Search Results (599)

This article presents a practice-oriented methodological proposal for designing inclusive multimodal learning content with Generative AI (GAI) in migrant adult literacy. It does not report an experimental intervention or a statistical evaluation of learning outcomes. Its contribution lies in formalizing a context-sensitive design pathway for early preA1–A2 literacy and language-learning provision in Italian CPIA settings, where learner profiles are highly heterogeneous, attendance may be discontinuous, and written language is both a learning goal and a barrier to participation. Unlike generic AI-supported instructional design frameworks, the proposed approach starts from recurrent communicative needs in adult migrant education and translates them into short, modular and reusable learning artifacts that coordinate textual, visual, audio-oral and interactive layers. The framework distinguishes multimodal design, understood as the pedagogical coordination of different semiotic modes, from the mere use of multiple media. It also integrates accessibility as a set of concrete design criteria, including linguistic readability, visual clarity, audio quality, layout, font size, contrast, cognitive load and usability in print or mobile formats. The article outlines a sequence of design operations: mapping learner profiles, selecting situated communicative scenarios, generating and revising textual material, developing visual and audio scaffolds, structuring guided interaction, and applying pedagogical, cultural and ethical review. An illustrative micro-unit on asking for information at a municipal office shows how this pathway can support dialog, visual glossary, audio practice, role-play and formative assessment. The proposal is intended for CPIA educators, adult literacy professionals, instructional designers and researchers in multimedia learning and educational technology. Its educational implication is that GAI can support inclusive material design only when its outputs are treated as provisional resources to be selected, adapted and validated through human pedagogical judgment. Full article

Speech deepfake detection (SDD) is commonly formulated as offline utterance-level binary classification, which limits early decisions in streaming communication and provides little mechanism-level evidence for a spoofing prediction. We propose C-MCSS-Mamba, a block-causal SDD framework that processes fixed-duration audio blocks with a partially fine-tuned XLS-R frontend and carries detection states across blocks through Mamba. Its selective scan is replaced by the proposed Counterfactual Mechanism-Contrastive Selective Scan (C-MCSS), which maintains shared, text-to-speech (TTS), and voice conversion (VC) states. Frame-level TTS/VC hypotheses directly modulate state update, retention, and forgetting. A Causal Counterfactual Evidence Reliability Module (C-CERM) further suppresses transient mechanism evidence through a recurrent reliability state that adaptively regulates these dynamics. Model-internal TTS/VC evidence is obtained by counterfactually disabling the corresponding recurrent state and measuring the resulting spoof-logit decrease. The model produces prefix-level spoof decisions and contribution-based state-dependence measures; these measures only characterize the model’s internal decision process, and do not identify the physical speech generation process of an individual sample. A joint objective combines detection, early-prefix, mechanism, contrastive, and intervention supervision. Experiments demonstrate competitive detection performance, achieving $0.47\%$ EER on the ASVspoof 2019 LA evaluation set while maintaining effectiveness across four cross-dataset benchmarks. Full article

Background/Objectives: Magnetic resonance imaging (MRI) is often supported by structured safety screening and preparation, yet first-time patients may still experience anxiety, claustrophobic distress, loss of control and non-completion. This study aimed to describe the experiences of adults undergoing MRI for the first time and to identify implications for nursing preparation, communication and diagnostic imaging service design. Methods: A descriptive phenomenological study informed by Husserlian philosophy was conducted in the radiology department of a university hospital in Thailand. Eleven adults who underwent first-time MRI were purposively recruited, including eight who completed and three who did not complete the examination; five participants were hospital personnel. Data were generated through in-depth semi-structured interviews, non-participant observation, audio recording and field notes, and were analysed using Colaizzi’s method. Results: Across the four themes, negotiation of control was identified as a descriptive cross-theme pattern grounded in participants’ accounts rather than as a separate interpretive construct. Participants entered MRI seeking diagnostic clarity, encountered a sensory and spatial environment that weakened control, attempted to regain control through coping and communication, and reflected on the support they would need for any future examination. Four interrelated themes were generated: becoming aware of bodily abnormality and accepting MRI; encountering the MRI environment; managing oneself inside the scanner; and reflecting after passing through the experience. Conclusions: The findings suggest that first-time MRI can be experienced as a nursing-relevant care encounter rather than a neutral technical event. Nursing preparation may need to move beyond routine instructions by addressing sensory realities, anxiety and claustrophobia, coping rehearsal, communication options and post-examination reflection. The effects of these strategies on completion and service outcomes require prospective evaluation. Full article

Real-time multilingual communication (RTMC) is increasingly important in academic, governmental, defense, and clinical settings, where cloud-based speech processing may raise privacy, data sovereignty, connectivity, and cost concerns. This study presents Yapzek Stream, a fully offline multilingual broadcasting and speech-translation platform that performs speech recognition, translation, and text-to-speech synthesis within institution-owned infrastructure. The system integrates Web Real-Time Communication (WebRTC)-based broadcasting with locally hosted artificial intelligence (AI) services and provides multilingual audio delivery, browser-based access, recording, transcript and subtitle export, and institutional authentication. The platform was evaluated through an implementation-oriented analysis and a university pilot involving two live sessions with 10 and 50 participants and 12 semi-structured interviews. Estimated end-to-end processing latency was 1.8–4.1 s, while pilot observations ranged from approximately 2 s for short utterances to 4.5–5 s for longer speech. The results indicate the feasibility of offline multilingual broadcasting for privacy-preserving and institution-controlled communication. Deployment-specific accuracy and translation evaluation, controlled scalability and GPU-utilization measurements, robustness testing, and larger-scale user-acceptance studies remain for future work. Full article

Background: Australia has experienced high rates of antibiotic shortages, yet little is known about how Australian pharmacists experience and manage them. This study aimed to explore Australian community and hospital pharmacists’ experiences of antibiotic shortages, including their perceived clinical impact and approaches to managing shortages. Methods: An exploratory qualitative study using semi-structured interviews was conducted with Australian community and hospital pharmacists between May and August 2024. Participants were recruited via convenience sampling through professional networks and social media. Interviews were audio-recorded, transcribed verbatim, and analysed thematically using an inductive–deductive approach, with coding performed independently by two researchers. Results: Fifteen interviews were conducted before data saturation was reached. Sixty percent of participants were female, 67% worked in hospital settings, and pharmacists were located across five Australian states. Four overarching themes were identified: factors driving shortages, communication and collaboration, impact of shortages, and mitigation and prevention. Pharmacists described antibiotic shortages as frequent and unpredictable, attributing them to supply-chain vulnerabilities, limited manufacturing, and market competition. Shortages were reported to affect treatment choice, contribute to antimicrobial resistance concerns, increase pharmacist workload and stress, and negatively affect patients. Pharmacists used strategies such as stock management, collaboration, and importing alternatives, but felt that lasting solutions required coordinated national action. Conclusions: Australian pharmacists perceive antibiotic shortages as a complex challenge affecting patient care, antimicrobial stewardship, workload, and healthcare efficiency. While pharmacists have developed reactive strategies to manage shortages, stronger communication, collaboration, and national policy coordination, alongside improved supply-chain resilience, are needed to reduce the impact of future shortages. Full article

Background/Objectives: Obstetric violence is increasingly recognised as a violation of women’s autonomy, dignity, and right to respectful maternity care, yet its interpretation may differ between women receiving care and midwives providing care within hospital systems. This study explored obstetric violence from the perspectives of women who perceived their childbirth as traumatic and midwives working in hospital birth settings. Methods: This qualitative study was conducted in one university hospital and two public hospitals in Türkiye. Data were collected through individual semi-structured interviews with 21 women who had experienced vaginal birth within the previous year and 20 midwives with labour and delivery experience. Interviews with women were conducted online, whereas interviews with midwives were conducted face-to-face. Interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis. Selected sociodemographic, obstetric, and organisational characteristics were collected descriptively to contextualise the findings. Results: Three interrelated themes were identified: lack of respectful maternity care, women’s emotional needs during childbirth, and systemic constraints affecting midwifery practice. Women described obstetric violence through emotional distress, loss of control, insufficient information, lack of consent, privacy violations, and imposed interventions. Midwives interpreted these experiences in relation to workload, institutional routines, physician-centred decision-making, and limited professional autonomy. Conclusions: Preventing obstetric violence requires improvements in communication, informed consent, privacy, emotional support, and system-level conditions that enable respectful, woman-centred care. Full article

Introduction: Friendship bereavement is under-recognised, and grief following a drug-related death may be compounded by stigma and limited social validation. This study examines how bereaved friends understand and experience grief, focusing on how relational dynamics, social context, and existential concerns shape bereavement. Methods: We undertook a qualitative study embedded in a Norwegian project on drug-related death bereavement. Fourteen bereaved friends (8 men, 6 women; 21–54 years) completed semi-structured interviews. Data were audio-recorded, transcribed verbatim, de-identified, and analysed using reflexive thematic analysis within an interpretive qualitative tradition. Ethics approval and written informed consent were obtained. Results: From the analysis, four interconnected themes were generated: (1) Meaningful bonds under pressure: friendships were deeply significant yet increasingly strained as substance use escalated, generating ethical and emotional labour and fluctuating closeness. (2) The struggle for recognition: friends often occupied marginal positions in grief hierarchies; family inclusion was profoundly validating, whereas absent recognition fostered isolation. (3) Moral ties and relational guilt: post-loss self-scrutiny centred on whether to remain close, step back, or repeatedly recalibrate involvement. (4) An existential turning point: losing a close friend with whom one shared important life experiences prompted reflection on vulnerability, mortality, and life direction. Discussion: Bereavement following drug-related death is not only emotional but socially negotiated and existentially charged. Practice may benefit from recognising friends as mourners and more deliberately including them in rituals and communication where appropriate; research should treat friends as a distinct group and examine how pre-loss relational labour and stigma shape grief trajectories. Highlights: 1. Friendship as an under-examined context of drug-death bereavement: This study advances limited scholarship by showing how friends navigate grief after a drug death, where relational strain, stigma, and emotional and ethical responsibilities profoundly shape the bereavement experience; 2. Recognition of friends as bereaved is crucial: Friends grieving a drug death are often marginalised within social grief hierarchies. When families and services acknowledge the friendship, it affirms their loss and may reduce isolation and stigma; 3. Losing a close friend with whom one shares important life experiences carries strong existential weight: The death of a close friend prompts deep reflection on vulnerability, life direction, and personal responsibility, making grief both emotionally demanding and existentially significant. Full article

Background/Objectives: AI voice interpretation applications like Google Translate in speech/voice mode are increasingly used in clinical settings to address verbal language access challenges, yet evidence comparing their performance to qualified in-person medical interpreters in authentic clinical encounters remains limited. The aim of this study is to compare the linguistic and clinical accuracy of AI-based Google Translate in speech/voice mode and qualified in-person medical interpretation using spoken real-world speech segments from clinical encounters. Methods: Outpatient clinical encounters involving patients with limited English proficiency were audio-recorded. Fourteen physician speech segments (mean length 78.5 words) representing common diagnostic, treatment, and counseling content were extracted, spoken in English into Google Translate speech/voice mode, and translated into six languages. Audio recordings of the same sentence segments were provided to qualified in-person medical interpreters. All non-English translations were back-translated into English by professional interpreters. Researchers and a clinician evaluated the back-translated English speech segments for linguistic accuracy, completeness, and clinical significance. Qualitative analyses examined error patterns and contextual loss; quantitative comparisons assessed error rate differences across languages and interpretation conditions. Results: Google Translate in speech/voice mode exhibited significantly higher linguistic errors (χ²[1] = 19.78, p < 0.001) and clinical accuracy errors (χ²[1] = 45.07, p < 0.001) than qualified medical interpreter translations. Clinically significant error rates were 33.3% for Google Translate in speech/voice mode versus 4.8% for interpreter-generated translations. Error rates were also higher for less commonly spoken languages compared to commonly spoken languages when using Google Translate in speech/voice mode (42.9% vs. 14.3%). Conclusions: Qualified in-person interpreters provided translated speech segments that had fewer errors that were either linguistically or clinically significant, and remain essential for safe, accurate clinical communication. Full article

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT. Full article

With the increasing diversity of multimedia data types, single-modal steganography is insufficient to meet the demand for the simultaneous covert communication of multiple types of data, and single optical transformation encryption schemes are insufficiently secure against cryptanalytic attacks. To address these challenges, this paper designs and implements a multimodal secret information steganography system based on the optical Gyrator transform. We propose a multimodal steganographic system for the covert transmission of three types of heterogeneous secret data—text, color images, and audio—using a three-level cascaded optical encryption architecture. The system first uniformly encapsulates the multimodal data into a unified bitstream via a Type–Length–Value (TLV) format; it then uses the Ushiki chaotic map to generate a pure phase mask for random phase modulation of the carrier image, followed by spatial-frequency scrambling via a fractional Fourier transform (FrFT, order γ = 1.6). The secret bitstream is embedded into all eight bit planes of the amplitude components in the FrFT domain using binary square representation, achieving an embedding capacity of 2.23 × 10⁶ bits—approximately 8.5 times that of traditional LSB methods; finally, a speckle-noise-like ciphertext is output via a Gyrator transform (angle α = 0.5). Experiments demonstrate that under non-attack conditions, the system achieves lossless recovery with a zero bit-error rate. Under known-plaintext and chosen-plaintext attacks on the Gyrator layer, the PSNR of the recovered images was only 4.89 dB and 4.80 dB, respectively, and the secret information could not be effectively extracted, as the chaotic-FrFT pre-encryption statistically isolates the intermediate image from natural image statistics. This system provides a functionally complete and practically secure solution for multimodal covert communication. Full article

In this publication we investigate in depth the design, architecture and implementation of a bio and cultural guiding system with augmented capabilities. Our platform will be able to provide a flexible and user-friendly application for smart mobile devices with Android OS, which will be able to provide to the user the ability to discover nearby places of interest such as museums, archeological sites, religious sites, natural beauty sites, etc. In addition, our application is able to offer users an enhanced, comprehensive and augmented tour experience, based on visual and audio smartphone services, using asynchronous and real-time user–server communication mechanisms, thus eliminating the need for a human tour guide operator in cases of a remote area, guiding service cost or unavailable time slot. The proposed platform integrates visual overlays, audio narration, Geolocation services, and cloud-based data management to enable users to explore cultural, historical, and natural points of interest without the need for a human tour guide. A modular, layered system architecture is developed, combining Firebase Realtime Database, RESTful web services, OpenStreetMap-based navigation, and Android-native components to ensure scalability, flexibility, and real-time responsiveness. UML modeling, including class and sequence diagrams, is employed to formally describe system structure and behavior, while a mathematical data model validates the consistency of the underlying database schema. The implementation demonstrates how AR guiding systems can enhance spatial understanding, accessibility, and user engagement while supporting sustainable tourism practices and efficient destination management. The results indicate that the proposed solution is technically feasible, user-centered, and adaptable to diverse bio-cultural contexts, contributing to the advancement of intelligent, inclusive, and sustainable digital tourism platforms. Full article

Background: Empathy is essential for supportive nursing work environments, yet little is known about Generation Z (Gen Z) nurses’ experiences of empathy from colleagues and nurse managers. Aim: To examine Gen Z nurses’ experiences of empathy in workplace relationships with colleagues and nurse managers and the individual, generational, and institutional factors shaping these experiences. Methods: A qualitative descriptive study design was employed. Data were collected between October 2025 and March 2026 through semi-structured, in-depth interviews with 20 Gen Z nurses working in diverse clinical settings in Turkey. Participants were recruited using purposive and snowball sampling. Interviews were conducted via Zoom, audio-recorded with consent, and transcribed verbatim. Data were analyzed using Braun and Clarke’s reflexive thematic analysis framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the study reporting. Results: Four main themes were identified: (1) perceptions of empathy among Gen Z nurses, (2) empathy experiences in workplace relationships, (3) factors influencing empathy experiences, and (4) expectations for building an empathic work environment. Empathy was experienced through feeling understood, non-judgmental listening, and emotional and practical support, particularly in peer relationships. Hierarchical communication, perceived intergenerational differences, workload, and time pressure were key factors influencing workplace empathy experiences. Conclusions: Participants described empathy as a relational and context-dependent experience embedded in everyday workplace interactions. Their accounts suggest that supportive, non-hierarchical relationships may facilitate empathic engagement, whereas rigid communication styles and heavy workloads may act as barriers. These findings represent the experiences and interpretations of the Gen Z nurses interviewed and should not be read as objective comparisons between generations. Organizational strategies that support empathic communication and psychologically safe teamwork may help strengthen team cohesion and nurse retention. Full article

Background: Mental health problems are common among people living with HIV (PLWH); however, the use of mental health services remains inadequate in many low- and middle-income countries. Objectives: This study aimed to explore the perspectives of health professionals on the provision of mental health services for PLWH presenting with mental health problems in primary health care in Lesotho. Methods: A qualitative descriptive approach was adopted, involving semi-structured interviews with 50 health professionals who were purposely selected, including nurses and medical officers, each with a minimum of 2 years’ primary health care experience in the Maseru district. Data were collected between December 2022 and January 2023, audio-recorded, and transcribed verbatim. Data collection continued until thematic saturation was achieved, and analysis was conducted using a thematic framework analysis. Results: The analysis revealed two main themes: (1) limited knowledge of mental health problems, encompassing an inadequate understanding of signs and symptoms, diagnosis, and management, and (2) barriers to the management of mental health problems. Key subthemes included the shortage of qualified mental health specialists and psychiatric medications, the absence of dedicated counselling services for the prevention of mental health problems, lack of a mental health department, time constraints within clinical practice, and limitations in clinical infrastructure. Cultural beliefs, stigma, and discrimination, both among health professionals and in the broader community, were also identified as significant impediments. Participants described a substantial treatment gap, driven by insufficient training and limited resources, which undermines the effective delivery of mental health services. Conclusions: The findings revealed that health professionals working in primary health care in Lesotho experience considerable knowledge gaps and systemic constraints that hinder the provision of adequate mental health services for PLWH who have mental health problems. These challenges can be mitigated through targeted capacity building, the integration of MHS into primary care, improved resource allocation, and strategies to reduce stigma, thereby enhancing health outcomes. Full article

Social media have become central tools for government communication; however, they also present significant accessibility challenges for people with disabilities, particularly those with visual impairments. This study analyzes inclusive communication and digital accessibility practices in the official Facebook accounts of six Ecuadorian public institutions. A mixed-methods approach was employed, combining documentary analysis, a focus group with visually impaired users, and content analysis of 2429 Facebook posts published between 2023 and 2025. The analysis was conducted using four dimensions: propositional communication, copywriting, images, and videos. The results show that most publications only partially comply with accessibility criteria. While progress was identified in the use of clear and accessible language in textual content, significant deficiencies persist in multimedia content, particularly in the lack of alternative text, subtitles, and audio descriptions. The study concludes that inclusive communication in Ecuadorian public institutions remains fragmented and is not yet implemented as a cross-cutting public communication policy. Full article

Background: Mental health conditions remain a major yet underrepresented public health concern in Pakistan and globally, highlighting the need for innovative and complementary interventions. Nature-based interventions (NBIs), which involve structured engagement with natural environments to enhance health and wellbeing, offer a promising approach, particularly in the Hazara Division of Khyber Pakhtunkhwa, Pakistan, a region renowned for its Himalayan forests, scenic valleys, and rich biodiversity. Methods: This study employed a qualitative descriptive design to explore mental health clinicians’ perceptions of NBIs in community mental health settings. Fourteen clinicians from the Hazara Division, Khyber Pakhtunkhwa, Pakistan, were recruited using purposive and snowball sampling between February and March 2026. Data were collected through semi-structured interviews and audio-recorded. Transcripts were analysed using inductive thematic analysis following Braun and Clarke’s framework, supported by HyperRESEARCH software. Results: Participants generally perceived engagement with nature as calming, restorative, and therapeutically beneficial, and many reported informally encouraging clients to participate in nature-related activities. Clinicians expressed willingness to integrate NBIs into routine practice and identified potential benefits including improved mood, relaxation, empowerment, and enhanced social connectedness. However, several barriers were also identified, including client-related factors such as anxiety, low motivation, and skepticism, as well as contextual and organisational constraints such as gender-based limitations in access to natural spaces and safety-related policies. Conclusions: Despite these challenges, clinicians demonstrated strong support for NBIs, suggesting their potential as a feasible adjunct to mental health care in Pakistan. Addressing identified barriers may facilitate integration into routine services and enhance access to holistic mental health support in community settings. Full article