PurposeTo describe the utilization of an on-call critical care pharmacist to bridge gaps in clinical coverage for subspecialized critically ill populations.MethodsIn October 2022, a 24/7 on-call team of medical and cardiac ICU pharmacists was established to field questions regarding patients with mechanical circulatory support and pulmonary hypertension. On-call pharmacists were available via centralized telephone number Monday through Friday from 4:00 p.m. to 8:00 a.m., and at all hours on weekends. Information characterizing calls received was collected in an electronic database. A review of all database entries through March 2025 was conducted and descriptive statistics were used to quantify calls received, time spent, multidisciplinary team member engagement, and types of interventions.ResultsOn-call pharmacists received 207 calls and documented 218 interventions. Calls were most often received between the hours of 4:00 p.m. and 8:00 a.m., and the median time spent per call was 10 minutes (IQR 5-20 minutes). On-call critical care pharmacists received the most calls for ECMO patients (38.2%), followed by pulmonary hypertension (26.1%) and Impella® patients (20.8%). The majority of inquiries were from pharmacists (35.7%), followed by advanced practice providers (33.3%) and physicians (21.3%). Anticoagulation and hemostasis was the most commonly cited intervention category (56.4%).ConclusionIn the absence of an onsite critical care pharmacist, a 24/7 on-call critical care pharmacist was utilized by members of the multidisciplinary team to bridge gaps in clinical coverage. Further research is needed to determine the pharmacoeconomic and clinical impacts of on-call critical care pharmacists when onsite resources are unavailable.

Methodological review: Prioritizing a future research agenda for overcoming immunization implementation barriers in Pakistan.

Mapping the affordances and adoption of artificial intelligence in entrepreneurial practice: A bibliometric analysis from 2000 to 2024

Estimation of the global number of nicotine vapers in 2025.

Immunization gaps and measles outbreaks in ASEAN (2015-2025): A systematic review and meta-analysis.

Cystinosis is a rare lysosomal storage disorder that affects approximately 1 in 100,000 to 200,000 live births worldwide. Long-term graft success in cystinosis depends on cysteamine adherence and structured multidisciplinary transition, supported by protocols developed by both pediatric nephrologists and hospital organizations. This review explores institutional and regional care models, structured programs such as the RISE protocol and Got Transition's Six Core Elements, and major barriers including adult nephrology expertise, psychosocial stressors, and insurance coverage gaps. Additionally, we explore the impact of digital health tools for their role in supporting cysteamine adherence and maintaining continuity of care. Emerging technologies such as machine learning also provide future opportunities to improve patient care during the transition period. Transition plans must also integrate digital tools and mental health-informed strategies tailored to Gen Z and Alpha cystinosis patients. Due to the lifelong nature of cystinosis and the complexity of adolescent development, transition models are essential to promoting long-term autonomy in patients. We conducted a comprehensive search of the PubMed databases for studies published between 2000 and 2025 that addressed structured transition protocols and long-term outcomes in pediatric patients with cystinosis. A critical analysis of existing cystinosis transition protocols is essential to evaluate their strengths and limitations and to identify approaches better tailored to the needs of pediatric cystinosis patient populations. This review aims to evaluate elements of existing protocols, highlight components of a successful transition, and propose future strategies to improve care in patients with cystinosis.

ABSTRACTIntroductionSouth Africa has the largest antiretroviral therapy (ART) programme in the world, with universal access available through the public health system. Yet, gaps in coverage persist. In the Western Cape (WC), an estimated 200,000 people living with HIV are not currently on ART—many of whom are known to the health services. Exploring how people who are not on ART differ from those who are on ART may help guide more effective strategies for re‐engagement and retention in care.MethodsWe conducted a cross‐sectional analysis of routine person‐level data from the WC Provincial Health Data Centre, including adults (≥15 years) known to be living with HIV who accessed public services between October 2022 and September 2024. ART status was inferred from visit and dispensing records. Relative risks (RRs) of current disengagement were estimated using multivariable log‐binomial regression on 25 imputed data sets, adjusting for sex, age, years since diagnosis, diagnosis setting and baseline CD4 count.ResultsOf 494,071 adults included, 131,368 (27%) were currently disengaged from ART. Those at elevated risk included men (aRR 1.20, 95% CI 1.19–1.21), younger people aged 15–24 years (aRR 1.54, 95% CI 1.51–1.57), those with CD4 >500 cells/mm3 at diagnosis (aRR 1.26, 95% CI 1.24–1.28) and individuals diagnosed in hospital (aRR 1.41, 95% CI 1.39–1.43) or during pregnancy (aRR 1.20, 95% CI 1.18–1.22). However, the majority of those disengaged were not from these groups, proportionally representing the underlying population living with HIV. Model discrimination was poor (AUC 0.614), indicating that these characteristics do not reliably identify those disengaged.ConclusionsMost disengaged individuals are from larger, lower‐risk demographic groups and would be missed by interventions targeting higher‐risk demographics. Whole‐population strategies that address common barriers to retention through more inclusive, person‐centred care offer the greatest potential to improve ART coverage.

A secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS) system and a portable membrane inlet mass spectrometer (MIMS) have been used for the first time to detect and monitor insect sex pheromones, both qualitatively and quantitatively. Monitoring insect sex pheromones in the field is important because mating disruption works only when pheromone concentrations remain sufficiently high and spatially uniform. Measuring pheromone levels enables quick identification of coverage gaps, helping prevent pest resurgence and optimizing reapplication to reduce unnecessary costs and inputs. Compounds tested include: (Z)-11-Hexadecenal, (Z)-11-Hexadecen-1-yl acetate, and (Z)-11-Hexadecen-1-ol. Gas-phase experiments were performed at concentrations ranging from low ppt to low ppm. For both methods, the results obtained showed excellent linearity within the examined concentration range, ppt limits of detection (LOD) for the SESI-HRMS system, and ppb limits of detection for the MIMS, low limits of quantification (LOQ) for both methods, and fast response (rise and fall) times. In addition, SESI-HRMS was tested for the direct analysis of real-life Plutella xylostella VOC samples, detecting the three key female pheromone components in female, but not male, headspace samples.

ABSTRACT This qualitative study explores the readiness of master’s-level counselling students, particularly those specialising in substance abuse, to engage effectively in HIV prevention work with people living with HIV (PLHIV). Given the complex intersection between substance abuse and HIV transmission, the study examines students’ educational preparation, perceived competence, and attitudes towards HIV-related counselling. Data were collected through semi-structured interviews focusing on curriculum content, training experiences, practicum exposure, and students’ self-assessed readiness. The findings reveal persistent HIV-related stigma, gaps in curriculum coverage, limited experiential learning opportunities, and variability in students’ confidence and preparedness. Attitudinal factors, including fear, uncertainty, and empathy, emerged as central influences on readiness. The study offers recommendations for strengthening counselling curricula through targeted training, experiential learning, and attitudinal development to better prepare future counsellors for comprehensive HIV prevention practice.

Advances in tumor sequencing enable routine detection of dozens to hundreds of somatic alterations per patient, yet only a minority can be linked to established therapeutic evidence. Curated resources such as OncoKB provide high-quality variant-drug annotations but remain limited in coverage, particularly for rare or low-frequency variants. This coverage gap motivates computational frameworks that can integrate curated, literature-derived, graph-based, and clinical-trial evidence to prioritize therapeutic hypotheses for expert review. We developed the Integrated Drug Annotation Pipeline (IDAP), a modular framework that combines four complementary evidence streams: curated variant-drug associations from OncoKB, literature-derived gene-drug mention counts from PubMed abstracts, graph-based drug prioritization using a TxGNN-derived biomedical knowledge graph, and cancer-specific clinical-trial evidence from ClinicalTrials.gov. Given a cancer type and a MAF file, IDAP generates patient-level reports summarizing detected variants, ranked therapeutic hypotheses, supporting evidence layers, and relevant clinical trials. Evaluated across five cancer types (n = 50 samples), IDAP expanded evidence-linked therapeutic hypotheses beyond curated databases alone. Among patients without OncoKB recommendations (26/50), IDAP identified a median of 87 candidate drugs (range: 2-473). To reduce cross-source scale imbalance, the final ranking used within-sample percentile normalization with fixed bonuses for curated evidence, multi-source support, and trial linkage. Under this revised ranking, 24/50 top-ranked candidates were supported by at least two evidence sources and 44/50 had associated ClinicalTrials metadata. In an exploratory external CIViC comparison, IDAP recovered at least one matched CIViC-supported therapy in 28/41 eligible samples, with 13/41 appearing within the top 10 candidates. These outputs are intended to support evidence triage and translational interpretation rather than direct treatment recommendation. IDAP is freely available at https://github.com/joonan-lab/IDAP-pipeline, with full documentation at https://joonan-lab.github.io/IDAP-pipeline. An archived snapshot of the code used in this study is deposited on Zenodo (DOI: https://doi.org/10.5281/zenodo.19301367). Supplementary data are available at Bioinformatics online.

Pneumococcal disease causes substantial morbidity and mortality among U.S. adults, with an estimated 20,000 deaths and 150,000 hospitalizations annually. Despite effective vaccines, coverage has remained below national targets. Pandemic-related disruptions and the 2022 Advisory Committee on Immunization Practices transition to simplified 15/20 valent Pneumococcal Conjugate Vaccine recommendations may have influenced uptake, but their impact has not been fully assessed. To address this gap, this study examines trends and determinants of pneumococcal vaccine uptake among U.S. adults following the pandemic and 2022 guideline changes. We conducted a pooled cross-sectional analysis of National Health Interview Survey data from 2019 to 2024, including 166,948 adults aged ≥ 18 years with complete data. Weighted bivariate analyses assessed associations between vaccination uptake and demographic (age, sex, race/ethnicity), socioeconomic (education, income, citizenship), health-related (chronic conditions including Chronic Obstructive Pulmonary Disease, diabetes, asthma, and cancer; smoking; influenza vaccination), and healthcare access factors (insurance, usual source of care, recent provider visit). Multivariable logistic regression identified independent predictors of vaccination. All analyses incorporated National Health Interview Survey complex survey design and sampling weights. Overall weighted pneumococcal vaccination coverage remained low, fluctuating between 29.6% and 33.2% across survey years. Coverage was highest among adults aged ≥ 65 years (65.7%) but remained substantially below the Healthy People 2020 goal of 90%. Only 23.0% of adults aged 55-64 years reported vaccination despite risk-based recommendations. Disparities persisted across racial/ethnic groups, with Hispanic adults showing the lowest uptake (13.9%) compared to non-Hispanic White adults (29.1%). In adjusted analyses, age ≥ 65 years (odds ratio [OR] = 9.39; 95% confidence interval [CI]: 8.84-9.96), chronic conditions including Chronic Obstructive Pulmonary Disease (OR = 2.04; 95% CI: 1.90-2.20) and diabetes (OR = 1.84; 95% CI: 1.74-1.95), recent healthcare visits (OR = 1.41; 95% CI: 1.31-1.51), and influenza vaccination were strong independent predictors of uptake. Lack of insurance (OR = 0.89; 95% CI: 0.81-0.98), absence of a usual source of care (OR = 0.81; 95% CI: 0.74-0.88), and non-receipt of influenza vaccine (OR = 0.29; 95% CI: 0.28-0.30) were associated with lower odds of vaccination. Pneumococcal vaccination coverage among U.S. adults remained stagnant from 2019 to 2024, with persistent gaps among younger high-risk adults and racial/ethnic minorities. Healthcare engagement, insurance, provider contact, and influenza vaccination, were strongly associated with uptake. These findings suggest that risk-based screening, provider recommendations, and improved access for underserved populations may help address coverage gaps.

To characterize the capabilities of CE-marked AI products for lung nodule analysis in lung cancer screening (LCS), quantify their coverage of tasks defined in nodule management recommendations, and assess their peer-reviewed evidence. Six core tasks in LCS (nodule detection, classification, measurement, growth assessment, malignancy risk estimation, and structured management) were derived from 4 nodule management recommendations: Lung-RADS 2022, British Thoracic Society (BTS) guidelines, European Union Position Statement (EUPS), and European Society of Thoracic Imaging (ESTI). Products were identified through www.healthairegister.com . Vendors confirmed capabilities using a standardized questionnaire; public documentation supplemented non-responders. Task coverage was calculated as the percentage of functional overlap (0-100%) per recommendation. Peer-reviewed evidence was evaluated using a six-level efficacy framework and assessed for study characteristics. In total, 16 products from 16 vendors were included; 10 vendors completed questionnaires. Analysis showed that 14 products detect and measure solid and subsolid nodules, 12 support growth assessment, and 9 provide malignancy risk estimation (PanCan in 5, AI-based scores in 4). No product provides support for endobronchial or cystic lesions. High task coverage (> 75%) was observed in 10 products for EUPS and 4 for BTS, whereas no product achieved high coverage for Lung-RADS or ESTI. Overall, 60 peer-reviewed studies were identified; 7% were prospective and evidence clustered at lower efficacy levels: 70% assessed diagnostic accuracy, while none reported patient outcomes or societal impact. Numerous CE-certified AI products could support CT-based lung cancer screening, but gaps in task coverage and predominantly lower-level evidence necessitate cautious, monitored implementation. Question Do commercially available AI products for lung nodule analysis functionally cover international nodule management recommendation-defined tasks, and what peer-reviewed clinical evidence supports them? Findings AI products support standard nodule detection and measurement in line with management recommendations but lack support for endobronchial or cystic lesions and high-level clinical evidence. Clinical relevance CE-marked AI products can assist radiologists with core lung cancer screening tasks, but capability gaps exist. Limited high-level clinical evidence complicates integrating AI into guidelines, securing reimbursement, and formulating recommendations for its use in lung cancer screening programs.

Chronic kidney disease (CKD) presents unique medical and psychosocial challenges in children and adolescents that differ from adult patients with CKD. Transitioning from pediatric to adult care is a critical period. Insufficient planning and inadequate preparation increase the risk of medication nonadherence, loss to follow-up, graft failure in transplant patients, and increased morbidity. Transition models address barriers to successful transition, yet vary in their approach. We conducted a scoping review of the transition of care in pediatric CKD in accordance with PRISMA-ScR guidelines. We included PubMed/MEDLINE full-text articles, KDIGO guidelines, and grey literature on transition models between 1st January 2000 and 31st August 2025. Eligible studies included original research articles in English, human clinical trials, and guidelines specifically addressing pediatric-to-adult CKD transition of care. We identified barriers to effective transition at the patient, provider, and system levels. Patients often lacked health literacy, emotional readiness, or independence. Providers faced challenges with communication across pediatric and adult care teams. System-level obstacles included gaps in insurance coverage and limited resources. To assess readiness, models such as ON TRAC, TRAQ, RTQ, and the UNC TRxANSITION offer valuable questionnaires. Early preparation between the ages of 11-14, a gradual increase in patient autonomy, multidisciplinary teams' involvement, and structured transfer clinics are recommended for proper CKD transition. An effective transition is vital for improving both pediatric and adult health outcomes. Future research should focus on standardized protocols such as the Six Core Elements of Health Care Transition and the integration of technology-based tools to better engage adolescent patients. Structured and evidence-based transition models supported by healthcare systems can improve transition.

Kuwait’s push for 21st century skills presumes that metacognition is routinely enacted in classrooms, which is an assumption this study tests. A nonparticipant, structured observation of 26 randomly selected ninth grade female social studies teachers across 13 public schools used a validated 34 item observation card grounded in Zimmerman’s (2000) self regulated learning framework. Findings indicate an overall low to moderate implementation of the metacognitive strategies. Across seven strategies, mind mapping showed the highest use, self learning the lowest, with reciprocal teaching and think aloud and modelling in the mid range. The reported constraints of time, curriculum coverage and training gaps help explain weaker enactment in self regulated learning performance and reflection phases. The study contributes observation based evidence of classroom practice and offers targeted actions of self regulated learning aligned professional development, structured peer observation and curriculum embedded metacognitive tools, to narrow the gap between policy intent and daily teaching. Received: 11 December 2025 / Accepted: 31 march 2026 / Published: May 2026

Protecting arthropod species that deliver pest control and pollination services in agricultural landscapes requires methods that account for exposure, toxicological sensitivity and capacity for population recovery. We developed a trait-based vulnerability framework for representative above-ground arthropod families occurring in European crops and combined it with chemical-specific acute contact toxicity data to produce family-level, scenario-dependent vulnerability indices. Trait information describing habitat use, feeding guild, life cycle (breeding phenology and voltinism and dispersal mode was used to calculate a partial vulnerability index based on exposure and recovery. These trait scores were then integrated with measures of acute contact toxicity, expressed as lethal application rates, to derive chemical-specific vulnerability estimates under two exposure scenarios (canopy spray and soil contact). Trait-only screening identified many ground-associated predators (notably several spider families, ground beetles and rove beetles), certain parasitoid wasps and several Diptera as having higher vulnerability related to exposure and limited recovery relative to common regulatory test species. Adding toxicity data produced compound-dependent re-ranking. For a subset of insecticides, families such as ground beetles, ladybirds, certain parasitoids, pteromalid wasps, lacewings and some moths exhibited higher overall vulnerability than the standard surrogates. Canopy exposure produced slightly higher mean vulnerability overall, while soil exposure increased vulnerability of several ground-dwelling families. Data gaps in toxicological coverage and reliance on family-level trait aggregation constrain full implementation. We conclude that a tiered approach that uses trait-based screening to prioritise taxa for targeted toxicological testing will improve ecological relevance of risk assessment and better safeguard arthropod-mediated ecosystem services in agricultural systems.

The wild bee fauna (Hymenoptera: Apoidea: Anthophila) of the Canary Islands has received considerable attention from researchers and naturalists over the years. However, since the last comprehensive report published in the 1990´s, critical knowledge gaps regarding taxonomy, distribution and origins remain. Here, we present an updated checklist of the bee species of the Canary Islands, incorporating recent taxonomic revisions, newly described species, and relevant distribution data by combining information from both literature and citizen science contributions. More than 8000 records from citizen science platforms, along with additional collections records, have been examined to update the spatial distribution coverage and address several biological knowledge gaps. Our results suggest a composition ruled by a high proportion of endemic and threatened species compared to adjacent continent areas. The present checklist encompasses 146 species and 46 subspecies for the archipelago, 60 of which are endemic species and 42 endemic subspecies. In total 63 new local records are provided and three species Lasioglossum medinai (Vachal, 1895), Seladonia gemmea (Dours, 1872) and Sphecodes rubripes Spinola, 1838 are reported for the first time. Our biogeographical approach reveals differences in faunistic composition among islands, identifying three clusters corresponding to species predominantly associated with eastern, central, and western islands. Overall, Canarian endemic and Palaearctic elements are consistently represented across the archipelago, with endemics notably dominant in the western islands and introduced global species more frequent in the central islands. In contrast, Saharo-Arabian and Mediterranean elements are more prominent in the eastern islands, likely reflecting their geographical proximity to North Africa.

Hepatitis B and C virus infections remain major public health challenges, particularly in low- and middle-income countries. Pregnant women are a high-risk group due to the potential for mother-to-child transmission. This study assessed the prevalence of HBV and HCV infections, vaccination coverage, and associated factors among pregnant women in Northeastern Nigeria. This hospital-based cross-sectional study was conducted between April and November 2025. Blood samples were collected from 423 pregnant women attending selected hospitals, after obtaining socio-demographic information. The samples were screened for HBsAg and anti-HCV antibodies using rapid diagnostic test kits. The prevalence of HBV, HCV, and HBV/HCV co-infection were 9.93%, 4.49%, and 0.95%, respectively. Higher prevalence of HBV (4.96%; 95% CI: 2.89-7.03) and HCV (2.13%; 95% CI: 0.76-3.50) was observed among women aged 25-34 years. Vaccination coverage was relatively low and was significantly associated with educational level (p < 0.001) and place of residence (p < 0.001). Awareness and knowledge of hepatitis infection, transmission routes, and vaccine acceptance were significantly associated with vaccination uptake. The major barriers to vaccination included lack of awareness (42.32%), fear of side effects (22.93%), and misconceptions regarding vaccine necessity (20.57%). HBV and HCV infections remain prevalent among pregnant women in Northeastern Nigeria, with low vaccination coverage and significant gaps in awareness and access to preventive services, demanding targeted health education, improved vaccination access and strengthened antennal programs to reduce the burden of the infections in the area. Not applicable.

Malaria remains a leading cause of pediatric morbidity and mortality in sub-Saharan Africa, with Plasmodium falciparum accounting for over 90% of cases in high-transmission regions. The RTS, S/AS01 vaccine represents the first licensed malaria vaccine, targeting the circumsporozoite protein to prevent sporozoite invasion of hepatocytes. This review critically synthesizes evidence on RTS, S/AS01 implementation in high-transmission sub-Saharan African pediatric populations, focusing on molecular mechanisms, clinical efficacy, and programmatic challenges. A systematic literature search was conducted in PubMed, Embase, and Web of Science databases (2015–2024), selecting randomized controlled trials, implementation studies, immunological analyses, and systematic reviews. Phase III clinical trials demonstrated modest efficacy of 36% against clinical malaria and 32% against severe malaria in children aged 5–17 months following a four-dose regimen, with waning immunity requiring booster doses. Immunological studies reveal that RTS, S/AS01 induces anti-circumsporozoite antibodies and CD4+ T-cell responses, though protection is incomplete and variant-dependent. Pilot implementation programs in Ghana, Kenya, and Malawi have vaccinated over 2 million children, confirming feasibility and acceptable safety profiles, yet coverage gaps, logistical barriers, and interaction with seasonal malaria chemoprevention persist. Cost-effectiveness analyses support integration into existing vaccination schedules in high-burden settings, though long-term population-level impact requires ongoing surveillance. RTS, S/AS01 represents a significant advance in malaria control but requires complementary interventions and next-generation vaccine development to achieve elimination targets in endemic regions. Keywords: RTS, S/AS01, Malaria vaccine, Circumsporozoite protein, Pediatric immunization, Sub-Saharan Africa.

Measuring antenatal care timing and content across 131 low-income and middle-income countries, 1995-2023: a systematic analysis of trends.

The Eastern Mediterranean Region (EMR) of the World Health Organisation (WHO) consists of 22 countries and territories which are exposed to high levels of natural and man-made emergencies, and which have significant gaps in coverage of essential health services. Narrow fiscal space, economic distress, periodic shocks of conflicts, pandemics and natural disasters, and sharp declines in development assistance, are factors contributing to gaps in access to essential health services. The region receives development assistance from a range of development partnerships, which, although contributing to improved programme coverage and disease prevention, has been limited in developing and sustaining longer term health system capabilities. The increasing threats of conflict, pandemics and climate-related natural disasters, as well as the recent sharp downturns in development assistance, builds the case for more effective, efficient and equitable development assistance programming. Development assistance principles of alignment of health partnerships with sector priorities and building of country systems provide opportunities to sustainably address chronic health coverage and equity challenges, improve the capability of health systems to withstand periodic shocks, and sustain health programme improvements over longer time frames. In this paper, we describe how these principles are being applied in the region through country health compacts for universal health coverage, country and regional coordination models, and implementation of monitoring and evaluation of development effectiveness. Given the rapidly changing development landscape, application of development effectiveness principles provides opportunities to strengthen health systems, safeguard health security, and progress towards universal health coverage.