Malocclusion is a highly prevalent developmental condition in children and adolescents and represents one of the most frequent reasons for referral from primary dental care to orthodontic services [1, 2]. General Dental Practitioners (GDPs), particularly newly qualified dentists, often face uncertainty when assessing malocclusion severity, determining the optimal timing of referral, and establishing eligibility for National Health Service (NHS) orthodontic treatment [11, 12]. This uncertainty may result in delayed referral of high-risk cases or inappropriate referral of children with minimal treatment need, placing unnecessary pressure on specialist services [13]. This narrative review proposes a stepwise orthodontic referral ladder, translating the Index of Orthodontic Treatment Need (IOTN) into a clinically intuitive and structured decision-making framework. The model classifies malocclusion from mild to severe, incorporates red-flag conditions requiring early or urgent referral, integrates optimal age for referral, and aligns with UK NHS commissioning and British Orthodontic Society guidance [18–20]. The framework aims to provide GDPs and new graduates with a clear, defensible, and patient-centred reference scale to support consistent orthodontic referral decisions and improve outcomes for children.

This paper examines the persistent gap between formal recognition and substantive realization of women’s land rights in Nigeria and South Sudan, where legal guarantees remain undermined by patriarchal norms, weak enforcement, and customary authority. In South Sudan, despite progressive frameworks such as the Transitional Constitution (2011), the Land Act (2009), the Local Government Act (2009), and the National Gender Policy (2013), women’s land tenure security remains precarious. Bazugba (2024a) demonstrates that statutory protections are often disconnected from lived realities, with approximately 80% of women lacking effective access to land ownership (IGAD, 2020). Building on this evidence, the paper advances a comparative argument that women’s land exclusion is not merely a legal or economic issue but a performative system of gendered injustice, reproduced through entrenched social scripts within families, customary institutions, and state practices. Employing a comparative feminist dramatic framework, the study analyzes how land governance in Nigeria and South Sudan emerges from the dynamic interplay between statutory law, customary norms, and political power. It integrates feminist theory, gender performativity, and political theory with interpretive insights drawn from Aristotle’s dramatic structure, Brechtian epic theatre, and Boal’s Theatre of the Oppressed. The paper argues that women’s dispossession persists because exclusion is continuously enacted and normalized as part of the social order. Through comparative analysis, it demonstrates that differing political and legal contexts can reproduce similar patterns of inequality when legal reform is not accompanied by effective enforcement and cultural transformation. It concludes by positioning theatre not only as metaphor but as a rigorous critical methodology for exposing systems of domination and reimagining participatory pathways toward feminist social justice.

Background: Anemia remains a major global health challenge, particularly in low- and middle-income countries. Medicinal plants rich in phytochemicals are widely used in traditional medicine for managing hematological disorders. However, systematic evidence on their hematopoietic effects remains limited. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published up to December 2025. Experimental studies evaluating plant-derived phytochemicals on hematological parameters—hemoglobin (Hb), packed cell volume (PCV), red blood cells (RBC), and white blood cells (WBC) were included. Data extraction and risk of bias assessment were performed using the SYRCLE tool. A narrative synthesis was conducted, supported by quantitative summaries. Results: A total of 10 studies met the inclusion criteria, spanning Nigeria, India, China, Ghana, South Africa, and Brazil. Most studies utilized rodent models and evaluated aqueous, methanolic, and ethanolic plant extracts rich in flavonoids, alkaloids, saponins, and tannins. Phytochemical interventions consistently improved hematological indices. Hemoglobin levels increased by 0.6–4.3 g/dL, with corresponding increases in PCV and RBC counts, indicating enhanced erythropoiesis. WBC counts were also elevated, suggesting immunomodulatory effects. Substantial heterogeneity was observed (I² ≈ 89.8%). Conclusion: Phytochemical-rich medicinal plants exhibit significant hematopoietic and immunomodulatory effects. However, high heterogeneity and reliance on animal models highlight the need for well-designed clinical trials.

Rotator cuff stain causes discomfort, stiffness, decreased range of motion, diminished athletic performance, and a lower quality of life for throwers. This study aimed to determine the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) stretching with Yogic Asanas in reducing pain and disability, increasing range of motion, and improving quality of life in young female throwers with rotator cuff stain. Sample from 30 female throwers was divided into three groups: PNF Technique, Yogic Asanas and Control group. Experimental groups underwent a 4-week intervention comprising PNF stretching, Yogic Asanas protocols. Pain levels were measured using the Visual Analogue Scale (VAS), and range of motion (ROM) was assessed with a goniometer. Pre-intervention readings of the Shoulder Pain and Shoulder Active Range of Motion (AROM) were taken at day 1 and post-intervention readings were taken at the end of week 4. The paired t-test was used to compare the values of the outcome measures for the preintervention and postintervention within the groups. Analysis of variance was used to compare the mean values of change in the outcome measures from preintervention to postintervention between the groups. Post hoc test was conducted to compare the postintervention values of the outcome measures between the groups. Total scores of Visual Analogue Scale (VAS) (p < 0.0001) and Shoulder ROM (p < 0.0001) demonstrated statistically significant improvements in the PNF stretching and Yogic Asanas group. The PNF stretching and Yogic Asanas group significantly enhances Shoulder AROM and reduces pain in young female throwers, offering a promising rehabilitation strategy. Furthermore, the study's results revealed that groups who PNF stretching outperformed other groups in terms of improvements in Shoulder AROM and reduces Shoulder pain.

The population of the East Region of Cameroon lives around the forest and shares precious knowledge about the medicinal plants they possess against diseases such as COVID-19 as the role of ethno-medicine may have favored resilience against the Covid-19 pandemic in Africa. The objective of this study was to identify medicinal plants used against Covid-19 by the local population through their knowledge of COVID-19 in the East Region of Cameroon. The sociodemographic profile, information on COVID-19, the medicinal plants used against COVID-19 and the symptoms were determined. An ethnobotanical survey was conducted from November 2025 to February 2026 across twenty-five (25) villages on 500 respondents. Demographically, a large proportion of the population were men (61.6%), most of whom were non-workers (70.2%), with a dominant age group of 41 to 50 years (35%). Seventy-one percent of the population claimed to know the means of transmission, with "shaking hands with an infected person" being the most cited (41%). Meanwhile, 67% claimed to know the symptoms, with "cough" being the most mentioned (47.4%). Regarding prevention, 68.4% knew of modern prevention methods, with 24.4% favoring social distancing. 52% of the surveyed population stated they had not contracted Covid-19 (with or without testing confirmation). Majority of the population preferred traditional medicine for their health care but only 20.6% of the respondents mentioned traditional treatments against COVID-19 which may be due to the fact that only 28.6% of the respondents had a good knowledge about COVID-19. Alstonia boonei De Wild. emerged as the most used medicinal plant in traditional Covid-19 treatments by the local population, with a citation frequency of 9%. This study sheds light on how local populations perceive, adopt, and adhere to public health crisis measures.

Applied Regression Analysis is a core course in Master of Applied Statistics programs. It consolidates students' statistical modeling foundations and develops their ability to analyze real-world data. Yet conventional course evaluation relies on final exams, lab reports, and project scores--emphasizing results over process and technique over problem-solving. Instructors struggle to identify where students struggle: data governance, model construction, diagnostics, communication. This design article proposes a dynamic evaluation system that uses a regression modeling competency map and process-oriented assessment to capture evidence from quizzes, code submissions, model outputs, case reports, presentations, and online behavior. The system converts this evidence into actionable feedback: problem localization, diagnostic attribution, and modeling prescription. Supported by automated code analysis, model diagnostics extraction, text analysis, and AI-assisted feedback, it is designed to evaluate students' modeling competencies throughout the full regression workflow. The system is intended to improve evaluation timeliness, specificity, and interpretability; support instructors in evidence-based teaching adjustments; and help students refine their modeling strategies.

This study aims to examine, on theoretical grounds, the sensitivity of corporate investment to internally generated cash flow in light of two central explanatory frames: financing constraints and the quality of financial disclosure. First, the study explores the emergence of investment–cash flow sensitivity as a research construct. In this part, we introduce the concept of cash flow sensitivity, then highlight the principal motives behind its emergence, its importance, and its objectives. Second, the study focuses on the role of financing constraints in shaping cash flow sensitivity. In this part, we examine the principles of the financing constraints theory, its implementation through standard empirical proxies, and its main determinants. Third, the paper examines the relationship between financial disclosure quality and investment–cash flow sensitivity. In this part, based on existing research, we clarify the role of high-quality disclosure in mitigating information frictions and reducing the dependence of investment on internal cash flow. Finally, we summarize how financing frictions and disclosure quality jointly shape the conversion of cash flow into productive investment, with consequences for capital allocation and the broader economy.

Learning Needs Assessment (LNA) is a fundamental component of professional nursing development, especially in tertiary care settings where nurses require specialized clinical and non-clinical competencies. King Fahad Specialist Hospital–Dammam (KFSHD), a major tertiary center in Saudi Arabia, provides advanced services across oncology, transplant, neurosciences, medical, surgical, critical care, and emergency departments. Due to the complexity of these specialties, assessing nurses’ learning needs is essential for guiding targeted continuing education activities. Aim: This study aimed to identify nurses’ learning needs across four components of continuing education, determine preferred locations and durations for learning activities, identify preferred learning methods, examine perceived barriers, evaluate satisfaction with current programs, and compare results across different years of experience. Methods: A cross-sectional survey was conducted in a tertiary hospital across all different levels of nursing. Sample was collected using quota sampling across inpatient and outpatient nursing departments at KFSHD. An online questionnaire consists of six domains was distributed to all nurses, supported by automated reminders to enhance participation. Data were analyzed using SPSS 2024 through descriptive statistics, chi-square testing, and content analysis. Results: A total of 903 nurses participated. The highest reported learning needs were related to emergency response (40.5%), crash cart and defibrillator use (34.6%), and medication courses (29.3%). Most participants (74.3%) preferred continuing education activities lasting no longer than one day, and nearly half indicated a preference for session durations of 15–30 minutes. Lecture-based presentations were the most preferred learning method (47.2%), while work schedule conflicts were the primary barrier to attendance (42.3%). Experience-based differences were evident, with less experienced nurses up to 5 years expressing higher learning needs for medication-related courses, while nurses with more than 15 years of experience showed greater needs for documentation training. Additionally, nurses with mid-level experience of 6-10 years demonstrated increased interest in nursing informatics. Conclusion: Nurses at KFSHD value continuing education and benefit most from short, experience-tailored training sessions. Educators should adopt micro learning and create level-specific pathways focused on high-priority clinical skills. Administrators must address workload barriers by providing flexible learning time and ensuring programs align with learning needs and operational realities.

Background: Health care waste management constitutes one of major public health concerns of modern health care. Since the healthcare workers are at the forefront of the waste generation, their knowledge on its management and hazard prevention is a major determinant of safe handling practices and effective infection control. Methodology: Present study has been conducted as a cross-sectional study among a convenient sample of health care workers, in King Salman Hospital Riyadh (N=131), during July-August 2024. A self-administered questionnaire was used to collect the quantitative data, in both English and Arabic language. The questions were asked under three main domains of the waste management; segregation, transportation and hazard prevention. Result: Out of total 133 study participants, majority of our study participants were nursing staff (77%, 103/133), in the age group of 31-40 years (54%, 72/133) and been working at our hospital for 2-5 years (46%, 61/133). For the survey items, the positive responses ranged from 72%-98%, 81-96% and 81-100% among the segregation, transportation and hazard prevention domains respectively. Conclusion: We have observed a high level of knowledge and awareness regarding hazardous waste management among healthcare workers, reflecting the efforts taken for continuous capacity building.

Necrotizing fasciitis or "flesh-eating disease," is a rare and serious infection that can kill a person in less than a day. Early diagnosis and appropriate treatment can avoid serious complications that can lead to death. Herein, we report three cases of necrotizing fasciitis of the hand admitted to the emergency department and detail their management, from the diagnosis to the outcome. Before causing death, necrotizing fasciitis causes massive destruction of the soft tissue and bones, even in early diagnosed patients. The diagnosis is challenging, even for orthopedic surgeons. Once it is suspected, "acting fast" is mandatory, and so the orthopedic surgeon should be alerted.

Background: Proper treatment of wounds is crucial, as untreated wounds can potentially become fatal. Ethnomedicinal herbs possess the ability to heal wounds without causing any adverse consequences, unlike chemical medications which are increasingly associated with negative effects. Hydrogels are highly promising and extensively employed in the realm of biomedicine. Hydrogel dressings have made tremendous advancements in their ability to reduce inflammation, effectively addressing many clinical problems encountered in efforts to enhance wound healing. Lupeol, a triterpene phytoconstituent, is present in numerous fruit plants and medicinal plants that have been extensively researched for its potential in treating various ailments, including skin wounds. Objective: The aim of present investigation is to assessed the wound healing efficacy of lupeol loaded hydrogel. Method: A hydrogel was synthesized by combining Carbopol 934 with HPMC polymers in a 1:1 ratio. The wound healing potential was assessed using both the excision and incision models, as well as by measuring the hydroxyproline content. Result: The excision wound study demonstrated that the H1 formulation including lupeol exhibited a substantial outcome that was comparable to the usual treatment. The duration of epithelization was determined to be 18 days. The incision wound model demonstrated that the tensile strength of H1 was much greater than the standard. The current study determined that the hydroxylproline content of formulation H1, which contains lupeol, was measured to be 43.52 +0.42, which is comparable to the standard. Conclusion: The exploration has demonstrated that the formulation has the ability to enhance the activity of wound healing. The discovery indicated that lupeol promotes the formation of new blood vessels, the expansion of fibroblast cells, and the production of cytokines and growth factors that are essential for the process of wound healing.

Digital transformation is reshaping India’s transportation and logistics sector by facilitating data-driven coordination, enhanced visibility, and sustainable supply chain operations. This study analytically examines the impact of digital technologies such as IoT, automation, artificial intelligence, and blockchain on dexterity, explicability, and sustainability in the modernization of India’s logistics ecosystem. Drawing on secondary data, policy frameworks including Gati Shakti, the National Logistics Policy (NLP), and the Unified Logistics Interface Platform (ULIP), along with recent empirical evidences, the study evaluates how digital tools strengthen decision-making, predictive logistics planning, and seamless collaboration among multiple stakeholders. It highlights the pivotal role of government initiatives in accelerating digital adoption and fostering integrated infrastructure development. Additionally, the study underscores several challenges unique to India, such as high implementation costs, fragmented logistics networks, limited digital literacy, inconsistent digital infrastructure, shortage of skilled labor, and regulatory complexities that impede the pace and depth of digital transformation. The findings indicate that while digital transformation presents significant opportunities for improvements in efficiency and sustainability, the challenges associated with its implementation remain unevenly distributed across different firm sizes and regions, particularly affecting micro, small, and medium enterprises (MSMEs) and rural corridors. The study wraps up with the need for strategic alignment, inclusive digitalization, skill development, and policy support to build a resilient, competitive, and sustainable logistics ecosystem in India, while also identifying potential avenues for future research in emerging digital logistics practices.

Climate change is an intensifying force reshaping the global sporting landscape. From elite international competitions to community-level recreation, rising temperatures, extreme weather events and shifting environmental conditions are profoundly affecting how sport is played, organised and sustained. Thus, this paper is an attempt to explore the multidimensional implications of climate change for athletes, competition frameworks and sports infrastructure, highlighting the urgent need for proactive adaptation and mitigation strategies within the sports sector. For athletes, the most direct consequences stem from increased heat exposure and deteriorating air quality. Prolonged training and competition in high temperatures elevate risks of heatstroke, dehydration and cardiovascular strain, while poor air quality impairs respiratory function and recovery. Outdoor sports such as athletics, football, tennis and cycling face heightened physiological demands, altering performance outcomes and increasing health-related withdrawals. Moreover, psychological stressors, including uncertainty about event cancellations and concerns over long-term health, add another layer of burden. Winter sports are particularly vulnerable, with declining snow cover and glacier retreat threatening venues for skiing, snowboarding and bobsleigh. Major events such as the Winter Olympics have already faced logistical challenges to secure adequate snow, prompting a rethinking of host selection and timing. Simultaneously, the carbon footprint of sports infrastructure, particularly energy-intensive arenas and sprawling event campuses, contributes to the very problem it must adapt to. As climate impacts intensify, the world of sport stands at a crossroads: continue business-as-usual while facing escalating disruptions or embrace its role as a catalyst for resilience and sustainability. In short, the choices made today will determine whether sport remains a viable, equitable and inspiring pursuit for future generations.

The current paper is a full statistical study of solar power generation and capacity utilisation using a huge sample (161,864 half-hourly observations) of the photovoltaic grid supply infrastructure in the United Kingdom. The primary goal is to analyse the dynamics in the production of solar energy and compare the effectiveness of using capacity under seasonal and diurnal variations. The information, acquired with the help of the Kaggle open-data platform, represents the data about the actual generation in megawatts (MW), the actual capacity, lower and upper confidence limits of the generation forecast, and the inferred data, such as the percentage of the capacity utilisation, and the range of the prediction interval. The statistical tests on descriptive statistics, Pearson correlation analysis, one-way analysis of variance (ANOVA) with a post hoc Tukey HSD, and multiple linear regression were done using IBM SPSS Statistics. The results show that the mean solar output varies significantly across the seasons, with the highest mean (M = 1959.49 MW, SD = 2362.23) and lowest (M = 492.23 MW, SD = 1057.79) in summer and winter, respectively. Diurnal analysis indicated the afternoon hours showed the highest generation (M = 2866.20 MW), and low generation in the night (M = 11.17 MW). The overall capacity utilisation was just 10.04, and this implies that the installed photovoltaic infrastructure was not well used. The outcomes present some practical information that may be utilised by grid operators, renewable energy planners and energy policymakers to utilise solar energy optimally in the national power systems.

Background: The Kingdom of Saudi Arabia has substantially expanded digital health services in recent years through eHealth platforms such as Sehaty and Wasfaty, aligning with the digital transformation pillar of Vision 2030. Despite this rapid expansion, the uptake of healthcare applications among older adults has remained uneven, with barriers reported in digital literacy, usability, and perceived benefit. Objective: This study aimed to examine the factors influencing older adults' awareness and utilization of healthcare applications and the perceived effect of these applications on quality of life in Jeddah City, Saudi Arabia. Methods: A cross-sectional quantitative design was adopted. Data were collected in Jeddah City through an electronic questionnaire distributed in June 2025. The target population consisted of Saudi adults aged 30 years and above. A stratified random sampling technique was used based on age, gender, and education level. Out of 316 distributed questionnaires, 227 were returned (71.8% response rate) and 161 valid responses were retained for analysis. A structured Arabic-language questionnaire comprising four sections was developed and pilot-tested. Data were analyzed using SPSS Version 26, including descriptive statistics, chi-square tests, t-tests, one-way ANOVA, Pearson and Spearman correlations, and multiple linear regression, with statistical significance set at p < 0.05. Cronbach's alpha coefficients ranged from 0.875 to 0.944 across the subscales, with an overall alpha of 0.889 for the 39-item instrument. Results: The final sample (n = 161) was predominantly female (74.5%), aged between 30 and 40 years (60.9%), held a bachelor's degree (62.7%), and was married (81.4%). Awareness of healthcare applications differed significantly by gender, age, education, job title, occupation, and marital status (all p < 0.001). The strongest positive correlates of awareness and utilization were perceived benefit (r = 0.831), perceived ease of use (r = 0.681), and health and ageing issues (r = 0.658). The multiple regression model was significant, R² = 0.727, F(6, 156) = 69.26, p < 0.001. Perceived benefit (β = 0.606, p < 0.001) was the strongest predictor, followed by perceived ease of use (β = 0.193, p = 0.002) and health and ageing issues (β = 0.146, p = 0.013). Conclusion: Perceived benefit and perceived ease of use emerged as the key drivers of older adults' awareness and utilization of healthcare applications in Jeddah City. User-friendly design and clear communication of tangible value are therefore essential to maximize adoption and enhance the quality of life of this growing population.