Search Results (567)

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

Background: A detailed understanding of cardiac anatomy and physiology is crucial in cardiovascular medicine. However, traditional learning methods often fall short in addressing this complexity. Augmented reality (AR) offers a promising tool to enhance comprehension. To assess its potential integration into the Heidelberger Curriculum Medicinale (HeiCuMed), we conducted a needs assessment among medical students and lecturers at Heidelberg University Medical School. Methods: Our survey aimed to evaluate the perceived benefits of AR-based learning compared to conventional methods and to gather expectations regarding an AR course in cardiovascular medicine. Using LimeSurvey, we developed a questionnaire to assess participants’ prior AR experience, preferred learning methods, and interest in a proposed AR-based, 2 × 90-min in-person course. Results: A total of 101 students and 27 lecturers participated. Support for AR in small-group teaching was strong: 96.3% of students and 90.9% of lecturers saw value in a dedicated AR course. Both groups favored its application in anatomy, cardiac surgery, and internal medicine. Students prioritized congenital heart defects, coronary anomalies, and arrhythmias, while lecturers also emphasized invasive valve interventions. Conclusions: There is significant interest in AR-based teaching in cardiovascular education, suggesting its potential to complement and improve traditional methods in medical curricula. Further studies are needed to assess the potential benefits regarding learning outcomes. Full article

Urban health planning requires a multi-scalar understanding of the territory, capable of capturing socio-economic inequalities and health needs at the local level. In the case of Rome, current administrative subdivisions—Urban Zones (Zone Urbanistiche)—are too large and internally heterogeneous to serve as effective units for equitable health planning. This study presents a methodology for the territorial redefinition of Rome’s Municipality III, aimed at supporting healthcare planning through an integrated analysis of census sections. These were grouped using a combination of census-based socio-demographic indicators (educational attainment, employment status, single-person households) and real estate values (OMI data), alongside administrative and road network data. The resulting territorial units—21 newly defined Mesoareas—are smaller than Urban Zones but larger than individual census sections and correspond to socio-territorially homogeneous neighborhoods; this structure enables a more nuanced spatial understanding of health-related inequalities. The proposed model is replicable, adaptable to other urban contexts, and offers a solid analytical basis for more equitable and targeted health planning, as well as for broader urban policy interventions aimed at promoting spatial justice. Full article

Background/Objectives: International students pursuing higher education in the United States face unique challenges that increase their risk of food insecurity, including limited financial resources, employment restrictions, and cultural barriers. While food insecurity among domestic students has been widely studied, limited research focuses on the lived experiences of international graduate students. This study explores the challenges, perceptions, and coping strategies related to food insecurity among international graduate students at a large public university in North Texas. Methods: This qualitative, ethnographic study involved 20 semi-structured interviews with international graduate students who were clients of the university’s food pantry. Participants were recruited using purposive convenience sampling. Interviews focused on students’ experiences with food access, financial constraints, campus resources, and cultural food preferences. Data were analyzed using thematic coding in MAXQDA. Two standardized food insecurity measures—the USDA and FAO scales—were also administered and analyzed using SPSS. Results: Findings revealed that 85% of participants experienced limited access to nutritious and culturally appropriate foods, with 70% reporting hunger due to financial constraints. Themes included lack of cooking skills, limited campus food options, difficulty accessing familiar groceries, and limited job opportunities. Students expressed that food insecurity significantly impacted their physical health, mental well-being, and social lives, though many continued to prioritize academics over personal nourishment. Conclusions: Food insecurity among international graduate students is multifaceted, shaped by financial, cultural, and institutional barriers. Addressing this issue requires culturally sensitive interventions, improved access to diverse food options, tailored student support services, and institutional efforts to better understand and meet the needs of international students. Full article

This paper presents a novel, multi-stage modelling approach for integrating Generative AI (GenAI) tools into design-based STEM education, promoting sustainability and 21st-century problem-solving skills. The proposed methodology includes (i) a conceptual model that defines structural aspects of the domain at a high abstraction level; (ii) a contextual model for defining the internal context; (iii) a GenAI-based model for solving the STEM task, which consists of a generic model for integrating GenAI tools into STEM-driven education and a process model, presenting learning/design processes using those tools. A case study involving the design of an autonomous folkrace robot illustrates the implementation of the approach. Based on Likert-scale evaluations, quantitative results demonstrate a significant impact of GenAI tools in enhancing critical thinking, conceptual understanding, creativity, and engineering practices, particularly during the prototyping and testing phases. This paper concludes that the structured integration of GenAI tools supports personalized, inquiry-based, and sustainable STEM education, while also raising new challenges in prompt engineering and ethical use. This approach provides educators with a systematic pathway for leveraging AI to develop STEM-based skills essential for future sustainable development. Full article

This paper aims to discuss the transition of new graduate nurses into the workforce, the preparation provided to equip them through the novice–beginner stage, and the theory–practice conundrum. Background: In Australia, new graduate transition programs have been in existence since the 1990s. While there is widespread acknowledgment that this period is pivotal for new graduate nurses entering the profession, there is a lack of consensus on the definition of best practice to achieve optimal preparation for new graduate nurses transitioning into the workforce. Methods: This discussion paper integrates the nursing literature on this topic with the extensive professional experiences of the authors, who are currently working as clinicians in metropolitan hospitals and hold academic positions at universities. Their insights are informed by the literature sourced from peer-reviewed English language journals, including reviews, empirical studies, and national and international reports. Discussion: Recruiting and retaining nurses presents a multifaceted challenge that requires the development of effective tools and strategies to build a sustainable workforce. Both the literature and the authors’ experiences highlight several key factors influencing the preparedness of new graduates. These factors include workplace culture, the demands placed on new graduates, and the support, education, and training they receive. The perspectives shared in this article offer valuable discussion points that can deepen our understanding of the current issues and contribute to the development of more effective solutions. Full article

While prior work has explored learner behavior using learning management systems (LMS) data, few studies provide week-level clustering validated against external engagement labels. To understand and assist students in online learning platforms and environments, this study presents a week-level engagement profiling framework for e-learning environments, utilizing K-means clustering and label-based validation. Leveraging log data from 127 students over a 13-week course, 44 activity-based features were engineered to classify student engagement into high, moderate, and low levels. The optimal number of clusters (k = 3) was identified using the elbow method and assessed through internal metrics, including a silhouette score of 0.493 and R² of 0.80. External validation confirmed strong alignment with pre-labeled engagement levels based on activity frequency and weighting. The clustering approach successfully revealed distinct behavioral patterns across engagement tiers, enabling a nuanced understanding of student interaction dynamics over time. Regression analysis further demonstrated a significant association between engagement levels and academic performance, underscoring the model’s potential as an early warning system for identifying at-risk learners. These findings suggest that clustering based on LMS behavior offers a scalable, data-driven strategy for improving learner support, personalizing instruction, and enhancing retention and academic outcomes in digital education settings such as MOOCs. Full article

Assessing teacher candidates’ self-efficacy in using reading strategies is essential for understanding their academic development. This study developed and validated the Teacher Candidates’ Self-Efficacy Scale for Informational Reading Strategies (TCSES-IRS) using a mixed-methods sequential exploratory design. Initial qualitative data from interviews with 33 candidates and a literature review guided item generation. Lawshe’s method confirmed content validity. The scale was administered to 1176 teacher candidates. Exploratory (n = 496) and confirmatory factor analyses (n = 388) supported a five-factor structure—cognitive, note-taking, exploration and preparation, physical and process-based, and reflective and analytical strategies—explaining 63.71% of total variance, with acceptable fit indices (χ²/df = 2.64, CFI = 0.912, TLI = 0.900, RMSEA = 0.069). Internal consistency was high (α = 0.899 total; subscales α = 0.708–0.906). An additional sample of 294 participants was used for nomological network validation. Convergent validity was demonstrated by significant item-total correlations and strong factor loadings. Discriminant validity was evidenced by moderate inter-factor correlations. Criterion-related validity was confirmed via significant group differences and meaningful correlations with an external self-efficacy measure. The TCSES-IRS emerges as a psychometrically sound tool for assessing informational reading self-efficacy, supporting research and practice in educational psychology. Full article

Despite navigation advancements in enhanced sensor utilization and increased focus on maritime training and education, most marine accidents still involve collisions with high human involvement. Furthermore, navigators’ knowledge and application of the most often misunderstood Rule 10 Traffic Separation Schemes (TSS) according to the Convention on the International Regulations for Preventing Collisions at Sea (COLREG) represents the first focus in this study. To provide insight into the level of understanding and knowledge regarding COLREG Rule 10, a customized, worldwide survey has been created and disseminated among marine industry professionals. The survey results reveal a notable knowledge gap in Rule 10, where we initially assumed that more than half of the respondents know COLREG regulations well. According to the probability calculation and chi-square test results, all three categories (OOW, Master, and others) have significant rule misunderstanding. In response to the COLREG misunderstanding, together with the increasing density of maritime traffic, the implementation of Decision Support Systems (DSS) in navigation has become crucial for ensuring compliance with regulatory frameworks and enhancing navigational safety in general. This study presents a structural approach to vessel prioritization and decision-making within a DSS framework, focusing on the classification and response of the own vessel (OV) to bow-crossing scenarios within the TSS. Through the real-time integration of AIS navigational status data, the proposed DSS Architecture offers a structured, rule-compliant architecture to enhance navigational safety and the decision-making process within the TSS. Furthermore, implementing a Fall-Back Strategy (FBS) represents the key innovation factor, which ensures system resilience by directing operator response if opposing vessels disobey COLREG rules. Based on the vessel’s dynamic context and COLREG hierarchy, the proposed DSS Architecture identifies and informs the navigator regarding stand-on or give-way obligations among vessels. Full article

Background: Patients with chronic kidney disease (CKD) G5 treated with dialysis (G5D) often experience reduced physical activity levels and impaired health-related quality of life (HRQoL), which are associated with poor clinical outcomes. Understanding the factors that influence these outcomes is crucial for improving patient care. This study aimed to evaluate the levels of physical activity and HRQoL and investigate the influence of potential confounding factors on these outcomes in patients with CKD G5D. Methods: One hundred and twenty-five patients with CKD G5D and 129 healthy controls completed a template with their general demographic and clinical information, followed by the short version of the International Physical Activity Questionnaire (IPAQ). Moreover, for patients with CKD G5D, the kidney disease-targeted version (KDQOL-SF36) was employed, whereas the healthy controls completed the standard SF-36. Results: A total of 59.2% of patients with CKD G5D demonstrated low physical activity levels, with a mean IPAQ score of 1163.38 MET-min/week, which was significantly lower than that of healthy controls (p = 0.002). Spearman’s rho correlation analysis revealed significant associations between KDQOL subscales and variables including sex, age, Charlson Comorbidity Index (CCI), hemodialysis (HD) vintage, educational level, employment status, and IPAQ activity category (p-values < 0.05). In the regression analyses, physical component summary (PCS) scores were significantly predicted by sex (β = 0.180, p = 0.036), CCI (β = 0.239, p = 0.045), and IPAQ total score (β = 0.316, p < 0.001). IPAQ scores were predicted by age (β = –0.303, p = 0.003), HD vintage (β = 0.275, p = 0.012), and PCS (β = 0.343, p = 0.002). Conclusions: The findings demonstrated a statistically significant association between physical activity and HRQoL, underscoring the importance of promoting physical activity among patients with CKD G5D. Additionally, several underexplored sociodemographic and clinical confounders were identified as significant correlates of these outcome measures. Full article

International students are an important group at German higher education institutions. Yet few studies have considered the psychosocial situation of these students. The present study combines the study demands-resources model (SD-R model) and the acculturation framework to adapt the former to the specific situation of international students, and examines the effects of study demands, institutional resources, individual resources (acculturation orientations, i.e., affective and cognitive orientations towards the home and host country), stress, and engagement on their life satisfaction as one indicator of well-being. We used cross-sectional survey data from 503 international students across more than 20 higher education institutions. Latent structural equation models showed that lower study demands were associated with lower stress and higher student engagement, which in turn predicted greater life satisfaction. Although higher institutional resources also related to increased engagement and, thus, higher life satisfaction, they were unexpectedly linked to increased stress, which was in turn associated with lower life satisfaction. Additionally, the expected positive effect of affective host country orientation on life satisfaction, mediated through perceived stress and engagement, was confirmed. The consideration of acculturation orientations in the SD-R model helps to understand the specific conditions of well-being amongst international students in Germany. Full article

This article analyzes the role of dance and the arts in European and national educational policy agendas and maps the provision of dance in upper-secondary schools in the district of Porto, Portugal. To understand the role of dance in educational policies, we conducted a document analysis of regulations and decree-laws inspired by Stephen Ball’s policy cycle approach. To explore how these policies materialize in educational contexts, a mapping approach was conducted in upper-secondary schools within the district of Porto, Portugal. Results show that, at the public education policy level, although there is no specific debate about dance, the arts are gradually being included in the educational agendas, but still in a scarce way and with a more instrumental approach. At the institutional level, access to dance in education is not sufficiently democratized, reinforcing social and territorial inequalities. Despite its local scope, the study contributes to the broader international debate on equity in access to education with the arts, mainly dance. It offers insights from Southern Europe—a region often underrepresented in global research—which can inform research and policy development aimed at more inclusive educational systems. Full article

As generative AI tools become increasingly embedded in education, their role in supporting student learning remains both promising and contested. These cross-continental multiple case studies explore how integrating AI into classroom-based creative projects can move students from intimidation to meaningful engagement, comprehension, and retention of course content. Drawing on data from four international university classrooms—in the USA, UK, Canada, and Australia—this mixed-methods study examines students’ experiences as they collaboratively created comic books using generative AI. Each instructor embedded the assignment within their own pedagogical context, enabling cross-institutional comparison of AI’s educational potential. Findings highlight a shared trajectory: students initially approached AI with uncertainty or overconfidence, but developed nuanced understandings of its capabilities through experimentation, reflection, and collaboration. The process of creating narrative-driven visual outputs required students to synthesize theoretical material, communicate effectively in teams, and creatively solve problems—fostering both cognitive and interpersonal learning. Students reported deeper comprehension of academic content and greater confidence using AI tools critically and ethically. This study concludes that when framed as a collaborative partner rather than a replacement for human thinking, AI can support deeper learning experiences. It also suggests that creative, team-based projects can demystify AI and build essential future-facing skills. Full article

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment approaches for TT, as well as involvement of health practitioners in its management. This study aims to examine the current knowledge and practices related to TT diagnosis and treatment among health professionals in Australia. Methods: A two-phase explanatory sequential mixed methods approach was adopted, comprising an online survey that collected participants’ demographic information and details on assessment, diagnosis, management, referral practices, and relevant experience and training. Phase one involved 47 health professionals from various disciplines in Australia who completed an online survey in its entirety. Phase two included in-depth interviews with seven speech-language pathologists (SLPs) to gain further insights into their experiences in managing TT. Survey data were analysed descriptively, and interview data was analysed thematically. Results: Most participants diagnosed TT using clinical assessments, such as general observation and oral motor examinations. Treatment approaches commonly included orofacial myofunctional therapy and the use of myofunctional devices. Interviews with SLPs identified four key themes: tongue thrust as a symptom rather than a diagnosis, facilitators to effective treatment, multidisciplinary approaches to management, and training and education gaps in clinical practice. Conclusions: This study provides valuable insights into how TT is identified, assessed, diagnosed, and managed by health professionals in Australia. It highlights the perspectives of SLPs on treatment approaches, as well as their views on the availability and adequacy of training and education in this field. The findings suggest the need for a broader understanding of TT management, emphasising the importance of multidisciplinary collaboration and professional development. These insights are globally relevant, as they stress the shared challenges and the value of international collaboration in improving TT diagnosis and treatment practices. Full article

Chronic kidney disease (CKD) remains a significant global health challenge, with its advanced stages necessitating timely and comprehensive patient education, particularly regarding kidney replacement therapy (KRT). Early initiation of education is crucial, as it enhances patient understanding and supports shared decision-making with healthcare teams, ultimately leading to better health outcomes. Evidence demonstrates that CKD education not only increases disease-specific knowledge, but also confers multiple benefits, including reduced healthcare utilization, greater adoption of self-management, delayed KRT initiation, improved survival, higher adherence to therapies, and increased transplant evaluation. Despite these advantages, a disconnect persists between the educational content desired by patients and what is prioritized by healthcare professionals. Structured educational interventions have been shown to improve patients’ ability to make informed decisions about KRT, with studies indicating that after targeted education, the vast majority of patients can articulate their therapy preferences. Furthermore, national and international guidelines highlight the necessity of embedding patient education as a core component of CKD care to empower patients and improve the quality of life. However, challenges remain, including disparities in access, health literacy, and the consistency of educational delivery. There is currently no standardized approach on how to effectively educate CKD patients. This review provides a comprehensive analysis of all aspects of pre-dialysis education and best practices for advanced CKD patient education. Full article