_s was found. POD1 better explained variability in O³ VFI and physiological parameters, with CLs proposed for V. lantana of 1.61 mmol m^–2 and 1.22 mmol m^–2 for a 4% reduction of A^sat and g_s, and a CL of 7.82 mmol m^–2 for the onset of O³ VFI.

Abstract: Background: Cancer pain remains highly prevalent and undertreated despite established guidelines. In Italy, Law 38/2010 mandates systematic pain assessment, yet only 26% of clinicians routinely evaluate pain at each clinical visit, and fewer than one-quarter have received formal training in pain medicine or palliative care. A national multidisciplinary roundtable, convened in Rome in March 2025, formally identified four systemic gaps – insufficient education, fragmented care pathways, unclear professional roles, and challenges in implementing shared diagnostic and therapeutic pathways – and planned the development of a structured Delphi consensus. Methods: A Delphi study was conducted in accordance with CREDES guidelines. The Steering Committee, comprising representatives of six Italian scientific societies (AIRO, AIOM, AISD, Federdolore-SICD, SICP, ACD-SIAARTI) and a patient advocacy group (Fondazione Nora e Alberto Gentili), developed 15 clinical statements addressing pain assessment, management, referral criteria, monitoring, and documentation. Sixty-six Italian clinicians from various specialties were invited to participate. Consensus was defined as ≥75% agreement (scoring 4 or 5 on a 5-point Likert scale). Results: Fifty-six clinicians completed the voting rounds (response rate: 84.8%), representing medical oncology, radiation oncology, pain therapy, and palliative care specialties. All statements reached consensus in the first round (78–100%), precluding the need for a second voting round. Panelists’ qualitative comments informed minor wording refinements; substantial content was unchanged. Conclusions: The Delphi process produced a validated, multidisciplinary clinical pathway for cancer pain management in the Italian NHS - National Health System. The pathway establishes structured roles for the clinical reference physician and specialist consultants, objective decision thresholds for analgesic titration and referral, and minimum requirements for standardized pain documentation. These consensus-based statements provide actionable clinical guidance that may help address analgesic undertreatment and support the implementation of Law 38/2010 across Italian oncology centers.

Abstract: Enhancing the soluble expression of heterologous proteins in chassis microorganisms is critical for fundamental biological research and synthetic biology-driven industrial ap-plications. Current methods for designing DNA sequences to ensure high soluble expres-sion often rely excessively on high-frequency codons while overlooking optimal codon context, leading to suboptimal outcomes. To address these limitations, we developed an integrated deep learning framework combining a synonymous codon generation (SCG) model and a gene expression level prediction (GELP) model. The SCG model captures co-don usage patterns in Escherichia coli using large-scale genomic data, whereas the GELP model leverages gene expression data to prioritize sequences with high soluble expression potential. We validated our approach by optimizing the DNA sequences of two industrial enzymes, α-glucan phosphorylase (αGP) and isoamylase (IA), achieving 20.52-fold and 3.05-fold increases in soluble expression, respectively, relative to the wild type. This study provides a powerful tool for designing DNA sequences that confer high soluble expression and for understanding the relationship between DNA sequence and protein expression. Notably, SCG-GELP reveals a protein surface-targeted codon optimization strategy that substantially enhances soluble protein yield. The framework is publicly accessible at https://scg-gelp.biodesign.ac.cn, and its open-source code and trained models are availa-ble on GitHub at https://github.com/yuddecho/SCG-GELP.

Abstract: Background and Objectives: GLP-1 receptor agonists (GLP-1 RAs) are effective weight-loss therapies, but data on body composition changes in pediatric obesity remain scarce. The primary objective was to evaluate the effects of GLP-1 RAs on body composition in children with obesity. Materials and Methods: We conducted a retrospective study of children with obesity evaluated at the National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, Romania, who initiated weekly injectable GLP-1 RA therapy (semaglutide) between January and December 2025. Patients were assessed at baseline and after a median follow-up of 5 months. Eight of ten participants with complete paired data were included in the final analysis; two were excluded because one was non-responder with weight gain and suspected non-compliance, while one responder could not maintain the standing position for bioimpedance measurement. Bioimpedance analysis and anthropometry were performed at both visits. Paired data were analyzed using Wilcoxon signed-rank tests. Results: Eight children (4 boys, 4 girls; mean age 14.9±1.8 years) completed the study. Significant Body Mass Index (BMI) Z-score improvements were observed (CDC: -0.14, p=0.012; WHO: -0.37, p=0.012), with median weight reduction of 4.75 kg (p=0.036). While absolute muscle mass showed non-significant change (-1.3 kg, p=0.362), predicted muscle mass percentage increased significantly (+1.9%, p=0.012), suggesting selective fat loss. Fat-free mass percentage increased (+2.0%, p=0.012) with reciprocal fat mass reduction (absolute: -3.85 kg, p=0.017; percentage: -2.0%, p=0.012). Fat-free mass index remained stable (-0.67 kg/m², p=0.161). No serious adverse events occurred. Sensitivity analysis (n=10) confirmed the robustness of the results, with BMI Z-score improvements remaining significant. Conclusions: GLP-1 RA therapy in children with obesity leads to notable improvements in BMI Z-scores and beneficial body composition changes, suggesting muscle mass preservation along with weight loss, even at submaximal doses. These findings support conducting a larger prospective study with body composition as the primary endpoint.

Abstract: Reflection is widely recognized as a pathway to deeper learning in higher education, yet many students struggle to engage in reflective tasks meaningfully. This study examined how student engagement and reflective performance developed across a seven-session structured reflective learning sequence in an undergraduate course. A longitudinal quantitative design was employed, including 59 students for participation data and 38 students for performance analysis. The instructional design incorporated teacher-led scaffolding, including exemplars, feedback, and structured prompts, with optional AI-supported assistance in later sessions. Results showed that engagement patterns were non-linear. Submission rates increased following the introduction of exemplars and feedback, declined when higher-order reflection was first introduced, and stabilized in later sessions, with the lowest participation observed in the final integrative task. Reflective performance also differed across stages. Step 1 (descriptive reflection) scores improved progressively, whereas Step 2 (analytical reflection) scores remained consistently high among students who completed substantive responses. The gap between attempted and completed Step 2 responses decreased over time. These findings suggest that reflective learning develops gradually and is sensitive to instructional conditions. The study highlights reflection as a staged developmental process and underscores the role of structured support in facilitating student engagement and performance.

Abstract: Background: Subcutaneous edema is a common condition seen on ultrasonography, characterized by thickening of the subcutaneous tissue with anechoic or hypoechoic fluid-containing spaces interspersed among fat lobules. The current descriptive term “cobblestone appearance” is used to describe this finding, but the metaphor lacks the vividness of the irregular, reticular pattern we have observed. Observation: We propose the “Cracked Earth Sign” as a novel sonographic sign to describe subcutaneous edema. The sign is defined by thickening of the subcutaneous tissue with irregular, reticular, or branching anechoic or hypoechoic clefts interspersed among fat lobules, resembling cracks in dry, sun-baked earth. Unlike the cobblestone sign, which focuses attention on individual fat lobules, the term “cracked earth sign” emphasizes the reticular network of clefts as a whole, offering a more intuitive visualization of edema distribution. Conclusion: The “Cracked Earth Sign” provides a simple, intuitive sonographic sign for recognizing subcutaneous edema. It may serve as a useful teaching tool for trainees.

Abstract: A descent sequence is a word π = π₁π₂ · · · πn of nonnegative integers satisfying π₁ = 0 and π_i ≤ 1 + des(π₁π₂ · · · π_i-1) for i = 2, 3, . . . , n, where des(π₁π₂ · · · π_m) denotes the number of indices j such that π_j > π_j+1. In this work, we study descent sequences subject to the additional restriction of avoiding a given pattern of length four. We analyze seven distinct avoidance classes and provide enumerative results for each of them. Our approach is based on the construction of generating trees with one or two labels, from which we derive succession rules and corresponding systems of recurrence relations. These recurrences are then used to compute explicit generating functions for the number of descent sequences of length n avoiding either 0001, 0010, 0011, 0012, 0021, 0110, 0112, 0123, or 0132.

Abstract: Chronic lung disease of prematurity (CLD) is a common complication of preterm birth with a com-plex pathology. Recent epidemiologic studies have identified a link between neonatal exposure to di(2-ethylhexyl) phthalate (DEHP), frequently used in medical equipment, and the development of CLD. We hypothesize that DEHP exposure in the early neonatal period contributes to lung injury in newborn rats. Newborn rat pups were raised in one of the following environments: room air (RA), RA + DEHP, hyperoxia (60% oxygen), and hyperoxia + DEHP. Ambient DEHP was inhaled in a dose of 25mg/m3 for 6 hours daily for 14 days. Lung tissue and blood samples were collected on day 14 of life. Independent exposure to DEHP and hyperoxia resulted in thicker pulmonary septal walls, fewer alveoli, increased pulmonary polymorphonuclear leukocytes and myeloperoxidase (MPO) activity and decreased expression of CD31 on endothelial cells in lung tissue. Additionally, DEHP-exposed rats showed higher serum malondialdehyde (MDA) levels and reduced vascular endothelial growth factor (VEGF) mRNA and protein levels compared to controls. Our experiments demonstrate that inhaled DEHP, with or without hyperoxia, resulted in a similar pattern of morphological lung injury and inflammation characteristic of CLD, and a causative link to CLD of prematurity.

Abstract: The increasing penetration of renewable energy sources demands dispatch strategies that balance technical reliability, environmental sustainability, and economic efficiency. While Hybrid Photovoltaic/Hydro/Diesel/Battery Energy Storage (BESS) systems have been studied, most existing works focus on single-objective optimization or genetic multi-objective trade-offs without explicit integration of global sustainability thresholds. This study introduces a novel policy-embedded Mixed Integer Nonlinear Programming (MINLP) dispatch framework that embeds policy-aligned constraints (losses ≤ 8%, CO₂ reduction ≥ 40%, and cost reduction ≥ 20%) directly into the optimization model of the IEEE 30-bus system. Unlike prior studies, the framework establishes a replicable benchmark for hybrid generator placement and sizing, combining renewable-first dispatch logic with explicit emission and cost caps.Results demonstrate that policy thresholds are achievable within technical feasibility, with losses halved, emissions reduced by over 40%, and costs lowered by 20%. Pareto frontier analysis reveals that global policy targets coincide with the frontier of achievable trade-offs, providing new evidence that sustainability agendas can be operationalized in dispatch optimization. This contribution advances hybrid system research by bridging technical modeling with global energy policy, offering actionable insights for grid operators, policymakers, and researchers. By systematically locating PV+BESS at Bus 19/30, Hydropower at Bus 6/11 and Diesel at Bus 2/5, the study provides a reproducible design logic that future researchers can adopt. This benchmark moves beyond abstract optimization to offer a practical system design contribution.

Abstract: Carbon-intensive firms face mounting pressure to develop substantive corporate climate risk management (CCRM), yet its firm-level and country-level antecedents remain unevenly understood. Drawing on stakeholder and institutional theory, we examine three drivers of CCRM: sustainability governance, voluntary climate-membership commitments, and regulatory quality. Our data cover 1,295 firm-year observations across 43 countries over 2018–2022. We estimate ordered logistic regressions with lagged regressors, with ordered probit, two-step system GMM, and sub-sample robustness checks. In the main specification, sustainability governance and regulatory quality are both positive antecedents (β = 2.441 and β = 1.676, p < 0.001); climate membership exerts a sector-conditional effect concentrated in energy and basic materials. Sub-sample analyses reveal that internal governance dominates among non-state-owned firms, while among state-owned firms (a sub-sample heavily concentrated in Chinese SOEs) regulatory quality dominates instead. We frame the latter as suggestive context-conditional substitution rather than a universal feature of state ownership. CCRM is highly persistent (system-GMM lagged coefficient = 0.693, p < 0.001), suggesting that climate risk management is best understood as a path-dependent organizational capability built incrementally over time. Firms strengthening CCRM should invest in integrated governance architecture; regulators should treat regulatory-quality reform as complementary to direct climate mandates.

Abstract: In dormant sunflower achenes, several structures -pericarp, seed coat and embryo- contribute to repress germination. Achene dormancy varies greatly among cultivated sunflowers, and how dormancy is transmitted to the hybrid progeny is relevant for hybrid seed production, but also to understand the role of these structures in achene dormancy. This work investigated how dormancy is transmitted to the F1 progeny with special focus on inhibition of germination at warm temperatures, or ther-mo-inhibition. Reciprocal crosses were performed using three oilseed inbred lines with varying dormancy phenotypes. Germination of achenes, seeds, and embryos was tested at 10 and 30°C at harvest and during postharvest, together with response to hormones (abscisic acid, ethylene and gibberellins) and measurements of endogenous ABA levels. Results show that expression of maternally inherited, pericarp-imposed ther-moinhibition is conditional to the level of dormancy displayed by the hybrid embryo, which follows a zygotic with incomplete dominance pattern. While embryo sensitivity to ABA related positively with thermo-inhibition, surprisingly, embryonic ABA content was inversely related to dormancy level across genotypes. Our results provide novel insight into physiological control of achene dormancy in sunflower while con-tributing to improve breeding for high quality hybrid seed.

Abstract: Adult plant resistance (APR) is widely used in wheat breeding, but its behaviour across genetic backgrounds remains poorly understood. In this study, we analysed the ex-pression of three APR loci (Lr34, Lr46, Lr67) following their introgression into elite winter wheat cultivars. BC2F1 populations derived from crosses between donor lines and com-mercial cultivars were evaluated under controlled infection with Puccinia triticina. Gene expression was assessed using RT-qPCR, and miRNA abundance was quantified by ddPCR at five time points (0–48 h post-inoculation). Expression patterns differed markedly between genetic backgrounds, affecting both the magnitude and timing of gene activity. Lr34 and Lr67 showed the highest expression prior to inoculation, with no consistent or sustained induction following infection. In contrast, the candidate gene Lr46-Glu2 displayed a clear tendency towards early induction, with peak expression typically observed at 6–12 h post-inoculation, although the amplitude of this response varied among genotypes. Levels of miRNA varied across genotypes and time points and did not consistently reflect mRNA expression, indicating additional layers of post-transcriptional regulation. The results indicate that APR loci do not operate as isolated genetic determinants, but as components of a background-dependent regulatory system. Distinct temporal expression patterns suggest that Lr34 and Lr67 contribute to constitutive defence layers, whereas Lr46 represents an inducible early-response component. These findings highlight the importance of genetic context in shaping APR gene behaviour and provide a framework for the effective deployment of durable resistance in wheat breeding.

Abstract: Human papillomavirus (HPV) has become a leading cause of oropharyngeal cancers, alongside well-known risk factors such as tobacco and alcohol use. Currently, HPV-positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has increased significantly in developed countries, with HPV-16 being the most common high-risk subtype. Clinically, HPV-OPSCC shows clear differences in prognosis compared to HPV-negative tumors, especially regarding survival rates and treatment responses. Patients with HPV-OPSCC tend to have notably better survival outcomes and a more favorable outlook. Strong evidence indicates that HPV-related oropharyngeal cancers form a distinct epidemiological, clinical, and molecular group, setting them apart from non-HPV-related cancers. As a result, treatment strategies for these subtypes should follow specific clinical protocols to achieve the best outcomes. Additionally, the viral oncoproteins E6 and E7, which systematically disrupt host tumor-suppressor networks, provide compelling reasons for targeted phytotherapeutic interventions. Therefore, there is growing interest in exploring plant bioactive compounds with promising anti-HPV and anticancer effects that target key oncogenic pathways. This review aims to compile the latest data on bioactive phytochemicals—such as polyphenols, flavonoids, carotenoids, glucosinolate derivatives, terpenoids, and alkaloids—with mechanistic evidence in HPV-OPSCC and to highlight their molecular interactions across oncogenic signaling pathways, focusing on research published from 2015 to 2025.

Abstract: Septic shock is a life-threatening condition characterized by a dysregulated host immune response to microbial infection, resulting in excessive inflammation, oxidative stress, and progressive multi-organ failure. Innate immune pathways are hyperactivated, resulting in overproduction of reactive oxygen and nitrogen species (RONS), amplification of cytokine signaling, and widespread tissue injury. Despite early administration of antibiotics, fluids, and vasopressors, treatment outcomes remain suboptimal due to infection-overwhelming defenses, delayed pathogen identification, and the growing prevalence of multidrug-resistant microorganisms. Such limitations emphasize the need for antibiotic-independent therapeutic strategies which directly target immune dysregulation. The unique architecture and tunable physicochemical properties of hollow nanoparticles make them a promising class of immunomodulatory therapies for septic shock. Early-generation empty lipid nanoparticles caused excessive immune activation and cytotoxicity, but advances in nanomaterial engineering now allow precise control of size, surface charge, and composition, enabling anti-inflammatory and cytoprotective effects. Rationally designed hollow nanoparticles are now known to exhibit intrinsic antimicrobial activity, scavenge RONS, suppress oxidative stress responses, reprogram macrophage polarization toward anti-inflammatory phenotypes, and neutralize immunogenic bacterial toxins and antigens. Lipid-based and biomimetic hollow nanoparticles show promise as immunomodulatory therapies through distinct mechanisms of immune modulation. Currently, VBI-S, a phospholipid-based nanoparticle colloid, is undergoing Phase III clinical evaluation for the management of hypotension in patients with septic shock. More broadly, hollow nanoparticle platforms can represent adaptable, antibiotic-independent therapeutic strategies with the potential to improve outcomes in complex inflammatory conditions.

Abstract: Mission diminishment and creep which is the gradual dilution of a faith-based organisation’s founding spiritual or theological purpose poses a defining challenge for faith-based organisations of many traditions navigating secular environments, leadership transitions, and the competing demands of contemporary governance. This paper reviews scholarship from theology, organisational studies, personnel psychology, and the sociology of religion, to examine the mechanisms through which faith-based identity erodes and to identify the structural factors that protect against it. Central to the analysis is the phenomenon of values camouflage, a term this paper introduces, where leaders adopt the language of faith for employability or cultural fit without necessarily embodying the spiritual, ethical, or pastoral commitments necessary to sustain organisational mission. The experience of Mary Aitkenhead Ministries (MAM) a Catholic mission-based organisation operating across health, education, and welfare in the tradition of the Religious Sisters of Charity is used to illustrate how founding charism, when institutionally sustained through Catholic Social Teaching, careful stewardship, and community engagement, can function as ways to navigate secular pressures rather than a liability to be concealed. Finally, the paper identifies four interconnected domains of protective action: engagement with modernity, recruitment integrity, the preservation of founding charism, and ongoing organisational formation. It also offers six evidence-based recommendations for boards, leaders, and chaplains across faith traditions committed to maintaining theological distinctiveness without sacrificing organisational effectiveness. Limitations and future research opportunities are also discussed.