Search Results (8,158)

Extreme heat poses health risks during pregnancy, but little is known about how pregnant individuals seek weather information to engage in heat-health protective actions. This study examined associations between routine and event-driven weather information seeking and both routine physiological heat-health protective actions (i.e., limiting sun exposure, staying hydrated, and spending time in air conditioning) and higher-threshold adaptive behaviors (i.e., changing plans due to heat). A cross-sectional survey of 195 pregnant individuals in Bexar County, TX, USA, was conducted during the summer and fall of 2024. Descriptive and nonparametric analyses explored relationships across trimesters. Participants demonstrated high routine weather information seeking and greater weather information needs since becoming pregnant. Over half (51.3%) reported increased weather information seeking during excessive heat, with lower increases during the first trimester. During extreme heat, most respondents increased heat-health protective actions. Increased information needs during pregnancy were significantly related to heat-health protective actions. Routine weather checking showed weak or inverse relationships with changing plans, suggesting that routine weather awareness alone may not prompt changing plans. Trimester patterns indicated heightened information seeking and protective actions later in pregnancy. Findings highlight the importance of pregnancy-specific heat risk communication with trimester-specific guidance provided in clinical counseling, public health messaging, and meteorological communication. Full article

Protected areas are critical to biodiversity conservation, yet their cultural values remain underexplored. The objective of this study is to identify the intangible cultural heritage of communities residing within and around the Imam Abdulaziz Bin Mohammed Royal Reserve and the King Khalid Royal Reserve in Saudi Arabia. Using a cross-sectional descriptive design, the study combines a literature review, semi-structured interviews, and participatory observation to identify intangible cultural heritage components across the five UNESCO domains: oral traditions, performing arts, social practices, knowledge of nature, and traditional craftsmanship. Fifty-five interviews were conducted across fourteen settlements. A comprehensive database was developed and includes the identification of fifty heritage elements—twenty-five actively practiced, sixteen were at risk of disappearance, and nine no longer practiced. Results show that craftsmanship and traditional arts were the most frequently documented domains, particularly among female participants, while some oral and performance-based traditions show signs of vulnerability in relation to intergenerational transmission. The proposed participatory and ethics-driven documentation framework, compliant with the UNESCO Convention of 2003, can support the inclusion of cultural heritage in protected area management efforts. The framework is aligned with Saudi Vision 2030 objectives related to cultural sustainability, community engagement, and heritage preservation. Full article

Generative artificial intelligence (GAI) enables students to offload cognitive tasks to an external system, yet the consequences of such cognitive offloading for the development of critical thinking—a core dimension of human intelligence—remain underexplored. Drawing upon cognitive offloading theory and distributed cognition theory, this study investigates the heterogeneity of critical thinking outcomes among Chinese university students who use GAI, focusing on how different patterns of human–AI collaboration relate to cognitive autonomy relinquishment. A questionnaire survey was administered to 353 university students across multiple provinces in China. Cluster analysis and regression analysis were employed to identify distinct user profiles and to examine predictors of critical thinking gains and cognitive autonomy. Four distinct user profiles emerged, ranging from “simple Q&A users” (25.2%) to “critical co-thinkers” (15.6%). Learning motivation was the strongest predictor of both critical thinking gains (β = 0.42) and lower cognitive autonomy relinquishment (β = −0.35). Notably, offloading depth positively predicted cognitive autonomy relinquishment (β = 0.25), revealing a paradoxical pattern: sophisticated GAI use was associated with greater dependence. A “high depth–high dependence” subgroup (25.8%) was identified, disproportionately composed of female students and Information and Communication Technology (ICT) majors. The findings challenge the assumption that deeper GAI engagement automatically yields cognitive benefits. Because all constructs were measured through self-report, the findings are interpreted as reflecting students’ perceptions of their cognitive behaviors and abilities; the methodological implications of this design are discussed in detail. Educational interventions should prioritize metacognitive training over technical skill development to ensure that cognitive offloading enhances rather than undermines critical thinking. Full article

(1) Introduction: Transit-oriented development is often framed as a strategy to expand opportunity and advance equitable transportation. However, evidence suggests it can also contribute to rising housing costs and displacement in historically marginalized communities. This study examines how a light rail expansion reshaped displacement risk in a Latina/o community in the U.S. Southwest, identifying early mechanisms through residents’ interpretations of the expansion during construction. (2) Materials and Methods: Using a qualitative, community-engaged design, the study draws on ten in-depth pláticas with Latina/o residents conducted during construction of a major rail expansion. Data were analyzed abductively and guided by Critical Race Ecological Systems Theory (CrEST) to identify multilevel mechanisms linking infrastructure policy to lived social conditions. (3) Results: Findings identify three mechanisms through which transit investment generated displacement risk prior to relocation. First, historical and intergenerational memory shaping anticipatory displacement. Second, place-based belonging intensifying psychosocial stress and loss. Third, policy-mediated mobility constraining residents’ ability to remain or benefit from reinvestment. (4) Discussion: Transit infrastructure operates as a structural policy intervention that reorganizes risk, belonging, and stability when histories of racialized disinvestment are not incorporated into policy design. These findings position infrastructure planning as a critical site for social work policy analysis and prevention-oriented intervention. Full article

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre–post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes. Full article

Rising cancer incidence and survival rates have led to an unprecedented demand for psychosocial care. Yet, limited financial and practical resources present a barrier to the provision of evidence-based care. Clinical practice guidelines (CPGs) are well-positioned to enhance the quality and efficiency of psychosocial oncology care; however, little is known about their use and perceptions in the field. The present study explored the use and perceptions of CPGs among 172 Canadian psychosocial oncology clinicians via a cross-sectional, online survey. Findings revealed substantial variation in awareness, with over 20% of participants reporting no familiarity with CPGs, and low to moderate use of CPGs (M = 2.97, SD = 2.96) among users. Key barriers included a lack of formal training, limited applicability to local contexts, and systemic constraints such as high workloads. Conversely, participants highly endorsed facilitators, including accessible training programs, relevant tools/interventions, and greater institutional and community engagement. Clinician perspectives are paramount to the dissemination and implementation of psychosocial oncology CPGs. Our findings suggest that successful implementation requires broader accessibility, widespread adaptation, and greater community engagement. By addressing these systemic constraints, CPGs may be better positioned to bridge the gap between evidence and real-world service provision. Full article

Large-scale location-based virtual reality (LBE VR) has become an important form of immersive cultural tourism, but its role in supporting sustained value transformation remains insufficiently understood. In this study, “sustained value transformation” refers to the extension, reinterpretation, and circulation of cultural, educational, social, and engagement-related value across physical venues, embodied virtual narratives, and digital platforms. Rather than assessing economic performance, environmental impact, or long-term operational viability, this study focuses on the cultural and social circulation of experiential value. It examines how physical venues, embodied virtual narratives, and digital platforms jointly mediate visitor experience in LBE VR-based cultural tourism. It compares representative LBE VR projects in museums and heritage institutions, emerging public cultural spaces, and commercial venues in China. A total of 10,862 project-related textual items and 464 visual samples were collected from Xiaohongshu and Douyin and analyzed through comparative content and visual analyses. The findings show that visitor choices are shaped by both the spirit of place in physical venues and platform-visible experience labels. In museums and heritage institutions, institutional knowledge authority and embodied narrative depth help visitors recognize interactive educational value. In emerging public cultural spaces, the intertwining of historical narratives and commercial operations produces more ambiguous experience labels. In commercial venues, platform discussions focus more strongly on value-for-money judgment, sensory stimulation, product quality, and service experience. The study argues that sustained value transformation in LBE VR-based cultural tourism cannot rely solely on platform traffic. Instead, it depends on collaboration among cultural institutions, tourism enterprises, platform content creators, educational actors, and community stakeholders to preserve cultural distinctiveness, improve experience quality, and extend cultural and social value beyond the immediate on-site experience. Full article

Background/Objectives: Wheelchair users with multiple sclerosis (MS) often face barriers that restrict participation in physical activity and exercise training. This manuscript reports on participant feedback to guide evaluating and refining a novel exercise training program, Seated Physical activity INtervention (SPIN). SPIN was adapted from the Guidelines for Exercise in MS (GEMS) approach using a three-step community-engaged research framework based on meeting the needs of wheelchair users with MS. Methods: Semi-structured interviews were conducted with 9 participants who completed the 16-week SPIN intervention. The key SPIN intervention components were the exercise prescription, exercise equipment, and behavioral coaching grounded in Social Cognitive Theory. Formative interview domains included overall experience, enjoyable and missing components, delivery modifications, barriers, lessons learned, and additional research topics of interest. Data were analyzed and reported using a rapid qualitative analysis approach. Results: Interviews averaged 16 ± 10 min. Participants reported enjoying SPIN, noting program strengths as being flexible and appropriate for individuals with MS, receiving coaching calls by knowledgeable staff that offered support and accountability, and receiving exercise equipment and video demonstrations. Participants also identified strategies for enhancing the program such as including peer support, offering real-time feedback during exercise, and adding other wellness behavior topics (e.g., diet). Conclusions: The results offer helpful ideas to consider when developing exercise training programs for wheelchair users with MS and other disabilities that may improve health and well-being. Full article

Artificial intelligence (AI) is increasingly applied to healthcare decision-making; however, many persistent patient safety risks arise from sociotechnical conditions such as communication breakdowns, coordination failures, and organisational culture rather than diagnostic or decision error alone. While simulation can engage these dimensions of care, AI-supported simulation remains limited by heterogeneity and a lack of explicit conceptual structure. This study presents a narrative and conceptual review of the healthcare simulation and AI literature to identify structural barriers to coherent AI reasoning about simulation. Drawing on this synthesis, we introduce Transformative Simulation (TfS) as an intentional framework that can be formalised as an ontology for AI-supported simulation focused on cultural and systems-level change. TfS structures simulation through explicit Simulation-Based Intentions, an aligned design–delivery–data–debrief process, and foundational considerations of purpose, perspective, power, preparation, and possibility. Framed in this way, TfS enables AI systems to interpret simulation artefacts in relation to declared intent, sociotechnical context, and ethical boundaries. We further describe an Intentionality–Simulation–Intelligence triad and a continuous learning loop that align human values, simulation structure, and AI reasoning. The findings of this review suggest that an important challenge in applying AI to healthcare simulation may be ontological as well as technical, and that explicit representation of intention and context is necessary to support coherent, context-sensitive, and system-aligned AI reasoning in healthcare. Full article

Over the past decade, educators and administrators in higher education have taken steps toward improving accessibility in teaching and learning. Yet research on supporting students with disabilities in experiential pedagogies, such as community-engaged learning, remains limited, particularly regarding best practices for inclusive instruction. The present study addresses this gap by exploring the perceptions and experiences of students with disabilities in community-engaged learning opportunities, as well as the support mechanisms that may contribute to their meaningful participation in these experiences. Forty-three students with disabilities participated in this qualitative study. Drawing on focus groups, individual interviews, and written responses, the study identifies themes for more inclusive design and delivery, including clearly outlining the physical and digital demands of engagement activities well in advance, designing courses with flexibility in mind, protecting students’ privacy, and including an accessibility statement in the syllabus. While the thematic analysis offers practical recommendations for educators and administrators, aimed at reducing barriers and fostering meaningful participation, the study also advocates for greater theoretical engagement with the personal and relational dimensions of experiential education. Full article

Renewable energy sources are fast becoming the most cost-effective option for adding new power generation capacity globally. In South Africa (SA), the transition from fossil fuels to renewable energy has steadily gained momentum over the years. However, this transition is beset by complex and multidimensional barriers. This research study analyses and prioritises renewable energy barriers and mitigation strategies in South Africa. The DEMATEL multi-criteria decision-making technique was employed to rank the barriers and assess their cause-and-effect relationships. The findings reveal the top three barrier categories as Agreement, Market, and Knowledge. The study further employed an integrated hybrid CRITIC-TOPSIS technique to prioritise the proposed mitigation strategies for each barrier in a defined category. The results indicate that strengthening local community engagement is the most suitable solution to the adoption of renewable energy in SA. A sensitivity analysis model was conducted to validate the robustness of the results. The findings validate the consistency of the methods, with the ranking of the barriers and mitigation strategies remaining stable under various scenarios. This study presents a context-specific causal analysis of barriers and an objective prioritisation of mitigation strategies in South Africa using an integrated hybrid DEMATEL and CRITIC–TOPSIS approach, providing policymakers and decision-makers with valuable insights to develop strategic plans and policies that address the identified barriers. Full article

Conventional approaches to motivating individuals within firms emphasize external incentives, sometimes referred to as the “carrot and stick” paradigm. However, such elements are often absent in volunteer environments, where incentive is derived from psychological and relational influences. In the work context, volunteers are an exceptional case as they lack traditional extrinsic incentives, making them suitable for researching motivation outside this paradigm. This study, based on Self-Determination Theory, explores the impact of communication methods on motivation, satisfaction, and retention of volunteers. The study employs a qualitative design to analyze data from 91 volunteers and 6 coordinators in nonprofit organizations, using content analysis conducted with ATLAS.ti version 26. The findings demonstrate that communication functions as a crucial motivator by promoting autonomy, competence, and relatedness. Volunteers are intrinsically driven by their engagement, the opportunity to make a significant contribution, and experiential learning. Conversely, coordinators influence these experiences by providing feedback, advice, and chances for engagement. The findings indicate a struggle between autonomy and control, illustrating variations in motivation within organizational contexts. The study contributes to existing knowledge by demonstrating that communication serves as a primary motivator and engagement catalyst in the absence of external rewards. This holds significant ramifications for nonprofit administration and motivational philosophy. Full article

Plastic waste presents a significant environmental and public health concern in Malawi, where rapid urban growth, limited waste collection services, and informal disposal practices contribute to persistent plastic waste hotspots. In Lilongwe City, the waste collection rate has been reported ranges from 10% to 30%. This means that out of the 500 to 600 tons of municipal solid waste produced each day, only about 50 to 150 tons are collected daily. These hotspots occur in settings such as drains, markets, settlement edges, riverbanks, and lakeshore environments. They intensify health-relevant exposure pathways by encouraging stagnant water, increasing flood risk, facilitating open burning, and supporting the formation of plastisphere biofilms that can contain pathogenic and antimicrobial resistant organisms. This research synthesises evidence on the main sources of plastic waste in Malawi, the mechanisms of leakage across different environments, and the associated health implications. It uses a scoping approach aligned with PRISMA-ScR guidance and is informed by the UK Research and Innovation (UKRI) funded Sustainable Plastic Attitudes to benefit Communities and their Environments (SPACES project), which highlights the influence of behavioural, governance, and environmental factors on plastic pollution. A two phase, risk-based decision framework to support targeted management of plastic waste hotspots is described. Phase 1 focuses on rapid harm reduction through the identification and ranking of hotspots according to risk severity, spatial extent, and feasibility, guiding timely interventions such as drain clearance, waste capture, and temporary stabilisation. Phase 2 addresses longer term prevention by tackling upstream drivers through policy measures, improved services, reuse and reduction schemes, and community engagement. The framework has been developed using evidence from Malawi; however, its methodology could be applied to other low- and middle-income countries that experience similar constraints and exposure pathways. The framework offers a transparent and practical tool for decision makers seeking to allocate limited resources effectively while reducing environmental and health risks associated with plastic waste. Full article

Additive manufacturing (AM), commonly known as 3D printing, has rapidly transformed modern manufacturing, creating a growing demand for engineers with both theoretical knowledge and practical skills. Despite its increasing relevance, AM is often incorporated into engineering curricula as a supplementary tool rather than a fully integrated subject, limiting students’ understanding of fundamental material–process–performance relationships. This study presents the development, implementation, and assessment of an integrated lecture–laboratory framework for AM education at the New Jersey Institute of Technology (NJIT). Two complementary courses were developed: an undergraduate course (Introduction to 3D Printing, CHE 415) and a graduate course (Additive Manufacturing and Applications, CHE 722). The curriculum integrates instruction in AM technologies, materials, and digital workflows with hands-on design challenges, team-based projects, and structured literature reviews, enabling students to engage in the complete design-to-fabrication process. Student learning outcomes were evaluated over multiple academic years using ABET-aligned assessments, grade distributions, and student self-assessments. Results demonstrate consistently high levels of student proficiency and engagement, with strong performance in design, problem-solving, and communication skills. The courses also attracted students from diverse disciplines, underscoring the interdisciplinary nature of AM education. While limitations remain in providing hands-on exposure to a broader range of AM technologies, ongoing expansion of laboratory infrastructure is expected to address these challenges. Overall, this work demonstrates that an integrated, project-based approach effectively bridges theory and practice and provides a scalable model for incorporating AM into engineering curricula. Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article