Indo-Pacific humpback dolphins Sousa chinensis face multiple anthropogenic threats in the coastal waters of Langkawi and the adjacent Perlis–Kedah mainland in north-west Peninsular Malaysia. The area is recognized by the IUCN as an Important Marine Mammal Area and harbours a significant population of humpback dolphins. Understanding their social structure is crucial for identifying conservation units to guide targeted management to preserve the species’ ecological processes, particularly for a species in the data-deficient Southeast Asia region. Association patterns and network analysis from a decade of photo-identification surveys (2010–2020) revealed a fission–fusion society defined by frequent changes in group membership and size, and characterized by loose associations between individuals. Association strength was generally low, although some non-random long-term associations persisted for 5 months to several years. Unusually large groups of humpback dolphins (81–204 individuals) were often observed, comprising travelling mother–calf pairs and functioning as nursery groups. The grouping plasticity and social dynamics reflect the species’ survival strategies in response to local environmental conditions, notably resource availability and predation pressure. Most importantly, our findings confirm that the humpback dolphin population in this region constitutes a stable and well-connected single conservation unit, necessitating coordinated protection by different governmental administrators across the extensive study area. The insights from our study should inform tailored management strategies for humpback dolphins and promote early detection of anthropogenic threats that may impact social-ecological processes and the overall survival of the population.

International students frequently report suicidal thoughts and behaviours, but often do not seek help. We evaluated the feasibility, acceptability, and preliminary effectiveness of an adapted version of safeTALK suicide prevention training for international students. Eight workshops were delivered in Melbourne, Australia (N = 128; 62.5% female, M age = 23.4). In this single-arm study, surveys were completed pre-, post-, and three months post-training, and 17 participants completed follow-up interviews. The training was rated as acceptable, helpful, and safe. Linear mixed models indicated increased confidence to intervene and stronger intentions to refer individuals to formal help sources, with improvements sustained at follow-up. Suicide stigma showed a small post-training reduction that was not sustained. Suicide literacy only improved three months post-training. Attrition limited inferences about long-term effects. Qualitative feedback supported the training’s value but highlighted the need for further cultural adaptation. Findings support adapted gatekeeper training as a promising strategy for suicide prevention among international students.

This paper critiques the use of the term ‘evil’ in philosophical discussions of the problem of evil. We argue that what is commonly identified as ‘evil’ in this debate is better as ‘misfortune.’ The division between moral and natural evil equivocates between agentic and non-agentic ‘evil,’ undermining its coherence as a unifying concept. Evil events are necessarily caused by evildoers, which are non-existent in events of natural evil. By contrast, ‘misfortune’ places the focus on the victim regardless of the source, better capturing what philosophers intend with the prior term ‘evil.’ Our more precise definition of ‘evil’ satisfies Jean Nabert’s notion of evil as the unjustifiable while also being sufficiently distinct from badness. What distinguishes ‘evil’ from mere badness is moral erasure, which is the perception of other human beings as objects unworthy of moral consideration. While a bad person causes misfortunes as a trade-off in pursuit of a perceived good, an evil person is either completely indifferent to their victim’s misfortunes, or malicious by deliberately causing misfortunes for pleasure’s sake. Our distinction between ‘misfortune’ and ‘evil’ clarified as (im)moral, indifferent, or malicious challenges the assumption that evil, as traditionally framed, poses a direct contradiction to God’s existence.

Background: Antimicrobial resistance (AMR) is a pressing global public health issue, and the limited development of new antibiotics necessitates robust Antimicrobial Stewardship Programs (ASP). As a global healthcare leader, IHH Healthcare successfully implemented ASP across 80 hospitals in seven countries (Singapore, Malaysia, India, Brunei, Hong Kong, China, and Turkey), aligned with the Centre for Disease Control and Prevention (CDC) Hospital ASP Core Elements, World Health Organization, and national guidelines. Method: A three-phase ASP strategy was developed following a crosswalk analysis of ASP practices across the seven countries (See Table 1): Phase 1 (2023): ASP committee establishment, terms of reference, and adoption of evidence-based guidelines. Phase 2 (2024): Guideline compliance audits, antibiogram development, resistance pattern monitoring, post-prescription audits, therapy optimization, and education. Phase 3 (2025): Antimicrobial preauthorization, infection-based interventions, and antimicrobial timeouts within 48–72 hours of initiation. Quarterly ASP meetings facilitated progress tracking and shared learning. Key metrics included guideline adherence, resistance trends, and antimicrobial utilization. Results: By 2023, all countries have established ASP committees and adopted guidelines for infections and surgical prophylaxis (see Table 2). In 2024, Phase 2 implementation (see Table 3) showed that: Guideline compliance: Regular audits monitored antimicrobial use for appropriateness, quantity, duration, and type, achieving full compliance across facilities. Education: Comprehensive initiatives included patient education on completing antibiotic regimens and continuous education for healthcare professionals. Post-prescription audits: Standardized protocols ensured systematic audits, with findings and targeted interventions shared with stakeholders. Antibiogram and resistance monitoring: Standardized antibiogram protocols monitored resistance patterns, guiding treatment decisions and policy updates. A framework for tracking key resistance organisms and hospital-acquired infections was also established. Therapy optimization: Policies required prescribers to document antibiotic doses and indications, while IV-to-oral conversion protocols reduced costs and improved outcomes. Metrics like Days of Therapy and Defined Daily Doses measured impact, with dose optimization improving treatment for resistant organisms. Conclusion: IHH Healthcare is the first large international group to adopt and implement the U.S. CDC ASP elements across its network of foreign hospitals. By utilizing a phased approach, we have ensured consistent and effective implementation across diverse healthcare settings. To date, all 80 hospitals have successfully completed Phase 2 of the program and are on track to achieve Phase 3 milestones by 2025 (see Table 4). Early outcomes from this initiative underscore the significant value of standardized ASPs in enhancing patient safety, reducing AMR and fostering sustainable quality improvement.

Digital Twinning (DT) has become a main instrument for Industry 4.0 and the digital transformation of manufacturing and industrial processes. In this statement paper, we elaborate on the potential of DT as a valuable tool in support of the management of intelligent infrastructures throughout all stages of their life cycle. We highlight the associated needs, opportunities, and challenges and discuss the needs from both the research and applied perspectives. We elucidate the transformative impact of digital twin applications for strategic decision-making, discussing its potential for situation awareness, as well as enhancement of system resilience, with a particular focus on applications that necessitate efficient, and often real-time, or near real-time, diagnostic and prognostic processes. In doing so, we elaborate on the separate classes of DT, ranging from simple images of a system, all the way to interactive replicas that are continually updated to reflect a monitored system at hand. We root our approach in the adoption of hybrid modeling as a seminal tool for facilitating twinning applications. Hybrid modeling refers to the synergistic use of data with models that carry engineering or empirical intuition on the system behavior. We postulate that modern infrastructures can be viewed as cyber-physical systems comprising, on the one hand, an array of heterogeneous data of diversified granularity and, on the other, a model (analytical, numerical, or other) that carries information on the system behavior. We therefore propose hybrid digital twins (HDT) as the main enabler of smart and resilient infrastructures.

Healthy diets are unaffordable for billions of people worldwide, with food prices rising in high-, middle- and low-income nations in recent times. Despite widespread attention to this issue, recent actions taken to inform policy prioritisation and government responses to high food inflation have not been comprehensively synthesised. Our review summarises (i) innovative efforts to monitor national food and healthy diet price, ii) new policy responses adopted by governments to address food inflation and (iii) future research directions to inform new evidence. Evidence synthesis. Global. None. We describe how timely food and beverage pricing data can provide transparency in the food industry and identify key areas for intervention. However, government policies that improve food affordability are often short-lived and lack sustained commitment. Achieving meaningful impact will require long-term, cross-sectoral actions that are led by governments to support food security, healthy diets and resilient sustainable food systems. This will necessitate a better understanding of how the political economy enables (or hinders) policy implementation, including through coherent problem framing, mitigating conflicts of interest in policymaking, working together as coalitions and developing and utilising evidence on the food security and related impacts of food pricing and affordability policies. Diverse actors must be better equipped with robust data platforms and actionable policy solutions that improve the affordability of healthy and sustainable diets, including by lowering food prices and addressing the broader socio-political determinants of food insecurity.

When Cuban sugar planters saw the abolitionist movement prevailing worldwide, they realised that African slavery was no longer a sustainable source of labour. They then searched the globe for substitutes, finding success in South China. The Chinese coolie trade to Cuba occurred between 1847 and 1874, during which time over 141,000 low-paid, low-skilled Chinese workers became indentured labourers. They sustained Cuban sugar production, among other vital economic activities. This paper examines how these Chinese workers contributed to Cuba’s labour transition from an enslaved to a free workforce. It argues that the substantial contributions of los colonos asiáticos, as the workers were known, went beyond their work in the sugar plantations: their minimally remunerated labour in key industries and usually unpaid work in public services made critical contributions to transforming the Spanish island’s economy and to meeting the ever-growing global demand for cash crops in the second half of the nineteenth century.

Hyperglycemia is defined as excessive blood glucose levels and often leads to a diagnosis of type 2 diabetes. Trehalulose, a rare disaccharide with a low glycemic index, was recently discovered to be a unique major bioactive component in stingless bee honey (SBH), produced alongside the regular disaccharides fructose and glucose [1]. Although traditionally, SBH is being used for the prevention of type 2 diabetes, currently, there are no available clinical studies correlating the effects. Therefore, this study was conducted to investigate the subacute and sub-chronic antidiabetic effects of trehalulose-rich SBH (TRSBH) consisting of 56% trehalulose in a non-diabetic and type 2 diabetic-induced (T2DI) Sprague-Dawley rat model.

The sample SBH produced by G. thoracica species were collected and pooled multiple times from Ladang 10, Universiti Putra Malaysia (UPM) (2°59'28.7''N, 101°42'52.9''E), between 2022 and 2023. Fifty-four female Sprague Dawley rats (age: 5-7 weeks age, body weight: 200 ± 20 g) were used for both subacute (28 days) and sub-chronic (60 days) anti-diabetic studies of TRSBH. Non-treated group and metformin-treated group (300mg/kg) were used as Controls. The TRSBH were supplemented at 1.0, 1.5, and 2.0 g/kg bodyweight for 28 days. Glucose area under the curve (AUC) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were calculated as glucose tolerance and insulin sensitivity indices, respectively.

Subacute supplementation showed no significant (P>0.05) effects on body weight, normal rats’ fasting blood glucose, insulin, or HOMA-IR. However, sub-chronic 60 days treatment at 1.0 g/kg body weight and 2.0 g/kg bodyweight trehalulose in SBH on T2DI rats were found to significantly (P<0.05) prevented hyperinsulinemia, improved glucose tolerance and insulin sensitivity comparable to the effects observed in the metformin-treated group and notably more significant (P<0.05) than the diabetic control rats. The T2DI rats were supplemented with 2.0 g/kg b.w. trehalulose in SBH exhibited significantly (P<0.05) lower fasting insulin levels (0.18 ± 0.01 ng/mL) than the diabetic control rats (0.29 ± 0.01 ng/mL). No toxicity effects were observed based on histopathological tests.

Our study is the first to demonstrate the dose-response effects of TRSBH supplementation in vivo. Sub-chronic supplementation of TRSBH for 60 days at low and moderate doses prevented hyperinsulinemia and induced significantly (P<0.05) improved glucose tolerance and insulin sensitivity in diabetic-induced rats comparable to the metformin-treated group. As a dietary supplement, a trehalulose dose of up to 2.0 g/kg bodyweight in SBH can benefit blood glucose and insulin regulation. In conclusion, although the current dietary guidelines for disaccharide intake in the daily diet are similar for all types, these findings suggest that the guidelines may need to be set explicitly for different types of disaccharides. However, further clinical investigation on the impact of its’ long-term consumption using randomized-control trials in humans should be conducted before drawing the guidelines.

University students consume relatively more unhealthy foods than healthy foods(1,2). This is concerning as poor dietary patterns could link to poor health. In the context of this study, modifying university students’ diets could maintain or improve their health.

Since the establishment of the Eatwell Guide, its adherence rate has been low(3), and only limited research on the topic. There is a potential gap in understanding how the Eatwell Guide is viewed as a health-promoting tool. It is also worth studying if university students see this tool as helpful for healthy eating. Therefore, this study aimed to explore the university students’ perceptions regarding the role of the Eatwell Guide, with the objective of identifying the university student’s perceived barriers and facilitators to using the Eatwell Guide.

Convenience, purposive, and snowball sampling were used to recruit participants (n=12) in London. Participants were divided into two groups for semi-structured focus group interviews. One focus group consisted of public health nutrition students (n=6) and another group was students of other disciplines (n=6). Public health nutrition students were recruited as their views could be significant in the effectiveness of the Eatwell Guide implementation, given their job nature. A thematic analysis was used to generate codes and themes.

Four themes emerged from the analysis: Healthy Eating Perception, Obstacles to Using the Eatwell Guide, Enablers to Use the Eatwell Guide, and Differences Between the Two Groups. Participants’ perceptions of healthy eating were different from the Eatwell Guide. Participants identified personal (financial situation, time consideration, preferences, and nutrition conception) and environmental factors (food availability, accessibility, and marketing strategies to promote unhealthy foods) as the obstacles to using the Eatwell Guide, while improving the food environment and the feasibility of the Eatwell Guide could be the facilitators. The nutritionist group is more knowledgeable about the Eatwell Guide. However, they also face the above obstacles that the non-nutritionist group faces when practising healthy eating.

Eating practice is highly individual, which makes it a complex area to intervene. The originality of this study contributes to the limited literature on the Eatwell Guide by increasing the understanding of factors that deter or help university students from using the Eatwell Guide for healthy eating. The findings could serve as monitoring and evaluation to inform what could result in the low adherence rate to the Eatwell Guide. The findings could also inform public health policy development to create more tailored interventions and improve the food environment for university students. Future research could replicate this study to evaluate the Eatwell Guide in wider populations and explore strategies to communicate it to reach different populations. Foremost, research is needed to examine ways to make the food environment more enabling for university students to improve public health.

This review highlights the importance of dietary fibres (DF) intake and its interconnection with the gut microbiome and psychological well-being, while also exploring the effects of existing DF interventions on these aspects in adults. The gut microbiota is a complex and diverse ecosystem in which microbial species interact, influencing the human host. DF are heterogeneous, requiring different microbial species to degrade the complex DF structures. Emerging evidence suggests that microbial fermentation of DF produces short-chain fatty acids (SCFA), which may play a role in regulating psychological well-being by affecting neurotransmitter levels, including serotonin. The effectiveness of DF interventions depends on factors such as baseline gut microbiota composition, the dosage and the source of DF consumed. Although the gut microbiota of adults is relatively stable, studies have shown that the abundance of the species in the gut microbiota can change within 24 h of an intervention and may return to baseline following the termination of DF intervention. This review underscores the need for larger and well-powered dietary clinical trials incorporating longitudinal biological sample collections, advanced sequencing and omic techniques (including novel dietary biomarkers and microbial metabolites), validated subjective questionnaires and dietary records. Furthermore, mechanistic studies driven by clinical observations are crucial to understanding gut microbiota function and its underlying biological pathways, informing targeted dietary interventions.