Sustainable Development Goal 4: Quality Education (49463)

This paper reports a design-rationale account of building and deploying a small ecosystem of AI-driven educational conversational agents with distinct pedagogical personas. Two strands target school contexts: (i) Talk to Bill, a historically grounded Shakespeare interlocutor intended to support close reading, contextual understanding, and interpretive dialogue; and (ii) Here to Help, a set of UK GCSE subject- and exam-board-specific tutors designed for formative practice in recognised question formats with feedback and iterative improvement. The third strand comprises six complementary assistants for an undergraduate Human–Computer Interaction (HCI) module, each bounded to a workflow-aligned role (e.g., empathise-stage coaching, study planning, course operations), with guardrails to privilege process quality over answer generation. We describe how persona differentiation is mapped to established learning, engagement, and motivation theories; how retrieval-augmented generation and provenance cues are used to reduce hallucination risk; and what early deployment observations suggest about orchestration, integration, and incentives. The contribution is a transferable, auditable rationale linking theory to concrete dialogue and UI moves for multi-persona tutoring ecosystems, rather than a claim of causal learning gains. Full article

Objective: To determine the prevalence of and risk factors for congenital toxoplasmosis in neonates treated in the public health network of the eastern region of the Brazilian Amazon, northern Tocantins state. Methods: A retrospective cohort study was conducted with neonates born to mothers with gestational toxoplasmosis who received care between 2017 and 2024. The outcome under analysis was positivity for immunoglobulin M in the electrochemiluminescence assay (CLIA). We estimated the prevalence of transplacental infection and respective 95% confidence intervals (95% CI) and its association with risk factors using the odds ratio (or) with a p-value < 0.05 in infected neonates before and after 16 gestational weeks at maternal infection diagnosis. Results: A total of 1142 neonates were surveyed, in which 496 were diagnosed with congenital toxoplasmosis (IgM positive), thus obtaining a prevalence of vertical transmission of 45.4%. The main risk factors for vertical transmission were the mother’s education level equal to or less than eight years, (OR = 1.5; 95% CI 1.2; 2.0) and having less than six prenatal consultations (OR = 22.8; 95% CI 3.0; 172.6). Conclusions: A high prevalence of congenital toxoplasmosis was observed, with higher rates of infection in neonates born to mothers with lower levels of education. Full article

This study investigates the efficiency of higher education systems across the 27 Member States of the European Union during the period 2017–2022, addressing increasing policy interest in data-driven decision support and optimization techniques for performance evaluation in education systems. Efficiency is assessed using Stochastic Frontier Analysis, an optimization-based econometric approach, applied to multiple output dimensions relevant to learning analytics: alignment between graduates’ skills and labour market requirements, scientific productivity measured by published articles, and the number of higher education graduates. The model incorporates key input variables, including the student–teacher ratio, public expenditure per student, research and development expenditure, and the number of academic staff, while controlling for real gross domestic product per capita. To support integrated efficiency measurement and information-based decision-making, multidimensional outcomes are aggregated into composite efficiency indices using entropy-based weighting. The results reveal substantial cross-country heterogeneity in efficiency across EU higher education systems, identifying a cluster of high-performing countries that consistently optimize scientific output and graduate production. Financial resources and academic staff availability emerge as significant drivers of efficiency, while skill matching to labour market demand remains a persistent structural challenge. By combining Stochastic Frontier Analysis with entropy-based aggregation, this study provides a robust data-driven decision support framework for efficiency assessment, offering valuable insights for education policy design, resource allocation, and learning-oriented system optimization. Full article

COVID-19 significantly disrupted the progress of the SDGs globally, including in Saudi Arabia. This study explores the progression of SDGs in Saudi Arabia during and after COVID-19, focusing on four dimensions: financial, socioeconomic, health, and environmental. A qualitative approach was employed, involving 19 semi-structured interviews conducted in two rounds (during and post COVID-19). Thematic analysis, conducted using NVivo 14.0, identified four main themes and 16 subthemes, which align with the SDG dimensions. The study revealed significant disruptions across four SDG dimensions during the pandemic. These included economic downturns, increased poverty, strained healthcare systems, and environmental changes. Guided by systems theory as an analytical lens, the study findings indicate that while COVID-19 caused disruptions across SDGs, it also acted as a catalyst for transformational shifts across interconnected SDG domains. The post-pandemic period has shown recovery, including economic growth, enhanced gender equality, improved mental health services, and a renewed focus on sustainability. Six cross-thematic themes emerged: (1) economic recovery and employment, (2) gender equity and education, (3) mental health and healthcare, (4) poverty reduction and food security, (5) environmental sustainability, and (6) digital transformation resilience. Based on these insights, the study provides recommendations for Saudi policymakers to align SDG progress with Saudi Vision 2030 in line with pragmatic sustainability. Full article

This study examines how climate change and vegetation are integrated into teacher education curricula across 26 countries, addressing a critical gap in understanding how future teachers are prepared to respond to the climate and biodiversity crises. To evaluate curricular integration systematically, we developed and validated the Climate and Vegetation Curriculum Integration Index (CCVI), which measures four dimensions: climate change, vegetation, links between the two, and pedagogical strategies. Content analysis of 70 official curriculum documents was conducted, with high inter-rater reliability (κ = 0.72–0.85) and internal consistency (Cronbach’s α = 0.89) confirming the robustness of the instrument. Results show that integration remains partial and uneven: climate change content is more common than biodiversity, while vegetation is often marginalized, perpetuating the phenomenon of “plant blindness.” Exemplary cases in Finland, Germany, Mexico, Norway, and Switzerland demonstrate that high levels of integration are achievable, but intra-country variability often exceeds cross-country differences, highlighting the influence of institutional design. The study concludes that teacher education worldwide is not yet aligned with the urgency of global sustainability challenges. The CCVI provides a practical tool for benchmarking progress and guiding reforms, underscoring the need to embed sustainability as a core element of teacher preparation to foster ecological literacy, resilience, and civic engagement. Full article

The COVID-19 pandemic necessitated the transition of physiotherapy programmes from traditional face-to-face anatomy teaching to fully online delivery. Studies conducted during this period have documented students’ positive adaptation to online anatomy learning, highlighting benefits such as increased flexibility and reduced stress, while also noting challenges, including diminished practical exposure. Although much of the existing research centres on medical and dental education, there is a relative paucity of studies examining physiotherapy students’ perspectives. In this study, a purposive sample of 53 entry-level physiotherapy students (Years 1–3) completed a questionnaire evaluating their experiences with anatomy education during the pandemic. Responses were compared between groups (Years 1 and 2 versus Year 3) using the Mann–Whitney U test and effect-size calculations. Year 3 students who experienced both face-to-face and online learning preferred practical sessions with silent mentors in the anatomy hall, citing greater active engagement and deeper learning. Conversely, all year groups reported that online assessments, such as the online Objective Structured Practical Examination, were less stressful than traditional formats. Year 1 and 2 students, lacking prior face-to-face practical experience, expressed neutral views regarding online practical components. Overall, while online theory and assessment components were well received, hands-on practical experience remains highly valued for promoting student engagement. These findings support the development of blended anatomy pedagogy that leverages the strengths of both modalities to enhance resilience and adaptability in the face of future educational disruptions. Full article

Asthma continues to affect millions of adults in the United States, with indoor environmental exposures playing a major role in symptom burden and control. Limited research has examined the combined influence of multiple household and environmental determinants on adult asthma morbidity, particularly in diverse states such as Texas. We analyzed pooled data from 1596 Texas adults with asthma who completed the Asthma Call-Back Survey between 2019 and 2022. Multivariable logistic regression models, adjusted for survey design and demographic covariates, were used to examine associations between household and environmental determinants and four morbidity outcomes: asthma attacks, recent symptoms, sleep difficulty, and limited activity due to asthma. Current smoking, lack of bathroom or kitchen ventilation, and absence of air purifier use were consistently associated with higher odds of morbidity. Protective associations were observed for homes without mold, rodents, or furry pets. Disparities were also evident, with older adults, women, and non-Hispanic Black respondents reporting greater morbidity. These findings highlight the importance of addressing modifiable exposures such as indoor smoking, ventilation, and allergen control within comprehensive asthma management strategies. Targeted interventions that combine environmental modifications with health education may help reduce asthma disparities and improve the quality of life for adults with asthma. Full article

Background: This study addresses a common challenge in music education: students’ limited emotional engagement during music listening. Objectives: This study compared two teaching methods—externally guided augmented reality (AR) integration and internally generated simulation—in terms of their neural and behavioral differences in guiding students’ visual mental imagery and influencing their musical affect processing. Methods: Using Chinese Pipa music appreciation as our experimental paradigm, we employed fNIRS hyperscanning to record inter-brain synchronization (IBS) during teacher–student interactions across three instructional conditions (AR group, n = 27; visual imagery group, n = 27; no-instruction group, n = 27), while simultaneously assessing students’ performance in music–emotion processing tasks (emotion recognition and experience). Results: At the behavioral level, both instructional methods significantly enhanced students’ ability to differentiate emotional valence in music compared to the control condition. Crucially, the AR approach demonstrated a unique advantage in augmenting emotional arousal. Neurally, both teaching methods significantly enhanced IBS in brain regions associated with emotion evaluation (lOFC) and imaginative reasoning (bilateral dlPFC). Beyond these shared neural correlates, AR instruction specifically engaged additional brain networks supporting social cognition (lFPC) and multisensory integration (rANG). Furthermore, we identified a significant positive correlation between lFPC-IBS and improved emotional arousal exclusively in the AR group. Conclusions: The visual imagery group primarily enhances emotional music processing through neural alignment in core emotional brain regions, while augmented reality instruction creates unique advantages by additionally activating brain networks associated with social cognition and cross-modal integration. This research provides neuroscientific evidence for the dissociable mechanisms through which different teaching approaches enhance music–emotion learning, offering important implications for developing evidence-based educational technologies. Full article

Background: Cervical cancer is associated with Human Papillomavirus (HPV) infection. Besides cervical cancer, oro-pharyngo-laryngeal or uro-genital cancers are also reported. The HPV vaccine has been strongly recommended for school age children. However, the parents’ or guardians’ hesitancy remains. Methods: This is a mixed-method study in which the parents or guardians of school children, aged 10–18 years, were enrolled voluntarily. Their general demographic data, knowledge, attitudes, and awareness of vaccine accessibility, healthcare cost entitlement of the children, types of school affiliation, education administration areas where the schools were located, and the presence of a healthcare professional in family were analyzed by multiple logistic regression analysis adjusted with all studied variables to define the significant associated factors with the parents’ or guardians’ HPV vaccine acceptance (p < 0.05). In-depth interviews were subsequently performed with the selected participants until the qualitative data were saturated. Thematic analysis was applied, and the results of the two study methods were integrated to explore the reasons for vaccine acceptance or hesitancy. Results: A total of 943 questionnaire respondents were enrolled, among whom 75.8% were female and 86.4% were parents. A total of 663 (70.3%) participants accepted the HPV vaccine. Parents’ or guardians’ knowledge and attitudes, awareness of vaccine accessibility, type of school affiliation, the children’s healthcare cost entitlement, and the presence of a healthcare professional in the family were significantly associated with vaccine acceptance in the multivariate analysis (p < 0.05). The qualitative study revealed that misunderstanding of the vaccine’s safety and benefits combined with inadequate reliable information sources were associated factors with HPV vaccine hesitancy among the parents or guardians. Conclusions: Providing clear-cut knowledge about the HPV vaccine benefit vs. risk and clearing financial barriers for the parents or guardians of school children are advocated. Full article

Inadequate hygiene knowledge and poor sanitation practices remain key challenges to safe learning environments in South Africa, with 462 million learners attending schools without basic handwashing facilities and many schools failing to meet sanitation standards. Although national policies and infrastructure investments have improved water, sanitation, and hygiene (WASH) services in some schools, access and behaviours remain uneven across socio-economic contexts. This study evaluated knowledge, attitudes, and practices (KAP) related to WASH among 1200 learners from 40 high schools in Durban using a cross-sectional design and interviewer-administered questionnaires. Data were analysed using descriptive statistics, Pearson correlations, ANOVA, and multiple regression. The study addressed the research question: To what extent do learners’ knowledge and attitudes predict hygiene practices across socio-economic contexts? It was hypothesised that higher knowledge and more positive attitudes would significantly predict improved hygiene practices. Results showed that while 74.6% reported handwashing after toilet use, only 39.3% consistently used soap. Knowledge of disease transmission through unsafe water was 35.4%, although overall attitudes were positive. Learners from higher-quintile schools had significantly better KAP scores than those from lower quintiles (p < 0.001). Both knowledge (β = 0.232, p < 0.001) and attitudes (β = 0.266, p < 0.001) were significant predictors of learners’ hygiene practices. Significant group differences were also observed by gender (t = 18.032, p = 0.001) and district (t = −3.895, p = 0.001). These findings highlight persistent WASH gaps and inequities across schools, underscoring the need for integrated interventions that strengthen both hygiene education and school infrastructure to achieve Sustainable Development Goal 6. Full article

Artificial intelligence (AI) is increasingly transforming higher education, evolving from simple personalization tools into a wide range of applications that support teaching, learning, and assessment. This study examines how university instructors in Lebanon perceive and adopt AI in their academic practices, drawing on evidence from two private institutions: Notre Dame University–Louaize (NDU) and the Holy Spirit University of Kaslik (USEK). The study also proposes practical directions for effective institutional implementation. Using a cross-sectional design and convenience sampling, data were collected from 133 faculty members. Although 73.7% of participants reported moderate to high familiarity with AI, their actual classroom use of such tools remained limited. Adoption was primarily centered on chatbots (69.2%) and translation tools (54.9%), while more advanced technologies, such as adaptive learning systems and AI-based tutoring platforms, were seldom utilized (under 7%). Additionally, participants identified efficiency (69.2%), increased student engagement (44.4%), and personalized learning opportunities (42.9%) as the main benefits of AI integration. In contrast, they reported insufficient training (46.6%), restricted access to resources (45.9%), and concerns about the accuracy of AI-generated outputs (29.3%) as major barriers. Moreover, statistical analysis indicated a strong positive relationship between familiarity with AI and frequency of adoption, with no significant differences across gender, age, or academic qualifications. Overall, the results suggest that faculty members in Lebanese higher education currently view AI primarily as a helpful tool for improving efficiency rather than as a transformative pedagogical innovation. To advance integration, higher education institutions should prioritize targeted professional development, ensure equitable access to AI tools, and establish transparent ethical and governance frameworks. Full article

The most widespread lesson preparation resource used by mathematics teachers is the textbook. Initial teacher training programmes should therefore develop the skill of curricular noticing, i.e., the ability to critically analyse and make decisions concerning an activity sequence from a textbook. This mix-method study focused on the interpretations and decisions adopted by 85 Spanish pre-service primary school teachers (PTs) in relation to a three-dimensional (3D) geometry activity sequence from a textbook. The PTs were assigned two tasks: the first was identifying the limitations of the activity sequence for supporting students’ geometrical understanding regarding three aspects—attributes, geometrical processes, and modes of representation—and the second was completing the sequence. Most PTs interpreted a number of activity sequence limitations. In terms of their decision-making, the PTs prioritised certain characteristics over others, such as introducing further attributes rather than changing representation modes, or adding geometrical processes to their activity sequence designs. Moreover, the analysis allowed determining how PTs completed the activity sequence to address limitations, thereby revealing relationships between their interpretations and decisions. The study findings help teacher educators to design courses aimed at supporting the PTs’ ability to make more informed and effective teaching choices that enhance student learning. Full article

Background and Objectives: Oral nicotine pouches (ONPs) are rapidly expanding nicotine products with limited evidence from the Middle East, particularly among young adults. This study assessed the awareness, perceptions, and use of ONPs among university students in Jazan, Saudi Arabia. Materials and Methods: A cross-sectional survey (November 2024–April 2025) used multistage stratified random sampling across six colleges at Jazan University. A self-administered questionnaire captured sociodemographic characteristics, tobacco-use history, ONPs awareness (aided), ever use and current use (past 30 days), and self-reported perceptions items across nine domains. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 624 students (mean age = 20.9 ± 1.7 years; 50.5% female), ONPs awareness was 69.7%, ever use 11.5%, and current use 7.5%. Awareness and use were higher among males and other tobacco users (p < 0.001). In multivariable models, male sex predicted awareness, ever use, and current use; rural residence was linked to lower awareness (aOR = 0.67; 95% CI 0.45–0.98), and being a medical student was linked to lower current use (aOR = 0.08; 95% CI 0.003–0.51) Most students perceived ONPs as addictive (80%) and harmful (68%), yet accessible (61%) and attractive (55%). Conclusions: ONPs awareness and use were high, particularly among males and tobacco users. Despite recognizing potential harm, students viewed ONPs as accessible and attractive. Ongoing surveillance, education, and balanced regulation are needed to guide harm-reduction policy and prevent unintended nicotine uptake. Full article

Background: Childhood undernutrition and overnutrition continue to be major public health challenges in South Africa. There is limited evidence on how socio-economic factors and dietary behaviors influence nutritional outcomes among school-aged children, particularly in rural areas such as Thulamela Municipality. Objective: This study aimed to examine the socio-demographic determinants, dietary patterns, and nutritional status among school-aged children in Thulamela Municipality, Limpopo Province, South Africa. Methods: A cross-sectional survey was conducted with 347 children aged 8–12 years. Simple random sampling was used to select eight villages from a total of 227 within the municipality. A snowball sampling method was used to recruit eligible children. Data on socio-demographic characteristics, including the child’s sex, parental education level, marital status, and employment status, were collected. Additionally, their dietary habits and meal frequency patterns were collected using structured questionnaires. Anthropometric measurements including height, weight, and BMI-for-age were obtained following WHO growth standards. Associations between variables were assessed using chi-square tests, with p-values < 0.05 considered statistically significant. Results: The prevalence of severe and moderate stunting was 20.5% and 21.0%, respectively. Overweight conditions and obesity affected 32.6% and 16.2% of participants, respectively. Parental education (p = 0.027), marital status (p = 0.001), and household income (p = 0.043) showed significant associations with height-for-age and BMI-for-age Z-scores. Additionally, regular breakfast consumption and the frequent intake of vegetables and dairy products were positively associated with improved nutritional outcomes (p < 0.05). Conclusions: The nutritional profile of school-aged children in Thulamela Municipality reflects a double burden of malnutrition, with concurrent high rates of stunting, overweight conditions, and obesity. Interventions that promote balanced diets and address socio-economic disparities are crucial for improving child growth and overall health. Socio-economic factors, including parental education, marital status, and household income, were significantly associated with children’s height-for-age and BMI-for-age. Furthermore, the regular consumption of breakfast, vegetables, and dairy products was associated with better nutritional outcomes, highlighting the influence of both dietary behaviors and socio-demographic determinants on child growth and health. Implementing nutrition education programs within schools that emphasize the value of balanced diets and highlighting the significance of eating breakfast regularly and incorporating vegetables and dairy products into daily meals is important. These programs should include both children and their caregivers to support regular healthy eating behaviors at home and in school. Additionally, schools should carry out regular growth monitoring and nutritional assessments to identify early indications of undernutrition or overnutrition, enabling prompt referrals and interventions for children who may be at risk. Full article

Early Childhood Mental Health Consultation (ECMHC) promotes children’s social–emotional development and reduces challenging behaviors in early care and education (ECE) centers, yet implementation barriers increase teacher stress and reduce confidence. Scalable, efficient, and accessible approaches are needed to meet ECE center demands. This quasi-experimental match-controlled study evaluated two ECMHC programs in promoting children’s social–emotional development and improving teachers’ skills/attitudes compared to an attention control condition in 22 ECE centers in lower-resourced areas of BLINDED. We compared Jump Start (JS; traditional human consultation model), Jump Start Go (JS Go; AI-enhanced consultation model), and Healthy Caregivers–Healthy Children (HC2; obesity-prevention consultation model). Child social–emotional development, teacher workplace stress/confidence, and classroom practices were assessed at pre-and post-intervention. Children in JS and JS Go interventions demonstrated significant social–emotional gains (F = 13.55, p < 0.001), with the largest reductions in internalizing problems observed in children who received JS Go (−2.91 points; F = 9.65, p < 0.001). JS Go classrooms also showed greater improvements in prosocial behavior (F = 5.05, p = 0.012) and resiliency (F = 8.95, p < 0.001) than HC2 classrooms. Findings suggest that both traditional and AI-enhanced ECMHC approaches can promote teachers’ capacity to support children’s social–emotional development. Full article

The fanasváhter is a special tool used by boatbuilders to determine how steeply the boatboards should be positioned. Sámi mathematics teacher educators, together with Sea Sámi boatbuilders and a pre-service mathematics teacher, present a descriptive case study of a Sea Sámi boatbuilder’s use of this tool. The aim is to reveal mathematical understanding that might be relevant for vocational school teaching. Firstly, we analyze a semi-structured interview with a skilled boatbuilder with respect to knowledge and values embedded in the use of the fanasváhter. Because the Sea Sámi boatbuilding tradition was almost extinct after the Nazis’ devastation in World War II, there is a need for some creativity in the boatbuilders’ regeneration of Sea Sámi boatbuilding. An analysis of the use of the fanasváhter with respect to creativity reveals how creativity is important in Sea Sámi boatbuilding. The analysis further reveals that Sea Sámi boatbuilders compare angles, but they do not refer to any angles measured in degrees. This contrasts with traditional school mathematics. Thus, the Sea Sámi boatbuilders’ mathematics is less abstract and more intuitive than traditional school mathematics. Full article

An effective response to the socio-environmental crisis requires the education of critical citizens, capable of articulating local action with collective socio-political engagement. Teachers occupy a central position in educating for Environmental Citizenship (EC), yet in-service professional development models in this area remain scarce. Within a Design-Based Research framework, this article discusses the expert evaluation of a training prototype. 32 experts—comprising EC researchers, TPD researchers, and specialist teachers—responded to a qualitative questionnaire regarding the model’s design. Data underwent inductive content analysis, with categories emerging directly from the responses. While results strongly validate the prototype’s structure, crucial recommendations emerged for its improvement. Pedagogically, experts suggested focusing on structuring methodologies like Problem-Based Learning and Case Studies to avoid fragmentation. Conceptually, they highlighted the need to deepen critical theoretical foundations and incorporate explicit training in activism and communication skills, enriched by ethical considerations. These findings inform the redesign of a model whose implementation aims to reduce the gap between ecological awareness and transformative civic action, preparing teachers to foster genuine agency in their students. Full article

The number of students living with disabilities entering post-secondary education, including health professional programs (HPPs), is increasing. However, disabled students continue to experience challenges in both the on-campus and fieldwork components of these programs. The purpose of this study is to understand the experiences and perspectives of fieldwork educators to determine how they can be supported by HPPs when supervising students living with disabilities. An online survey was developed and circulated to fieldwork educators who supervise students in nine HPPs at McMaster University in Canada. Descriptive statistics and content analysis were used to analyze survey responses. The survey was completed by 42 respondents, 10 of whom reported living with a disability and demonstrated a nuanced understanding of accommodation issues. More than half of the total respondents reported they had supervised disabled students in fieldwork; however, only 12 received accommodation plans and evaluation occurred informally, if at all. Respondents requested training on how to accommodate specific student needs. Efficient processes are needed for educator training, and the involvement of educators is needed in accommodation development. Accommodations must be evaluated to ensure students have equitable opportunities for learning and assessment. Educators living with disabilities provide valuable insights on dismantling systemic barriers to inclusion. Full article

Background: Parents of youth with chronic health conditions face several challenges in supporting their children across contexts. Involvement of parents in a child’s pain management approach is accepted as best practice, yet there is little guidance on how to best parent the child with chronic pain. Prior studies have shown that parents require support and education to effectively care for their children and themselves. This quality improvement program evaluation aimed to evaluate group-level: (1) feasibility of the Creating Bonds program, (2) acceptability and perceived effectiveness of the program, and (3) suggestions for program improvements. Methods: In this quality improvement program evaluation, parents (N = 40) of youth with chronic pain from the United States and Europe were recruited online to participate in a virtual peer-support and educational program, Creating Bonds, offered through the nonprofit organization, Creative Healing for Youth in Pain. Creating Bonds is an 8-week, virtual, supportive, and educational program for parents and caregivers of youth with chronic pain led by a licensed clinical psychologist. A mixed methods approach evaluated the impact of and suggestions for improving the program. Independent samples t-tests were used to examine quantitative items related to understanding of pain, isolation, confusion, distress, relationships, and self-care. Qualitative responses were evaluated for common themes through an inductive thematic analysis. Results: Results indicated that Creating Bonds significantly improved parents’ level of understanding of chronic pain, relationships with others, and self-care, and significantly reduced confusion about parenting a child with chronic pain, stress, and anxiety levels (ps < 0.05). Levels of isolation moderately decreased. Parents qualitatively described the experience as validating, connecting, and educational, with both emotional relief and practical strategies emerging as benefits. Conclusions: Quantitative results and qualitative themes capture the dual role of the Creating Bonds program in providing tangible parenting tools alongside education and critical psychosocial support. Parents entered with uncertainty, a desire for strategies, and hope for connection, and they came away with validation, practical parenting tools, and a community facing similar experiences. Full article

Tick-borne diseases (TBDs) pose a significant threat to livestock productivity and rural livelihoods in South Africa, particularly among resource-poor communal farmers. This narrative review synthesises findings from case studies on communal farmers’ knowledge, attitudes, and practices (KAPs) toward TBDs and their control. The analysis reveals that while many farmers can identify TBDs and their symptoms, significant gaps exist in understanding acaricide resistance and effective tick management. Socioeconomic factors, including age, gender, education, and access to veterinary services, strongly influence knowledge and practices. Indigenous ethnoveterinary practices are commonly used alongside conventional methods, although their efficacy remains understudied. The review emphasises the importance of integrated pest management, participatory approaches, and targeted awareness campaigns. A One Health framework is recommended to enhance surveillance, collaboration, and sustainable TBD control. Empowering farmers through training and inclusive communication strategies is crucial for mitigating the impacts of TBDs on communal farming systems. Full article

Introduction: Several studies have been conducted in the field of education for older adults, with an emphasis on teaching and learning processes related to the use of digital technologies. Among the relevant aspects to be considered in this context is the cognitive vulnerability of this age group in terms of digital security. Objective: The aim of this study was to analyze the relationship between cognitive aspects of older adults and their ability to identify digital risks, before and after participating in an educational intervention, as well as the effect of the intervention on cognition in this age group. Methodology: Analyses were conducted according to the educational intervention and control groups, further stratified by digital risk (SJT) and dementia risk, according to the ACE-R test. The Mann–Whitney test was used to identify possible differences in the likelihood of falling for digital scams, considering the dimensions generated by the simulations (SJT). Results: Overall, the educational intervention was effective for the media education dimension (delta −0.5), regardless of dementia risk. More specifically, a particular effect was observed in the post-intervention stage. Conclusions: The educational intervention was able to promote cognitive gains and reduce digital risks among older adults, particularly in the identification of misinformation, underscoring the importance of continuous and adapted programs to promote digital security in this population. Full article

Caregiving for visually impaired individuals imposes substantial psychological, social, and financial burdens. This study examined depressive symptoms among family caregivers in rural Limpopo, South Africa, and their associations with sociodemographic and socioeconomic factors. A cross-sectional survey was conducted among 253 informal caregivers (response rate: 85.5%). Data on age, gender, marital status, education, employment, income, and socioeconomic status were collected. Depressive symptoms were assessed using the full 20-item Centre for Epidemiologic Studies Depression Scale (CES-D), and associations were analysed using chi-square tests, Cramer’s V, and logistic regression. Moderate-to-severe depressive symptoms were reported by 29.2% of caregivers, with 28.1% experiencing mild-to-moderate symptoms. Male caregivers were less likely to report minimal symptoms (OR = 0.3; 95% CI: 0.12–0.65). Caregivers aged 50–59 years were more likely to report lower depressive symptoms (OR = 1.3). Unmarried caregivers had higher odds of depressive symptoms compared with married caregivers (OR = 2.3). Education was protective: secondary education was associated with lower odds of severe symptoms, while primary education significantly increased risk (OR = 18.1). Lower-income caregivers tended to report higher depressive symptoms. Depressive symptoms among caregivers are influenced by gender, age, marital status, education, and income. Interventions such as psychosocial support, financial assistance, and community-based respite services are essential to reduce caregiver burden. Full article

Evidence for flipped-classroom learning in the health professions is growing, yet its advantage over lectures when transferable learning is tested remains unclear. We conducted a cross-sectional, inter-institutional comparison of two European programs (anonymized as Center A—lecture-based; Center B—flipped classroom). Students in Years 1 to 3 completed two anatomy examinations (0–10 scale): their own institutional exam and the partner’s exam. A 10-item Likert questionnaire produced a 0 to 10 Global Satisfaction Index. Analyses included Welch’s t test, effect sizes, and 95% confidence intervals. Own scores were comparable between centers (mean difference ≈ +0.10; p = 0.66; Hedges’ g ≈ 0.07). Cross scores strongly favored Center B [difference ≈ −2.40; 95% CI −2.72 to −2.07; p < 10⁻³²; g ≈ −1.87]. By course, the Own → Cross drop was large in Center A across Years 1 to 3, moderate in Center B, and nearly absent in Year 3. Satisfaction was higher in Center B; internal consistency of the 10-item scale was modest overall (α ≈ 0.61). When assessment demands transfer to an unfamiliar format, flipped-classroom exposure confers a large performance advantage and higher satisfaction, while differences vanish on familiar exams. The findings support aligning anatomy curricula with active, application-focused learning and mixed-format assessment to promote durable, transferable learning. Full article

Artificial intelligence (AI) is rapidly transforming anesthesiology practice across perioperative settings. This review explores the evolution and implementation of hybrid decision-making models that integrate AI capabilities with human clinical expertise. From historical foundations to current applications, we examine how machine learning algorithms, deep learning networks, and big data analytics are enhancing anesthetic care. Key applications include perioperative risk prediction, AI-assisted patient education, automated analysis of clinical records, airway management support, predictive hemodynamic monitoring, closed-loop anesthetic delivery systems, and pain management optimization. In procedural contexts, AI demonstrates promising utility in regional anesthesia through anatomical structure identification and needle navigation, monitoring anesthetic depth via EEG analysis, and improving quality control in endoscopic sedation. Educational applications include intelligent simulators for procedural training and academic productivity tools. Despite significant advances, implementation challenges persist, including algorithmic bias, data security concerns, clinical validation requirements, and ethical considerations regarding AI-generated content. The optimal integration model emphasizes a complementary approach where AI augments rather than replaces clinical judgment—combining computational efficiency with the irreplaceable contextual understanding and ethical reasoning of the anesthesiologist. This hybrid paradigm reinforces the anesthesiologist’s leadership role in perioperative care while enhancing safety, precision, and efficiency through technological innovation. As AI integration advances, continued emphasis on algorithmic transparency, rigorous clinical validation, and human oversight remains essential to ensure that these technologies enhance rather than compromise patient-centered anesthetic care. Full article

This literature review examined the relationship between energy drink consumption and cardiovascular health in young people. Following PRISMA 2020, we searched Scopus for articles published from 2020 to 2025 and included 33 original studies after screening 133 records. Evidence from observational, clinical, and experimental research was synthesized into six themes: youth consumption; direct cardiovascular outcomes; composition and toxicity; animal or cellular experiments; perceptions and habits; and occupational or sociodemographic factors. Across studies, habitual intake was linked to acute blood-pressure rises, arrhythmias, endothelial dysfunction, and metabolic disturbances, sometimes within 24 h of a single can. Risks were amplified by high caffeine and taurine doses and by co-use with alcohol or intense exercise. Adolescents and young adults were most vulnerable, due to heightened sympathetic responses, frequent use under academic or work stress, and limited risk perception. Authors highlighted five actions: longitudinal research; tighter ingredient monitoring and transparent labeling; consumer education; protection of vulnerable groups; and clinical guidance for responsible use. These results were observed across regions and study designs. Overall, the findings indicate that unregulated energy-drink consumption is a preventable cardiovascular risk in youth, justifying the use of coordinated public-health measures, including curriculum-based education, marketing restrictions, ingredient oversight, and clinical screening to mitigate harm. Full article

Background: There is a high prevalence of the double burden of malnutrition (DBM) in children and adolescents in South Asia. This research aims to explore which sociodemographic factors are attributed to DBM in urban Bangladesh, a South Asian country. Methods: We conducted secondary analyses of data obtained from the national survey of childhood obesity among school-age children in Bangladesh (2012–2013). The sample includes 4140 children (aged 5–9 years) and adolescents (10–19 years) randomly recruited from the city corporation (urban) areas in all administrative divisions. At the population level, DBM was defined as the coexistence of underweight and overweight/obesity among children and adolescents. At the household level, DBM was defined as maternal underweight co-occurring with child overweight/obesity within the same mother-child dyad. A multivariable logistic regression model was fitted to estimate odds ratios and 95% confidence intervals. A rapid policy review was conducted to understand the implication of the results obtained from the analysis. Results: The prevalence of DBM at the population level was 45.2% (95% CI: 42.5–45.5%), ranging between 40.0% and 47.6% across seven divisions (p < 0.001). At the household level, DBM prevalence was 16.6% (95% CI: 14.7–18.7%), ranging between 14.0% and 19.0% across seven divisions (p = 0.015). At the population level, DBM odds were 56% higher among younger children (5–9 years) than adolescents (10–19 years) (OR: 1.56; 95% CI: 1.37–1.78), and this association was found in four divisions. At the household level (mother-child pairs), DBM odds were 64% higher in younger children than adolescents (OR: 1.64; 95% CI:1.38–1.95); and higher in children living at a lower-middle socioeconomic status (SES) and middle SES, than upper SES. The policy review revealed that Bangladesh has made substantial commitments to improve nutrition; however, reference to DBM is absent from policy documents. Conclusions: The prevalence of DBM is high among children in urban areas in Bangladesh, disproportionately affecting younger children and households with low SES. In the current policy space, Bangladesh should revise national nutrition frameworks to recognize DBM as a public health priority and implement region-sensitive strategies for preventing and reducing malnutrition among school-aged children. Full article

Background/Objectives: Many studies have investigated the Cognitive Acceleration through Science Education (CASE) programme, demonstrating its impact on students’ reasoning and learning development across different educational contexts. Likewise, numerous experimental investigations have employed the Solomon Four-Group Design (SFGD) to control for pretest sensitisation and improve the validity of intervention studies. However, despite the extensive use of both frameworks independently, no previous research has integrated them within a single study. The present research therefore combines the theoretical foundations of CASE with the methodological rigour of the SFGD to explore the influence of intervention outcomes under different pretest conditions on learners’ cognitive growth. Methods: This study examines differences associated with pretest sensitisation and the CASE programme among middle school students using a quasi-experimental research design. The study was conducted with 88 students divided into four groups, two experimental and two control, following the Solomon Four-Group Design to account for pretest sensitisation and its potential interaction with the treatment. Results: Statistical analyses revealed that the observed outcomes differed between pretested and non-pretested groups, with the pretested conditions showing larger post-test differences than the non-pretested ones. Conclusions: Rather than establishing causal effects, this study highlights key methodological considerations related to pretest sensitisation when evaluating cognitive acceleration interventions. The findings provide practical guidance for researchers and educators in designing, analysing, and interpreting classroom-based intervention studies where pretesting may influence observed outcomes. Full article

The growing prevalence of anxiety, depression, and stress among students highlights the urgent need for school-based strategies that promote psychological well-being and timely intervention. This study explores the use of artificial intelligence (AI) as a scalable and data-driven tool to support institutional mental health initiatives in higher education. Using synthetic and real datasets derived from validated psychometric instruments (the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS-14)), we trained and evaluated 32 deep neural network architectures for the early detection of emotional distress. Optimized three- and four-layer dense models achieved classification accuracies exceeding 95%, demonstrating the feasibility of deploying AI-based screening tools in educational settings. Beyond prediction, this approach can support counselors and educators in identifying at-risk students and informing proactive, school-based interventions to improve mental health and resilience in post-pandemic academic environments. Full article

Objective: To provide a narrative overview of the scientific knowledge on Last Aid Courses and experiences from different countries. Background: The levels of death literacy, grief literacy, and knowledge about palliative care are low in many countries around the world. For many people, dying, death, and grief are still a taboo. Public Palliative Care Education (PPCE), the public knowledge approach, and the Last Aid Course (LAC) aim to increase death literacy, grief literacy, and public knowledge about palliative care. Methods: A literature search in the databases PubMed/Medline, CINAHL, and PsycInfo was undertaken. Other additional sources were found by hand searching, books, reference lists, and the internet. A narrative overview of the existing literature on LAC and Public Palliative Care Education (PPCE) is provided. Experiences with PPCE and LAC from different countries are presented. Based on the findings, a future agenda for research on PPCE and LAC is presented. Results and Discussion: PPCE and LAC have been introduced in 23 countries. A total of 17 articles and reviews on Last Aid were included. Research on the effects of LAC in different countries and cultural issues connected to LAC are ongoing. Conclusions: Since 2015, LACs have been introduced in 23 different countries. The LAC, the LAC-KT, and PPCE may enhance the public debate on dying, death, grief, and palliative care and may empower people to contribute to end-of-life care in the community. Future research on PPCE, the LAC, and the LAC-KT should focus on retention over time and the long-term effects of the courses. Full article

This article examines the configuration of carceral Islam in Algeria as an instrument of moral governance and civic re-education. Drawing on a multi-year qualitative investigation conducted within several research projects and framed by a comparative Maghrebi perspective, the study analyses how imam and Murshidat contribute to the construction of an “administered religion,” in which spiritual authority is translated into institutional competence and a tool of moral regulation. Through the examination of institutional sources, interviews, and field observations, the research shows how faith becomes a language of discipline, how Tawba (moral and spiritual repentance) is converted into a form of moral capital, and how spirituality functions as a technology of civic conformity. The Algerian prison thus emerges as a laboratory of religious governmentality, where the spiritual dimension is incorporated into logics of security and social control. The comparison with Tunisia—and, to a lesser extent, Morocco—highlights both convergences and divergences among Maghrebi models of religious management, opening new avenues for research on the public function of religion and on the contemporary forms through which states moralize the sacred in Muslim societies. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions in childhood. Beyond biological factors, social and environmental conditions influence developmental experiences and pathways to diagnosis. Nationally representative studies examining multiple social determinants in relation to ADHD, ASD, and comorbidity across recent years remain limited. Methods: We analyzed pooled cross-sectional data from six cycles (2018–2023) of the U.S. National Survey of Children’s Health, including 205,480 children aged 3–17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes; comorbid ADHD and ASD were examined secondarily. Social determinants included household income relative to the federal poverty level, parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Survey-weighted prevalence estimates and logistic regression models accounted for the complex sampling design and adjusted for demographic, family, regional, and temporal factors. Results: The weighted prevalence of ADHD was 9.7% and ASD was 2.9%; 1.1% of children had comorbid ADHD and ASD. Lower household income, food insecurity, unsafe neighborhood conditions, and lower parental education were associated with higher adjusted odds of both conditions. Boys had substantially higher odds of ADHD and ASD. After adjustment, non-Hispanic Black and Hispanic children had lower odds of ASD than non-Hispanic White children, consistent with differential identification rather than lower underlying prevalence. Comorbidity was concentrated among socially disadvantaged children. Conclusions: ADHD and ASD are socially patterned across U.S. children. Integrating developmental screening with assessment of social risks may support more equitable identification and intervention. Full article

Fiscal capacity is a core dimension of state capacity. Effective oversight of public expenditure is therefore essential for fiscal sustainability, a foundational element of sustainable development. As local government debt has steadily increased in China, participatory budgeting has emerged as an innovative mechanism for citizens to exercise such oversight and influence fiscal decisions. Our paper examines the effect of participatory budgeting on local government debt in China. Using a panel dataset covering 242 Chinese cities from 2013 to 2022, we examine the effect of participatory budgeting adoption on the scale of explicit government debt. Our results show that adopting participatory budgeting moderately reduces local government debt levels. Further mechanism analysis indicates that participatory budgeting operates through two channels. First, by enhancing budgetary transparency, it strengthens public scrutiny, which in turn disciplines government borrowing. Second, it redirects public spending toward welfare sectors like education and health, thereby crowding out large, debt-financed investment projects. Our findings contribute to the literature on participatory budgeting, fiscal democracy, and bottom-up accountability in public finance. The results suggest that participatory budgeting can be an effective policy tool for improving fiscal discipline and curbing government debt risks, ultimately fostering more sustainable and equitable local governance. Full article

Background: Evidence suggests that physical activity and fitness tend to decline during the transition to higher education, yet the influence of institutional environment on these variables remains unclear. Objectives: This study aimed to compare physical fitness and physical activity levels between first-year students from two higher education institutions within the same national context. Methods: Fifty-eight male university students (IPB (Instituto Politécnico de Bragança): n = 31; IPG (Instituto Politécnico da Guarda): n = 27; mean age IPB = 19.2 ± 1.8 years; IPG = 19.8 ± 5.5 years) were assessed for body composition, handgrip strength, mid-thigh pull, standing long jump, stork balance, flexibility, and estimated VO_2max (StepTest4all). Physical activity levels were determined using the International Physical Activity Questionnaire (IPAQ) and were classified as low, moderate, or high. Between-group comparisons were performed using independent samples t-tests, with statistical significance set at p < 0.05. Results: Students from IPB presented significantly higher IPAQ scores (2.97 ± 0.18) compared with those from IPG (2.56 ± 0.64; t = 3.235, p = 0.003, d = 0.90), along with superior standing long jump performance (1.95 ± 0.15 m vs. 2.12 ± 0.24 m; t = −3.239, p = 0.002, d = 0.85). No significant differences were observed for body composition, strength, flexibility, balance, psychological well-being or VO_2max (all p > 0.05), although small effects were noted for flexibility (d = 0.50) and VO_2max (d = 0.48). The distribution of physical activity categories revealed that 96.8% of IPB students were classified as highly active, whereas IPG students were more evenly distributed across high (63.0%), moderate (28.6%), and low (7.4%) activity levels. Conclusions: These findings indicate that institutional environment and access to exercise opportunities may influence physical activity behavior and lower-limb power in university students. Promoting structured physical activity programs and recreational opportunities within higher education may help sustain adequate fitness and health in this population. Full article

The agroecological (AE) transition of agri-food systems can help address climate change impacts in Tunisia, including reduced local food production and high import dependency, but it requires understanding consumer behavior toward eco-friendly food products. Thus, a survey of 521 Tunisian consumers was conducted to assess environmental awareness and willingness to pay (WTP) for food produced under AE practices. Principal Component Analysis (PCA) indicated that sustainable consumption is mainly influenced by knowledge of AE practices, which is stronger among consumers with higher education and income. However, WTP for sustainable products remains low, making it essential to develop marketing strategies that target distinct demographic groups, improve product labeling, and enhance environmental education. Full article

Background: Vietnam is undergoing a rapid nutrition transition, yet evidence on nutrient intake and inadequacy among adolescents and young adults remains limited. This study aimed to assess nutrient intakes and patterns of inadequacy among Vietnamese youth aged 16–25 years across population groups and regions. Methods: A cross-sectional study was conducted among 1005 participants from five provinces in northern, central, and southern Vietnam. Dietary intake was assessed using a two-stage 24 h recall, and nutrient inadequacy was evaluated using Estimated Average Requirement (EAR), Acceptable Macronutrient Distribution Range (AMDR), and Estimated Energy Requirement (EER) reference standards. Results: Energy and macronutrient intakes differed across groups. University students had the lowest energy intake, while young workers consumed the highest proportion of carbohydrates. Calcium inadequacy exceeded 95% in all subgroups. Regional disparities were observed, with lower intakes of several micronutrients in the South. Compared with high school students, university students showed higher risks of inadequate protein and vitamin A intake, whereas young workers exhibited lower risks of inadequate carbohydrate and folate intake but a higher risk of vitamin A inadequacy. Conclusions: Vietnamese youth exhibited substantial micronutrient inadequacies with marked variation across groups and regions. These findings underscore the need for targeted nutrition interventions tailored to specific youth contexts. Full article

As artificial intelligence (AI) technologies and Virtual Exchange (VE) become increasingly embedded in higher education, AI-driven digital humans have begun to feature in design-oriented virtual international workshops, providing a novel context for examining learner behaviour. This study develops a structural model to examine the links between system support, interaction processes, self-efficacy, satisfaction, and international learning intention. Specifically, it investigates how perceived AI support, system ease of use, and interaction intensity influence students’ continuous participation in international learning through the mediating roles of learning self-efficacy, interaction quality, and satisfaction. Data were collected through an online questionnaire administered to undergraduate and postgraduate students who had participated in an AI-driven digital human–supported online international design workshop, yielding 611 valid responses. Reliability and validity analyses, as well as structural equation modelling, were conducted using SPSS 22 and AMOS v.22.0. The results show that perceived AI support, system ease of use, and interaction intensity each have a significant positive effect on learning self-efficacy and interaction quality. Both self-efficacy and interaction quality, in turn, significantly enhance learning satisfaction, which subsequently increases students’ intentions for sustained participation in international learning. Overall, the findings reveal a coherent causal chain: AI-driven digital human system characteristics → learning process experience → learning satisfaction → sustained participation intention. This study demonstrates that integrating AI-driven digital humans can meaningfully improve learners’ process experiences in virtual international design workshops. The results provide empirical guidance for curriculum design, pedagogical strategies, and platform optimization in AI-supported, design-oriented virtual international learning environments. Full article

While Greek EFL learners’ pragmatic competence has been frequently investigated, few studies have focused on Greek EFL teachers’ pragmatic knowledge. Complementing these earlier studies based on semi-structured interviews, we employed an extended online questionnaire and discourse completion tasks (DCTs) to explore the pragmatic competence of 72 Greek EFL teachers. Pragmatic comprehension was evaluated using scenarios that required participants to assess speech acts, while their ability to produce pragmatically appropriate responses was also assessed. Likert-scale items explored teachers’ perceptions about L2 instruction and their own abilities in this regard. Findings suggest that Greek EFL teachers possess an above average level of pragmatic competence, which nevertheless has not led to them systematically integrating L2 pragmatics instruction in their classrooms. Additional qualitative data collected through semi-structured interviews suggest that teachers’ lack of integration of explicit pragmatics instruction is not due to their not recognizing its importance, but rather to feeling inadequately prepared to implement this, which in turn points to the lack of emphasis on L2 pragmatics in teacher education programs. We catalog the most significant challenges in incorporating L2 pragmatics instruction in Greek EFL classrooms in terms of teacher and learner factors, as well as the Greek EFL context itself. Full article

Biodiversity knowledge is fundamental to conservation planning and sustainable environmental decision-making; however, general-purpose Large Language Models (LLMs) frequently produce hallucinations when responding to biodiversity-related queries. To address this challenge, we propose BioChat, a domain-specific question-answering system that integrates a Retrieval-Augmented Generation (RAG) framework with a Re-Ranker–based retrieval and routing mechanism. The system is built upon a verified biodiversity dataset curated by the National Institute of Biological Resources (NIBR), comprising 25,593 species and approximately 970,000 structured data points. We systematically evaluate the effects of embedding selection, routing strategy, and generative model choice on factual accuracy and hallucination mitigation. Experimental results show that the proposed Re-Ranker-based routing strategy significantly improves system reliability, increasing factual accuracy from 47.9% to 71.3% and reducing hallucination rate from 34.0% to 24.4% compared with Naive RAG baseline. Among the evaluated LLMs, Qwen2-7B-Instruct achieves the highest factual accuracy, while Gemma-2-9B-Instruct demonstrates superior hallucination control. By delivering transparent, verifiable, and context-grounded biodiversity information, BioChat supports environmental education, citizen science, and evidence-based conservation policy development. This work demonstrates how trustworthy AI systems can serve as sustainability-enabling infrastructure, facilitating reliable access to biodiversity knowledge for long-term ecological conservation and informed public decision-making. Full article

The intention of trans and queer (TQ) center(ed) diversity work is to address the persistence of heterosexism, trans oppression, and other manifestations of oppression in higher education. Yet, TQ center(ed) diversity work has often been in a precarious position of understaffing and limited resources. In the current moment, the impact of anti-DEI legislation on TQ center(ed) diversity work is evident by the recent shutting down of centers and services across the United States. Yet, how do those in these roles navigate these challenges and still imagine liberatory futures in the face of such legislation? This paper stems from a larger participatory action research project, which explored the narratives of 14 TQ center(ed) diversity workers as they navigated the tumultuous sociopolitical climate that seeks to disrupt and/or defund their work. Our findings underscored how TQ center(ed) diversity workers found ways to subversively navigate their practice in the face of anti-DEI legislation, including empowering students to engage in the action of ‘complaints.’ Additionally, their stories revealed the challenges in being able to think about liberation within an institutionalized role, especially given the spectrum of sociopolitical contexts where they were present. Full article

Background/Objectives: This systematic review examines neuroplasticity-informed approaches to learning under cognitive load, synthesizing evidence from functional imaging, brain stimulation, and educational technology research. As digital learning environments increasingly challenge learners with complex cognitive demands, understanding how neuroplasticity principles can inform adaptive educational design becomes critical. This review examines how neural mechanisms underlying learning under cognitive load can inform the development of evidence-based educational technologies that optimize neuroplastic potential while mitigating cognitive overload. Methods: Following PRISMA guidelines, we synthesized 94 empirical studies published between 2005 and 2025 across PubMed, Scopus, Web of Science, and PsycINFO. Studies were selected based on rigorous inclusion criteria that emphasized functional neuroimaging (fMRI, EEG), non-invasive brain stimulation (tDCS, TMS), and educational technology applications, which examined learning outcomes under varying cognitive load conditions. Priority was given to research with translational implications for adaptive learning systems and personalized educational interventions. Results: Functional imaging studies reveal an inverted-U relationship between cognitive load and neuroplasticity, with a moderate challenge in optimizing prefrontal-parietal network activation and learning-related neural adaptations. Brain stimulation research demonstrates that tDCS and TMS can enhance neuroplastic responses under cognitive load, particularly benefiting learners with lower baseline abilities. Educational technology applications demonstrate that neuroplasticity-informed adaptive systems, which incorporate real-time cognitive load monitoring and dynamic difficulty adjustment, significantly enhance learning outcomes compared to traditional approaches. Individual differences in cognitive capacity, neurodiversity, and baseline brain states substantially moderate these effects, necessitating the development of personalized intervention strategies. Conclusions: Neuroplasticity-informed learning approaches offer a robust framework for educational technology design that respects cognitive load limitations while maximizing adaptive neural changes. Integration of functional imaging insights, brain stimulation protocols, and adaptive algorithms enables the development of inclusive educational technologies that support diverse learners under cognitive stress. Future research should focus on scalable implementations of real-time neuroplasticity monitoring in authentic educational settings, as well as on developing ethical frameworks for deploying neurotechnology-enhanced learning systems across diverse populations. Full article

Introduction: The Mediterranean Diet is known for its protective effects against cardiovascular and metabolic diseases. Metabolic syndrome, characterized by multiple health risk factors, is increasingly concerning in older populations. Understanding dietary impacts on metabolic health is key for promoting healthy ageing. Objectives: This feasibility study aimed to explore the relationship between adherence to the Mediterranean Diet and metabolic risk factors in older adults participating in a community exercise program and to evaluate the feasibility of applying validated tools in this setting. Methods: A cross-sectional design was used. Adherence to the Mediterranean Diet was evaluated using the PREDIMED questionnaire, while Metabolic Syndrome was evaluated according to National Cholesterol Education Program criteria. Blood samples were taken following WHO guidelines. Results: Ten participants (mean age 73.1 years; 90% women) were included. 50% showed high adherence to the Mediterranean Diet, while 40% had moderate or low adherence. No participants met the full criteria for Metabolic Syndrome. Significant associations were found between Mediterranean Diet adherence and chronic disease (r = 0.869, p < 0.01), and an inverse correlation with the number of Metabolic Syndrome criteria (r = –0.707, p < 0.05). The Mediterranean Diet score was also inversely related to cholesterol (r = –0.740, p < 0.05). Conclusions: Higher adherence to the Mediterranean Diet was associated with better metabolic profiles, highlighting its potential protective role. The study demonstrates the feasibility of incorporating nutritional screening in community exercise programs for older adults. Future research should include larger and longitudinal samples and integrate inflammatory biomarkers. Full article

Background: Schools play a central role in child development and socialization and can function as protective environments that mitigate the effects of adversity. Building on the Social Ecological Model and Community School Transformation, we propose a “Schools-as-Neighborhoods” framework that conceptualizes schools as intentionally designed microenvironments capable of generating social capital, promoting positive childhood experiences, and buffering harmful neighborhood exposures through trauma-informed programming. Methods: We conducted a convergent mixed-methods study across four public and charter schools in Milwaukee, Wisconsin, serving grades five through nine. STRYV365’s peak team and Brain Agents gamified intervention were implemented between 2022–2024. Quantitative surveys and qualitative data assessed students’ lived experiences, exposure to adversity, emotional awareness, coping skills, and school connectedness/climate across multiple waves. Results: Across the four schools (n = 1626 students), baseline academic proficiency was low, and exposure to adversity was high among surveyed participants (n = 321), including bereavement (74%) and family incarceration (56%). Despite these challenges, qualitative findings revealed strengthened emotional regulation, empathy, motivation, and goal setting among students engaged in trauma-informed programming. Teachers reported improved peer interaction and community building during sustained implementation. Conclusion: The Schools-as-Neighborhoods framework highlights the value of trauma-informed, relationship-centered school environments in promoting student well-being. By positioning schools as cohesive ecosystems that foster belonging and cultivate social capital, this approach offers educators and policymakers a pathway for mitigating the effects of hostile lived environments and supporting students’ mental health, social development, and engagement in learning. Full article

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

This study examines agricultural labour dynamics and sustainability practices in East Crete, assessing how labour structure, education, and input intensity shape ecological outcomes. Using data from 108 farms in Heraklion and Lassithi, we constructed composite indicators, such as Labour Intensity, Sustainability Engagement, and Training-Adjusted Labour indices. Analysis of 37 farms with data revealed a heterogeneous landscape. Traditional family-based systems persist alongside uneven shifts toward agroecological practices. The Training-Adjusted Labour Index correlated with reduced pesticide use, while subsidy participation alone was not a reliable predictor of sustainable behaviour. Findings highlight limits of compliance-based incentives and the importance of knowledge-driven transitions. This study advocates typology-informed policies and longitudinal research for future policy design. Full article

Homegardens are traditional agroforestry systems that harbor genetic resources and ancestral knowledge, as well as contributing to food security and self-sufficiency in many rural communities. In this study, we analyze homegardens in a Mixtec community in coastal Oaxaca, Mexico, to document their arrangement and components, the useful flora and fauna they contain, and the social, cultural and economic aspects associated with their management. We used snowball sampling to perform semistructured interviews with 36 women in charge of homegardens, which represented 10% of the total homes in the community. During guided tours, we diagrammed the homegardens and collected and identified plant specimens to compile a full floristic listing. Plant specimens were deposited in the CHAP herbarium. We also calculated the Jacknife alpha diversity index and Sorensen’s beta diversity index to quantify the diversity of the garden flora. We summarized the interview data using descriptive statistics and performed a multiple regression analysis to evaluate the effects of the size of the homegarden and the homegarden owner’s age, years of school attendance, and language use on the number of useful plant species in the garden. Additionally, we conducted a multiple correspondence analysis on the homegardens, the sociodemographic variables, and the plant species contained. The components of the homegardens were the main dwelling, patio, kitchen, bathroom, chicken coop, and pigpen. We documented 15 animal species from 15 genera and 13 families and 236 plant species from 197 genera and 84 families. The most represented plant families were Araceae, Fabaceae and Apocynaceae. The main plant uses were ornamental, edible, and medicinal. The multiple correspondence analysis and multiple regression both showed sociodemographic variables to make a very low contribution to homegarden species richness (evidenced by low percentage variance explained and no statistically significant effects, respectively). The first-order Jacknife diversity index estimated a total of 309 plant species present in the homegardens, indicating high agrobiodiversity. The Sorensen index value ranged from 0.400 to 0.513. Similarity among the gardens was mostly due to high similarity among edible plants. There was community-level resilience in family food self-sufficiency, as 80.56% of the interviewees use harvest from their homegardens to cover their families’ food needs. Women play a central role in the establishment and management of the gardens. Overall, our findings demonstrate that homegardens in this community are sustainable; have high agrobiodiversity; provide food, medicine, and well-being to residents; contribute to food self-sufficiency; and conserve agrobiodiversity as well as traditional culture and knowledge. Full article

Panoramic radiography remains a cornerstone diagnostic tool in dentistry; however, its two-dimensional nature limits the visualisation of complex maxillofacial anatomy. Three-dimensional reconstruction from single panoramic images addresses this limitation by computationally generating spatial representations without additional radiation exposure or expensive cone-beam computed tomography (CBCT) scans. This systematic review and conceptual study traces the evolution of 3D reconstruction approaches, from classical geometric and statistical shape models to modern artificial intelligence-based methods, including convolutional neural networks, generative adversarial networks, and neural implicit fields such as Occudent and NeBLa. Deep learning frameworks demonstrate superior accuracy in reconstructing dental and jaw structures compared to traditional techniques. Building on these advancements, this paper proposes HoloDent3D, a theoretical framework that combines AI-driven panoramic reconstruction with real-time holographic visualisation. The system enables interactive, radiation-free volumetric inspection for diagnosis, treatment planning, and patient education. Despite significant progress, persistent challenges include limited paired 2D–3D datasets, generalisation across anatomical variability, and clinical validation. Continued integration of multimodal data fusion, temporal modelling, and holographic visualisation is expected to accelerate the clinical translation of AI-based 3D reconstruction systems in digital dentistry. Full article

(1) Background: With the continuous development of intelligent education, classroom behavior recognition has become increasingly important in teaching evaluation and learning analytics. In response to challenges such as occlusion, scale differences, and fine-grained behavior recognition in complex classroom environments, this paper proposes an improved YOLOv11-ASV detection framework; (2) Methods: This framework introduces the Adaptive Spatial Pyramid Network (ASPN) based on YOLOv11, enhancing contextual modeling capabilities through block-level channel partitioning and multi-scale feature fusion mechanisms. Additionally, VanillaNet is adopted as the backbone network to improve the global semantic feature representation; (3) Conclusions: Experimental results show that on our self-built classroom behavior dataset (ClassroomDatasets), YOLOv11-ASV achieves 81.5% mAP₅₀ and 62.1% mAP_50–95, improving by 1.6% and 2.9%, respectively, compared to the baseline model. Notably, performance shows significant improvement in recognizing behavior classes such as “reading” and “writing” which are often confused. The experimental results validate the effectiveness of the YOLOv11-ASV model in improving behavior recognition accuracy and robustness in complex classroom scenarios, providing reliable technical support for the practical application of smart classroom systems. Full article

Background: An increasing number of university students report feeling lonely, a negative experience arising from a mismatch between perceived and actual social relationships. Loneliness has been linked to poorer mental health. However, the relationship between qualitative (sources of loneliness) and quantitative (high or low) differences in loneliness and mental health is under researched. The aims of this research were to (a) identify profiles of loneliness among university students across three indicators of loneliness, namely, social, family, and romantic indicators, using latent profile analysis (LPA); (b) examine the differences among identified profiles based on dimensions of mental health indicators (depression, anxiety, and stress), social support, and life satisfaction; and (c) assess profile membership based on demographic variables (gender, social isolation, relationship status, and education characteristics) and the Big Five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism). Method: A cross-sectional survey was conducted on 912 university students from five cities in Uttar Pradesh, India. Participants completed questionnaires covering demographic details and validated measures assessing loneliness, depression, stress, anxiety, social support, life satisfaction, and the Big Five personality traits. Data were analyzed using the latent profile module in Jamovi and fit indices, namely, BIC, AIC, and BLRT, and entropy was used to select the best profile. Results: The latent profile analysis identified four profiles for university student loneliness, including Social and emotional lonely (31.4%), Moderate romantic lonely (23.8%), Moderate social lonely (8.2%), and Severe romantic lonely (36.6%). Moreover, the Social and emotional lonely profile scored the highest on depression, anxiety, and stress. The Moderate romantic lonely profile scored the highest on life satisfaction and social support. Being in a relationship decreased the likelihood of being categorized as Severe romantic lonely. In terms of personality, neuroticism was the strongest predictor of profile membership. This study is a step towards identifying at-risk lonely individuals with varying sources of loneliness. Identifying different profiles of lonely individuals will have direct implications for designing interventions that cater to a particular group rather than a one-size-fits-all approach. Full article

The Fozu tongji 佛祖統紀 (Comprehensive Records of the Buddha and Patriarchs), compiled by the Tiantai monk Zhipan 志磐 during the Song dynasty, is a seminal work in the history of historiography. This article focuses on its inclusion process during the Ming dynasty, revealing the interplay between textual transmission and political power. Through primary source analysis and textual criticism, this article examines how the Fozu tongji became included in Ming court editions of the Buddhist Canon. Two main conclusions emerge: First, the Fozu tongji—a text documenting the history of the Tiantai school—was formally included through advocacy by Puqia 溥洽 of the seng lu si 僧錄司 (Buddhist Registry Office), signifying the imperial rulers’ recognition of the Tiantai school. Second, to align with state ideology, all prophecy-related content was systematically eliminated from the original text. This case study provides a window into practices of religious governance in the early Ming Dynasty. Furthermore, it enriches the scholarly understanding of the dissemination history of the Fozu tongji and also provides broader insights on the inclusion of Buddhist texts. While inclusion in the canon elevated the Fozu tongji’s influence, the text was altered under the ideological “purification” imposed by the state. Full article

Background/Objectives: The impact of choline on congenital heart defects (CHDs) in humans remains unclear. This study aimed to investigate the associations between maternal dietary intakes of choline and choline derivatives during pregnancy and CHD. Methods: This case–control study included 474 cases and 948 controls from hospitals in Northwest China. Pregnant women admitted for delivery were enrolled and completed a validated food frequency questionnaire to assess their dietary intake during pregnancy. A standardized questionnaire was also administered to collect additional pregnancy-related information. Mixed logistic regression models were used to estimate ORs (95%CIs) for CHD in association with choline intake. Results: Higher intakes of total choline, phosphatidylcholine, sphingomyelin, glycerophosphocholine, and phosphocholine in pregnancy were associated with reduced risks of total CHD, ventricular septal defects, and atrial septal defects, with all trend tests showing statistical significance (all p < 0.05). The ORs (95%CIs) of total CHD, comparing the highest with the lowest tertiles of intake, were 0.38 (0.24–0.61) for total choline, 0.51 (0.38–0.70) for phosphatidylcholine, 0.37 (0.26–0.51) for sphingomyelin, 0.34 (0.21–0.53) for glycerophosphocholine, and 0.53 (0.34–0.82) for phosphocholine. The inverse associations remained unchanged according to maternal age, work, education, parity, passive smoking, anemia, medication use, or folate/iron supplements use in pregnancy; however, these associations appeared to be more pronounced among pregnant women in urban areas. Conclusions: Higher maternal intake of dietary choline during pregnancy may be associated with a lower risk of CHD. Promoting choline intake in pregnant women could serve as a potential strategy for the primary prevention of fetal CHD in China. Full article