Microbial metabolites at the front line: Orchestrating gastrointestinal and systemic barrier immunity across the lifespan.

Climate change is progressively recognized as an emerging determinant of metabolic health outcomes, particularly in relation to diabetes mellitus. This review summarizes mechanistic and epidemiological evidence linking climate-related exposures to diabetes outcomes: namely, 1) heat stress, 2) air pollution, and 3) extreme weather-related disruption of diabetes care. Warming temperatures, worsening air quality, and more frequent extreme weather events are intensifying exposures that disproportionately affect populations with pre-existing chronic diseases; patients with diabetes may be at the center of climate-related vulnerability. While the greatest burden of diabetes is shouldered by countries in the Global South, these same regions are also at the front lines of climate change, facing extreme environmental conditions. Together, diabetes and climate change can converge to create compounding pressures on already strained public health systems in the world's most climate-vulnerable regions. Using global case studies from climate-vulnerable settings, we show the pathways through which diabetes outcomes and climate change can be connected highlighting the need for climate-informed diabetes prevention and management.

BACKGROUNDStudies of short-term mental health (MH) outcomes among frontline (FL) healthcare workers (HCWs) during the pandemic have been extensively published and have reached dramatically variable conclusions. Long-term MH outcomes in this population have received less study. A synthesis of available data on long-term MH outcomes among FL HCWs associated with the coronavirus disease 2019 (COVID-19) pandemic is needed to inform efforts for screening, mobilizing psychiatry resources, and preparing for the long-term MH consequences of future pandemics.AIMTo determine the prevalence of MH sequelae of FL HCWs 1-3 years after the COVID-19 pandemic.METHODSAll studies published between March 1, 2023, and December 1, 2025, that reported on the post-pandemic MH of FL HCWs affected by the COVID-19 pandemic, such as insomnia, stress, burnout, anxiety, and depression, were identified using PubMed, PsycINFO, Scopus, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, MEDLINE, and Web of Science. Articles identified in the search were screened using the approaches recommended by the PRISMA 2020.RESULTSOf the 1819 articles, 1679 were excluded after review of the title and abstract, 140 were reviewed at length, and 19 were included. The available data (entirely based on symptom screening measures) suggest that FL HCWs are at risk for stress-related, anxiety, depressive, and sleep disorders at least 1 year after the end of the pandemic.CONCLUSIONThese results suggest that enhanced access to psychiatry services is warranted in HCW populations exposed to pandemics.

A longitudinal network analysis of social connection and professional quality of life among healthcare workers during the COVID-19 pandemic.

The full-scale invasion of Ukraine in February 2022 launched years of large-scale combat operations, requiring rapid and recurrent generation of combat medical capabilities in order to maintain the fighting force. The operational requirements drove changes in the training and development of combat medics serving on the front lines. Duration of training was significantly shortened, resulting in challenging decision making on which skills to prioritize within the time available. Ethical principles of beneficence and nonmaleficence must be considered when operational requirements drive modifications of combat medic training.

This research paper presents a comprehensive study of the institutional status and functional role of state registrars within the national system for preventing and combating the laundering of proceeds from criminal activities. The relevance of the topic stems from the need to transform the activities of registrars from a technical process of recording legal facts into an effective tool of preventive financial monitoring. The author highlights the existence of an ‘institutional vacuum’ whereby state registrars, whilst being on the ‘front line’ of control during the establishment of business entities, are not, de jure, granted the status of primary financial monitoring entities, which limits their ability to detect signs of fictitious business at the pre-transaction stage. The paper provides a thorough analysis of the current regulatory framework, in particular the Law of Ukraine “On Prevention and Counteraction to Legalisation (Laundering) of Criminal Proceeds, Terrorist Financing and Financing of Proliferation of Weapons of Mass Destruction” and legislation in the field of state registration. A causal link has been established between the inadequacy of procedures for identifying high-risk individuals and the growth of the shadow economy. Based on an analysis of practical case studies and data from open sources (in particular, the Opendatabot platform), the paper highlights schemes involving the use of ‘nominee services’, the mass registration of business entities under a single individual, and ‘business fragmentation’ for the purpose of minimisation of the tax burden. Particular attention has been paid to a critical analysis of the provisions of the National Revenue Strategy for 2024–2030, specifically regarding the potential introduction of value added tax for individual entrepreneurs. The risks that such changes would pose to small businesses have also been assessed. The academic novelty of the research lies in the development of specific proposals for amending Ukrainian legislation with the aim of granting state registrars the status of primary financial monitoring entities and integrating their activities with the databases of the State Tax Service and the National Bank of Ukraine. The author argues that the introduction of a risk-based approach at the stage of state registration will shift the focus of control from the banking sector to the stage of establishing business operations, thereby ensuring transparency in the business environment and enhancing the country’s economic security. Recommendations have been formulated regarding the creation of a unified digital platform for interaction between the Ministry of Justice of Ukraine, tax authorities and the banking sector to enable the rapid identification of ‘shell companies’ and prevent the exploitation of vulnerable groups of population in unlawful financial schemes.

AimTo describe evidence‐based nursing (EBN) competence, attitudes, and associated factors among a sample of Finnish nurse leaders.DesignThis study was carried out as a descriptive cross‐sectional study.MethodsData were collected via an electronic questionnaire in 2021 from 215 nurse leaders registered in nursing trade unions, working as front line, middle, or senior leaders in Finnish social and healthcare organizations. A self‐assessment instrument (ActEBN‐managers) was used to measure EBN competence, attitudes, and supporting structures. Data were analyzed using descriptive statistics, t‐test, analysis of variance, and linear regression. The reliability of the ActEBN‐managers instrument was 0.893.ResultsIn this sample of Finnish nurse leaders, EBN competence and attitudes were overall good. EBN competence and attitudes were associated with several background factors, as well as with factors related to organizational support structures and culture, in the independent group analyses. An independent statistical association was identified between EBN competence and higher education (t = 2.074, p = 0.039). Furthermore, an independent statistical association was identified between EBN attitudes and the service provider background (t = −2.503, p = 0.013), with more positive attitudes observed among nurse leaders working in the public sector. EBN attitudes were also associated with the availability of a best practices bank (t = −2.591, p = 0.010).ConclusionsThe findings suggest that social and healthcare organizations may benefit from focusing on strengthening nurse leaders’ EBN competence and attitudes by supporting their educational development, introducing EBN support structures more widely, and promoting an organizational culture that facilitates EBN. Nurse leaders play an important role in enabling and supporting the implementation of EBN.

Treatment-resistant juvenile depression is a globally prevalent issue, with a need for better pharmacotherapy. Typically, Selective Serotonin Reuptake Inhibitors are front line, but recently there is interest in examining using ketamine or esketamine adjunct in adolescents. In this study, a novel method is used to explore the adverse effects of sub-anesthetic doses of ketamine in a female pre-pubescent rat model, to assess its potential clinical implications. We assessed the severity and duration of dissociative behavior at three sub-anesthetic doses of ketamine (40, 50, and 60 mg•kg−1). Dissociative behaviors cause a subject to feel apart from their reality and ketamine is often abused for such effects. Dissociative behaviors, such as circling and ataxia, were observed following ketamine administration, with higher doses leading to increased severity and duration of symptoms up to 120 min post-injection. Our findings revealed that increasing doses of ketamine intensified both the severity and duration of dissociative behaviors. In conclusion, these results suggest a correlation underlying ketamine's rapid-acting antidepressant effect, particularly with higher sub-anesthetic doses associated with more pronounced dissociative behaviors and a rapid-acting antidepressant effect. Further investigation into ketamine's impact on longer-term dissociative effects is warranted to deepen our understanding of its therapeutic risks of ketamine treatment of adolescent depression.

During the process of responding to epidemics stemming from sudden public health emergencies, front line medical staff often experience death anxiety to varying degrees; however, this phenomenon has not been the focus of extensive attention. In this study, using the outbreak of the COVID-19 pandemic as a case example, we aimed to investigate the status of death anxiety and corresponding coping strategies among front line medical staff within the context of public health emergencies. By convenient sampling, 170 front line medical staff were recruited into this study. The self-made general data questionnaire, the Death Attitude Profile-Revised scale, death anxiety and coping during the epidemic questionnaire were used as tools for questionnaire survey. Our results indicate that the total score of the DAP-R scale for front line medical staff was 96.64 ± 14.23. Among the five dimensions of the scale, the scores in the neutral acceptance (4.07 ± 0.52) and death avoidance (3.27 ± 0.77) dimensions are relatively high. 81.2% participants reported that combating the pandemic could lead to more positive attitudes towards death. Medical staff experienced serious death anxiety before traveling to epidemic areas and after hearing about the infection of colleagues. In coping with death anxiety, helpful information support included "Information on the disease treatment and prevention" (70.59%) and "Positive news about fighting against the COVID-19" (66.47%). "Communication between medical teams" (71.76%) and "reading supporting information" (68.24%) were considered useful interventions that could ameliorate death anxiety. Death anxiety existed throughout the entire cycle of epidemic control and management, and medical staff required support to overcome it. The data generated in this study provide a reference to inform development of death education and support programs according to the needs of the medical staff and the characteristics of public health emergencies.

Background and Objectives: Although clinically useful, homologous recombination deficiency (HRD) testing has recently been more broadly adopted in ovarian cancer (OC) management. The VALIDATE study evaluated HRD status and treatment patterns in patients with newly diagnosed advanced OC in Bulgaria to better understand HRD prevalence and disease management. Materials and Methods: This real-world, observational, multi-centre, medical chart review study included 100 adult patients with HRD testing results available at study entry. Data collected at least 30 days after HRD results and 6 months later were descriptively analysed in the full cohort and subgroups (HRD, BRCA mutation, and genomic instability score [GIS]). Results: Mean age at diagnosis: 61.3 years; stage III: 51.0%, prevalence of HRD+ 58.0% (95% confidence intervals [CI] 47.7–67.8%) and HRD− 42.0% (95% CI 32.2–52.3%). Among the 58 HRD+ patients, 20 (34.5%) were BRCA+, whereas 38 (65.5%) were BRCA−, and 52 (89.7%) were GIS+, and 6 (10.3%) GIS−. Overall, platinum–taxane chemotherapy plus antiangiogenics was the most common front-line (FL) treatment (77.0%), regardless of subgroups (range: 66.7–85.0%). Six months later, 81 patients were alive, and 73 (90%) started maintenance therapy (MT). Antiangiogenic monotherapy (32.0%) and antiangiogenic plus PARP inhibitor (34.0%) were the most common MTs. The latter was also common across subgroups (range: 33.3–60.5%), except for HRD− (61.9% received antiangiogenic monotherapy). Conclusions: In this dataset, more than half of advanced OC patients had HRD+ status. Our study provides relevant insights into recent clinical practice patterns in advanced OC in Bulgaria that could serve as an anchor for future, more robust research in this field.

Researchers have paid little attention to the control of narcotics in the modern period. Different governments in modern China introduced rules and regulations on narcotics. The establishment of the management office of narcotic drugs during the period of the Nanjing Nationalist Government was a tortuous process, which demonstrates that state monopoly of narcotic drugs could not be secured in a day. After the outbreak of the Chinese People’s War of Resistance against Japanese Aggression, narcotic drugs were no longer the subject of criticism and became important medical supplies which were urgently needed behind the front line. Affected by wartime economy and post-war domestic situation, the price of narcotics skyrocketed, which made it difficult to purchase and transport the drugs. When the management office of narcotic drugs was relocated to Taiwan, government monopoly of narcotic drugs was retained on the island and lost in the mainland.

Abstract More than 17 million people volunteer and work in the Red Cross Red Crescent (RCRC) Movement. 1 With more than 130 active armed conflicts in at least fifty countries, it can be estimated that at least 4 million RCRC volunteers and staff live and work in armed conflict settings; 2 most volunteers and staff work in their own countries, delivering essential humanitarian assistance to their communities. In 2025, twenty-seven RCRC volunteers and staff lost their lives in the line of duty, with additional fatalities occurring off-duty. 3 Extreme working conditions and constant exposure to suffering often cause long-term psychological consequences, and the mental health and psychosocial impacts occur in a wider context that can lead staff and volunteers to question their fundamental moral values. This qualitative study seeks to explore the mental health and psychosocial 4 experiences of national volunteers and staff by amplifying their voices and acknowledging the hardships that they go through. Through a lens of moral injury and trauma-informed approaches, the findings of the study shed light on the lived experiences of national staff and volunteers working and living in armed conflict contexts. Key themes that emerged from the study include a strong commitment to the RCRC Movement, exposure to harm, mental health impacts, and the need for support systems for staff and volunteers. These insights underscore the urgency of embedding trauma-informed approaches in Movement-wide policies and support systems to strengthen protection and well-being for staff and volunteers.

ABSTRACT This joint essay examines the use of the arts as a powerful pathway into the academic study of the First World War. The article discusses the creation and performance of three works – dance, multimedia theatre, and music – along with the use of these works as companion pieces to the traditionally taught history of the war. The use of original writings (poetry, novels, journals, memoirs) from individuals whose lives were caught up in the Great War informs and brings authenticity to artistic interpretations of the wartime experience. This both deepens students’ historical understanding and encourages their critical inquiry, empathy, and interdisciplinary learning. An integrated approach to the study of the First World War engages students on multiple levels, to think critically about the nature of war and conflict, and to see this history as relevant to their own time. Development of performance pieces also brings to life a broader, far more inclusive understanding of the Great War’s impacts, by focusing on women’s diverse wartime experiences, for example, and a clear awareness of cultural and geopolitical implications extending well beyond the battlefields of the European front lines. The approach has pedagogical significance in drawing on theories of ‘multiple intelligences’, its ability both to tap into and to exploit for advantage students’ multiple learning abilities and modes. Further, it provides pathways to explore history with both emotional and scholarly engagement. Those pathways offer a living link to the past and opportunities to project students’ insights forward with relevance to their own lives and times. Students’ participation in and responses to these works – works performed in secondary school and institutions of higher learning – demonstrate the continuing resonance of artistic form in interpreting the human experience of this war.

Background/Objectives: The COVID-19 pandemic exerted unprecedented pressure on healthcare professionals and systems worldwide. To manage this increased demand, hospitals extended working hours, resulting in increased strain on workers and impacting their professional well-being. Simultaneously, the numerous deaths due to illness meant that healthcare professionals did not have sufficient time to process grief, which may have led to unresolved grief and other mental health problems. The aim of this study was to understand the experiences of loss and grief and their repercussions on Brazilian healthcare professionals working on the front lines during the COVID-19 pandemic. Methods: This qualitative study followed Charmaz’s constructivist grounded theory. The study used the COREQ checklist. Between August 2024 and January 2025, 24 healthcare professionals who worked on the front lines during the COVID-19 pandemic were interviewed via telephone. Participants were primarily female (n = 14) with a mean age of 42 years (SD = 9.13). Interviews were audio-recorded and transcribed. Results: The core phenomenon that emerged from the analytical process is “between exhaustion and resilience in a war-like scenario: challenges and opportunities in the care provided by frontline professionals during the COVID-19 pandemic”. This main axis was anchored in three categories: (1) adversities imposed by COVID-19 on the functioning of health services; (2) witnessing sudden deaths and the physical absence of families; (3) reconstruction of meanings and personal and professional growth. Conclusions: The experience of grief was intensified by the peculiarities permeating the death process in the pandemic context and the modification of farewell moments. The study exposes a need for training programs focused on medical, nursing, psychological, and other areas of care education that involve not only understanding clinical issues but also recognizing loss and grief as an integral part of care processes. Importantly, legislators should allocate additional resources to services that provide psychological support to healthcare professionals, in order to promote their adaptive coping.

Abstract In the early days of the full-scale russian invasion, Mykolaiv was a city on the outskirts of which Ukrainian troops stopped the invaders. Until the liberation of Kherson, the city remained on the front line, and Russia repeatedly attacked it from the air with missiles and drones, resulting in the destruction of a large number of residential, administrative, public, and industrial buildings in the city. Among the buildings destroyed by shelling are also architectural and historical monuments, of which there are 139 architectural monuments and 109 historical monuments. Almost half of these objects were damaged during the shelling, and prominent buildings such as the Mykola Arkas Gymnasium building and the so-called Admiralty building, the administrative building of the Mykolaiv Shipyard, were completely or partially destroyed. In order to develop design and restoration documentation for the destroyed monuments, it is necessary to first study the technical condition of the building, which should be based on a very detailed digital model of the object. The aim of the study is to conduct field surveys of destroyed objects and to test 3D scanning and photogrammetry methods as a basis for creating an inventory database that can be used in further work with the monument – from recording the crime to developing conservation and restoration documentation. An important part of the work was the detailed recording of even the building debris, not just the preserved structures and substances of the building.

From energy performance indicators to institutional strategies: a multi-cluster benchmarking study of Fijian schools

The Community Representative Council of the National Drug Abuse Treatment Clinical Trials Network: Co-Design and Early Impact

Farmers and ranchers are on the front lines of climate change, facing escalating production pressures, economic uncertainty, and profound psychological impacts. Drawing on first-person experience and research in agricultural communities, this Commentary uses narrative to illuminate how climate grief-grief experienced in response to actual or anticipated loss resulting from climate change-affects farmers and ranchers and shapes their capacity for climate adaptation. In addition to this experiential framing, the authors include an illustrative example of a team-developed intervention designed to support farmers' and ranchers' mental health; this example is offered not as original research but as a practice-based case to stimulate the broader policy conversation. Taken together, these perspectives underscore the need to integrate mental health support into agricultural climate resilience efforts. Although programs such as the Department of Agriculture's Farm and Ranch Stress Assistance Network represent important progress, current initiatives remain fragmented and underresourced. Research on mental health interventions related to climate change in general is sparse. Increasing investment and coherent policy are essential to ensuring that climate adaptation strategies address the full spectrum of challenges that farmers and ranchers face-physical, economic, and psychological.

Type 2 Diabetes Mellitus (DMT2) requires effective self-care management to prevent complications. The health center in Mojokerto City plays a crucial role as the front line in education and support for DMT2 sufferers. This study aims to identify the level of self-care management in DMT2 patients in the work area of the First Level Health Facility (FKTP) of Mojokerto City. This descriptive study involved 372 respondents selected using the Slovin formula (5% error tolerance) from a population of 5,328 DMT2 sufferers. The instrument used is the Diabetes Self-Management Questionnaire (DSMQ). The distribution of the level of self-care management shows an almost even distribution: the Low category is 33.87% (126 people), the High category is 33.33% (124 people), and the Medium category is 32.80% (122 people). The high proportion of the low category (33.87%) indicates that good access to information has not been fully able to improve patient compliance and independent practices. This shows that there are practical obstacles or motivations in the application of medical information. Self-efficacy is a key factor; the higher the patient's self-confidence, the better the self-care management practices are performed. A more applicable educational strategy and strengthening psychological support are needed to increase the independence of DMT2 sufferers in Mojokerto City.

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease with unknown cause, affecting one child out of 2,000. In more than a third of cases, the temporomandibular joints (TMJs) are involved. TMJ arthritis may cause significant functional disorders such as pain, reduced mouth opening, and malocclusion, as well as permanent aesthetic issues involving facial deformity. The purpose of this article is to describe the diagnosis and treatment of these children. Based on a literature analysis of TMJ involvement in JIA and our own personal experience, we present the data obtained and the questions that remain. Diagnosis of TMJ arthritis in JIA relies on clinical examination and MRI with injection. It is often made too late, when sequelae are already permanent, due to the asymptomatic nature of TMJ arthritis in many children and because deformities appear long after destructive lesions of one or both joints. Screening for TMJ inflammation in JIA should be routine. MRI with injection has been chosen as the best screening tool, but false positives are numerous. How to improve TMJ arthritis screening in JIA remains an unanswered question. Treatments of active TMJ arthritis are varied, including orthodontic procedures, maxillofacial surgery, and systemic therapies, but there is currently no unified strategy, and the use of intra-articular corticosteroid injections in children is increasingly being challenged. Many aspects of the management of TMJ arthritis remain a matter of debate, from the early detection of inflammatory involvement of the TMJs, which may place the orthodontist on the front line, to the role of orthodontic and systemic treatments, as well as that of maxillofacial surgery. These unanswered questions could be addressed via a French multidisciplinary network involving orthodontists, maxillofacial surgeons, radiologists and pediatric rheumatologists.