Search Results (465)

Background/Aims: The increasing complexity of disasters requires effective integration of nurses into Civil Defense (CD) systems. Despite their crucial role, the competencies needed to operate within these multi-agency frameworks remain fragmented and insufficiently defined. The main aim of the study was to map nursing competencies for disaster response within the CD context, identifying essential skills, contextual variations, and barriers to application. Methods: A scoping review was conducted following the JBI methodology and reported according to PRISMA-ScR guidelines. Major databases (PubMed, CINAHL, Scopus, Embase) were searched without time limits, resulting in the inclusion of 27 studies published between 2011 and 2025. Results: 12 core competency domains were identified. Clinical care was the most cited competency (70% of studies), followed by communication (63%), leadership (60%), triage (48%), and psychosocial support (48%). The lack of specific training emerged as the primary individual barrier (44%), while the absence of standardized curricula was the leading systemic obstacle (41%). Competency requirements varied significantly based on the hazard type and organizational setting. Conclusions: Disaster nursing is emerging as an essential specialized field in response to the increasing frequency of climate-related events and global conflicts. There is an urgent need to move beyond purely clinical training to integrate “organizational literacy” and psychological resilience, harmonizing educational pathways with national CD policies and competency-based disaster preparedness programs. Full article

Background: Crimean–Congo hemorrhagic fever virus (CCHFV) is an important tick-borne zoonosis and an emerging public health threat across Africa. Although evidence of viral circulation is mounting, information remains fragmented, limiting a comprehensive understanding of transmission ecology, regional hotspot heterogeneity, and preparedness needs across the continent. Methods: This narrative review critically synthesized published literature on CCHFV in Africa, identified through PubMed, Scopus, and Google Scholar and supplemented by citation tracking and authoritative public health reports. Evidence from epidemiological, ecological, molecular, surveillance, and One Health studies was integrated to examine transmission dynamics, geographic hotspot distribution, viral diversity, risk factors, diagnostic and surveillance challenges, and preparedness strategies. Results: Available evidence shows marked geographic heterogeneity in CCHFV transmission across Africa, with hotspot regions shaped by ecological suitability, Hyalomma tick distribution, livestock–human interactions, and health system capacity. Livestock consistently show higher exposure than humans, underscoring their role as key indicators of viral circulation. Diagnostic limitations, passive surveillance, ecological variability, and serological cross-reactivity contribute to substantial under recognition of disease burden, while molecular studies reveal considerable viral diversity and ongoing evolution across African regions. Conclusions: CCHFV remains underdiagnosed and underreported in many African settings because of limited surveillance and diagnostic capacity. Strengthening integrated One Health surveillance, expanding laboratory and genomic capacity, utilizing livestock as sentinel populations, and improving cross-sectoral collaboration are critical for enhancing early detection, outbreak preparedness, and effective public health response across the continent. Full article

Investments in urban water supply should be informed by resilience management frameworks that consider traditional reliability requirements, community preparedness during system disruptions, and sustainability goals in long-term planning. Grounded in a framework (WARATA) that integrates these aspects, this paper presents a stepwise, performance-based theoretical approach to resilience quantification, supported by explanations and practical guidance. For instance, in addition to the piped infrastructure components, emergency supply options and human resources should be incorporated within the system boundaries (Step 1), and water supplied to users is recommended as a single performance measure (Step 2). During disruptions, performance at user nodes is influenced by operational rules for resource allocation (Step 3), which must be implemented in the required computer model for simulating performance (Step 4). Equations for computing withstanding, absorptive, restorative, adaptive, and transformative capabilities as time-based metrics are proposed (Step 5), enabling the analysis of results from the bottom up (Step 6) to inform resilience management. Using illustrations of performance curves at individual system nodes, this paper advocates for extended system boundaries that bridge the gap between infrastructure and community resilience; discusses challenges with the modeling of dynamic, adaptive performances; and emphasizes the importance of assessing temporal distances to fail-safe and safe-fail thresholds during disturbances. Pending case study validation and integration into tools for predictive and real-time analyses of options, the quantification approach could support infrastructure and emergency response planning and management, ultimately ensuring sustainable system designs with equitable resilience outcomes. Full article

Earthquake-induced infrastructure disruption can delay emergency response and prolong recovery, yet many post-earthquake damage studies either focus primarily on superstructures or examine individual infrastructure sectors separately. This study presents a questionnaire-based expert assessment of earthquake-induced damage factors and mitigation measures in urban infrastructure systems. Fourteen damage factors and seventeen mitigation measures were identified through a structured literature review and evaluated by 424 technical experts using a five-point Likert scale. The responses were analyzed using reliability analysis, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), the Relative Importance Index (IRI), and Pearson correlation analysis. The dataset showed high internal consistency (Cronbach’s alpha = 0.926), with KMO = 0.941 and a significant Bartlett’s test (p < 0.001), confirming its suitability for factor analysis. EFA and CFA grouped the damage factors into three dimensions: Post-Earthquake Intervention Challenge (PEIC), Health Food Water Security (HFWS), and After-Earthquake Preparedness (AEP). IRI results ranked PEIC as the highest-priority expert-perceived factor group (average IRI = 90.61%), followed by HFWS (88.32%) and AEP (85.10%). Pearson correlations indicated that resilient network and pipeline infrastructure, resource diversification and redundant distribution capacities, regular maintenance and inspection, strategic stockpiles, site-selection reassessment, slope stabilization, and early warning systems were strongly associated with one or more factor groups (r > 0.60; p < 0.001). The findings should be interpreted as expert-perceived priorities rather than objective damage probabilities; nevertheless, they provide a structured basis for preliminary prioritization of urban infrastructure resilience measures in earthquake-prone contexts. Full article

The Architecture, Engineering, and Construction (AEC) industry has significant potential to improve productivity, quality, and sustainability of its projects through emerging digital technologies. Advances in technology and the complexity of what new graduates need to learn have resulted in persistent training gaps and have highlighted new needs to be addressed in education. One of the new needs is the level of learners’ awareness of new technologies and their adoption practices. This research examines how current education and training practices in the selected sample of the Australian AEC sector support or hinder the development of digital capabilities. The set of technologies considered in this study focuses on Artificial Intelligence (AI), Building Information Modelling (BIM), Digital Twins (DTs), Virtual and Augmented Reality (VR/AR), and the Internet of Things (IoT). A mixed-method design integrates a structured survey of industry professionals and students, along with semi-structured interviews of industry and academic stakeholders, to evaluate exposure, self-rated capability, training participation, organisational support, and perceptions of graduate preparedness. Findings show comparatively higher maturity in BIM, but limited capability in other technologies, inconsistent formal training, and barriers linked to time, cost, organisational priorities, and rapid technological change. Qualitative findings and interpretation of preparedness-related survey responses indicate that stakeholders place greater value on transferable, interdisciplinary digital competencies than on narrow tool-specific proficiency. The research delivers statistically robust findings and actionable recommendations that address the identified barriers and promote the development of a skilled workforce in the AEC industry. Full article

Institutional trust plays a critical role in shaping organizational responses to risk, particularly in emerging market financial systems. This study examines the psychosocial mechanisms through which institutional trust is associated with preparedness for social responsibility (SR) implementation in Ecuadorian savings and credit cooperatives. Using covariance-based structural equation modeling (CB-SEM) with 5000 bootstrap resamples (n = 2116), we assessed four competing structural models comparing direct, sequential, and parallel mediation pathways. The findings demonstrate that institutional trust has a significant direct impact on preparedness (β = 0.626, p < 0.001), accounting for 42.3% of its variance. The statistical rejection of full mediation models validates that readiness cannot be exclusively elucidated through cognitive or affective risk perception pathways. Notably, the study uncovers a “Trust Paradox”: contrary to the conventional “trust-as-control” heuristic, trust exhibited a significant positive correlation with both severity perception (β = 0.200, p < 0.001) and worry (β = 0.100, p < 0.001). This suggests that in high-reliability cooperative contexts, trust appears to function primarily as a validator of information credibility rather than a mitigator of threat magnitude. While the affective pathway was significant, its effect size was modest compared to the direct governance effect. These results indicate that preparedness for SR implementation in cooperative finance is driven more by governance legitimacy than by threat perception. The study enhances sustainability research by recognizing institutional trust as a fundamental structural driver of organizational resilience and vigilant preparedness in emerging market financial cooperatives. Full article

Simulation-based learning (SBL) is increasingly used within Initial Teacher Education (ITE) to bridge the gap between theory and practice, enhancing pre-service teachers’ (PSTs) preparedness for the complexities of classroom practice. Despite its growing adoption, limited research has examined how simulation design shapes PSTs’ learning experiences. This study addresses this gap by exploring PSTs’ experiences of two low-technology simulation modalities, mixed-media and multiple-choice formats, implemented within undergraduate primary ITE programmes at two UK universities. Using a sequential mixed-methods design, quantitative data were collected from 249 PSTs through the Educational Practices Questionnaire for Teacher Educators (EPQ-TE) and the Preparing Educators for Practice in Simulation Questionnaire (PEPS-Q), alongside qualitative data from open-text survey responses and focus groups. Findings indicate that PSTs reported high levels of perceived quality, engagement, and preparedness across both modalities, with no statistically significant differences between formats or institutions. Reflexive thematic analysis was used to explore simulation design features valued by PSTs, identifying three key themes: authenticity and realism, the benefits and challenges of peer collaboration, and the role of scaffolding and feedback in supporting professional learning. These findings suggest that learning in SBL emerges through the interaction of scenario design, learner participation, and tutor facilitation, offering practical insights for teacher educators seeking to design and implement simulation-based learning within ITE, as well as recommendations for future research. Full article

Vaccination remains one of the most effective strategies for preventing infectious diseases. Yet, the success of modern vaccines increasingly depends on the rational design of adjuvants that enhance and shape immune responses. In this review, we examine current and emerging adjuvant strategies for viral vaccines across the human lifespan. Traditional adjuvants, particularly aluminum salts, have long served as the foundation of vaccine formulations. Still, their limitations have driven the exploration of novel platforms, including emulsions, nucleic acid-based adjuvants, and advanced particulate delivery platforms with intrinsic immunostimulatory properties. These newer approaches act through diverse mechanisms, such as activating innate immune pathways via pattern recognition receptors (PRRs) and stimulating antigen-presenting cells (APCs), thereby improving both humoral and cellular immunity. Recent advances in molecular biology, nanotechnology, and systems vaccinology have deepened mechanistic understanding and enabled more precise modulation of immune responses. However, significant challenges remain, including incomplete knowledge of adjuvant mechanisms, limited diversity among licensed adjuvants, safety concerns, and inconsistent efficacy across age groups. In particular, immune immaturity in infants and immunosenescence in older adults highlight the need for age-specific adjuvant strategies. The review identifies critical gaps in comparative studies, long-term safety data, and the development of adjuvants capable of inducing broad and durable immunity. Further, this article integrates licensed and emerging viral vaccine adjuvants through a lifespan framework. Addressing these limitations through interdisciplinary research and precision-based approaches will be essential for advancing next-generation vaccines and improving global preparedness for emerging infectious diseases. Full article

The National Special Pathogens System (NSPS) stratifies U.S. healthcare facilities by their readiness level to care for patients with high-consequence infectious diseases (HCIDs). While NSPS Level 1 and 2 facilities possess advanced biocontainment capabilities to care for patients for the duration of their illness, most U.S. hospitals fall under a NSPS Level 3 or 4 designation, with limited resources to manage patients with a suspected or confirmed HCID. However, emerging zoonotic threats like H5N1 underscore the need to bolster HCID preparedness across all NSPS Levels. Beginning in March 2024, the U.S. H5N1 outbreak has primarily impacted wild bird flocks, poultry, and cattle, along with some human infections. The continuation of this outbreak in wild and domesticated animals increases the likelihood of further human spillover and eventual viral evolution in human hosts. At the frontlines, rural farming communities are likely to be most affected, with potential outbreaks exacerbated by a lack of accessible NSPS Level 1, 2, or 3 facilities in these regions. Thus, strengthening the HCID preparedness of local NSPS Level 4 facilities is critical to preventing transmission, minimizing societal disruption, protecting communities and the healthcare workforce, along with ensuring an equitable, coordinated response to future emerging infectious disease threats. This manuscript explores the financial, societal and health system impacts of HCID outbreaks to delineate the necessity of strengthening the preparedness of NSPS Level 4 facilities. Full article

Wildfires are significant and increasing hazards in the United Kingdom (UK), affecting both ecosystem integrity and public safety, particularly within many rural–urban interface locations. In moorland environments, where recreational pressure is high, human negligence often remains a major ignition source. The Peak District National Park in Central England is vulnerable to these hazards, as exemplified by the 2018 wildfire at The Roaches Nature Reserve, which was triggered by an out-of-control barbecue. Despite increasing wildfire risk due to climate change, public awareness and perceptions of wildfire impact in the UK are limited. This study used an online questionnaire survey to examine public understanding of wildfires among a non-specialist audience and how the ‘2018 Roaches wildfire’ influenced Reserve users’ perceptions of impacts, recovery, and management. Respondents demonstrated a general awareness of wildfire severity, ignition sources, and global fire geography, although familiarity with specific UK incidents varied. Perceptions of impacts were mixed, reflecting different experiences and emotional responses to the 2018 event. Ecological aspects, such as soil, biodiversity, and landscape aesthetics, were widely perceived as ‘slow to recover’, whereas recreation, safety, and health were viewed as returning to normal more quickly. A strong sense of shared responsibility for wildfire safety emerged, with participants emphasizing the need for clearer communication, improved public education, and higher levels of community involvement. These findings provide exploratory but valuable insights into public perceptions of UK wildfires, thereby informing future research pathways to strengthen fire management and preparedness. Full article

Background/Objectives: Natural disasters and climate-related emergencies increasingly disrupt maternal healthcare systems, placing growing demands on the midwifery workforce. While midwives play a critical role in maintaining continuity of care, evidence on how workforce preparedness influences service delivery remains limited. This systematic review aimed to synthesize evidence on determinants of midwives’ disaster preparedness and examine their association with continuity of maternal care. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, CINAHL, Scopus, and Web of Science from inception to March 2026. Eligible studies examined midwives or midwifery-led care in natural disasters or climate-related emergencies. Data were extracted independently by two reviewers, and methodological quality appraised using the Mixed Methods Appraisal Tool (MMAT). Due to substantial methodological and clinical heterogeneity across study designs, populations, and outcomes, a meta-analysis was not feasible and findings were synthesized narratively. Results: Nine studies met the inclusion criteria, with the evidence base consisting predominantly of qualitative and cross-sectional studies, alongside one cohort study. Evidence was mainly derived from earthquake-affected settings. Preparedness was influenced by individual, professional, organizational, and psychosocial factors. Insufficient disaster-specific training, role ambiguity, and limited institutional preparedness were linked to reduced response capacity and disruptions across antenatal, intrapartum, and postnatal care. Conclusions: The evidence suggests that midwifery workforce preparedness is an important determinant of continuity of maternal care during disasters and climate-related emergencies. Strengthening disaster education, integrating midwives into emergency planning, and enhancing organizational support are essential to improve health system resilience. Further longitudinal and intervention-based research across diverse disaster contexts is needed to strengthen the evidence base. However, the findings should be interpreted cautiously due to the limited number and heterogeneity of included studies. Full article

Background/Objectives: Teachers are often the first adults responsible for supporting students with type 1 diabetes mellitus (T1DM) during the school day. This study assessed schoolteachers’ diabetes-related knowledge, attitudes, emergency readiness, and routine school practices in Jordan. Methods: A cross-sectional online survey was conducted among teachers working in public and private schools in Jordan between February and April 2026. The final sample included 604 teachers. Multivariable relationships were examined using path analysis in R with full information maximum likelihood. Results: The median age was 43 years (IQR: 38–47), 88.6% of participants were women, and 15.9% had received prior diabetes-related training. Median composite scores were 11/14 (IQR: 9–12) for knowledge, 43/50 (IQR: 39–46) for attitudes, 23/35 (IQR: 18–28) for emergency readiness, and 24/30 (IQR: 20–26) for routine practices. The path model showed close fit indices (chi-square(1) = 0.243, p = 0.622; CFI = 1.00; RMSEA = 0.00; SRMR = 0.001), although these indices were interpreted cautiously because the model had only one degree of freedom. Greater knowledge was associated with more favorable attitudes (beta = 0.374, p < 0.001), and more favorable attitudes were associated with better emergency readiness (beta = 0.141, p < 0.001) and routine practices (beta = 0.244, p < 0.001). Teachers with prior diabetes-related training also reported higher attitudes, emergency readiness, and routine practice scores. Conclusions: Jordanian teachers appeared willing to support students with diabetes, but this willingness was not matched by consistent emergency preparedness. Targeted training and stronger school-level protocols are needed to improve the safety and quality of diabetes care in schools. Full article

Background: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may support healthcare access, continuity of care, and disaster preparedness in underserved settings. This study examined the Texas A&M University (TAMU) nurse-led mobile clinic model with respect to rural service delivery, health equity, operational considerations, and disaster preparedness. Methods: A mixed-methods descriptive program evaluation was conducted using programmatic operational data, survey responses, and preparedness-planning records. The TAMU mobile clinic serves six rural counties through primary, preventive, and behavioral healthcare delivery using in-person care, telehealth, and home visits. Disaster preparedness activities were integrated through the annual Disaster Day interprofessional simulation involving approximately 600–700 learners. A 2025 Central Texas flooding event served as a case study to evaluate operational preparedness and system readiness. Results: Mobile clinic operations supported healthcare access, continuity of care, and community engagement in rural settings. Interprofessional education simulation findings demonstrated perceived gains in teamwork, triage, communication, and rapid decision-making. During the 2025 flooding event, activation protocols were initiated; however, deployment was not authorized, highlighting system-level constraints related to administrative approval pathways despite operational readiness and workforce preparedness. Conclusions: Nurse-led mobile clinics may serve as an adaptable infrastructure for improving rural healthcare access, supporting continuity of care, and strengthening disaster preparedness. Findings further emphasize that clinical preparedness alone is insufficient without coordinated administrative processes, interoperable systems, and governance structures capable of supporting rapid emergency deployment. Full article

Postpartum hemorrhage (PPH) is a high-stakes obstetric emergency in which delayed recognition and inadequate structured management may result in severe maternal morbidity. Medical students have limited exposure to such scenarios during clinical rotations, raising concerns regarding preparedness for emergency obstetric care. Simulation-based training has been proposed to address this situation; however, its impact on emergency-specific performance, confidence calibration, and determinants of skill acquisition remains incompletely understood. Methods: A single-group prospective pre–post-educational intervention study was conducted among sixth-year medical students following an obstetrics and gynecology rotation. Participants completed a structured high-fidelity simulation module focused on PPH management. Outcomes included an objective composite performance score and self-assessed emergency confidence. Results: A total of 215 students were included. Simulation-based training resulted in substantial improvements in PPH composite performance (scaled 0–1: 0.34 ± 0.20 to 0.67 ± 0.23; p < 0.001; Cohen’s dz = 1.38). Conclusions: Structured simulation-based PPH training markedly enhances emergency management performance among final-year medical students. Learning gains are primarily determined by baseline competence, while motivational responses are influenced by perceived realism, supporting the integration of structured emergency simulation into undergraduate curricula. Full article

This systematic review examines how organisational resilience is conceptualised, enacted, and enabled in the Digital Age, characterised by Artificial Intelligence (AI), Generative AI, the Internet of Things (IoT), Big Data, and Robotics. Despite their transformative potential, these technologies are often treated as peripheral tools rather than core mechanisms in resilience architectures. Adopting a critical realist paradigm, we conducted a Systematic Literature Review (SLR) following the PRISMA 2020 protocol to review thirty (30) peer-reviewed empirical studies (2017–present). A pre-SLR conceptual framework, linking Business Intelligence and Responsiveness constructs, guided data extraction and synthesis. Building on this, we propose a conceptual framework and explanatory model grounded in the Context–Mechanism–Outcome logic. The model distinguishes generative mechanisms (real domain), organisational responses (actual domain), and observable indicators (empirical domain). The review identifies Collective Capability (CC), Adaptive Capability (AC) and Dynamic Capability (DC) mechanisms as key generative powers, with Digital Age enablers embedded within Adaptive Capability (AC) and Dynamic Capability (DC). Together, these mechanisms contribute to Systemic Preparedness (SP), Rapid Recovery (RR) and Generative Stability (GS), thereby supporting the emergence of Organisational Resilience (OR). This reconceptualises resilience as an emergent, non-linear outcome of mechanism interactions, offering a unified direction. Future research should prioritise longitudinal multi-case studies and quantitative testing of Context–Mechanism–Outcome configurations, supported by mixed-method designs to validate and refine the proposed framework. Full article