Abstract Global physical inactivity has remained high and unchanged for the past two decades. We assessed global political priority for physical activity. An analysis of national policy documents from 200 countries revealed notable progress in policy adoption since 2004, but we found limited evidence of implementation. A qualitative case study design, including insights from 46 key informants, confirmed low political priority. Four key challenges emerged: (1) domination of health-centric approaches; (2) limited recognition of benefits beyond non-communicable disease prevention; (3) interest across sectors but lack of clarity defining physical activity policy and of leadership; and (4) limited multisectoral partnerships. Proposed solutions include: (1) building consensus on physical activity policy with consideration of context; (2) acknowledging the scope of benefits; (3) clarifying multisectoral leadership and responsibilities; and (4) increasing partnerships beyond obvious proponents. Prioritizing physical activity policy is essential for improving human, societal and planetary health.

Background Healthcare conflicts are a global public health priority, and medical petitions are a primary resolution pathway in China. Zhejiang Provincial Hospital of Chinese Medicine (ZPHCM) found that a reactive administrative approach failed to curb clinical disagreements and petition frequency, requiring optimized management strategies. Methods A single-institution before-and-after observational pilot study (no concurrent control) was conducted across ZPHCM’s Qiantang and Hubin campuses. The Proactive Service Model (PSM) was initiated in January 2025; outcome metrics were compared between an 8-month pre-intervention period and a 9-month post-intervention period. Analyses were performed using IBM SPSS Statistics 27.0 and R v.4.4.3 (descriptive statistics, Cohen’s d, Mann–Whitney U tests). Results Post-PSM deployment, both campuses showed significant improvements: Qiantang Campus had communication resolution rate (CRR) increased from 35.95% ± 13.02 to 52.97% ± 8.22 (+17.02 percentage points) and petition incidence rate (IP) decreased from 34.88% ± 6.89 to 27.67% ± 5.47 (−7.20 points); Hubin Campus had CRR raised from 46.02% ± 8.55 to 57.87% ± 5.75 (+11.85 points) and IP reduced from 33.48% ± 7.73 to 25.85% ± 5.29 (−7.63 points). Effect sizes were substantial (CRR: Qiantang d = 1.59, Hubin d = 1.65; IP: both d = −1.17) with 95% CIs excluding zero, and CRR changes were statistically significant (U = 9, p = 0.011). Conclusion As a pilot study, this work lacks definitive causal evidence, but it demonstrates a meaningful association between PSM implementation and improved communicative dispute resolution alongside reduced petition incidence at ZPHCM, supported by notable effect sizes.

PurposeChronic kidney disease (CKD) is a global public health priority. Adherence to complex therapeutic regimens is crucial for non-dialysis patients. However, the absence of multidimensional assessment instruments has impeded precise adherence evaluation and targeted interventions. This study aimed to develop and validate a disease-specific Treatment Adherence Scale for Non-Dialysis CKD Patients (TAS-NCKD).MethodsA cross-sectional mixed-methods study was conducted in China. Preliminary items were developed by a scoping review and two Delphi expert rounds. Three rounds of surveys (n=160, 350, and 370) were conducted for the construction and psychometric validation of the scale. Feasibility, reliability, validity, discrimination and difficulty, and optimal cutoff determination was verified.ResultsThe third validation cohort consisted of 181 patients with CKD stage 1, 49 with stage 2, 59 with stage 3, 38 with stage 4, and 43 with stage 5. The final TAS-NCKD comprises 45 items across 5 dimensions. The scale demonstrated high feasibility with a completion rate of 92.5%, and a completion time within 18 minutes. The Cronbach’s α, split-half reliability, test-retest reliability for the scale were 0.955, 0.968, and 0.836. The scale-level content validity index (CVI) and item-level CVI were 0.992 and 0.875–1. Confirmatory factor analysis showed a good model fit. Convergent and discriminant validity both met the standards. Item characteristic curves were ideal and the optimal cutoff was established at 179 points.ConclusionThe TAS-NCKD is a valid and reliable instrument for assessing treatment adherence in Chinese non-dialysis CKD patients. This study provides targeted insights for improving patient self-management and may help slow disease progression.

Sepsis remains a leading cause of in-hospital mortality worldwide. In recognition of its substantial morbidity and mortality even with optimal treatment, the World Health Organization has declared sepsis a global health priority. The immunoregulatory mechanisms in sepsis are highly complex, and the immune status during the disease course is closely associated with both short- and long-term patient outcomes, making early recognition and intervention critical for survival. While single-cell RNA sequencing (scRNA-seq) has been widely applied to decipher innate immune responses in sepsis patients, in-depth characterization of T lymphocyte subsets remains relatively limited. Urosepsis is a common complication of urinary tract stones. Although clinical studies have identified several risk factors for urosepsis, the immunological alterations in high-risk individuals are poorly understood. Here, we employed single-cell transcriptomics to investigate T-cell immunological changes in high-risk urosepsis patients and septic patients, complemented by single-cell T cell receptor (TCR) sequencing (scTCR-seq) to profile the peripheral TCR repertoire in these two pathological states. Our analysis revealed that, compared to non-high-risk controls, septic patients exhibited features of T cell exhaustion across multiple subsets, whereas high-risk individuals showed signs of enhanced T cell-mediated adaptive immunity. Notably, we identified a distinct CD4 + T cell subset (C10_Tn_IFN) and, through protein-protein interaction analysis, uncovered key protein targets ( IFIT3, RSAD2 ) potentially regulating its interferon signaling pathway. Furthermore, we observed significantly reduced TCR diversity accompanied by altered CDR3 sequence characteristics and VJ gene usage frequencies in several CD4 + and CD8 + T cell subsets from sepsis patients. These findings provide important insights into the relationship between T cell functionality and the severity of infectious inflammation.

United we stand, divided we fall: Strengthening clinical alliances between human and veterinary medicine to tackle global priority antimicrobial-resistant bacterial pathogens.

Antimicrobial resistance (AMR) is a global health threat predicted to hit 10 million deaths per year by 2050. Most conventional antimicrobial stewardship (AMS) strategies focus on clinical settings, failing to address community-level overuse, a primary driver of AMR in low- and middle-income countries. This commentary leverages novel evidence to argue for the prioritization of water, sanitation, and hygiene (WASH)-nutrition integration as a global health policy and first-line defense strategy against AMR. This argument is grounded on a target article that utilized causal mediation analysis to establish how low-cost household level WASH and nutrition interventions reduced pediatric antibiotic use via multiple biological pathways. This transforms prevention into a measurable antimicrobial defense strategy through antibiotic doses averted and limits antibiotic demand. These findings provide an empirical basis for integrated preventive measures, a quantifiable scorecard for securing political and fiscal commitment and redefinition of AMS as an element of global health policy and environmental conservation.

The generation of hazardous waste is a necessary side effect of modern industrial production. Factories must cope daily with large accumulations of unrecyclable chemical by products generated by normal production techniques. Sustainable waste management is a growing global priority, especially in agro industrial sectors where large volumes of waste are generated. This study assesses the waste management practices at Zambia Sugar Plc, one of the largest agro processing companies in Zambia. This study aims to engage the Zambia Sugar Company on the causes, effects and improvement strategies on improper waste management. Data was obtained from respondents by means of interviews, questionnaires and project observation Schedules. The sample consisted of one hundred respondents. Frequency, percentages, tables, graphs and pie charts were used to analyze the qualitative and quantitative data obtained. The study recommended that moving towards and achieving sustainable waste management requires policy advocacy, more community engagements, partnership and collaboration as well as new technology solution and other mitigation measures in waste management.

The phenomenon of corporate sustainability, manifested through Environmental, Social, and Governance (ESG) and Corporate Social Responsibility (CSR) initiatives, has become a global priority, encouraging companies to integrate environmental, social, and governance criteria into their strategies and operations. Pressure from environmental protection organizations and stakeholders has made continuous improvement a crucial topic in corporate management. Positive Relationship between Sustainability and Financial Performance (FC)/Firm Value (FV): Empirical evidence supports the hypothesis that continuous CEP improvement is positively related to both accounting-based and market-based CFP financial performance. In general, sustainability performance has been shown to have a significant positive relationship with financial performance, measured by Return on Assets (ROA) and Market Value (MV/BV). This approach aligns with the social impact hypothesis and the reputation-building explanation. Strengthening Internal Governance (IAQ) in the Digital Age: Encourage research focused on the role of internal governance mechanisms (e.g., IAQ) in verifying ESG data and mitigating the risk of Greenwashing (GW). The literature review should emphasize that managers should understand and use GW as an environmental communication strategy, but should do so carefully and be supported by effective internal audit. Alternative Performance Variables: Encourage the use of more comprehensive alternative financial and sustainability performance variables, such as additional economic and social dimensions within GW, broader corporate governance functions within IAQ, or other metrics such as ROE.

The protection and promotion of the human rights of individuals with mental disorders is a critical global priority, and initiatives such as the WHO QualityRights program aim to strengthen rights-based mental health care. We aimed to investigate the impact of the QualityRights core training on promoting knowledge and practices among healthcare professionals regarding the human rights of individuals with mental disorders, and to assess whether this training can reduce the stigma associated with mental disorders among these professionals. A quasiexperimental pre–post study was conducted with 26 primary healthcare professionals. Of these, 14 provided complete paired data, enabling direct comparison before and after the intervention. Participants completed standardized questionnaires assessing attitudes toward people with mental health conditions and psychosocial disabilities. Data were analyzed using paired statistical tests for pre–post comparisons, followed by multiple linear regression to examine factors associated with changes in scores. The training produced meaningful improvements in several items related to autonomy, legal capacity, coercion, and rights-based practices. Higher educational level was associated with greater attitudinal change. The WHO QualityRights training positively influenced healthcare professionals’ attitudes toward human rights in mental health. Future research should include larger samples and long-term follow-up to strengthen the evidence base and evaluate the sustainability of these changes across diverse care settings.

Abstract Integration of renewable resources to meet growing energy demand is becoming a global priority under decarbonization mandates. This study contributes to ongoing efforts on this key subject by assessing the feasibility of using urban renewable energy resources, namely, offshore wind and rooftop photovoltaic systems, to meet electricity demand of New York City during the intense recent heat wave period of June 2025. A unified modelling framework, based on the Urbanized Weather Research and Forecasting model, is used to simulate climate, renewable resources and energy demand variables. Findings show significant energy load miss-match of approximately 20000 GWh over the month, between the demand and the combined renewable generation outcome. Three storage integration scenarios are analyzed to mitigate the deficits, reducing said deficits by a minimum of approximately 22% over the duration of the month. This study provides a transferable modelling framework tool for evaluating renewable integration in dense urban environments that can be used by grid operators to support grid resilience planning and management during extreme heat events.

Inclusive education has emerged as a global priority, emphasizing equitable access, participation, and learning outcomes for learners with disabilities. Recent advances in Artificial Intelligence (AI) and Machine Learning (ML) have introduced new opportunities to address diverse learner needs through adaptive, personalized, and accessible educational technologies. This systematic review synthesizes empirical evidence on the effectiveness of AI- and ML-based interventions for learners with disabilities across educational contexts. Guided by PRISMA 2020 standards, a comprehensive literature search was conducted across Scopus, Web of Science, ERIC, IEEE Xplore, and Google Scholar, identifying 245 peer-reviewed studies published between 2015 and December 2025. Following duplicate removal, screening, eligibility assessment, and quality appraisal, 19 studies met all methodological and thematic inclusion criteria and were included in the final thematic narrative synthesis. The review examined types of AI/ML technologies, disability categories (learning, sensory, physical, and psychosocial), educational and inclusion-related outcomes, and ethical and accessibility considerations. The included studies employed quantitative (47.4%), qualitative (31.6%), and mixed-methods (21.0%) designs. AI-driven interventions, such as intelligent tutoring systems, natural language processing applications, assistive technologies, and learning analytics, demonstrated positive effects on academic achievement, accessibility, learner autonomy, engagement, psychosocial outcomes, and social inclusion, with particularly strong evidence for learners with learning and sensory disabilities. However, evidence for institutional-level impact and long-term outcomes remains limited. Key challenges identified include algorithmic bias, data privacy risks, uneven accessibility compliance, and persistent inequities between high-income and low-resource contexts. Overall, the findings indicate that AI and ML can meaningfully support inclusive education when grounded in Universal Design for Learning (UDL) principles and rights-based frameworks. The review underscores the need for more methodologically rigorous, geographically diverse, and longitudinal research to determine which technologies are most effective for specific disability groups and to ensure that AI-enabled education advances inclusion rather than reinforcing existing inequities.

Methicillin-resistant Staphylococcus aureus (MRSA) is the most threatening infectious resistant bacterium worldwide, thus the discovery of effective antibiotics against MRSA is a critical global priority. In this study, we report the chemical evolution of a natural product to discover a novel and potent antibiotic candidate. Specifically, neocryptotanshinone was semisynthetically modified, and its enantiomeric derivative (S)-7n demonstrated pronounced efficacy in vitro and in vivo for treating MRSA infection. This candidate was effective against vancomycin-resistant S. aureus (VRSA) and various clinical MRSA isolates, while exhibiting low toxicity. Mechanistic exploration suggests that (S)-7n exerts a dual antibacterial action, combining selective membrane depolarization with perturbation of the transcriptional regulator TetR/AcrR, likely independent of classical efflux pump control. This dual mechanism facilitates potent biofilm eradication, bacteria growth inhibition, and synergistic activity with specific antibiotics. Collectively, this work establishes (S)-7n as a promising, mechanistically novel lead compound and provides a natural product-inspired strategy to overcome MRSA resistance.

ABSTRACT Supporting student wellbeing has become a global priority in schools, yet subject-specific foci on wellbeing are limited. This study addresses this gap by exploring science wellbeing (ScWB) through value fulfilment theory, defining it as the fulfilment of students’ values in science, accompanied by positive feelings (e.g. enjoyment) and functioning (e.g. belonging, engagement). Building on an existing ScWB framework, this qualitative study analyses responses from 320 Australian Year 8 (ages 13-14) students to three open-ended questions about what they consider important for positive science learning experiences. Thematic analysis identified 51 instrumental values that mapped to eight ultimate values. Students primarily valued cognitive aspects (e.g. understanding science concepts), engagement (e.g. interest in science), and relationships (e.g. teacher and peer support). Females and males demonstrated similar value hierarchies; however, females more frequently valued relationships in science. The study also identified co-occurring values; for instance, teacher support was often valued alongside enjoyment and understanding. This is the first known study to systematically extract and document students' science-related values, providing empirical support for a values-based ScWB framework. The findings can help teachers identify and fulfil students' values in science classrooms, potentially enhancing enjoyment, engagement, and participation in science education.

Building resilient cities that can survive, adapt, and thrive amid climate and ecological challenges has become a global priority, yet achieving this goal requires adequate financial support. This study investigates the impact of green finance on urban ecological resilience (UER) by exploiting the establishment of China’s Green Finance Reform and Innovation Pilot Zones (GFPZs) as a policy shock. Using a DPSIR-based (driving force–pressure–state–impact–response) evaluation framework and a staggered difference-in-differences approach with panel data from 277 cities (2011–2022), the empirical results show that (1) the GFPZ policy significantly enhances UER; (2) green finance improves UER through three transmission channels—government environmental governance, green technological innovation, and public environmental participation; (3) the policy effects display clear spatial and structural heterogeneity, with stronger impacts in southern, less-developed, and non-traditional industrial cities, as well as positive local effects, negative spatial spillovers, and significant synergies with national big data pilot zones. This study clarifies how financial instruments contribute to building resilient cities and offers insights for embedding green finance into urban ecological strategies.

The mental health and well-being of staff working in healthcare settings (SWHS) is an urgent global public health priority and an issue of significant importance to society. This study assessed the preliminary effectiveness of ‘OK Positive’, a new personalized mental health and well-being app (MHapp), aimed at improving well-being, psychological flexibility, burnout, secondary traumatic stress, and compassion satisfaction in SWHS. Participants were provided access to the MHapp and prompted to complete online questionnaires every three days, at 30 and 60 days, to evaluate the impact of the MHapp. Out of 119 initial participants, only 22 completed the follow-up measures, yielding a response rate of 18%. SWHS initially self-reported moderate levels of burnout and compassion satisfaction, and low levels of secondary traumatic stress. Descriptive analyses revealed mixed results regarding the MHapp’s preliminary effectiveness and acceptability, highlighting challenges in user retention. While the MHapp showed preliminary support for improving well-being among a motivated subset of users, the study’s limitations emphasized the need for further research and organizational support. Therefore, future research is required to continue exploring the efficacy of interventions to meet the well-being and mental health needs of a diverse range of SWHS.

It has been demonstrated in multiple randomized trials that the PAX Good Behavior Game is an effective school-based program for reducing the severity and progression of childhood emotional and behavioral problems that are prognostic of mental disorders, personality disorders, and self-harm behavior in adolescence and early adulthood. Embedding effective programs into routine practices of frontline settings is a global priority for mental health prevention, however, little is known about what strategies effectively support program implementation in schools. The purpose of this study was to test the effect of a multicomponent implementation strategy on the adoption and efficacy of the PAX Good Behavior Game, using a cluster randomized controlled trial with a type-3 implementation-effectiveness design. The trial was conducted in 25 primary schools across New South Wales, Australia. Schools were randomly assigned to receive the PAX Good Behavior Game plus an implementation toolkit to support adoption (intervention group) or the PAX Good Behavior Game only (control group). The primary outcome was change in rate of program adoption, measured as current use or support of the PAX Good Behavior Game, first measured at 6weeks post-registration (T0). The secondary effectiveness measure was change in students' emotional and behavioral problems, using the teacher-reported Strengths and Difficulties Questionnaire (SDQ). The first measure of the SDQ occurred at trial registration, prior to program implementation (T0). Both adoption and effectiveness were re-measured at 6months post-registration (T1). All data were analyzed using intention-to-treat methods. Early program adoption was higher in the intervention group compared to control group (93.6% vs 45.2%: OR = 21.20, 95% CI [3.50, 128.45], z = 3.32, p < 0.001), with no differential effects at 6months (96.8% vs 95.7%: OR = 1.21, 95% CI [0.16, 9.04], z = 0.18, p = 0.855). Emotional and behavioral problems reduced in both groups from baseline to 6months (p < 0.001, d = - 0.25), with no differential effects observed at T1 (p = 0.474, d = - 0.08). There was a positive linear relationship between adoption and the perceived acceptability, appropriateness, and feasibility of the program for the pooled sample. It seems that providing implementation support early in the process of establishing new innovations in schools may help accelerate early adoption by increasing perceived appropriateness and acceptability, but uncertainty remains as to what support is needed to optimize implementation and effectiveness longer term. The protocol was retrospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001125819.

Adverse childhood experiences (ACEs), including abuse and neglect, are strongly associated with children’s long-term development and have become a global policy priority. Although existing research has highlighted the predictive effects of ACEs and neighborhood characteristics on individual health outcomes, there is still a lack of systematic integration and review of evidence on the association between neighborhood characteristics and ACEs, which is critical to understanding child development. Following the PRISMA guidelines, we searched four major databases, screened the search results from 1999 to 2025, and used standardized tools for quality assessment. Ultimately, we identified 39 pieces of evidence and conducted a systematic review of these 39 studies, narratively summarizing the research findings. This review incorporates multidimensional neighborhood characteristics into the theoretical framework with the aim of exploring the association between neighborhood structural characteristics (such as poverty, racial diversity, safety, and resource accessibility) and non-structural characteristics (such as collective efficacy) with ACEs. The research results indicate that there is a significant association between neighborhood characteristics and ACEs risk. Therefore, considering neighborhood characteristics when developing ACEs intervention and prevention policies and strategies can help ensure the comprehensiveness of the plan.

Growing consumer pressure for businesses to adopt sustainable practices has made green branding a global priority, particularly in emerging markets such as Indonesia where environmental challenges and rising awareness intersect. This study investigates how green brand image and message clarity influence sustainable purchase behavior through the mediating role of consumer trust, and how green skepticism shapes this process. Using a quantitative cross-sectional design, data were collected from 172 Indonesian consumers with prior experience purchasing eco-friendly products. Structural equation modeling with partial least squares (PLS-SEM) was applied to test the hypotheses. The results show that both green brand image and message clarity significantly enhance consumer trust, which in turn strongly drives sustainable purchase behavior. Trust is also confirmed as the key psychological mechanism mediating the effects of brand signals on consumer action. Importantly, the analysis reveals that green skepticism weakens this pathway: even when consumers trust a brand, higher skepticism reduces the extent to which trust translates into sustainable purchases. These findings extend Signaling Theory by demonstrating how trust and skepticism jointly shape consumer responses to green branding in a high-information-asymmetry context. Practically, the study offers actionable insights for managers and policymakers by emphasizing the need for consistent brand identity, transparent communication, and verifiable claims. By addressing both trust-building and skepticism-reduction, businesses can advance more effective green marketing strategies and foster authentic consumer engagement with sustainability.

Our multicentre, double-blind, randomised, placebo-controlled Azithromycin therapy for prevention of chronic lung disease of prematurity trial assessed if early 10-day azithromycin treatment improved survival without development of chronic lung disease of prematurity when compared with placebo in 796 preterm-born infants. Since antibiotic resistance remains a significant global health priority, we had preplanned macrolide-resistance assessment in recruited infants. We, therefore, identified baseline macrolide-resistant genes in respiratory samples and determined if this was altered by azithromycin treatment. Furthermore, we assessed if macrolide-resistant bacteria isolated from respiratory samples were also resistant to other common antibiotic classes. Six common macrolide-resistant genes: erm(A), erm(B), erm(C), erm(F), mef(A/E) and msr(A) were identified by quantitative PCR (qPCR) from serial nasopharyngeal and endotracheal aspirates from recruited infants at baseline (pretreatment), day-5, day-10 and day-14 (post treatment). Azithromycin-resistant bacteria were assessed by culture in presence/absence of azithromycin and underlying resistance mechanisms were confirmed by qPCR. Resistance to other common antibiotics was also evaluated and molecular determinants were identified by whole genome sequencing. From 1108 (n=541 azithromycin, n=567 placebo) respiratory aspirates from 348 preterm infants, the overall prevalence of macrolide-resistant genes was similar in the placebo (63.7%) and azithromycin (63.9%) groups, with only erm(C) gene increased by azithromycin. Azithromycin-resistant bacteria were resistant to multiple clinically used antibiotics, being associated with several different underlying resistance mechanisms. Coagulase-negative staphylococci (CoNS) were the most recovered macrolide-resistant bacteria. Macrolide-resistant genes were noticeably prevalent in the placebo group, with minimal increase with azithromycin treatment, suggesting that, regardless of the additional use of azithromycin, judicious use of antibiotics is required in preterm-born infants.

IntroductionPseudomonas aeruginosa is a leading cause of severe nosocomial infections worldwide. This opportunistic pathogen is associated with increased morbidity and mortality rates due to its high levels of antibiotic resistance. The identification of novel therapeutic targets is therefore a pressing global health priority. This study aims to identify potential drug targets and vaccine candidates through structural characterization and functional annotation of hypothetical proteins (HPs) commonly found in multidrug‐resistant Pseudomonas aeruginosa strains.MethodsThe multidrug‐resistant and carbapenem‐resistant strains of Pseudomonas aeruginosa were retrieved from genomic databases and 15 common HPs among these resistant strains, with a minimum length of 200 amino acids, were obtained and bioinformatics tools were employed to predict the structural, functional, and immunological properties of these common HPs.ResultsTwo common HPs (gene ID: 2877781443 and 2877781545) were identified as the most promising drug and vaccine candidates among the investigated HPs based on their structural and physicochemical properties, functional domains, signals peptides, subcellular localization, pathogenicity factors, toxicity, antigenicity, and allergenicity.ConclusionThe findings of this study will contribute to the development of novel vaccine and drug candidates against Pseudomonas aeruginosa through experimental validations.