Suicide is a serious global health problem with ~73% deaths by suicide occurring in low- or middle-income countries (LMICs), many of which are among people experiencing humanitarian emergencies. Few guidelines outline specific steps and strategies to tackle suicide risk and manage post-attempt consequences in these settings, leaving program implementers with limited information to translate guidance to practice. This article describes the implementation of the Common Elements Treatment Approach (CETA) suicide safety protocol as part of a randomized controlled trial in northern Thailand for displaced adults from Myanmar with chronic physical health conditions. The CETA safety protocol has been used in many trials and programs to screen for and manage suicide risk, including in a prior CETA effectiveness trial with Myanmar adults. In this article, we describe how this safety protocol was adapted for the study setting, and utilized to effectively screen, assess suicidal thoughts and behaviors, develop and manage action plans for study participants with active suicidal ideation. We present three illustrative case descriptions of individuals with whom we implemented the safety protocol to highlight how suicide risk intersects with physical illness, psychosocial stressors and structural vulnerability. Reflections on feasibility, acceptability and adaptations – such as language translation, culturally grounded referral pathways and training for nonspecialist providers – are shared to inform future implementation. Our findings support the implementation of suicide safety protocols within humanitarian programming and offer practical insights for global health practitioners and policymakers working in similarly complex settings.

Achieving net-zero energy systems requires combining technological deployment with governance innovations that secure public legitimacy, equity and international credibility. Nuclear energy – including large reactors and emerging small modular reactors (SMRs) – offers firm, low-carbon power that can complement variable renewables, but expansion is constrained by public distrust, governance fragmentation, workforce challenges and concerns about cost and waste. This article advances the Qudrat-Ullah Nuclear Peace and Trust (Q-NPT) framework as a systemic governance approach that explicitly embeds trust, equity and institutional learning into nuclear energy deployment strategies, aligning nuclear investments with energy transition objectives. Using Canada as a detailed case, we map Q-NPT elements onto Canadian governance structures, energy infrastructure and nascent SMR programs. Empirical material (national generation shares, regulatory milestones, SMR licensing progress and workforce trends) shows both the opportunity and the governance barriers Canada faces.

This study introduces measurable governance metrics – covering trust, equity, transparency, participation and institutional capacity – to evaluate nuclear social legitimacy and transition readiness. Quantitative thresholds include targeted increases of ≥20 percentage points in public trust; ≥25% Indigenous participation in decision processes; ≥80–90% transparency in project documentation and a workforce pipeline of 75,000–90,000 skilled workers by 2040. These thresholds provide a predictive, results-oriented basis for evaluating governance progress, addressing a key gap in existing nuclear policy frameworks.

We propose actionable institutional reforms (independent trust panels, stakeholder engagement protocols, workforce pipelines and international integration strategies) and an operational roadmap for Q-NPT implementation. Results indicate that applying Q-NPT measurably improves governance performance compared to conventional models by elevating trust, reducing procedural conflict, strengthening equity outcomes and accelerating regulatory acceptance. Without such deliberate trust-building and equity mechanisms, nuclear energy’s technical potential will remain underutilized; conversely, Q-NPT provides a structured pathway for achieving just, credible and scalable decarbonization.

The reduction of anthropogenic methane emissions is a priority due to its potent global warming potential. Radiocarbon (14C) can distinguish between methane from natural biogenic and fossil fuel sources, however, the analysis of methane 14C by conventional accelerator mass spectrometry (AMS) techniques is demanding. At SUERC, a prototype positive ion mass spectrometer (PIMS) is set up to directly analyze 14C in methane with minimal sample preparation. Methane gas was mixed with a stoichiometric amount of oxygen in an open split and admitted directly into the source. A series of modern, blank and unknown methane samples were clearly distinguishable by their 14C/13C raw ratios. The collision cell gas flowrate was then increased to lower the limit of detection. We obtained a corrected 14C/13C raw ratio of less than 2 × 10–13 for blank fossil methane which corresponds to a radiocarbon age greater than 50 kyr. Modern biogenic methane had a measured 14C/13C raw ratio approaching 1 × 10–10 which is consistent with the nominal value of contemporary atmospheric methane. These first results indicate that PIMS has the potential to be a valuable new analytical technique for screening the 14C content of biogas and in climate research studies.

The Nerja Cave is a key archaeological site in the Southern Iberian Peninsula. It was inhabited by humans from the Upper Palaeolithic until recent Prehistory (30 and 3.7 ka cal BP). Various excavation campaigns performed in its external chambers (Vestíbulo, Mina and Torca) have recovered evidence of its use as habitat and burial site. Multiple studies on these matters have been published, but, until now, no Bayesian chronological modeling that utilized radiocarbon dates of the three chambers has been performed. To do so, all the available radiocarbon dates and stratigraphic and archaeological data have been compiled. These comprehend ample and diverse information about which, firstly, individual phase models based on the stratigraphic sequence of each one of the chambers have been created. After critically evaluating the results for each of the chambers, a general phase model for the prehistoric occupation of the external chambers has been created considering the cultural adscription of the samples. This has enabled the identification of 11 phases which correspond to the different technocomplexes of the Gravettian, Solutrean, Magdalenian, Epipalaeolithic, Mesolithic, Neolithic and Chalcolithic. Still pending are the refinement and improvement of the model for the Neolithic horizon among other phases of the sequence. The individual and the general models have evidenced important differences between the different archaeological phases in radiocarbon information as well as in the occupation of the three chambers.

It is well known that any higher-order Markov chain can be associated with a first-order Markov chain. In this primarily expository article, we present the first fairly comprehensive analysis of the relationship between higher-order and first-order Markov chains, together with illustrative examples. Our main objective is to address the central question as posed in the title.

Health technology assessment (HTA) processes provide evidence to inform the supply of healthcare, often comparing results from economic evaluation to a policy threshold to judge cost-effectiveness. However, recommended policy thresholds may not always align with empirical estimates of the opportunity costs of health care expenditure, captured by marginal productivity of healthcare expenditure (‘k’). Such estimates are needed to inform the net health impact of funding decisions. We map policy thresholds in HTA guidelines against published estimates of k. We extract information from HTA guidelines identified in a previous literature review, including recommended perspective, relevant costs and outcomes, and justification for the threshold. Studies estimating k were obtained from a separate review. Of the 47 included HTA guidelines, 20 state an explicit policy threshold and 12 justify their choice. Estimates of k were available for 13 countries. Among the eight countries with explicit policy thresholds and k estimates, three matched. The recommended perspective influences whether k alone is sufficient or appropriate to inform cost-effectiveness judgements. It is important that guideline setters are aware of empirical estimates of k; and that economic evaluations consider k to reflect health opportunity costs even where the policy threshold is justified on other grounds.

In this nationwide cohort study, we assessed the long-term risk of major cardiovascular events following intensive care unit (ICU) treatment for community-acquired sepsis and septic shock, compared to the general population. We included 20313 adults admitted to Swedish ICUs between 2008 and 2019, identified through national healthcare registries, and matched each case to 20 randomly selected population controls. Entropy balancing adjusted for baseline co-morbidities, healthcare utilization, and socio-demographics. The association between sepsis and subsequent cardiovascular events (hospitalizations or deaths due to myocardial infarction, heart failure, or cerebral infarction) was analysed using Cox proportional hazards models. Sepsis was associated with increased cardiovascular risk, particularly during the first year (days 0–30 adjusted hazard ratio [aHR] 6.1 (95% CI 4.7–7.9); days 31–90; aHR 2.4 (95% CI 1.8–3.2); days 91–365 aHR 1.4 (95% CI 1.2–1.6)), with risk persisting through years 2–5 (aHRs 1.1–1.3). Heart failure risk remained elevated across all intervals, while risks of myocardial and cerebral infarction were mainly short term. The highest relative risks were observed in patients without prior heart disease or with low baseline cardiovascular risk. These findings suggest that sepsis might be an independent and under-recognized driver of long-term cardiovascular disease, highlighting the need for preventive strategies.

This article offers a detailed analysis of a Kachchhi-Gujarati manuscript chart of the southern Red Sea and Gulf of Aden dating probably from the eighteenth or early nineteenth centuries and held at the Royal Geographical Society–Institute of British Geographers in London (mr Asia S.4.). The origins and possible dating of the manuscript are examined. Astronomical data inscribed on the chart, establishing latitude and providing sailing directions, are identified, interpreted, and projected. Its Devanagari toponyms are transcribed and identified with real-world locations. Coastal profiles and unnamed features representing significant navigational landmarks are individuated. Islamic buildings depicted on the chart are identified as specific regional mosque-shrines. The presence of Ottoman and other regional polities are inferred. The place of the chart within an early modern tradition of western-Indian navigational manuscripts and a wider Indian Ocean tradition is explored. Our analysis establishes the chart as a detailed and highly practical navigational work—countering earlier scholarly denigrations of its accuracy. In contrast, we show it to be one of the most detailed surviving indigenous navigational charts produced in an Indian Ocean tradition.

Despite substantial digital investment and stakeholder initiatives, billions in the Global South remain excluded from digital participation. This systematic literature review synthesizes 122 empirical studies published between 2003 and 2024 in Asia, Africa, Latin America, and Oceania to analyze key stakeholders, their challenges, and the strategies employed to foster sustainable digital inclusion. Drawing on stakeholder theory and digital ecosystems theory, the study identifies ecosystem fragmentation as a central bottleneck. We advance stakeholder theory by introducing the concept of Ecosystem Coordination Stakeholders (ECS), a role-based stakeholder group whose salience derives from coordination capability alongside power, legitimacy, and urgency. The findings highlight the need for policy frameworks that develop and strengthen institutional capacity for coordination, extend ecosystems theory by recognizing coordination as an architectural developmental need, and highlight the importance of design strategies responsive to specific fragmentation patterns in diverse regional contexts. Our study also reveals that work remains concentrated in Asia and Africa, with continued Global North–Global South inequities in authorship and journal visibility. This study offers management and policy insights on digital poverty that may also apply to other complex challenges requiring effective and sustained multi-stakeholder collaboration.

The effect of the finite ion Larmor radius on the dynamics of two counterstreaming weakly collisional plasma flows in a magnetic field of an arch configuration is considered. Hybrid numerical simulations show that in a system whose dimensions are close to the ion Larmor radius, more intense interaction dynamics is observed and the magnetic arch experiences a significant expansion with the formation of a region with an irregular character of magnetic lines, in which magnetic reconnection processes occur. In this case, the generation of a surface wave of the ion-cyclotron range is observed at the boundaries of the arch. An increase in the scale of the system compared with the ion Larmor radius leads to a transition to the ideal magnetohydrodynamic regime, in which the evolution of the arch occurs much more slowly, and the development of instabilities is not observed.

Sea cucumber fisheries have continued to expand during the past decade at a fast rate, despite the predictable drop during the COVID-19 period. The exploitations are now qualified as ‘serial’ and ‘contagious’. The most recent trends are shown through the analysis of Food and Agriculture Organization’s capture data, collected from different countries and territories. The mean captures per year, in fresh weight, are over 90.103 tonnes. The mean trade data for years 2019–2021 are given by category of commodities, which complicates the trade analysis. The imports, in quantity and value, show the usual importance of China and Hong Kong, and now of Saudi Arabia. The exports show the importance of the frozen products from Canada. The statistics from Hong Kong in quantities and values (for imports and re-exports) are analysed for the past decade. Globally, catches have increased in comparison to previous studies, with new countries and territories developing export fisheries, new species targeted from new regions, and new products traded. The continued growth and expansion of the global sea cucumber trade is alarming as the sustainability of many species-specific fisheries remains of great concern. Stronger conservation measures, and their implementation, at national, regional, and international levels, are required to effectively protect biodiversity, promote sustainable resource use, and address the escalating impacts of the increasing exploitation efforts.