BACKGROUND: Identifying and exploiting stewardship and financing challenges in Iran\'s health insurance system as an ecosystem is essential to achieving predetermined goals. This study aimed to determine the challenges and strategies in the Iranian health insurance ecosystem to provide relevant evidence to healthcare managers and policymakers to improve its functions and perform necessary reforms.
METHODS: This qualitative study was conducted at the national level in Iran. Data were collected using semi-structured interviews and analyzed using the directed content analysis method. The study participants included managers and experts in health insurance and faculty of universities of medical sciences, who were selected by purposive sampling.
RESULTS: The challenges and strategies expressed by participants were categorized into two functions: stewardship and financing. Four main themes, ten subthemes, 22 challenges, and 24 strategies were identified in the stewardship function, along with three main themes, 12 subthemes, 17 challenges, and 16 strategies in the financing function. The major challenge in the Iranian health insurance ecosystem was the complexity and conflict of interests between multiple actors with different roles, which led to fragmentation, diverse structures, and a gap between other functions and objectives, hindering the effective functioning of the ecosystem.
CONCLUSIONS: In order to deal with the challenges of the health insurance ecosystem, it is suggested to create a coherent insurance system through a single utility system, and by paying more attention to health-oriented services, the health insurance ecosystem becomes a health-oriented system instead of being treatment-oriented. In addition, in order to strengthen the governance of the country\'s health insurance ecosystem, the number of actors with multiple roles should be reduced and the roles of the actors should be clarified and separated in order to prevent conflicts of interest and structural corruption in this ecosystem.

Digital mental health interventions are routinely integrated into mental health services internationally and can contribute to reducing the global mental health treatment gap identified by the World Health Organization. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience with digital mental health intervention design and evaluation to identify 8 of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These include: (1) harm caused by online recruitment work; (2) monitoring of intervention safety; (3) exclusion of specific demographic or clinical groups; (4) inadequate robustness of effectiveness and cost-effectiveness findings; (5) adequately conceptualizing and supporting engagement and adherence; (6) structural barriers to implementation; (7) data protection and intellectual property; and (8) regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device (SaMD) are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges we have identified highlight a substantial body of required knowledge and expertise, either within the team or through access to external experts. Ensuring access to knowledge requires careful planning and adequate financial resources (for example, paying public contributors to engage in debate on critical ethical issues or paying for legal opinions on regulatory issues). Access to such resources can be planned for on a per-study basis and enabled through funding proposals. However, organizations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups that can retain necessary competencies, such as in medical device regulation.

BACKGROUND: The need for dental data in healthcare services and the inadequacy of paper records due to their inherent limitations have led to a shift towards electronic dental record systems (EDR). Implementing EDR comes with numerous barriers and challenges. Therefore, this research was conducted to identify the implementation barriers and facilitators for EDRs.
METHODS: This descriptive-analytical cross-sectional study was conducted on dentists working in public and private clinics in Tehran, Iran. A questionnaire consisting of three sections was designed to collect data on the demographic information of dentists, the barriers in five categories including financial barriers (6 questions), organizational barriers (11 questions), technical barriers (5 questions), personal barriers (3 questions), and ethical and legal barriers (6 questions), as well as facilitators for the implementation of EDR (15 questions) based on the literature, using a five-point Likert scale. 130 dentists from 60 dental clinics participated in the study. The data were analyzed using descriptive statistics (calculating frequency distribution, mean, and standard deviation). The mean scores were classified into four categories based on quartiles from very low importance to very high importance including very low importance (mean ≤ 1.25), low importance (1.25 ≥ mean < 2.5), important (2.5 ≥ mean < 3.75), and very high importance (mean ≥ 3.75). Finally, each of the barriers and facilitators among user dentists and non-user dentists was compared using the Mann-Whitney U test. The data were analyzed using SPSS software.
RESULTS: The findings indicate that dentists consider all barriers and challenges in implementing EDR to be important, and all the proposed facilitators for addressing these challenges to be very important. Among these important barriers are the rapid turnover of managers and policymakers at higher levels (3.69 out of 5) as a personal barrier, legal issues related to electronic records (3.65 out of 5) as an ethical-legal barrier, the lack of necessary standards for data exchange between different systems (3.64 out of 5) as a technical barrier, dentists\' limited awareness of the benefits of this system (3.63 out of 5) as a personal barrier, and the lack of suitable legal infrastructure for EDR implementation (3.62 out of 5) as an ethical-legal barrier. Additionally, among the very important facilitators, training dentists and staff on EDR (4.31 out of 5) is noteworthy.
CONCLUSIONS: To address the important barriers to EDR implementation, including legal-ethical barriers, legal institutions, and regulators must establish relevant laws and regulations to overcome these obstacles. Furthermore, if system users learn about the features, goals, benefits, and positive impact of EDR on their work and gain the necessary awareness, their resistance to changes will decrease, and their interest and readiness to accept EDR will increase.

Over the past ten years, significant advancements have been made in exploring plant-derived exosome-like nanoparticles (PELNs) for disease therapeutics and drug delivery. PELNs, as inherent nanoscale particles comprised of proteins, lipids, nucleic acids, and secondary metabolites, exhibit the capacity for cellular uptake by human cells. This intercellular interaction transcends biological boundaries, effectively influencing biological functions in animals. PELNs have outstanding biocompatibility, low immunogenicity, enhanced safety, and environmentally friendly sustainability. This article summarized the preparation methods and characteristics of PELNs. It provided a systematic review of the varied roles of PELNs derived from fruits, vegetables, and herbs in disease therapeutics and drug delivery. The challenges in their production and application were discussed, and future prospects in this rapidly evolving field were explored.

In 2022, mpox virus (MPXV) spread worldwide, causing 99,581 mpox cases in 121 countries. Modified vaccinia Ankara (MVA) vaccine use reduced disease in at-risk populations but failed to deliver complete protection. Lag in manufacturing and distribution of MVA resulted in additional MPXV spread, with 12,000 reported cases in 2023 and an additional outbreak in Central Africa of clade I virus. These outbreaks highlight the threat of zoonotic spillover by Orthopoxviruses. mRNA-1769, an mRNA-lipid nanoparticle (LNP) vaccine expressing MPXV surface proteins, was tested in a lethal MPXV primate model. Similar to MVA, mRNA-1769 conferred protection against challenge and further mitigated symptoms and disease duration. Antibody profiling revealed a collaborative role between neutralizing and Fc-functional extracellular virion (EV)-specific antibodies in viral restriction and ospinophagocytic and cytotoxic antibody functions in protection against lesions. mRNA-1769 enhanced viral control and disease attenuation compared with MVA, highlighting the potential for mRNA vaccines to mitigate future pandemic threats.

BACKGROUND: Food loss and waste estimates are highly inconsistent as a result of methodological and systemic differences. Additionally, the absence of in-depth evidence surrounding the biological drivers of food loss and waste precludes targeted mitigation action. To address this challenge, we undertook a metanalysis utilising a systematic literature review combined with industry stakeholder surveys to examine the incidence of food loss and waste in the UK fruit and vegetable supply chain between primary production and retail.
RESULTS: We estimated that 37% of fruit and vegetables, equivalent to 2.4 Mt of produce, is lost between production and sale. In the UK, primary production is the main stage responsible for these losses (58%), and is dominated by four crops (apple, onion, carrot and potato), which contribute 71% of total food loss and waste. Quality and supply/demand mismatch are the core drivers, combined with limited ability to control postharvest quality decline as a result of technical or economic barriers.
CONCLUSIONS: Innate biological mechanisms contribute to, and detract from, marketable quality generating food loss risks where these cannot be adequately modified or controlled. Through climate change effects, reduced pesticide availability, changing consumer behaviour and increased pressure to reduce resource/energy inputs during pre- and postharvest handling, food loss and waste risk is likely to increase in the short term unless targeted, coordinated action is taken to actively promote its mitigation. © 2024 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Lawsonia intracellularis is the causative agent of ileitis in swine that manifests as slower weight gain, mild or hemorrhagic diarrhea and/or death in severe cases. As an economically important swine pathogen, development of effective vaccines is important to the swine industry. In developing a subunit vaccine with three recombinant antigens - FliC, GroEL and YopN - we wanted to identify a formulation that would produce robust immune responses that reduce disease parameters associated with Lawsonia intracellularis infection. We formulated these three antigens with four adjuvants: Montanide ISA 660 VG, Montanide Gel 02 PR, Montanide IMS 1313 VG NST, and Montanide ISA 61 VG in an immunogenicity study. Groups vaccinated with formulations including Montanide ISA 660 VG or Montanide ISA 61 VG had significantly more robust immune responses than groups vaccinated with formulations including Montanide Gel 02 PR or Montanide IMS 1313 VG NST. In the challenge study, animals vaccinated with these antigens and Montanide ISA 61 VG had reduced lesion scores, reduced lesion lengths, and increased average daily gain, but no reduction in shedding relative to the control animals. This work shows that this vaccine formulation should be considered for future study in a field and performance trial.

Diabetes mellitus (DM) and obesity have become public issues of global concern. Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach; however, there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM. In this review, we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM. I believe that our insights will be of great help to clinicians in their daily practice.

Early cancer detection is crucial for effective treatment, but current methods have limitations. Novel biomaterials, such as hydrogels, offer promising alternatives for developing biosensors for cancer detection. Hydrogels are three-dimensional and cross-linked networks of hydrophilic polymers that have properties similar to biological tissues. They can be combined with various biosensors to achieve high sensitivity, specificity, and stability. This review summarizes the recent advances in hydrogel-based biosensors for cancer detection, their synthesis, their applications, and their challenges. It also discusses the implications and future directions of this emerging field.

Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms\' widespread applicability. Additionally, the \"black box\" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems\' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.