Sustainable Development Goal 4: Quality Education (39698)

This study investigates the impact of professional competencies (moral, knowledge, and skill) on the occupational identity of government-supported preschool teacher trainees and examines the moderating role of support from significant others, including family, peers, and mentors. A quantitative research methodology was employed, involving a cross-sectional survey of 193 publicly funded teacher trainees. Validated scales were used to measure professional competencies, occupational identity, and perceived support. The results revealed a strong positive correlation between professional competencies and occupational identity (r = 0.61, p < 0.01), supporting the hypothesis that higher competency levels enhance trainees’ professional identity. Furthermore, support from significant others moderated this relationship, with a higher level of support amplifying the positive association (β = 1.412, p < 0.01). These findings highlight the interconnected nature of professional competencies and social support in shaping occupational identity. Based on these results, it is recommended that teacher training programs integrate targeted competency-building strategies alongside structured support systems to enhance professional identity formation. These initiatives are critical for fostering sustainable professional development and improving the quality and stability of preschool education. Full article

Food contact materials release bioactive molecules that are potentially detrimental to health. Despite the relevance of this daily and repeated exposure, little attention is paid to single-use materials in contact with food. In Cameroon, despite the local tradition of using biodegradable and compostable leafy plants and the government’s decision to ban the use and marketing of plastics, they are still massively used in contact with food. The aim of this study was to explore the dynamics of the ongoing trend in the use of plastics for food handling. A cross-sectional study was conducted in March 2023 to investigate consumers’ perceptions of the benefits and drawbacks of plastics and traditional leaves as food contact materials. Two hundred consumers were interviewed at eight restaurants in Kumba municipalities through a structured questionnaire. The result of this study revealed that consumers considered that plant-based materials do not affect human health; they know that leaves, compared to plastics, are easier to dispose of and that plastic is an environmental hazard. Age and education turned out to significantly affect all the answers, while income did not. The current study highlights the need to provide clear and updated information on the long-term danger posed to health and the environment by plastics used to cook, store, protect, and transport food. Despite the numerous advantages and benefits of traditional leaves as food contact material, their traditional use by the population has been lost. Consumers in Cameroon are at a critical juncture in choosing biodegradable and compostable food contact materials. This transition can be accelerated if governments invest in actions and measures to curb and potentially reverse the widespread adoption of plastics as a symbol of modernity. Scientific and technological research should engage in the innovation of traditional plant-based materials. This local example is also intended to provide impetus for more global investment in traditional plant-based materials for food packaging to support sustainability and the planetary health agenda. Full article

Newborn screening (NBS) presents an opportunity to identify a subset of babies at birth who are at risk for developmental delays and could benefit from a range of developmental services. Potential developmental services in the United States include Part C Early Intervention (EI), private therapies, and school-based services. Using parent-reported outcomes, this study examined the rates at which a sample of children diagnosed with NBS conditions used each developmental service. An online survey of 153 parents representing children with 27 different NBS conditions found that nearly 75% of children (n = 112) used at least one developmental service, with private therapies being the most frequent. Children were referred to EI relatively early and were often eligible because their medical diagnosis automatically qualified them. When examining condition-specific results for children with severe combined immunodeficiencies, congenital hypothyroidism, and Pompe disease, we found variability in rates of use, with high rates overall. Our findings suggest that many children diagnosed with an NBS condition continue to have developmental delays even after they receive appropriate medical care. Future research with more systematic follow-up is needed to understand whether the NBS program facilitates entry into these services and whether more streamlined processes could benefit children and families. Full article

Cigarette brand variant names and characteristics such as the taste and feel of the smoke can mislead consumers into believing some products are less harmful. We assessed the characteristics of three common cigarette variants sold in Australia, “gold”, “blue” and “red”, to determine which characteristics differed by color, and which affected tar, nicotine and carbon monoxide (TNCO) yields. TNCO yields, physical parameters, expanded tobacco and filter ventilation were measured in cigarette color variants from eight brands. Filter ventilation and expanded tobacco were common across brands and variants. Compared to blue and red variants, gold variants had slightly shorter tobacco rods and greater filter ventilation. Gold variants had lower TNCO when measured using the industry-favored International Organization for Standardization (ISO) protocol. ISO-measured TNCO yields were associated with filter ventilation and tobacco rod length, but not use of expanded tobacco. When measured using the Health Canada Intensive (HCI) protocol, which better emulates human smoking behavior, TNCO emissions were markedly higher, and the emission differences by extent of filter ventilation were minimized, indicating that ISO measurements are misleading. These findings confirm that cigarette color names, and the filter ventilation levels they signify, remain misleading more than a decade after plain packaging eliminated pack colors in Australia, as higher levels of filter ventilation are not associated with reduced TNCO emissions measured using the HCI protocol. Consumer education and communication campaigns could amplify the impacts of Australia’s newly passed tobacco legislation banning color and other variant names that imply reduced harm. Full article

This study designs and develops a wearable exoskeleton piano assistance system for individuals recovering from neurological injuries, aiming to help users regain the ability to perform complex tasks such as playing the piano. While soft robotic exoskeletons have proven effective in rehabilitation therapy and daily activity assistance, challenges remain in performing highly dexterous tasks due to structural complexity and insufficient motion accuracy. To address these issues, we developed a modular division method based on multi-domain mapping and a top-down process model. This method integrates the functional domain, structural domain, and user needs domain, and explores the principles and methods for creating functional construction modules, overcoming the limitations of traditional top-down approaches in design flexibility. By closely combining layout constraints with the design model, this method significantly improves the accuracy and efficiency of module configuration, offering a new path for the development of piano practice assistance devices. The results demonstrate that this device innovatively combines piano practice with rehabilitation training and through the introduction of ontological modeling methods, resolves the challenges of multidimensional needs mapping. Based on five user requirements (P), we calculated the corresponding demand weight (K), making the design more aligned with user needs. The device excels in enhancing motion accuracy, interactivity, and comfort, filling the gap in traditional piano assistance devices in terms of multi-functionality and high adaptability, and offering new ideas for the design and promotion of intelligent assistive devices. Simulation analysis, combined with the motion trajectory of the finger’s proximal joint, calculates that 60° is the maximum bending angle for the aforementioned joint. Physical validation confirms the device’s superior performance in terms of reliability and high-precision motion reproduction, meeting the requirements for piano-assisted training. Through multi-domain mapping, the top-down process model, and modular design, this research effectively breaks through the design flexibility and functional adaptability bottleneck of traditional piano assistance devices while integrating neurological rehabilitation with music education, opening up a new application path for intelligent assistive devices in the fields of rehabilitation medicine and arts education, and providing a solution for cross-disciplinary technology fusion and innovative development. Full article

This study documents the unique personal and professional experiences that Latina leaders bring to the role of community college president. Guided by a Chicana Feminist conceptual framework, we examined the tools, strategies, and assets that Latina presidents possess to persist as higher education leaders within a white patriarchal dominant culture. As a research collective, we conducted platicas as a Chicana Feminist methodology with five Latina community college presidents in California. Each platica lasted between 60 and 90 min. Findings exemplified four sources of cultural intuition that Latina community college presidents drew from to redefine higher education leadership and drive student equity on campus: (1) personal experiences with marginality in educational spaces, (2) accumulated professional knowledge, (3) scholarly training in graduate school, and (4) the process of leading itself. The study found that Latina presidents possessed important knowledge and distinct perspectives based on their experiences as Women of Color, children of immigrants, and former community college students to guide their leadership approaches in equity driven ways. Full article

The main goal of the research is to develop an artificial intelligence technology to assess the practical knowledge of air traffic controller (ATCo) students based on their responses in simulated multitasking situations using the proposed neuro-fuzzy model verified in experiments. An informational neuro-fuzzy model was developed and verified on 157,500 real data points. It illustrates an example of inferring the level of practical knowledge in selected ATCo students who were tested using a device measuring the reaction time and relative error rate in multiple-task tasks. The average error in the incorrect response was 7.7% of the experimental data. Data processing was performed using fuzzy set theory and intellectual knowledge analysis. These measurement results are useful for an individual approach to the student’s education to understand and master the correct solutions to achieve the desired educational results. Ensuring a personal approach to the student’s education is key to acquiring the necessary skills, knowledge, and competencies in the profile of the graduate. The developed technology will enable the integration of automated knowledge and skills assessment systems into the real educational process and the identification of problematic topics and tasks in the training of individuals. The result of the conducted research was used for the software design for the practical application in the flight training of ATCo students. Full article

Older adults in the third-age group (60–79 years) maintain reading comprehension skills similar to those of younger adults, but little is known about individuals in the fourth age (80+ years). This study investigates differences in reading comprehension in a between-group design. We evaluated a sample of 150 older adults, comprising 86 third-age and 64 fourth-age participants. We examined the influence of sex, cognitive functioning, formal education, self-perceived reading difficulties, and reading habits on their text comprehension abilities. The results show that fourth-age adults have a significant decline in reading comprehension compared to third-age adults. Strong reading habits were positively associated with better comprehension across both groups, suggesting that regular reading may buffer against age-related cognitive decline. Poor readers read less frequently and perceived greater difficulty with the tasks. Cognitive functioning and education did not significantly influence comprehension—possibly due to the generally low education levels in the sample. However, strong reading habits appeared to compensate for these limitations. These findings suggest a potential protective role of lifelong reading habits and highlight the need for interventions to support reading skills in older adults, especially those with lower educational backgrounds. Future research should explore these dynamics further to enhance cognitive resilience in the oldest populations. Full article

Education is an activity that involves great cognitive load for learning, understanding, concentrating, and other high-level cognitive tasks. The use of the electroencephalogram (EEG) and other brain imaging techniques in education has opened the scientific field of neuroeducation. Insights about the brain mechanisms involved in learning and assistance in the evaluation and optimization of education methodologies according to student brain responses is the main target of this field. Being a multidisciplinary field, neuroeducation requires expertise in various fields such as education, neuroinformatics, psychology, cognitive science, and neuroscience. The need for a comprehensive guide where various important issues are presented and examples of their application in neuroeducation research projects are given is apparent. This paper presents an overview of the current hardware and software options, discusses methodological issues, and gives examples of best practices as found in the recent literature. These were selected by applying the PRISMA statement to results returned by searching PubMed, Scopus, and Google Scholar with the keywords “EEG and neuroeducation” for projects published in the last six years (2018–2024). Apart from the basic background knowledge, two research questions regarding methodological aspects (experimental settings and hardware and software used) and the subject of the research and type of information used from the EEG signals are addressed and discussed. Full article

The goal of this study is to evaluate the Eye Home Clinic app (ver 1.0), which uses deep learning models to assess the quality of self-captured anterior segment images and detect anterior segment diseases using only the patient’s smartphone. Images undergo quality assessment based on the ‘DL-Image Eligibility’ model, and usable images are analyzed by the ‘DL-Diagnosis’ model to detect one of several anterior segment diseases. A dataset of 1006 images was used for training, and a dataset of 520 images was used for validation. The ‘DL-Image Eligibility’ model achieved an AUC of 0.87, with an accuracy of 0.75. The ‘DL-Diagnosis’ model had higher specificity (0.97) but lower sensitivity (0.29), with an AUC of 0.62. While the app shows potential for anterior segment telemedicine, improvements are needed in the DL model’s sensitivity for detecting abnormalities. Oversampling techniques, transfer learning, and dataset expansion should be considered to enhance the performance in future research. Based on data from users in over 100 countries, significant differences in photo quality among user groups were also identified. iOS users, younger users (21–40 years), and users reporting eye symptoms submitted more usable images. This study underscores the importance of user education and technological advancements to optimize smartphone-based ocular diagnostics. Full article

The value of discourse in the mathematics classroom is evident across standards, policy documents, and research. The quality of discourse is associated with students’ mathematical understanding and achievement. Productive mathematical discourse includes students providing explanations and critically listening to and evaluating the ideas of others. Such high-level discourse takes time to develop and is impacted by how teachers structure lessons and interact with students (e.g., talk moves). The present case study reports on an incremental professional development, S³D Approach, that guides teachers through a two-phase process to enhance small-group, student-to-student discourse. One middle school mathematics teacher implemented the incremental stages of the S³D Approach with support from a mathematics teacher educator, who conducted weekly observations and debrief meetings. Qualitative analyses revealed that, despite initial challenges, the S³D Approach became integrated into the teacher’s practice, enabling the teacher to identify and build upon incremental improvements in the small-group discourse. Overall, the findings demonstrate how through a reframing of starting points and the definition of success, incremental PD supports sustainable changes in a teacher’s practice and student engagement in productive mathematical discourse. Full article

In this post-pandemic hybrid world of PK12 education, the onus is still on education leaders to close achievement gaps through equitable means. There are current socioeconomic, racial, gender, and geographical disparities that limit students’ full access to computer science education (CS). This case study reports how one urban PK12 school district in the United States is addressing the “leaky pipeline” with sustainable solutions for CS education with minoritized students. Using an online engagement framework, an ethnographic lens was used with document review, to conduct a content analysis of projects, programs, and services set up through the central office for nearly 20,000 students at the primary, middle grades, and secondary levels in computer sciences. Findings acknowledge leadership’s planning for student engagement in STEM+C (science, technology, engineering, math and computer science) for virtual instruction. This study will contribute to the burgeoning knowledge of leadership for CS activities in PK12, and serve as a beacon for learning organizations bolstering CS activities in the future. Full article

Background: Hepatitis B (HBV) and Delta (HDV) virus infections pose critical public health challenges, particularly in Romania, where HDV co-infection is underdiagnosed. Methods: This study investigates the epidemiology, risk factors, and clinical outcomes of HBV/HDV co-infection in vulnerable populations, leveraging data from the LIVE(RO2) program. Conducted between July 2021 and November 2023, the program screened 320,000 individuals across 24 counties, targeting socially disadvantaged groups such as rural residents, the Roma community, and those lacking health insurance. Results: Among 6813 hepatitis B surface antigen (HBsAg)-positive individuals, HDV antibody prevalence was 4.87%, with active replication confirmed in 75.6% of HDV-positive cases. Regional disparities emerged, with higher HDV prevalence and replication rates in the Eastern region compared to the South. HDV-positive individuals were more likely to be younger, male, and from rural or socioeconomically disadvantaged backgrounds. Clinically, HDV co-infection correlated with increased liver stiffness, advanced fibrosis stages, and lower steatosis levels compared to HBV mono-infection. Psychiatric comorbidities were more prevalent among HDV-positive patients, highlighting the need for integrated care. Conclusions: This study underscores the urgent need for targeted public health interventions, including enhanced screening, education, and access to novel antiviral therapies like bulevirtide to address the significant burden of HBV/HDV co-infection in Romania. Full article

Studies have shown that the school atmosphere perceived by students can play a key role in promoting their well-being and success in school. No study to date has analyzed whether the students’ perceived school atmosphere might contribute to school refusal (SR), which in turn might reduce students’ engagement and promote underachievement. A cross-sectional study was conducted with 528 Italian high school students (M_age = 16.08, SD = 1.38; 50.8% males, 47% females, and 2.3% not declared), with the aim of assessing the role of the mediation of SR (Anxious Anticipation, Difficult Transition, Interpersonal Discomfort, and School Avoidance) in the association between students’ perceived school atmosphere (Student Relations, Student–Teacher Relations, Educational Climate, Sense of Belonging, and Interpersonal Justice) and school engagement and underachievement. Data were collected using validated instruments, including the SChool REfusal EvaluatioN for school refusal, the Multidimensional School Climate Questionnaire for school atmosphere, and the Utrecht Work Engagement Scale for school engagement. To evaluate the association between variables, we performed structural equation modeling with latent variables. Mediation analysis indicated that Difficult Transition fully mediates the association between Sense of Belonging and school engagement (β = 0.20, p ≤ 0.05). This study extends the knowledge of school refusal behavior. Full article

Sustainable Urban Drainage Systems (SUDS) represent a paradigm shift in stormwater management, offering holistic solutions to urban water challenges. This review examines SUDS principles, design strategies, effectiveness and barriers to implementation. SUDS prioritize infiltration and mimic natural hydrological processes to reduce flood risk, improve water quality and support ecosystems in urban environments. Effective SUDS design integrates different components such as permeable pavements, green roofs, and rain gardens, tailored to the local context. Evidence suggests that well-designed SUDS can mitigate peak flows, reduce runoff volumes, and purify water. However, barriers to widespread adoption include lack of awareness, upfront costs, and regulatory complexity. Overcoming these will require collaborative stakeholder action to prioritize education, policy support, and funding opportunities. Future research should focus on optimizing SUDS design, assessing long-term performance, and quantifying socio-economic benefits. By integrating SUDS into urban landscapes, cities can strengthen hydrological resilience, promote sustainability, and enrich urban life. Full article

Background/Objectives: It is often challenging for patients to understand treatment options, their mechanisms of action, and the potential side effects of each treatment option for glomerular disorders. This study explored the ability of ChatGPT to simplify these treatment options to enhance patient understanding. Methods: GPT-4 was queried on sixty-seven glomerular disorders using two distinct queries for a general explanation and an explanation adjusted for an 8th grade level or lower. Accuracy was rated on a scale of 1 (incorrect) to 5 (correct and comprehensive). Readability was measured using the average of the Flesch–Kincaid Grade (FKG) and SMOG indices, along with the Flesch Reading Ease (FRE) score. The understandability score (%) was determined using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). Results: GPT-4’s general explanations had an average readability level of 12.85 ± 0.93, corresponding to the upper end of high school. When tailored for patients at or below an 8th-grade level, the readability improved to a middle school level of 8.44 ± 0.72. The FRE and PEMAT-P scores also reflected improved readability and understandability, increasing from 25.73 ± 6.98 to 60.75 ± 4.56 and from 60.7% to 76.8% (p < 0.0001 for both), respectively. The accuracy of GPT-4’s tailored explanations was significantly lower compared to the general explanations (3.99 ± 0.39 versus 4.56 ± 0.66, p < 0.0001). Conclusions: ChatGPT shows significant potential for enhancing the readability and understandability of glomerular disorder therapies for patients, but at a cost of reduced comprehensiveness. Further research is needed to refine the performance, evaluate the real-world impact, and ensure the ethical use of ChatGPT in healthcare settings. Full article

Introduction: Pregnant women’s experiences and concerns regarding childbirth are complex, necessitating a multidimensional and personalized approach in maternal care. This study explores the psychological and emotional factors influencing pregnant women’s decisions regarding their mode of delivery. The results will provide valuable insights for the development of educational and counseling strategies designed to support pregnant women in making informed and conscious decisions about their childbirth. Material and method: This cross-sectional study aimed to develop and validate a questionnaire exploring the psychological dimensions of childbirth. Factor analysis was employed to assess emotional perceptions, perceived medical risks, and the impact of cesarean section on pregnant women. The questionnaire was distributed online via Google Forms, using social networks like Facebook and Instagram to ensure rapid and broad accessibility. The questionnaire was available for seven months, from January to July 2023. Results: McDonald’s ω, Cronbach’s α, average inter-item correlation, and total item correlations were calculated to assess the consistency of the questionnaire items in measuring the same construct. The three-factor model emerged as the primary structure based on exploratory and confirmatory factor analyses (EFA and CFA). The first profile, centered on the psychological and emotional benefits of vaginal birth, highlights the importance of the natural birth experience for the mother’s psychological well-being. The second profile addresses concerns about medical risks and the need for interventions. The third profile focuses on perceptions and concerns related to the intelligence and adaptability of children born by cesarean section and the effects of anesthesia. Conclusions: Each profile reflects different strategies for seeking control and security amid childbirth uncertainties. These include emphasizing the psychological benefits of vaginal birth, addressing medical risks, and focusing on the impact of interventions on child development. Understanding these variables is essential for providing appropriate counseling and psychosocial support, thereby optimizing the birth experience and promoting the health of both mother and child. The integration of multi-factor and single-factor models in the questionnaire analysis serves complementary purposes, providing distinct yet interrelated insights into the instrument’s structure and validity. Full article

Pharmacists have been recognized as the most accessible healthcare professionals, and research has been carried out on expanded pharmacy services they could provide. Additional pharmacy services are a cost-effective way to prevent medication errors, reduce the number of drug-related problems, and prevent chronic disease progression. Therefore, this study aims to evaluate pharmacy service users’ views of expanded pharmacy services in Croatia. This study included 745 participants. Patients who have a healthcare professional in their family more frequently knew of the existence of e-health records and the option to share it with their pharmacists (134, 56.3% vs. 229, 45.2%, p = 0.005), while persons that have chronic illness more frequently visit the same pharmacy (176, 77.9% vs. 178, 34.3%, p < 0.001). Participants are confident that pharmacists can provide screening services and education on inhaler usage; however, only around 60% agreed that pharmacists can independently lead therapy adjustment, medication substitution, or monitor therapy based on test results. Our findings should be supported with projects evaluating the cost-effectiveness of such services as they would be accepted by a greater number of pharmacy service users if covered by the national health insurer. Full article

After the lifting of the COVID-19 pandemic restrictions, urban socio-economic development has been continuously recovering. Researchers’ attention to urban vitality recovery has increased. However, few studies have paid attention to the recovery and driving of urban vitality in university fringe areas. This study aims to address this gap by exploring the driving mechanisms of urban vitality recovery in the university fringe areas using both linear and nonlinear models. The results reveal the following: (1) The recovery of urban vitality in university fringe areas follows a distinct pattern where central urban areas with greater openness recover more rapidly, while university fringe areas farther from the city center with stricter management experience slower recovery. (2) The fitting coefficients of the student enrollment, school area, the density of various POIs, and opening hours are 0.0020, −0.0105, −0.0053, and 0.0041 respectively. These variables exhibit a more pronounced linear relationship, and the significance level is quite high. Recovery effects also express significant spatial heterogeneity. (3) Both university opening hours and school area show a nonlinear positive relationship with the urban vitality recovery of university fringe areas, demonstrating a clear threshold effect. This relationship is characterized by slow growth at lower values, rapid acceleration once a critical threshold is reached, and eventual stabilization at higher values. This study offers targeted strategies for urban planning, fostering more responsive and adaptive urban governance that aligns with the evolving needs of urban development. Full article

With the growing emphasis on sustainability, awareness of the environmental impacts and negative potential inherent in current business systems has increased. The circular economy (CE) represents an innovative approach that transforms the traditional linear economy into a restorative system, focussing on extending the life cycle of materials through continuous circulation. The Circular B project aims to develop an international framework that considers multiple facets of the CE, including material and asset management and the use of components in the built environment throughout the entire life cycle of the value chain. The primary objective of the CE is to eliminate waste and pollution (e.g., carbon reduction) and strengthen the resilience of the value chain. However, the current implementation of circular strategies has not yet been found to be effective, with several challenges that cause adverse impacts. This study focuses on investigating and analyzing these challenges, particularly in the cultural and societal domains, using both qualitative and quantitative approaches. The scope of the questionnaire was to identify (1) awareness and understanding, (2) cultural attitude, (3) barriers to adoption, (4) incentives and motivations, (5) participation and engagement, and (6) education and training. A questionnaire was distributed to 270 respondents, with anonymous responses collected. The survey included eight questions specifically designed to address cultural and societal challenges. The survey was conducted with participants from various sectors, including academia, local authorities, industry professionals, consultants, and others collected from all over the world, ensuring diverse perspectives. The main weaknesses found based on this survey are related to (1) budget constraints due to high costs of reintegrating in the loop of materials or components due to the complexity of circular processes, (2) applicability on the market remains still limited, (3) the importance of planning and design in the initial phases, (4) the importance of establishing a comprehensive network to enhance collaboration among stakeholders, and (5) inadequate policies. The insights gained from this study will help stakeholders, such as constructors, maintainers, engineers, designers, and consultants, across various organizations in the value chain to develop practical solutions to mitigate these challenges and improve the overall business system. Full article

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has changed the dietary behavior of college students; however, the persistence of the changes in dietary behavior remains uncertain. This study aims to explore the changes in school food consumption and dietary quality of college students during three distinct COVID-19 periods: pre-epidemic (stage T1), epidemic (stage T2), and post-COVID-19 epidemic (stage T3). Methods: The persistent 6-year data, involving 3,484,081 dietary records from January 2018 to December 2023, for college students were acquired from the “Intelligent Ordering System (IOS)”. School food consumption and total energy intake of each college student per day were evaluated by information on three meals in the IOS combined with the corresponding food database of each dish. The school dietary quality of college students was evaluated by the Chinese Healthy Eating Index (CHEI). Results: In total, 459 college students were included in the T1 period, 530 in the T2 period, and 1316 in the T3 period. At stages T2 and T3, the energy, protein, and fat intakes of college students were higher than those at stage T1 (p < 0.001). Meanwhile, the breakfast energy ratio exhibited a significant decrease (0.27 vs. 0.25), while the lunch (0.37 vs. 0.38) and dinner (0.37 vs. 0.38) energy ratios exhibited varying degrees of increase (p < 0.001). After the COVID-19 pandemic, the components’ score of the CHEI for dark vegetables, red meats, and sodium showed an increase, while tubers exhibited a decrease (p < 0.01). Conclusions: This study provides compelling evidence of the significantly negative impact of the COVID-19 pandemic on school food consumption and dietary quality among Chinese college students. However, the duration of this effect may be limited. There was a certain degree of improvement in the food consumption and school diet quality of college students in China following the conclusion of the epidemic. Full article

Effective communication between students and instructors is vital for student success. Traditionally, this communication has taken place in person within classroom settings. However, with technological advancements, online classes have become more common. The COVID-19 pandemic accelerated this shift, significantly disrupting traditional communication methods between students and instructors and transforming the educational landscape, particularly in higher education. We conducted a qualitative narrative literature review of the technological tools that emerged during the pandemic and explored how today’s instructors can effectively use them to enhance student engagement and motivation in online classrooms. The review utilized the SANRA (scale for the assessment of narrative reviews) guidelines to ensure the quality of the studies used. Twenty-two articles published within the last ten years were chosen based on their relevance to higher education and student–instructor communication. The articles were analyzed for effective and ineffective educational communication tools (e.g., Zoom or Google Classroom) utilized during the pandemic, focusing on what worked and what could be improved. The findings revealed that live video sessions were more effective than pre-recorded videos, voice-only sessions, or email/text communications in fostering student engagement and motivation. Full article

Generative artificial intelligence (GenAI) is transforming various sectors, including education. This study investigates the integration of GenAI in higher education, focusing on its potential to enhance teaching and learning. Through a series of workshops and courses delivered to university professors, it examines opportunities such as improved resource creation and challenges like ethical AI usage, proposing best practices for the sustainable implementation of GenAI in the classroom. The main objective is to analyze how the use of GenAI tools such as ChatGPT, Gemini, and Claude can improve teachers’ professional skills and the overall educational experience while ensuring ethical and responsible use. The methodology comprised a literature review and practical experimentation with university professors. Data collection involved observations, surveys, discussion forums, cooperative activities, and exercises focused on evaluating AI-generated educational resources and analyzing forum insights to identify best practices. The results highlight several opportunities around the use of GenAI in education, including improving writing, creating educational resources, supporting lesson planning, and increasing teacher productivity. In addition, significant challenges were identified, such as the ethical use of AI and strategies for detecting AI-generated text. For instance, workshops demonstrated a 30% increase in teacher confidence with GenAI tools like ChatGPT, highlighting the effectiveness of these technologies in professional development. To address these challenges, best practices for the responsible integration of GenAI in education are presented, focusing primarily on ongoing training, the establishment of institutional policies, the encouragement of responsible use, and the ongoing evaluation of impact in the educational setting. Best practices include clear ethical guidelines, prompt development techniques, and continuous professional training to ensure teachers can effectively and responsibly integrate GenAI tools into their instructional practices. These practices for the effective use of GenAI tools in education aim to maximize benefits while mitigating risks. These include the development of effective prompts for various activities and guidance on the ethical use of AI to ensure a balanced and responsible approach to the integration of GenAI in higher education. Full article

Introduction: Traditional medical education often emphasises theory, but clinical competence relies greatly on practical, hands-on skills. This quasi-experimental study examines how a combined approach—flipped classroom learning and simulation-based internships—affects medical students’ self-assessed clinical abilities. This model seeks to build students’ understanding, practical skills, and confidence in clinical settings through online preparation and realistic simulation exercises. Methods: This study examined changes in medical students’ self-perceived clinical skills after a flipped classroom and simulation-based internship. A total of 391 third- and fourth-year students completed a nine-hour program with morning practice sessions and afternoon high-fidelity scenarios. Surveys before and after the program assessed self-perceived thoracic and abdominal/general skills. ANCOVA controlled for baseline scores, and paired Wilcoxon signed-rank tests examined overall and subgroup improvements. Results: After the program, significant improvements were observed in self-perceived clinical skills across all domains. Thoracic skills increased from a median of 2.19 to 7.36, and abdominal skills from 5.11 to 9.46. Medical history, vital signs, and blood pressure scores also improved significantly. Third-year students and those attending the Clinical Methodology course showed the greatest gains. All post-intervention improvements were statistically significant (p < 0.001). Conclusions: The combination of flipped classroom learning and intensive simulation training markedly improved students’ perceived clinical competence. These findings suggest that such methods boost students’ practical skills and confidence. Further research is recommended to explore the long-term impact of this approach on skill retention and professional practice. Full article

In this commentary, I challenge the field to take seriously the idea of incremental professional development (PD) for teachers of mathematics. I begin by briefly describing the history of PD in the United States since the publication of NCTM’s Curriculum and Evaluation Standards, what we have learned about effective PD through research, and then pose set of dilemmas we face in having a wide impact on the teaching of mathematics in the United States. Through reflecting on my story of incremental and transformative change as a high school mathematics teacher and 28 years as a mathematics teacher educator and scholar, I argue that the concept of incremental PD is worthy of exploration. Full article

Background: Non-communicable diseases (NCDs) are the leading cause of global mortality. The WHO projects a rise in NCD-related deaths from 36 million in 2018 to 55 million by 2030, with developing countries being the most affected. Effective community-based primary health care (PHC) can reduce the burden of chronic diseases of lifestyle (CDLs). This study aimed to develop a risk assessment and health promotion framework to strengthen CDL prevention and control in Free State (FS) communities in South Africa. Methods: A convergent mixed-method design was used. Quantitative analysis identified CDL risk factors in rural and urban FS settings, while qualitative focus group discussions explored participants’ knowledge of CDLs and their experiences with program implementation. Results: Key findings highlighted differences in risk profiles, CDL training needs for PHC teams, patient education gaps, and curriculum development. Step 1 of the framework development identified differences and similarities in the CDL risk profiles of the study populations. Step 2 identified CDL training needs for PHC teams, patient educational needs, and CDL curriculum development needs. Step 3 revealed three main barriers: resource constraints, patient non-compliance, and the lack of supporting healthcare services. In Step 4, the six focus areas identified (steps 1–3) were used to develop strategies for implementing a tailored, community-based, patient-centred approach. Conclusions: The results provide valuable insights for improving PHC responses in resource-limited settings. Full article

In the context of changing demographics at regional universities (including our own), we highlight an ongoing project at our university that addresses the last area of acceptable bias in English-medium higher education: bias against speakers of other languages and non-standard dialects of English. We discuss the hegemonic aspect of the Standard Academic English used by default at most US institutions of higher education and its role in potential discrimination against users of languages other than English and dialects other than the Standard. Data from over 2000 surveys, 55 follow up interviews, and three focus groups from faculty, staff and students in the university community are being analyzed. Preliminary findings show pervasive ignorance of the nature of language variation and how that plays a role in continuing discrimination against those who use other languages and diverse varieties of English even in our very multilingual setting. We conclude by outlining next steps, including the development of onboarding materials for new faculty, staff, and students. Full article

School meals play a critical role in supporting students’ biopsychosocial growth, development, learning, academic performance, and the establishment of healthy eating habits. In public institutions, food procurement is conducted through formal public procurement processes. However, emphasizing cost-effectiveness in bidding criteria, such as prioritizing the lowest product price, may inadvertently encourage the acquisition of foods high in critical nutrients. In Brazil, specific guidelines for public school food procurement have been introduced to improve the nutritional quality of foods included in school menus. Objective: To evaluate the impact of legislative measures and regulations implemented during the COVID-19 pandemic on the nutritional composition of school meals provided by federal high schools in Rio Grande do Norte, located in northeastern Brazil. It also compared the composition and origin of foods procured before and after the pandemic. Methods: This is a longitudinal observational panel study conducted across 20 federal schools. Procurement documents from 2019 (pre-pandemic) and 2021 (post-pandemic) were analyzed to assess changes in the nutritional profile of procured foods. Results: Post-pandemic, the procurement of natural and minimally processed and processed foods increased, representing 73.39% and 10.34%, respectively, of the total approved foods. There was also a 39% reduction in ultra-processed foods compared to 2019, in addition to a reduction in culinary ingredients. Additionally, the proportion of foods containing excessive levels of critical nutrients declined. A significant shift was observed in the origin of procured foods, with a notable increase in the purchase of locally sourced items. Conclusions: The findings indicate a positive shift in the nutritional quality of foods procured after the COVID-19 pandemic, with a decrease in ultra-processed food purchases and an increase in the procurement of natural and minimally processed options. Nonetheless, the continued presence of ultra-processed foods and items with excessive critical nutrients highlights the need for further improvements in public procurement practices to fully align with nutritional guidelines. Full article

Background/Objectives: Adherence to sports-specific nutritional guidelines can help optimize athlete performance and health. However, adolescent athletes may not have adequate nutrition knowledge and understanding of specific nutritional requirements. The objective of the current study was to examine the nutrition knowledge and perceived dietary requirements of adolescent athletes. Methods: Male (n = 29, age: 15.7 ± 1.3 yrs.; height: 178.9 ± 8.3 cm; body mass: 74.7 ± 17.2 kg; body fat %: 13.9 ± 7.9%) and female (n = 15, age: 16.5 ± 1.4 yrs.; height: 169.9 ± 6.5 cm; body mass: 63.3 ± 4.5 kg; body fat %: 23.7 ± 3.8%) secondary school student-athletes completed body composition testing (hydrostatic weighing) and electronic surveys (Abridged Sports Nutrition Knowledge Questionnaire (ASNKQ); self-perception of dietary energy and macronutrient requirements). Results: Athletes demonstrated poor sports nutrition knowledge, with no differences observed between sexes for the number of questions answered correctly (males: 45.1 ± 9.8% vs. females: 43.1 ± 12.7%; p = 0.57). No relationships were observed between ASNKQ scores and body composition parameters or between ASNKQ scores and self-reported perception of dietary energy and macronutrient requirements (p > 0.05). Athletes self-reported a lower perceived energy (−560 ± 1272 kcal/d; p = 0.014) and carbohydrate intake (−73 ± 376 g/d; p = 0.014) requirement compared to calculated nutritional recommendations. Athletes self-reported a higher perceived protein intake (263 ± 586 g/d; p = 0.026) requirement compared to calculated nutritional requirements. Conclusions: The current sample of adolescent athletes from the secondary school level appears to have a poor level of sports nutrition knowledge and understanding of energy and macronutrient requirements. Full article

This study aimed to determine the prevalence of co-infection with malaria and intestinal parasites and assess its association with anemia in school-aged children from rural and urban settlements in Gabon. This cross-sectional study involved afebrile school children recruited at schools between May and June 2021. Blood and stool samples were collected from participants whose parents or legal guardians provided informed consent to participate in the study. Hemoglobin concentration (Hb) was measured using a HemoCue photometer (HemoCue 201, HemoCue, Angelholm, Sweden). Giemsa-stained blood films were examined to detect malaria parasites and any filarial infections, while the merthiolate-iodine concentration (MIC) method was used to identify intestinal parasitic infections (IPI). A total of four hundred and seventy (470) school-aged children were successfully enrolled in this study. The observed prevalence values were as follows: malaria infection at 69.6%, IPIs at 19.1%, filaria at 5.1%, Schistosoma infection at 15.0%, and anemia at 29.0%. Co-infections of malaria with IPIs, filaria, and Schistosoma were present in 12.3%, 4.7%, and 6.6% of the children, respectively. Malaria and filaria infections were associated with residing in Lastourville city (p < 0.05) and were also correlated with age (p < 0.05), whereas IPIs were associated with male gender and living in the city of Lastourville. Anemia was linked to malaria infection (p < 0.05) and was more prevalent among children living in rural areas. The findings of this study indicate that malaria, IPIs, and Schistosoma infections continue to pose a significant public health problem in the study area, even though only malaria infection appeared to be associated with anemia. Nevertheless, these results highlight the need for implementing control measures to reduce the prevalence of malaria, IPIs, filaria, and Schistosoma, particularly in Lastourville. Full article

Background/Objectives: To assess the feasibility and acceptability of freelisting for adolescents with chronic musculoskeletal pain (CMP) and use freelisting to identify how adolescents with CMP cope with pain. Methods: This was a mixed-methods cross-sectional single-center study of patients 12–18 years old, diagnosed with CMP. Twenty-seven subjects participated in an interview which included the freelisting exercise, probing questions, Connor-Davidson Resilience Scale 10-item, and semi-structured interview. Feasibility was pre-defined as ≥85% completion. A list of ‘standardized’ freelisting terms was created, and we calculated Smith’s salience index. Freelisting terms were grouped into individual, family, friends, school, and medical domains. Results: In this predominantly female population, resilience levels were low to moderate, and on average, participants had moderate pain intensity and functional disability. The freelisting exercise was feasible and acceptable among females, with low recruitment of males. Salient words to describe adolescents’ pain included frustrating, upsetting, annoying, and painful. Participants identified family, friends, teachers, guidance counselors, and health professionals as key sources of support. Many participants reported difficulties communicating their pain. Helpful coping strategies included rest, distraction, relaxation, endurance, and extracurricular participation. Conclusions: Freelisting was well perceived among female adolescents with CMP. Supportive relationships with community members play an important role for this population. However, perceived stigma may deter female adolescents from talking about their pain. Purposive sampling of male participants and recruitment strategies ensuring diverse patient representation are necessary to ensure generalizability of future results when using the freelisting method for adolescents with CMP. Full article

This article emphasises the critical role higher education institutions (HEIs) play in fostering critical knowledge and social cohesion by exploring students’ perceptions of the social and solidarity economy (SSE). It addresses the need for a more diverse curricular approach within HEIs, particularly in economics and business education, to challenge the dominance of the neoclassical model. This study, conducted at the Faculty of Economics and Business (FEB) of the University of the Basque Country, investigates whether students perceive the SSE as a viable alternative to the current economic paradigm and its necessity and innovation in higher education. Utilizing a free-association questionnaire and Iramuteq software analysis, the findings reveal a strong demand for a more inclusive educational framework that incorporates heterodox economic theories, especially the SSE. This research contributes to the discourse on integrating SSE into economics and business courses as part of university social responsibility (USR), highlighting its unique social values. Full article

Omega-3 fatty acids (ω-3-FAs) represent a group of essential nutrients, but modern diets often do not allow for a balanced ratio between the intakes of ω-6-FA and ω-3-FA, which is vital for health. ω-3-FA can be found primarily in algae and fish, while the intake of ω-3-FA dietary supplements can be seen as an efficient way of providing nutrients important for many physiological functions. Background/Objectives: The aim of this research was to investigate the use of ω-3-FA-rich food and supplements, as well as the knowledge and attitudes on these nutrients among residents of the central Balkans—the Republic of Serbia and the Republic of Srpska. Methods: The research was performed as a prospective, cross-section, online survey. Results: A total of 895 responses were collected, with relatively high usage of ω-3-FA supplements (34.2%). It was found that the respondents use these supplements due to inadequate dietary intake, but also in therapy or prevention of certain diseases and conditions. Users take the supplements on a regular basis, although for short periods of time. The respondents reported the dietary intake of food rich in ω-3-FA. It was found that more than half of parents give these supplements to their children, with similar purposes, although more frequently and for longer periods of time. The use of ω-3-FA via supplements in pregnant and breastfeeding women is also present. Conclusions: The residents of the investigated territory seem to have an awareness of the importance of ω-3-FA use, with its consumption being registered in both the general population and specific subpopulations. Future steps would include further promotion and education on the given topic. Full article

Introduction Emerging evidence suggests an association between obesity and Functional Gastrointestinal Disorders (FGIDs). Childhood obesity and FGIDs share many common features, such as high prevalence in the pediatric population, risk factors related to diet and lifestyle, gut microbiota impairments, and psychological distress. This narrative review aims to summarize the main evidence regarding FGIDs in childhood obesity, with a specific focus on the role of diet and its impact on the microbiota. Additionally, the review highlights potential common-ground solutions for preventing and managing both obesity and FGIDs. Methods A comprehensive PubMed search was conducted. Keywords used included terms related to children and adolescents, obesity, functional gastrointestinal disorders, and microbiota. Results The review emphasizes the importance of holistic, multidisciplinary approaches to managing symptoms. In addition to nutrition education, physical activity, and medical care, complementary strategies such as psychological interventions and personalized dietary modifications (e.g., low-FODMAP and fiber-enriched diets) are critical. Given the interplay between gut microbiota alterations, obesity, and FGIDs, microbiota modulation through probiotics, prebiotics, and integrative support shows significant promise. However, the variability in current evidence underlines the need for robust longitudinal studies to develop standardized protocols and maximize treatment efficacy. Conclusions Bridging gaps in knowledge and practice with an integrated, evidence-based framework could improve patient outcomes and deepen understanding of the complex relationship between metabolic and gastrointestinal health in children and adolescents. Full article

Background: As part of simulation-based learning, it is well known that debriefing plays a crucial role; ineffective debriefing can lead to a reiteration of errors in decision-making and a poor understanding of one’s limitations, compromising the learner’s psychological safety and making future simulated learning experiences less effective. In Italy, although simulation has been used in nursing education for more than 20 years, there is a general lack of data regarding the elements of debriefing. Methods: An exploratory, cross-sectional, multicenter nationwide study was conducted to identify current debriefing practices in Italian simulation-based nursing education. A non-probability sample of all directors of the Italian Bachelor school of Nursing and the directors of simulation centers on Italian national territory was surveyed with an online questionnaire. Results: Fifty-four nursing degree programs and 11 simulation centers participated in the survey. Significant differences were found between debriefing practices used by simulation centers and those used by the Bachelor School of Nursing. Specifically, differences concerned the training of debriefers, the knowledge of a debriefing framework, the use of different rooms for debriefing and the time spent on this activity. Conclusions: There is an emerging need for a harmonization process in Italian nursing education debriefing practices that would align the current reality with the best practices of the literature. Full article

After a period of rapid growth, China’s pharmaceutical industry is facing multiple challenges, including insufficient innovation and severe pollution. Current research on the efficiency of pharmaceutical companies in China primarily focuses on financial or innovation aspects. Therefore, a holistic approach to operational efficiency is needed. To measure the operational efficiency of pharmaceutical companies in China more accurately and holistically, while accounting for environmental pollution, this study employs a three-stage Data Envelopment Analysis (DEA) model with undesirable outputs to evaluate efficiency across five dimensions: market performance, profitability, financial risk control, innovation, and sustainability. This approach integrates financial, innovation, and sustainability indicators to provide a more industry-specific framework for efficiency measurement. Furthermore, integrating with Stochastic Frontier Analysis (SFA) allows for revealing the impact of environmental factors on efficiency. The results show that both technical efficiency (TE) and pure technical efficiency (PTE) are relatively low in the first and third stages, with significant regional disparities. After excluding environmental factors, some regions—typically economically developed areas—showed improved overall efficiency. This indicates that the local environment in these regions is not conducive to the development of pharmaceutical enterprises. The SFA results further demonstrate that investments in education and high-level talent significantly enhance efficiency, whereas pollutant emissions and per capita income reduce operational efficiency. The findings suggest that local governments should enhance the operational efficiency of pharmaceutical enterprises by investing in education, attracting skilled talent, and improving waste infrastructure. Additionally, less efficient firms are encouraged to optimize resource allocation to achieve higher efficiency. Full article

This paper explores contemporary approaches to preserving and promoting cultural heritage by integrating game elements and advanced technologies, such as Virtual Reality (VR) and Augmented Reality (AR). In an era increasingly shaped by digital innovation, preserving cultural heritage demands new strategies to sustain engagement with historical narratives and artifacts. Emerging technologies like VR and AR offer immersive, interactive experiences that appeal to modern audiences, especially younger generations accustomed to digital environments (Bekele and Champion). Gamification—the use of game design principles in non-game contexts—has gained significant traction in education and cultural heritage, providing new methods for increasing user engagement and retention (Werbach and Hunter). By incorporating gamified features, heritage can be made more accessible, fostering emotional connections and deeper understanding (Huotari and Hamari; Zichermann and Cunningham). This aligns with the shift toward interactive digital storytelling as a tool to transform static heritage presentations into dynamic, participatory experiences (Champion and Rahaman). Central to this research is the conceptualization and development of a mobile application leveraging VR and AR to enhance user engagement and education around cultural heritage. Drawing on the principles of self-determination theory (Deci and Ryan) and empirical findings on gamified learning (Landers and Landers), the application combines educational content with interactive elements, creating an immersive learning environment. By addressing both content accessibility and interactive immersion, this application bridges the gap between traditional heritage preservation and the expectations of a digitally native audience. The recent literature underscores the potential of VR and AR in cultural preservation, emphasizing their ability to transcend physical boundaries, simulate historical environments, and promote active participation (Milgram and Kishino, Addison; Azuma). As virtual environments evolve, platforms like the metaverse expand possibilities for experiencing cultural heritage in spaces free of geographical limitations (Cipresso et al.; Radianti et al.). Such advancements have already demonstrated significant educational and experiential benefits (Wu et al.; Akçayır and Akçayır). This study employs both quantitative and qualitative methods to examine the target group’s attitudes toward gamified technologies for cultural heritage preservation. The initial results indicate substantial interest and willingness among users to engage with applications employing VR and AR. This aligns with findings in the literature that suggest immersive experiences can enhance learning outcomes and foster long-term engagement (Merchant et al.; Speicher et al.). The project has garnered significant recognition, receiving the Rector’s Award for the best scientific paper in the technical field at the University of Zagreb and earning bronze medals at the ARCA Innovation Fair and the INOVA Fair. These accolades underscore the project’s innovative approach and its potential for real-world application. By presenting a robust framework for integrating gamification and immersive technologies into cultural heritage preservation, this paper contributes to the growing discourse on utilizing advanced digital tools to ensure the sustainability and relevance of cultural heritage for future generations. Full article

Background & Objectives: Correct nutrition during pregnancy is key to guaranteeing success at this stage of a woman’s life, and nutritional education is the fundamental tool for achieving this. Studies carried out in different countries indicate that pregnant women do not comply with dietary and nutritional recommendations. Given the lack of evidence available in Spain and the importance of this knowledge to be able to assess the need for nutritional intervention in this group, the aim of this study focused on the current status of the issue in Spain: the quality of the diet of Spanish pregnant women and its conditioning factors. Methods: Two representative regions of the country were selected, one located in the north of Spain (Burgos) and the other in the south (Granada), and a descriptive, cross-sectional observational study (sample size: 771) was carried out using a questionnaire administered at the University Hospital of Burgos and the Hospital Clínico San Cecilio in Granada, which had previously been subjected to a process of evaluation by expert judgement. Results: Pregnant women presented an adequate diet quality (8.0 ± 2.0), according to the questionnaire used, despite their poor knowledge of food and nutrition (4.9 ± 1.6 out of 10). However, deficiencies were detected in the consumption of very interesting food groups from a nutritional point of view, such as legumes, nuts and fish (just 29.4%, 37.6% and 24.8% of the pregnant women met the recommendations, respectively) and insufficient physical exercise. The eating habits of pregnant women depend on their age, their country of origin, their level of education, their pre-pregnancy BMI, the knowledge acquired during pregnancy and the degree to which they put into practice the advice received from their midwife. Most pregnant women do not change their habits during pregnancy, although there are positive trends in this respect. Conclusion: The quality of the diet of the Spanish pregnant women surveyed, and their level of physical activity, could be improved by enhancing the nutritional education they receive during this stage of life. The role of the dietician in this respect, as part of multidisciplinary teams, should be the basis for future research. Full article

Background/Objectives: Acute drug intoxications (ADIs) are a significant concern in pediatric healthcare, contributing to both accidental and intentional morbidity. This study aimed to analyze the demographic, clinical, and therapeutic characteristics of pediatric ADI cases to identify trends and inform preventive strategies. Methods: This retrospective study included 120 cases of pediatric ADI admitted to the Second Pediatric Clinic of Craiova County Emergency Clinical Hospital in 2022 and 2023. The inclusion criteria encompassed children aged 0–17 years with confirmed pharmaceutical intoxications. Cases involving mixed poisonings or non-pharmaceutical substances were excluded. Clinical severity was classified using the Poisoning Severity Score (PSS). Data on demographics, substances involved, clinical presentations, interventions, and outcomes were analyzed. Results: The majority of cases occurred in females (73.3%) and urban residents (77.5%). Accidental intoxications were prevalent in children aged 1–5 years (45%), while intentional ingestions were common in adolescents (47.5%). The most frequently implicated substances included antibiotics (46.7%), benzodiazepines (20.8%), and acetaminophen (15.8%). Severity was classified as mild (44.2%), moderate (26.6%), or severe (29.2%), while treatment primarily included supportive care, intravenous fluids (62.5%), and antidotes (35.8%). Severe cases required respiratory support in 29.2% of the instances. Hospitalization duration significantly decreased from 2022 (3.8 ± 1.9 days) to 2023 (2.3 ± 0.9 days) (p < 0.05), and no fatalities were recorded. Conclusions: Pediatric ADIs predominantly involve accidental ingestions in young children and intentional overdoses in adolescents. Targeted public health strategies, such as parental education, adolescent mental health support, and improved rural healthcare access, are essential to reduce incidence and severity. These findings underscore the need for focused prevention and optimized clinical management. Full article

The extent to which fishery ecological protection policy objectives are aligned with fishermen’s preferences is central to their participation in environmental protection behavior and can enhance their utility. In this study, survey data are analyzed from 352 fishing households in Weihai City, China, using the choice experiment method and a random parameter logit model to examine the differences in the fishermen’s target preferences for fishery ecological protection measures and their behavior in terms of participation in environmental protection. The results indicate that incorporating fishery ecological policy objectives into conservation programs significantly increases the fishermen’s enthusiasm for environmental protection and their willingness to participate, reflecting their ecological and social rationality. In addition, the environmental protection behavior of fishermen is influenced by their ecological awareness of fisheries, risk perception, willingness to pay, per capita annual income, employment status, number of laborers, fishery technology training, participation in cooperatives, and education level, in addition to other important factors, including the economic conditions and social background. Therefore, designing fishery ecological protection plans that incorporate various policy objectives from which fishermen can choose provides effective decision support and practical pathways for fishery ecological protection and sustainable development. The effective alignment of policies with fishermen’s preferences can thereby enhance their participation in environmental protection. Full article

Background and Aims: Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7–12 years, within a physical activity intervention framework. Methods: This study was nested in the CHAMPS-DK trial, a quasi-experimental study. Participants (n = 529) were recruited from intervention schools offering 270 min of physical education (PE) per week (active arm) and control schools with 90 min of standard PE. Soft drink intake was assessed via a food-frequency questionnaire at baseline. Dual-energy X-ray absorptiometry (DXA) was used to measure Bone Mineral Content (BMC), Bone Area (BA), and Bone Mineral Density (BMD) at baseline and two-year follow-up (primary outcomes). Fracture incidence over a five-year period was recorded using the SMS-Track parental reporting system (secondary outcome). Multilevel mixed-effects linear regression and Weibull survival models were used to analyze associations. Results: Soft drink intake of more than twice per month did not significantly affect BMC, BA, or BMD over two years (Total body BMD: β = 0.004; 95% CI: (−0.007; 0.016). Adjustment for confounders such as age, sex, BMI, pubertal status, socioeconomic status, and physical activity did not change the results. Additionally, no significant difference in fracture risk was observed (HR = 0.86; 95% CI: [0.43; 1.71]). Conclusions: Soft drink intake had no measurable impact on bone health indices or fracture risk in children, irrespective of PE intervention. Future studies should investigate the effects of specific soft drink types (carbonated vs. non-carbonated) on bone development. Full article

The LBS2ITS project, titled “Curricula Enrichment Delivered through the Application of Location-Based Services to Intelligent Transport Systems”, is a collaborative initiative funded by the Erasmus+ program of the European Union. The primary objectives of the project were twofold: to develop new curricula and modernize existing programs at four universities in Sri Lanka. This effort was driven by the need to align educational offerings with the rapidly evolving fields of Location-Based Services (LBSs) and Intelligent Transport Systems (ITSs). A key feature of the LBS2ITS project is its interdisciplinary approach, which draws on expertise from a range of academic disciplines. The project has successfully developed curricula that integrate diverse fields such as geomatics, cartography, transport engineering, urban planning, environmental engineering, and computer science. By blending these perspectives, the curricula provide students with a holistic understanding of LBSs and ITSs, preparing them to address complex, real-world challenges that span multiple sectors. In this paper, the curriculum development and modernization process is detailed, with a particular focus on the two key phases: teacher training and curriculum development. The teacher training phase was crucial in equipping educators with the skills and knowledge necessary to deliver the new and updated courses. This phase also provided an opportunity for teachers to familiarize themselves with the latest trends and technologies in LBSs and ITSs, ensuring that they could effectively convey this information to students. The development phase focused on the creation of the curriculum itself, ensuring that it met both academic standards and industry needs. The curriculum was designed to be flexible and responsive to emerging technologies and methodologies, allowing for continuous improvement and adaptation. Additionally, the paper delves into the theoretical frameworks underpinning the methodologies employed in the project. These include Problem-Based Learning (PBL) and Problem-Based e-Learning (PBeL), both of which encourage active student engagement and foster critical thinking by having students tackle real-world problems. The emphasis on PBL ensures that students not only acquire theoretical knowledge but also develop practical problem-solving skills applicable to their future careers in LBSs and ITSs. Furthermore, the project incorporated rigorous quality assurance (QA) mechanisms to ensure that the teaching methods and curriculum content met high standards. This included regular feedback loops, stakeholder involvement, and iterative refinement of course materials based on evaluations from both students and industry experts. These QA measures are essential for maintaining the relevance, effectiveness, and sustainability of the curricula over time. In summary, the LBS2ITS project represents a significant effort to enrich and modernize university curricula in Sri Lanka by integrating cutting-edge technologies and interdisciplinary approaches. Through a combination of innovative teaching methodologies, comprehensive teacher training, and robust quality assurance practices, the project aims to equip students with the skills and knowledge needed to excel in the fields of LBSs and ITSs. Full article

The traditional graduate admission method is to evaluate students’ performance and interview results, but this method relies heavily on the subjective feelings of the evaluators, and these methods may not be able to comprehensively and objectively evaluate the qualifications and potential of the applicants. At present, artificial intelligence has played a key role in the reform of the education system, and the data processing function of artificial intelligence has greatly reduced the workload of screening work. Therefore, this study aims to optimize the graduate enrollment evaluation process by applying a new composite model, the random forest–improved sparrow search algorithm (RF–ISSA). The research used seven data sets including research, cumulative grade point average (CGPA), letter of recommendation (LOR), statement of purpose (SOP), university rating, TOEFL score, and graduate record examination (GRE) score, and carried out the necessary data pre-processing before the model construction. The experimental results show that the RMSE and R values of the composite model are 0.0543 and 0.9281, respectively. The predicted results of the model are very close to the actual data. In addition, the study found that the importance score of CGPA was significantly higher than other characteristics, and that this value has the most significant impact on the outcome of the graduate admissions assessment. Overall, this study shows that combining the integrated strategy sparrow search algorithm (ISSA) with hyperparameter optimization and focusing on the most influential features can significantly improve the predictive performance and applicability of graduate admissions models, providing a more scientific decision support tool for school admissions professionals. Full article

Background/Objectives: Traditional food markets are essential in urban food environments in Kenya and other low- and middle-income countries (LMICs). They provide affordable fresh food, particularly for low-income urban communities, and are vital places of livelihoods and local economic activities. Despite their importance, associations between market-related factors and diet quality for vendors and consumers are underexplored. This study explores these relationships to inform policies aimed at improving diets and nutrition in LMICs. Methods: Survey data were collected from 1042 vendors and 876 consumers in five urban markets in Kenya. The survey assessed market-related factors, consumer purchasing behavior, socioeconomic factors, and dietary outcomes using the Kenya Diet Quality Questionnaire. Linear regression models were employed to evaluate associations between the availability of foods, consumers’ purchase of foods, proximity to the market, reported sickness from food, and diet quality indicators, including the Dietary Diversity Score (DDS), Global Dietary Recommendations (GDRs), NCD-Protect, and NCD-Risk scores. Results: Vendors’ own dietary outcomes were characterized by lower DDS, NCD-Protect, and NCD-Risk scores but higher GDR scores compared to consumers. Significant associations were identified between the purchase of specific food groups (e.g., vegetables, legumes, and nuts) and improved diet quality for consumers. Longer travel times were linked to lower diet quality for both vendors and consumers. Socioeconomic factors, such as gender, age, and education, significantly influenced diet quality. Conclusions: Traditional markets play a pivotal role in urban food environments. Policies that enhance market access and support vendors and consumers, particularly women, young adults, and low-income groups, are essential to improving diets and nutrition outcomes in LMICs. Full article

Video location prediction for handwritten digits presents unique challenges in computer vision due to the complex spatiotemporal dependencies and the need to maintain digit legibility across predicted frames, while existing deep learning-based video prediction models have shown promise, they often struggle with preserving local details and typically achieve clear predictions for only a limited number of frames. In this paper, we present a novel video location prediction model based on Convolutional Gated Recurrent Units (ConvGRU) that specifically addresses these challenges in the context of handwritten digit sequences. Our approach introduces three key innovations. Firstly, we introduce a specialized decoupling model using modified Generative Adversarial Networks (GANs) that effectively separates background and foreground information, significantly improving prediction accuracy. Secondly, we introduce an enhanced ConvGRU architecture that replaces traditional linear operations with convolutional operations in the gating mechanism, substantially reducing spatiotemporal information loss. Finally, we introduce an optimized parameter-tuning strategy that ensures continuous feature transmission while maintaining computational efficiency. Extensive experiments on both the MNIST dataset and custom mobile datasets demonstrate the effectiveness of our approach. Our model achieves a structural similarity index of 0.913 between predicted and actual sequences, surpassing current state-of-the-art methods by 1.2%. Furthermore, we demonstrate superior performance in long-term prediction stability, with consistent accuracy maintained across extended sequences. Notably, our model reduces training time by 9.5% compared to existing approaches while maintaining higher prediction accuracy. These results establish new benchmarks for handwritten digit video prediction and provide practical solutions for real-world applications in digital education, document processing, and real-time handwriting recognition systems. Full article

Cancer patients receiving non-endocrine therapies are at risk of hepatitis B virus (HBV) reactivation (HBVr). Guidelines recommend HBV screening prior to treatment. The Ottawa Hospital Cancer Center implemented a screening pilot for all patients receiving FOLFOX-based regimens between January and April 2023. We assessed the pilot from a quality improvement perspective. Charts were retrospectively reviewed, and patient and disease characteristics were collected. The primary endpoint was to identify the proportion of patients who underwent HBV screening prior to treatment start. Univariate analyses assessed the association between baseline characteristics and failure to screen. Quality metrics were also reviewed. There were 32/42 patients (76.2%) who completed screening, and 5 (11.9%) had a positive screen. The majority of eligible patients (59.5%) completed screening prior to the first treatment as intended. Four of five patients who tested positive were referred to Infectious Diseases. Of those, one received antivirals for chronic HBV. There were no treatment delays due to pending screening and no HBV reactivation. Receipt of prior systemic therapy was significantly associated with failure to screen (55 vs. 95%, OR 17.1 (95% CI 1.92–153), p = 0.011). The results of this pilot highlight the importance of building HBV screening into standardized treatment plans and engaging all team members to ensure high levels of screening. Prior systemic therapy receipt was associated with failure to screen, and thus, programs should include education on the necessity of screening as recommended by medical guidelines. Full article

Background/Objectives: Multicomponent, non-pharmacological therapies are the preferred first-line treatments for fibromyalgia (FM), but little is known about them in primary care settings. Our study assessed the effectiveness of the FIBROCARE Program in improving the quality of life, functional impact, mood, and pain of people with FM. Methods: We conducted a pragmatic, randomized controlled trial that was not blinded for both patients and the professionals delivering the treatments in the study groups. We compared a group receiving non-pharmacological multicomponent group therapy (MT) based on health education, physical exercise, and cognitive–behavioral therapy with another group receiving the usual clinical care. The MT group was treated in the primary care context in Catalonia (Spain) through 12 consecutive weekly sessions. Both groups were followed up with at the end of the MT group sessions and 6 and 12 months after the group sessions with the Short-Form 36 (SF-36) v2 Health Survey questionnaire, the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the Visual Analog Scale, and the Revised Fibromyalgia Impact Questionnaire (ClinicalTrials.gov: NCT04049006). Results: Improvements in pain intensity, functional impact, physical health, fatigue, and emotional problems that affect daily activities in the MT group lasted up to 12 months. Benefits measured by the SF-36 Mental Health dimension and the HADS-A subscale were lost after 6 months. Effects on the SF-36 Social Functioning dimension and HADS-D present at 6 months persisted for up to 12 months. Generally, the longer the time since the FM diagnosis, the better was a patient’s mood. Conclusions: The FIBROCARE Program effectively improves all the studied health outcomes except patient mood, since anxiety symptoms persist. The program should reinforce patient psychological support overall, focusing particularly on the years initially after diagnosis. Full article

The international tertiary education sector was significantly affected by the COVID-19 pandemic due to the risk of negative learning and psychosocial experiences. Most international students who remained in the host countries demonstrated admirable resilience and adaptability during those challenging times. An integrative review of factors shaping international students’ learning and mental wellbeing during the COVID-19 pandemic was conducted. Five electronic databases—CINAHL, MEDLINE, ProQuest, PsycINFO, and Web of Science—were searched from 2020 to 2023 using the key search terms ‘international students’, ‘tertiary education’, ‘mental health and wellbeing’, and ‘COVID’. A total of 38 studies were included in this review. They revealed six factors across learning and psychosocial experiences. Predisposing factors for maladjustments included the students being younger and possessing poor English proficiency. Precipitating factors were related to online teaching/learning, and lack of accessibility and or insufficient learning and living resources. Perpetuating factors pertained to living arrangements. The protective factor identified was institutional support. This review highlighted that multifaceted factors were associated with international students’ experiences and mental health and wellbeing. In-depth understanding of risk and protective factors can help policymakers to prepare for unprecedented challenges and reduce disruptions to international students’ education and mental health when studying abroad. Full article

Educational cooperation in higher education offers valuable opportunities for students and institutions alike. However, it also introduces significant challenges, particularly regarding student enrollment processes. Traditional centralized systems for managing this task can pose issues around authority, transparency, accountability, security, and cost, often hindering scalability and sustainable growth. This paper introduces the Cross-Institutional Blockchain Enrollment System (BCHEEN), a novel decentralized platform designed to streamline and enhance cross-institutional enrollment processes. Un-like existing solutions, BCHEEN employs a unique hybrid architecture that leverages blockchain technology to ensure transparency and security while maintaining scalability through innovative off-chain data management using the “replicate when used” approach. The platform was prototyped as a permissioned blockchain platform using the Hyperledger Composer framework and evaluated through functional, performance, and security analyses using tools such as Cucumber and Hyperledger Caliper. Evaluation results show that BCHEEN achieved a peak throughput of 18 tps at a send rate of 47 tps, with an average latency of 4.32 s under the same conditions, demonstrating its scalability and reliability. Furthermore, a computational cost analysis highlights the efficiency of the “replicate when used” approach in reducing storage overhead while preserving data integrity. BCHEEN’s practical impact includes streamlining enrollment processes, reducing administrative costs, and fostering secure, scalable, and transparent inter-institutional collaboration. These contributions position BCHEEN as a transformative tool for higher education, supporting policy advancements and promoting resilience and sustainability in educational practices. Full article