Effective July 2022, kidney transplant centers were required to adjust waiting time for Black candidates using a new race-neutral eGFR (estimated glomerular filtration rate) calculation. Little has been reported about the impact and limitations of this policy change on transplant access for Black patients. A retrospective, single-center, cross-sectional study was performed in 04/2024 on adult (> 18years) kidney transplant candidates who were eligible for wait-time modification. Clinicodemographic data and adjusted dialysis start dates were extracted from the medical record. Descriptive statistics were performed. A total of 274 Black patients were eligible for a wait-time modification. Of these, 26 (9.5%) had been delisted, nine (3.3%) were deceased, 26 (9.5%) were already transplanted, and 104 (38.1%) did not have the required laboratory documentation available. In total, 109 (39.8%) candidates ultimately received wait-time modifications. Of the 109, mean age was 56years old and 47 (42.7%) were female. Mean wait-time gained was 2.7years (median, 1.7years; range, 1month-21years). Total wait-time gained by Black patients at this center was 298.5years. Patients who did not receive time back were more likely to have recent bloodwork from maintenance dialysis as the source of evaluated laboratory data (52.7% vs. 33.0%) (p < 0.001). Removing race from the eGFR calculation expanded transplant access for Black patients with eligible patients receiving an average of 2.7years of additional wait time at a large metropolitan center. However, wait-time recovery was limited by the availability of laboratory data, indicating that assistance with finding older lab values may help realize the full potential of this policy.

This study examined how resource mobilisation practices influence the viability of academic programs in private universities located in resource-constrained regional contexts, using evidence from Fort Portal City, Uganda. While private universities play a critical role in expanding access to higher education, empirical evidence on how governance- and relationship-based resource strategies sustain academic programs at the sub-national level remains limited. Grounded in Resource Dependence Theory, Resource Governance Theory, and the Institutional Capacity Model, the study assessed the influence of stakeholder engagement, partnership effectiveness, and financial resource mobilization on academic program viability, defined in terms of sustainability, relevance, quality assurance, staffing continuity, and curriculum resilience. An exploratory sequential mixed-methods design was employed, involving qualitative interviews with senior university leaders and managers, followed by a survey of academic and administrative staff across the two private universities operating in Fort Portal City. Quantitative data were analysed using descriptive statistics and multiple regression analysis, while qualitative data were analysed thematically. The findings indicate that partnership effectiveness is the strongest predictor of academic program viability (β = 0.437, p &lt; 0.001), followed by stakeholder engagement (β = 0.259, p = 0.006) and financial resource mobilisation (β = 0.230, p = 0.002). Together, these factors explain 25.2% of the variance in academic program viability. Qualitative evidence reinforces these results, revealing heavy dependence on tuition fees, governance rigidities, and the central role of external partnerships in sustaining specialised and practice-oriented academic programs. The study concludes that academic program viability in regional private universities is shaped less by the volume of financial resources and more by governance quality, partnership functionality, and institutional capacity to deploy resources strategically. Practically, the findings underscore the need for formalised partnerships, decentralised resource governance, and capacity-building strategies tailored to the realities of private universities operating outside major metropolitan centres.

Understanding the impact of the metropolitan center structure on commuting distance is essential to effectively reduce commuting costs and promote urban sustainable development. Current literature on the relationship between the center structure and commuting distance is controversial and overlooks the influence of the functional dimension. This study uses massive commuting data provided by Baidu Maps and proposes a three-step method to explore this issue; first, identifying the metropolitan employment centers based on density clustering; second, characterizing the center structure from morphological and functional perspectives; third, analyzing the relationships between commuting distance and the characteristics of center structures from three perspectives of spatial heterogeneity. The results show that the center structure has a significant effect on commuting distance, demonstrating spatial heterogeneity. The number of centers and center commuting flow symmetry have no significant impact on commuting distance, while the increases in center equilibrium (CE), center intensity, and center independence shorten the average commuting distance. A higher center contact intensity is related to a longer commuting distance in metropolitan areas. Moreover, influence factors and their effects on commuting distance vary among the central system, administrative system, and distance groups, in which CE exhibits negative correlations in most instances. These findings can provide valuable insights to policymakers to conduct commuting-cost-reducing-oriented regional planning.

ABSTRACTBackground and AimEpidemiological data suggest a greater risk of inflammatory bowel disease in first‐ and second‐generation migrants from a low to high prevalence country, with the risk of ulcerative colitis (UC) preceding Crohn's disease. This study evaluated demographic trends and outcomes of UC and acute severe ulcerative colitis (ASUC) hospitalizations in an area with an expanding multicultural population.MethodsDemographic and disease characteristics of patients admitted with UC and ASUC at a tertiary metropolitan center from January 2016 to December 2024 were recorded. Trends in presentation and 12‐month outcomes in ASUC patients of European and non‐European descent were compared.ResultsOf 218 patient admissions with UC, 158 admissions met criteria for ASUC. A sixfold increase was seen in yearly admissions for UC (8 in 2016 to 48 in 2024) and ASUC (6 to 39, p < 0.001 for both). A total of 111 (50.9%) of patients hospitalized with UC, and 81 (51.2%) of patients with ASUC, were of European descent. Patients of non‐European descent comprised an increasing proportion of hospitalized patients with UC (32.1% from 2016 to 2019 to 47.5% from 2020 to 2024, p = 0.047) and ASUC (not statistically significant: 28.9% to 51.0%, p = 0.076). No differences in disease severity, length of stay, 12‐month readmission or colectomy rates were noted between European and non‐European descent patients.ConclusionsA significant rise in hospitalizations for UC and ASUC, with an increasing proportion of patients with UC of non‐European descent. There were no significant differences in clinical outcomes in ASUC admissions in patients of non‐European descent compared to European descent.

The prevalence of dementia cases within post-acute rehabilitation hospitals in Canada poses a unique challenge due to the distinctive vulnerabilities of the patient demographic in these settings. Healthcare staff in rehabilitation hospitals receive limited formal education about responsive behaviours. To address a practice gap, a program evaluation of the Gentle Persuasive Approaches (GPA) in Dementia Care education program was implemented at an inpatient rehabilitation hospital in a large metropolitan centre. A multiple method, pre-post intervention design was used to assess the impact of GPA classroom sessions on staff capacity for providing person-centred dementia care. Eighty-eight staff members attended GPA sessions and completed quantitative and qualitative evaluation measures of dementia care self-efficacy and knowledge both pre- and post-intervention. Paired t-tests and reflexive thematic analysis were used to compare pre- and post-intervention scores and responses. Quantitative findings revealed that after attending GPA sessions, participants showed significant improvements in both self-efficacy and knowledge scores relative to baseline. At 6-8 weeks post-intervention, significant improvements in self-efficacy were sustained. Qualitative responses before the intervention showed that during situations involving escalating responsive behaviours, participants relied upon basic strategies to regulate their own emotions and provide person-centred approaches with variable success. In contrast, 6-8 weeks after GPA education sessions, participants identified and described responsive behaviours by relating them to the unmet need that needed to be addressed. Participants then reported successful application of tailored non-pharmacological approaches with confidence and skill at the point of care. GPA dementia education improved staff capacity to provide compassionate and effective care to individuals with dementia. No patient or public contribution.

ABSTRACT Existing studies suggest that remote work may encourage employees to reside farther from workplaces because of reduced commuting frequency, potentially offsetting benefits through longer trips. This study introduces a novel partial equilibrium model demonstrating that teleworkers’ residential preferences depend critically on telecommuting intensity (remote days) and a land price gradient threshold. For flatter decay rates, hybrid telecommuters prefer closer proximity to metropolitan centres for social facilities and trip frequency, while full-time telecommuters relocate farther, suggesting that ‘telesprawl’ may not occur uniformly. Crucially, hybrid employees exhibit a more substantial vehicle miles travelled (VMT) rebound effect under steeper land price decay than full-time teleworkers. This leads them to reallocate farther from urban cores, undertaking longer and more frequent trips that erode the benefits of commute reduction. These findings are empirically validated through a 2019–2024 London case study, providing a theoretical foundation for work-from-home preferences and indirect relocation motivations. This study clarifies residential shifts under hybrid work and outlines the strategies for managing this ‘new normal. Highlights Hybrid work encourages residential relocation closer to city centres. Full-time telecommuting leads to suburban sprawl and longer trips. Vehicle miles travelled (VMT) depend on land price decay rates. Hybrid workers have higher trip rates than full-time remote workers. London case study shows hybrid work can reduce total city travel.

Purpose Rural applicants to medical school are known to be disadvantaged, given their observed poorer performance on most selection measures. This study aims to examine performance differences of rural and metropolitan applicants on all UCAT-ANZ (University Clinical Aptitude Test in Australia and New Zealand) subtests and overall, as well as explore whether increasing rurality is associated with poorer performance. Methods Retrospective repeated cross-sectional study of all UCAT-ANZ applicants between 2019 and 2023, stratified by rurality according to the Modified Monash Model. Six performance scores of the UCAT-ANZ were assessed: verbal reasoning, abstract reasoning, decision making, quantitative reasoning, situational judgement and aggregate cognitive score. Results Rural origin applicants consistently achieved lower scores compared with the metropolitan origin applicants across all five years and most test components, with quantitative reasoning and abstract reasoning having the largest differences. Most test scores consistently decreased with each rurality level, even after accounting for key socio-economic and demographic differences. Additionally, the gap between metropolitan and rural applicants increased for decision making, quantitative reasoning, abstract reasoning and overall. The largest decrease in scores between rurality categories occurred for metropolitan and large regional centre applicants, with scores generally decreasing with each subsequent rurality category. Conclusions There remains a substantial disadvantage for rural applicants completing standardised tests for selection into medical school, and this worsens with increasing rurality. The performance gap between rural and metropolitan applicants has somewhat widened in the last five years, emphasising the need for immediate action to help address rural disadvantage within medical school selection. Failure to address this risks selection not aligning with social justice principles. Key actions include increased efforts from an earlier age to better support rural applicants, decreased reliance on these tests for selection decisions, or decreased direct competition between rural and metropolitan applicants through the use of quotas or separate tiers.

Abstract Background Tissue transglutaminase antibodies (tTG-IgA) are the primary tool for celiac disease (CeD) screening, can be incorporated into a formal diagnosis of CeD without the need for biopsy-confirmation, and are recommended for subsequent monitoring of disease status. However, it remains understudied how frequently children are further tested after an initial positive result. Methods Administrative data from Alberta, Canada were utilized to identify children with their first positive tTG-IgA result between 2016 and 2023. Children were stratified according to baseline result: low (1.0-2.9× the upper limit of normal [ULN]), medium (3.0-9.9× the ULN), and high (≥10× the ULN). Mean cumulative functions were estimated to determine the average number of repeated tTG-IgA tests across time. Further differences were evaluated by sex, age, urban-rural status, and socioeconomic status. Results Among 4405 children with incident CeD autoimmunity, almost half (49.1%) had high baseline values at index positivity. These children also had the most overall and positive follow-up tests, on average. For example, within 5 years, those with baseline tTG-IgA ≥10× the ULN had, on average, 3.7 overall (95% CI, 3.6-3.9) and 2.5 positive (95% CI, 2.4-2.6) repeat tests, respectively, compared to 2.1 overall (95% CI, 2.0-2.2) and 0.8 positive (95% CI, 0.7-0.8) among those with 1.0-2.9× the ULN. Significant differences were also present across the urban-rural spectrum and the socioeconomic gradient (eg, highest in metropolitan centres). Conclusion These findings showcase notable variation in follow-up tTG-IgA testing among children with incident CeD autoimmunity in Alberta, Canada.

Karnataka state in southern India is an advanced regional economy with a higher Net District Domestic Product and higher Per Capita Income. This was achieved with the help of the well-positioned secondary and tertiary sectors’ contributions and employment opportunities. It is also largely urbanizing regional economy with almost half the number of households living in urban areas of different class sizes. However, the positive emergent economic strengths have kept social advancement at bay, particularly poverty and deprivations in human settlements remain unattended. Regrettably, the growing urbanization trend is highly skewed towards the metropolitan and major urban centers, resulting in the other tiers facing development starvations. Besides, it has accommodated a world of slums within the urban areas with substandard living of the dwelling poor families. Deficient housing stock as a principal source of poverty and deprivations of human necessities have left unaffordable poor households to face life threats and no access to amenities respectively. The poverty trap is very conspicuous in slums and informal settlements of poorer segments. This paper highlighted all these issues in greater detail with the help of the official data and offered a few policy implications for corrective public actions.

This retrospective cohort study evaluated the oncological care of people with psychiatric conditions at an outer metropolitan center to audit for clinical disparities in comparison to people without psychiatric conditions. A retrospective review of multidisciplinary team meetings was conducted, and those with comorbid psychiatric disorders (cases) were identified. Demographic, psychiatric, and oncological data were collected. Psychiatric conditions were stratified into three categories: Cat1: mild affective disorders; Cat2: complicated affective disorders, substance use disorder, and post-traumatic stress disorder; and Cat3: severe mental illness (SMI) (e.g., bipolar affective disorder and schizophrenia). A control group of people without psychiatric conditions (Cat0) was selected at random from matched MDMs. A comparison between cases and controls for differences in cancer outcomes was performed. Between 2021 and 2022, 853 people were discussed at MDMs. Of these, 170 (20%) cases were identified, and 57%, 29%, and 14% were in Cat1, Cat2, and Cat3, respectively. A further 170 people without mental illness were included for comparison (Cat0), and the total cohort examined was 340. People in Cat1 (p<0.001) and Cat3 (p<0.001) were more likely to present with metastatic or unresectable disease compared to those in Cat0. The treatment offered to Cat3 was more likely to deviate from treatment guidelines (p=0.001). Cat3 was also found to have significantly reduced recurrence-free survival (hazard ratio 4.27, 95% CI 1.46-12.48, p=0.008) compared to Cat0. Psychiatric disorders were associated with worse cancer outcomes compared to those without. This is potentially due to higher rates of treatment non-adherence. This institutional study suggests that people with SMI have increased needs in navigating cancer care and highlights a need to examine this on a larger scale.

Parastomal hernia (PSH) is a debilitating long-term complication of stoma formation, often required as part of curative or palliative treatment for colorectal cancer. As a common downstream consequence of cancer surgery, PSH contributes significantly to chronic morbidity and impairs quality of life, yet practices surrounding its prevention and repair remain heterogeneous. Despite randomised evidence supporting prophylactic mesh, adoption is limited, and operative approaches to elective and emergency repair vary widely. A cross-sectional survey of colorectal surgeons in Australia and New Zealand was conducted via the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) to assess current PSH management. The survey examined stoma creation practices, prophylactic and therapeutic mesh use, operative techniques, and responses to clinical vignettes. Subgroup analyses explored variation by surgeon seniority, practice setting, and country. Ninety-three surgeons responded (93/365, 25.5%), including 74/93 (79.6%) from Australia and 19/93 (20.4%) from New Zealand; 79/93 (84.9%) practised in metropolitan centres and 39/93 (41.9%) had > 15 years' experience. Routine prophylactic mesh use at stoma formation was reported by 11/93 (11.8%). For elective repair (n = 89), open access was preferred by 48/89 (53.9%) and Sugarbaker repair was the most common configuration (40/89, 44.9%). Technique selection differed by access: among surgeons favouring minimally invasive surgery (n = 41), 33/41 (80.5%) selected Sugarbaker, whereas those favouring open surgery (n = 48) more often selected keyhole (22/48, 45.8%) or retrorectus "sandwich" repair (18/48, 37.5%) (p < 0.00001). In the emergency small-bowel obstruction vignette, surgeons with > 15 years' experience more often favoured mesh use than those with ≤ 15 years (21/39, 53.8% vs 10/50, 20.0%; p = 0.0015). Overall operative volume was low, with 65/93 (69.9%) reporting 0-5 PSH repairs per year. PSH prevention and repair across Australasia is marked by wide variability, low uptake of prophylactic mesh, and inconsistent technique selection. Operative approach strongly influenced repair configuration, and seniority appeared to drive emergency decision-making. Addressing PSH represents an important opportunity to reduce treatment-related morbidity in patients with pelvic malignancies undergoing stoma formation.

A retrospective cohort study of proliferating pilar tumors at a large metropolitan academic center.

Impact of the nonavalent human papillomavirus vaccine as adjuvant to conization in women with high-grade cervical intraepithelial neoplasia. A metropolitan hospital colposcopy center experience, 24 months - follow up.

Lahore has become the new hub of employment, higher learning, health and specialized services in Punjab, Pakistan due to rapid urbanization and urban primacy. Such a density has created extreme daily commuting streams between the peripheral settlements and secondary cities in the metropolitan centre leading to road congestion, environmental destruction, social strain, and deteriorating urban living conditions. This paper is in reaction to this and explains plans and design of Sahulat Nagar, an envisaged self-sufficient new town at the outside of the Lahore Metropolitan Boundary close to Muridke. The primary goal of the project is to transform urban development into a system where people no longer commute to the city but rather community through the formation of an entire city in which the people can live, work, learn, and receive healthcare without having to travel to Lahore on a daily basis. The study is based on a planning approach that utilizes a studio-based approach with assistance of secondary data, national planning standards, and an overview of urban literature on Pakistan to create an integrated master plan that focuses on mixed land use, employment creation, walkable neighbourhoods, and a robust town centre. The results indicate that the new towns that are planned in an appropriate manner may be crucial in alleviating the commuting stress on Lahore and enhancing the lives of people and facilitating balanced development of the region. The paper ends with recommendations on the policies to implement to use self-sufficient new town strategies as a model of urban growth in Pakistan.

Background/Objectives: Mechanical cardiopulmonary resuscitation (mCPR) devices offer consistent chest compressions during prolonged resuscitations and transport, but their impact on ventilation and patient outcomes remains unclear. This study aimed to compare gas exchange, metabolic parameters, and clinical outcomes in patients with ongoing manual versus mechanical CPR upon arrival at the emergency department (ED) after out-of-hospital cardiac arrest (OHCA). Methods: We conducted a retrospective analysis of 394 consecutive adult patients with non-traumatic OHCA admitted to a metropolitan cardiac arrest center between January 2019 and December 2024. Patients were categorized into three groups: Return of spontaneous circulation (ROSC) on arrival (n = 240), ongoing manual CPR (n = 107), and ongoing mechanical CPR (n = 47). Gas exchange and metabolic parameters were obtained from initial arterial blood gas (ABG) analysis and monitor readings. The primary outcome was survival to hospital discharge; secondary outcomes included 24 h survival and neurological status at discharge (CPC 1-2). Results: Survival to hospital discharge was significantly higher in the manual CPR group (8.4%) compared to 0% in the mechanical CPR group (p = 0.04). Both groups showed severe acidosis and hypercapnia upon ED arrival; however, PaCO2 levels were significantly higher in the mCPR group (83.0 ± 25.5 mmHg vs. 72.3 ± 21.6 mmHg, p = 0.01). ROC analysis identified lactate (AUC = 0.765) and pH (AUC = 0.743) as the strongest predictors of survival, while EtCO2 had limited prognostic value (AUC = 0.541). Conclusions: In patients with refractory out-of-hospital cardiac arrest admitted with ongoing cardiopulmonary resuscitation, mechanical CPR was associated with higher PaCO2 levels on emergency department arrival compared with manual CPR, while other gas exchange parameters did not differ significantly. Given the limited sample size and small number of survivors, these findings are exploratory and hypothesis-generating, underscoring the need for prospective studies on ventilation during continuous chest compressions.

Transoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS. We conducted a retrospective cross-sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD-10-CM codes and TORS with ICD-10-PCS codes including a robotic-assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county-level procedure counts, calculated GLMA-level Herfindahl-Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS). We identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000-9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio [IRR]: 1.99, 95% CI: 1.63-2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high-volume GLMAs (IRR: 0.82, 95% CI: 0.76-0.87). Among Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high-volume markets, with shorter LOS in high-volume regions, highlighting trade-offs between centralization and access.

Objective – To investigate public policies aimed at promoting health and well-being among older adults, specifically physical exercise, in the small town of Centenário do Sul, Paraná, Brazil. Methodology – To this end, an exploratory qualitative study was conducted, using simple observation and structured interviews with older adults residing in Centenário do Sul, Paraná, Brazil. Originality/Relevance – The study stands out for focusing on the interface between population aging, public policies, and the everyday use of preventive health urban facilities in a small town—an empirical setting that remains underexplored compared with analyses concentrated in metropolitan centers. It is also relevant to policy formulation, as it shows that the mere provision of infrastructure does not, in itself, ensure adherence or changes in habits. Results – The findings indicate that the outdoor gyms have not been used by older adults living in the neighborhoods where they were installed; that older adults do not conceive physical exercise as a means of promoting health; and that there are no municipal management actions that contribute to building a new perspective on physical exercise in old age. Theoretical/Methodological Contributions – The research contributes by linking the discussion of aging to the production/use of urban space and to the effectiveness of public policies in non-metropolitan contexts, highlighting socio-territorial dimensions (location, accessibility, meanings attributed to the equipment, routines, and sociability networks) that condition policy outcomes. Methodologically, it demonstrates the value of combining simple observation and structured interviews to capture the mismatch between institutional provision (equipment) and social appropriation (use, meaning, and practices). Social and Environmental Contributions – The findings provide support for improving municipal policies on health and well-being in later life, indicating the need for integrated actions (health education, professional follow-up, regular groups, community engagement strategies, and the participation of older adults in the design of initiatives). Indirectly, they reinforce the role of public spaces and open areas in promoting health, social interaction, and the appreciation of the urban environment, fostering the qualified appropriation of outdoor facilities and the everyday activation of collective spaces.

Abstract The emergence of a cohort of Malaysia-born writers producing works in English from metropolitan centres in the West alongside a growing body of Mahua (or Malaysian Chinese) literature, whose practitioners are ethnic Chinese based primarily in Taiwan and writing in Chinese, constitutes two principal trajectories in contemporary Malaysian literature. Yet, comparative discussions between Anglophone and Sinophone Malaysian literatures remain scarce. This paper seeks to address this gap by proposing the Nanyang (literally, the “South Seas”) as a decolonial framework that reveals how these literatures delink from colonial legacies and state-centric imaginaries while enacting epistemic disobedience through pluriversal engagement. The Nanyang as a pluriverse does not merely entail the coexistence of these distinct literary traditions but emerges as a non-hierarchical space of convergence for Anglophone and Sinophone Malaysia, both in the literary worlds constructed by their authors and the cultural spaces they inhabit. By examining Tash Aw and Ng Kim Chew as exemplars of Anglophone and Sinophone Malaysian literary trajectories, respectively, this paper illustrates how these marginalised literary traditions converge through complex negotiations of nationalist, global, and diasporic hegemonies, reimagining the Nanyang as a pluriverse of routes and relationality. This reframing also positions the Nanyang as a site of “stateless poetics” and the “diasporic local,” concepts that challenge institutionalised paradigms of Malaysian literary and cultural production, which continue to marginalise non-Malay linguistic traditions. The paper concludes by gesturing to other Southeast Asian littoral imaginaries to support ongoing Global South dialogues on relationality, plurilingualism, and decolonial aesthetics.

India’s rapid digital expansion has significantly reshaped its cultural landscape and social organization. With nearly 886 million internet users in 2023–2024 projected to exceed 900 million by 2025 and rural users forming about 55% of the total, digital media has penetrated beyond metropolitan centres into everyday rural and semi-urban life. Smartphone access among youth exceeds 90%, making young people the primary drivers of digital culture. As a result, digital platforms now play a central role in communication, identity formation, cultural expression, and information exchange. This study examines digital media as a double-edged force that simultaneously promotes cultural innovation and contributes to social disorganization. Using a mixed-methods design that integrates secondary national data, platform content mapping, and qualitative case insights, the study explores changes in family authority, gender norms, and social practices. Findings reveal growing youth autonomy, hybrid cultural identities, and increased virtual interaction, alongside weakening traditional social controls, intergenerational conflict, misinformation exposure, and rising cyber deviance. Rural and tribal youth show heightened identity dissonance due to exposure to homogenized digital narratives. The study also highlights that digital literacy, regional-language content, and community-based digital initiatives can strengthen cultural connectedness and responsible media use. It concludes that India’s digital transformation must be guided through inclusive literacy, culturally grounded content ecosystems, and balanced governance so that digital growth supports social cohesion and sustainable development rather than social fragmentation.

Background: Suboptimal medication adherence represents a critical obstacle to achieving target blood pressure levels in hypertensive patients globally. Fixed-dose combination (FDC) formulations have demonstrated potential for enhancing therapeutic compliance through streamlined dosing protocols and reduced medication complexity. To evaluate comparative effectiveness of fixed-dose combination antihypertensive regimens versus conventional monotherapy and free-combination approaches regarding medication adherence patterns and blood pressure management outcomes. Methods: This 6-month prospective observational cohort study recruited 1,248 treatment-naïve adults (ages 35-75) with newly diagnosed essential hypertension from three metropolitan primary care centers in Hyderabad, Pakistan between January and July 2025. Primary endpoint assessed medication adherence via proportion of days covered (PDC) methodology. Secondary endpoints included blood pressure target achievement rates, time-to-control intervals, and major adverse cardiovascular events. Results: FDC recipients (n=624) exhibited substantially superior medication adherence versus control participants (n=624), with mean PDC values of 82.4% compared to 64.7% (p&lt;0.001). Target blood pressure achievement (&lt;140/90 mmHg) at 6 months occurred in 73.1% of FDC patients versus 54.8% of controls (p&lt;0.001). Median time-to-target was significantly reduced in the FDC cohort (8.2 weeks vs. 12.6 weeks, p&lt;0.001). Conclusions: Single-pill combination antihypertensive strategies demonstrate marked superiority in medication adherence and blood pressure control metrics compared to traditional therapeutic approaches, supporting their prioritization in contemporary hypertension management protocols.