BACKGROUND: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential.
OBJECTIVE: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions.
METHODS: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach.
RESULTS: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members\' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease.
CONCLUSIONS: Staff members\' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.

The healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group.
The workgroup provided a list of words or expressions that, in their opinion, described, evaluated or compared the healthcare pathways for patients, caregivers or regulators. The review group checked this list and added or deleted words or expressions. Then, definitions were added by the workgroup based into account three dimensions: official, academic and from the field. The review group validated the definitions and provided complementary proposals if needed.
After pooling the list of words proposed by each of the six members of the working group, 417 words/expressions were ranked. After the two rounds of evaluation, 294 words/expressions were rated \"appropriate\" and were analyzed by the review group. This group, after two rounds of evaluation, agreed on 263 words/expressions that were transmitted to the working group who defined them. These definitions were rated by the review group. The first round of evaluation established 195 definitions as being appropriated whereas 68 definitions were amended by the review group.
This glossary supports transdisciplinary communication, reduces the extent of variations in practice and optimizes decision-making. International debate on all aspects might be strengthened by an improved understanding of the concept of health pathway.

As human activity accelerates the global crisis facing wildlife populations, private land conservation provides an example of wildlife management challenges in social-ecological systems. This study reports on the research phase of \'WildTracker\' - a co-created citizen science project, involving 160 landholders across three Tasmanian regions. This was a transdisciplinary collaboration between an environmental organisation, university researchers, and local landholders. Focusing on mammal and bird species, the project integrated diverse data types and technologies: social surveys, quantitative ecology, motion sensor cameras, acoustic recorders, and advanced machine-learning analytics. An iterative analytical methodology encompassed Pearson and point-biserial correlation for interrelationships, Non-Metric Multidimensional Scaling (NMDS) for clustering, and Random Forest machine learning for variable importance and prediction. Taken together, these analyses revealed complex relationships between wildlife populations and a suite of ecological, socio-economic, and land management variables. Both site-scale habitat characteristics and landscape-scale vegetation patterns were useful predictors of mammal and bird activity, but these relationships were different for mammals and birds. Four focal mammal species showed variation in their response to ecological and land management drivers. Unexpectedly, threatened species, such as the eastern quoll (Dasyurus viverrinus), favoured locations where habitat was substantially modified by human activities. The research provides actionable insights for landowners, and highlights the importance of \'messy,\' ecologically heterogeneous, mixed agricultural landscapes for wildlife conservation. The identification of thresholds in habitat fragmentation reinforced the importance of collaboration across private landscapes. Participatory research models such as WildTracker can complement efforts to address the wicked problem of wildlife conservation in the Anthropocene.

Participatory and collaborative approaches in sustainability science and public health research contribute to co-producing evidence that can support interventions by involving diverse societal actors that range from individual citizens to entire communities. However, existing philosophical accounts of evidence are not adequate to deal with the kind of evidence generated and used in such approaches. In this paper, we present an account of evidence as clues for action through participatory and collaborative research inspired by philosopher Susan Haack\'s theory of evidence. Differently from most accounts of evidence for use in policies and interventions, our account combines action-oriented (the how) and actors-oriented (the who) considerations. We build on Haack\'s theory and on the analysis of examples of participatory and collaborative research in sustainability science and public health research to flesh out six procedural criteria for the generation and mobilization of evidence in and from participatory research. Action-oriented criteria invite to look at evidence from a (a) foundherentist, (b) gradational and (c) quasi-holistic perspective. Actors-oriented criteria point out that evidence generation and utilization are (d) social, (e) personal, and (f) embedded. We suggest that these criteria may reinforce participatory and collaborative approaches to evidence co-production when addressing complex problems in sustainability science and public health allowing for the generation of a kind of practical objectivity.

Contemporary medical research increasingly focuses on the blood-brain barrier (BBB) to maintain homeostasis in healthy individuals and provide solutions for neurological disorders, including brain cancer. Specialized in vitro modules replicate the BBB\'s complex structure and signalling using micro-engineered perfusion devices and advanced 3D cell cultures, thus advancing the understanding of neuropharmacology. This research explores nanoparticle-based biomolecular engineering for precise control, targeting, and transport of theranostic payloads across the BBB using nanorobots. The review summarizes case studies on delivering therapeutics for brain tumors and neurological disorders, such as Alzheimer\'s, Parkinson\'s, and multiple sclerosis. It also examines the advantages and disadvantages of nano-robotics. In conclusion, integrating machine learning and AI with robotics aims to develop safe nanorobots capable of interacting with the BBB without adverse effects. This comprehensive review is valuable for extensive analysis and is of great significance to healthcare professionals, engineers specializing in robotics, chemists, and bioengineers involved in pharmaceutical development and neurological research, emphasizing transdisciplinary approaches.

This Letter to the Editor provides an update on the research from the Glushkov Institute of Cybernetics of the National Academy of Sciences of Ukraine. The Institute\'s research team in collaboration with Ternopil National Medical University began a new project called \"Development of the cloud-based platform for patient-centered telerehabilitation of oncology patients with mathematical-related modeling.\" The project is dedicated to the development of a hybrid cloud-based platform, and the creation on its basis of information technology for the telemedicine rehabilitation of cancer patients, and adapted for patients with combat stress disorder. The distinctive features of the proposed technology are a combination of artificial intelligence methods with accurate mathematical methods for optimization: developing mathematical models of problems of discrete, and non-smooth optimization, subgradient space transformation algorithms (to minimize non-smooth functions with tens of thousands of variables), and a method of global equilibrium search, etc.

BACKGROUND: This paper discusses a paradox in mental health. It manifests as a relationship between adverse \"bad\" effects (suffering, clinical costs, loss of productivity) in individuals and populations and advantageous \"good\" aspects of mental disorders. These beneficial aspects (scientific, artistic and political accomplishments) emanate at the societal level through the frequently unprecedented creativity of people suffering from mental disorders and their relatives. Such gains can contribute to societal innovation and problem-solving. Especially in times of accelerated social-ecological change, approaches are needed that facilitate best-possible mental health care but also recognize creative ideas conducive to beneficial clinical and social-ecological innovations as soon as possible.
CONCLUSIONS: This paper emphasizes the need to account for creativity as a crucial component in evolving mental health systems and societies. It highlights the need for wide-ranging approaches and discusses how research targeting multiple facets (e.g., brain level, cognitive neuroscience, psychiatry, neurology, socio-cultural, economic and other factors) might further our understanding of the creativity-mental disorder link and its importance for innovating mental health systems and societies.
CONCLUSIONS: Our discussion clarifies that considerable research will be needed to obtain a better understanding of how creativity associated with mental disorders may help to create more sustainable societies on a fast-changing planet through innovative ideas. Given the current-state-of-the-art of research and healthcare management, our discussion is currently speculative. However, it provides a basis for how pros and cons might be studied in the future through transdisciplinary research and collaborations across sectors of society.

Sustainability science needs new approaches to produce, share, and use knowledge because there are major barriers to translating research into policy and practice. Multiple actors hold relevant knowledge for sustainability including indigenous and local people who have developed over generations knowledge, methods, and practices that biodiversity and ecosystem assessments need to capture. Despite efforts to mainstream knowledge coproduction, less than 3% of the literature on nature\'s contributions to people (NCP) integrates indigenous and local knowledge (ILK). Approaches and tools to better integrate scientific and ILK knowledge systems in NCP assessments are urgently needed. To fill this gap, we conducted interviews with ILK experts from Abancay and Tamburco, Peru, and convened focus groups and workshops during which participatory mapping, a serious game, a Bayesian belief network based on ILK were introduced. We inventoried 60 medicinal plants used to treat different illnesses, and analyzed the spatial distribution of the 7 plants that contribute the most to a good quality of life, and delineated their nonmedicinal uses. Based on the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services conceptual framework, we defined dimensions of a good quality of life according to indigenous and local worldviews. Medicinal plants contributed strongly to health and household security, among other contributions. Climate change and overexploitation were the main perceived threats to medicinal plants, despite the existence of formal and customary institutions to regulate trade. Our approach was flexible enough to integrate diverse forms of knowledge, as well as qualitative and quantitative information from, for example, the Bayesian belief network.
Coproducción de conocimiento para mejorar la evaluación de las contribuciones de la naturaleza para las personas Resumen La ciencia de la sostenibilidad necesita nuevos enfoques para producir, compartir y utilizar los conocimientos, ya que existen grandes obstáculos para trasladar la investigación a la política y la práctica. Varios actores poseen conocimientos relevantes para la sostenibilidad, incluidos los pueblos originarios y locales que han desarrollado conocimientos, métodos y prácticas a lo largo de generaciones, que deben reflejarse en las evaluaciones de la biodiversidad y los ecosistemas. A pesar de los esfuerzos por integrar la coproducción de conocimientos, <3% de la bibliografía sobre las contribuciones de la naturaleza a las personas (CNP) integra los conocimientos autóctonos y locales (CAL). Se necesitan urgentemente enfoques y herramientas para integrar mejor los sistemas de conocimiento científico y los conocimientos autóctonos y locales en las evaluaciones de los CNP. Para llenar este vacío, realizamos entrevistas con expertos en CAL de Abancay y Tamburco, Perú, y convocamos grupos focales y talleres durante los cuales se introdujeron el mapeo participativo, un juego serio y una red de creencia bayesiana basada en CAL. Inventariamos 60 plantas medicinales utilizadas para tratar diferentes enfermedades y analizamos la distribución espacial de las siete especies de plantas que más contribuyen a una buena calidad de vida y delineamos sus usos no medicinales. A partir del marco conceptual de la Plataforma Intergubernamental Científico-Normativa sobre Diversidad Biológica y Servicios de los Ecosistemas, definimos las dimensiones de una buena calidad de vida según las cosmovisiones autóctonas y locales. Las plantas medicinales contribuían en gran medida a la salud y a la seguridad de los hogares, entre otras aportaciones. El cambio climático y la sobreexplotación fueron las principales amenazas percibidas para las plantas medicinales a pesar de la existencia de instituciones tradicionales que regulan el mercado. Nuestra estrategia fue lo suficientemente flexible para integrar el conocimiento diverso, así como la información cualitativa y cuantitativa, como por ejemplo la red de creencia bayesiana.
【摘要】可持续科学需要新的方法来生产、分享和利用知识, 这是因为将研究成果转化为政策和实践仍存在重大阻碍。该过程的各方参与者都拥有与可持续相关的知识, 包括土著人和当地人, 他们经过数代人的努力已经形成了生物多样性和生态系统评估所需的知识、方法和实践。然而, 即便人们已在努力将知识共创纳入主流, 但在关于自然对人类贡献的文献中, 仅有不到3%的文献整合了土著和地方知识 (Indigenous and local knowledge, ILK) 。因此, 目前急需建立在自然对人类贡献评估中更好地整合科学知识体系与 ILK 知识体系的方法和工具。为了填补这一空白, 本研究对秘鲁阿班凯和坦布尔科的 ILK 专家进行了访谈, 组织了焦点小组会议和研讨会, 介绍了参与式地图绘制、严肃游戏和基于 ILK 的贝叶斯信念网络。我们整理了 60 种用于治疗不同疾病的药用植物, 分析了对提高生活质量贡献最大的7种植物的空间分布, 并界定了它们的非药用用途。根据生物多样性和生态系统服务政府间科学政策平台的概念框架, 我们按照土著和地方世界观定义了优质生活的各个层面。我们发现, 药用植物除其他贡献外, 还对健康和家庭安全做出了巨大贡献。人们认为气候变化和过度开发是药用植物面临的主要威胁, 尽管已存在正式和惯例的贸易监管体系。我们的方法非常灵活, 可以整合各种形式的知识, 以及来自贝叶斯信念网络等定性和定量的信息。【翻译:胡怡思;审校:聂永刚】.

Supporting sustainability requires understanding human-nature relations, which we approached as social constructions that can be studied through nature-related discourses. We examined human-nature relations in Finland by combining approaches from environmental social sciences and arts-based research into a mixed-methods design. A public online survey (n = 726) and post-performance audience interviews (n = 71) portrayed nature positively. Respondents\' ideas of nature ranged from natural scientific to philosophical; from dualistic to holistic; and from ecocentric to anthropocentric. A factor analysis revealed discourses focusing on wellbeing, conservation, ecoanxiety, pro-environmentalism, outdoor activity, and enjoying nature. Interviews added spiritual and over-generational aspects and revealed the importance of embodied experiences in nature relations. We identified dimensions that structure the relations, including human-nature positionality, engagement and contact with nature, and conception and thought. The emotional and experiential aspects, and nature-related practices, deserve further research. We demonstrate how a diversity of human-nature relations co-exists and co-evolves.

Snakebite envenoming (SBE) is a neglected tropical disease that kills and maims hundreds of thousands of people yearly, particularly in impoverished rural settings of the Global South. Understanding the complexity of SBE and tackling this disease demands a transdisciplinary, One Health approach. There is a long-standing research tradition on SBE in toxinology and human medicine. In contrast, other disciplines, such as veterinary medicine or social sciences, still need to be better developed in this field, especially in countries with a high incidence of SBE. Broadening the disciplinary landscape, connecting various research approaches, methods, and data across disciplines and sectors, and engaging with communities affected by SBE in implementing evidence-based solutions are needed. This review summarizes areas that require strengthening to better understand the complexity of SBE and to generate a robust body of knowledge to be translated into effective public health interventions.