The ecological framework of population health - Adding public trust as a forcing factor for U.S. life expectancy and COVID-19 mortality.

Health literacy is essential for informed decision-making, patient safety, and public trust in science. This, in part, relies on the ability of health professionals to communicate complex scientific information in language accessible to the general public, yet undergraduate health science programs often lack formal training in lay communication. We describe a 60-min interactive virtual workshop designed to introduce undergraduate students to health literacy and audience-centered science communication. The workshop combined brief instruction with hands-on use of an online readability tool (Sydney Health Literacy Lab, SHeLL), facilitated small-group activities, and peer feedback. Students worked collaboratively to translate a recent scientific abstract into language appropriate for 12th- and 8th-grade reading levels, practicing strategies to reduce jargon and simplify complex information. The workshop successfully engaged students and facilitated awareness of the challenges and importance of communicating health information clearly to nonexpert audiences. This adaptable workshop model provides a practical approach for integrating health literacy and science communication training into undergraduate education and workforce preparation.NEW & NOTEWORTHY Health literacy depends on scientists' and health care professionals' ability to translate complex information into language people understand and trust. This article describes an interactive virtual workshop that equips undergraduates with tools to communicate health and science to diverse audiences. Using brief instruction and hands-on practice rewriting research abstracts, students build lay communication skills and explore links to equity, patient outcomes, and public trust.

Resilience narratives of multiethnic communities during water supply disruptions in the climate change era: evidence from Malaysia

Public trust in AI: A dynamic social media view

What breaks when federal commitments break: comment on Beccia et al.

Freedom of information (FOI) requests are a central mechanism for providing citizens with information about government operations. However, the operational burdens these requests place on public servants and their implications remain underexplored. Conceptualizing FOI requests through a red tape perspective, we examine perceived compliance burdens and dysfunction related to FOI processing among public servants. We argue that public servants' perception of red tape in the processing of FOI requests is negatively associated with their trust in citizens. This association is partially mediated by negative associations with public servants' beliefs that citizens trust them. To examine this, we use unique survey data collected from public servants dealing with FOI requests in Croatia ( n = 1547) and Slovakia ( n = 2188). Using structural equation models, we find that perceived FOI dysfunction, but not perceived compliance burden, is negatively associated with trust in citizens both directly and indirectly through public servants' perceptions of being trusted by citizens. The findings emphasize the need for considering public servants' attitudes toward government transparency processes, and the impact such attitudes may have on state-citizen relationships. • The processing of freedom of information (FOI) requests can generate red tape for public servants. • The article examines correlates of FOI process red tape among public servants in Croatia and Slovakia. • Public servants perceiving FOI dysfunction believe that citizens trust them less, and trust citizens less. • Clarifying connections between FOI and core organizational goals may improve trust among public servants and citizens.

• The CO 2 storage component of DACCS is less desired than the capture. • Benefit perception and feelings of tampering with nature are the strongest drivers of DACCS acceptance. • Government and the industry are the least trusted actors; science and NGOs the most trusted. • DACCS is still largely unfamiliar to the public. • Exposure to information decreases acceptance. Direct Air Capture and Storage (DACCS) has recently emerged as one of the most researched and funded Carbon Dioxide Removal (CDR) technologies. However, there is limited empirical evidence on the social mechanisms influencing the acceptance of DACCS. This study conducted a survey to assess the acceptance of DACCS. The survey was conducted in Germany; a country that has historically expressed strong opposition to CO 2 storage. The findings revealed that DACCS is relatively unfamiliar to the public. Benefit perception emerged as the most significant positive determinant of DACCS acceptance, while perceptions of tampering with nature were the strongest negative driver. The results showed a decrease in acceptance of DACCS as participants were exposed to more information, suggesting that access to information does not necessarily lead to higher acceptance. Among societal actors, industry and government were identified as the least trusted, highlighting potential challenges for future DACCS projects. These insights underlined the importance of addressing public trust before implementing DACCS.

Recent advances in generative modeling have enabled the creation of highly realistic deepfake facial images, posing significant risks to digital security, media integrity, and public trust. Although deep learning-based detection methods have achieved strong performance, they often suffer from limited cross-dataset generalization, sensitivity to manipulation-specific artifacts, and reduced interpretability. To address these limitations, this paper proposes a forensic-first hybrid deepfake face detection framework that integrates handcrafted local forensic descriptors with multi-CNN deep semantic representations. Specifically, manipulation-sensitive regions are captured using a Bag-of-Visual-Words (BoVW) model constructed from Histogram of Oriented Gradients (HOG) features extracted at salient keypoints detected via SURF, FAST, and BRISK. In parallel, high-level features are obtained from fine-tuned ResNet-50, MobileNet, and ShuffleNet models and fused at the feature level to capture complementary semantic information. The combined feature representation is classified using a Support Vector Machine (SVM), enabling stable decision boundaries and improved generalization. Extensive experiments on six benchmark datasets of varying scale and complexity demonstrate that the proposed approach consistently outperforms state-of-the-art methods, achieving up to 97.55% accuracy while maintaining robustness under cross-dataset and challenging forensic conditions. The results highlight the effectiveness of integrating explicit forensic features with deep representations to achieve a robust, interpretable, and generalizable solution for deepfake face detection.

Blood-based biomarkers (BBBM) for Alzheimer's disease (AD) are entering clinical practice with new clinical practice guidelines and the first FDA-approved blood test. Their implementation will depend not only on assay performance but also on public willingness, trust, and understanding of probabilistic results. We examined attitudes towards BBBM in the general population and psychosocial factors that may facilitate or hinder uptake. We conducted an online cross-sectional survey among adults aged ≥ 35 years (M = 51.08, SD = 9.79) in the Czech Republic (N = 666). The survey assessed willingness to undergo BBBM testing, sociodemographic characteristics, experience with AD, depressive symptoms (Patient Health Questionnaire, PHQ-9), concerns about developing AD, and medical distrust (Medical Distrust Index, MDI). Logistic regression models (unweighted and weighted for gender and region) were estimated to examine the association with willingness. Open-ended responses were analyzed thematically to identify motivators and barriers. Overall, 92.8% of participants reported that they would undergo BBBM testing. Greater concern about developing AD was the strongest facilitator (OR = 1.59-2.34). Having AD in a close family member was associated with lower willingness (OR = 0.31-0.43), as was higher medical distrust (MDI OR = 0.79 in the fully weighted model). Education, age, gender, depressive symptoms, and AD knowledge were not significantly associated with willingness. Qualitative analyses showed that participants viewed BBBM as a way to "take action in time", "know one's health status" and "prepare for the future", whereas fear of AD, preference "not to know", perceived lack of treatment, test uncertainty/"only probability", and privacy concerns were common barriers. Public willingness to undergo BBBM testing is high, but psychosocial barriers, particularly familial experience of AD and medical distrust, may limit real-world uptake. Addressing these barriers through targeted education, probabilistic risk communication, and trusted primary-care pathways will be essential for the responsible implementation of BBBM in clinical practice.

Reflections Since the Formation of the American College of Epidemiology (ACE) Ethics and Policy Committee, 2023-2025.

Healthcare systems in transitional economies frequently fail to translate formally adopted strategies into consistent patient-centered care. This persistent disconnect between strategic intent and frontline execution is conceptualized in this study as the Strategic Implementation Fidelity Gap. This paper introduces the concept of whether differences in strategic implementation fidelity are associated with measurable variations in patient-perceived service quality in public healthcare organizations. A comparative cross-sectional study was conducted in two state-owned healthcare institutions in Almaty, Kazakhstan: a hospital characterized by higher implementation fidelity and a polyclinic with lower fidelity. Service quality was assessed using the SERVQUAL model, reconceptualized here as a behavioral indicator of strategic execution. Non-parametric analysis was applied to compare service quality gaps across five dimensions. The findings reveal significant negative service quality gaps in both institutions, with the largest deficiencies consistently observed in empathy and responsiveness. Crucially, the institution with higher implementation fidelity demonstrated a significantly smaller overall SERVQUAL gap (p=0.003), indicating that differences in execution capacity translate directly into measurable differences in patient experience. This study provides compelling evidence; however, its findings should be interpreted in light of the following limitations. Cross-Sectional Design: The study employed a cross-sectional design, collecting data at a single point in time. While this allows for statistical comparison between institutions, it limits the ability to establish definitive cause-and-effect relationships or track the dynamic evolution of the Strategic Implementation Fidelity Gap over time. Future research should utilize longitudinal designs to assess the impact of implemented managerial protocols. Perceptual Data Dependency: The research relies primarily on patient-perceived quality data (SERVQUAL), which is inherently subjective. Although this is a crucial measure of service quality, the scope does not include the perspectives of healthcare providers or objective clinical outcome data. Generalizability: The sample was restricted to two public healthcare institutions in a single large city (Almaty, Kazakhstan). Therefore, the generalizability of the results to diverse regional healthcare settings or other transitional economies should be approached with caution. Strategic Resource Rebalancing: The results offer a clear rationale for healthcare decision-makers to strategically rebalance investments. Priorities must shift from sole reliance on structural assets to rigorous development and control of managerial and staff protocols, placing a specific focus on the identified areas of weakness: Empathy and Responsiveness. Management Monitoring Tool: The statistically significant differences between institutions demonstrate that the SERVQUAL gap score can serve as a quantifiable management monitoring tool for supervisory bodies to audit the quality of strategic execution and compliance. Applicability in Transitional Systems: The findings provide an actionable governance model for all transitional and emerging economies seeking to modernize their health systems, demonstrating that reform success is predicated on the quality of Behavioral Governance. Restoring Public Trust: The identified gaps in Empathy and Responsiveness are primary drivers of eroded public trust in the healthcare system and government-led reforms. Addressing the Strategic Implementation Fidelity Gap through mandatory behavioral governance directly contributes to restoring citizens' trust in public institutions. Promoting Social Equity: Inconsistent service quality (low Implementation Fidelity) creates barriers to equitable access to effective care. Ensuring every facility adheres to standardized protocols (especially in behavioral aspects) promotes social equity and guarantees consistent quality of service for all population segments. Enhancing Patient Well-being: Directly addressing failures in Empathy and Responsiveness not only improves the clinical experience but also significantly enhances the psychological and emotional well-being of patients, increasing their adherence to treatment plans and overall satisfaction with state interaction. The study provides the first empirical quantification of a Strategic Implementation Fidelity Gap in a transitional healthcare system and demonstrates that service quality deficits are not solely driven by resource constraints, but by failures in behavioral execution. By repositioning SERVQUAL as a diagnostic tool for strategic implementation, the study offers a novel framework for assessing how governance and execution shape frontline outcomes. The findings suggest that healthcare reforms should move beyond structural investment and prioritize behavioral governance, performance monitoring, and the standardization of frontline practices to ensure effective strategy implementation.

This study discusses the analysis of the account opening procedure for E-mas Savings through the digital platform BYOND by Bank Syariah Indonesia. The selection of this topic is motivated by the development of digital services in Islamic banking and the increasing public interest in gold investment products based on sharia principles. The purpose of this study is to identify the procedure for opening an E-mas Savings account and to examine its compliance with sharia accounting principles and DSN-MUI Fatwas. This research was conducted at Bank Syariah Indonesia KCP Tegal Sutoyo using data collection techniques in the form of observation, interviews, and documentation. The study employed a qualitative descriptive approach to obtain an in-depth understanding of the implementation of digital-based E-mas Savings services. The focus of the research was directed toward the stages of the account opening procedure, transaction mechanisms, and the application of sharia principles in digital banking services. The results indicate that the procedure for opening an E-mas Savings account has been implemented in accordance with applicable regulations and sharia principles, although there are still obstacles related to the uneven level of customer understanding regarding digital service mechanisms. In addition, the implementation of digital services through BYOND by BSI is considered capable of providing convenience, efficiency, and flexibility for customers in conducting gold investments without having to visit bank branches directly. Therefore, increased education and socialization for customers are needed so that the utilization of E-mas Savings can run more optimally and enhance public trust in digital-based sharia investment products..

Indonesia's criminal law system, which is still oriented towards criminalizing offenders (offender oriented), has not been able to optimally guarantee the recovery of state losses. The method used is a normative juridical approach with conceptual and comparative analysis. The results of the study show the need for a paradigm shift towards an asset-oriented approach through strengthening the mechanisms of non-conviction based asset forfeiture, value-based confiscation, and limited and balanced reverse proof, as well as the reformulation of procedural law through in rem justice and early confiscation. Criminal law reform is expected to increase the effectiveness of asset recovery while maintaining the principles of due process of law and human rights protection. Philosophically, this reform is based on substantive and restorative justice, juridically in line with the constitution and the UNCAC, and sociologically responds to public demands. Thus, an integrated and fair asset forfeiture system is the key to the effectiveness of eradicating corruption and strengthening public trust.

This study investigated the relationships among job satisfaction, emotional exhaustion, and turnover intention among nurses. The research was conducted with a sample of 356 nurses employed at a university hospital and examined the moderating roles of demographic variables, including age, marital status, experience at the hospital, and working time in the profession. The data collection tool was organized into two main sections. The first section focused on gathering socio-demographic information, including gender, age, marital status, experience at the hospital, and working time in the profession. The second section comprised validated scales used to measure the study variables. Data analysis was conducted using statistical software. Descriptive statistics were first employed to examine the demographic characteristics of the sample. To test the moderating effects of demographic variables on the relationship between emotional exhaustion and job satisfaction, the PROCESS Macro was utilized. For the moderation analysis, demographic variables such as age, marital status, hospital experience, and professional tenure were utilized. Other variables, including gender and educational status, were used solely for descriptive statistics. The findings indicated that experience at the hospital moderated the relationship between job satisfaction and turnover intention, while age, marital status, and working time in the profession moderated the relationship between emotional exhaustion and job satisfaction. Given the critical importance of sustainable human resources in the healthcare sector, these results offer valuable insights for healthcare administrators and policymakers aiming to enhance nurse retention and improve workforce stability. Given the critical importance of sustainable human resources in the healthcare sector, these results offer valuable insights for healthcare administrators and policymakers aiming to enhance nurse retention and improve workforce stability. The fact that the study was conducted at a single center in Turkey constitutes a limitation. This study offers guidance for healthcare institutions aiming to improve nurse retention. Emotional exhaustion reduces job satisfaction and increases turnover intention, especially among early- and mid-career nurses. Hospitals can reduce turnover through burnout-prevention strategies such as supportive supervision, mentorship, flexible scheduling, and improved staffing and reward systems. The identification of key demographic moderators (e.g. age, experience, marital status) enables institutions to tailor interventions- for example, career-development and coping-skills programs for younger nurses and work-family balance support for mid-career/married nurses. Nurse burnout and turnover undermine the quality, safety, and accessibility of patient care. By underscoring the importance of supporting nurses' well-being, this study contributes to public discussions on strengthening healthcare systems. Reducing turnover can enhance patient outcomes, public trust, and system resilience-particularly important during public health crises. In this study, a contribution to the literature was made by testing the validity of the Conservation of Resources Theory while determining the relationships among job satisfaction, burnout, and turnover intention. Furthermore, the study may provide guidance to healthcare administrators and policymakers in understanding the factors that contribute to workforce retention among nurses.

ABSTRACT The proliferation of realistic-looking visuals such as maps and images that are deliberately fabricated to spread misinformation has ignited a public trust crisis. Does the visual nature of this misinformation make it more credible and memorable? Does debunking affect people’s credibility judgments and memory of misinformation? This study explores these questions by conducting an online pre-post test experiment (N = 317). Accordingly, we compare responses to one misinformation article story in three different formats: text-only, text and ground-image, and text and satellite map while investigating if the inclusion of a follow-up debunking article changes these responses. Our findings suggest that visual modalities did not lead to higher recall or message credibility compared to text modality. However, debunking was effective in decreasing message credibility regardless of the modality of misinformation and in bolstering recall of misinformation and correcting information. Beyond expanding our theoretical understanding of modality effects by studying maps, our findings provide guidance on how to effectively debunk misinformation with fact-checking.

This study aims to analyse the opportunities and barriers in marketing the Qurban Savings product at BMT Al-Hikmah Permata. This study employs a qualitative approach, with data collection techniques including interviews, observation and documentation. Data analysis was conducted through the stages of data reduction, data presentation, and drawing conclusions. The results of the study indicate that the Qurban Savings product has significant market potential, supported by the strong tradition of the Qurban ritual and the high level of public interest in performing it. This product also serves as an alternative solution for those with limited funds through a gradual savings system. However, the marketing of the product still faces several obstacles, such as low public literacy regarding the product, perceptions equating it with conventional savings groups, the habit of performing qurban directly, low savings discipline, unstable economic conditions, as well as competition with other financial institutions and more established qurban savings groups. These findings indicate that marketing success is influenced not only by market potential but also by the level of public understanding and trust. Therefore, strategies are required to enhance education, promote the product based on religious values, innovate the deposit system, and improve service quality so that the product can develop more effectively.

Extracorporeal cardiopulmonary resuscitation (ECPR) offers a life-saving option for select patients with refractory cardiac arrest, yet a substantial proportion suffer devastating neurological injury and die despite extracorporeal support. In this context, organ donation may emerge as a potential downstream pathway, introducing complex ethical tensions at the intersection of life-sustaining treatment, end-of-life care, and organ preservation. This narrative review examines the ethical challenges associated with organ donation following ECPR, with particular attention to the transition from resuscitative intent to donation-oriented care. We discuss the clinical and ethical challenges of ECPR programs related to patient autonomy, informed consent, conflicts of interest, and equity of access in both adult and paediatric populations. Building on core principles of biomedical ethics, we propose a structured ethical model to guide clinicians and institutions navigating these scenarios. Central elements include strict separation between resuscitative and donation-related decision-making, transparent prognostication, robust safeguards around treatment intent, and early integration of ethics consultation and structured communication processes. We extend the prior evidence by offering ECPR-specific considerations, including concrete governance triggers, bedside tools, the integration of paediatric perspectives, and the translation of ethical principles into operational guidance. By defining clear ethical boundaries and governance mechanisms, this review aims to support the responsible integration of organ donation pathways following ECPR, while preserving public trust and reaffirming the primacy of patient-centred care.

Abstract The increasing integration of artificial intelligence in healthcare services has raised concerns about privacy, accountability, and public trust, particularly for vulnerable populations. This study examines state-level governance frameworks regulating artificial intelligence in the United States healthcare. It analyzes 141 enacted state laws to identify key regulatory themes, including data privacy, electronic health records, patient consent, biometric data, and algorithmic transparency. Findings reveal regional disparities and fragmented legal protections, suggesting that regulatory inconsistency may undermine public trust and exacerbate healthcare inequalities. The paper concludes with theory-informed policy recommendations to strengthen governance frameworks while supporting responsible innovation.

Evidence for an ethics-practice gap in digital anatomy education: Provenance and consent disclosure in English-language YouTube videos.

ABSTRACT Background Artificial intelligence (AI) is increasingly embedded in scientific research, reshaping how knowledge is produced, evaluated, and legitimised. While much existing research examines AI as a technical innovation or pedagogical tool, less attention has been paid to how scientists themselves articulate its role within science. Purpose This study examines how scientists discuss AI in Nature and Science commentaries and considers implications for the nature of science (NOS) and science education. Sample The dataset comprises AI-related commentaries published in Nature (N = 242) and Science (N = 226) between 2021 and 2024, covering scientific discourse both prior to and following the public release of ChatGPT in late 2022. Design and methods Data were analysed using reflexive thematic analysis (RTA), with the Family Resemblance Approach to NOS (FRA – NOS) as an analytical orientation. This study is among the first to combine RTA with FRA – NOS to identify cross-cutting patterns between epistemic, methodological, social, institutional, political, and value-laden aspects of science. Such combination is methodologically resonant with Wittgenstein’s notion of family resemblance, foregrounding overlapping patterns of meaning rather than discrete categories. Result AI is not framed as a discrete tool but as a cross-cutting condition that reconfigures epistemic authority, infrastructure, scientific labour, governance, and public trust. Conclusion The analysis points to the importance of approaching AI in science education not merely as an add-on topic or technical skill, but as an opportunity to engage learners with science as a socially embedded, institutionally governed, and value-laden practice. Concrete examples are provided through educational applications of FRA – NOS. Methodologically, the study illustrates how combining RTA and FRA supports the identification of cross-cutting patterns that may be less visible in specific aspects of NOS or reliability-driven analyses.