Technical standards and renewable energy exports: Governance pathways for sustainable futures

This study aimed to quantify the real-world availability of a single-segment great saphenous vein (GSV) in a nonselective Korean cohort with peripheral arterial disease and to identify patient-level predictors that may limit the adoption of a vein-first strategy. This retrospective analysis of prospectively collected data included 115 consecutive patients admitted for evaluation and planning of lower-extremity revascularization (53 with claudication and 62 with chronic limb-threatening ischemia [CLTI]) from 2023 to 2024. All patients underwent mandatory bilateral duplex mapping before treatment by registered vascular technologists under a standardized protocol (reverse Trendelenburg position, temperature 25°C-26°C, inner-to-inner measurements). A suitable single-segment conduit was defined as a continuous, thrombus-free GSV from the saphenofemoral junction to the proximal calf without duplex-detected reflux and was categorized by minimum diameter as ideal (≥3.0 mm), acceptable (≥2.5 mm), or borderline (≥2.0 mm). In the ipsilateral limb, the GSV met the ideal, acceptable, and borderline thresholds in 23/115 (20.0%), 39/115 (33.9%), and 57/115 (49.6%) patients, respectively. When the contralateral limb was included, overall availability (either limb) increased to 28/115 (24.3%), 58/115 (50.4%), and 75/115 (65.2%), corresponding to absolute gains of 4.3, 16.5, and 15.6 percentage points, respectively. Ipsilateral and overall ideal availability tended to be lower in CLTI than in claudication (14.5% vs. 26.4%, P=0.112 for ipsilateral; 17.7% vs. 32.1%, P=0.074 for overall). On multivariable analysis, older age and female sex were independently associated with reduced overall ideal availability (adjusted odds ratio [aOR] per year, 0.932; 95% confidence interval [CI], 0.887-0.979; female sex: aOR, 0.201; 95% CI, 0.046-0.869). In this consecutive real-world cohort, ideal single-segment GSV availability (≥3.0 mm) was low and was further limited by older age and female sex. These findings highlight an important limitation of a vein-first strategy in routine practice and support standardized bilateral mapping to clarify conduit availability and guide individualized revascularization planning.

Introduction: Navigated transcranial magnetic stimulation (nTMS) is an advanced, noninvasive method for stimulation-based functional brain mapping. Its main clinical value in neurosurgery lies in preoperative identification of eloquent cortical areas and the integration of functional information into neuronavigation-based surgical planning. State of the Art: This narrative review with a structured literature search summarizes the historical and technical foundations of TMS/nTMS, but primarily focuses on neurosurgical applications, including motor and language mapping, comparison with functional MRI and direct cortical stimulation, safety considerations, and practical limitations. Broader neurological and therapeutic applications are discussed as contextual extensions rather than as a comprehensive disease-specific review. Clinical Implications: Current evidence is strongest for preoperative motor mapping in patients with tumors located in or near the motor–eloquent cortex. Language mapping, neurological diagnostics, and therapeutic repetitive TMS (rTMS) applications remain more heterogeneous and require careful interpretation according to the level of evidence, protocol standardization, and patient selection. Future Directions: Further multicenter studies, standardized mapping protocols, integration with advanced imaging and tractography, and health-system implementation strategies are needed to define the optimal role of nTMS in personalized neurosurgical and neurological care.

Endometrial cancer incidence and mortality are rising globally, disproportionately affecting health systems facing diagnostic, therapeutic, and survivorship constraints. Rapid innovations-including the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging, molecular classification, sentinel lymph node (SLN) mapping, evolving adjuvant strategies, immunotherapy, and digital tools-risk exacerbating inequities if implementation mismatches system readiness. This narrative review synthesizes key trials, international guidelines, and high-impact implementation studies published between 2010 and September 2025. We summarize contemporary evidence across staging, molecular pathology, imaging, surgery, radiotherapy, systemic therapy, survivorship, equity, and artificial intelligence (AI), translating this into a pragmatic, resource-stratified framework. A previously published principal-component-based structural-readiness clustering model encompassing 68 countries is applied-but not re-derived-to illustrate how health-system capacity shapes access to diagnostics, treatment, and innovation. Persistent gaps include limited availability of universal mismatch repair (MMR) and p53 immunohistochemistry, variable adoption of standardized SLN mapping, uneven radiotherapy access, restricted use of immunotherapy for mismatch-repair deficient (dMMR)/microsatellite instability high (MSI-H) tumors, and fragmented survivorship care. A minimum-core-optimal implementation ladder is proposed to guide diagnostic, surgical, radiotherapeutic, systemic-therapy, and survivorship priorities across varying resource levels. AI-supported quality assurance is discussed alongside essential requirements of local validation, bias mitigation, and robust governance. Rather than generating new empirical data, this review employs a cluster-informed, equity-oriented lens, applying previously validated system-level typologies to contextualize implementation gaps and support context-sensitive guideline adaptation.

Cholinergic activity supports cortical activation during REM sleep, while other neurotransmitter systems are almost silent. Here, we tested the long-standing hypothesis that early cholinergic denervation may be associated with REM sleep EEG slowing in older adults. Twenty-four older participants without dementia (mean age: 71.29 ± 4.85 years; 58.33% women; 25% participants with amnestic Mild Cognitive Impairment) underwent a night of in-laboratory polysomnography, comprehensive neuropsychological evaluation, structural MRI and molecular PET imaging with [18F]-Fluoroethoxybenzovesamicol (FEOBV) to quantify brain cholinergic innervation. Voxel-wise multiple regressions assessed the associations between REM sleep characteristics (i.e., REM sleep percentage, relative theta power and EEG slowing ratios, defined as [delta + theta]/[alpha + beta] power) and FEOBV-PET standard uptake value ratio maps, controlling for sex. Given that FEOBV uptake was higher in women compared to men, we also performed exploratory sex-stratified analyses adjusted for age. Higher REM sleep EEG slowing over frontal (F3-F4), central (C3-C4), parietal (P3-P4), occipital (O1-O2) and temporal (T5-T6) derivations was significantly associated with cortical cholinergic denervation, notably in fronto-parietal areas and the medial temporal lobe. Sex-stratified analyses showed that higher REM sleep EEG slowing ratios were associated with cholinergic denervation mainly in medial temporal regions in women, and neocortical regions in men. These findings suggest that global REM sleep EEG slowing may represent a sensitive marker of cortical cholinergic denervation in older adults without dementia, and may constitute a promising marker for early diagnosis and disease-modifying interventions in Alzheimer's disease.

Accurate sentinel lymph node (SLN) mapping is essential for staging melanoma and guiding adjuvant therapy. Conventional mapping uses technetium-99m (Tc-99m) radiocolloid ± blue dye. Near-infrared fluorescence with indocyanine green (ICG) offers real-time, radiation-free visualization but varies in transcutaneous performance. This review synthesizes contemporary evidence comparing ICG to Tc-99m and blue dye for SLN detection in melanoma, highlighting anatomic, technical, and safety considerations relevant to surgical workflow. Narrative review of prospective series, head-to-head studies, and recent systematic reviews/meta-analyses evaluating SLN identification rates, node-level detection, transcutaneous vs. intraoperative fluorescence, false-negative considerations, and adverse events, with special attention to head/neck melanoma and dual-tracer strategies. ICG achieves high patient-level SLN identification (≈79-100%), comparable to Tc-99m (≈86-100%) and consistently superior to blue dye alone. Dual-tracer approaches (ICG + Tc-99m or ICG + blue dye) frequently report near-universal detection and practical reductions in missed nodes. Transcutaneous fluorescence through intact skin is variable, limited by near-infrared penetration and BMI, whereas intraoperative fluorescence after a small incision is highly reliable and expedites dissection. Head/neck basins particularly benefit from real-time fluorescence to delineate complex channels and confirm first-echelon nodes. ICG demonstrates an excellent safety profile with rare hypersensitivity, avoids radiation exposure, and integrates smoothly with gamma-probe guidance. Adoption barriers include heterogeneous dosing/timing, equipment cost, and lack of standardized reporting. ICG fluorescence is a robust adjunct to standard SLN mapping, offering intraoperative "visual GPS" especially valuable in head/neck melanoma. Current evidence supports ICG as a complement for radiocolloid mapping.

Purpose Global adoption of integrated care provides opportunities for enhancing life outcomes and personalised services and addressing health and social inequality, with the attainment of these aspirations requiring specific educational interventions. This project sought to address the paucity of available interventions within the literature by presenting an effective curriculum framework for training pre-registration health and social care students to provide integrated care within the primary context of English integrated care systems. Design/methodology/approach An action research approach developed the curriculum framework in four stages: (1) a literature review identified existing evidence available for educating students around integrated care; (2) thematic mapping of professional standards and health and social care course learning outcomes confirmed the elements required for successful practice; (3) student evaluation of the mapping outputs and perspectives on integrated care confirmed applicability to programmes and (4) conceptualisation of the final framework. Findings The curriculum framework comprises eight domains, each containing competency requirements to achieve the overall outcome aligned to successful practice in integrated care and within integrated care systems. The presented framework provides the overall thematic outcome for the domain and the learning outcomes required. The framework is centralised by person-centred care as a hallmark of effective practice and commitment within integrated care. Research limitations/implications The framework offers a tailored approach to educating undergraduate health and social care students around integrated care and working within integrated care systems. Practical implications The framework offers a new and novel mechanism for training the future workforce in integrated care and for working in integrated care systems. Originality/value The integrated care curriculum framework offers an opportunity to address the current evidence gap of interventions designed to train students for future practice in integrated care and within integrated care systems and the requirements of professional education for enhancing knowledge in the field.

Process standardization in development departments is a critical strategic lever for improving operational efficiency, reducing variability, and enhancing product quality in manufacturing organizations. This research paper investigates the current challenges associated with non-standardized development processes, explores frameworks and methodologies for process standardization, and evaluates the measurable efficiency improvements achievable through systematic standardization initiatives. Grounded in principles of Production and Operations Management, the study examines key standardization tools such as Standard Operating Procedures (SOPs), workflow mapping, Lean methodology, and Kaizen practices. Drawing from secondary research, industry case studies, and established literature in operations management, the paper presents a structured model for implementing process standardization in development departments. Findings indicate that organizations that implement well-defined process standards experience significant reductions in cycle time, rework, and resource wastage, while simultaneously improving team productivity and output consistency. The paper also identifies critical success factors, including leadership commitment, employee training, and continuous improvement culture, that are essential for sustaining standardization efforts. Recommendations are provided for organizations seeking to align their development processes with global best practices in operations management.

To assess the accuracy of 18F choline PET/magnetic resonance (MR) when compared with the reference standard MRI-guided template mapping (TPM) biopsies for evaluation of biochemical relapse of prostate cancer in patients with clinically significant and insignificant disease. A total of 26 prostate lobes in 13 patients with rise in prostate-specific antigen (PSA), age range 56-79; median 66 years, who had 18F choline PET/MR and underwent TPM. Whole body PET/MR images were correlated with maximum cancer core length (MCCL) and total cancer core length (TCCL) obtained via TPM. The mean age of the patients was 66 years (median: 66, range: 56-79 years), and the mean PSA level was 5.17 ng/ml (median: 4.40 ng/ml, range: 1.0-11.1 ng/ml; Roche Modular method). The mean maximum standard uptake value (SUVmax ) was 3.18 (median: 2.3, range: 0.6-12.3). The mean MCCL was 1.5 mm (range: 1-9 mm), mean TCCL was 3.1 mm (range: 1-28 mm). We evaluated the correlation (P value) between MCCL, TCCL, and SUVmax on 18F choline PET/MR with univariate analysis. P value for MCCL was 0.078 and for TCCL 0.093. Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were 77, 70, 58, 85, and 0.621 (95% confidence interval: 2.16-4.19). 18F choline PET/MR allows detection of clinically significant and insignificant prostate cancer. Multiple previous treatments can give false positive results. False negative results with 18F choline PET/MR can be because of very small volume (≤2 mm) disease.

To develop an interpretable feature-based Deep Parametric Response Mapping (PRM D ) method that combines wavelet scattering convolution networks and machine learning to spatially detect and quantify functional small airways disease (fSAD) and emphysema on paired inspiratory-expiratory CT scans, with enhanced noise robustness. In this retrospective analysis of prospectively acquired data (2007-2017), we developed and validated a deep learning-based PRM approach using paired CT scans from 8,972 tobacco-exposed COPDGene participants (≥10 pack-years; mean age 60.1 ± 8.8 years; 46.5% women), including controls with normal spirometry (n = 3,872; controls), PRISm (n = 1,089), GOLD 1-4 COPD (n = 4,011). Data were stratified into training, validation, and testing sets (24:6:70). PRM D extracts translation-invariant image features using a wavelet scattering network and applies a subspace learning classifier to classify voxels as emphysema or non-emphysematous air trapping (fSAD). PRM D was compared with conventional density-based PRM for voxel-wise agreement, correlation with pulmonary function, robustness to noise, and sensitivity to misregistration using Pearson correlation, Bland-Altman analysis, and paired t tests. PRM D achieved 95% voxel-wise agreement with standard PRM (r = 0.98) while demonstrating significantly greater robustness under noise. PRM D showed stronger correlations with FEV (emphysema: r = -0.54; fSAD: r = -0.51; P < 0.0001) than standard PRM (r = -0.42 for both; P < 0.0001). Under simulated high-noise conditions, standard PRM overestimated disease by ∼15%, whereas PRM D limited error to < 5% ( P < 0.001). PRM D provides an interpretable, feature-driven and noise-resilient alternative to traditional PRM for emphysema and fSAD classification, enhancing the reliability of CT-based COPD phenotyping for multi-center studies and low-dose imaging applications. This study introduces combined wavelet scattering and subspace learning for medical image segmentation, enabling accurate, interpretable voxel-level classification of emphysema and functional small airways disease on paired CT scans.The proposed Deep Parametric Response Mapping method demonstrated 95% voxel-wise agreement with standard Parametric Response Mapping and stronger correlations with spirometric measures, enhancing the clinical relevance of CT-based phenotyping for Chronic Obstructive Pulmonary Disease. Deep Parametric Response Mapping significantly improved robustness to image noise-reducing overestimation of emphysema and functional small airways disease from ∼15% to <5% ( P < 0.001)-and benefits from reduced data requirements due to the fixed, mathematically defined filters used in wavelet scattering. Deep Parametric Response Mapping improves the accuracy and noise robustness of CT-based classification of emphysema and functional small airways disease using feature-based representations, enhancing the reliability of COPD phenotyping.

Understanding the location of modified nucleosides in RNA sequences is crucial to understanding their biochemical significance. Mapping the sequence location of modified nucleosides from low abundance RNAs is challenging. Here, we report the development of a liquid chromatography tandem mass spectrometry (LC-MS/MS) exclusion list strategy that enhances sequence information from modified oligonucleotides. This approach, compatible with standard RNA modification mapping methods that utilize LC-MS/MS, enables the exclusion of any unmodified oligonucleotide from fragmentation during MS/MS thereby enabling enhanced dissociation of modified oligonucleotides. This universal exclusion list is applicable to natural RNAs of any type from any organism. We find this approach generates at least 10% more mapped RNase T1 digestion products than using DDA alone. To demonstrate the broad utility of this approach for discovery-based analyses, RNA modification mapping of total tRNAs from four distinct organisms spanning both prokaryotic and eukaryotic domains was conducted.

The Melnikov-Arnold integrals (MA-integrals) is a well-known instrument used to measure the splitting of separatrices in Hamiltonian systems. In this article, we explore how calculation of MA-integrals can be used as well to estimate sizes of secondary resonances. Within the standard map model, we show how the newly developed MA-based procedure allows one to estimate the sizes of secondary resonances of any order (up to the order of the optimal normal form), without relying on the cumbersome traditional normalization procedure.

Prompt 3D mapping of grain storage is essential for effective management. However, standard mapping algorithms encounter a number of challenges, with the typical granary environment containing dust, grain piles, and narrow aisles. A single robotic agent is not able to provide complete area coverage, and most multi-robot approaches involve re-scanning the same areas due to a lack of explicit viewpoint-based task allocation processes. In order to overcome the above issues, we propose an air-ground collaborative exploration system for complex multi-grain pile scenarios. Exploration redundancy can be reduced by estimating the advantages of viewpoints through ray tracing and assigning the tops of the grain piles to aerial robots with ground vehicles in lower regions and narrow aisles. In order to manage dense dust (5-15 mg/m3), the quality-aware fusion strategy evaluates the reliability of the distance and point density of the sensing to reduce the influence of degraded aerial depth data. Moreover, mapping relies on LiDAR data to ensure mapping quality. A mechanism for re-scanning to enable coverage-driven exploitation of insufficiently explored regions is subsequently proposed. The simulation results show that the design achieved a grain pile coverage of 97.2%, with the total exploration time reduced by 20.1% over single-robot baselines. The results indicate that viewpoint-aware task allocation and dust-sensitive perception fusion can offer a practical solution for autonomous inspection in GPS-restricted, dust-rich industrial environments, such as granary facilities.

In this paper, we propose the Manifold Random Drift Particle Swarm Optimization (MRDPSO) algorithm for matrix optimization on smooth manifolds. Conventional swarm intelligence methods generally converge prematurely in constrained domains. To mitigate this issue, we introduce the swarm intelligence methods to the manifold and a Random Drift mechanism that regulates the search process. Using Riemannian geometry, our framework treats constrained problems as unconstrained ones on the manifold, which preserves the intrinsic geometric structure of the data. Particles are initialized on the manifold, while updates are performed in tangent spaces. Since geodesic calculations are computationally expensive, we use an inverse retraction as a faster alternative to standard logarithmic mapping. Numerical experiments on Grassmann, Stiefel, and Oblique manifolds show that MRDPSO achieves higher accuracy and superior convergence stability compared to recent state-of-the-art manifold-adapted heuristics, namely IISSO and MSSO.

Background: Predicting functional recovery after selective nerve transfer remains challenging. Intraoperative nerve action potential (NAP) recording is widely used to confirm axonal continuity in peripheral nerve surgery; however, its quantitative prognostic value in selective nerve transfer has not been clearly established. This study evaluated whether intraoperative donor fascicle NAP amplitude predicts functional recovery following selective ulnar-to-musculocutaneous nerve transfer (Oberlin procedure) for restoration of elbow flexion. Methods: This retrospective exploratory observational study included 20 patients who underwent selective ulnar-to-musculocutaneous nerve transfer (Oberlin procedure) with standardized intraoperative neurophysiological mapping and quantitative donor fascicle NAP recording. Functional outcome specific to elbow flexion was assessed at last follow-up using the Medical Research Council (MRC) grading system. Time to first electromyographic evidence of biceps reinnervation was recorded. Associations between intraoperative NAP amplitude and functional, temporal, and clinical variables were analyzed using Spearman's rank correlation coefficient and non-parametric tests. Results: Donor NAP amplitude demonstrated substantial interindividual variability (range 60-400 µV; median 137.5 µV, IQR 87.5-200 µV). No significant associations were observed between NAP amplitude and final MRC grade (ρ = -0.103; p = 0.666), time to electromyographic reinnervation (days: ρ = -0.123; p = 0.617), patient age, or time from injury to surgery. A moderate negative correlation between NAP amplitude and lesion severity was observed but did not reach statistical significance in this small cohort (ρ = -0.419; p = 0.0659). In contrast, shorter time to electromyographic reinnervation was significantly associated with improved final functional outcome (ρ = -0.559; p = 0.013). No patient reported postoperative hand weakness. Conclusions: In this exploratory cohort, intraoperative donor NAP amplitude was not associated with time to electromyographic reinnervation or final elbow flexion strength following selective ulnar-to-musculocutaneous nerve transfer. Although intraoperative NAP mapping remains essential to confirm axonal continuity and conduction viability of the donor fascicle, NAP amplitude did not demonstrate prognostic value in this cohort and should be interpreted cautiously as an isolated predictor of functional recovery, particularly given the limited sample size and exploratory design. These findings suggest that recovery after selective nerve transfer may be influenced by broader biological determinants, including regenerative timing, rather than by isolated intraoperative amplitude metrics.

Background: The formal implementation of Integrated Care Systems in England from July 2022 offered various opportunities for enhancement of life outcomes for underserved groups, including addressing health and social inequality and personalisation of care. To harness these improvements, the future health and social care professional workforce, trained within university pre-registration courses, require specific educational interventions around integrated care and practice within Integrated Care Systems. This project sought to address the lack of available interventions within the literature through the development of a tailored educational framework. By provision of the Integrated Care Curriculum Framework, the project develops programmes of theoretical and practice learning experiences within services providing interprofessional and integrated care. Approach: The project sought to develop an Integrated Care Curriculum Framework for all undergraduate health and social care education at the project site university. An action research approach was utilised to develop the curriculum framework in a multi-stage process. A rapid literature review was undertaken to identify evidence available for educating health and social care students in integrated care and Integrated Care Systems. This review was followed by a thematic mapping of professional standards and health and social care course learning outcomes, to identify the requirements of achieving successful practice. Student evaluation was subsequently undertaken of the mapping outputs and perspectives on effective practice within Integrated Care Systems. Based on these findings, the framework was successfully compiled in accordance with the identified learning requirements into a useable model for development of both theoretical and practical learning in integrated care and Integrated Care Systems. Results: The completed curriculum framework consists of 8 domains, each containing the required competencies to achieve the domain outcome, aligned to successful practice within Integrated Care Systems and interprofessional working to provide integrated care. The completed framework demonstrates the overall thematic outcome for the domain and the learning outcomes required for health and social care students to attain proficiency within the domain. The framework is centralised by a commitment to person-centred care as a hallmark of effective practice within Integrated Care Systems. The framework is now being utilised across the Faculty of Health and Social Sciences at the project site university to structure educational programmes and strategy for interprofessional and practice-based learning, evidenced within an initiative to place nursing students into social care placements. Implications: The framework addresses the current lack of interventions designed to train health and social care students for future practice within Integrated Care Systems in England and the requirements of professional education for achieving this in undergraduate courses. Future development of the framework includes evaluation of implementation across the Integrated Care System and the effectiveness of interprofessional practice learning experiences.

The development of Smart Tourism often overlooks the “Wilderness Last Mile”, leading to the spatial exclusion of people with disabilities in mountain areas. This problem exists because standard tourist maps and urban-centric accessibility models rely on averaged terrain data, failing to identify critical micro-scale barriers (e.g., short, sudden steep ascents) that pose severe safety and traction risks for off-road wheelchair users. To address this gap, this article presents a novel GIS methodology for planning accessible off-road tourism for electric Specialized Off-Road Wheelchairs. The proposed four-stage analytical model includes (1) graph-based trail network topologization to enable precise routing; (2) traction safety verification utilizing high-resolution (1 × 1 m) Digital Elevation Model (DEM) micro-segmentation to detect hidden slope barriers; (3) multi-criteria evaluation combining a user-calibrated Difficulty Index (EDI) and a Tourism Quality Index (TQI); and (4) a hub optimization algorithm that prioritizes locations maximizing the diversity of accessible routes. The method was empirically tested in a case study of the Bieszczady Mountains (Poland), calibrating the model with the technical limits (25% max slope) of a prototype wheelchair. The experimental results clearly validate the model’s superiority over traditional approaches: the micro-segmentation successfully identified hidden terrain traps, disqualifying 55% of the standard trail network that would have otherwise been deemed safe by average-slope assessments. Furthermore, the model identified a contiguous safe network of 153 km and pinpointed the optimal rental hub location, ensuring the highest inclusivity and route variety. Ultimately, this approach transforms raw spatial data into safe, ready-made tourism products, providing a precise tool with which to implement Universal Design in natural environments.

Over the past several years, states began formally enacting telehealth policies to avail audio-only services for those unable to receive care in-person or over video. Such policies may be especially important in community-based health centers (CHCs) where, when telehealth is provided, it is primarily via audio-only. This retrospective study examined whether codified policies for Medicaid reimbursement and payment parity of audio-only telehealth were associated with greater use of telehealth. Electronic health records for Medicaid-insured adults 18-64 years with visits to primary care (n = 700,051) and to behavioral health care (n = 95,136) in 433 primary care and 279 behavioral health care CHCs from April 1, 2021, to March 31, 2023, were analyzed. We collected policies using standardized legal mapping methods to identify audio-only telehealth policies having: (1) no reimbursement for telehealth, (2) reimbursement for telehealth, but no payment parity, or (3) reimbursement for telehealth, at parity. One-third of primary care visits were telehealth, most of which were audio-only. Two-thirds of behavioral health care visits were telehealth, half of which were audio-only. Primary care visits in states with audio-only telehealth reimbursement policies not at parity were 4.8 percentage points more likely, and behavioral health care visits in states with reimbursement at parity were 3.2 percentage points more likely to use telehealth. While audio-only telehealth reimbursement only modestly impacted overall telehealth utilization, Medicaid policies remain one of the few mutable factors important for primary care and behavioral health care access among safety-net populations.

Abstract Mount Kilimanjaro, with its steep elevational gradient (770–5,886 m a.s.l.) and pronounced land-use heterogeneity, supports high biodiversity and diverse Nature’s Contributions to People (NCP), but it is underrepresented in global spatial assessments. We address this gap by mapping NCP supply across 12 ecosystem types on the southern slopes identifying hotspots and coldspots and quantifying synergies and trade-offs among NCP categories. We use 25 context-specific NCP categories that integrates local and scientific knowledge with field measurements and remote-sensing-derived proxies. Combining long-term field data with remote sensing and machine learning, we upscaled plot-scale indicators into standardized supply maps. Total NCP supply is strongly concentrated in mid-elevation ecosystems: the 1,100–2,200 m band alone accounted for ~59% of total supply compared with ~18% in the lowlands (700–1,100 m), and the 1,100–2,800 m belts together provide ~73%, whereas high-elevation zones (2,800–4,600 m) contribute &lt;9%. Hotspots clustered in lower montane forest, Ocotea forest and homegardens at mid-elevations, while coldspots occur in Erica forest and Helichrysum vegetation at high elevations and in maize fields and savanna at low elevations. We detected moderate (r = 0.55) to strong synergies (r = 0.83) among the three NCP groups (material, regulating, non-material). After accounting for climatic co-variation, the correlations among NCP groups weakened (r = 0.23 to 0.44), underscoring the critical role of climate for NCP supply. Our study maps NCP hotspots and coldspots across Mt Kilimanjaro and provides a decision-support layer for conservation, restoration and agroforestry management, as well as a blueprint for spatially-explicit NCP mapping and analyses.

The catastrophic impact of Hurricane Helene proved that standard FEMA flood maps are often inadequate for assessing risk in complex mountainous terrain. Using Buncombe County, North Carolina, as a case study, this research introduces a replicable framework for siting emergency shelters based on a multi-dimensional Flood Risk Index. By synthesizing HAND-derived inundation data, land-use intensity, and a machine learning-based Socio-Economic Vulnerability Index (SEVI), we mapped the intersection of hazard and vulnerability. Our analysis reveals a significant misalignment—a large portion of the current shelter network sits in high-risk zones, while safer upland corridors in the north and west remain underutilized. This study delivers a data-driven roadmap for disaster preparedness, ensuring that future shelter placement is not only safe from terrain-driven floods but also strategically and equitably located.