Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift camps of Ukhiya, Cox’s Bazar. Methods: A descriptive cross-sectional study was conducted among 96 pregnant Rohingya women from June to September 2022. Data were collected using structured questionnaires assessing socio-demographic characteristics, food security, and dietary diversity. Food security was evaluated using the Household Food Insecurity Access Scale (HFIAS), while dietary diversity was assessed through a 24-hour dietary recall and a 7-day food frequency questionnaire. Data were analyzed using SPSS (Version 26) and Stata (Version 13), employing descriptive statistics and chi-square tests to examine associations. Results: Most participants (57.3%) were food secure, and 85.4% demonstrated high dietary diversity, consuming seven or more food groups. However, 21.9% of households experienced severe food insecurity, highlighting ongoing challenges in food access. The highest consumption was observed for starch, flesh foods, dark green leafy vegetables, and vitamin A-rich fruits and vegetables (99.0%), while dairy products (69.8%) and organ meat (34.4%) were consumed less frequently. Despite high dietary diversity, severe food insecurity persists, indicating gaps in food assistance programs. Conclusions: While food support programs appear to contribute to high dietary diversity among pregnant Rohingya women, severe food insecurity remains a significant concern. Strengthening food security interventions, improving access to diverse nutrient-rich foods, and integrating sustainable food assistance models are essential to addressing these challenges. Future research should explore long-term strategies to enhance food security and assess the impact of targeted nutritional interventions on maternal health outcomes in refugee settings.

Background: Nursing students are exposed to significant stress due to academic and clinical demands, which can adversely affect their mental health, academic performance, and future clinical competence. Despite the global acknowledgment of this issue, limited research has been conducted to explore the prevalence and determinants of stress among nursing students in Bangladesh. Methods: This cross-sectional study was conducted from December 2023 to February 2024 among 372 nursing students enrolled in selected nursing colleges in Bangladesh. A purposive sampling technique was used, and data was collected using a semi-structured questionnaire. The questionnaire assessed socio-demographic characteristics, academic challenges, and psychological symptoms, with mental health stress measured using a Likert scale. Descriptive statistics and Chi-square tests were used to analyze the data, with a 95% confidence interval applied to all analyses. Results: The findings revealed that 31.7% of nursing students experienced severe stress, 23.9% reported moderate stress, and 16.7% had mild stress. Age, academic semester, and course load difficulties were significantly associated with stress levels (p < 0.05). Psychological symptoms such as anxiety, difficulty concentrating, and loss of interest in activities were also significantly linked to higher stress levels. Notably, students in their first semester and those reporting harder course loads were more likely to experience stress. However, gender was not significantly associated with stress levels. Conclusions: This study underscores the high prevalence of stress among nursing students in Bangladesh, driven by academic and clinical challenges and psychological symptoms. The findings highlight the need for targeted interventions, such as stress management training, enhanced mental health support, and policies to alleviate academic pressures. Future research should explore longitudinal trends in stress and evaluate the effectiveness of interventions to support a resilient nursing workforce.

Artificial Immune Systems (AIS) are bio-inspired computational frameworks that emulate the adaptive mechanisms of the human immune system, such as self/non-self discrimination, clonal selection, and immune memory. These systems have demonstrated significant potential in addressing complex challenges across optimization, anomaly detection, and adaptive system control. This paper provides a comprehensive exploration of AIS applications in domains such as cybersecurity, resource allocation, and autonomous systems, highlighting the growing importance of hybrid AIS models. Recent advancements, including integrations with machine learning, quantum computing, and bioinformatics, are discussed as solutions to scalability, high-dimensional data processing, and efficiency challenges. Core algorithms, such as the Negative Selection Algorithm (NSA) and Clonal Selection Algorithm (CSA), are examined, along with limitations in interpretability and compatibility with emerging AI paradigms. The paper concludes by proposing future research directions, emphasizing scalable hybrid frameworks, quantum-inspired approaches, and real-time adaptive systems, underscoring AIS's transformative potential across diverse computational fields.

Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published between January and December 2020. These studies were analyzed to identify common psychological outcomes and coping mechanisms among HCWs. Results: Healthcare workers experienced significant psychological distress during the COVID-19 pandemic, including anxiety, stress, insomnia, and depression. Anxiety was the most commonly reported issue, particularly among women, younger healthcare workers, and frontline staff. Stress levels were heightened by high workloads, exposure to COVID-19 patients, and inadequate protective measures. Coping strategies and self-care behaviors, such as seeking social support and utilizing institutional resources, varied in effectiveness across populations. Conclusion: The findings highlight the urgent need for targeted mental health support and resilience programs for HCWs, ensuring they are better equipped to face future health crises.

Considering the current climate conjuncture, it is a consensus that green spaces in large contemporary urban areas should be increasingly more numerous and simultaneously more sustainable, being adapted to the edaphoclimatic conditions of the site, and with reduced maintenance costs. In the case of Algarve, where this research is focused, the current and future water availability, assumes a preponderant role in the design of green spaces, where the demands mentioned above can only be achieved if we deviate from conventional landscape practices and develop holistic strategies of management and design of green spaces that integrate different areas of knowledge and not merely aesthetic issues. In this context, this work aims to develop more adapted and resilient landscaping practices to the current and future climatic conditions of the Algarve, thus reinventing the concept of landscaping in the south of Portugal. Thus, it will be of paramount importance to develop more sustainable, resilient and tolerant projects to worsening ecological conditions, particularly limitations associated with water availability. The xeromorphic succulents are a group of plants with mechanisms of tolerance to water stress and with very specific characteristics, being succulence one of the most relevant. Studies on these mechanisms are increasingly frequent, which may prove to be very advantageous in our adaptation to future climatic challenges. In addition, their ornamental potential is enormous, since their bold forms and colours are a veritable sensory explosion, which, combined with their morphological and physiological characteristics, make them the species of choice in the reconversion or creation of xerophytic gardens.

1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. 3) Method: Using Concept Analysis by Walker and Avant (2019). 4) Results: A total of 20 articles were reviewed. Four major attributes were identified: psychological and emotional impact, communication barriers, acculturation and quality of life, and organizational challenges. 5) Conclusion: This paper explores the challenges faced by nurses from foreign countries due to cultural adjustment and proposes solutions to minimize its effects. It is beneficial for nurses, healthcare organizations, and policymakers, aiming to improve patient care and health outcomes. 6) Implication for Practice: Addressing culture shock can promote a smooth transition, enhance nurses' experience, and improve their cultural competence. Providing tailored orientation and mentorship programs can help IENs feel supported and empowered, leading to increased job satisfaction, retention rates, and better patient outcomes.

This paper investigates the constructability of angles multiples of 3 within the framework of Euclidean geometry. It makes a significant contribution by presenting the first geometric construction for all such angles, offering a rigorous solution to a longstanding geometric problem. The paper reaffirms the efficacy of Euclidean geometry in providing precise constructions and robust proofs for these angles, demonstrating the enduring strength of Euclidean principles from classical to modern times. The presented workflow goes beyond Euclidean geometry to examine non-Euclidean methods, particularly analytical approaches, revealing misconceptions that compromise the genetic and geometric rigor of Euclidean principles. The paper exposes incongruities when algebraic proofs related to angle constructability are applied to the Euclidean system, emphasizing the misalignment of fundamental geometric concepts. A notable result in the paper is the construction of a angle, introducing the “ angle chord” as a novel geometric property. This property challenges assumptions made by non-Euclidean methods and highlights the nuanced geometric properties crucial for rigorous constructions. The paper refutes the fallacy of relying solely on algebra for solutions to angles multiples of , emphasizing the necessity of embracing Euclidean geometry for geometric discoveries. The paper underscores the merits and resilience of Euclidean geometry, showcasing its independence and depth across historical and modern perspectives. The newly presented geometric construction not only resolves a longstanding question but also emphasizes the intrinsic strength and uniqueness of Euclidean principles in contrast to alternative methodologies.

The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.

A persistent problem in the pharmaceutical industry that has existed for centuries is the prevalence of counterfeit drugs, and the World Health Organization (WHO) estimates that millions of people are affected by this issue each year. In particular, 4 out of 10 drugs in poor or underdeveloped countries may be adulterated, which can lead to severe adverse events. To address this problem, many countries have implemented regulatory compliance measures such as pharmaceutical drug serialization, which requires the unique identification of every drug package manufactured. This enables tracking and tracing of individual packages throughout the supply chain and helps to prevent counterfeit drugs from entering the market. In this paper, we conduct a systematic review of the serialization process evaluation and its impact on the pharmaceutical industry. We discuss the benefits of pharmaceutical drug serialization, including its ability to improve drug security and reduce adverse events and investigations. We also examine the challenges associated with implementing serialization processes and the regulatory requirements necessary for compliance. Finally, we explore the various tracking and tracing technologies used in serialization processes and their effectiveness in preventing the distribution of counterfeit drugs. Overall, this paper highlights the importance of pharmaceutical drug serialization in ensuring the safety and efficacy of drugs in the healthcare industry, particularly in poor or underdeveloped countries where the problem of adulterated drugs is especially prevalent.

This review aimed to analyze some problems and challenges that emerged from the COVID-19 pandemic since it has affected all global business sectors. During the pandemic, remote work was increased in response to social distance requirements to decrease the transmission of disease. In addition, increased delegation, teamwork, supply chains, sales activities, and business operations have all been disrupted. Many challenges have emerged in the management of organizations due to the pandemic including the lack of direct contact as the lockdown made many people work from home and placed restrictions on movement and travel and uncertainty about the future. The healthcare system was also affected by the COVID-19 pandemic and faced several difficulties including increased demand for medical supplies and personal protective equipment, a greater need for nurses and other skilled healthcare professionals, and increased pressure on healthcare facilities, emergency services, and critical care departments. These challenges have created some opportunities in the management systems of healthcare organizations and other sectors. It is recommended for leaders prepare and continuously work proactively to be ready for unexpected future crises. Risk management and planning for any unexpected situation are among the very important aspects of organizational management.

Neurodegeneration and aging are pressing issues with significant personal, economic, ethical, and social consequences. However, the underlying biological mechanisms of these conditions remain largely unknown, making the development of effective treatments challenging. The difficulty in early detection and diagnosis of neurodegenerative diseases further compounds the issue. Recent advancements in genetics, genomics, and brain imaging technology hold great promise for improving our understanding of neurodegeneration and aging, as well as the development of personalized medicine and new drugs and therapies. Addressing these challenges will require a multi-disciplinary and collaborative approach from researchers in various fields. This Special Issue offers valuable insights and perspectives on this critical area of research, which can help advance our understanding and improve the health and well-being of our aging population.

Background: By rediscovering the medical field spiritual foundation, clinicians sought to balance their care and realize that spirituality is frequently associated with healthcare, thus one’s spiritual beliefs influence patients' decisions between aggressive care and complementary therapies in oncology care. Aim: This study investigates clinicians’ experiences and perceptions of spirituality in oncology care that clinicians can utilize to improve cancer and spiritual care provision. Methods: A thematic, qualitative synthesis. Results: Four main themes emerged from the synthesis of the 11 included studies that can steer future framework and policies to make clinicians more inept in providing care to address spiritual well-being of the patients and their family from a clinician's point of view of spirituality: “Maintaining Hope and Spiritual Wellness, Clinician’s Sensitivity to Cancer Patients, Provision of Culturally Respectful Spiritual Care, and Education in Providing Spiritual Care”. Conclusion: Cancer patients, cancer survivors, and clinicians’ quality of life is correlated with measures of spirituality and spiritual well-being. Spirituality also fulfill these oncologic patients has been linked to improved emotional and spiritual adjustment. Implications: Clinicians with different proficiencies, novice or expert, develop a strong spiritual belief can also be a strength when it comes to caring for those terminally ill patients, to be able to aid them in their sufferings. Amidst the challenges of spiritual care, these clinicians provide a patient strategy approach that is holistic to the care.

In this article, we discuss a new proposed concept of economic engineering that seeks to innovate a new model by combining the theories of Karl Marx and Adam Smith, taking into consideration main economic factors to create a sustainable and inclusive economic system that addresses existing challenges and provides a roadmap for future economic growth. Through a brief analysis of the existing gaps between Marxist and Smithian economics, we developed a new economic matrix that leverages the strengths of both theories while also incorporating the latest insights from modern economic research. Our novel approach to economic engineering represents a fresh perspective on the economy and offers practical tool for addressing the most pressing challenges facing society today.

Poor irrigation water quality due to oil spillage on surface water can result in food insecurity, health and economic challenges. This paper investigated the effect of total petroleum hydrocarbon (TPHC) and lead (Pb) on irrigation water quality in the oil spill prone area of the Niger Delta region of Nigeria. Water samples were taken from five different sections labelled A, B, C, D, and E along the Choba River, in Rivers State, Nigeria. Sections B, C, D and E were direct industrial effluent discharge points while section A was without direct industrial effluent discharge. Standard methods were employed in the water sampling and analysis. Suitability of Choba river water for irrigation was assessed by comprehensive pollution index (CPI) that incorporated salinity, sodicity, and permeability hazard potentials as well as the specific toxicity hazard potentials of TPHC and Pb. Results showed that all primary water parameters except pH were within the Food and Agriculture Organization (FAO) guidelines. The pH was low, ranging between 4.48 and 5.6. TPHC values for four out of the five samples were greater than the 10mg/l guideline as recommended by the Directorate of Petroleum Resources for surface water. TPHC for the four samples ranged between 14.52 and 174.32mg/l. The parameters with the most impact on CPI include EC, PI and TPHC with TPHC having the most impact. Water samples from sections A, B and E with CPI values 0.14, 0.37, and 0.8 respectively were classified in the clean, sub clean and slightly polluted categories respectively, while water samples from sections C and D with CPI values greater than 1 range from moderately to heavily polluted and not suitable for agricultural irrigation. Only water sample A was found suitable for irrigation.

Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X²) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.

Education stratum of India as well as world are worst-hit by Covid-19 and has imposed lockdown originating deleterious effect on academic life. A sheer number of learners ceased moving educational institutions and all pedagogies halted in India. Catastrophe has behaved as a stimulant for the educational institutions to cultivate and choose for platforms with technologies which were previously noviced. Education sector has been challenging to weather the crux with alternative strategy and digitizing the challenges to hoover the menaces of the pandemic. Hypothesis of digital study has prognosis to impact the ventures of higher education for eon. Findings evince that despite digital learning is a nice adventure for little skills, varying illiberalities partake. Learners are crunched and academy also exclusively in unstable job. It has yet to be established the scope whereupon digital study would climactically cover for conventional study. Covid-19 conundrum has divulged prefacing dilemma and disparities clamoring synergetic attempt to contemplate even so pandemic’s approach. This deliberate paper illuminates sparse impeccable education in India and has discussed the positive and negative impacts of Covid-19. The paper also contributes a methodical substantiation of the experience and lessons digested from the impact of the pandemic on the transitional education panorama, and the dissemination and acceptance of e-learning in education. To end, few suggestions along with policy recommendations have been made to meet didactics during the pandemic contingency.

Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.

The principle of Undetectable = Untransmittable (U=U) posits that people living with the human immunodeficiency virus (HIV) who are able to achieve and maintain a viral load of <200 copies/mL by regularly taking antiretroviral drugs (ARVs) are considered virally suppressed and cannot transmit the HIV virus to other individuals through sex. This groundbreaking message has emerged as a key HIV prevention strategy for eliminating transmission risks and enhancing the quality of life of people living with HIV. This narrative review explores the clinical foundation of U=U, the level of awareness and acceptance of the message globally, and the psychosocial impact on people living with HIV. It has been discovered that this message minimizes stigma, improves mental health, promote treatment adherence and good disclosure behaviors among people living with HIV. Evidence has shown that despite the U=U revolution for HIV prevention, there are significant differences in awareness and acceptance of the message among different population groups. The challenges noted were poor communication by healthcare providers, limitations in the health system, and stigma issues. Nevertheless, the inclusion of U=U in mainstream HIV services has proven to increase awareness and enhance its adoption. The urgent need in the present review is to advocate for strategies to increase the equitable distribution of U=U to harness its full potential in public health.

Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. Clinical Description: A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. Conclusion: This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.