Fragile Systems Research Articles

Positioning plant health within the evolving human-animal-environmental health paradigms

The evolution of the global scenario, which involves such converging crises as the climate crisis, the COVID-19 pandemic and its aftermath, and the Russia-Ukraine and Israel-Palestine wars, has underscored the fragility of the current food systems and the interdependence of human, animal, plant, and environmental health. Plant health is an important element in all these crises as plants provide food and feed, fix CO2, produce oxygen, and stabilize the soil. As a result of the Covid 19 pandemic, the One Health concept has finally obtained the attention of scientists and funding agencies. However, despite their role in global nutrition, the economy, and in climate crisis, plants are often excluded from the One Health efforts and funding streams. This paper advocates the need for an updated and more holistic view of plant health as public goods within the context of the evolving global challenges and explores opportunities within the Circular Health paradigm.

A Case of Subarachnoid Hemorrhage Due to Vertebral Artery Dissection Following Spontaneous Coronary Artery Dissection on the Same Day: A Clinical Image

A woman in her 60s with well-controlled dyslipidemia presented with anterior chest pain. The electrocardiogram, chest radiograph, and echocardiogram were unremarkable; however, cardiac enzymes levels were elevated. Coronary angiography performed after dual antiplatelet therapy revealed spontaneous coronary artery dissection (SCAD). On the same day, the patient complained of mild headache that was initially treated as migraine. Hours later, the patient reported severe headache, followed by a decline in consciousness. Computed tomography of the head showed subarachnoid hemorrhage, while the angiography revealed bilateral vertebral artery dissection. The ruptured right vertebral artery dissecting aneurysm was treated with coil embolization. Despite treatment, the patient died seven days later. Autopsy confirmed dissections of the coronary and vertebral arteries. Although SCAD is rare, it often coexists with extracoronary vascular abnormalities due to systemic arterial fragility. Therefore, consider cerebrovascular disorders and promptly implementing diagnostic and management strategies in patients with SCAD and headaches is necessary.

Maternal health in conflict-affected settings: a case study from a frozen conflict zone

Abstract Background Reproductive, maternal, newborn and child health are negatively impacted in conflict-affected settings, and may be acutely affected in frozen conflicts due to fragile health systems and uncertain geopolitical contexts. To better understand maternal health in a frozen conflict zone, we examined maternal health outcomes in Nagorno-Karabakh during a ceasefire period prior to the forced displacement of the entire population. Methods Multistage cluster sampling was used to sample 1023 households in Nagorno-Karabakh during the summer of 2022. From each household, one woman, age 18 to 49, participated in an interviewer-administered survey. Maternal health outcomes were assessed among all married women who had ever given birth. Women with at least one child under 5 years were also asked about their most recent pregnancy. Results Among all married women, 85.5% had ever given birth, 19.0% ever had a miscarriage, and 2.8% ever had a stillbirth. Of the 299 women with at least one child under 5, 97.7% received antenatal care, of which 90.4% had at least 4 visits. Over half experienced toxicosis (51.8%), 16.4% high blood pressure, 13.0% anemia, and 6.4% hemorrhage during their most recent pregnancy. The most common delivery complications were uterine scarring (19.7%), breached birth (7.0%), prolonged labor (6.4%) and hemorrhage (5.7%). Age was found to be a significant factor, with the odds of toxicosis (p = 0.039) and breached birth (p = 0.009) decreasing, yet the odds of miscarriage (p = 0.001) and hypertension (p = 0.007) increasing with age. Conclusions Almost all women reported adequate antenatal care with birth outcomes comparable to global statistics, demonstrating the ability of Nagorno-Karabakh to provide sufficient maternal healthcare while in a frozen conflict. Fortifying and ensuring access to maternal and reproductive healthcare, particularly antenatal care, is vital for ensuring the health and wellbeing of women and children in conflict-affected settings. Key messages • Women in Nagorno-Karabakh received antenatal care and experienced birth outcomes similar to global rates, demonstrating the value of access to reproductive healthcare in conflict-affected settings. • Future studies should examine the impact of forced displacement on the women of Nagorno-Karabakh to better understand the effect of conflict on reproductive and maternal health.

Land covers associated with forest expansion hot spots in the Nepal Himalaya

Abstract Many regions of the Himalaya are experiencing forest expansion, signifying a widespread forest transition across this fragile mountain system. In the Nepal Himalaya, forest expansion is increasingly attributed to the narrative of cropland abandonment driven by rural outmigration. Understanding forest change dynamics as consequences of land use changes is critical in the context of rural mountain societies such as Nepal, which exhibit complex interactions between forest, agriculture, and livelihoods. We analysed forest gain in Nepal from 2000–2019 to inquire where and when forests have expanded and what land covers transitioned into forests. We integrated spatiotemporal analysis of national land cover maps and photointerpretation of very high resolution (VHR) imagery to improve analytical estimates. The Middle Mountain physiographic region experienced the strongest hot spots of forest gains relative to the high mountains or lowlands. Visual interpretation of VHR showed that 68.8% of forest gains since 2000 occurred on shrubland, and 26.5% on cropland. The dominance of shrubland-forest transitions implied that shrubland is an intermediate stage in a multi-decadal succession process, or a semi-permanent state such as arrested succession. Notably however, we also detected cropland-forest transitions occurring as fast as 6–10 years, indicating the potential for rapid forest succession if biophysical conditions permit. Thus, variations in land cover transitions to forests in the hills implicated multiple pathways of forest regeneration, reflecting a variety of spatiotemporally explicit drivers. Our results differ from previous studies because VHR image analysis accounted for land cover classification errors and improved land cover quantification. Further research on spatially explicit mechanisms and drivers of forest gain are needed to understand the synergies of forest, agriculture, and livelihoods to inform land use land cover policies that could be leveraged to enhance rural mountain livelihoods.

AUMENTO DO USO DE ANSIOLÍTICOS APÓS A PANDEMIA – REVISÃO DA LITERATURA

Introduction: Anxiety disorders are significant areas of research due to the high incidence of anxiety being diagnosed in the population, leading to temporary or permanent disability. Investigations conducted on the mental health of Brazilian residents during the COVID-19 outbreak indicate an increase in diagnoses of anxiety, depression, and stress. The deterioration of mental well-being was influenced by multiple factors, including the absence of proper funeral ceremonies, the escalation of unemployment, and the decline in financial capacity, which heightened tension and anguish among those needing a source of income to support their families. This scenario significantly contributed to the increase in the use of anxiolytics, as many individuals resorted to these medications as a form of immediate relief for the symptoms of anxiety and stress exacerbated by the pandemic, highlighting the need for a broader and more integrated approach to mental health treatment in the current context. Objectives: To analyze the increase in the use of anxiolytics after the COVID-19 pandemic and its implications for public health. Methodology: This study is structured as a literature review, aiming to compile and analyze existing information on the topic. Additionally, the research is exploratory and descriptive, with the objective of mapping existing knowledge on the subject and outlining its nuances. The platforms Scielo, Portal de Periódicos CAPES, and Medline were used. The period considered was from 2018 to 2023, with texts fully available online, in Portuguese. Results: The results indicate a significant increase in the use of anxiolytics during and after the COVID-19 pandemic, especially among more vulnerable groups, such as the elderly and people with pre-existing health conditions. The use of medications like Alprazolam increased by 35% in 2020, reflecting the intensification of anxiety in the population. Conclusion: The pandemic exposed the fragility of mental health systems, highlighting the need for public policies that combine pharmacological treatment with continuous support. Future research is essential to monitor the long-term effects of anxiolytic use in the post-pandemic period.

Quantum-Resilient Self-Evolving Blockchains: AI- Driven Consensus and Autonomous Security Upgrades

The fragility of conventional blockchain systems is becoming more apparent in face of the relentless march forward in quantum computing. In this paper, we suggest the optimal architecture for quantum-resistant blockchains deploying AI regarding consensus self- evolving security protocols and mechanisms. An intuitive example of this integration is the use of machine learning algorithms for a self-adapting security system, which automatically adjusts the protection on its infrastructure capabilities to evolving quantum threats. In this paper, we address the consequences of quantum computing in blockchain security introduce a framework for AI-assisted consensus (Section 3) and cover the feasibility of self- evolving blockchains that guarantee their reliability as well as integrity in a post-quantum era.

System fragility analysis of highway bridge using multi-output Gaussian process regression surrogate model

This study presents a multi-output Gaussian process regression (GPR) surrogate model for seismic-fragility analysis of bridge structural systems. Multi-output GPR can model the correlations among multiple outputs, accuracy and stability are achieved with fewer training data, which reduces the computational cost of fragility analysis. Furthermore, the explainability of the constructed surrogate model is implemented by adopting an automatic relevance-determination (ARD) kernel in the GPR. The estimated hyperparameters can provide the contribution of the uncertainty of each input parameter to the outputs. The fragility analysis using the multi-output GPR surrogate model was verified by applying it to a seismic isolation highway bridge with multiple spans and a curved geometry. The effectiveness of the multi-output GPR was demonstrated by the construction of an accurate and stable surrogate model with 46 inputs and 28 outputs. The relative contributions of the uncertainties to the structural properties and input earthquake loads could also be understood. The fragility curves, at both the component and system levels, were appropriately obtained using a sufficient number of samples in a Monte Carlo calculation. Furthermore, the failure modes were evaluated, identifying which structural components contributed to the system failure. This enabled discussions on structural system failures from the viewpoint of the structural dynamic characteristics of the bridge and earthquake-load properties.

The Fragility of Democracy: Political Conflict in South Asia

The complex interplay between political conflict and democratic fragility in South Asia is the focus of this research paper. The study examines South Asia to understand how conflict catalyzes and hinders democratic progress. The research delves deep into the root causes of conflict, including socio-economic disparities, ethnic and religious tensions, and institutional weaknesses. It analyzes how conflict can trigger democratic reforms through popular mobilization and erode governance and institutions. The study highlights the fragility of democratic systems in the face of deep-rooted conflicts and the challenges of balancing competing interests. It underscores the need for South Asian nations to address underlying grievances to strengthen democratic institutions and foster inclusive dialogue to navigate conflict constructively and secure a stable democratic future. The research employs a qualitative approach, relying on a comprehensive literature review and case study analysis to draw insights into the multifaceted relationship between political conflict and democratic development in the selected region.

Quality of neonatal health care in comprehensive specialized hospitals, Amhara Region, Ethiopia: a retrospective study with neonatal death audit

BackgroundNeonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region.MethodsA multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner.ResultsFrom 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates’ mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm.ConclusionHigher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers’ complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.

The Mpox Threat: Challenges and Implications of Clade Ib for Afghanistan's Healthcare Stability.

The global spread of the Mpox virus represents a significant public health challenge, particularly for regions with fragile healthcare systems. Afghanistan, already grappling with severe healthcare deficits, faces the added threat of Mpox, a zoonotic disease caused by the monkeypox virus. The recent emergence of Clade Ib, a new strain associated with rising outbreak cases, exacerbates concerns as Afghanistan's healthcare infrastructure continues to deteriorate due to reduced international aid, healthcare worker shortages, and an ongoing socio-political crisis. This commentary underscores the urgent need for international intervention to avert a potential public health crisis that could devastate Afghanistan's already weakened healthcare system. It calls for immediate support to enhance disease surveillance, improve healthcare infrastructure, and address the pressing challenges of malnutrition and access to medical services.

Caloric Restriction Diet Attenuates Systemic Bone Fragility after Radiotherapy.

Bone fragility is a well-documented long-term side effect of radiotherapy, which currently has no preventative treatments. In this study, we applied a caloric restriction (CR) diet to attenuate both local and systemic bone loss after irradiation (RTx) in an established female Balb/c mouse model (4 consecutive daily doses of 5 Gy to the right hindlimb only). CR mice were tapered down to a 30% reduced calorie diet (RTx/CR) one week before irradiation, while regular diet (RD) mice received food ad libitum (RTx/RD). Unirradiated (sham) mice received either a 30% CR diet (SH/CR) or received food ad libitum (SH/RD). Irradiated, contralateral, and unirradiated hindlimbs were evaluated at 2, 4, and 8 weeks postirradiation using micro-computed tomography (μCT) to assess bone morphology and 3-point bending to quantify femur strength. Histological analysis of irradiated and unirradiated tibiae was performed to examine general bone tissue cytology and serum biomarker analysis was performed using terminal blood draw samples. After treatment, femur strength and metaphyseal bone quantity was decreased in irradiated and contralateral femora of RTx/RD mice compared to SH/RD femurs; this finding is consistent with previous studies. RTx/CR mice had positive effects when compared to RTx/RD mice, including increased strength relative to body mass in both the irradiated and contralateral limb, increased trabecular bone mass, and decreased marrow adiposity. However, a number of adverse effects were also observed, including a significant decrease in body mass and decreased cortical bone. Overall, CR shows promise as a preventative treatment for postirradiated bone fragility, yet questions remain to be addressed in future studies. Ideal diet duration, impact to normal tissue, and mechanism of action must be explored to better understand the clinical implication of a CR diet.

Abstract A100: Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico

Abstract Introduction: Cancer is one of the most expensive medical conditions to treat due to the cost and duration of treatment. Financial toxicity (FT) describes the problems that a cancer patient has related to the cost of medical care, including subjective financial concerns. Despite the high burden of cancer, significant levels of poverty, and a fragile healthcare system in Puerto Rico (PR), no previous studies have evaluated FT among cancer patients in PR. Thus, we aimed to assess FT and associated social determinants among Hispanic cancer patients in PR. Methods: We are conducting a cross-sectional study through an online survey among cancer patients aged 21+ years who have received active cancer treatment over the last year. We use the COST-FACIT questionnaire, a validated survey composed of 12 questions; to measure low (score ≥ 21) and high (score &amp;lt; 21) FT. We also collect information on social determinants, including demographics, clinical characteristics, access to healthcare services, quality of life, social support, and patient navigation services, among others. Cronbach's alpha was used to assess the internal consistency of the FT score. Univariate (ULRM) and multivariate logistic regression models (MLRM) were used to determine the social determinants associated with FT. MLRM included significant variables in the ULRM (p &amp;lt; 0.10) and predictors supported by scientific literature. Results: As of April 8th, 2024, 387 people accessed the survey, with 294 (80.0%) completing it, including the FT section. The final sample size for this preliminary data analysis included 226 participants due to the exclusion of missing information on important covariates. Most of the participants were 51 to 64 years of age (46.9%), female (72.6%), had annual income &amp;lt; $25,000 (59.7%), and had a bachelor’s degree or higher (51.8%). COST-FACIT demonstrated good internal consistency (alpha=0.83). Approximately 46.0% of the participants had a high FT (overall FT mean score = 21.0±8.9). MLRM show that retired participants (OR: 0.22, 95%CI: 0.22-0.59) had less odds of high FT, while those who have public health insurance (OR: 2.38, 95%CI: 1.02-5.54), have comorbidities (OR: 2.27, 95%CI: 1.08-4.79), and have had a cancer diagnosis for more than 1 year (OR: 1.90, 95%CI: 1.02-3.53) have significantly higher odds of experiencing high FT. Conclusion: FT is higher among cancer patients with public health insurance, comorbidities, and more than one year since cancer diagnosis, but FT is lower in retired cancer patients. More research is needed to identify and evaluate interventions to address the FT of cancer treatment and the social determinants associated among Hispanic/Latino patients. IRB: This project was approved by the Institutional Review Board of the University of Puerto Rico Comprehensive Cancer Center (IRB # 2023-11-123). Citation Format: Marievelisse Soto-Salgado, Sofía Contreras-Fernández, Lorena González-Sepúlveda, Karina Torres-Mojica, Rocío Avilés-Mercado, Juan Paulo González-Mayoral, Nancy Cardona-Cordero. Addressing financial toxicity and associated social determinants among Hispanic cancer patients in Puerto Rico [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A100.

Health system interventions and responses to anti-microbial resistance: A scoping review of evidence from 15 African countries.

The global rise in antimicrobial resistance (AMR) is claiming the lives of more than 1.2 million people each year. According to the World Health Organization (WHO) this global health crisis is particularly acute in Africa, largely due to fragile and underfunded health systems. Efforts to combat this public health threat have led to the implementation of health system interventions worldwide aimed at managing and containing the spread of AMR. However, the literature on the real time impacts and the barriers that hinder the implementation of these interventions in the African context is limited. The objective of this scoping review was to identify AMR interventions in African health systems, their impact, and the challenges of the implementation. Drawing on Muka and colleague's 24 step approach for scoping reviews, two major public health databases (PubMed and Global Health) were searched for articles in accordance with the PRISMA guidelines resulting in 4,783 records. Screening and retrieval of articles was done using Rayyan software based on specified inclusion criteria and 36 articles included in the final list. These articles were synthesized after extracting specific data on AMR interventions and their impact on African health systems. The review identified four broad impacts of AMR interventions including 1. Reduction in antibiotics use, 2. Increased adherence to guidelines and protocols, 3. Enhanced laboratory-based AMR surveillance, 4. Development of antimicrobial stewardship (AMS) Action Plans and Teams. However, challenges such as poor laboratory infrastructure, logistical challenges, poor financial commitment and inadequate education and training were identified as challenges impeding the successful implementation of AMR interventions in Africa. Our findings reveal a range of successful AMR interventions in African health systems although infrastructural and financial challenges remain. Better standardization and reporting of AMR diagnosis while leveraging the available information is needed to improve the optimization of treatment guidelines across Africa.

Heavy metal changes related to land use changes in a karst area: a case study in Changshun, Guizhou Province, China

Karst areas are often characterized by fragile ecological systems, and environmental pollution has increased the pressures on people living in such regions. This study aimed to investigate the status of pollution caused by heavy metals (Pb, Cd, Hg, As, and Cu) in soils based on different land uses in Changshun County, a karst area in southwestern China. Soil samples were collected from natural forestlands (NFLs), natural brush lands (NBLs), natural pasture lands (NPLs), artificial forestlands (AFLs), artificial brush lands (ABLs), and artificial pasture lands (APLs) for evaluation. The results suggest that the soil profile characteristics of the heavy metals studied herein vary significantly among different land uses. The heavy metal concentrations in all soil samples collected from NFLs were lower than those in samples from other land uses. Forest trees can protect soil from heavy metal pollution caused by atmospheric deposition; this is especially true for Hg. In cultivated forestlands and brush lands, special attention should be devoted to Cd pollution in the soil, which may be caused by the use of fertilizers. Changing both natural and artificial pastoral lands to forestlands could benefit the local ecosystems as it may reduce Hg contamination.

Management Delays and Outcomes in ST-Elevation Myocardial Infarction (STEMI) in the COVID-19 Era in Senegal: Insights from a Tertiary Center

Low-and middle-income countries (LMICs) face many challenges regarding the timely management of STEMI, and the COVID-19 pandemic has impacted our already fragile health systems. The aim of this study was to assess the delays in managing STEMI during COVID-19 and evaluate the 6-month mortality rates related to these delays. A retrospective cross-sectional study was conducted over two years starting from January 2020 at a tertiary center in Dakar, Senegal. All patients referred for STEMI during the study period were included. Statistical analysis was performed using R, version 4.4.0 (R Foundation for Statistical Computing). A total of 273 patients were enrolled during the study period (65.9% males, mean age: 59 ± 12.4). Diabetes Mellitus was present in 37.7% of cases. Only 1 out of 5 patients (20.5%) reached medical attention within 1 hour after symptoms onset, and the time from first medical contact to ECG was &amp;lt; 10 minutes in 39 % of cases. Primary PCI within the first 24 hours was performed in 23.5% of cases. Factors significantly associated with late hospital admission (&amp;lt;12h) were first medical contact &amp;lt; 1h (P 0.0009, OR: 4.06 95% CI; 1.8-9.64), time to first ECG &amp;lt; 10 minutes (P 0.002, OR: 2.79 95% CI; 1.45-5.41) and number of facilities visited &amp;lt; 2 (P 0.004, OR: 3.4 95% CI 1.51-8.22). The 6-month mortality rate was 18.7%, and the probability of death increased with a more significant delay in first medical contact. Our study found persisting delays in STEMI management in Senegal. Establishing a standard of care for STEMI in Senegal is mandatory to overcome healthcare system weaknesses and improve the outcomes of our STEMI patients.

Serviceability fragility assessment of non-seismically designed railway viaducts in Turkey under near-field and far-field earthquakes

While many railway viaducts still in use in Turkish railway networks are located on active fault zones that produced historical destructive earthquakes, they are not seismically designed in accordance to current standards. This study aims to provide a better understanding about the serviceability fragility of such systems by conducting detailed probability-based seismic assessments under near-field and far-field earthquakes. To achieve this, firstly, 3D finite element models of a range of selected viaducts in Turkey were generated based on their original design drawings. The developed FE models were validated by comparing the analytical modal frequencies with the results of in-situ dynamic tests involving a series of acceleration measurements. Nonlinear time history analyses were then carried out under 25 near-field and 25 far-field real three-component ground motion recordings to obtain the seismic response of each selected viaduct. Subsequently, probabilistic seismic demand models were defined using linear regression analysis to determine relationships between engineering demand parameters (EDPs) and ground motion intensity measures (IMs). Peak ground acceleration (PGA), peak ground velocity (PGV) and spectral acceleration at 1.0 s (Sa (1.0)) were used as the IM parameter, while the maximum lateral displacement of the bridge spans for different service velocities defined in the Eurocode was considered as the EDP at serviceability damage state. Finally, analytical fragility curves for all the selected railway viaducts were developed considering maximum damage probability for the IM levels. The results, in general, demonstrate the seismic vulnerability of the existing viaducts in Turkey. It is shown that while at low speed limits the viaducts exposed to far-field ground motions were more vulnerable than those under near-field ground motions, at high speed limits the viaducts subjected to near-field ground motions were more vulnerable. Also, it is seen that reinforced concrete and masonry viaducts are generally more vulnerable to earthquakes than the steel viaducts. The outcomes of this study should prove useful for the seismic risk assessment, loss estimation and rehabilitation of the railway transportation networks in future studies.

Migration of Medical Doctors from Nepal: Analyzing Trends and Policy Implications

One way migration of health care professionals especially from low-income countries like Nepal has become a concerning issue where the already fragile health system of the country faces challenges of losing skilled health care professionals to high-income countries. This trend analysis provides insights into the dynamics of Nepal's healthcare workforce migration, it offers a tailored understanding of factors influencing migration patterns, and its impact on the general population of the country and globally. It helps formulate targeted policies for workforce retention, resource planning, and addressing the country's healthcare needs and comparison with the global context. Analyzing the migration trends of medical professionals enhances medical literature by offering a comprehensive understanding of the factors affecting healthcare systems, public health, economics, education, and policy development. This knowledge plays a vital role in shaping future policies in the field of medicine in Nepal.

Pluralist economics in an era of polycrisis

Interacting crises at economic, societal, ecological, and geopolitical levels reveal the fragility of connected global systems and give momentum to pluralist economic thinking as a suitable approach to address the complexity and uncertainty of today’s economy. This special issue (SI) explores how young economists, educated in this era, study economic phenomena through pluralist lenses. Due to the structure of interdependent crises and inherent uncertainty, pluralism of values, theory and methods may benefit the academic and policy debate on solutions for today’s political, social, and scientific challenges. Applied to the crisis context, this SI shows a range of research methods and interdisciplinary approaches, reflecting a shift in economic thinking that embraces the complexity, limited predictability, and fragility of socioeconomic systems. The SI aims to promote a dialogue across schools of economic thought to enhance our understanding and contribute to robust and inclusive policy.

Life-cycle seismic resilience prediction of sea-crossing bridge piers exposed to chloride-induced corrosion in marine environments

The life-cycle seismic resilience assessment of sea-crossing highway bridges plays a crucial role in guiding decisions for their long-term operation, maintenance, and rehabilitation. Due to the inherently stochastic nature of marine environments, evaluating the resilience of bridges while considering all possible environmental scenarios throughout their service life necessitates substantial computational efforts and presents practical challenges. Thus, this study develops a three-stage framework for predicting the life-cycle seismic resilience of sea-crossing highway bridges. Stochastic models for marine environmental conditions and bridge durability are developed and validated using experimental measurement data. A modified Good Lattice Point-Partially Stratified Sampling (GLP-PSS) method is employed to generate a uniform and limited number of samples. A typical prestressed concrete sea-crossing highway bridge is selected as the benchmark bridge, and parameterized numerical models are established using 460 representative environmental parameter samples on the OpenSees platform. Leveraging the environmental model and material properties, the durability of the bridge is predicted over its service life. Nonlinear time history analyses are carried out for each bridge model using 120 real ground motion records, which allow the identification of variations in seismic demands, capacities, and system fragilities at different time intervals. Subsequently, the life-cycle seismic resilience of the bridge is predicted utilizing surrogate models based on the response surface method (RSM) and artificial neural networks (ANN), respectively. Finally, the time-dependent probabilistic characteristics of seismic resilience are thoroughly discussed. Results indicate that ANN demonstrates a higher degree of generalization capability in predicting the life-cycle seismic resilience. Focusing solely on changes in mean resilience over the service time may lead to an underestimation of bridge resilience, as it may ignore the tails of its distribution, potentially resulting in an overestimation of bridge resilience. Furthermore, global warming may expedite the decline in resilience.