Spontaneous intracranial hypotension (SIH) profoundly affects quality of life. We aimed to identify and quantify various aspects of patients' experiences with SIH. We piloted an "SIH Impact Inventory," a cross-sectional survey developed in collaboration with patients, family members, and caregivers. Potential participants were identified from a single center using diagnosis and procedure codes. Participants completed the inventory online using REDCap between December 2021 and April 2022. Ninety-eight adult patients completed the inventory. The mean age was 50.6 years, and 69.4% were female. Sixty-three percent had a confirmed diagnosis of SIH, and 36.7% had clinically suspected but unconfirmed SIH. The mean time to diagnosis was 2.0 (interquartile range: 0.5-4.8) years; 25.5% went undiagnosed for 5 or more years, and 75% were initially misdiagnosed. The 3 most common symptoms were head pain, neck pain, and "brain fog." Of those undergoing epidural blood patch procedures, 22% experienced relief of symptoms for a median time of 1.3 months; those with a confirmed diagnosis had more prolonged relief. 58.2% reported experiencing rebound intracranial hypertension after a therapeutic procedure. Surgical repair of the leak was most likely to result in a symptom-free status (p = 0.003) than nonsurgical treatments. Of those working for compensation when they developed SIH, 95.2% indicated that the condition affected their ability to work and 65.1% stopped working. The financial burden was substantial for 65.3% of our cohort, with medical expenses (98.4%) and travel for health care (65.6%) being the most prevalent expenses. SIH negatively affected personal and family relationships for most patients. Individuals with confirmed and suspected SIH experience difficulties related to the disorder itself and the lengthy process of diagnosis and treatment. Our findings demonstrate the marked impact of SIH on employment, education, interpersonal relationships, and finances. Compared with previous studies, our cohort reported considerable cognitive difficulties, with rates approaching those of head pain. Heightened awareness of SIH, referral to a center with expertise in SIH, increasing the number and geographic distribution of SIH centers, and advances in diagnostic and treatment modalities can help alleviate some of the challenges that patients face.

The worldwide acceleration of digital transformation in healthcare underscores the need for professionals to continuously adapt and sustain robust digital health competence, shaped not only by individual characteristics and institutional environments but also by broader social, cultural, and geopolitical factors. This study aimed to identify distinct clusters of digital health competence among healthcare professionals across 19 diverse countries and regions, and to examine the factors influencing the development and distribution of these competence clusters. A cross-sectional international survey study was conducted between 2023 and 2024, using a validated survey instrument measuring digital health competence and its influencing factors. Data were collected from healthcare professionals in 19 countries and regions (n=6440; n=5945 used for this study), following a harmonised protocol with shared demographic templates and instruments. K-means cluster analysis was employed to derive digital competence profiles, with comparative analyses conducted to investigate associations between the identified clusters and individual characteristics (e.g., age, education, professional experience). Five distinct clusters of digital health competence were identified: (1) Beginners, (2) Developing Professionals, (3) Emerging Users, (4) Proficient Practitioners, and (5) Pioneers. Higher competence clusters (4 and 5) were associated with younger age, higher education, hospital-based work, and stronger perceived support from management, organisational structures, and colleagues. In contrast, lower-performing clusters reported limited digital engagement and minimal support. Perceived leadership influence, particularly managerial commitment to digital change, was a key differentiator across clusters. The findings demonstrate substantial variation in digital health competence across healthcare professionals internationally. Cluster-specific strategies, such as targeted upskilling, peer mentoring, and leadership engagement, are needed to address competence gaps. The results provide a foundation for policy development and workforce training frameworks aimed at strengthening digital readiness in global healthcare systems. Future research should explore longitudinal competence development and evaluate targeted interventions.

ABSTRACT Family‑centric wellness travel addresses both parents’ physical and psychological well‑being (e.g., stress reduction, rejuvenation) and children’s developmental needs (e.g., health, learning, and entertainment), and has been growing in popularity in recent years, reflecting a broader societal shift toward integrated family health and holistic lifestyle tourism. While wellness tourism has been well researched, there is a gap in understanding the specific products in wellness destinations that meet the needs of families with children on wellness vacations. Guided by an expanded push-pull framework, this qualitative study examines the relationship between motivation and product in this context through semi-structured interviews with 52 Chinese families. It identified how different products that rely on natural resources, cultural resources, and services can fulfill the complex motivations of the family members. Theoretically, this study fills a gap by introducing the family perspective into wellness tourism research and expands the push-pull motivation dimension in family tourism theory. Practically, this study also mapped the products of specific family wellness tourism destinations, provided practical guidance for developing product designs for wellness tourism destinations.

The role of public health interventions in modifying associations between prenatal exposures to ambient air pollution and extreme heat with child health outcomes: A systematic review.

Dementia, a progressively debilitating neurodegenerative disorder, poses a growing challenge to global healthcare due to its subtle early onset and lack of accurate temporal diagnostic models. Traditional machine learning (ML) approaches for dementia prediction, including SVMs, Random Forests, and CNNs, often rely on static, cross-sectional data that fail to capture the progressive cognitive decline observed in real-world patient trajectories. To address these limitations, this study introduces a novel deep learning-based framework TCBiNet (Temporal Convolutional Bidirectional Attention Network) designed to model both short- and long-term symptom evolution using sequential clinical data. The architecture strategically integrates Temporal Convolutional Networks (TCN) to identify localized trends, BiLSTM for bidirectional temporal analysis, and a Temporal Attention mechanism to highlight critical symptom intervals. Implemented in Python using TensorFlow 2.11, the model processes longitudinal data from 2,149 patients aged 60-90, with cognitive, behavioral, and functional metrics segmented into 30-day intervals. Compared to conventional models such as CNN-LSTM and BiLSTM-DRL, TCBiNet demonstrated superior performance, achieving an accuracy of 99.51%, F1-score of 99.35, and AUC-ROC of 0.990 reflecting an improvement of over 4.4% in accuracy and 6.2% in F1-score relative to the best-performing existing models. This significant gain is attributed to the model's capacity for temporal pattern mining and attention-guided symptom weighting. The proposed system not only improves prediction accuracy but also enhances interpretability and clinical relevance. By offering a robust, sequence-aware diagnostic tool, this research paves the way for proactive interventions in dementia care, encouraging further exploration into longitudinal neurocognitive modeling for early disease detection.

Background: Despite the growth of wellness tourism, few studies have empirically examined healing as a multidimensional construct within the Hybrid Wellness Tourism model, integrating traditional, modern, and digital practices. The distinction between wellness tourism, healing tourism, and Hybrid Wellness Tourism remains underexplored, particularly in the context of Indonesian local wisdom. Objective: This study aims to empirically validate a multidimensional healing construct within the Hybrid Wellness Tourism framework, examining its impact on revisit intentions at local wisdom-based wellness destinations in Indonesia. Methods: An explanatory quantitative approach using Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed. Data were collected from 312 wellness tourism participants in Java, Indonesia, utilizing structured questionnaires and focusing on four dimensions of healing experiences: Anticipated, Embodied, Interactive, and Reminiscence Healing. Results: The findings show that Healing Tourism Experience significantly influences revisit intentions, with an R² of 0.64. Embodied Healing (β = 0.34) and Reminiscence Healing (β = 0.29) had the strongest effects, followed by Interactive (β = 0.18) and Anticipated Healing (β = 0.14). The Hybrid Wellness Tourism framework, integrating traditional, modern, and digital elements, proved to be a strong predictor of destination loyalty. Conclusion: This study expands wellness tourism literature by validating a multidimensional second-order healing construct. It highlights the importance of physical, emotional, and post-trip reflective experiences in fostering tourist loyalty, offering practical implications for destination managers to design immersive wellness experiences, integrate digital technologies, and involve local communities to enhance sustainability and revisit intentions.

To assess the clinical effectiveness, safety, technical feasibility, and challenges of remote robotic surgery in general surgery, gynecology, orthopedics, and urology, focusing on issues like communication technology, ethics, and cost. Relevant reports on remote robotic surgery were retrieved from databases such as PubMed, EMbase, Web of Science, Cochrane Library, VIP, CNKI, and Wanfang (2001-2025). Literature quality was evaluated using tools from the Joanna Briggs Institute (JBI). A total of 26 articles were included (13 in Chinese, 13 in English) covering general surgery, gynecology, orthopedics, urology, and thyroid surgery. The results showed that the average operation time was slightly longer than that of traditional methods (about 10-30min), but the safety was good. Most studies had communications backup plans, such as backup networks or local physician take-overs, to deal with the risk of disruption. Tele-robotic surgery has a high success rate and accuracy with controllable network latency, showing the potential to expand access to medical resources, especially in remote areas. However, it still faces challenges such as network stability, equipment cost, operation accuracy, data privacy, and ethical issues. Most of the included studies reported successful cases, and there was a lack of in-depth analysis of failure cases or adverse outcomes of patients, which may have publication bias. Despite challenges, remote robotic surgery shows promise in overcoming geographical and resource limitations. The quality of current evidence is low, with serious methodological limitations and reporting bias. The establishment of international mandatory registration systems, standardized safety protocols, and transnational collaboration networks are urgent to promote this field from "proof of concept" to "clinical practice". But, with continuous technological advancements, it is expected to play an increasingly significant role in global healthcare.

This study explores how the multifaceted servicescape of wellness hotels influences customers’ intentions to revisit and recommend, with customer satisfaction acting as a mediating mechanism. Drawing on the Stimulus–Organism–Response (S-O-R) model and experiential marketing theory, this study conceptualizes servicescape across four dimensions: sensory, social, wellness-related activities, and cultural experiences. Survey responses were gathered from 483 Korean adults who had visited a wellness hotel within the last six months. The data were processed using SPSS (version 27.0) and AMOS (version 23.0). Findings suggest that while sensory, social, and wellness activity experiences have a significant positive impact on satisfaction, cultural experience does not yield the same effect. Satisfaction mediates both revisit and recommendation intentions. Moreover, multi-group analysis confirmed that wellness interest moderates the influence of sensory and wellness activity experiences on satisfaction. Notably, individuals with a high interest in wellness report increased satisfaction through active participation in wellness programs, whereas those with low wellness interest show greater responsiveness to sensory aspects. Theoretically, this study contributes to the existing body of literature by embedding wellness psychology and sustainable development goals (SDGs 3 and 12) into servicescape research. In terms of managerial implications, this study emphasizes the need for wellness hotels to improve sensory-based designs and experiential service quality, while also segmenting their strategies based on customers’ wellness profiles. By presenting an integrated model that connects experiential value, satisfaction, and behavioral intention, this study provides deeper insights into sustainable wellness tourism from both academic and practical perspectives.

Digital marketing strategies for sustainable medical tourism development: a framework for emerging destinations

Abstract The accuracy and acceptability of clinical guideline translations from English to various languages are critical to global healthcare, enabling medical practitioners in regions such as China to implement evidence-based recommendations effectively. Despite recent advancements in generative AI translation (GenAIT), its reliability in this specialized domain of clinical translation remains underexplored. This study assesses the necessity of human post-editing (PE) in improving GenAIT outputs of English-to-Chinese (E-C) clinical guideline translations and investigates its impact on readers' cognitive load. Clinical guidelines were translated using ChatGPT 3.5 and DeepSeek, then manually post-edited by professional translators. Errors were collected and categorized, revealing frequent semantic errors (42.6%), followed by syntactic (38.6%) and pragmatic (18.8%) issues. A qualitative assessment using a modified NASA-TLX scale demonstrated that post-editing significantly enhanced translation accuracy and reduced cognitive load, thereby improving comprehension. These findings underscore the value of integrated AI-human workflows, demonstrating that combining GenAIT's computational efficiency with expert PE is crucial for producing reliable, high-quality clinical translations.

The reality of rising greenhouse gas emissions and global temperatures underscores the urgency of transitioning to a net-zero energy system. Modern radiotherapy contributes to the total healthcare domain emissions. As the global incidence of cancer rises, expanding treatment capabilities is critical. However, sustainability in high-emission healthcare disciplines is equally paramount. This paper explores the academic knowledge base and practical strategies for understanding and managing emission contributions to align with sustainability goals. The European Union's Corporate Sustainability Reporting Directive and climate disclosure frameworks in Australia and New Zealand require certain organisations, including large hospitals and radiotherapy networks, to report their direct and indirect emissions. Climate disclosure frameworks emphasise transparency and resilience to climate risks, supported by methodologies such as the Greenhouse Gas Protocol and ISO 14064. The study narratively examines existing literature and practical solutions through engaged scholarship and provides insights into modelling radiotherapy emissions guided by the principles of the Corporate Sustainability Reporting Directive. Radiotherapy emissions are a small but significant share of healthcare emissions, with indirect emissions dominating. They are estimated at 6.75 Mt. CO2e, accounting for approximately 0.3% of global healthcare emissions. While sustainable construction and innovative technologies reduce upstream impacts, downstream greenhouse gas reductions remain limited despite travel minimisation efforts. By advancing sustainability in radiotherapy, this work contributes to the broader healthcare sector's efforts to mitigate climate impacts and aligns with international climate commitments.

Wellness tourism represents a significant growth sector within the global tourism industry; however, empirical research examining development determinants in resource-constrained, emerging African destinations remains limited. This study investigates the structural relationships among infrastructure development, community involvement, marketing and promotion, and visitor expectations/service quality in advancing wellness tourism at Allelobad Hot Spring in Ethiopia’s Afar Region. Using a quantitative methodology, structured questionnaires were administered to 210 respondents (visitors, local community members, and tourism stakeholders), resulting in 186 valid responses. Data were analyzed through Confirmatory Factor Analysis (CFA) and Partial Least Squares Structural Equation Modeling (PLS-SEM). Results demonstrate that all four determinants exert statistically significant positive effects on wellness tourism development (p < 0.001), with visitor expectations and service quality emerging as the strongest predictor (β = 0.35), followed by infrastructure development (β = 0.32), marketing and promotion (β = 0.30), and community involvement (β = 0.27). The structural model explains 68% of the variance in wellness tourism development, indicating substantial explanatory power. These findings underscore that sustainable wellness tourism growth in emerging destinations necessitates integrated, multidimensional strategies that simultaneously address physical infrastructure, stakeholder engagement, strategic positioning, and experiential excellence, rather than isolated sector-specific interventions.

ABSTRACT Composite smart contracts coordinate vaccine supply chains, where multiple contracts run in parallel and inputs are uncertain. Existing verification tools typically capture concurrency while assuming crisp inputs, or handle uncertainty while omitting explicit interactions among contracts. This separation reduces detection power and weakens formal guarantees under realistic noise and interleavings. A fusion of Fuzzy Logic (FL) and Colored Petri Nets (CPN) (FL–CPN) models both aspects in one framework. The FL layer converts uncertain measurements into crisp scores; the CPN layer encodes places, transitions, colors, and guards; integration maps scores to token colors and guard enabling so that fuzzy outcomes drive execution. This enables formal verification and vulnerability analysis of composite smart contracts under uncertainty and concurrency. Contributions are: (1) a formal FL–CPN integration with algorithms and execution semantics; (2) a verification workflow covering safety, liveness, and reachability with attack path tracing; (3) case studies on counterfeit insertion and temperature log tampering with rule driven token flows and mitigations; (4) an empirical comparison against CPN, FSM, and NuSMV using 10‐fold cross‐validation and standard metrics. Across folds, the approach achieves precision 0.9828–0.9937, specificity 0.964–0.988, sensitivity 0.973–1.000, accuracy 0.9758–0.9933, and F 0.9733–0.9908. The method extends to other supply chains and multi‐party blockchain workflows that combine uncertain evidence with concurrent contract interactions.

Pulmonary fibrosis (PF) caused by interstitial lung diseases (ILDs) affects up to 0.1% of the global population. There is growing global interest in PF, evident from a nearly threefold increase in PF-related research publications over the last 15 years. Idiopathic PF, connective tissue disease-related ILD, sarcoidosis and hypersensitivity pneumonitis rank as the top four causes of ILD-related PF, in descending order of incidence. This article explores the variation in global incidence and prevalence, genetics, diagnostic pathways, treatment approach, care gaps and recent advances in PF management. The global annual incidence of ILD-related PF has more than doubled between 1990 and 2019; conservative estimates suggest current incidence of about 15-20 cases per 100 000 population. The incidence, prevalence and spectrum of ILD-related PF vary greatly across regions based on genetics, environment, industries and diagnostic rigour. Diagnosis of PF hinges on chest imaging, lung histology and expert evaluation, which remain scarce in underserved regions. About 30-60% of patients with ILD-related PF develop progressive disease over 1-2 years. Annual PF care cost averages approximately US$30 000 in developed countries. Although significant gaps remain in PF care globally, recent progress is encouraging. Key steps to enhance PF care include ensuring universal health coverage via public systems or insurance, improving access to imaging and expert diagnostic teams, incorporating telehealth technologies, accelerating drug development and expanding the availability of pulmonary rehabilitation, palliative care and lung transplantation. Emerging techniques such as gene silencing, alveolar organoids, stem cells, lung-on-a-chip and nano-based drug delivery could transform PF care in the future. PF is an important global healthcare challenge, especially due to its clinical heterogeneity and geographic variation. Gaps in care need to be addressed by prioritising new drug development and ensuring wider dissemination of PF-related awareness and services.

Background: The escalating prevalence of chronic non-communicable diseases (NCDs), including diabetes mellitus, cardiovascular diseases, and neurodegenerative disorders, presents a significant challenge to global healthcare systems. The traditional paradigm of episodic, reactive care is increasingly proving insufficient. Consequently, a digital transformation is underway, characterized by the adoption of Continuous Monitoring (CM) technologies such as Continuous Glucose Monitoring (CGM), remote Electrocardiography (ECG), and wearable biosensors. Objectives: This narrative review aims to provide a comprehensive overview of emerging trends in continuous monitoring technologies from 2020 to 2025. Specifically, it evaluates the impact of these technologies on treatment adherence and Quality of Life (QoL), analyzes the integration of Artificial Intelligence (AI) and Digital Twins, and identifies sociotechnical barriers to widespread implementation. Methodology: A rigorous narrative review was conducted based on a systematic search of high-impact literature. Thirty two key studies, including systematic reviews, meta-analyses, and technical frameworks, were synthesized to explore the intersection of technological innovation (IoMT, AI) and social science dimensions (behavioral change, patient empowerment, and equity). Results: Current evidence indicates that CM technologies significantly improve clinical outcomes, including HbA1c reduction in diabetes and decreased hospital readmission rates for heart failure. However, the impact on QoL is bidirectional: while fostering empowerment and safety, continuous surveillance can also induce anxiety and symptom preoccupation. Novel frameworks like Digital Twins and AI-driven predictive analytics offer promising avenues for personalized medicine but raise ethical and privacy concerns. Conclusion: Continuous monitoring serves as a critical enabler of proactive health management. Future advancements must prioritize user-centered design, interoperability, and equitable access to realize the full potential of these technologies in improving societal health and well-being.

Cloud Computing and the Internet of Things play pivotal roles in advancing the healthcare system through enhanced observation mechanisms. These mechanisms can be implemented using various algorithms, including the Sparrow Search Algorithm (SSA), Goal Programming Algorithm (GPA) and Reptile Search Algorithm (RSA) etc. Task scheduling is one of the major challenges in cloud computing, as solving this problem requires reducing costs while meeting deadlines. Efficient task scheduling is essential to optimize resource utilization and ensure timely completion of tasks. To overcome this challenge, this study presents an innovative algorithm named Adaptive Parameter Control Reptile Search Algorithm (APC-RSA) which is designed to optimize healthcare tasks scheduling by achieving a balance between time and cost as well as ensuring tasks completion within deadlines. The performance of APC-RSA is driven by dynamic parameter adjustment that balances exploration and exploitation during optimization. This study evaluates the effectiveness of APC-RSA demonstrating the significant improvements over existing algorithms like SSA, GPA and RSA. Experimental results indicate that APC-RSA achieves a minimized cost of 17,061.68 with a 99.83% task success rate. In comparison, RSA achieves a cost of 45,821.17 with a 99.70% success rate, SSA achieves a cost of 50,411.52 with a 99.67% success rate, and GPA incurs a cost of 138,448.73 with a 95.37% task success rate. The findings suggest that APC-RSA has the potential to significantly enhance cloud task scheduling in the healthcare sector, offering a cost-effective and reliable solution to improve global healthcare systems.

The article examines the essence, structure and justification of measures to ensure decent work and economic growth of businesses in the health and recreation sector based on sustainable development principles. The health and recreation sector is an inter-sectoral complex that covers activities related to temporary accommodation, catering, healthcare and leisure organisation, grouped into different sections according to the 2010 Classification of Economic Activities. The key objectives of ensuring decent work and economic growth in the health and recreation sector based on sustainable development have been substantiated. The economic objective is to ensure sustainable growth and competitiveness of businesses in the health and recreation sector. The social goal is to ensure decent work and the accumulation of human capital in the health and recreation business. The environmental goal is to ensure environmental efficiency and minimise the negative impact of business on the environment. It was concluded that ensuring decent work and economic growth of businesses in the health and recreation sector should be based on sustainable development by integrating target benchmarks in social, economic and environmental dimensions. Economic growth of businesses in the health and recreation sector should be based on diversification of services (medical tourism, year-round occupancy) and resource efficiency to increase competitiveness and reduce operating costs. Ensuring decent work in the health and recreation sector is based primarily on providing formal employment, setting competitive wages and increasing investment in staff professional development. It is advisable to develop clustering and localisation of value chains in the health and recreation sector, which will create synergies for all participants in the health and recreation services market. Sustainability in the health and recreation sector should be achieved through synergy between financial stability of businesses, social protection of employees and their environmental responsibility.

Background: Adverse Drug Reactions (ADRs) remain a critical challenge in clinical therapeutics, significantly impacting global morbidity, mortality, and healthcare costs. In the Indian context, the Pharmacovigilance Programme of India (PvPI) serves as the primary regulatory framework for identifying and mitigating these risks.  Objective: This study aimed to evaluate the incidence, clinical patterns, and severity of suspected ADRs, perform rigorous causality assessments, and implement a structured pharmaceutical counseling framework to enhance medication safety in a tertiary care setting.  Methodology: A prospective, non-interventional observational study was conducted across the Inpatient Departments (IPD) of Orthopedics and General Surgery at Arunai Medical College and Hospital (October 2025–February 2026). Out of 728 screened patient records, suspected ADRs were documented using the CDSCO reporting tool. Causality was validated via the WHO-UMC scale and Naranjo’s Probability Scale, while severity was stratified using the Modified Hartwig and Siegel Scale.  Results: A total of 80 ADRs were identified, representing an incidence rate of 10.98%. Demographic analysis revealed a male predominance (63.75%) and a higher susceptibility within the geriatric and middle-aged cohorts (mean age: 53.6 \pm 21.1 years). Antimicrobials (23.75%) and Analgesics (15%) were identified as the primary pharmacotherapeutic triggers. The most frequent clinical manifestations were gastrointestinal (39.2%), with constipation being the predominant symptom. Severity assessment categorized 56.25% of reactions as "Mild" and 43.75% as "Moderate." Causality analysis classified the majority of cases (66.25%) as "Probable."  Conclusion: The study underscores a notable ADR burden in surgical and orthopedic settings, frequently exacerbated by polypharmacy. These findings advocate for an integrated pharmacovigilance approach—led by clinical pharmacists— emphasizing active surveillance and patient education to pre-emptively manage medication-related risks and optimize therapeutic outcomes.

Objectives Despite its established efficacy and safety, and wide international use, there is currently limited experience of the CI632 cochlear implant system (Cochlear™ Nucleus ® CI632 Profile™ Plus Implant with Slim Modiolar Electrode) in China. The aim of this study was to evaluate the performance and safety of the CI632 system in a Chinese population and gain insights from surgeons implanting this device in a real-world setting. Methods This prospective, real-world observational study enrolled children and adults with bilateral moderate sloping to profound sensorineural hearing loss who were identified as candidates for the CI632 system. Participants traveled to the Bo'ao Lecheng International Medical Tourism pilot area for implant surgery, which was performed by experienced cochlear implant surgeons at the Bo'ao Super Hospital. Participants returned to their home province for activation of the device and follow-up management, performed at clinics located across mainland China. Hearing performance was evaluated pre- and post-operatively (3 and 6 months after activation of the device) using aided 4-frequency pure tone thresholds (PTA4 at 500, 1000, 2000, and 4000 Hz) and age-appropriate functional listening questionnaires. At the time of surgery, cochlear implant surgeons completed a survey that assessed ease of implantation and satisfaction with the CI632. Results Participants ( n = 25; 18 males, 7 females) were aged between 2 and 62 years (mean 22.6 years). All participants tested were able to access the speech spectrum for PTA4 (500, 1000, 2000, and 4000 Hz) at 6 months post device activation. Improvements in hearing thresholds were evident at 3 and 6 months post device activation [mean within-subject improvement in PTA4 from best-aided baseline: 30 dB (95% confidence interval 34.5, 25.4) at 6 months]. Hearing function as measured with age-appropriate questionnaires showed mean improvements from baseline at both 3 and 6 months post device activation for both adults and children across all domains assessed. No surgical complications were reported. Six mild ear-related adverse events were reported during follow up, all resolved during the study. Surgeons ( n = 4) gave high ratings for the ease and satisfaction of the surgical procedure with the CI632 implant, and all surgeons indicated they would consider using this device in future surgeries. Conclusion This real-world, observational study demonstrated the safety and hearing performance achieved in children and adults with the CI632 implant system when implemented via a representative cochlear implant-management setting in China (travel to a central location for surgery with device activation and follow up at local clinics in mainland China). Surgeons reported high levels of confidence and satisfaction with device insertion. Improvements in hearing function and audiometric outcomes were demonstrated across a wide age-range of participants at 3 and 6 months post activation.

Nurse practitioners (NPs) play a critical role in meeting global health care needs, yet their job satisfaction varies across countries because of differences in regulation, role clarity, and organizational support. Although numerous studies have examined NP job satisfaction within individual nations, cross-national evidence remains limited. To systematically review and meta-analyze international evidence on NP job satisfaction and to examine subgroup differences based on demographic and professional characteristics. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Nursing and Allied Health, PubMed, the Cochrane Library, and 2 Chinese databases for studies published between 2014 and 2024. Ultimately, 35 studies involving 36,756 NPs were included. Because the Misener Nurse Practitioner Job Satisfaction Scale is the most widely used and consistently reported cross-national instrument, it was selected as the common metric for pooling outcomes. Consequently, 15 studies using this scale contributed to the cross-national meta-analyses. Job satisfaction differed significantly across countries, with the highest levels observed in the United States, followed by Taiwan and Canada. Subgroup analyses revealed no significant differences by sex or educational attainment, and substantial heterogeneity was present. Overall, structural and organizational contexts-rather than demographic factors-appear to shape international variation in NP job satisfaction. These findings underscore the need for clearer role definitions, standardized measurement approaches, and stronger structural support to inform workforce planning and sustain the NP profession globally. Strengthening regulatory support, expanding practice autonomy, and improving organizational resources may enhance NP retention and job satisfaction across diverse health care systems.