Snakebite is a neglected tropical disease affecting underprivileged farming communities in rural tropics and subtropics, causing significant morbidity and mortality. While acute effects of envenoming are well-known, information on long-term consequences remains scarce, despite the public health importance of the issue. Therefore, we explored the existing knowledge about the long-term effects of snake envenoming in the global literature by conducting a scoping review, which revealed that existing literature on snakebite predominantly relies on retrospective associations between envenoming and clinical outcomes, often without precise offending snake species authentication, comprehensive documentation of acute management, or baseline clinical data. Consequently, they could not provide a detailed picture of the long-term clinical epidemiology of envenoming. To overcome these gaps, we prospectively followed up snakebite patients to determine the true prevalence, severity, clinical progression, and risk factors of long-term effects of snakebites using a cohort of snakebite patients admitted to the Teaching Hospital, Anuradhapura, Sri Lanka. Based on a prospective study conducted at one and four-years post-envenoming, long-term musculoskeletal impairments appear to be infrequent and less severe among snakebite survivors in rural Sri Lanka. In contrast, a substantial proportion of individuals report persistent, non-specific systemic and oral symptoms, with the prevalence increasing over time after the bite. In the same two groups of patients, renal functions showed no significant association between snakebite or snakebite-associated AKI, with the development of CKD, or CINAC on review, though microalbuminuria was common. Serum sickness was reported in only 4% of the patients after discharge, despite high rates of acute adverse reactions to antivenom. Meanwhile, a significant number of viper bite patients leave the hospital with mild persistent local effects, which commonly leads them to seek further treatment, emphasizing the need for post-discharge follow-up of snakebite survivors.

A Call for Leadership: Lessons Learnt from a Case of Artificial Intelligence (AI)-Augmented Cognitive Behavioural Therapy (CBT).

Independent evaluations have shown substantial over-issuance of REDD+ (Reducing Emissions from Deforestation and Degradation) credits traded on the voluntary carbon market. We synthesise these evaluations to estimate the additional forest conservation achieved by first-generation REDD+ projects and to identify mechanisms underlying over-crediting. We combine six independent ex post evaluations of avoided deforestation covering 44 REDD+ projects. These evaluations show that most projects reduced deforestation, but that they claimed an aggregate of 10.7 times more avoided deforestation than is justified by independent estimates. This discrepancy is not driven by the choice of forest cover data, but by selection bias in projects' control areas and modelling approaches. Although recent initiatives that transfer assessment to unconflicted parties and restrict methodological flexibility are critical, they are insufficient. Ex post certification against credible counterfactuals is necessary if carbon markets are to represent causal reductions indeforestation.

ABSTRACT River restoration can be difficult to evaluate due to insufficient monitoring over timescales too short to adequately capture physical and ecological response. To better understand restoration outcomes, this study quantified changes in physical habitat (depth, velocity, substrate composition) and macroinvertebrates at two restoration projects on a chalk stream (River Test, UK) over 8–9 years using a Before‐After repeated measures approach. Restoration involved coarse substrate addition, tree hinging/woody material placement and planform reprofiling. At both sites, habitat heterogeneity (e.g., cross‐sectional depth variability) and macroinvertebrate abundance and diversity increased, whilst non‐rheophilic taxa increased in dominance at one site. Substrate composition varied over time but generally became coarser post‐restoration. Macroinvertebrate metrics remained relatively stable following restoration, except in 2016 (1‐ and 3‐years post‐restoration) when several metrics were lower (e.g., abundance and taxon richness). The reasons for this are unclear but could represent local disturbance (e.g., river management) or variability in data collection between surveyors. This study provides evidence for the effectiveness of restoration and highlights the benefits and challenges of longer‐term monitoring. Considering the cost of restoration, there is a need to adequately evaluate project outcomes over the long‐term to ascertain reasons for success and failure and overall cost: benefit. Equally, it is recognised that due to the small‐scale of many opportunistic projects it is not economically viable to include extensive monitoring. Therefore, we recommend a strategic programme of robust, long‐term appraisals be developed assessing exemplar restoration sites to evidence restoration effectiveness and guide future efforts.

Purpose:This study explores the role of service learning in achieving educational goals among Doctor of Public Health (DrPH) students at Universiti Kebangsaan Malaysia (UKM) and its impact on sustaining community empowerment and engagement initiatives. Methodology:A community health intervention project was implemented over 4 years in Semenyih and Cheras, involving four cohorts of DrPH students. Enrolment in the elderly health module was an elective course under the family health discipline, with one of the learning outcomes requiring students to design and implement a community-based intervention informed by a situational analysis and needs assessment. A total of 76 students took part in the elderly health promotion projects. All students were required to submit a reflective report. All reports were analysed through qualitative document review. Findings: Analysis revealed two major themes underpinning the integration of service learning with community engagement: (1) participatory action research and (2) capacity development. These themes were further explained through the application of social learning theory, the theory of planned behaviour, and self-determination theory, offering insights into student and community behavioural dynamics. Conclusion:Embedding service learning within doctoral public health education fosters meaningful community engagement and strengthens capacitybuilding initiatives. This approach demonstrates potential for sustaining health promotion participation while simultaneously enhancing higher education outcomes.

Global Battlefields: Learning Lessons, Facing Challenges

This paper presents an innovative application of generative artificial intelligence to the evaluation of project-based learning (PBL) lesson preparation by pre-service teachers of vocational subjects. Using a system prompt grounded in the Gold Standard PBL criteria (Larmer, Mergendoller, & Boss, 2015), the AI analyses project quality in terms of intellectual challenge, authenticity, student voice and choice, reflection, critique and revision, and public product, with particular attention to the development of critical thinking and problem-solving skills. The evaluation process includes criterion-based commentary, identification of strengths and areas for improvement, and the provision of constructive feedback to students. The primary aim is to support the development of key professional competencies among future teachers and to enhance their ability to design meaningful and effective project-based instruction. The paper further discusses the pedagogical benefits, limitations, and ethical considerations associated with this approach.

Follicular dendritic cell sarcoma (FDCS) is a rare, aggressive malignant neoplasm usually arising in lymph nodes of the head and neck, but it can also occur at extranodal sites (ENFDCS). Due to its rarity, optimal management is not well defined, underscoring the need for further research. We conducted a retrospective analysis of patients with histologically confirmed ENFDCS treated in the gastrointestinal oncology unit of a tertiary cancer center. Clinical features, treatments, and outcomes were reviewed. Fourteen patients (10 males, 4 females; median age 41 years) were included. Primary sites were colon (n = 6), retroperitoneum (n = 3), rectum (n = 2), mesentery (n = 1), liver (n = 1), and pelvis (n = 1). Four tumors (28.6%) were initially misdiagnosed. Final diagnosis was based on morphology and immunohistochemistry for CD21, CD23, and CD35; Epstein-Barr virus testing was not performed. Five patients underwent primary surgery at our center; two patients with metastatic disease at presentation received systemic therapy alone. Among the five primary surgeries, three were preceded by perioperative chemotherapy (n = 1), neoadjuvant chemotherapy (n = 1), or neoadjuvant radiotherapy (n = 1). Seven patients presented with residual or recurrent disease after prior surgery elsewhere; three underwent re-resection following appropriate systemic therapy, and four received only systemic therapy. At a median follow-up of 26 months (range 7-153), median overall survival was not reached, and median disease-free survival was 24 months. Four of five patients primarily operated at our center remained disease free; one recurred at 39 months, was successfully treated with re-resection and systemic therapy, and was alive at 153 months. Of the three patients re-resected at our center, one remained disease free at 17 months, one developed systemic recurrence and eventually received best supportive care at 11 months, and one was disease free until 94 months before being lost to follow-up. Overall, 10 patients were alive, two died of disease progression, and two were lost to follow-up. ENFDCS is frequently misdiagnosed; surgery is the cornerstone of treatment, and multimodality therapy for recurrences can yield durable survival. Outcomes appear better when patients are managed at specialized oncologic centers, highlighting the importance of early recognition and timely referral.

Endoscopic Trans-Orbital Approach - Learning Curve as New Faculty, Technical Challenges and Lessons Learnt

LEGAL FRAMEWORK FOR ADDRESSING MATRIMONIAL INCORPOREAL INJURY: A CONTEMPORARY CHALLENGE TO THE MUSLIM FAMILY INSTITUTIONS IN NIGERIA AND LESSONS LEARNT FROM OTHER JURISDICTIONS

Decarbonisation of urban areas is essential to reaching climate neutrality, as cities house half the global population and account for over 70% of carbon emissions. However, applying innovative approaches, such as establishing positive energy districts (PEDs), remains challenging due to stakeholder engagement and funding constraints, largely driven by knowledge gaps and a lack of best practices. This study examines barriers, facilitators and lessons learnt from six case studies in Europe, Canada and Singapore through a mixed-methods approach, including stakeholder interviews, grey literature analysis and a semi-structured review. Findings highlight district heating networks, heat pumps and photovoltaics as key technologies, with regional variations. While Mediterranean regions prioritise solar energy, northern climates employ a diverse range of solutions, including geothermal and seasonal storage. Political commitment and funding enable progress, whereas regulatory gaps and stakeholder misalignment hinder it. The study underscores the need for sharing best practices to enable PED implementation.

Ambiguity in contractual clauses is a frequent source of disputes and provides the basis for applying the contra proferentem principle under Article 1349 of the Indonesian Civil Code. However, Indonesian contract law lacks an adequate methodological framework to determine when a clause should be classified as ambiguous, resulting in the risk that contra proferentem is applied intuitively and inconsistently. This research seeks to formulate a systematic ambiguity-testing framework as a prerequisite for the application of contra proferentem, by examining and reconstructing judicial practice in Singapore, particularly through an analysis of Hewlett-Packard Singapore (Sales) Pte Ltd v Chin Shu Hwa Corinna. This research employs normative legal research, using a case approach and a conceptual approach. Primary legal materials in the form of Singapore court decisions are analysed alongside secondary materials from scholarly literature and journals to develop a coherent conceptual framework for testing ambiguity. This research finds that ambiguity must be assessed through four sequential stages: (i) examination of the contractual text; (ii) analysis of the relevant factual context; (iii) determination of the parties’ objective intention; and (iv) evaluation of whether the remaining meaning is reasonably acceptable within commercial reality. The contra proferentem principle may be applied only as a last resort, where more than one equally rational interpretation remains after these stages have been exhausted. The novelty of this study lies in its formulation of a structured ambiguity-testing framework that can be transplanted into Indonesian contract law practice to enhance legal certainty and strengthen party autonomy.

ABSTRACT After-Action Reviews (AARs) have become essential tools for organizational learning and development, particularly in post-crisis contexts such as public health emergencies. This study examines the processes, characteristics, and challenges of AARs, focusing on their application during the COVID-19 pandemic. We conceptualize AARs as communication processes that enact, encode, and disseminate lessons learned, contributing to organizational resilience and innovation. By analyzing a sample of COVID-19 AARs from various organizations, we explore the variability in AAR form, structure, and content across different organizational levels. Our findings reveal consistent themes in assessment and recommendations, particularly emphasizing the importance of communication, coordination, and inclusive planning for vulnerable populations. Results highlight the significance of AARs as tools for translating crisis experiences into actionable insights for future pandemic preparedness and response.

As the population ages, certain neurodegenerative diseases (NDs) are becoming a major health issue. For this reason, this review will focus on the most common ND with onset after 65 years old; Alzheimer's disease, Parkinson's disease, Lewy body dementia, and frontotemporal dementia. NDs are the results of multifactorial processes causing pleiotropic changes in molecular and protein networks linking a host of biological processes that lead to protein dysregulation and aggregation that ultimately leads to neurodegeneration. Genetic, transcriptomic, and proteomic studies have been instrumental to identify novel genes and proteins implicated on diseases that point to novel disease mechanism, as well as the identification of disease biomarkers. Here, we provide a review of the genomic, transcriptomic, and proteomic studies on ND so far, as well as future opportunities and challenges. ANN NEUROL 2026;99:566-587.

ECMO offer a salvage option in selected severe dengue patients; however, profound capillary leak, coagulopathy and MODS remain obstacles.The need for VA-ECMO, high lactate levels, and CRRT requirement were associated with increased mortality.Larger multicenter datasets are required to develop selection criteria and improve survival outcomes in dengue patients requiring ECMO.

Abstract Massive open online courses (MOOCs) have emerged as powerful educational tools for disseminating complex scientific knowledge. This study examines the RECONECT MOOC, an innovative online learning platform designed to educate stakeholders about nature-based solutions (NbS) for hydrometeorological risk reduction. Developed by a multidisciplinary team of international experts, the course drew on diverse professional and geographical perspectives, across a range of national and sectoral contexts. Its primary aim to bridge the knowledge gap in climate adaptation strategies across diverse professional sectors. The research investigated the effectiveness of interactive, multimedia-based learning approaches in communicating advanced NbS concepts. Using the Sharable Content Object Reference Model (SCORM) framework, the course integrated multiple learning methods, including reading, listening, inquiry-based learning, discussion forums and practical application exercises. The MOOC was divided into six modules and targeted local authorities, policymakers, academics, postgraduate students and other stakeholders interested in climate resilience. Findings revealed that 90% of participants gained additional NbS knowledge, 69% reported a shift in perception and 62% felt confident applying what they learned. Participants valued the interactive resources and flexible, self-paced format. Overall, the study demonstrates that MOOCs can effectively support scientific knowledge dissemination and strengthen understanding of complex environmental solutions.

A growing body of work has linked the dysregulation of transmembrane (TMEM) proteins to the proliferation, metastasis, drug resistance, and tumor microenvironment remodeling of lung cancer, the leading global cause of cancer mortality. Renamed members such as STING1 (stimulator of interferon response cGAMP interactor 1, TMEM173), ANO1 (anoctamin-1, TMEM16A), ORAI1 (ORAI calcium release-activated calcium modulator 1, TMEM142A), ORAI3 (TMEM142C), and NDC1 (NDC1 transmembrane nucleoporin, TMEM48) are among the most extensively studied ones. Mechanisms of TMEM dysregulation in lung cancer span the modulation of Ca2+ influx, lysosomal exocytosis, ferroptosis, Wnt and β-catenin signaling, and immune cell infiltration and immune checkpoint rewiring, among others. Epigenetic silencing and targetable fusions (i.e., TMEM106B-ROS1 and TMEM87A-RASGRF1) create DNA-level vulnerabilities, while miRNA sponges offer RNA-level druggability. A subset of studies revealed context-specific expression (endothelial, B cell, and hypoxic EV) that can be exploited to remodel the tumor microenvironment. One study specifically focused on how isoform-specific expression and localization of TMEM88 determine its functional impact on tumor progression. Yet for most TMEMs, only pre-clinical or early-phase data exist, with many supported by a single study lacking independent validation. This review brings together scattered evidence on TMEM proteins in lung cancer, with the aim of guiding future work on their possible use as biomarkers or therapeutic targets.

Abstract Introduction Global interest in, and funding for, ecosystem restoration is growing in the face of ongoing ecosystem degradation. The role and inclusion of Indigenous Peoples and local communities (IP&LCs) have not been given sufficient attention in ecosystem restoration. Objective The objective of this research is to apply the lessons from the experience of protected and conserved areas (PCAs) in order to better consider the role of IP&LCs in ecosystem restoration. Methods To do this, I develop a framework along three stages that apply to both PCAs and restoration: (1) site identification and planning; (2) management/implementation; and (3) impacts/outcomes. Questions were identified along each stage and used to guide eight in‐depth expert interviews (including with four Indigenous Peoples), the analysis of six case studies and a literature review. Results Along each of the three main phases of the restoration process I find several lessons from PCAs of relevance. Phase I – Site selection: Carry out inclusive processes for identification of restoration sites; Guarantee full FPIC; Share data transparently; Give voice to IP&LCs; Facilitate consultation processes; Prioritize tenure security; Use locally developed maps; Acknowledge divergent worldviews; Adapt western ideas to Indigenous knowledge and practice in restoration. Phase II – Implementation: Develop collaborative restoration plans; Ensure fair remuneration; Include Indigenous knowledge in implementation; Include IP&LCs in governance mechanisms; Recognize the role of IP&LCs in ongoing monitoring. Phase III – Outcomes: Ensure restoration responds to the needs of IP&LCs; Ensure governance and management mechanisms enable favorable outcomes for IP&LCs; Ensure benefits of restoration reach IP&LCs; Attend to within‐community variation (e.g., gender, ethnicity, religion, age sometimes), which can distort benefits distribution; Include IP&LC values in measures of restoration impact. Conclusions Current and future restoration project would benefit from learning lessons from protected and conserved areas to ensure that IP&LCs are included at all stages of the restoration process. Three fundamental issues emerge: 1. Recognition that different worldviews guide IP&LCs and western approaches to restoration practice; 2. the need for innovative tools to combine knowledge systems at all stages of the restoration cycle; 3. the need for more comprehensive and culturally relevant measures of restoration.

Qualitative researchers have strived to recenter epistemic authority and knowledge creation by increasingly engaging with Indigenous methodologies. Such effort is fundamental to decolonizing research i.e., putting the research participant in the position of the knower and facilitating the emergence of their knowledge through methods aligned with their ontoepistemology. In this paper, we introduce the method of cuerpo-territorio (body-territory) to the wider social science Anglophone qualitative research milieu and join the conversation regarding the centrality of emotions in research. Cuerpo-territorio is a method for qualitative research centered on emotional and embodied responses to environmental change, developed by Latin American communitarian feminists and collectives. It is grounded in the ontological understanding that what happens to the environment is reflected and experienced in one’s body. In this article, we draw on original material from two case studies in Oña and Nabón, Ecuador and Xolobeni, South Africa, where local communities are involved in resisting the threat of impending mining projects. We reflect on the lessons we have learnt through applying cuerpo-territorio, particularly in relation to participants’ time availability and discomfort in drawing and linking the body and the territory to strengthen the method and enhance its broader application. We learnt that we cannot assume that participants will be fully able to appreciate its value and lend their time to it. In ideal circumstances, having time to properly deploy the method, leaving space for plenty of participants’ reflections, avoids instrumentalizing the method as purely a data-gathering tool and opens the possibility of rupturing it and making it their own for participants and researchers alike. Realizing when these circumstances are not present and adjusting the course of our projects is a fundamental part of our work of reflexivity as scholars.

Abstract. Recently, the disaster risk field has made substantial steps forward to develop increasingly comprehensive risk assessments, accounting for the incidence of multiple hazards, trickle-down effects of cascading disasters and/or impacts, and spatiotemporal dynamics. While the COVID-19 outbreak increased general awareness of the challenges that arise when disasters from natural hazards and diseases collide, we still lack a comprehensive understanding of the role of disease outbreaks in disaster risk assessments and management, and that of health impacts of disasters. In specific, the occurrence probabilities and the impacts of disease outbreaks following natural hazards are not well-understood and are commonly excluded from multi-hazard risk assessments and management. Therefore, in this perspective paper, we develop a research agenda that focusses on (1) learning lessons from interdisciplinary communities such as compound risks and the socio-hydrology community for modelling the occurrence probabilities and temporal element (lag times) of disasters and health/disease-outbreaks, (2) the inclusion of health-related risk metrics within conventional risk assessment frameworks, (3) improving data availability and modelling approaches to quantify the role of stressors and interventions on health impacts of disasters. Collectively, this agenda is intended to advance our understanding of disaster risk considering potential health crises. The developed research agenda is not only crucial for scientists aiming to improve risk modelling capabilities, but also for decision makers and practitioners to anticipate and respond to the increasing complexity of disaster risk.