Search Results (8,349)

Against the background of deepening culture–tourism integration and growing concern for cultural sustainability, intangible cultural heritage (ICH) educational tourism has become an important means of connecting cultural communication, educational practice, and tourism experience. Taking Hebei Province as a case, this study combines a document and data review, a questionnaire survey (N = 204), and semi-structured interviews (N = 12) to examine representative practices, user perceptions, and implementation contexts. The findings were synthesized across visual, experience, and product design. Although Hebei has developed diverse forms of ICH educational tourism, weaknesses remain in visual identity and information guidance, learning tasks and feedback, and products that support cultural understanding, preserve outcomes, and sustain post-activity engagement. Process participation and immersive experience, together with visual and information design, were consistently and positively associated with overall evaluation. The interviews identified further barriers involving the learning thread, connections among touchpoints, and post-activity product use. Drawing these findings together, the study adapts Garrett’s five-plane model to the context of ICH educational tourism and develops strategies across the strategy, scope, content, interaction, and surface layers. The resulting framework provides a design basis for Hebei and a methodological reference for comparable regions. Full article

Off-grid and low-impact lifestyles have emerged as important sites of socio-ecological experimentation that challenge conventional understandings of sustainability. This study examines the initiative ‘Portugal It Is’, a Lithuanian diaspora homestead in rural Portugal, as a qualitative case through which to explore the relevance of such lifestyles to the emerging concept of the Symbiocene. Using an abductive case study approach informed by the Biomimetic–Organizational Ecology framework, the research draws on a longitudinal analysis of publicly available video narratives, supplemented by field observations and informal research conversations. The findings indicate that the transition to off-grid living involved processes of adaptive learning, ecological stewardship, livelihood diversification, and the development of new relationships with local communities, digital networks, and ecological systems. Rather than achieving complete self-sufficiency, the initiative evolved through forms of socio-ecological interdependence and relational value creation. The study develops and empirically illustrates the concept of symbiotic livelihoods to describe livelihood arrangements that integrate environmental care, adaptive learning, and community engagement. The findings suggest that off-grid initiatives can function as experimental niches in which alternative human-nature-economy relationships are developed and refined. The paper contributes to sustainability transitions literature by advancing a regenerative and co-evolutionary perspective on emerging socio-ecological futures. 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

Agriculture is one of the most hazardous occupational sectors, with conventional safety training often suffering from limited realism, low engagement, and reduced opportunities to reproduce hazardous scenarios safely. This article provides a structured analysis of digital and technology-enhanced approaches for safety education and training in agriculture. A literature-based framework was developed by combining five groups of digital tools—immersive technologies, simulators and digital twins, serious games and gamification, e-learning systems, and AI-based educational tools—with five learning contexts: formal education, vocational education and training, apprenticeships and traineeships, lifelong and on-the-job learning, and peer or community-based learning. In addition, a heuristic Application Priority Score (APS) was proposed to assess each technology–context combination according to evidence availability, cost–benefit feasibility, technology–learner fit, and inclusivity/accessibility. The results show that evidence is unevenly distributed, with stronger attention to immersive technologies, simulation-based approaches, and game-based learning in formal education, whereas lifelong, on-the-job, and peer/community learning remain less explored. The scoring framework also indicates that no single digital tool is universally suitable: the most promising solutions depend on the training context, learner experience, implementation costs, and accessibility barriers. The study provides a context-sensitive framework to support future research and the design of more inclusive and effective digital safety training solutions in agriculture. Full article

This community-engaged qualitative study co-defined digital health and artificial intelligence (AI) priorities with First Nations communities in Manitoba, Canada, including those with disabilities. Grounded in Indigenous research methodologies and community-based participatory research, the project responded to persistent inequities in rehabilitation and health service access shaped by geography, colonial legacies, and jurisdictional fragmentation. These inequities are especially important in the context of aging, as older adults and Elders may experience compounded barriers related to disability, chronic conditions, mobility limitations, and digital exclusion. Over approximately 12 months, an interdisciplinary team consisting of First Nations scholars and partners, disability organizations, clinicians, and researchers conducted relationship-building visits and meetings with First Nations leadership, Elders/Knowledge Keepers, health providers, and community members to inform the design of a Gathering focused on disability, digital health, and AI. A one-day community-engaged Gathering was held on Treaty 1 and 2 Territory in Winnipeg and convened approximately 70 participants from multiple First Nations communities and disability/health organizations. Five facilitated roundtables explored: (1) health and research priorities for First Nations persons with disabilities; (2) primary care and disabilities; (3) digital access and cultural safety; (4) culturally safe and ethical AI use; and (5) health system challenges, disability, and digital health. Data consisted of facilitator-produced, de-identified table summaries, facilitator reflection forms, and participant-validated plenary notes; no recordings or individual sociodemographic data were collected. Using qualitative description and team-based content analysis, three interrelated domains emerged: (1) relationships, identity, trust, and cultural safety; (2) system, infrastructure, and equity conditions required for accessible care and digital inclusion (e.g., connectivity “dead zones,” device access, transport, and culturally safe services); and (3) opportunities, risks, and governance principles for AI and data use (e.g., AI literacy, privacy, bias, Indigenous data sovereignty, and Nation-specific governance). Findings emphasize that equitable digital health and AI must be relational, disability-informed, culturally safe, and led under First Nations authority, with AI positioned to support, rather than replace, human care relationships. The findings also highlight the importance of designing digital health and AI initiatives that remain accessible and trustworthy for older adults and Elders, particularly where aging, disability, and rural or remote living intersect. Full article

Gamma-band oscillations centered around 40 Hz play an important role in cortical communication, and their disruption has been documented as a neurophysiological feature of several neurodegenerative and neuropsychiatric disorders. This narrative review synthesizes preclinical and early-phase clinical evidence for 40 Hz non-invasive brain stimulation across five delivery modalities: (1) auditory stimulation, which leverages the 40 Hz auditory steady-state response (ASSR) to probe parvalbumin-positive (PV⁺) interneuron circuits and serves as a validated neurophysiological biomarker in schizophrenia; (2) visual stimulation, using luminance or invisible spectral flicker to induce steady-state visually evoked potentials (SSVEPs) and, in animal models, to activate microglial phagocytosis; (3) transcranial alternating current stimulation (tACS), which delivers sinusoidal sub-threshold membrane polarization at gamma frequency, with preliminary case-series evidence suggesting tau burden reduction and EEG-based biomarker changes in Alzheimer’s disease; (4) repetitive transcranial magnetic stimulation (rTMS), offering focal cortical entrainment that, when combined with tACS in phase-synchronized protocols, produces sustained gamma enhancement in the dorsolateral prefrontal cortex; and (5) multisensory combined stimulation, which engages multiple convergent pathways and currently represents the approach with the most promising early translational signal, including cognitive stabilization and hippocampal volume preservation in small AD trials. While single-session entrainment does not reliably yield cognitive gains, multi-week applications have shown neurophysiological and preliminary biomarker-level changes in selected populations. It should be emphasized, however, that the human evidence base remains early-phase and largely derived from small, often uncontrolled studies; 40 Hz stimulation should accordingly be regarded as a biologically plausible and well-tolerated investigational approach rather than an established therapeutic intervention. Adequately powered, randomized, sham-controlled trials are required before clinical conclusions can be drawn. Full article

Background: Despite substantial progress in prevention of mother-to-child transmission (PMTCT) programmes and widespread access to antiretroviral therapy (ART), maternal HIV infection remains associated with adverse maternal and neonatal outcomes in many high HIV-burden settings. This study compared maternal and perinatal outcomes among women living with HIV and HIV-negative women delivering at a tertiary referral hospital in the Eastern Cape Province, South Africa. Methods: A retrospective comparative cohort study was conducted using routinely collected clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered at Nelson Mandela Academic Hospital between January and December 2019. Maternal, obstetric, and neonatal characteristics were compared according to maternal HIV status. Associations were evaluated using chi-square tests, multivariable logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: Women living with HIV were older, had higher parity, and were more likely to have documented anaemia and delayed antenatal care attendance than HIV-negative women. HIV-exposed pregnancies had higher frequencies of preterm birth (26.3% vs. 20.3%) and low birthweight (LBW). In adjusted analyses, maternal HIV-positive status remained independently associated with increased odds of LBW (AOR = 1.88; 95% CI: 1.18–3.00; p = 0.008). LBW was independently associated with neonatal intensive care unit (NICU) admission (AOR = 2.45; 95% CI: 1.46–4.11; p < 0.001) and an increased hazard of in-hospital neonatal mortality (HR = 2.40; 95% CI: 1.55–3.70; p < 0.001). Maternal HIV-positive status (HR = 1.75; 95% CI: 1.12–2.71; p = 0.015) and unsuppressed maternal viral load (HR = 2.05; 95% CI: 1.13–3.73; p = 0.018) were also associated with increased hazards of neonatal mortality. However, these findings should be interpreted cautiously, given the limited number of neonatal mortality events (n = 32). Among HIV-exposed infants with documented HIV test results, the observed mother-to-child transmission rate was 1.7%. However, incomplete infant follow-up and HIV testing data limited the precision of this estimate. Among women living with HIV, birthweight did not differ significantly according to the timing of ART initiation. Conclusions: In this tertiary referral hospital cohort, maternal HIV infection was associated with adverse maternal and neonatal outcomes, particularly anemia, preterm birth, and LBW. LBW emerged as an important predictor of neonatal morbidity and mortality. These findings support continued efforts to strengthen integrated HIV and maternal healthcare services, promote early antenatal care engagement, maintain maternal viral suppression, and improve monitoring and care of high-risk neonates. Given the retrospective observational design, incomplete follow-up for selected outcomes, limited numbers of neonatal mortality events, and the tertiary referral setting, the findings should be interpreted as associations rather than evidence of causal relationships and may not be generalizable to lower-level healthcare facilities or community-based obstetric populations. Full article

This study develops a theory of parental engagement by exploring the perspectives of both parents and practitioners within a socio-economically disadvantaged area in Dublin, Ireland. Using Constructivist Grounded Theory, data were generated through focus groups with participants involved in the family literacy programme Breakfast Buddies. Analysis resulted in the development of a substantive theory, The Dance of Engagement, which conceptualises parental engagement as a relational, non-linear, and co-constructed process. The findings identify three foundational tenets—safety, equality and trust—as essential conditions underpinning effective parental engagement. Four interconnected categories describe how engagement unfolds in practice: choosing to engage, co-creating engagement, connecting to engage and sharing. These categories illustrate how engagement is initiated, sustained and extended beyond programme settings into home and community contexts. The study demonstrates that personalised practitioner approaches, relational environments and shared ownership of engagement processes support greater parental confidence, sustained participation and reciprocal learning between parents and practitioners. The resulting theory challenges deficit-oriented and participation-based models of parental engagement by focusing on collaboration and contextual responsiveness. The Dance of Engagement offers a theoretically grounded framework with clear implications for policy and practice, particularly for designing inclusive family literacy practices to improve outcomes for children and families in disadvantaged communities. Full article

Per- and polyfluoroalkyl substances (PFAS) are persistent “forever chemicals” associated with environmental and public health risks. Despite increasing concern, policies and mitigation strategies often lag behind PFAS contamination, and many communities lack accessible solutions for reducing exposure. Effective risk communication is needed to develop public awareness of, engagement with, and adoption of PFAS mitigation practices. This study examined how risk message framing may influence behavioral intentions to reduce PFAS contamination in everyday living environments. A between-subjects experiment (N = 296) exposed participants to one of four PFAS messages varying in threat (high vs. low) and efficacy (high vs. low) levels. Participants reported very limited prior exposure to PFAS risk messaging. High-threat messages generated greater fear than low-threat messages, but high-efficacy messages did not produce significantly greater perceived efficacy than low-efficacy messages. The interaction between threat and efficacy significantly predicted emotional flow, with the high-threat/high-efficacy condition generating greater emotional flow than the low-threat/low-efficacy condition. Fear, perceived efficacy, and emotional flow were significant positive predictors of PFAS mitigation behavioral intentions. Findings suggest that PFAS risk communication should pair credible threat information with actionable efficacy cues that help audiences move from fear toward agency, hope, and protective intentions. Full article

Drowning is a largely preventable global public health problem. Many unintended drownings are linked to the initial responses to cold-water immersion (cold shock), which includes a rapid involuntary cardio-respiratory response that increases the risk of aspirating water within the first two minutes of immersion. Floating rather than struggling to swim can help survival in this circumstance. In light of early research and subsequent changes in anthropometry, we are re-examining whether bone mineral density (BMD) in people from African, Caribbean, and Asian communities influences their float. This study examined predictors of float outcome. A total of 101 participants of African, Caribbean, Asian, or mixed heritage were recruited; 96 attempted a two-minute supine float following instruction and practice, of whom 89 were successful. Body fat percentage strongly correlated with buoyancy and floating outcome, while other predictors, including BMD, showed weak or no association. Passive floaters (no movement required) demonstrated greater buoyancy and less exertion than active floaters (purposeful movement required). These findings suggest that body fat percentage is the primary factor influencing float outcome, and that with appropriate instruction and practice, individuals of African, Caribbean and Asian heritage can “find their float”. The results indicate that floating is a learnable competence and highlight the need for integrated drowning prevention strategies combining existing campaigns with accessible, community-based practices and co-produced approaches to improve engagement and equity. Full article

Background/Objectives: Communication about illness severity in the neonatal intensive care unit (NICU) occurs in settings of uncertainty and changing clinical status. Reviewing how the literature describes this communication may clarify current practices and identify gaps in how parents receive severity-related information. This scoping review aimed to describe how illness severity is communicated to parents in the NICU, including parental engagement, communication goals, informational content, framing, and communication across periods of clinical stability and deterioration. Methods: We conducted a scoping review using the Joanna Briggs Institute method and reported it according to PRISMA-ScR guidelines. MEDLINE (Ovid) was searched from 2010 to 2025. We included studies that reported empirical data on communication about infant clinical status or illness severity and included parental perspectives. A framework, informed by parental information behaviour and prognostic communication models, guided the data extraction. Results: We included 25 studies. Communication was most often clinician-led and often combined active and passive approaches. Communication primarily focused on information sharing rather than decision-making. Discussions were largely biomedical; however, several studies also included treatment- and care-related information. Studies inconsistently described prognostic communication and did not emphasize optimistic or pessimistic framing. Few studies examined communication across distinct phases of illness trajectory, such as clinical stability or deterioration. Conclusions: Illness severity communication in the NICU remains largely clinician-led, with limited attention to parental engagement and changes across the infant’s clinical course. Greater consideration of parental information needs, prognostic communication, and illness trajectory may support more responsive communication practices in NICU care. Full article

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl’s framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity. Full article

This study explores how teachers working in social music projects in Spain understand their professional development and which elements they identify as central to their learning processes. Although teacher professional development (TPD) has been widely studied in formal music education contexts, less is known about how it unfolds in socially oriented and community-based settings. The study adopts a qualitative design based on in-depth semi-structured interviews with seven music teachers involved in social music projects across Spain. Data were analysed using qualitative content analysis to identify recurring themes and patterns in participants’ accounts. The findings show that teachers understand professional development as an ongoing and situated process closely linked to their daily practice. Experiential learning, adaptation to uncertainty, collaboration with others, and continuous reflection emerge as key elements in their development. In addition, participants highlight the importance of expanding beyond strictly musical training to include pedagogical, social, and relational competences. These results suggest that professional development in social music projects differs from more traditional models by emphasising context, experience, and community engagement. The study contributes to current discussions on music teacher development by highlighting the need for more flexible, collaborative, and context-sensitive approaches to TPD. Full article

Caregivers’ knowledge of language milestones and active engagement in responsive interactions are critical predictors of children’s long-term literacy and communication outcomes. Qualitative inquiry that captures caregivers’ personal perspectives and systemic barriers is essential in order to fully understand how these language-rich environments are created. This study examines caregivers’ perceptions of their natural everyday interactions with children under five, exploring their knowledge of resources and barriers to accessing speech–language support services. Eight primary caregivers of at least one child aged under five participated. After completing a brief demographic questionnaire each participant engaged in a semi-structured interview focused on their perceptions and knowledge of supporting children’s language development through everyday verbal interactions and navigating barriers to services. Data were analyzed using reflexive thematic analysis. Findings highlight the new insights that emerge when caregivers are asked to reflect on how they create language-rich environments. Participants valued Early Childhood Education (ECE) networks as a key source of information but reported a lack of reliable, accessible guidelines on language developmental milestones. Caregivers also expressed a need for practical strategies to enhance everyday interactions. Despite sample size limitations, these findings highlight challenges faced by caregivers and the critical need for further qualitative inquiry into how caregivers’ perceptions shape communication-supportive practices. Full article

Amid shifting urban renewal approaches and industrial restructuring in China, small and medium-sized cities face the challenge of conserving industrial heritage through adaptive reuse. Drawing on gazetteers, planning documents, and interviews, this paper examines the transformation of the Anqing Baiqitun Cement Plant into a cultural and creative park across environmental, social, economic, and governance dimensions. The case is significant as a typical heavy industrial heritage in a smaller city, while the enterprise’s restructuring and relocation have produced a rupture in collective memory and identity. The study finds that minimal intervention in the heavy industrial remains achieved carbon sequestration and emission reduction, succeeded in ecological restoration, and attained financial viability by leveraging local markets and intangible assets. However, the industrial past has been selectively reconstructed, creating a divide between the former industrial community and the present one, partly due to an over-reliance on Authorised Heritage Discourse logic and insufficient collaboration with the existing enterprise. Participatory governance, driven mainly by government coordination and market capital, proved efficient but lacked public engagement. The paper argues that regenerating industrial heritage in small and medium-sized cities requires not only physical upgrading but also social mechanisms that enable public participation in conservation. Full article