Introduction: The development of science and technology has made people more selective in choosing quality health facilities to get the best service and achieve high satisfaction. Objectives: The study aimed to analyze patient satisfaction with the quality of health services at the Baros Health Center, Sukabumi City—methods: This type of descriptive research. The population is patients who visit the Baros Health Center with a sample of 248 people. The sampling technique is proportional random sampling and accidental sampling. Methods of data collection using a questionnaire. Methods of data analysis using IPA, KANO, and IPA-KANO Integrity. Results: The results showed that health services are considered very important (4.67), the performance of health services is very good (4.22), and there is still a gap (-0.45). Priority indicators that must be improved are in the aspect of the ability of health workers to prioritize immediate action, the ability of health workers to prioritize immediate action, while the good priority indicators are the aspects of indicators that are already good the aspects of cleanliness and comfort of the examination room. examination room, the CSI value is 0.78, which is in the satisfied category. Conclusions: It is hoped that the Baros Health Center will conduct periodic satisfaction surveys to evaluate a service provided to create quality services so that patient satisfaction will be higher.

To develop a multi-stakeholder, consensus-based decision support framework for prioritizing innovative anticancer drugs in Chinese hospital formularies, balancing clinical benefit, patient access, and financial sustainability. A two-round Delphi survey was conducted with a multidisciplinary expert panel (n = 62 in Round 1; n = 51 in Round 2, 82.3% retention rate) comprising clinicians, pharmacists, health administrators, and patient representatives. The initial set of 19 indicators across 9 dimensions, derived from a literature review, was iteratively refined based on panel feedback. Consensus was defined as ≥ 80% of respondents rating an indicator as 4 or 5 on a 5-point Likert scale, dispersion was summarized by interquartile range (IQR). The panel reached a clear consensus on a structured framework comprising seven key dimensions and 16 measurable indicators. The top three prioritized dimensions were clinical benefits, safety, and economic impact. The framework incorporates policy-sensitive indicators relevant to China's healthcare system, such as pharmaceutical access and access barriers of genetic testing. Five indicators from the initial list were discarded, and two new ones were added based on expert input, with specific metrics refined for enhanced objectivity and practicality (e.g., "patient out-of-pocket expenditure per year"). This study presents a transparent, standardized, and actionable decision-making framework to support formulary selection of innovative anticancer drugs in Chinese hospitals-particularly in resource-adequate settings. By incorporating diverse stakeholder perspectives and establishing clear evaluation criteria, the framework reduces subjectivity and supports consistent value assessment. It provides practical guidance for hospital pharmacy and therapeutics committees and contributes to more equitable, evidence-informed, and financially sustainable drug policy development in China. Patient representatives participated in the first-round expert panel, where they rated candidate indicators, shared their lived experiences, and provided feedback on the interview guides and questionnaires.

A performance evaluation system for the coffee supply chain is essential to ensure the sustainability of the coffee industry in the Malang Raya region. This study aimed to design a performance measurement system focusing on the social dimension of the coffee supply chain in Malang Raya, to assess the performance score of each indicator and provide improvement recommendations. The performance evaluation applies the Supply Chain Operations Reference (SCOR) model, with weighting of performance indicators using the Analytical Hierarchy Process (AHP), and normalization of values using the Snorm De Boer method. The Traffic Light System (TLS) is employed to identify priority indicators for improvement. Results from the SCOR-based assessment indicate that Karangploso farmers scored 61.03 (Average), Dampit farmers 70.01 (Good), and Wonosantri farmers 78.32 (Good). The performance score for the roastery was 67.66 (Average), while the coffee industry scored 79.53 (Good). Based on the TLS approach, improvement recommendations for farmers, roasteries, and the coffee industry include enhancing workforce training and skill development, increasing local labor absorption, developing policies to fulfill social standards, expanding strategic partnerships, and promoting the sustainability of the coffee industry through a holistic, multi-stakeholder approach.

The study develops and implements a methodology for prioritizing power units (PUs) of captive power plants (CPPs) to support the development of maintenance and repair (M&R) programs considering their actual technical condition (TC) and reliability indicators. The proposed approach is based on the joint assessment of the technical condition index (TCI), the consumed technical resource (CTR), and the risk level (RL) of the PUs. To describe the statistical patterns of failures, a two-parameter Weibull distribution is applied, while the temporal change in the TCI is approximated by a linear relationship that accounts for differences between actual and nominal operating conditions. The CTR is defined as an integral characteristic reflecting the deviation between the actual and nominal TCI degradation functions. The RL is evaluated as a function of the probability of failure and the consequences of PU failure. Based on these individual indicators, an integrated priority index is formed to provide an unambiguous ranking of PUs. The methodology was implemented using actual operational data from a fleet of PUs of an energy company. The results demonstrate that using the TCI alone does not fully reflect the actual TC of the PUs, whereas the combined consideration of TC, CTR, and RL enables a more justified formation of M&R programs. The practical significance of the study lies in the possibility of applying the developed methodology for reliability management of PUs at CPPs under resource constraints.

The article considers benchmarking as a tool for increasing the competitiveness of enterprises in international economic activity, with a focus on working with the European Union market. It is argued that in the EU, suppliers are evaluated not only by price and volume, but also by their operating model – their ability to consistently deliver quality, meet delivery deadlines, maintain service, ensure supply chain transparency, be ready for audits, and handle complaints effectively. Under such conditions, benchmarking should be aimed at comparing not only the final indicators, but also the “technology for achieving results”: standards, control points, quality and deadline risk management, documentation, and interaction with counterparties. The impact of the dynamic EU regulatory environment and increased requirements for safety, labeling, and compliance is emphasized, while it is noted that even with changes in regulatory thresholds, commercial requirements of buyers and audit results often remain high; therefore, the benchmarking system should focus on best practices rather than the minimum acceptable level. The criticality of compliance with fiber naming and composition labeling rules is outlined, as well as the need to take into account the trend towards sustainability and circularity, which increases the requirements for product data and value chain transparency. A three-contour benchmarking model for the EU direction is proposed: strategic contour (selection of segment and competitive offer), operational contour (decomposition of results into processes and KPIs), and advisory contour (accelerated “alignment” of the quality system, documentation, planning, and audit readiness with parallel formation of an internal competence team). Key objects of comparison in the EU market have been identified: product and compliance; production processes and quality; foreign economic activity as a system of business processes; economics and operational efficiency. For the operational circuit, examples of priority indicators (OTIF, lead time, defects, returns/claims, material losses in cutting, productivity, planning accuracy, changeover time), and it is emphasized that the comparison should end with a change in standards (control points, instructions, distribution of roles, KPIs), rather than a formal analytical report. The practical result of the article is the justification of a cyclical algorithm for implementing benchmarking: “planning-execution-verification-consolidation,” where “consolidation” involves standardizing changes through the unification of documentation, updating labeling and packaging instructions, setting quality control points, appointing responsible persons, and launching change management mechanisms (regular review of indicators, corrective actions, staff training). It is concluded that this approach enhances process manageability, reduces losses and rework, and increases the reliability of supplies, which are decisive factors for the long-term consolidation of the enterprise in the EU market.

CARDIO4Cities is a multisector initiative that aims at improving cardiovascular population health in urban areas across the globe. Shared measurement systems are key to systematize reporting on progress and health outcomes and to provide comparable evidence across countries. This article documents the development of a global theory of change (TOC) and its evaluation framework (EF) to serve as scalable, global reference tool. It further describes the adaptation of the EF for long-term impact evaluation in Dakar, Senegal and São Paulo, Brazil. A mixed-method approach was applied including a document review and key informant interviews with seven individual CARDIO4Cities partners. The information obtained revealed a three-phased process for developing the global TOC and EF and the adaptation into local EFs: 1) planning of the global CARDIO4Cities strategy; 2) development of the global TOC and its EF; 3) co-creation of local EFs. Coherence between the global EF and local frameworks was assessed as an indication of the perceived local value and applicability of the global EF tool. The final TOC was composed of 14 interventions leading towards the overall expected impact of a 10% decrease in strokes in the target cities’ populations. The resulting global EF consisted of 52 quantitative programmatic (medical and non-medical) and qualitative performance indicators, of which 33 were designated key priority indicators (KPIs). Both, Dakar and São Paulo adopted half (50% and 52%) of the total global EF indicators. While 20 global EF indicators were taken up by both cities, 19 indicators were excluded by both, and 13 indicators were adopted by only one of the cities. The most consistently adopted indicators across cities were the performance KPIs (86% for both cities) and the optional non-medical program indicators (100% for both cities). Conversely, the non-medical program KPIs (0% for both cities) and the optional performance indicators (33% and 17%) were least consistently adopted by the two cities. We provide a roadmap for developing a reference EF which offers a simple shared means of tracking cardiovascular health initiatives across different countries. The EF allowed global partners to have a consolidated overview of program implementation and to compare results across cities.

Delays in construction project completion remain a major issue, particularly in multi-construction project environments characterized by limited resources and allocation conflicts. These conditions require high-quality project management human resources (HR) to ensure optimal project time performance. This study aims to analyze the effect of project management HR quality on time performance in multi-construction projects by examining five key dimensions: competence, loyalty, discipline, and integrity, with work motivation as a mediating variable. This study adopts a quantitative approach using the Structural Equation Modeling–Partial Least Squares (SEM-PLS) method with SmartPLS 4 software. Data were collected through questionnaire surveys involving respondents engaged in three construction projects managed simultaneously. In addition, Importance Performance Analysis (IPA) was applied to identify practical priority indicators for improvement. The results indicate that the research model demonstrates very strong predictive capability, with coefficients of determination (R²) of 0.933 for time performance and 0.874 for work motivation. All HR quality variables have a positive and significant effect on project time performance, with the dominant influence order being discipline, competence, work motivation, loyalty, and integrity. Work motivation is proven to act as a mediating variable that strengthens the influence of HR quality on time performance. The IPA results identify four priority improvement indicators: technical competence, discipline in standard operating procedures and working hours, accuracy in project time control, and social motivation along with work environment support. This study concludes that improving the quality of project management HR implementation—particularly in the aspects of discipline and competence supported by work motivation—is a key factor in achieving effective time performance control in multi-construction projects.

The nominal group technique has been shown to be an effective method for reaching consensus among a group of healthcare experts when selecting clinical indicators for application in primary care research, especially where there are competing prioritisation criteria being considered. In the context of manifest barriers to traditional face-to-face meetings, and with the advent of evolving and improved digital tools, alternative approaches are being more commonly utilised to overcome these challenges. In this study, we sought to prioritise a set of existing, validated clinical indicators proposed for inclusion in ACTMed (ACTivating primary care for MEDicine safety), a clinical trial aiming to reduce medicine-related harm in primary care. A modified nominal group technique, using a fully online approach, was employed to facilitate consensus among a group of pharmacists and general practitioners. Quantitative data were obtained using an online survey platform both prior to the structured virtual forum and again following group discussion. Qualitative material was gathered from written feedback included in the pre-forum questionnaire and through verbal contributions made during the online forum. The highest priority indicators determined by the two-staged survey process were for myocardial ischaemia, cerebrovascular ischaemia related to atrial fibrillation, heart failure, asthma/chronic obstructive pulmonary disease and falls with fracture. Qualitative reasoning behind the participants' evaluation of the clinical indicators included value for money, impact of the intervention, consequences of clinical outcomes and ability to implement the intervention in practice. In this study, the interactive component of the nominal group technique process had little impact on the final prioritisation of the clinical indicators. Potential explanations for this might include previously established strong participant views and preferences or relative group homogeneity based on similar learning, research or clinical experience.

Abstract Background TikTok, a widely used social media (SM) platform, creates a unique environment for open self-expression. It serves as a valuable outlet for young Crohn’s disease (CD) patients undergoing surgery to voice their experiences and concerns. This study seeks to evaluate patient-created TikTok content to gain deeper insights into their priorities and challenges in relation to surgery. Methods A new TikTok account was created exclusively for data collection. The most popular combinations and hashtags for each CD procedure were identified, following preliminary searches combining relevant keywords. The first 10 results for each search were analysed, after application of exclusion criteria. Data collection included video and creator demographics, and a hybrid content-thematic analysis was undertaken, structured around Braun and Clarke’s six-stage approach. Results A total of 12 searches was performed, combining search terms and hashtags for CD and surgical procedures. 120 videos were retrieved from all searches and a total of 64 videos were analysed, following exclusion of 56 videos. Mean duration was 141 seconds (6-446), with a mean of 5148 likes (8-181,600) and 161 shares (0-7,902). Most of the videos (88%) were categorised as informational/raising awareness, from patient to patient. Thematic analysis identified 4 broad, inter-connecting themes: provision of information in relation to CD’s pathophysiology and procedures, provision of information in relation to the immediate peri-operative journey, informing on daily living after surgery and the impact on quality of life (QoL) and community building and network development, with a focus on normalising life after surgery and breaking any stigma around it. Conclusion This study is the first to explore key themes shared by patients undergoing surgery for CD on a popular SM platform. It enhances clinicians’ understanding of patient priorities and interests, as a means to improve communication and support in pre-operative decision-making. Most importantly, the study underscores the value of sharing lived experiences among patients themselves: this remains an irreplaceable source of insight, that cannot be replicated by medical professionals. Conflict of interest: Petmeza, Christina Anna: No conflict of interest Goyal, Chirag: No conflict of interest Mr. Argyriou, Orestis: No conflict of interest Ghersin, Itai: No conflict of interest Worley, Guy: No conflict of interest Tozer, Philip: Personal Fees: Takeda - speakers fees, member of Inspire, and advisory boards Ferring - speakers fees Falk - speakers fees Tillott’s - speakers fees J & J - speakers fees Abbvie - speakers fees Hart, Ailsa: Grant: Takeda Personal Fees: Abbvie, Amgen, Arena, AZ, Falk, Celltrion, Eli Lilly, Ferring, Genentech/ Roche, GSK, Pfizer, Takeda, Napp, Pharmacosmos, Janssen (J & J), Bristol-Myers Squibb, Gilead, Galapagos, Alfasigma Sahnan, Kapil: Speaker fees from Takeda, JnJ, Intuitive Ad Board with Medtronic

Toll roads can play a vital role in supporting mobility, logistics, and regional economic growth. However, issues such as congestion, declining road quality, and limited real-time information systems often hinder service performance. This study aims to update the Toll Road Service Quality (TRSQ) model by integrating artificial intelligence (AI)-based technological innovations as a mediating variable to enhance excellent toll road services. Using a quantitative explanatory approach, data were collected from 480 users of the Pemalang–Batang Toll Road via a questionnaire survey. Data analysis employed SmartPLS to test causal relationships among TRSQ variables, which include information, accessibility, reliability, mobility, safety and security, rest areas, and responsiveness. Results show that all TRSQ variables significantly influence service excellence, both directly and through technology as a mediator. Priority indicators identified include toll gate queue length, availability of road markings and information boards, traffic flow, real-time traffic updates, and service comfort. The study highlights the urgency of applying AI-based intelligent transportation systems—such as innovative CCTV, remote sensors, and automated information management—to optimise toll road performance, improve user satisfaction, and strengthen sustainable transport services. Keywords: artificial intelligence, smartpls, technological innovation, toll road service, TRSQ model, user satisfaction

In response to the growing demand for sustainable and resilient refugee settlements, this study proposes a comprehensive framework that integrates prioritized design indicators with network-based spatial planning. Through a comparative evaluation of six international refugee camps and the application of the Analytic Hierarchy Process (AHP) to thirteen key design categories, the research identifies the most critical factors for developing inclusive, adaptive, and environmentally sustainable settlements. A customized network analysis is employed to visualize the systemic relationships between physical features and design priorities across global case studies. The proposed framework is applied to a design scenario for Kilis, a province in Turkey significantly affected by the 2023 Kahramanmaraş earthquake and home to a dense population of Syrian refugees. Informed by local architectural traditions and socio-cultural dynamics, the scenario incorporates modular housing, decentralized sanitation systems, solar energy infrastructure, and participatory planning processes. The resulting network diagram for Kilis demonstrates how priority indicators (such as safety, sustainability, and health) can be spatially embedded within the camp design. This integrative approach offers a replicable model for future refugee settlement planning, aligning humanitarian needs with long-term urban sustainability goals.

The BRICS countries, which include the Russian Federation, currently have great prospects for intensive sustainable development. The ten countries that make up the community are located on different continents of the globe, and there are a number of other countries that may join BRICS in the future, currently being observers. There are prospects for creating a global-level atlas information system that would store a variety of data on the development of these countries. It is very important to evaluate sustainable development indicators over time. A variety of approaches to the development of sustainable development indicators have developed worldwide. There are also studies on sustainability indicators for BRICS countries. This article proposes an approach based on the identification of key (basic) indicators, which is often used in the world, for states under study (a system of indicators of sustainable development based on special indicators and the identification of key integral indicators). The need to identify key indicators is linked to an attempt to identify priority indicators of sustainable development that would be relevant to the main development problems of the BRICS countries, which are quite diverse in terms of socio-economic level, often with different social, economic and environmental agendas. Approach to the selection and justification of key indicators allows us to overcome, to a certain extent, the multi-vector nature of development measurement, which makes it difficult to identify priorities. With several dozen indicators available, it is difficult to determine the allocation of resources and funds to priority indicators, the achievement of which will enable the BRICS countries to solve important problems. The tables of indicators (which often differ greatly from country to country) that could be compiled are supplemented by a series of infographics.

Indonesia’s pursuit of sustainable development—integrating economic, social, and environmental dimensions—remains challenged by persistent regional disparities. In 2022, only four of seven national priority indicators were achieved, while 21 provinces failed to meet more than three targets. To capture these disparities more precisely, this study applies hierarchical and non-hierarchical clustering to classify 34 provinces based on seven development indicators. The comparative approach enhances robustness: hierarchical clustering reveals inter-provincial linkages, while non-hierarchical clustering improves internal consistency. Validation tests identify Ward’s method as optimal, yielding four distinct clusters. Cluster 1 includes four eastern provinces with multidimensional inequality—high stunting (31.43%), early marriage (10.37%), and low literacy (36.44%). Cluster 2 comprises 20 provinces with structural stagnation, marked by persistent stunting (24.80%) and reliance on primary sectors. Cluster 3 consists of seven industrial provinces with strong economic performance (manufacturing 33.59% of GDP) and improving social indicators. Cluster 4 includes three service-based provinces excelling in social outcomes—lowest stunting (13.07%) and highest literacy (78.46%)—but facing environmental challenges. These findings highlight the urgency of region-specific, evidence-based policy interventions to promote equitable and sustainable development.

This research aims to analyze the influence of transformational leadership, personality, achievement motivation, and organizational culture on teachers’ professional commitment in private vocational high schools (SMK) in West Jakarta. Using a quantitative approach with path analysis and the SITOREM method (Scientific Identification Theory to Conduct Operations Research on Education Management), this study involved 240 teachers selected through proportional random sampling. The findings indicate that transformational leadership, personality, and achievement motivation have a positive and significant direct effect on professional commitment. Organizational culture mediates the indirect relationship between transformational leadership and teachers’ commitment. The SITOREM analysis revealed that the priority indicators to enhance teachers’ commitment include moral integrity, innovation encouragement, and goal alignment. The study contributes theoretically by integrating psychological and organizational factors in teachers’ professional development and provides practical recommendations for school leaders to strengthen human capital in educational institutions.

BackgroundQuality health services are key to achieving Universal Health Coverage (UHC) but challenging to measure and deliver in resource-limited settings. Continuous quality improvement (QI) is an approach to health service improvement that has not yet been widely implemented in Kenya. The Academic Model Providing Access to Healthcare (AMPATH) and the Busia County Ministry of Health (MOH) piloted a QI training and mentorship program for healthcare workers (HCWs) in Bunyala Subcounty, Kenya. A 4-day training was conducted, followed by quarterly health facility mentorship visits. A qualitative process evaluation was conducted to assess perceived barriers and facilitators to forming and sustaining QI initiatives.MethodsOne year after initial QI training, 11 semi-structured key-informant interviews and 5 focus groups discussions (FGDs) were conducted. 48 MOH leaders and HCWs at Bunyala health facilities were purposefully selected to participate. Interviews were transcribed, and an a priori thematic analysis was conducted using domains and constructs from the updated 2022 Consolidated Framework for Implementation Research (CFIR) with modifications recommended for low-middle income country (LMIC) settings.ResultsWithin the CFIR domains, constructs that emerged as key facilitators to QI implementation included: the adaptability of QI aims to facility priorities, perceived source and MOH ownership, performance measurement pressure; access to knowledge through training; tailoring strategies of mentorship through the MOH supervision, and teamwork. Key barriers were identified in Domain VI, an LMIC modification and included poor resource continuity (supply chains) and systems architecture leading to transfers of HCWs. Engagement with patients and the community emerged as a theme suggesting that QI can provide a structure for developing more patient-centered services.ConclusionsAnalysis using the 2022 CFIR with modifications for the LMIC setting provided insight into the perceptions of HCWs and MOH leaders. Recommendations to facilitate continuous QI in this setting include adequate training and continued mentorship, MOH ownership, structuring QI initiatives around MOH priority indicators, and strategies to mitigate health system gaps leading to supply chain irregularities.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13699-1.

This study examines the direct and indirect effects of service quality and training programs on customer satisfaction, organizational image, and customer loyalty. Using quantitative methods, including path analysis and SITOREM analysis, the study was conducted with 176 training participants at the UPTD Health Training, West Java Provincial Health Office. Results show that service quality and training programs significantly and positively influence customer satisfaction, organizational image, and customer loyalty. Customer satisfaction serves as an important mediating variable, strengthening the relationships between service quality and training programs and organizational image and customer loyalty. SITOREM analysis identified priority indicators for improvement, such as service response and training content, to enhance participant satisfaction and experience. This study supports the theory that superior service quality and training programs can improve organizational image and customer loyalty through satisfying customer experiences. These findings provide strategic implications for public service management, particularly in developing relevant, high-quality training programs to support the sustainability of institutions in the health sector.

Gili Trawangan, a premier destination in North Lombok, has experienced a surge in tourists, with significant impacts on the local environment, culture, and economy. This study aims to analyse stakeholder perceptions of the Limits of Acceptable Change (LAC) and identify critical indicators for sustainable tourism management. The researchers used a qualitative approach, including in-depth interviews, observations, and document analysis. This research is analysed qualitatively using thematic analysis. The research results indicate that, while the socio-cultural aspect of local income has increased, disparities in business access and dependence on tourism have created vulnerabilities.Meanwhile, the environmental situation is critical, marked by declining water quality, ecosystem damage, and increased plastic waste. This study emphasises the need to implement indicator-based LAC, multi-stakeholder collaboration, and adaptive strategies to sustain small islands. Based on these findings, the application of the LAC concept is recommended through the establishment of priority indicators, change-tolerance standards, and periodic strengthening of multi-stakeholder collaborations. Strengthening research provides a theoretical contribution to refining the LAC concept in the context of small islands and offers practical implications for formulating sustainable tourism management policies in Indonesia.

Women´s emotional fertility intentions to conceive are an integral part of Reproductive Health (RH) right which can also be considered as decision-making over their fertility. In this study, postpartum emotional fertility intention was measured by asking a cohort of women how they would feel if they became pregnant by their one year postpartum following the index birth. Emotional health and couples communication are key during pregnancy, childbirth and in the postpartum period coupled with the simultaneous reproductive coercion (RC) minimization. The postpartum period is a key for the newborns milestones development and in maintaining maternal emotional, psychosocial, and mental health. Therefore, this study aimed at determining the level of one-year postpartum emotional fertility intention and identifying its correlates among a cohort of one-year postpartum women. The Ethiopian Federal Ministry of Health and relevant developmental partners can use this evidence as an action point to empower women to exercise their reproductive health rights and rights related to reproduction. Nationally representative Ethiopia Performance Monitoring for Action (EPMA) women and newborns cohort survey data collected from eligible women in four rounds were further analyzed in this study. This study collected real-time data on various sexual, reproductive, maternal and newborns nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using a standard pretested questionnaire prepared in English and translated in three local languages (Amharic, Afan Oromo and Tigrigna) by well-experienced resident enumerators. This study was limited to the further analysis of 1,703 non-pregnant women by their one-year postpartum. Frequencies were computed to describe the study participant's characteristics. The partial proportional odds statistical modeling was fitted to identify correlates for the hierarchical variation in one-year postpartum emotional fertility intention. Results were presented in the form of percentages and odds ratios alongside with 95% Confidence Interval. Statistical significance was declared at a p-value of 0.05. The proportion of one-year postpartum emotional fertility intention of being unhappier was found to be nearly two thirds, 64.87% (62.20%, 67.45%). Nearly one in 6, (17.12% (15.15%, 19.29%)) and one in 20, (4.63% (3.60%, 5.94%)) women reported that they have experienced a mixed and very happy feelings in the same period. The proportional cumulative odds of one-year postpartum emotional fertility intention were 0.66 (0.44, 0.97) and 0.43 (0.29, 0.63) respectively among women who reported that they had ever used contraceptive and those who reported that they have resumed their contraceptive use by one-year postpartum compared with their counterparts. The proportional cumulative odds of one-year postpartum emotional fertility intention were found to be lower and asymmetrical among women with higher birth order and those who do not want to have additional children. One-year postpartum emotional fertility intention of being unhappier is more pronounced in Ethiopia which calls for enhancing intended and spaced pregnancies by ensuring women reproductive health decision making autonomy. Activities and efforts that promote spaced pregnancies, and diversifying access to postpartum contraceptives are likely to improve the level of one-year postpartum emotional fertility intention. Activities and interventions that enable women to decide over their contraceptive use alongside patient-centered contraceptive use counseling could also contributed to the improvement of one-year postpartum emotional fertility intention as well. The study findings implied that awareness creation on and availing the specific inter-pregnancy contraceptive services and mental health preconception care packages could also contribute in addressing the varying level of one-year postpartum emotional fertility intention. The other implication of the findings calls for strengthening postpartum contraceptive counseling and intensifying actual service provision. Besides, enabling high parity women to use contraceptive through access and diversification of the methods could help in this regard. Moreover, installing the inter-pregnancy preconception care packages in the health care system, enhancing informed contraceptive use decision making and improving one-year postpartum contraceptive uptake are imperative. Provision of one-year post-partum contraceptive could reduce maternal and newborns morbidity and mortality through spacing, improving women´s emotional and mental health in the postpartum period. These activities and interventions are very critical to improve postpartum emotional fertility intention.

Biofloc technology (BFT) is an environmentally sustainable approach in aquaculture that improves water quality and natural food availability through microbial flocs in the water column; however, there is insufficient data regarding its comparative efficacy with other management strategies for Clarias batrachus in intensive indoor culture systems. To compare the static systems, aerated systems, and probiotics-aided biofloc systems on the basis of quality and quantity of water, growth, feed utilization, and survival of Clarias batrachus in an indoor culture environment. This research involved three 500 L tanks replicated three times to take 90 days of experimentation. There were three treatments as follows: (T1) static biofloc, (T2) aerated biofloc and (T3) probiotic-assisted biofloc. Parameters of water quality (temperature, dissolved oxygen, pH, TAN, nitrite) and indicators of fish performance priority (weight gain, specific growth rate, feed conversion ratio, and survival) were also measured every week. Mean values and graphical trends were done with Microsoft excel. The dissolved oxygen was maintained at a higher level (6.2 ± 0.2 mg/ml) and the TAN and nitrite were also lower (0.52 ± 0.02 mg/ml; 0.15 ± 0.02 mg/ml) in probiotic-assisted biofloc (T3) than aerated (T2) and non-aerated (T1) system. Fish cultured in T3 had the highest final weight (84.2g), weight gain (72g), specific growth rate, improved feed conversion ratio and survival rate as compared to T2 that was ranked second and T1 had the lowest values. The research concludes that probiotic aided biofloc systems have the best effect in improving the water quality, improving growth, and survival of the Clarias batrachus in an indoor and intensive fish culture, and its applicability as an eco-friendly strategy of fish farming.

目的探讨肥胖对阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）合并高血压的影响及风险关联，明确不同肥胖评估指标〔体质量指数（body mass index, BMI）、颈围（neck circumference, NC）、腰围（waist circumference, WC）、体脂率（body fat percentage, BF%）、内脏脂肪指数（visceral adiposity index, VAI）〕在OSA人群高血压风险预测中的价值，为西南地区OSA患者高血压风险分层提供区域化证据。方法纳入2024年四川大学华西第四医院睡眠医学中心299例 OSA患者，按高血压诊断分为单纯OSA组（179例）和OSA合并高血压组（120例）。采用logistic回归分析肥胖指标与OSA合并高血压的风险关联，受试者工作特征（receiver operating characteristic, ROC）曲线评估各指标的预测效能，并结合年龄分层（≤45岁/>45岁）分析风险差异。结果两组（OSA合并高血压组 vs. 单纯OSA组）在年龄（中老年占比，65.0% vs. 38.5%）、文化程度（高中及以下占比，37.5% vs. 22.9%）、高血压家族史（60.0% vs. 33.0%）方面差异有统计学意义（P<0.01）。所有肥胖指标与OSA合并高血压均有风险关联，且随指标等级升高风险递增；VAI风险梯度最明显：≥P75者风险为<P25者的45.96倍〔比值比（odds ratio, OR）=45.96，95%置信区间（confidence interval, CI）：15.46～136.59〕，P50～P75者风险为<P25者的8.06倍（OR=8.06，95%CI：2.86～22.73）。VAI 预测效能最佳〔曲线下面积（area under the curve, AUC）=0.856，95%CI：0.819～0.893〕，优于传统指标（AUCBMI=0.821，95%CI：0.782～0.860；AUCWC=0.799，95%CI：0.760～0.838）；中老年组各肥胖指标对应的高血压风险均高于青年组。结论肥胖是OSA合并高血压人群的关键风险因素，VAI在OSA合并高血压风险预测中表现最优，可以作为该区域OSA患者高血压筛查的优先指标；年龄与肥胖指标存在风险叠加效应，中老年OSA人群需加强肥胖管理。