Promoting physical activity among the general population as well as among people with a history of migration is a crucial aspect of health promotion. However, we still lack a general understanding of physical activity levels and their potential correlates among adults with a history of migration living in Germany. The GEDA Fokus study, conducted by the Robert Koch Institute from 11/2021 to 05/2022, is a nationwide cross-sectional health interview survey of adults (18-79 years) with Croatian, Italian, Polish, Syrian or Turkish citizenship living throughout Germany (n = 6,038). The Aims of this study were (1) to assess the physical activity levels of adults with selected citizenships in Germany, specifically, adherence to World Health Organization (WHO) recommendations for aerobic activity and muscle strengthening, and in addition, cycling as a means of transport and (2) to identify sociodemographic, migration-related and psychosocial correlates of their physical activity behaviour. Approximately 70% of the participants reported not achieving the WHO recommendations for aerobic physical activity and 75% did not achieve the recommendation for muscle strengthening. The physical activity levels among the participants were associated with a number of sociodemographic, migration-related and psychosocial factors. Multivariable regression analyses showed that men compared to women, adults with higher educational levels, higher subjective social status, better German language proficiency and a higher level of social support were more likely to achieve the WHO recommendations for physical activity. In addition, men compared to women and adults with higher educational levels were more likely to cycle as a means of transport. Overall, the study found that physical activity levels among adults of Croatian, Italian, Polish, Syrian or Turkish citizenship living in Germany were low in comparison to the general population, and there were significant associations between their physical activity behaviour and a range of sociodemographic, migration-related and psychosocial factors. Further in-depth research is needed, both from a public health and health sociology perspective, to identify barriers to physical activity among people with a history of migration and to derive appropriate measures for intervention planning.

The bicycle as a means of transport gains popularity among the inhabitants of European cities, being not only an alternative to cars, but also a way to improve health and wellbeing. The aim of the study is to identify and provide an in-depth analysis of health benefits, as well as potential environmental and traffic hazards resulting from regular commuting to work by bicycle. The study, conducted in the form of a diagnostic survey, included 285 adult inhabitants of Lublin, Poland. The criterion of purposive sampling was the respondents' occupational activity and choosing a bicycle as a means of commuting to the place of work. The study was carried out using an author-constructed questionnaire and a standardized research tool - Satisfaction with Life Scale. Statistical analysis was performed by means of χ2 test for independence; the p values p≤0.05 were considered statistically significant. Most respondents evaluated their overall health as good (55.4%) or very good (31.9%), and their self-assessed immune status as high (57.9%) or very high (23.5%). Year-round cycling was significantly associated with a higher self-assessment of health (p<0.01). Commuting by bicycle was associated with improved physical fitness (43.9%) and immunity (21.4%). Cyclists achieved a mean SWLS score of 23.4, indicating above-average life satisfaction. The main identified traffic hazards were cars/drivers (60%) and insufficient infrastructure (41.8%). Regular commuting to work by bicycle is positively associated with perceived health benefits, including higher self-assessed fitness, higher self-assessed immune status, and fewer reported colds, as well as with above-average satisfaction with life. However, road safety concerns and insufficient cycling infrastructure remain significant barriers to active and safe commuting.

BackgroundAccording to the World Health Organization, all healthy pregnant women are recommended to engage in at least 150 min of regular moderate-intensity aerobic activity per week. This level of physical activity is associated with numerous physical and psychological health benefits and helps to reduce the risk of being overweight, gestational diabetes, and preeclampsia. Despite its importance, adherence to the recommended levels of physical activity is low among pregnant women in Ethiopia, particularly in urban areas. Therefore, there is a need for a better understanding of barriers and enablers that affect physical activity levels. Thus, this study explored the perceived awareness, barriers, and enablers that influence pregnant women’s physical activity in their everyday lives.MethodsSeven focus group discussions were conducted with 45 pregnant women who attended routine antenatal care visits at selected health centers in four Ethiopian cities. The data were transcribed and exported to NVivo version 14 software for data management and analysis. An inductive process of thematic analysis was employed, and themes were developed.ResultsMost of the pregnant women had awareness about the health benefits of physical activity. However, some lacked awareness regarding safety precautions and the types of physical activities that can be done during pregnancy. Additionally, some had misconceptions about physical activity throughout the first trimester, believing that it results in abortion. The preferred method of physical activity was walking, both as a means of transportation and recreation. Health conditions, personal factors (such as being office worker, time constraint lack of commitment), societal factors (such as fear of judgment, culture) and environmental factors(such as lack of paved sidewalks, unfavorable weather conditions) were identified as barriers whereas partner support, experience sharing from pregnant women who had been exercising previously and having access to green space were identified as facilitators.ConclusionsThis study identified several barriers and enablers that influence physical activity during pregnancy. By addressing Identified barriers, policy makers can create more enabling conditions for women to engage in safe, regularphysical activity during pregnancy, thereby reducing NCDs and improving maternal wellbeing and pregnancy outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-026-09454-x.

BackgroundDeciding whether to continue driving or transition to alternative means of transportation is a challenging issue for older adults in preventive care settings. This study aimed to identify potential associations between the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and driving as the primary mode of transport among older adults.MethodsThe participants of this cross-sectional study were community-dwelling older adults participating in a long-term preventive care program. Participants were divided into two groups (DRIVING or OTHER) based on their questionnaire response regarding the main mode of transport used when going out, where the OTHER group included all participants who selected any other mode than a car driven by themselves. Cognitive function was measured using 13 MoCA-J tasks. Binary logistic regression analysis was used to identify associations between MoCA-J results and inclusion in the DRIVING group.ResultsAmong the 199 participants, 156 were categorized into DRIVING group and 43 into OTHER group. The DRIVING group showed significantly higher task achievement rates than the OTHER group in trail-making, digit span, and phonemic verbal fluency tests. Of these, only the trail-making test results were associated with inclusion in the DRIVING group (odds ratio, 2.82; 95% confidence interval, 1.22–6.51; p =.016).ConclusionsThe trail-making task of MoCA-J may assist health-care professionals in providing driving guidance to older adults.

Birth preparedness and complication readiness have the goal of reducing maternal and neonatal mortality. This concept requires pregnant women to seek health care without delay in case of obstetric complications and delivery. This study determined the practices and factors associated with birth preparedness and complication readiness among pregnant women in the Cape Coast Metropolis, Ghana. A facility-based cross-sectional design was employed among 384 participants, collecting data using a self-administered questionnaire and analyzing them using Stata (Version 16) at the 0.05 significance level and 95% CI. The practice of birth preparedness and complication readiness was 53.4%, and single pregnant women were more likely to practice birth preparedness and complication readiness (AOR=2.19; 95% CI=1.13, 3.45; p=0.020). Respondents whose husbands had completed the tertiary education level were more likely to practice birth preparedness and complication readiness (AOR=1.15; 95% CI=0.05, 1.46; p<0.001). Pregnant women who did not have enough money to cater for expenses, those who had no means of transportation to the health facility, those who did not have someone to accompany them to the health facility, those who did not receive advice from a birth attendant regarding their pregnancy, and those who did not have enough food at home to cater for the household were less likely to practice birth preparedness and complication readiness (all: p<0.05). Health promotion programs to increase the practice of birth preparedness and complication readiness should target all women, particularly those with limited social and financial support and families with no or basic education.

Regular physical activity in childhood and adolescence supports cardiometabolic health, mental wellbeing, and learning, yet many countries lack routine surveillance and actionable, benchmark-linked accountability tools. The Active Healthy Kids Global Alliance (AHKGA) "Report Card" approach synthesizes the best available national evidence to grade physical activity behaviours and their determinants, enabling cross-country comparisons and policy dialogue. Ghana last published a Report Card in 2018; since then, new evidence and policy developments warrant an updated appraisal, including attention to children and adolescents with disabilities and/or chronic conditions (CAWD). We compiled and synthesized Ghana-specific evidence used for the 2025 Ghana Report Card within the AHKGA Global Matrix 5.0 framework. Ten common indicators were graded for the regular population (ages 5-17 years) using the Global Matrix 5.0 rubric bands (A + to F; INC for insufficient evidence). Data sources included national school-based surveillance (Global School-based Student Health Survey (GSHS) 2012 fact sheets/microdata), peer-reviewed studies (2009-2022), theses, policy documents, and program-based budgets. When multiple eligible estimates were available, we applied transparent synthesis rules (e.g., unweighted means for Active Transportation). CAWD grades were assigned only when disability-relevant, benchmark-aligned evidence or defensible structured consensus supported grading. Ghana's highest grades were Sedentary Behaviour (B+) and Active Transportation (B), while Overall Physical Activity was graded D-. Key benchmark-linked estimates included: 25.0% meeting an MVPA proxy guideline (Overall Physical Activity), 27.6% participating in sport ≥ 3 times/week (Organized Sport), 73% active travel to/from school (Active Transportation; unweighted mean), and 78.4% below the "high sedentary time" threshold (Sedentary Behaviour). Physical Fitness was graded C- (mean percentile ~ 40-42 across three field tests). School (D) and Community & Environment (D-) reflected low effective PE delivery and limited access to acceptable, publicly accessible spaces in an Accra-based audit proxy. Government was graded B based on rubric-aligned policy, implementation, and funding/accountability scoring (mean score 67%). For CAWD, 7/10 indicators were INC; assignable grades were Family & Peers (C-), Community & Environment (F), and Government (D+). Ghana's 2025 Report Card highlights persistently low physical activity levels alongside gaps in school delivery, community environments, and surveillance systems. The CAWD results are dominated by evidence insufficiency, underscoring an urgent need for disability-disaggregated surveillance and inclusive infrastructure, alongside strengthened PE implementation and safer active travel systems.

Vaccine-preventable diseases remain significant contributors to illness and death among children. Globally, immunization stands out as one of the most effective and economical public health interventions. In the West Arsi zone, the results of the Rapid Convenient Survey (RCS) were inconsistent with the DHIS-2 report regarding the coverage of full vaccination. To determine the proportion of incompletely vaccinated children aged 12-35 months and identify associated factors. A community-based cross-sectional study was conducted in the West Arsi Zone from June 23 to August 17, 2023. A total of 1,316 children were selected using a multi-stage stratified random sampling technique. Data were collected through face-to-face interviews with mothers or caretakers and by reviewing immunization records, utilizing a structured questionnaire programmed in Open Data Kit (ODK). The data were cleaned and analyzed using Stata version 17. A binary logistic regression model was developed to identify associated factors. The prevalence of incomplete vaccination was 43.6% (95% CI: 40.9, 46.3) by recall and/or card review, and 36.8% (95% CI: 33.7-39.9) by card review only. OPV0 and MCV2 had the highest incompleteness. The main reasons reported for incompleteness were the unavailability of the vaccine/vaccinator and not knowing the need for the next dose. Incomplete vaccination was associated with accessibility of the kebele, availability of a refrigerator at the health post, residence of the respondent, age of the respondent, respondent's education level, child sex, child age, respondent's awareness of HEWs, respondent's knowledge about immunization, means of transport to the health facility, wealth index, and participation in the Productive Safety Net Program. The study revealed a high proportion of incomplete vaccination among children, with coverage varying across different vaccines. Major gaps were observed in OPV0 and MCV2. A wide range of socio-demographic, health system, and accessibility related factors were significantly associated with incomplete vaccination. Enhancing caretaker awareness, improving health facility readiness, and addressing social and cultural barriers could improve vaccine uptake.

The proportion of older adults living alone is rapidly increasing in Korea, making this population vulnerable to physical, psychological and social health problems. Functional decline in activities of daily living (ADL) and instrumental activities of daily living (IADL) is particularly pronounced among those living alone. This study applied network analysis to identify the structural relationships and central ADL/IADL items in older adults living alone. We utilised the data from the 2022 Korean Longitudinal Study of Aging. Participants were 1,006 community-dwelling older adults aged ≥ 65 years living alone. ADL (seven items) and IADL (ten items) were coded dichotomously (0 = independent, 1 = required help). Network analysis was performed using IsingFit and qgraph in Rand centrality indices (strength, closeness and betweenness) were estimated. Network stability was evaluated using 1,000 bootstrap case-dropping subsets. Among the participants, 8.55% required help with at least one ADL item, and 20.68% required at least one IADL item. 'Using means of transportation' demonstrated the highest strength centrality, followed by 'going in and out of bathroom, cleaning after urinating or defecating, then getting dressed', 'preparing hot meals' and 'bathing or showering'. The findings of this study highlight central ADL and IADL items within the functional network of older adults living alone. These results provide insights into the interrelationships among functional abilities and may guide future research on strategies to support or prevent functional decline in this population.

Delivering energy deep into turbid media is essential for applications like biomedical imaging, medical treatment, and material processing. We applied wavefront shaping to enhance light penetration by manipulating the phase of incident light. Using feedback-based phase optimization and numerical solutions of Maxwell’s equations, we present an approach that significantly and non-invasively increases the energy density deep inside complex scattering media by minimizing the reflected light, without prior knowledge of the media. In simulations of media with a transport mean free path as low as , we achieved a 2.5-fold enhancement of the energy density at a depth of about . Light transport through this simulated medium is equivalent to propagation through approximately of biological tissue with optical properties typically found in the red or infrared wavelength range. By switching between minimized and maximized reflection, the energy density can be modulated by up to a factor of 12 deep inside the scattering medium, while the energy density at shallow depths remains fairly unchanged.

Abstract Imaging objects obscured by optically thick scattering media remains a major challenge in biomedical imaging, industrial nondestructive evaluation, and remote sensing. This challenge becomes even more severe when accurate color recovery is required. This work introduces a hybrid deep learning framework for high-fidelity color imaging through strongly scattering media with optical thicknesses up to 33 transport mean free paths. The approach combines a Convolutional Neural Network CNN with an analytical model, enabling accurate reconstruction of an object in terms of shape, size, and intrinsic color. To overcome the usual requirement for very large training datasets, the model is trained efficiently using only 500 simulated three-channel measurements by incorporating a specialized preprocessing transform that promotes stable, rapid learning. The method is experimentally validated as a non-invasive, real-time imaging scheme under white-light illumination and is shown to be robust in dense, dynamic scattering environments. The proposed framework substantially outperforms the widely used UNet architecture, yielding approximately two orders of magnitude lower Mean Squared Error MSE, more than 2.5 times higher Peak Signal to Noise Ratio PSNR, a fourfold improvement in Pearson correlation, and more than 1.5 times enhancement in Structural Similarity Index Measure SSIM. These results demonstrate a robust, accurate, and generalizable solution for color imaging through highly scattering media, with strong potential for advanced biomedical imaging, environmental monitoring, and remote sensing applications.

In the rock art of Armenia, a special place is occupied by depictions of construction, transportation, and communication using materials from the Geghama and Syunik Mountains, as well as from the entire Armenian Highland. The research also involves artifacts from the other spheres of later cultural heritage. This topic has been explored previously; meanwhile, the new data gives us the opportunity to elucidate it from both material-functional and spiritual-sacral perspectives. When studying pictures of transportation means, carts, military, and ritual chariots are examined. As communication ways, land and water routes are presented, and the mythologeme of the ladder is interpreted as a symbolic link between the lower and upper worlds. The depiction of buildings and dwellings is compared with the plans of newly discovered settlements. Images of houses are analyzed in relation to compositions from Shengavit, the Armenian rural house described by Xenophon, and ancient temple structures. Examples from Armenian mythology are also presented, testifying to the veneration of gods and goddesses who served as protectors of home and domestic hearth. The article concludes with sections adjoining the main material, devoted to applied images and educational aids that contributed to the development of architectural skills and ensured the transmission of this knowledge to subsequent generations. The material on petroglyphs studied in this article attests to the continuity and longevity of ancient knowledge throughout the entire history of Armenia.

The growing need for sustainable and cost-effective urban transport has led to increased attention towards alternative fuels such as Compressed Natural Gas (CNG). This paper analyses the adoption and usage behaviour, level of satisfaction and future intentions of the users of CNG auto services in semi-urban setting. Descriptive and analytical research design was used and primary data was obtained via a structured questionnaire that was given to CNG auto users. The analysis on the impact of socio-economic factors, awareness, cost perception, and service quality on the usage behaviour and satisfaction is conducted. The results indicate that the lower and middle-income populations have been the major users of CNG autos, which can be attributed to the fact that it is affordable and is perceived to save money. The statistical analysis shows that the awareness and frequency of usage have a significant association, and the service quality factors, especially comfort and availability, have a significant association with customer satisfaction. Moreover, environmental awareness is determined to have a positive impact on intentions to adopt in the future. The paper concludes that CNG-driven auto services are the potential and sustainable means of transportation, with both economic and environmental benefits. However, challenges related to infrastructure and availability needs to be addressed to enhance adoption. The results can be useful to policymakers and service providers to advance environmentally friendly urban mobility solutions.

BackgroundThe health of the population is shaped by political, social and environmental conditions – referred to as contextual factors in this paper – which influence the risk of type 2 diabetes and other non-communicable diseases (NCD). The article provides an overview of selected indicators for this topic.MethodThe indicators were developed based on a literature review and a multi-stage selection process, considering their relevance for the prevention of diabetes and other NCD as well as the availability of data. Available nationwide data were used for operationalisation.ResultsSix indicators were agreed upon: tobacco control, the consumer price index, food taxation and prevention expenditure in the area of health policy measures, the at-risk-of-poverty rate in the area of employment and social affairs, and use of means of transport in the area of built and physical environment. The time trends for these indicators are integrated into the NCD Surveillance of the Robert Koch Institute (RKI) and are presented on the web portal of the federal health reporting. The results for all indicators point to inadequate prevention measures.ConclusionsContext indicators help to track changes over time in environmental determinants of health. As part of NCD Surveillance at the RKI, this topic will be continuously developed.

Radiation-induced segregation (RIS) poses a significant challenge for ferritic Fe–Cr alloys under irradiation, as it can compromise mechanical integrity and increase susceptibility to intergranular corrosion. Yet, the mechanisms governing Cr segregation remain incompletely understood. In this study, we present a physics-based rate-theory model parameterized using self-consistent mean field theory-based Onsager transport coefficients to investigate RIS at the grain boundary in dilute Fe-(0.1 at. %) Cr. Under equal production rates of vacancies and self-interstitial atoms (SIA), and their equal absorption rates by bulk dislocations, the model simulates the experimentally observed transition from Cr enrichment at low temperatures to depletion at higher temperatures. Under these unbiased conditions, systematic investigation reveals that while temperature-dependent transport properties dictate the segregation direction, dose rate, grain size, and dislocation density only influence the magnitude and spatial extent of Cr segregation. However, under more realistic conditions of preferential vacancy production within damage cascade and/or preferential SIA absorption by bulk dislocations, the enrichment-to-depletion transition shifts to lower temperatures. Our findings demonstrate that RIS predictions based solely on transport coefficients are valid only under symmetric point defect flux conditions, and that biases in defect production and absorption must be considered for accurate predictions. This work provides a mechanistic framework for understanding RIS in ferritic alloys and informs alloy design for advanced nuclear systems.

Background: Walkability reflects designing of road infrastructure to encourage walking as a means for transportation. It demarcates the extent to which the built environment supports and encourages walking by providing safe, comfortable, accessible, and pleasant conditions. It is being increasingly recognized as a key component of sustainable urban development. In the context of rapidly populated and inadequately urbanized Indian cities, promotion of walkability can contribute significantly to environmental sustainability, public health, economic vibrancy, and social equity. Objective: This paper investigates the influence of walkability on the sustainable development of Chennai City, the fourth largest metropolitan city of India and the largest in South India. Through a multi-dimensional approach, the study examines the interplay between pedestrian infrastructure, urban design, public health outcomes, environmental impacts, and socio-economic inclusivity. Methods: The research adopts both qualitative and quantitative methods, including field surveys, GIS-based spatial analysis, and stakeholder interviews, to assess the current walkability conditions in five distinct localities across Chennai: Mylapore, Anna Nagar, Velachery, T. Nagar, and Sholinganallur. Parameters such as sidewalk width and quality, pedestrian crossings, street lighting, traffic calming measures, and encroachment levels were analysed. Findings: Findings reveal significant disparities in walkability across neighbourhoods, with high-density and mixeduse areas generally faring better than peripheral or vehicle-dominated zones. One of the central findings of the study is the correlation between improved pedestrian environments and reduced vehicular dependency, which in turn contributes to lower carbon emissions and better air quality. Moreover, walkable environments promote physical activity, thereby addressing growing public health concerns such as obesity, cardiovascular diseases, and mental health issues. Socially, walkable cities tend to be more inclusive, especially for vulnerable populations like children, the elderly, and the economically disadvantaged, who rely heavily on non-motorized transport. Challenges and Recommendations: Despite the benefits, several challenges persist in Chennai's urban fabric that hinder walkability. These include poor maintenance of footpaths, unregulated street vending, encroachments by parked vehicles, insufficient shade, extreme heat, and fragmented governance over transport and land use. The study also highlights the need for integrated planning frameworks that bridge gaps between urban design, mobility planning, and policy implementation. Drawing insights from global best practices and successful Indian initiatives such as the Complete Streets project in Pune and the pedestrian zones in Bengaluru, the paper proposes a set of strategic interventions for Chennai. These include developing pedestrian-priority zones, implementing universal design standards, enhancing last-mile connectivity with public transport, introducing intelligent traffic signal systems for pedestrians, and launching public awareness campaigns to foster a walking culture. Conclusion: The research concludes that enhancing walkability in Chennai is both a feasible and necessary step toward achieving a more liveable, equitable, and environmentally responsible urban future. By reorienting city planning around human-scale mobility rather than vehicular traffic, Chennai can set a precedent for other Indian cities striving to meet the goals of sustainable urban development

Spinal pain is a common musculoskeletal complaint among young adults and is sometimes influenced by lifestyle and behavioral factors. Motorcycles are the most common and convenient means of transportation in India, especially among the younger population. This study aimed to estimate the prevalence of spinal pain among young motorcycle riders and examine the predictors associated with spinal pain, while exploring the statistical mediating role of body mass index (BMI). The study was conducted at a large multidisciplinary higher education institution in India with approximately 60,000 students across 300 programs. As motorcycles are one of the common modes of transport, 422 eligible motorcycle riders were recruited for this study. Data were collected using systematic random sampling, a structured expert-validated questionnaire, and physical measurements. Bivariate and multivariate binary logistic regression model analysis was used to identify factors associated with spinal pain. A bootstrapped mediation analysis was performed to determine the extent to which the mediator variable (i.e., BMI) explained the association between the riding frequency and spinal pain. The overall cumulative prevalence of self-reported spinal pain experienced in the past year was 37.7% (95% CI: 32.7, 42.5). Factors like obesity (AOR 6.24, 95% CI: 1.9, 20.49), being overweight (AOR 2.78, 95% CI: 1.21, 6.37), not engaging in regular physical activity (AOR 2.24, 95% CI: 1.44, 3.48), experiencing fatigue while driving (AOR 2.66, 95% CI: 1.62, 4.42), and being female (AOR 1.87, 95% CI: 1.47, 2.97) were significantly associated with the likelihood of self-reported spinal pain among young motorcyclists in a multivariate logistic model with the level of significance set at 0.05. Furthermore, BMI appeared to partially explain the relationship between bike riding and spinal pain. Spinal pain was common among young motorcycle riders, and it is associated with higher BMI, riding fatigue, and physical inactivity. BMI partially explained the association between riding frequency and spinal pain. The findings highlight the potential importance of healthy body weight, regular physical activity, and addressing riding-related fatigue as part of spinal health strategies among young motorcycle riders.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-026-48458-7.

Background: Neonatal transport is a critical component of neonatal care, particularly in low-resource settings where inadequate transport conditions may contribute to increased neonatal morbidity and mortality. This cross-sectional study aimed to assess knowledge and practices related to neonatal transport among healthcare providers in Eastern Morocco.Methods: This study included healthcare facilities providing care at different levels. A structured anonymous questionnaire created using Google Forms was distributed online. Data was collected between April 1 and April 9, 2026. Statistical analysis was performed using Microsoft Excel (Microsoft Corporation, Redmond, USA).Results: A total of 77 healthcare providers participated in this study. Most participants correctly identified key aspects of neonatal transport, including neonatal stabilization (70/77, 90.9%), thermoregulation (75/77, 97.4%), and recognition of hypothermia (57/77, 74.0%). However, reported practices were less consistent. Only 40 (51.9%) participants consistently performed stabilization before transport, 35 (45.5%) ensured continuous monitoring, and 38 (49.4%) of the 77 participants systematically applied preventive measures against hypothermia. In addition, standard ambulances were the most commonly used means of transport (52/77, 67.5%), while only 20 (26.0%) reported using equipped ambulances.Conclusion: Neonatal transport practices in Eastern Morocco remain inconsistent despite relatively high levels of knowledge among healthcare providers. This gap between knowledge and practice highlights the need for structured training programs and improved transport infrastructure to enhance neonatal outcomes in resource-limited settings.

Abstract The South China Sea Meridional Overturning Circulation (SCSMOC), a key prominent component of the Pacific meridional overturning circulation, features two profound circulation cells (upper and deep cells) in the vertical direction. Variations in the SCSMOC play a significant role in regulating meridional heat transport within the SCS and influencing the broader Pacific Ocean water cycle. For instance, a weakened deep cell inhibits the upwelling of North Pacific Deep Water and hinders water cycling in the Pacific, whereas a strengthened upper cell intensifies northward oceanic heat transport, potentially affecting the climate of Eastern Asia. Using a high-resolution coupled climate model, we identify a strengthening trend of 0.04 Sv·century⁻¹ in the upper cell, equivalent to 3% of its mean transports during 1900–2100. In contrast, the deep cell weakens at a rate of 0.05 Sv·century⁻¹, representing a 20% reduction over the same period. The increased sea surface height difference between the northern and southern Luzon Strait—linked to weaker subtropical wind in a warming climate—leads to a stronger upper-layer inflow into the SCS, thereby intensifying the upper cell of the SCSMOC. In contrast, the more rapid freshening of the Pacific Ocean than the SCS diminishes the deep-layer meridional pressure difference in the Luzon Strait, resulting in a reduced deep inflow and a weakened deep cell of the SCSMOC. Our findings highlight the importance of long-term monitoring of the SCSMOC and comprehensive understanding of associated impacts.

To examine whether group-based medical mistrust predicts willingness to enroll in a rheumatology clinical trial and, among those unwilling, to identify logistical factors that most influence their decision. We conducted a single-center, cross-sectional survey at an academic rheumatology clinic between November 2024 and February 2025. Adults (≥18 years) with physician-confirmed rheumatic disease completed the 12-item Group-Based Medical Mistrust Scale (GBMMS; range 12-60, higher=more mistrust), rated 11 logistical factors on a 7-point scale (1=extremely unlikely to influence, 7=extremely likely), and answered a yes or no item on trial willingness. We assessed GBMMS internal consistency, compared mean mistrust by willingness using Welch's t-test, and fit a univariable logistic regression with GBMMS predicting willingness. Among those unwilling, we ranked logistical factors by mean importance. Forty-seven patients participated (79% women; mean age 49.2 ± 13.6 years); 66% reported willingness to enroll. Mean mistrust did not differ by willingness (willing 24.7 ± 11.6 vs unwilling 25.3 ± 13.4; t26=0.13, P=0.893), and GBMMS did not predict willingness (odds ratio 0.996, 95% confidence interval 0.95-1.05; P=0.89). Among the 16 patients unwilling to participate, the highest-rated influences were the prospect of stopping disease progression (mean 5.38), physician encouragement (mean 4.56), travel or transportation (mean 4.13), and shared language with the doctor (mean 4.13). Group-based medical mistrust did not predict self-reported willingness to join a rheumatology clinical trial. Instead, expectation of concrete disease improvement and personal endorsement by one's treating rheumatologist emerged as the strongest drivers of participation. Recruitment strategies that emphasize realistic potential benefits, incorporate physician-delivered invitations, and address logistics may improve enrollment.

Background: Caregivers’ knowledge of childhood vaccination, including vaccine schedules, doses, and disease prevention, varies widely across settings. In Calabar, there is limited evidence assessing caregivers’ knowledge of childhood vaccination. Objectives: This study assessed knowledge of childhood vaccination and its determinants among caregivers in Calabar South Local Government Area. Methods: A community-based cross-sectional study was conducted among caregivers of children aged 12–23 months in Calabar South LGA using a multistage sampling technique. Data were analyzed with SPSS version 25.0. Descriptive and inferential statistics were applied. Factors associated with caregivers’ knowledge were assessed using multivariate binary logistic regression, with statistical significance set at p&lt;0.05. Ethical approval was obtained from the Cross River State Health Research Ethics Committee (CRSMOH/RP/HRE/2023/401). Results: A total of 460 caregivers participated in the study out of which 395(85.9%) were females while 65(14.1%) were males. Overall, caregivers’ knowledge of vaccine-preventable diseases was poor. Knowledge of diseases prevented by BCG, OPV, yellow fever, and pentavalent vaccines was 28.5%, 20.9%, 14.4%, and 8.2%, respectively. Health facilities were the main source of vaccine information (29.1%), followed by radio (17.9%) and home visits (14.3%). Caregivers’ age, relationship with the child, education, and occupation were significantly associated with knowledge. Vaccine timeliness, educational level, and means of transport to health facilities were significant predictors of knowledge of childhood vaccination. Conclusion: Caregivers’ knowledge of childhood vaccination was poor. Strengthened health education campaigns are needed to improve awareness and support for childhood vaccination.