Graphical abstract. Aqueous Cotoneaster nummularia leaf extract was tested by broth microdilution against E. coli and P. aeruginosa from hospital waste; partial inhibition (47–72 %) was observed without reaching the MIC criterion. Escherichia coli and Pseudomonas aeruginosa are leading causes of drug-resistant infection and are listed among the World Health Organization priority pathogens. Species of Cotoneaster (Rosaceae) are used in traditional Asian medicine and are rich in polyphenols, but evidence for activity of Cotoneaster nummularia against Gram-negative bacteria of clinical or environmental origin is scarce. Leaves of C. nummularia were collected in Dir Lower, Khyber Pakhtunkhwa, Pakistan, and extracted with water (1g: 400 mL; 24 h maceration followed by 10 min at 80 °C). E. coli and P. aeruginosa were isolated from dry waste of Saidu Teaching Hospital, Swat. Growth inhibition was measured by 96-well broth microdilution over a two-fold series of 4.88–156.25 µg/mL (leaf-equivalent) by optical density at 600 nm after 24 h at 37 °C. The minimum inhibitory concentration (MIC) was defined a priori as the lowest concentration producing ≥ 90 % inhibition. Concentration–response association was assessed by Spearman correlation and between-isolate differences by the Wilcoxon signed-rank test. The extract partially inhibited both isolates at every concentration tested (E. coli 47.2–67.7 %; P. aeruginosa 52.6–71.8 %). No concentration reached 90 % inhibition; the MIC therefore exceeded 156.25 µg/mL for both organisms. Inhibition of ≥ 50 % was observed from 9.77 µg/mL for E. coli and at all concentrations for P. aeruginosa. Inhibition was not significantly associated with concentration (E. coli ρ = 0.77, p = 0.07; P. aeruginosa ρ = 0.26, p = 0.62), and mean inhibition did not differ between isolates (difference −1.5 percentage points; p = 0.84). Aqueous C. nummularia leaf extract exerts a partial, plateau-type growth-inhibitory effect on Gram-negative hospital-waste isolates but does not achieve MIC-level inhibition within the tested range.

The core objective of this research is to investigate the association between Safety Leadership (SL), Safety Climate (SCL), Occupational Health and Safety Management System (OHSMS), and Safety Performance (SP). The research is grounded in 307 usable survey responses gathered from a hydropower construction firm, employing a cross-sectional design. The researcher used SPSS 23 and Amos 21 for structural equation modelling. Study results indicated that SCL serves as a positive complementary partial mediator between SL and SP. Additionally, the study presents a novel investigation into the moderating effect of OHSMS, demonstrating its supportive role in aligning SL with SCL to enhance sustainable SP outcomes. This research provides additional empirical support for the direct links between SL and SP, and between SL and SCL. Moreover, the study emphasizes the moderating effect of OHSMS within the mediated relationship of SL between SCL and SP. Additionally, this empirical evidence can serve as a valuable guide for managers and safety practitioners in developing countries to enhance the sustainable SP of hydropower construction firms.

Background: Occurrence variance reporting (OVR) systems are essential tools for identifying, mitigating, and preventing risks in healthcare, yet they are widely under-used because of inadequate training, fear of blame, and unclear definitions of what constitutes a reportable event. In Saudi Arabia, Vision 2030 reforms place incident reporting at the centre of quality and patient-safety improvement. Objective: To examine whether a hospital-wide staff training program on the OVR system was associated with changes in the number of incident reports, the distribution of risk levels, and the distribution of incident categories at Al-Noor Specialist Hospital, Makkah. Methods: A quantitative, retrospective, single-group pre–post quasi-experimental design without a control group was applied to secondary data extracted from the hospital’s electronic OVR system. The intervention was a 40-minute face-to-face session (presentation, case study, and system-demonstration video) delivered from mid-May 2024 to 430 documented attendees (≈18.7% of 2,300 employees). A total census of 4,981 reports was analysed across a pre-intervention period (1 July 2023–30 June 2024; n = 2,018) and a post-intervention period (1 July 2024–30 June 2025; n = 2,963). Monthly volumes were compared with the Mann–Whitney U test after Shapiro–Wilk testing; risk-level and category distributions were compared with chi-square tests of independence. Results: Total reports increased by 46.8%, and monthly volume rose significantly (median 154 vs. 241; U = 11.00, z = −3.52, p < .001, rank-biserial r = 0.847). The reporting rate rose from 15.90 to 24.99 per 1,000 patient-days (+57.2%) despite a 6.6% fall in patient-days. Risk-level distribution changed significantly (χ²(3, N = 4,981) = 262.44, p < .001, Cramér’s V = 0.230), shifting toward low- and moderate-risk reports (82.0% to 95.9%). Incident-category distribution also changed significantly (χ²(5, N = 4,981) = 243.42, p < .001, Cramér’s V = 0.221), with notable increases in the Incident (0.8% to 10.5%) and Adverse Event (29.7% to 34.8%) categories. Conclusion: Staff training on the OVR system was associated with a sustained increase in incident reporting and with changes in the risk-level and category profile of reports. Because the design lacked a control group and classifications were not independently verified, the changes cannot be attributed to training alone or interpreted as improved classification accuracy. Training appears to be a promising, low-cost strategy against under-reporting when combined with leadership support, feedback to reporters, and evaluation in controlled studies.

The adaptation potential of The Case of the Speluncean Explorers lies in its presentation of the same facts through different judicial opinions, thereby keeping the determination of facts distinct from the evaluation of responsibility. A murder mystery game can translate this structure of multiple interpretations of the same case into a participatory process of judgment through multiple roles, asymmetric information, behavioral clues, and interactive mechanics. Zuixue uses character backstories, rules governing resource consumption and voting-based elimination, and character-specific skills to translate the original work’s jurisprudential debates into concrete interpersonal conflicts and contests of interest. Yet such an adaptation may also reduce the central question to a mystery-solving exercise focused on who inflicted the fatal injury. This article argues that The Case of the Speluncean Explorers is suitable for adaptation into a murder mystery game only if clues and post-game debriefings do not serve solely to identify the person responsible. The question of what happened must be treated separately from that of how the conduct should be evaluated.

Background: Endometrial carcinoma is commonly managed using clinicopathological risk stratification to guide adjuvant treatment. However, p53 and mismatch repair (MMR) status may identify biological risks not captured by conventional classifications. Local evidence regarding discordance between clinicopathological and molecular risk profiles remains limited. This study aimed to assess this discordance and to describe treatment allocation and one-year outcomes among patients with molecular abnormalities. Methods: This prospective observational study was conducted at the National Institute of Cancer Research and Hospital, Dhaka, from October 2021 to May 2023 and included 42 women with endometrial carcinoma who underwent definitive surgery. Risk was assigned by the ESGO/ESTRO/ESP 2021 consensus, p53 and MMR proteins were assessed by immunohistochemistry and patients were followed for one year. Fisher's exact test was used for outcome comparisons. Results: Conventional classification identified 17 low-risk (40.5%) and 18 high-risk (42.9%) patients, with seven in intermediate categories. Abnormal p53 expression was found in five patients (11.9%) and MMR deficiency in 16 (38.1%). Among the 17 low-risk patients, one (5.88%) had abnormal p53 and seven (41.17%) were MMR deficient; among the 18 high-risk patients, four (22.2%) had abnormal p53 and five (27.78%) were MMR deficient. No low-risk patient with a molecular abnormality received adjuvant treatment or progressed. Freedom from progression was 60.0% with abnormal p53 versus 97.3% with normal p53 (p=0.001) and 93.8% versus 92.3% for MMR-deficient and MMR-retained tumours (p=0.414). Conclusion: Molecular abnormalities occurred in conventionally low-risk endometrial carcinoma, indicating that clinicopathological classification alone does not capture molecular risk. Combined assessment may refine risk stratification, pending larger confirmatory studies.

Background: Placenta accreta spectrum (PAS) is an important cause of severe maternal morbidity, particularly among women presenting with antepartum haemorrhage (APH). Early identification of women at increased risk may facilitate timely referral and appropriate obstetric planning. This study aimed to identify predictors of PAS among women presenting with APH. Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Sylhet Women's Medical College Hospital, Sylhet, Bangladesh, from January to December 2025. A total of 110 women presenting with APH after 28 weeks of gestation admitted to the Department during the study period were included. Results: Among 110 women, 25 (22.7%) had PAS. Significant associations were observed with maternal age ≥35 years, multiparity, ≥2 previous cesarean deliveries, previous uterine surgery, previous dilatation and curettage, placenta previa, anterior placenta, recurrent APH, and multiple ultrasonographic features suggestive of PAS. On multivariable analysis, ≥2 previous cesarean deliveries (adjusted OR=5.76, 95% CI: 2.01–16.53), placenta previa (adjusted OR=6.92, 95% CI: 2.41–19.86), and ≥2 suggestive ultrasonographic features (adjusted OR=18.64, 95% CI: 5.02–69.19) were independent predictors of PAS. Cesarean hysterectomy, blood transfusion, ICU admission, preterm delivery, and low birth weight were significantly more common among women with PAS. Conclusion: PAS was relatively common among women presenting with APH, particularly those with previous cesarean delivery, placenta previa, and characteristic ultrasonographic findings. Early identification of these risk factors may help improve antenatal risk stratification and obstetric preparedness.

Enterococcus species inhabit the human gastrointestinal tract and may be recovered from urine, wounds, abdominal specimens, and blood. Their isolation raises a recurring clinical question: does the organism represent harmless colonization, contamination, or a causative pathogen requiring treatment? This narrative review synthesizes contemporary clinical guidelines and selected studies, emphasizing practical interpretation across specimen types, species-level identification, and antimicrobial stewardship. Enterococcus faecalis and Enterococcus faecium differ substantially in epidemiology, antimicrobial susceptibility, and association with healthcare exposure. Asymptomatic bacteriuria generally should not be treated, except during pregnancy or before selected endourological procedures associated with mucosal trauma. Conversely, enterococcal bloodstream infection requires prompt clinical assessment, source investigation, and consideration of endocarditis, especially for E. faecalis. Deep or normally sterile-site specimens provide stronger evidence of pathogenicity than superficial swabs or surveillance cultures, although specimen quality and the possibility of contamination remain critical. Intra-abdominal isolation must be interpreted in relation to source control, severity, healthcare association, and polymicrobial growth. Species identification, susceptibility testing, and targeted therapy are essential because intrinsic cephalosporin resistance and acquired vancomycin resistance limit treatment options. A stepwise clinical–microbiological framework can reduce both missed invasive infections and unnecessary antibiotic exposure. Enterococci should neither be dismissed reflexively nor treated solely because a culture is positive; management must be driven by syndrome, specimen validity, host factors, and the strength of microbiological evidence.