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Zainab Alimoradi,1,* Chung-Ying Lin,2– 5,* Irfan Ullah,6 Mark D Griffiths,7 Amir H Pakpour8 1Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran; 2Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Kabir Medical College, Gandhara University, Peshawar, Pakistan; 7International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 8Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden*These authors contributed equally to this workCorrespondence: Irfan Ullah, Kabir Medical College, Gandhara University, Peshawar, Pakistan, Email irfanullahecp2@gmail.com Amir H Pakpour, Department of Nursing, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, 55111, Sweden, Email amir.pakpour@ju.seBackground: The COVID-19 pandemic is still ongoing and is not yet under control. Evidence regarding the impacts of COVID-19 on psychological distress has been widely reported worldwide, and one of the primary concerns regarding psychological distress is fear (ie, fear of COVID-19). Therefore, having a robust instrument for assessing fear of COVID-19 is important. The present systematic review aimed to synthesize the psychometric evidence evaluated using item response theory (IRT) on the Fear of COVID-19 Scale (FCV-19S).Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four academic databases (Scopus, PubMed Central, ProQuest, and ISI Web of Knowledge) were used to search target papers. Keywords used for search were “Fear of COVID-19 Scale” and its abbreviation (ie, “FCV-19S”) and IRT-related terms. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was then applied to evaluate the methodological quality of the reviewed papers. Moreover, psychometric properties using IRT methods were synthesized using a qualitative method.Results: The initial search resulted in 552 papers (73 duplicates) and 479 were screened based on their titles and abstracts. Finally, 16 papers were included for review regarding their methodological quality (via COSMIN) to synthesize the psychometric evidence for FCV-19S. The 16 papers included 21 countries with 16 language versions of FCV-19S.Conclusion: All the psychometric evidence indicated that the seven items in the FCV-19S fit with the concept of fear. The FCV-19S is a strong and valid instrument for assessing fear across different languages. The seven items in the FCV-19S appear to be unidimensional in assessing fear, which indicates that all items are necessary in the FCV-19S.Keywords: COVID-19, fear, item response theory, psychometrics, Rasch, review

I-Hua Chen,1,* Pei-Ling Wu,2,3,* Cheng-Fang Yen,4– 6,* Irfan Ullah,7 Sheikh Shoib,8 Shafi Ullah Zahid,9 Aadil Bashir,10 Naved Iqbal,11 Frimpong-Manso Addo,12 Emma Sethina Adjaottor,12 Gifty Boakye Amankwaah,12 Daniel Kwasi Ahorsu,13 Mark D Griffiths,14 Chung-Ying Lin,15– 18 Amir H Pakpour19 1Chinese Academy of Education Big Data, Qufu Normal University, Qufu City, Shandong, People’s Republic of China; 2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 3Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan; 4Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; 5Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, 80756, Taiwan; 6College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, 91201, Taiwan; 7Kabir Medical College, Gandhara University, Peshawar, Pakistan; 8Sheikh Shoib Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, India; 9Department of Neurosurgery, Jamhuriat hospital, Kabul, Afghanistan; 10Department of Social Work, University of Kashmir, Kashmir, India; 11Department of Psychology, Jamia Millia Islamia, New Delhi, India; 12Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 13Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 14International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 15Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 16Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 17Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 18Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 19Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden*These authors contributed equally to this workCorrespondence: Emma Sethina Adjaottor; Chung-Ying Lin, Tel +233 20 816 85080 ; +886-6-2353535-5106, Fax + 886-6-2367981, Email eadjaottor.chs@knust.edu.gh; cylin36933@gmail.comPurpose: The percentage of individuals who were fully vaccinated against COVID-19 was 53% worldwide, 62% in Asia, and 11% in Africa at the time of writing (February 9, 2022). In addition to administrative issues, vaccine hesitancy is an important factor contributing to the relatively low rate of vaccination. The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S) was developed to assess COVID-19 vaccination acceptance levels. However, it has only been tested among Taiwanese, mainland Chinese, and Ghanaian populations (Chen et al, 2021; Fan et al, 2021; Yeh et al, 2021). Therefore, the present study examined the construct validity and measurement invariance of the MoVac-COVID19S among individuals from five countries (ie, Taiwan, mainland China, India, Ghana, and Afghanistan).Participants and Methods: A cross-sectional survey study recruited 6053 participants across five countries who completed the survey between January and March 2021. Confirmatory factor analysis (CFA) fit indices were used to examine factor structure and measurement invariance across the five countries.Results: The fit indices of the CFA were relatively good across the countries except for the root mean square error of approximation (RMSEA). Moreover, the four-factor structure (either nine or 12 items) had a better fit than the one-factor structure. However, the four-factor model using nine MoVac-COVID19S items was the only model that had measurement invariance support for both factor loadings and item intercepts across the five countries.Conclusion: The present study confirmed that the MoVac-COVID19S has acceptable psychometric properties and can be used to assess an individual’s willingness to get COVID-19 vaccination.Keywords: factor structure, vaccine hesitancy, young adults

Aamir Hussain,1– 3 Shaheena Kousar,2 Ihsan Ullah,3 Aqsa Zulfiqar,2 Hafiz Arslan Ali,2 Amina Manzoor,2 Atif Aziz,2 Asghar Javaid,4 Mubashar Aziz,2 Binish Khaliq,5 Humera Nazir,2 Aleem Ahmed Khan,2 Ahmed Akrem,2 Muhammad Qamar Saeed2 1Combined Military Hospital Multan, Multan, Pakistan; 2Dr. Ghulam Nabi Chaudhry Laboratory of Microbial Technologies, Department of Microbiology and Molecular Genetics, Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Pakistan; 3Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan; 4Pathology Department, Nishtar Medical University, Multan, Pakistan; 5Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore, PakistanCorrespondence: Muhammad Qamar SaeedDr. Ghulam Nabi Chaudhry Laboratory of Microbial Technologies, Department of Microbiology, Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, PakistanTel +92 333-0231222Email mqamarsaeed@bzu.edu.pkPurpose: Drug resistance against antimicrobials is on the rise at alarmingly high rates. Acinetobacter baumannii is one of the six ESKAPE pathogens which are a significant “one health” issue. Clinical isolates of A. baumannii exhibit MDR phenotype mostly and infrequently the XDR and PDR phenotype. As a result, these infections have one of the highest mortality rates in hospitals. Alternative therapies are urgently needed.Methods: Various phages were enriched against XDR clinical strain of A. baumannii. A potent phage, QAB 3.4, was further tested against 100 clinical strains. Because of its broad lytic activity, it was further tested for stability, resistance development and as an infection control agent.Results: Phage QAB 3.4 showed broad lytic activity against 100 MDR and XDR clinical isolates representing a wide diversity of infection sites. Assays conducted to document the phage’s stability, and ability of clinical isolates to develop resistance against it, showed promising outcomes for its potential use in clinical applications. Phage QAB 3.4 was able to eradicate A. baumannii from pre-inoculated solid surfaces. It provides a proof of concept that phages can be used as environmentally friendly infection control agents.Conclusion: We propose the phage QAB 3.4 is a promising candidate for further pre-clinical and clinical studies to test its biosafety and efficacy.Keywords: ESKAPE, A. baumannii, bacteriophages, phage therapy, host-range, lytic activity

Irfan Ullah,1 Assad Ullah,2 Sher Ali,3 Petra Poulova,4 Ahsan Akbar,5 Muhammad Haroon Shah,6 Alam Rehman,7 Muhammad Zeeshan,8 Fakhr E Alam Afridi3 1Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 2School of Economics, Henan University, Kaifeng, People’s Republic of China; 3Department of Economics, Islamia College Peshawar, Peshawar, Pakistan; 4Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, 500 03, Czech Republic; 5International Business School, Guangzhou City University of Technology, Guangzhou, 510080, People’s Republic of China; 6College of International Students, Wuxi University, Wuxi 214105, Jiangsu, People’s Republic of China; 7Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 8College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People’s Republic of ChinaCorrespondence: Ahsan AkbarInternational Business School, Guangzhou City University of Technology, Guangzhou, 510080, People’s Republic of ChinaEmail akbar@gcu.edu.cnObjective: The provision of healthcare facilities remains high on the manifesto of various political parties in Pakistan and healthcare spending has witnessed a significant surge in the last two decades that is expected to positively influence health outcomes in the country. Therefore, this research aims to explore the effects of healthcare expenditures on the actual health status of the masses in Pakistan for the period 1995Q1 to 2017Q1.Methods: We apply the Quantile Autoregressive Distributed Lag (QARDL) approach for estimation purposes. This is the most recent and emerging estimation technique in time series analysis.Results: Our findings confirm that public healthcare spending significantly impacts health outcomes in Pakistan both in the short-run and long-run. Public healthcare spending improves life expectancy and reduces death rate and infant mortality.Conclusion: The study concludes that public healthcare is the main focus of the current regime. It is noticed that spending on healthcare significantly contributes to the health outcomes in Pakistan. These efforts by the government significantly promote life expectancy and drop down the mortality ratio in the country. Based on these notable facts, the government should allocate sufficient resources towards the latest healthcare technologies and equipment to optimize health outcomes in the country.Keywords: healthcare spending, health outcomes, healthcare technologies, Quantile cointegration, QARDL, Pakistan

Muhammad Imran Shah,1 Irfan Ullah,2 Xiao Xingjian,2 Huang Haipeng,2 Alam Rehman,3 Muhammad Zeeshan,4 Fakhr E Alam Afridi5 1School of Mathematics and Statistics, Wuhan University, Wuhan, People’s Republic of China; 2Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 3Faculty of Management Sciences, National University of Modern Languages Islamabad, Islamabad, Pakistan; 4College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province, 125105, People’s Republic of China; 5Islamia College Peshawar, Peshawar, PakistanCorrespondence: Irfan UllahReading Academy, Nanjing University of Information Science and Technology, People’s Republic of ChinaEmail irfnecon@nuist.edu.cnObjective: This study investigates life expectancy and trade openness in China for the period 1960– 2018.Methods: We purposed a theoretical model that is tested for China by applying regime-switching regression.Results: Our findings suggest that trade openness increases life expectancy in China; trade affects life expectancy from two aspects; firstly, trade expansion and industrialization lead to high economic activities and resulted in raise the income of the people in society leading to improve life expectancy. Secondly, industrial expansion increases the CO2 emissions which leads to imposes a negative implication on human health and thus reduces life expectancy.Conclusion: Thus, the net effect of trade liberalization depends on the value of income effect and volume of CO2 emissions. Therefore, the government needs to support the trade policies which causes a low level of CO2 emissions, the government may provide incentives to exports and industrialists to adopted green energy in the production process. Besides, the government may impose some regulations such as carbon tax to mitigate the CO2 emissions in society.Keywords: trade, life expectancy, CO2 emissions, health quality, regime-switching regression, China

Muhammad Zeeshan,1 Jiabin Han,1 Alam Rehman,2 Irfan Ullah,3 Fakhr E Alam Afridi4 1College of Business Administration, Liaoning Technical University, Xingcheng, Liaoning Province, 125105, People’s Republic of China; 2Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 3Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 4Islamia College Peshawar, Peshawar, PakistanCorrespondence: Alam RehmanFaculty of Management Sciences, National University of Modern Languages, PakistanEmail amrehman@numl.edu.pkObjective: This study investigates the nexus between household health expenditure, CO2 emissions and environmental pollution in China. We analyzed the asymmetric dynamic relationship between CO2 emissions, environmental pollution and household health expenditure for the period 1990 to 2019 in China.Methods: This study adopted nonlinear autoregressive distributed lag (NARDL) and Granger causality following the diagnostic test. Furthermore, we applied Dickey–Fuller (ADF), PP unit root tests, Zivot and Andrews test for structural breaks in our analysis. The NARDL is the most suitable econometric technique for estimations, especially if the asymmetric relationship exists among the variables. NARDL technique is capable to explore the dynamic relationship between CO2 emissions, environmental pollution and household health expenditure.Results: The empirical results verify the asymmetric nexus between CO2 emissions, environmental pollution and household health expenditure in the context of China. The outcomes revealed that in the short run and long run positive shocks of CO2 emissions and environmental pollution positively affecting health expenditure, while negative shocks reduce health spendings. The results also demonstrate bi-directional causality among household health spendings, CO2 emissions and environmental pollution.Conclusion: Our results support many previous studies, documenting that CO2 emissions positively contribute to the amount of household health expenditure, confirming the asymmetric relationship between CO2 emissions and household health expenditure. The results also confirm the statistically significant and asymmetrically positive relationship between environmental pollution and household health expenditure. This implies that Chinese residents have to bear more household health expenditure, in the case of more CO2 emissions and a greater amount of environmental pollution.Keywords: CO2 emissions, environmental pollution, household health expenditure, China

Ahsan Akbar,1 Alam Rehman,2 Irfan Ullah,3 Muhammad Zeeshan,4 Fakhr E Alam Afridi5 1International Business School, Guangzhou College of South China University of Technology, Guangzhou 510080, People’s Republic of China; 2Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan; 3Reading Academy, Nanjing University of Information Science and Technology, Nanjing, People’s Republic of China; 4College of Business Administration, Liaoning Technical University, XingCheng, Liaoning Province 125105, People’s Republic of China; 5Islamia College Peshawar, Peshawer, PakistanCorrespondence: Alam RehmanFaculty of Management Sciences, National University of Modern Languages, Islamabad, PakistanEmail amrehman@numl.edu.pkObjective: Most of the Southeast Asian countries witnessed remarkable economic growth in the last few decades. Trade is a primary factor in achieving this exponential economic progress in these countries. Besides, the positive implications of trade, it has associated cost of escalated energy consumption, CO2 emissions, and resulting health complications which leads to higher public health expenditures. This study examines the nexus between trade liberalization, energy consumption, CO2 emissions, and health expenditures in Southeast Asian countries for the period of 1991 to 2018.Methods: The empirical methods used in this study entail diagnostic testing, correlation analysis, and structure equation modeling (SEM) technique. SEM is an advanced multivariate analysis technique that can test complex multivariate causal associations among a set of variables. Therefore, it is the most suitable econometric approach to explore the dynamic association between trade openness, energy consumption, CO2 emissions, and health expenditures.Results: The empirical results reveal a nexus between trade openness, energy consumption, CO2 emissions, and health expenditure in Southeast Asian countries. Nevertheless, pollutant emissions have a direct impact on health expenditures, whereas trade and energy consumption shows an indirect influence on the escalation in public health spending in sample Southeast Asian countries. Moreover, the mediating path of each indirect effect is energy consumption.Conclusion: These results imply that Southeast Asian countries heavily rely on fossil energy to fuel economic growth. Hence, to promote sustainable and eco-friendly economic development, the respective governments need to reform their energy sectors by tapping into renewable energy resources and deploy green technologies to reduce pollutant emissions for the development of a healthy society. In addition, governments should levy taxes on highly polluting industries so as to curtail carbon emissions and resulting health expenditures.Keywords: trade liberalization, energy consumption, CO2 emissions, health expenditures, Southeast Asia

Syeda Lamiya Mir,1 Abdul Moiz Sahito,1 Irfan Ullah2 1Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan; 2Kabir Medical College, Gandhara University, Peshawar, PakistanCorrespondence: Syeda Lamiya MirDow Medical College, Dow University of Health Sciences, Karachi, PakistanEmail lamiyamir@gmail.com View the original paper by Dr Mougdal and colleagues

Inayat Ullah,1 Khakemin Khan,2 Muhammad Sohail,3 Kifayat Ullah,4 Anwar Ullah,4 Shabnum Shaheen5 1Lanzhou Center for Tuberculosis Research and Institute of Pathogen Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China; 2Department of Chemistry, Hazara University, Mansehra, Khyber Pakhtunkhwa, Pakistan; 3School of Chemical Engineering and the Environment, Beijing Institute of Technology, Beijing 100081, People’s Republic of China; 4Department of Biosciences, COMSATS Institute of Information Technology, Park Road, Chack Sahzad, Islamabad, Pakistan; 5Department of Botany, Lahore College for Women University, Lahore, Punjab-Pakistan Abstract: In this research work, copper (Cu), palladium (Pd) and their bimetallic palladium@copper (Pd@Cu) nanoparticles were synthesized using trisodium citrate as a stabilizing agent using the known chemical reduction method. The synthesized Cu, Pd and Pd@Cu nanoparticles were characterized by the ultraviolet–visible spectroscopy, scanning electron microscopy and X-ray diffraction spectroscopy, respectively. The different volumes of trisodium citrate were used for the stability of synthesized monometallic Cu, Pd and bimetallic Pd@Cu nanoparticles. The synthesized Cu, Pd and their bimetallic Pd@Cu nanoparticles were used as catalysts for the reduction of 4-nitrophenol in the presence of NaBH4. The bimetallic Pd@Cu nanoparticles had efficient catalytic activities with a high rate constant (1.812 min-1) as compared to monometallic Cu (0.3322 min-1) and Pd (0.2689 min-1) nanoparticles, respectively. The correlation coefficient (R2) was found to be 0.99 for these three nanoparticles. Meanwhile, the effect of Cu, Pd and bimetallic Pd@Cu nanoparticles was checked on the physiology of specific different micro-organism strains. The bimetallic Pd@Cu nanoparticles reported the maximum resistance at maximum level the growth of bacterial strain and had observed a smooth antibacterial graph than the monometallic analogs. Keywords: stabilizing agent, bimetallic nanoparticles, catalytic activities, antimicrobial effects

Ajmal Khan,1,2 Sadia Naz,1 Umar Farooq,1 Muhammad Shahid,3 Irfan Ullah,4 Iftikhar Ali,5 Abdur Rauf,6 Yahia Nasser Mabkhot7 1Department of Chemistry, COMSATS Institute of Information Technology, Abbottabad, Pakistan; 2University of Nizwa Chair of Oman’s Medicinal Plants and Marine Natural Products, University of Nizwa, Nizwa, Oman; 3Department of Pharmacy, Sarhad University of Science and Information Technology, 4Department of Pharmacy, University of Peshawar, Peshawar, 5Department of Chemistry, Karakoram International University, Gilgit-Baltistan, 6Department of Chemistry, University of Swabi, Khyber Pakhtunkhwa, Pakistan; 7Department of Chemistry, College of Science, King Saud University, Riyadh, Saudi Arabia Background: Vitex negundo L. has been widely studied for its beneficial effect in inflammatory and pain conditions. The present study describes the isolation of two new bioactive chromone constituents from V. negundo and their in vivo evaluation for anti-inflammatory and antinociceptive activities. Methods: Two new chromone derivatives, namely, methyl 3-(2-(5-hydroxy-6-methoxy-4-oxo-4H-chromen-2-yl)ethyl)benzoate (1) and 3-(1-hydroxy-2-(5-hydroxy-6-methoxy-4-oxo-4H-chromen-2-yl)ethyl)benzoic acid (2) were isolated from V. negundo and their structures were determined through various spectroscopic techniques including mass spectrometry, UV, IR, 1H NMR, 13C NMR, and two-dimensional-NMR like correlation spectroscopy and heteronuclear multiple bond correlation techniques. The isolated compounds (1–2) were tested for their prospective antinociceptive activity in acetic acid-induced abdominal constriction assay and anti-inflammatory activity in the carrageenan-induced paw edema assay in mice. Results: Significant attenuation (P

Fakhar ud Din,1,* Waqar Aman,2,* Izhar Ullah,3 Omer Salman Qureshi,4 Omer Mustapha,5 Shumaila Shafique,6 Alam Zeb7 1Department of Pharmacy, Quaid-i-Azam University, Islamabad, 2Department of Pharmacy, Kohat University of Science and Technology, Kohat, 3Department of Health and Medical Sciences, University of Poonch, Rawalakot, Azad Kashmir, 4Faculty of Pharmacy, University of Lahore, Lahore, 5Faculty of Pharmacy, Ziauddin University, Karachi, 6Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, 7Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan *These authors contributed equally to this work Abstract: Nanotechnology has recently gained increased attention for its capability to effectively diagnose and treat various tumors. Nanocarriers have been used to circumvent the problems associated with conventional antitumor drug delivery systems, including their nonspecificity, severe side effects, burst release and damaging the normal cells. Nanocarriers improve the bioavailability and therapeutic efficiency of antitumor drugs, while providing preferential accumulation at the target site. A number of nanocarriers have been developed; however, only a few of them are clinically approved for the delivery of antitumor drugs for their intended actions at the targeted sites. The present review is divided into three main parts: first part presents introduction of various nanocarriers and their relevance in the delivery of anticancer drugs, second part encompasses targeting mechanisms and surface functionalization on nanocarriers and third part covers the description of selected tumors, including breast, lungs, colorectal and pancreatic tumors, and applications of relative nanocarriers in these tumors. This review increases the understanding of tumor treatment with the promising use of nanotechnology. Keywords: nanocarriers, drug delivery, solid lipid nanoparticles, liposomes, polymeric nanoparticles, dendrimers, breast tumor, lungs tumor, colorectal tumor, prostate tumor

The unprecedented use of Earth's resources by humans, in combination with increasing natural variability in natural processes over the past century, is affecting the evolution of the Earth system. To better understand natural processes and their potential future trajectories requires improved integration with and quantification of human processes. Similarly, to mitigate risk and facilitate socio-economic development requires a better understanding of how the natural system (e.g. climate variability and change, extreme weather events, and processes affecting soil fertility) affects human processes. Our understanding of these interactions and feedback between human and natural systems has been formalized through a variety of modelling approaches. However, a common conceptual framework or set of guidelines to model human-natural-system feedbacks is lacking. The presented research lays out a conceptual framework that includes representing model coupling configuration in combination with the frequency of interaction and coordination of communication between coupled models. Four different approaches used to couple representations of the human and natural system are presented in relation to this framework, which vary in the processes represented and in the scale of their application. From the development and experience associated with the four models of coupled human-natural systems, the following eight lessons were identified that if taken into account by future coupled human-natural-systems model developments may increase their success: (1) leverage the power of sensitivity analysis with models, (2) remember modelling is an iterative process, (3) create a common language, (4) make code open-access, (5) ensure consistency, (6) reconcile spatio-temporal mismatch, (7) construct homogeneous units, and (8) incorporating feedback increases non-linearity and variability. Following a discussion of feedbacks, a way forward to expedite model coupling and increase the longevity and interoperability of models is given, which suggests the use of a wrapper container software, a standardized applications programming interface (API), the incorporation of standard names, the mitigation of sunk costs by creating interfaces to multiple coupling frameworks, and the adoption of reproducible workflow environments to wire the pieces together.