To assess public and healthcare professional knowledge, attitudes, perceptions and behaviours regarding spatial computing technologies, virtual reality (fully immersive computer-generated environments), augmented reality (digital overlays on the physical world) and mixed reality (spatially anchored holograms) in healthcare, with a focus on perceived benefits for self-care and barriers to adoption in primary care and community settings. Cross-sectional online survey. UK-wide, web-based survey conducted between January 2025 and August 2025. Community-dwelling adults aged ≥18 years residing in the UK, including healthcare professionals. A total of 405 respondents completed the survey; 41 were healthcare professionals. No intervention was delivered. Participants completed a structured questionnaire assessing familiarity with spatial computing, perceived utility across self-care domains aligned to the Seven Pillars of Self-Care and perceived barriers to adoption. Primary outcomes were self-reported familiarity with spatial computing technologies and perceived benefit across self-care domains. Secondary outcomes included perceived barriers to adoption and associations between demographic characteristics and familiarity. Analyses used descriptive statistics and exploratory inferential tests (χ², Fisher's exact, Friedman and Wilcoxon signed-rank tests with Bonferroni correction). Most respondents (71.4%) reported familiarity with spatial computing technologies, although regular use was uncommon (4.7%). Oculus Quest (57.5%) and Apple Vision Pro (46.9%) were the most recognised platforms. Participants perceived strong potential for supporting health literacy, mental well-being and physical activity, particularly through guided mindfulness, avatar-led exercise and immersive patient education. Perceived benefit was lower for medication management and dietary guidance. Familiarity was statistically associated with gender (p<0.001), age (p=0.002) and ethnicity (p=0.006), with higher awareness among men, younger adults and some minority ethnic groups. The most frequently cited barriers to adoption were high cost (56.5% rating as critical), lack of training (67.4% rating 4-5) and data privacy concerns (63.5%). Spatial computing is viewed positively by the public and healthcare professionals as a tool to support self-care and aspects of healthcare delivery, particularly health literacy, mental well-being and physical activity. However, high cost, training gaps and privacy concerns remain substantial barriers. Targeted investment in evidence generation, workforce training and inclusive governance will be necessary to support equitable and responsible implementation.

Community paramedicine is an emerging model of care that focuses on preventative and rehabilitative health and improves equitable access to primary care. Four community health services in rural and regional Victoria, Australia, implemented the evidence-based Canadian CP@clinic (Community Paramedicine at Clinic) program. The paramedic-led program delivers free drop-in clinics with chronic disease screening, onward referrals, care navigation and health education. We conducted a reflexive thematic analysis of de-identified monthly meeting records of 13 CoP meetings. Analysis specifically focussed on the barriers and enablers of program delivery and on how the CoP supported CP@clinic program administrators, researchers and community paramedics. CP@clinic implementation in rural, regional and remote Australia was shaped by four interrelated themes: workforce development, community engagement, data collection and program sustainability. Barriers centred on role ambiguity and transition from emergency care, the time intensity of trust-building within communities and referral navigation, administrative burden compounded by digital infrastructure constraints and persistent funding and workforce instability. Within these dynamics the CoP emerged as a crucial implementation mechanism that enabled both individual practitioners and organisations to navigate uncertainties, build capacity and maintain program adherence. CP@clinic can take root in rural, regional and remote Australia but only if the conditions are right. The CoP acted as the engine room for implementation accelerating role transition, local adaptation and practical problem solving. Yet persistent barriers - role ambiguity, time-intensive trust building, heavy data demands in low-connectivity settings and funding instability - continue to stall momentum. To move from a promising pilot to durable system change, the CP@clinic program needs CoP-enabled learning along with structural investment in training, digital infrastructure, evaluation support and long-term funding.

ABSTRACT The COVID-19 pandemic disrupted labour markets globally, intensifying inequalities and reshaping employment structures. In Vietnam, migrants who relocated in search of a higher income were disproportionately affected, and non-migrant workers faced distinct challenges. Using data from the Vietnam Household Living Standards Survey 2018–2022, this study applies propensity score matching to investigate the effect of migration on labour income. Although migrant workers earned more than non-migrant workers, they experienced greater income volatility during the pandemic and recovery periods. Stratified analyses revealed the diverse effects of migration on income. Although the pandemic created short-term job opportunities that were more accessible to migrants owing to their specific characteristics, the surge in demand was temporary. In the post-pandemic period, labour market conditions returned to normal, and a gradual transition towards automation and digitalization shifted labour demand in favour of more skilled and digitally literate workers. Consequently, migration benefits have become more pronounced for high-school graduates than for less-educated individuals. These findings highlight the importance of policies that promote lifelong learning and employment protection alongside investments in education, vocational training, and digital access. Such measures are essential for building adaptive, inclusive, and resilient labour markets.

Implementation of the World Health Organization’s (WHO) recommended shorter 4-month treatment regimen for non-severe tuberculosis (TB) in children requires classification of disease severity on chest X-ray (CXR). Access to specialists for CXR interpretation is limited. We explored the use of computer-aided detection of CXR (“CAD”) to automate CXR classification of radiological disease severity. To do this, we combined three CXR datasets from children with confirmed and clinically diagnosed TB across the disease spectrum. CXRs were independently classified as radiologically severe or non-severe by two expert human readers. Definition of radiological disease severity aligned with WHO guidelines. CAD scores were generated by CAD4TB v7.0 and qXR v3.0 software. Neither software product was specifically trained with paediatric CXRs or for disease severity classification. We compared CAD scores between CXRs classified by human readers as non-severe versus CXRs classified by human readers as severe. CXRs from 526 children were included in this analysis: median age was 2.1 years (inter-quartile range 1-4.2 years); 57% of the children had microbiologically confirmed TB. We found that median CAD scores were significantly lower for CXRs classified as non-severe versus severe by human readers; the difference was greatest in children >5 years. The area under the receiver operating curve was 0.82 and 0.78 for qXR, and 0.79 and 0.76 for CAD4TB, against the reference of ‘severe’ as classified by each individual human reader respectively. These results demonstrate that CAD is a promising tool for TB disease severity stratification and has the potential to support access to shorter TB treatment regimens for children. Investment in paediatric CAD training and development to optimize solutions for children beyond the TB screening and diagnosis use-case is warranted.

Advances in the diagnosis and detection of chronic kidney disease.

Radiotherapy in Sudan: facing infrastructure, workforce and armed conflict challenges.

BackgroundNear point-of-care (n)POC Human Immunodeficiency Virus (HIV) viral load (VL) monitoring, consisting of VL testing in laboratories close to HIV treatment facilities, improves turnaround time from sampling to result. Other benefits of using nPOC monitoring are reduced laboratory workload, and limited loss of results, all leading to improved clinic retention and treatment adherence. However, the specific implementation bottlenecks are still unclear. This study aims to investigate the bottlenecks in the implementation of nPOC HIV VL monitoring among children and young people (ages 0–24 years) living with HIV, as experienced by healthcare workers (HCWs) in Tanzania.MethodsWe conducted observations in clinics and in-depth interviews with HCWs from January 2023 to January 2024 at Tanzanian intervention sites within the East Africa Point-of-Care Viral Load Monitoring (EAPOC-VL) study. The EAPOC-VL study was conducted in four countries in East Africa (Tanzania, Kenya, Rwanda, Uganda). It was a cluster-randomised controlled trial, in which participants were tested at three time points (months 0, 6, and 12). We purposively selected 25 HCWs involved in implementing nPOC at the intervention sites for in-depth interviews. We interviewed HCWs at baseline (month 0) and after the initiation of nPOC HIV VL monitoring (months 1 and 6). We conducted deductive thematic framework analysis using the Measurement Instrument for Determinants of Innovations (MIDI), to which an inductive approach was added to identify facilitators and barriers across intervention, provider, organisational, social and political contexts. We used NVivo 12 to organise the data.ResultsA total of 75 interviews were conducted among 43 HCWs across 3 time points: 33 at baseline (T0), 25 at month 1 (T1; 19 participants from T0 and 6 new participants) and 17 at month 6 follow up (T2;6 participants from T1, 7 returning participants from T0 and 4 new participants). Observations and interviews showed that nPOC HIV VL testing improved result turnaround time and enabled same-day counselling, which motivated both HCWs and clients. This data showed that knowledge, confidence, and adherence to procedures after training. Near POC, HIV VL was supported by compatibility with existing practices, strong teamwork, and management commitment. However, challenges included clients waiting at the clinic for over two hours to receive their results, the scarcity of resources, such as rooms and electricity, and staff shortages. Finally, delays were observed when samples had to be transported to nearby laboratories.ConclusionNear POC HIV VL monitoring shortens turnaround times and enables immediate counselling. To maximise these benefits, there is a need to prioritise investment in staff training, infrastructure, improving sample handling/turnaround time and guideline alignment. Developing these areas will enhance service delivery and allow for improved outcomes among children and young people living with HIV.

Antimicrobial resistance (AMR) is a global public health crisis disproportionately affecting sub-Saharan Africa (SSA), where it was directly responsible for approximately 255,000 deaths in 2019 alone. Despite this burden, community-level mitigation strategies remain underdeveloped. Community health volunteers (CHVs), embedded within their communities and trusted by populations with limited healthcare access, represent an underutilised but promising platform for AMR mitigation. This scoping review aimed to map the breadth, nature, and outcomes of CHV-led or CHV-supported AMR interventions in SSA; identify barriers and facilitators to implementation; and identify evidence gaps to inform future research and policy. Following the Arksey and O’Malley (2005) framework and reported according to PRISMA-ScR 2018 guidelines, we systematically searched PubMed/MEDLINE, EMBASE, Cochrane Library, AJOL, WHO IRIS, and grey literature for studies published from January 2018 to January 2026. Studies conducted in SSA involving CHVs and addressing AMR mitigation through at least one of education, surveillance, diagnostics, waste management, or One Health approaches were eligible. Data were charted using a standardised extraction form and findings synthesised narratively. Of 847 records identified, 26 studies and reports met the inclusion criteria. The evidence base encompassed educational interventions (n = 14), diagnostic integration (n = 3), waste and environmental management (n = 3), and multisectoral One Health approaches (n = 6). CHV-led educational interventions improved AMR knowledge by 49.3%–97.1% and reduced inappropriate antibiotic prescribing by 18–44%. Point-of-care diagnostic integration reduced antibiotic use by up to 24.6% without increasing adverse outcomes. Key barriers included inadequate resources, training overload, weak regulation, and lack of integrated surveillance, while facilitators included tailored training, diagnostic tools, community trust, and policy alignment. The evidence supports embedding structured AMR roles for CHVs within national AMR action plans, integrated community case management, One Health frameworks, and investment in CHV training and diagnostic capacity.

ABSTRACTIncreased weather challenges propelled by climate change are projected to significantly impact postharvest operations, threatening the livelihoods of most small‐scale farmers in several parts of Africa. While research on the effects of climate variability on food production exists, less attention has been given to the impacts of climate change on postharvest management of vegetable crops, especially tomatoes widely produced and consumed on the continent. This study examined the effects of climate variability on the postharvest losses of tomatoes and its implications on the livelihoods of small‐scale tomato farmers in the Kilolo district, southeast Tanzania. Using semi‐structured interviews, focus group discussions, and field observations, data were obtained from 52 (n = 52) tomato farmers. Results indicate that unpredictable rains, poor storage conditions, transportation delays, and weather‐related pick‐up delays were major causes of postharvest tomato losses, with farmers reporting losses of up to 40% linked to a lack of storage facilities. Findings also reveal that preharvest tomato losses linked to pest outbreaks were common but not significant compared to postharvest losses caused by poor storage conditions. The study calls for investment in both postharvest crop management training and extension services, and the deployment of low‐cost postharvest infrastructure, especially cold storage and tomato processing facilities, to reduce losses of unsold tomatoes amid weather challenges.

Core outcome sets (COS) standardise the outcomes reported in clinical trials and research, reducing outcome heterogeneity and enabling evidence synthesis. Most neonatal COS have been developed in high-income country (HIC) contexts and may not reflect the priorities, health system capacities, or disease burden of low- and middle-income countries (LMICs). Kenya's neonatal mortality rate remains high at 21 per 1000 live births, yet no COS exists for neonatal care and research in Kenya or, more broadly, in sub-Saharan Africa. This study aimed to develop a contextually appropriate COS for neonatal care and research in Kenya, and to assess the feasibility of adapting an existing HIC COS for use in an LMIC setting. A mixed qualitative and consensus-based approach was used, guided by the COMET handbook. The process comprised three phases: a rapid review of outcomes reported in neonatal trials from sub-Saharan Africa compared with an existing HIC COS; qualitative stakeholder engagement through key informant interviews (KIIs) and focus group discussions (FGDs) with healthcare providers, national-level policymakers, and mothers of previously admitted neonates at two Kenyan hospitals representing urban and rural settings; and an in-person consensus workshop using the nominal group technique with 13 multidisciplinary stakeholders. Thematic analysis followed Braun and Clarke's six-phase framework. Outcomes endorsed by ≥ 70% of consensus meeting participants were included in the final COS. Seventeen stakeholders participated in KIIs, and 15 mothers participated in two FGDs. Sixteen candidate outcomes were presented at the consensus meeting. Five outcomes achieved immediate universal consensus: survival, length of hospital stay, ability to feed/weight gain/growth, cognitive ability, and visual impairment/retinopathy of prematurity (RoP). Following discussion and voting, a further seven outcomes were endorsed: impact on mothers and wider family, financial costs to the mother, pain, adverse events due to medicines, respiratory distress, quality of life, and sepsis/infections. The final COS comprises twelve outcomes. Seven overlapped with the existing HIC COS, though with contextually adapted definitions. Five outcomes are Kenya-specific, reflecting the out-of-pocket payment structure, high comorbidity burden, and family-centred care priorities of the Kenyan health system. Adapting an HIC neonatal COS for use in an LMIC context is feasible, but requires systematic definitional adaptation, engagement with existing local frameworks such as WHO Essential Newborn Care guidelines, and attention to diagnostic capacity constraints. The Kenya COS captures both clinical and life-impact outcomes, reflecting the priorities of diverse stakeholder groups including mothers. Realising its value requires phased implementation sensitive to urban-rural differences in facility capacity, investment in workforce training, and stronger collaboration between clinicians and researchers to ensure outcome measurement serves both care improvement and evidence generation. This is not a clinical trial. not applicable.

Artificial intelligence in health systems of the WHO European region: implementation, applications, opportunities, and barriers.

Vaccination remains one of the most cost-effective interventions for reducing childhood morbidity and mortality from vaccine-preventable diseases. Despite global progress, vaccination coverage has recently declined, particularly in low- and middle-income countries (LMIC). In Rwanda, national childhood vaccination coverage is at 95%, yet gaps persist in reaching last-mile and hard-to-reach populations. Community Health Workers (CHWs) play a critical role in promoting and delivering vaccination services at the community level. However, evidence on their specific contributions, particularly in rural settings such as Burera District in Northern Rwanda, remains limited. This study aimed to (1) describe CHW-reported and perceived factors influencing their involvement in promoting childhood vaccination, (2) describe self-reported CHW roles in vaccination activities among children under five, and (3) explore caregivers' perspectives on CHWs' involvement in childhood vaccination. A mixed-methods study design was employed, combining a quantitative survey of 345 CHWs with individual interviews from 5 children's caregivers who benefited from community-based vaccination interventions conducted across 5 health centers in Burera District. Quantitative data were collected using structured questionnaires in REDCap and analyzed descriptively using STATA version 18. Qualitative data were analyzed using thematic analysis. Most CHWs were female (67.5%), married (98.8%), had primary-level education (86.1%), and were engaged in farming (98.6%). Nearly all CHWs had received vaccination-related training (94.5%) and considered children under-5 years of age vaccination very important (98.3%). Over half reported facilitating vaccination activities twice per month, and 93.9% were involved in community mobilization and campaign planning. Key activities included referring children to health facilities (58.0%) and conducting home-based vaccination outreach (42.0%). Caregivers highlighted CHWs' roles in health education, appointment reminders, and home-based services, emphasizing strong trust and their function as links between communities and the formal health system. Identified challenges included logistical constraints, the need for more consistent training and communication support. More than half of CHWs recommended strengthening structured community awareness, intervention and provision of monetary incentives for improving vaccination service delivery and community engagement. The perceived roles and self-reported practices showed that CHWs play a central role in sustaining high childhood vaccination coverage in rural Rwanda by improving access, awareness, and service delivery. Continued investment in CHW training, supervision, and logistical support is essential to sustain gains and achieve universal vaccination coverage by 2030.

Cancer is a main driver of death with serious health-related suffering. The growing body of evidence for early integration of palliative care alongside oncological treatment to optimises patient-reported outcomes is almost exclusively from high-income countries whilst the greatest need is in low- and middle-income countries (LMICs). We aimed to explore the perspectives of patients, families and clinical staff on what constitutes a feasible, acceptable and appropriate model of integrated palliative and oncology care in Zimbabwe. We conducted an exploratory qualitative study underpinned by indicators for integrated oncology and palliative care. Participants comprised healthcare professionals, patients & families. Semi-structured guides were developed and iteratively refined. Deductive framework analysis was conducted to Hui's evidence-based framework of integrated oncology and palliative care indicators. The data was then further inductively coded into the framework. Analysis of data from 45 stakeholders (n = 15 per group) identified 19 of 38 indicators (50%) aligned with Hui's model, indicating partial and uneven integration. Alignment was strongest in clinical processes (n = 9) and education (n = 5), with more limited support for administration (n = 3) and structure (n = 2). No findings aligned with the research domain. Inductive coding identified three indicators which aligned with clinical processes (routine discussion of prognosis, advance care planning and goals), clinical structure (physical environment) and education (training needs). While the Hui model is broadly applicable, substantial contextual adaptation is required. Integration cannot be achieved through coordination alone and requires system-level investment in workforce, training, infrastructure, and policy. We propose a phased "minimum package" for integration tailored to Zimbabwe and similar LMICs settings. Our findings highlight the need to strengthen multi-professional collaboration and communication in oncology settings. Although tumour board meetings involve surgeons, oncologists, radiologists, and pathologists, they do not routinely include palliative care specialists such as social workers and psychologists. Including palliative care team members could broaden discussions to address symptom control, goals of care, and communication of difficult news.Developing a contextually relevant model that incorporates both existing and newly identified indicators of integration may help patients, families, and health systems realise the benefits of integrated oncology and palliative care.

Lung cancer remains one of the leading causes of cancer-related mortality in Africa, with survival rates starkly lagging behind global benchmarks because of systemic inequities in prevention, diagnosis, and treatment access. Despite representing only 6% of global smokers, the continent faces a disproportionate burden driven by environmental and occupational carcinogens, aggressive tobacco marketing, and fragmented health care infrastructure. Key challenges include prohibitive delays in accessing targeted therapies like epidermal growth factor receptor inhibitors and immunotherapies, a dire shortage of radiotherapy infrastructure-0.12 megavoltage units per million people versus the International Atomic Energy Agency's recommended five megavoltage units per million, and a dearth of thoracic surgeons (0.03 thoracic surgeons per 100,000 people). These barriers contribute to over 90% of patients presenting with advanced-stage disease and 5-year survival rates below 10%. Multifaceted strategies are essential to bridge these gaps: regional pooled procurement and compulsory licensing to lower drug costs, telemedicine platforms like the African Radiation Oncology Network to expand radiotherapy access, and task-shifting surgical training programs through institutions such as The College of Surgeons of East, Central, and Southern Africa, which graduates 15 cardiothoracic specialists annually and partnerships such as that between the West African College of Surgeons and Global Oncology Group at Queens University, Canada. Investments in critical care infrastructure, exemplified by dedicated thoracic intensive care units in Ghana and Kenya, alongside harmonized guidelines from the African Cancer Coalition, are pivotal. The Lancet Oncology Commission underscores the urgency of political commitment and sustainable investment in diagnostics, workforce training, and technology transfer to align Africa's cancer care with global standards. Addressing these inequities is a clinical imperative and a moral obligation to ensure life-saving innovations benefit all populations equitably.

A comprehensive assessment of a product's economic viability, along with a value chain analysis, is essential to identify opportunities for improvement, ascertain actual costs and margins, understand the interrelationships between activities, and enhance production efficiency. This study evaluates the economic viability and value chain of summer tomato cultivation, a sector gaining importance due to rising off-season demand and price premiums. A total of 50 summer tomato growers and 45 traders were selected using multi-stage sampling techniques from the Netrokona and Kishoreganj districts in Bangladesh. The results indicates that the adoption levels of ploughing, planting periods, seedling usage, pesticide application, and hormone use were high, whereas the use of urea, gypsum, MoP, boron, and zinc was low. The total cost of summer tomato cultivation was Tk. 2,75,606 per acre, while the average net return per acre was Tk. 3,43,364. The Benefit-Cost Ratio (BCR) of summer tomato cultivation was found to be 2.25, indicating that producing summer tomatoes is economically viable. Seven marketing channels were identified, with retailers contributing 42.58% of the overall value addition, marking the most significant contribution to the gross marketing margin. The summer tomato value chain in Bangladesh is sustainable due to its capacity to create income, encourage efficient resource utilization, enhance food security, and adapt to climatic changes. By maintaining investments in technology, training, and market systems, this value chain has the potential to flourish and contribute to a more resilient and inclusive agricultural economy.

Non-communicable diseases (NCDs) are a growing public health challenge, particularly in low- and middle-income countries (LMICs), where weak health systems limit access to effective care. Achieving Universal Health Coverage (UHC) requires health facilities that are equipped and ready to deliver NCD services. However, evidence on the readiness of health facilities to provide these services in various contexts is limited. This study contributes to filling this gap by assessing the availability and readiness of health facilities to provide essential NCD services in the context of Zanzibar. We employed a facility cross-sectional survey and collected data across all 52 public and parastatal health facilities in Zanzibar using an adapted WHO Service Availability and Readiness Assessment (SARA) tool, incorporating elements from the Pen Plus survey and the Access Bottlenecks, Costs, and Equity (ABCE) survey tools. We generated readiness scores across various strata and used multiple regression analysis to examine factors associated with readiness. Readiness was assessed in terms of availability of trained workforce, essential medicines, diagnostic capacity, financial risk protection mechanisms, and patient registration and follow-up systems. We found an average readiness score of 54% across all facilities, with primary health care centers having the lowest readiness score (29%) compared to the referral hospital (73%). Readiness was particularly low in diagnostic and treatment services (40%), financing and payment mechanisms (31%), and essential medicines (53%), but comparatively higher in healthcare workforce (73%) and infrastructure readiness (69%). Lower-level facilities were associated with lower readiness scores after adjusting for key confounders in the multiple regression analysis. Availability of both inpatient and outpatient care was associated with significantly higher readiness (β = 10.50, p = 0.029). Primary health care facilities remain underprepared to deliver essential NCD services and overall readiness scores mask substantial variation by service type and facility. Strengthening service readiness will require targeted investments in workforce training, diagnostic capacity, supply chain systems, and financial protection measures to advance equitable NCD care as part of UHC efforts.

Post-diagnostic support is a critical yet underdeveloped aspect of dementia care, especially for autistic adults who present with distinct cognitive, sensory, and communication needs. Although interventions such as medication management, psychosocial support, environmental modifications, and carer training are known to improve outcomes, their relevance and accessibility for autistic individuals remain poorly understood. As part of the Second International Summit on Intellectual Disability and Dementia, an international working group examined the intersection of autism and dementia with a focus on post-diagnostic care. Drawing on interdisciplinary expertise, the group identified key barriers and opportunities in clinical practice, caregiving, and service delivery. Recommendations are organized across seven areas, including models of post-diagnostic support, caregiving contexts, pharmacological and non-pharmacological interventions, environmental adaptations, and care planning. The discussion emphasizes the complex needs of autistic adults-many of whom have co-occurring intellectual disabilities, psychiatric conditions, or chronic health issues-and the need for individualized approaches that account for sensory sensitivities and communication differences. Existing dementia care frameworks often fail to address these complexities, resulting in significant service gaps. The report calls for urgent investment in research, workforce training, and policy reform to promote equitable, autism-informed post-diagnostic support and improve quality of life for this underserved population.Lay AbstractAutistic adults who develop dementia often experience challenges that are not well addressed by current dementia care systems. After a dementia diagnosis, people may need help with memory, communication, behavior changes, and daily living. For autistic adults, these supports must be adapted to their individual sensory sensitivities, communication styles, and social differences. This article reports on the work of an international group of researchers, clinicians, and advocates who met during the Second International Summit on Intellectual Disability and Dementia. The group examined how post-diagnostic support for autistic adults with dementia could be improved. They reviewed existing evidence, identified key barriers to care, and proposed strategies to strengthen services in areas such as medication use, environmental design, caregiver training, and personalized care planning. The report emphasizes that many autistic adults also have intellectual disabilities, mental health conditions, or long-term physical health issues, which can make care more complex. Current dementia care frameworks often overlook these overlapping needs, resulting in limited or unsuitable supports. The authors call for more research, workforce training, and autism-informed policy changes to ensure that post-diagnostic care is equitable, individualized, and responsive. Enhancing understanding and adapting support can help autistic adults with dementia maintain dignity, comfort, and quality of life.

BackgroundPhishing remains a dominant initial attack vector in health care, exploiting psychological factors such as urgency and authority. Despite extensive investment in technical controls and awareness training, health care staff remain highly susceptible in real operational conditions. Cognitive dissonance (CD), the discomfort arising from inconsistencies between beliefs and actions, has been proposed as a mechanism to disrupt unsafe rationalization at the moment of exposure, but has rarely been evaluated in live organizational settings using objective behavioral outcomes.ObjectiveThis study examined whether a brief CD-based priming intervention, delivered immediately prior to a real-world phishing simulation, was associated with differences in phishing susceptibility among health care staff. Secondary objectives explored whether CD exposure was associated with directional differences in security-related perceptions and self-reported practices.MethodsA 2-stage hybrid randomized-encouragement experiment was conducted at a large Norwegian hospital. In Stage 1, staff were randomly assigned to a control or CD-primed condition and completed a survey assessing security perceptions and self-reported practices (n=62). In Stage 2, an in-the-wild phishing simulation was sent to all staff, enabling objective measurement of phishing susceptibility via observed link-click behavior. Behavioral outcomes were analyzed across 3 groups—control (n=34), CD-primed (n=32), and neutral nonresponders (n=753)—using a prespecified omnibus chi-square test as the sole confirmatory analysis. Survey-based multivariate and univariate analyses were treated as exploratory due to limited sample size and variable construct reliability.ResultsDue to voluntary uptake, only a subset of randomized participants received the intervention. Observed phishing click rates were 65% (22/34) in the control group, 44% (14/32) in the CD-primed group, and 53% (396/753) in the neutral group. The omnibus chi-square test did not detect a statistically significant association between group membership and click behavior (χ²2=3.00; n=819; P=.22; Cramér V=0.06). Descriptive comparisons within the randomized subset suggested lower click rates in the CD-primed group, but effect estimates were imprecise and associated with wide CIs. Survey-based analyses indicated group differences across combined psychological constructs; however, several constructs exhibited low internal consistency, and follow-up analyses were underpowered.ConclusionsIn a real-world hospital phishing simulation, pre-exposure CD priming was associated with a directional but statistically nonsignificant pattern of reduced phishing click behavior. This evidence does not establish a reliable behavioral effect, and construct-level findings are exploratory. CD-based prompts may serve as a lightweight behavioral signal in real-world conditions, but larger, fully randomized, and longitudinal studies with improved psychometric validation are needed before such interventions can be considered reliable complements to established cybersecurity controls.

Introduction and Aims:Histopathology remains the gold standard in cancer diagnosis, but conventional approaches are increasingly limited by issues of reproducibility, efficiency, and adaptability to growing clinical demand. This study aimed to evaluate recent innovations—wholeslide imaging (WSI), artificial intelligence (AI), and liquid biopsy—and assess their potential to transform diagnostic accuracy, workflow efficiency, and personalised oncology care.Methods:A narrative literature review was conducted,evaluating recent peer-reviewed literature on WSI, AI algorithms in diagnostic pathology, and circulating tumour DNA (ctDNA)-based liquid biopsies. Studies were critically appraised for diagnostic performance, clinical applicability, and integration potential.Results:WSI has enabled remote diagnostics, digital workflows, and global collaboration. AI-driven tools demonstrated enhanced detection of subtle histological patterns, reduced interobserver variability, and prognostic capabilities, particularly in lung cancer. Liquid biopsies provided minimally invasive access to tumour genomics, aiding in early detection, monitoring, and treatment stratification. Multimodal approaches integrating WSI, AI, and ctDNA analysis showed promise in improving diagnostic precision and personalising care. However, barriers included high costs, regulatory challenges, data security, and clinician adoption.Discussion:Emerging evidence suggests that digital histopathology, augmented by AI and liquid biopsy, could revolutionise cancer diagnostics, bridging morphological and molecular insights. While transformative, successful implementation requires investment in infrastructure,validation studies, and clinician training. Integration of these technologies represents a critical step toward precision medicine in oncology.

Strengthening the health workforce is a central policy challenge in fragile and low-income settings, yet governments often lack basic information on what it costs to train health professionals. This study provides the first institutional level evidence on the structure and magnitude of medical education costs in Afghanistan using detailed administrative and financial records from Kabul Medical University. A retrospective costing approach combined with a step-down cost accounting framework is used to allocate all direct and shared expenditures across faculties and across years of study. The results reveal large differences in per student costs across programs, with Curative Medicine requiring substantially more resources than Stomatology, Nursing, and Public Health. Support services account for a large share of total expenditure, and resource use rises sharply in clinically intensive years. A sensitivity analysis that varies personnel costs, allocation rules, and price adjustments shows that these patterns remain stable. The findings indicate that fiscal pressures, gender imbalances in enrollment, and inefficient allocation of support costs limit the effectiveness of current training investments. The study provides a quantitative foundation for policies that seek to improve the financial sustainability of medical universities, align training capacity with national health needs, and strengthen resource tracking systems in fragile and low-income contexts.