Search Results (914)

This paper proposes a conceptual framework for strengthening school quality assurance through knowledge management to support sustainable education. Drawing on the international priorities of the OECD and UNESCO, the study positions school self-evaluation as a central quality-assurance mechanism that can promote continuous improvement, accountability, equity, and better learning outcomes. Methodologically, the study adopts a quantitative research design to collect data from 978 teachers across 20 schools in Hong Kong. Exploratory factor analysis and structural equation modelling were employed to identify the latent variables and validate the conceptual framework. Results show that effective quality assurance depends on both formal procedures and the school’s capacity to create, share, and use knowledge. Key knowledge management enablers include visionary leadership, professional autonomy, bureaucratic control, information technology infrastructure, and a collaborative culture of knowledge sharing. Within this model, professional autonomy and knowledge sharing link management conditions to evidence-informed reflection, planning, and improvement. The framework is situated in the context of Hong Kong schools while offering broader relevance for education systems seeking sustainable development. The study concludes that sustainable school self-evaluation is driven primarily by teacher professional autonomy (β = 0.738, total effect = 0.795), with knowledge sharing functioning as a critical mediating mechanism that transmits the effects of visionary leadership (indirect β = 0.343) and enabling bureaucratic control (indirect β = 0.103) into evaluation quality. IT infrastructure does not exert a significant direct effect on SSE (β = 0.056, p = 0.098), indicating that technological provision is a necessary but insufficient condition for evaluation effectiveness in the Hong Kong context. Full article

Background/Objectives: Large language models (LLMs) and generative AI are rapidly being integrated into healthy ageing initiatives for tasks ranging from companionship and cognitive support to personalised health advice and reduction in social isolation among older adults. Current ethical discussions predominantly address bias, privacy, and accuracy, leaving unresolved three critical governance questions: How do LLM sentiments towards transformative technologies diverge from human values in ageing contexts? What epistemic status do LLM outputs hold when applied to geriatric care? When is trust in those outputs justified for older adults? And who bears responsibility when AI-informed decisions affect functional ability or well-being? Methods: The framework was developed through normative conceptual analysis, synthesizing philosophical principles of medical knowledge and trust, ethical theories of responsibility, empirical evidence on LLM sentiment divergence, digital ageism, and applications of AI in geriatric care (structured searches in PubMed, PhilPapers, and relevant databases, January 2020–March 2026). Results: The integrated framework produces (i) adaptation of SAIA for multidimensional evaluation of human–machine value convergence specific to healthy ageing values (functional ability, autonomy, dignity, equity); (ii) a four-tier classification of LLM outputs tailored to geriatric scenarios; (iii) conditions for warranted trust calibrated to age-related vulnerabilities such as cognitive decline and digital divide; and (iv) responsibility allocation via RACI models with testable hypotheses linking governance design to trust calibration and patient safety outcomes. Conclusions: Without explicit societal alignment and epistemic governance, generative AI risks reinforcing benevolent ageism, automation bias, and responsibility gaps in healthy ageing. The 2025–2027 period offers a decisive window to shape institutional norms that place functional capacity, human dignity, and value convergence at the centre of AI deployment in geriatric care. Full article

Background: Maternal mortality remains a major global health challenge, disproportionately affecting black and Indigenous women. Hypertensive disorders of pregnancy and postpartum hemorrhage are the leading direct causes of maternal death. Artificial intelligence (AI) tools have emerged as potential strategies for predicting these complications, yet concerns persist about their equity and validation across racial groups. Methods: A rapid review was conducted in five databases, PubMed, EMBASE, Web of Science, Scopus and LILACS, to synthesize recent evidence on the use of AI for preventing maternal mortality due to hypertension and postpartum hemorrhage. Studies published in the last five years that included racial or ethnic data were selected and analyzed narratively. Results: Ten studies met the inclusion criteria, showing high predictive accuracy of AI models (AUROC often >0.95) for severe maternal outcomes. However, few models incorporated racial variables or underwent external validation in racially diverse or low-resource populations. Evidence suggests that unrepresentative datasets may perpetuate or exacerbate existing health inequities. Conclusions: AI demonstrates strong technical performance in predicting maternal complications but limited equity in application. Broader racial representation, external validation, and ethical governance are essential for ensuring that AI-based tools reduce rather than reinforce racial disparities in maternal mortality. Full article

Aboriginal people in Western Australia (WA) experience poorer cancer outcomes compared to non-Aboriginal Australians, with significant disparities in cancer screening participation, later-stage diagnosis, and lower survival rates. This narrative review, informed by selected scoping methods, examined 69 peer-reviewed studies contributed by WA researchers from 2000 to 2024 to inform understanding of and address these inequities. Recurring issues requiring attention included promoting cultural safety in healthcare, addressing barriers to and disparities in cancer care, boosting cancer screening and awareness, enhancing education and communication, strengthening support systems and care navigation, improving treatment access and outcomes, and building workforce capacity. Recommendations to address the above challenges and improve cancer care and outcomes for Aboriginal people in WA included addressing barriers and disparities in cancer care; promoting effective education, communication, and culturally appropriate support; enhancing cancer screening participation and awareness initiatives; improving access to cancer treatment and outcomes; strengthening policy and system-level interventions; supporting families and communities throughout their cancer journey; building research capacity and data collection to guide Aboriginal and community-led initiatives. These recommendations highlighted that multi-level interventions are needed, from empowering Aboriginal people and strengthening communities to improving service delivery and driving systematic reforms. Overall, this narrative review informs future research, policy, and practice focused on equity to improve cancer outcomes for Aboriginal people in WA and beyond. Full article

The global energy transition is frequently advocated as a means to achieve environmental sustainability. However, its distributional impacts remain inadequately understood, particularly in developing nations where approximately 666 million individuals still lack access to electricity. This study investigates whether the expansion of renewable energy consumption mitigates or exacerbates socioeconomic inequality across 82 developing economies from 2000 to 2022. Employing a multi-method econometric framework that considers cross-sectional dependence, heterogeneity, and nonlinear dynamics, we analyze three dimensions of equity: income inequality, monetary poverty, and disparities in electricity access between urban and rural populations. The findings reveal a complex relationship. While the expansion of renewable energy is associated with improvements in income distribution, it is also linked to persistent poverty and unequal access to energy services. This tension reflects what we term the “biomass paradox,” wherein the continued reliance on traditional biomass in low-income countries constrains the inclusiveness of energy transitions. Quantile regression analysis reveals that the effect of renewable energy reverses across the distribution: renewable energy slightly widens the energy access gap in countries where disparities are already small, but narrows it substantially in countries where the gap is widest. The results further indicate that the equity effects of renewable energy vary across contexts and are particularly sensitive to initial conditions and institutional capacity. In settings with weak governance, renewable expansion shows no statistically distinguishable effect on equity outcomes, whereas in stronger institutional environments, its effects become more transformative. These findings suggest that aggregate renewable energy targets that do not differentiate between traditional and modern sources may be misleading. More broadly, achieving a just energy transition necessitates not only expanding renewable capacity but also strengthening governance frameworks and directing investments toward contexts where energy inequalities are most pronounced. Full article

Dementia affects approximately 55 million people worldwide, yet the psychological experience of diagnosis and the determinants of post-diagnostic well-being remain underexplored relative to biomedical research priorities. The existing literature has been predominantly deficit-oriented, focusing on cognitive decline, neuropsychiatric symptoms, and carer burden, with limited attention to preserved psychological capacities and what supports flourishing following diagnosis. This narrative review applies a positive psychology framework to synthesise evidence on meaning, purpose, hope, and post-diagnostic adjustment in early-stage dementia. A central empirical observation motivating the review: the well-being paradox—subjective well-being in early-to-moderate dementia is frequently higher than carers and clinicians predict. It is also more strongly associated with psychosocial variables than with objective cognitive status. Evidence from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort and related longitudinal research demonstrates that emotional responsiveness, need satisfaction, and capacity for meaning-making are preserved in early-stage dementia and constitute clinically relevant assets. Four positive psychology constructs are identified as evidence-based targets for intervention: hope, self-compassion, social identity, and meaningful engagement. Clinical implications include integrating strengths-based assessment, meaning-centred group interventions, structured peer support, and validated positive outcome measures into post-diagnostic care pathways. Health equity considerations and research priorities are addressed, including the underrepresentation of minority ethnic communities and people with young-onset dementia in existing research. The review argues that meaningful progress requires deliberate reorientation of clinical, commissioning, and research priorities toward a positive psychology framework for dementia care. Full article

Integrated care is increasingly shaped by digital infrastructures, data governance, and AI-enabled analytics, yet the relevant literature remains fragmented across health-services research, digital health, and machine learning. This article reports a scoping review, conducted in line with PRISMA-ScR guidance, that maps how integrated care models have evolved conceptually, what digital and AI-enabled infrastructures support them, how their clinical, economic, and equity impacts can be evaluated, and what current implementations imply for sustainable scaling. We searched PubMed, Scopus, Semantic Scholar, and Crossref (retrieval date 31 October 2025; forward screening to 31 March 2026) and added grey literature from named policy bodies. The searches identified 15,189 records, reducing to 11,789 after intra- and cross-source deduplication and grey-literature integration; 620 full texts were assessed and 192 were included in the synthesis. Four domains were synthesised: conceptual foundations of integrated care, AI and multimodal analytics, implementation barriers, and digital-governance foundations. We chart the field using a Type I–V maturity scheme (disease, cohort, whole-system, digital-integrated, learning), benchmarked against the Rainbow, MacColl, EMRAM/AMAM, and NHS ICS models. Most deployments cluster at digitally integrated but only weakly adaptive Type IV; recurrent failure modes—temporal blind spots, maintenance debt, semantic drift, and governance gaps—block progression to Type V, and high-profile clinical-AI failures illustrate the cost of attempting Type V analytics on Type IV-or-worse infrastructure. A walk through nine world regions maps each to its current Type I–V position and shows that organisational and payment integration—not digital sophistication alone—is currently the dominant driver of progress. The COMFORTage Integrated Care Model Library is positioned as a workflow of AI agents orchestrating predictive, preventive, and personalised care across the integrated-care lifecycle rather than as a single federated-learning programme. The review positions AI-enabled integrated care less as a finished model than as an emerging design space requiring longitudinal data assets, stewarded model lifecycles, accountable governance, and outcome-based contracting for clinically useful, equitable, and trustworthy learning systems. Full article

Patient navigation is a promising intervention to address barriers and improve access to cancer clinical trials. Although navigation has been widely studied across the cancer continuum, its role in facilitating clinical trial participation has not been systematically evaluated. This scoping review aims to identify, characterize, and synthesize evidence on patient navigation interventions designed to increase access to cancer clinical trials. Nine databases were searched for English peer-reviewed articles from inception through 5 March 2025. Two independent researchers screened titles, abstracts, and full texts and extracted data using standardized forms. The results were interpreted using descriptive statistics and collated using predetermined conceptual frameworks. Of 10,238 citations identified, 23 studies met inclusion criteria. All were conducted in North America, and five (21.7%) were randomized controlled trials. Thirteen studies (56.5%) evaluated enrollment outcomes, with mixed results. One randomized trial and two observational studies found no significant effect, while three observational studies and seven single-arm reports suggested improved enrollment. Navigation interventions most commonly included education/information provision (100%), care coordination (60.9%), and empowerment (47.8%). Navigators were primarily lay navigators (73.9%), often selected for community or lived experience; training varied widely, and only two programs reported certification. Fifteen studies (65.2%) targeted equity-deserving groups, most frequently racial and ethnic minorities, with reports of increased representation in trial enrollment. Patient navigation shows promise in improving access to cancer clinical trials, particularly for equity-deserving populations, but current evidence is limited, heterogeneous, and largely observational. Standardized definitions, rigorous trial designs, and reporting of navigator training and outcomes are needed to clarify effectiveness. Full article

Climate change represents one of the defining global health challenges of the 21st century, with far-reaching implications for population health, health systems, and health equity. The acceleration of environmental change, evidenced by record-breaking global temperatures, extreme weather events, and ecological degradation, poses a direct threat to achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all. This manuscript presents a narrative review and policy analysis of the intersection of climate change and global public health in light of the outcomes of the 2025 United Nations Climate Change Conference (COP30) in Belém, Brazil. Drawing on peer-reviewed literature, major institutional reports, and relevant policy documents, we explore how climate change exacerbates communicable and non-communicable diseases, undermines health system resilience, and disproportionately affects vulnerable populations worldwide. Particular attention is given to heat-related morbidity, infectious disease expansion, air pollution, food and water insecurity, displacement, gender inequities, antimicrobial resistance, and mental health impacts. The paper highlights the significance of the Belém Health Action Plan (BHAP), which is treated here as a COP30-associated action framework that places health more centrally within climate policy discussions. However, major challenges remain, including its voluntary orientation, the absence of dedicated financing mechanisms within the framework itself, and limited clarity on accountability arrangements, as identified through our synthesis of the available policy and evidence base. We argue that achieving SDG 3 is no longer feasible without integrating climate adaptation and mitigation into health systems and policies, and that progress will depend on translating global commitments into context-specific country strategies, governance arrangements, and implementation pathways. Full article

Despite extensive progress in breast cancer biomarker research, only a limited proportion of candidate biomarkers successfully transition from early discovery to clinically validated tools for targeted early detection. This article examines the key translational barriers that impede this progression across the biomarker development continuum. Five major gaps are identified: (i) discovery-to-clinical relevance, (ii) methodological and analytical validation, (iii) regulatory and administrative complexity, (iv) translational performance and real-world integration, and (v) equity and deployment challenges. Collectively, these gaps highlight limitations not only in scientific and methodological rigor but also in validation frameworks, regulatory alignment, implementation feasibility, and healthcare system equity. This article emphasizes that successful biomarker translation requires more than analytical validity. Finally, it requires a supportive ecosystem that enables effective breast cancer early detection strategies and improves population-level outcomes in breast cancer care. Full article

This study examined how digital equity conditions and bundled professional development policies are associated with sustainable teacher learning, self-efficacy, and student engagement in Greek primary schools. A total of 460 in-service teachers from urban, suburban, and rural areas participated in the study. Data were collected through Likert-scale measures assessing information systems use, TPACK-aligned professional development outcomes, teacher self-efficacy, implementation challenges, and student engagement. The analysis included ANOVA, MANOVA, OLS regression with interaction terms, and theory-informed indirect-pathway models. The findings indicated that infrastructure funding alone was not significantly associated with teacher capacity or student engagement after the introduction of relevant controls. More consistent associations emerged when funding was combined with mandated and time-protected professional development, together with minimum connectivity standards. Teacher self-efficacy was consistent with a partial indirect pathway between information systems use and student engagement, while stronger indirect associations were observed among early-career teachers. In addition, a bundled governance index was associated with narrower urban–rural disparities in teacher capacity. The findings suggest that sustainable digital equity in primary education depends not only on access to resources but also on coherent professional support structures that are associated with teacher confidence, instructional continuity, and long-term engagement. Implications are discussed for the design of sustainable professional development policies in teacher education and primary schooling. Full article

Heart transplantation remains a vital therapy for patients with end-stage heart failure, yet organ scarcity and evolving allocation policies necessitate robust risk prediction models to optimize outcomes and equity. This narrative review explores the current landscape of risk assessment in heart transplantation, contextualized within the broader framework of solid organ allocation and the emerging continuous distribution (CD) model. While kidney, liver, and lung transplantation have integrated validated risk scores into allocation systems, heart transplantation continues to rely on therapy-based criteria without a unified, benefit-based approach. We examine existing pre- and post-transplant predictive models and highlight their strengths and limitations. Additionally, we discuss the multidimensional factors influencing transplant success, ranging from donor and recipient characteristics to psychosocial and system-level variables. As CD expands across organ types, the development and integration of validated heart-specific risk scores will be essential to ensure equitable and effective organ allocation. Full article

Background: Upgrading existing housing, particularly affordable housing in China’s high-altitude cold regions, to near-zero energy standards requires balancing three key considerations: carbon reduction, life-cycle cost, and residents’ affordability. Methods: We developed a simulation-based multi-objective optimization framework to evaluate repair-and-retrofit packages involving the building envelope, ventilation, heating electrification, on-site renewables, and control strategies, subject to social feasibility and affordability constraints. Results: The Pareto-optimal solutions revealed a clear knee region in which substantial operational carbon reductions and acceptable thermal safety could be achieved at moderate investment levels. Further decarbonization was enabled by strong system-level synergies among heat recovery ventilation, heat pumps, and photovoltaic systems. Affordability-constrained optimization shifted the feasible solution space toward options associated with lower household energy burdens and more favorable distributional outcomes. Conclusions: Policy scenario analysis indicates that grid decarbonization and targeted financial support can expand the feasible space for low-carbon pathways and improve equity, thereby enabling scalable near-zero energy upgrading strategies. Full article

This study examines whether patient capital promotes the persistence of corporate green innovation and, if so, through what mechanism. Drawing on a panel of 21,811 firm-year observations for 3495 Chinese A-share listed firms from 2010 to 2022, we construct a patent-based measure of green innovation persistence and examine the role of strategic equity ownership as a form of long-horizon patient capital. The baseline results show that patient capital is positively associated with green innovation persistence after controlling for firm characteristics, industry fixed effects, and year fixed effects. Mechanism tests indicate that information disclosure quality is a significant partial mediator: patient capital improves disclosure quality, and higher-quality disclosure is associated with more continuous green innovation. The indirect effect is supported by both the Sobel test and a firm-level cluster bootstrap. Robustness checks using alternative green innovation outcomes, an alternative patient-capital measure, and alternative winsorization thresholds yield consistent results. Supplementary endogeneity analyses using lagged instrumental-variable estimation and propensity-score-matched-sample regressions support the baseline association, while temporal tests are interpreted cautiously because ownership and innovation exhibit strong serial persistence. Heterogeneity analyses show that the patient-capital effect is stronger among large firms and firms in heavily polluting industries, whereas evidence for information–environment and ownership heterogeneity is suggestive or statistically inconclusive. The findings contribute to research on investor horizons, green innovation persistence, and the real effects of corporate disclosure. Full article

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at discharge from Durham Homeless Care Transitions (DHCT). We analyzed data from DHCT, a transitional care program serving PEH. Independent variables included demographic characteristics, self-efficacy, mental healthcare status, and unmet identity and communication access (ICA) needs, including lack of personal identification documentation and technology access. We performed bivariate analyses and multivariable regression to assess associations with being rehoused at discharge. In both bivariate and multivariable analyses, non-White PEH were less likely to be rehoused at discharge than White PEH. Greater unmet ICA needs were also significantly associated with lower likelihood of rehousing. These findings add to the mixed prior literature regarding racial inequities in rehousing among PEH. The concept of ICA needs has not previously been studied and may offer an actionable target for transitional care programs seeking to improve rehousing outcomes and advance equity. Full article