Public Health and Healthcare

Abstract: Background: Fluid and electrolyte imbalances are common in hospitalised patients, and safe management depends heavily on nurses’ knowledge. Data on this topic from Bangladeshi hospitals are limited.Objective: To assess nurses’ knowledge regarding the management of fluid and electrolyte imbalance and its association with educational qualification and working department at Rangpur Community Medical College Hospital, Rangpur.Methods: A descriptive cross-sectional study was conducted from January to June 2026 among 50 nurses working in the Medicine and Emergency wards. Data were collected using a structured questionnaire of 25 knowledge items (score 0–25; low ≤12, moderate 13–18, high ≥19). Data were analysed in SPSS version 27 using descriptive statistics and the Pearson chi-square test.Results: Most respondents were female (68.0%) and aged 26–30 years (52.0%); 52.0% held a diploma and 48.0% a B.Sc. in nursing. Knowledge was low in 30.0%, moderate in 50.0% and high in 20.0% of nurses. Sodium as the main electrolyte of fluid balance (76.0%) and the intake–output chart (76.0%) were most often answered correctly, whereas only 14.0% knew that sudden weight gain should not be ignored, 18.0% that fluid restriction is not appropriate for all dehydrated patients, and 24.0% that heart failure causes fluid excess. High knowledge was found in 33.3% of B.Sc. versus 7.7% of diploma nurses (χ² = 8.974, df = 2, p = 0.011); working department was not associated with knowledge (p = 0.189).Conclusion: Only one in five nurses had a high level of knowledge, with specific misconceptions about fluid excess, fluid restriction and weight monitoring. Structured continuing education and standardised ward protocols, particularly for diploma-prepared nurses, are recommended.

Abstract: Urban arboviral diseases represent a persistent epidemiological challenge for the Brazilian Unified Health System (SUS), requiring institutional resilience and health compliance from local governments. Objective: To analyze the resilience of municipal health systems in responding to urban arboviruses in a health region of Espírito Santo, Brazil, using secondary data from the Integrated Instrument for the Assessment of the Response to Arboviruses (IIARA 2026), while preserving the anonymity of the federated entities. Methods: Observational, descriptive and analytical ecological study based on aggregated secondary data from 23 municipalities. Forty-eight criteria distributed across six thematic axes were assessed. The Resilience Index (IR%) was calculated per axis and globally, applying the "Deal Breaker" (Critical Cut-off) rule to the risk classification criteria in primary and hospital care. Results: The mean regional global IR was 67.15% (range 40.3%–89.6%). The Epidemiological Surveillance axis showed the best performance (87.7%), whereas Management and Governance showed the greatest fragility (41.4%). Only six municipalities achieved the Silver Seal; four municipalities with global scores above 70% were withheld by the Deal Breaker due to failures in care risk classification, preventing certification. Conclusion: The IIARA proved to be an effective health compliance tool, revealing significant regional heterogeneity. The Deal Breaker rule fulfilled its role by preventing the certification of municipalities with critical care fragilities, pointing to the need for priority interventions in local governance and in risk-classified reception.

Abstract: Background. Sepsis, Clostridioides difficile infection (CDI), and oral cavity and pharyngeal cancers are high burden conditions monitored separately by U.S. national surveillance systems. Comparing their national trajectories over the same decade shows how different forces, namely infection prevention, diagnostic and coding practice, and changing cancer risk factors, move disease indicators in different directions. Methods. This descriptive, ecological trend analysis used publicly available aggregate data for 2011-2020: sepsis hospitalization rates, costs, and length of stay (LOS) from HCUP Fast Stats and HCUPnet; CDI hospitalization rates from a published HCUP National Inpatient Sample analysis (Malik et al.); and age adjusted oral cavity and pharyngeal cancer incidence from CDC United States Cancer Statistics. Hospitalization rates are per 10,000 discharges and cancer incidence is per 100,000 population, so the series are compared by direction, not magnitude. Trends were estimated with simple linear regression on calendar year. Because 2020 coincided with the COVID-19 pandemic and sepsis coding changed in October 2015, sensitivity analyses excluded 2020 and examined sub-periods. Results. Sepsis hospitalizations rose from 337.1 to 725.4 per 10,000 discharges (+46.5 per year; 95% CI 40.7 to 52.3; P < .001). CDI hospitalizations rose slightly from 115.4 to a peak of 121.6 in 2015, then fell to 78.1 in 2020 (linear slope -4.0 per year; 95% CI -6.3 to -1.8; P = .003; -8.9 per year from 2015 to 2020). Oral cavity and pharyngeal cancer incidence rose from 11.6 to 12.3 per 100,000 between 2011 and 2019, then fell to 11.7 in 2020. The 2011-2020 trend was not significant (+0.055 per year; P = .058), but the 2011-2019 trend was (+0.095 per year; R² = 0.90; P < .001), indicating that the 2020 value drives the non-significant result. Sepsis stays cost about 1.5 to 1.8 times, and lasted about 1.5 to 1.8 times as long as, the average inpatient stay; mean sepsis cost rose from $18,377 to $23,170 (2020 USD). Conclusions. Over 2011-2020, sepsis hospitalizations rose steadily, CDI hospitalizations fell after 2015, and oral cavity and pharyngeal cancer incidence rose modestly until a 2020 dip likely related to the pandemic. These aggregate, ecological findings are consistent with, but cannot establish, the effects of infection prevention, coding changes, and shifting cancer epidemiology. Patient level linked data are needed to test connections between these conditions.

Abstract: Caregiver knowledge of early child development (ECD) may shape the developmental opportunities available to young children, yet few measures assess this knowledge during the preschool years, particularly in low- and middle-income countries (LMICs). This study developed and psychometrically evaluated the Caregiver Knowledge of Early Child Development Inventory (CKECDI) and examined associations between its domains and preschool children’s executive and motor functions in Nigeria. In Phase one, 517 caregivers completed the CKECDI. Exploratory factor analysis (n = 259) and confirmatory factor analysis (n = 258) supported a 35-item, four-factor structure comprising cognitive development, socioemotional caregiving, school readiness, and health, nutrition, and safety. The four-factor model demonstrated good fit (CFI = .994, TLI = .994, RMSEA = .013, SRMR = .078), with acceptable internal consistency across domains (KR-20 = .74–.90; ω = .74–.89). Known-groups validity was supported by significant differences in domain scores across caregiver educational attainment. In Phase two, the CKECDI was administered to an independent sample of 286 caregiver-child dyads. Adjusted path analyses showed distinct associations between CKECDI domains and children’s inhibitory control, working memory, cognitive flexibility, and motor function. The CKECDI provides a multidimensional assessment of caregivers’ knowledge of preschool child development in LMICs and may support developmental assessment and research in culturally and contextually diverse settings.

Abstract: Background/Objectives: Kazakhstan experienced one of the largest measles epidemics in the WHO European Region in 2023–2024 and a pertussis resurgence in 2024, while documented parental vaccine refusals kept accumulating. Subnational, register-based evidence on refusal is lacking for Central Asia. We assessed trends, geography, structure and data quality of registered refusals and their ecological links with coverage and disease incidence. Methods: Nationwide ecological study of the official refusal register (20 regions; stocks on 1 January 2024–2026), surveillance reports and population data. We estimated prevalence per 100,000 with exact Poisson 95% confidence intervals (CIs) and rate ratios (RRs), and applied χ² tests, Ward clustering, Moran’s I with local indicators of spatial association, Spearman correlation, negative binomial regression and Bland–Altman analysis. Results: Registered refusals rose from 39,792 to 66,240 (198.6 to 323.2 per 100,000; RR 1.63, 95% CI 1.61–1.65). Prevalence varied 23-fold between regions (39.8 in Turkestan to 932.4 in Atyrau) and increased significantly in 16 of 20 regions (Kostanay, RR 2.79). Personal beliefs dominated (62.1%); religious refusals (15.5%) clustered in the west and south (Moran’s I = 0.39, p = 0.011); media-attributed refusals grew by 39.8%. In 2024, refusal prevalence was associated with measles incidence (ρ = 0.55; incidence rate ratio 1.18 per 1/1000, 95% CI 1.03–1.34), and refusal explained 54.7% of pertussis cases. The register recorded 3.35–3.84 times more bacille Calmette–Guérin (BCG) refusals than routine coverage reports, and 46 of 180 cumulative vaccine-specific counts decreased. Conclusions: Vaccine refusal in Kazakhstan is growing, regionally heterogeneous in magnitude and motive, and tracked measles burden during the epidemic. Reason-tailored regional strategies and a validated, individual-level electronic refusal register are needed.

Abstract: Background/Objectives: Heart rate variability (HRV) is widely used to monitor autonomic responses to training and match load in professional soccer, but the evidence is heterogeneous and its added value remains debated. This systematic review aimed to synthesize and critically appraise prospective longitudinal observational studies on HRV monitoring in male professional and semi-professional soccer players. Methods: The review followed PRISMA 2020 and was registered in PROSPERO (CRD420261533316). PubMed, Scopus and Web of Science were searched from inception to September 2026. Two reviewers independently selected studies and extracted data; methodological quality was assessed with the Newcastle–Ottawa Scale (NOS). Owing to heterogeneity, a narrative synthesis was conducted. Results: After duplicate removal, 489 records were screened and eight studies (109 players; mean ages 18.7–26.6 years) were included: six during the competitive season and two during pre-season. NOS scores ranged from 6 to 8 out of 9, with confounder control as the main weakness. Time-domain vagal indices predominated (RMSSD in three studies, Ln-RMSSD in three). Reductions in RMSSD/Ln-RMSSD were associated with accumulated fatigue and high training loads, whereas increases in RMSSD and SD1 accompanied fitness gains during pre-season. RMSSD also related to match performance. One study linked an elevated LF/HF ratio to fatigue and muscle injury, although respiratory control was rarely reported. Conclusions: Short-term morning RMSSD/Ln-RMSSD, interpreted against individual baselines, appears the most consistent HRV marker, whereas spectral indices require cautious interpretation. Heterogeneity, small samples and limited confounder control prevent firm conclusions. Standardized protocols and multidimensional monitoring frameworks are needed.

Abstract: Orofacial myofunctional practices now circulate widely on social media, often reaching patients before any clinical assessment, yet critiques of online misinformation tend to treat these trends as a single problem. This article draws on a narrative review of peer-reviewed literature and consensus statements, interpreted from the standpoint of clinical practice in orofacial motricity. Four distinct patterns of mismatch between claims and evidence are proposed: a plausible but untested intervention (nocturnal mouth taping, evaluated in ten studies, all of poor quality); a valid construct stretched beyond its evidence (tongue resting posture recast as adult facial remodelling, or “mewing”); a legitimate procedure whose indications have outpaced the data (frenotomy); and a device presented as a substitute for therapy (prefabricated myofunctional appliances). Some current misconceptions are traced to the field’s own literature, and in obstructive sleep apnoea, the evidence for orofacial myofunctional therapy itself is of very low to moderate certainty. Each pattern calls for a different response: trials, conceptual precision, assessment thresholds or resistance to substitution. The credibility of orofacial myology depends on applying to its own claims the standards it demands of popular trends.

Abstract: Mental health conditions, including substance use disorders, are a leading underlying cause of pregnancy-related death in the United States, yet agencies deciding where to add perinatal screening, referral, and treatment have had no open national table that sets county need beside county treatment capacity. We built the U.S. County Perinatal Behavioral Health Need and Capacity Panel, a versioned, fully reproducible county-level dataset for all 3,144 counties and county-equivalents of the 50 states and the District of Columbia, assembled only from open federal sources. Need is described by births (NCHS natality via the Area Health Resources Files), women aged 15–44, model-based adult depression prevalence (CDC PLACES), and the CDC/ATSDR Social Vulnerability Index. Capacity is described by 26,642 SAMHSA FindTreatment.gov treatment listings (99.7% placed in a county) coded for preg- nant/postpartum (PPW) programs, 11,769 HRSA health center sites, and 1,544,251 obstetric, behavioral health, and family medicine clinicians identified by NUCC taxonomy codes in the CMS NPPES registry. Each county receives percentile-based need and capacity scores, a need-minus-capacity gap score, rural and frontier flags, data-year fields, and small-number flags. We find that 1,793 counties (57.0%), home to 12.7% of U.S. births, have no substance use treatment listing with a PPW program; the share rises from 35.1% of metro to 65.5% of rural and 86.6% of frontier counties. The PPW program field exists only for substance use listings, so open data cannot identify perinatal-specific mental health facilities. Need and capacity are only weakly related across counties (Spearman ρ = 0.24), and 107 counties combine top-quartile need with bottom-quartile capacity, 72 of them rural. Clinician counts agree closely with independent AMA-based counts (log-scale r = 0.93 obstetric, 0.89 psychiatric), and gap rankings are robust to eight alternative specifications (Spearman ρ ≥ 0.973). The panel, code, codebook, and provenance log are openly released in three versioned parts.

Abstract: Occupational burnout among nurses is a major global concern affecting well-being, job performance, and quality of patient care. This hospital-based cross-sectional study assessed the prevalence of burnout and associated factors among 310 nurses at a regional referral hospital in Dar es Salaam, Tanzania. Data were collected using the Maslach Burnout Inventory-Human Services Survey. The prevalence of burnout was 43.5%. High emotional exhaustion, high depersonalization, and low personal accomplishment were reported by 60.3%, 50.9%, and 57.1% of participants, respectively. Burnout was significantly associated with having three or more children (aPR = 2.92; 95% CI: 1.89–4.50), male sex (aPR = 1.33; 95% CI: 1.05–1.68), alcohol use (aPR = 1.38; 95% CI: 1.09–1.75), and presence of chronic illness (aPR = 1.47; 95% CI: 1.11–1.93). Work-related factors including conflict at work (aPR = 1.90; 95% CI: 1.50–2.42) and job dissatisfaction (aPR = 1.60; 95% CI: 1.38–1.87) were also significantly associated with burnout. Burnout among nurses was highly prevalent and was associated with both personal and workplace factors. The findings highlight the need to consider mental health support, workplace conflict, and job satisfaction in strategies aimed at improving nurses' occupational well-being.

Abstract: Robot-assisted shoulder rehabilitation benefits from mechanisms that guide the arm along physiological paths about a Remote Center of Motion (RCM) aligned with the shoulder. Single-actuator spherical linkages are an attractive low-cost option, but their dimensional synthesis is hindered by branch, circuit, and order defects. This paper proposes a design-optimization procedure for an actuated spherical Stephenson III linkage used as a single-drive upper-limb rehabilitation device. The displacement problem is decoupled into a base four-bar loop and a closing dyad, solved by two nested quadratic equations that give exactly the four assembly modes in closed form. The two discriminants are shown to coincide with the singularity conditions of the velocity equations, so a single positivity test detects both branch crossing and toggle configurations, while a two-bit label tracks one assembly mode along the workspace. Velocity coefficients, expressed in closed form via triple products, provide a dimensionless manipulability index for discarding candidate designs. The procedure is applied to a reaching task, and yields a defect-free, compact device with smooth velocity profiles and is compared with a previously published optimization-based synthesis of the same mechanism.

Abstract: Objectives. To test whether product characteristics available in public Food and Drug Administration (FDA) data, measured before a fixed date, identify prescription drugs that are added to the FDA shortage list after that date.Study Design. Temporal validation at two cutoff dates, applying a previously developed cross-sectional risk screen.Methods. Drugs marketed as of each cutoff were identified from National Drug Code directory marketing dates. Drugs already on the shortage list at the cutoff were excluded. Features were computed only from products marketed at the cutoff; the outcome was first shortage listing after it. L2-penalized logistic regression, a random forest and a fixed-weight three-item rule were compared under repeated stratified cross-validation. Because the rule has no fitted parameters, its score is a fully out-of-time prediction; the two fitted models are not, and are interpreted accordingly.Results. At a January 2025 cutoff, 125 of 2,779 eligible drugs (4.5%) were newly listed. Area under the receiver operating characteristic curve (AUC) was 0.732 for the random forest, 0.692 for logistic regression and 0.655 for the rule, with average precision (AP) of 0.143, 0.117 and 0.116 against a chance value of 0.045. At a January 2023 cutoff, 137 of 2,577 drugs (5.3%) were newly listed, with AUCs of 0.705, 0.675 and 0.649 and AP of 0.119, 0.133 and 0.125 against chance of 0.053. Discrimination was higher among injectables on both measures, but the two measures ranked the approaches differently: the rule achieved the highest AUC at both cutoffs (0.806 and 0.742) while logistic regression achieved the highest average precision at both (0.266 and 0.224). All between-approach differences were smaller than the fold-to-fold standard deviations.Conclusions. Public product characteristics carry modest forward signal for shortage listing, concentrated in injectables. A three-item rule with no fitted parameters discriminates comparably to fitted models out of time, though which approach ranks highest depends on the measure used and no approach leads on both. Absolute precision remains low, so the ranking is a screening aid rather than a forecast.

Abstract: Objectives: This study examined the effects of turmeric extract supplementation on oxidative stress markers and antioxidant defense parameters in Muaythai athletes and sedentary individu-als. Methods: Forty-four healthy men aged 18–25 years were assigned to four groups (n = 11 each): Muaythai control, Muaythai plus turmeric, sedentary control, and sedentary plus turmeric. The supplementation groups received 400 mg of turmeric extract daily for 28 days, while the athlete groups followed a structured training program. A three-day rest period was implemented before blood sampling to minimize the effects of acute exercise. Venous blood samples were collected on days 1 and 28. Malondialdehyde (MDA), catalase (CAT), and reduced glutathione (GSH) were measured spectrophotometrically. Data were analyzed using appropriate parametric and non-parametric tests. Results: At baseline, athletes had significantly lower MDA levels and higher CAT and GSH levels than sedentary participants (p < 0.05). After 28 days, MDA decreased (p = 0.021) and GSH increased (p = 0.006) in the Muaythai plus turmeric group, whereas the change in CAT was not significant (p = 0.233). In the sedentary plus turmeric group, MDA decreased and CAT increased (both p = 0.001), with no significant change in GSH (p = 0.424). Neither control group showed significant changes. Conclusions: Turmeric extract supplementation was associat-ed with favorable changes in selected oxidative stress and antioxidant defense markers in Muay-thai athletes and sedentary individuals.

Abstract: Background: Vitamin D modulates innate and adaptive immunity, but population-level evidence linking vitamin D status to hepatitis B surface antibody (anti-HBs) positivity is limited. Methods: We conducted a cross-sectional analysis of 4,852 U.S. adults aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) August 2021–August 2023 cycle with measured serum 25-hydroxyvitamin D [25(OH)D] and anti-HBs. Survey-weighted logistic regression estimated odds ratios (ORs) for anti-HBs positivity by 25(OH)D status (<50 vs ≥50 nmol/L), adjusting for age, sex, race/ethnicity, education, and family income-to-poverty ratio. Effect modification and six sensitivity analyses were examined.Results: The weighted prevalence of anti-HBs positivity was 27.1% (95% CI 25.0–29.3), and 20.0% of adults had 25(OH)D <50 nmol/L. The crude association was null (OR 0.92, 95% CI 0.78–1.08), but after adjustment, 25(OH)D <50 nmol/L was associated with lower odds of anti-HBs positivity (OR 0.72, 95% CI 0.61–0.86). Each 10 nmol/L increase in 25(OH)D was associated with higher odds (OR 1.03, 95% CI 1.00–1.05), and odds were lowest below 30 nmol/L (OR 0.67, 95% CI 0.51–0.87). There was no evidence of nonlinearity. Interaction tests suggested stronger associations in women and younger adults (p = 0.015 and p = 0.022), and sensitivity analyses yielded consistent estimates (ORs 0.67–0.78).Conclusions: Low vitamin D status was independently associated with lower anti-HBs positivity among U.S. adults. The cross-sectional design and the inability to distinguish vaccine-induced from infection-acquired antibodies preclude causal inference.

Abstract: Kidney transplantation offers a route beyond long-term dialysis, yet access depends on a sequence of clinical, organizational, and biological decisions. This analytical essay combines a patient coauthor's lived experience with a narrative synthesis of published studies, registry reports, and public policy documents. It examines dialysis-market concentration, referral and waitlisting, organ-offer transparency, kidney nonuse, and the limits imposed by ischemic injury. Observational associations between facility ownership and transplant access are distinguished from evidence of intentional conduct. Established evidence for hypothermic machine perfusion is separated from investigational oxygen-carrier applications, including Biological Hemoglobin Oxygen Carriers (BHOC), for which product-specific benefit must be demonstrated. A patient-centered quality framework links referral timelines, allocation decisions, organ support, graft outcomes, and patient-reported experience. The central proposal is to assess economic reform and biomedical innovation together rather than as competing explanations for limited transplantation. This is not a systematic review, original clinical study, or demonstration of BHOC efficacy; it proposes an evidence-generation and quality-improvement agenda.

Abstract: Objectives: Functional capacity is frequently used to estimate the care needs of hospitalised patients, although it does not necessarily capture all components of nursing care intensity. This study aimed to analyse the association between functional capacity and the intensity of the basic and technical care delivered and to examine whether these associations varied during hospitalisation among adults admitted to general inpatient units. A secondary objective was to examine the gradient in basic and technical care needs across functional capacity categories. Methods: A prospective longitudinal observational study was conducted in seven adult inpatient units. The baseline Barthel Index assessment was performed within the first 24 h of hospitalisation, with daily assessments thereafter. CUDYR-D and CUDYR-R were first recorded on the second day and then daily, summarising the care delivered during the preceding 24 h. Analyses included cross-sectional correlations, correlations adjusted for age and comorbidity, differences between functional categories, and longitudinal associations assessed using linear mixed-effects models. Results: The analytical sample included 188 patients and 789 daily assessments. The Barthel Index was more strongly associated with CUDYR-D (ρ = −0.823; 95% CI: −0.868 to −0.762) than with CUDYR-R (ρ = −0.472; 95% CI: −0.580 to −0.346); this difference persisted after adjustment for age and comorbidity (Δ|ρ| = 0.360; 95% CI: 0.248 to 0.484). The gradient across functional categories was higher for CUDYR-D than for CUDYR-R. In the longitudinal models, the standardised coefficients for the Barthel Index were −0.838 for CUDYR-D and −0.508 for CUDYR-R. Interactions with time were small and not statistically significant. Conclusions: Functional capacity was strongly associated with the intensity of basic care delivered but was only moderately associated with technical care and clinical surveillance. The Barthel Index should not be used alone as a proxy for overall care intensity or nursing workload.

Abstract: Background: Emerging adults aged 18–25 years who have a parent with mental illness face increased risks to their mental health and wellbeing, yet few interventions are tailored to their support needs. Compassion-based approaches may be relevant, yet little is known about whether this group perceives therapy topics informed by these approaches as helpful or how they would prioritise them. This study identified and prioritised compassion-informed therapy topics that emerging adults with lived experience perceived as helpful. Methods: A two-round modified Delphi study was conducted with emerging adults aged 18–25 years living in Australia who were raised by a parent with mental illness and/or substance misuse concerns. In Round 1 (n = 25), participants rated eight topics informed by Compassion-Focused Therapy and Mindful Self-Compassion and provided open-text feedback, which was analysed using content analysis, and informed six additional topics. In Round 2 (n = 15), participants rated the additional topics and ranked the original eight by perceived helpfulness. Consensus was defined as ≥80% agreement. Results: Eleven of 14 candidate topics achieved consensus, with healthy relationships and reducing self-criticism among the highest-priority topics. Endorsed topics spanned three areas: (i) relationships, caring and responsibility; (ii) self-criticism and self-compassion; and (iii) understanding and responding to internal experiences. Conclusions: Emerging adults who have a parent with parental mental illness perceived a range of compassion-informed therapy topics as helpful for addressing their support needs. These findings may inform content selection for a tailored intervention for this at-risk group. Endorsement patterns further suggest that therapy content may be perceived as more helpful when it is linked to recognizable personal experiences and concrete ways of responding.

Abstract: Lung adenocarcinoma has become the predominant histological subtype of lung cancer in many settings, particularly among women, but recent data from Peru are limited. This retrospective observational study analyzed anonymized records of 1,545 patients with histologically confirmed primary lung cancer treated at the National Institute of Neoplastic Diseases in Lima between January 2020 and December 2024. Demographic and clinical characteristics were summarized, the association between sex and adenocarcinoma was assessed using Pearson’s chi-square test, and multivariable logistic regression was used to estimate adjusted odds ratios (ORs). Women accounted for 60.0% of cases,and adenocarcinoma represented 61.29% of all diagnoses. Adenocarcinoma was more frequent among women than men (64.5% vs. 56.5%; χ² = 9.49, p = 0.002). In the adjusted model, female sex was associated with higher odds of adenocarcinoma (OR = 1.38, 95% CI: 1.12–1.70, p = 0.002). Age and geographic areas were also associated with adenocarcinoma, whereas year of diagnosis was not. The annual proportion among women varied, declining in 2021–2022 and increasing again through 2024. These institutional data indicate sex-related differences in histological distribution, but the retrospective design and lack of information on smoking, molecular markers, and individual exposures limit causal interpretation.

Abstract: Clinical AI education should develop judgement that persists and transfers across systems, yet changing the AI system only at follow-up confounds transfer with forgetting. We developed a crossed assessment framework and evaluated its statistical properties using 5,000 Monte Carlo replications per scenario. Sixty synthetic learners per replication completed four system-by-time assessment cells, with 15% independent attrition, 20 decisions per cell and a shared learner effect. Familiar-system accuracy declined from 0.75 to 0.67; unfamiliar-system penalties ranged from zero to ten percentage points. When the penalty was five points, the diagonal comparison misattributed an additional 4.98 points to forgetting and achieved only 30.42% interval coverage of retention. Within-system retention estimates maintained approximately 95% coverage. A deterministic example showed that improved override alone can conceal complete rejection of safe advice. An accompanying resource audit corrected illustrative expenditure calculations while identifying unsupported energy comparisons. These computational findings support identifiable assessment contrasts and separate acceptance and override outcomes. They do not demonstrate adaptive-training effectiveness, clinical benefit or measured environmental savings; those claims require prospective validation.

Abstract: Aim: To examine nurse managers’ ethical decisions and the concordance and response stability of generative artificial intelligence in simulated management scenarios. Background: Nurse managers balance obligations to patients, staff, and organizations. Evaluating both agreement and repeated response variability is necessary when considering artificial intelligence for ethical deliberation and organizational governance. Design: An exploratory study combining a cross-sectional census at a Spanish public university hospital with repeated evaluation of three models using identical sce-narios. Methods: Models received the complete questionnaire in new web conversations. Analyses examined human response distributions, management-level variation, model concordance, and within-model stability. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Nurse managers converged most strongly on protective and fairness-related actions. Staffing and informed consent elicited more heterogeneous choices. Overall concordance was similar, although two models were highly stable and the third varied more across repetitions. Scenario-specific agreement differed. All models consistently diverged from the human mode in conscientious objection and informed consent. Exploratory comparisons did not establish model superiority or equivalence. Conclusion: Repeated evaluation provides a more informative account of model behavior than a single response. Aggregate agreement con-cealed distinct response patterns. Stability, professional concordance, and ethical defensibility represent separate questions; consistent outputs may still diverge from professional preferences. These findings do not establish clinical effectiveness or ethical correctness. Implications for Nursing: Leadership education should combine ethical reflection with critical appraisal of model outputs and context-sensitive justification of decisions. Implications for Health Policy: Organizational govern-ance should retain accountable nursing oversight, require local evaluation and review after model updates, and define procedures for resolving consequential disagreement.

Abstract: Federated diabetes prediction can expand risk identification without centralising records, but prevention depends on accessible services. This study develops a capacity-constrained model connecting identification, navigation, enrolment and programme completion. Published English programme counts provide empirical context; intervention effects and costs are hypothetical. Seven strategies were evaluated for 1,000 eligible adults over twelve months, with sensitivity analyses varying coverage, navigation benefit and resource requirements. Enhanced identification alone increased expected completions from 220.8 to 307.2 while widening the completion gap from 16.8 to 19.2 percentage points. With 180 navigator hours, throughput maximisation produced 343.2 completions and a 25.2-point gap. Preventing disparity from worsening retained 341.1 completions, a 0.6% reduction. Halving only the barrier-group navigation benefit increased this loss to 4.8%, demonstrating that equity costs depend on relative productivity. At least 53.3 navigator hours were needed to restore the baseline gap under base assumptions. Enhanced identification cost an illustrative £656 per additional completer against matched navigation. The contribution is a testable capacity-feasibility and comparator framework. Deployment decisions should connect validated prediction to funded support, subgroup participation and demonstrable incremental value.