Search Results (661)

The education sector in Tanzania faces significant challenges, especially in public primary schools. Unmanageably large classes and critical teacher–pupil ratios hinder the provision of tailored tutoring, impeding pupils’ educational growth. However, artificial intelligence (AI) could provide a way forward. Advances in generative AI can be leveraged to create interactive and effective intelligent tutoring systems, which have recently been built into embodied systems such as social robots. Motivated by the pivotal influence of teachers’ attitudes on the adoption of educational technologies, this study undertakes a qualitative investigation of Tanzanian primary school mathematics teachers’ perceptions of contextualised intelligent social robots. Thirteen teachers from six schools in both rural and urban settings observed pupils learning with a social robot. They reported their views during qualitative interviews. The results, analysed thematically, reveal a generally positive attitude towards using social robots in schools. While commended for their effective teaching and suitability for one-to-one tutoring, concerns were raised about incorrect and inconsistent feedback, language code-switching, response latency, and the lack of support infrastructure. We suggest actionable steps towards adopting tutoring systems and social robots in schools in Tanzania and similar low-resource countries, paving the way for their adoption to redress teachers’ workloads and improve educational outcomes. Full article

The growing disconnection between humans and nature—particularly in urban environments—has been associated with declining well-being and lower engagement in pro-environmental behavior. Although the Connectedness with Nature Scale (CNS) has been widely used internationally to measure this relationship, there is a lack of evidence on its validity and reliability in Latin American contexts, especially in urban and rural settings. This study aims to address this gap by examining the psychometric properties of the CNS in a sample of 956 Colombian participants. Using exploratory and confirmatory factor analyses, we tested two versions of the scale (14-item and 12-item models), both showing good fit and high internal consistency (α > 0.90). Convergent validity was confirmed through strong correlations with the Environmental Identity and Pro-environmental Behavior Scales. These findings support the CNS as a valid and reliable tool to assess the human–nature connection in Colombia and highlight its potential for informing urban sustainability initiatives, environmental education, and public policy in diverse sociocultural contexts. Full article

Background: Telehealth is an essential component of modern healthcare, and it was especially relevant during the COVID-19 pandemic, but disparities in digital and technological literacy among health professionals may limit its equitable adoption and impact. Objective: This study seeks to validate an eight-item telehealth literacy survey among health professionals in Central–South Chile and to examine demographic and behavioral determinants of literacy levels, developing predictive models to identify key factors. Methods: In this cross-sectional study, 2182 health professionals from urban and rural centers in Central–South Chile completed the adapted survey along with questions on age, gender, nationality, and frequency of telehealth use. We assessed internal consistency (Cronbach’s α), explored factor structure via exploratory factor analysis (EFA), and tested associations using Pearson correlations, t-tests, one-way ANOVA, and both linear and multinomial logistic regressions. Results: The instrument demonstrated high reliability (Cronbach’s α = 0.92) and a two-factor structure explaining 65% of variance. Age negatively correlated with literacy (r = −0.26; p < 0.001), while the frequency of telehealth use showed a positive correlation (r = 0.26; p < 0.001). Female professionals and those in urban settings scored significantly higher on telehealth literacy (p = 0.005 and p < 0.001, respectively). The reduced multinomial model achieved moderate classification accuracy (51.65%) in distinguishing low, medium, and high literacy groups. Conclusions: The validated survey is a reliable tool for assessing telehealth literacy among health professionals in Chile. The findings highlight age, gender, and geographic disparities, and support targeted digital literacy interventions to promote equitable telehealth practice. Full article

This study examines diurnal surface temperature dynamics across major Moroccan cities during the growing season and explores the interaction between urban and vegetated surfaces. We also introduce the Urban Thermal Impact Ratio (UTIR), a novel metric designed to quantify urban thermal comfort as a function of the surface urban heat island (SUHI) intensity. The analysis is based on outputs from a land surface model (LSM) for the year 2010, integrating high-resolution Landsat and MODIS data to characterize land cover and biophysical parameters across twelve land cover types. Our findings reveal moderate urban–vegetation temperature differences in coastal cities like Tangier (1.8 °C) and Rabat (1.0 °C), where winter vegetation remains active. In inland areas, urban morphology plays a more dominant role: Fes, with a 20% impervious surface area (ISA), exhibits a smaller SUHI than Meknes (5% ISA), due to higher urban heating in the latter. The Atlantic desert city of Dakhla shows a distinct pattern, with a nighttime SUHI of 2.1 °C and a daytime urban cooling of −0.7 °C, driven by irrigated parks and lawns enhancing evapotranspiration and shading. At the regional scale, summer UTIR values remain below one in Tangier-Tetouan-Al Hoceima, Rabat-Sale-Kenitra, and Casablanca-Settat, suggesting that urban conditions generally stay within thermal comfort thresholds. In contrast, higher UTIR values in Marrakech-Safi, Beni Mellal-Khénifra, and Guelmim-Oued Noun indicate elevated heat discomfort. At the city scale, the UTIR in Tangier, Rabat, and Casablanca demonstrates a clear diurnal pattern: it emerges around 11:00 a.m., peaks at 1:00 p.m., and fades by 3:00 p.m. This study highlights the critical role of vegetation in regulating urban surface temperatures and modulating urban–rural thermal contrasts. The UTIR provides a practical, scalable indicator of urban heat stress, particularly valuable in data-scarce settings. These findings carry significant implications for climate-resilient urban planning, optimized energy use, and the design of public health early warning systems in the context of climate change. Full article

The increasing demand for high-speed internet and advanced digital services necessitates the deployment of robust and scalable broadband infrastructure, particularly in smaller urban and rural areas. This paper presents the design and implementation of a passive optical network (PON) based on a gigabit-capable passive optical network (GPON) standard to deliver fiber-to-the-home (FTTH) services in a small-town setting. The proposed solution prioritizes cost-effectiveness, scalability, and minimal energy consumption by leveraging passive splitters and unpowered network elements. We detail the topology planning, splitter architecture, installation practices, and technical specifications that ensure efficient signal distribution and future network expansion. The results demonstrate the successful implementation of an optical access infrastructure that supports high-speed internet, Internet Protocol television (IPTV), and voice services while maintaining flexibility for diverse urban layouts and housing types. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

The integration of renewable energy with circular economy strategies offers effective pathways to reduce greenhouse gas emissions while enhancing local energy independence. This study analyses three real-world projects implemented in Spain that exemplify this synergy. LIFE Smart Agromobility converts pig manure into biomethane to power farm vehicles, using anaerobic digestion and microalgae-based upgrading systems. Smart Met Value refines biogas from a wastewater treatment plant in Guadalajara to produce high-purity biomethane for the municipal fleet, demonstrating the viability of energy recovery from sewage sludge. The UNDERGY project addresses green hydrogen storage by repurposing a depleted natural gas reservoir, showing geochemical and geomechanical feasibility for seasonal underground hydrogen storage. Each project utilises regionally available resources to produce clean fuels—biomethane or hydrogen—while mitigating methane and CO₂ emissions. Results show significant energy recovery potential: biomethane production can replace a substantial portion of fossil fuel use in rural and urban settings, while hydrogen storage provides a scalable solution for surplus renewable energy. These applied cases demonstrate not only the technical feasibility but also the socio-economic benefits of integrating waste valorisation and energy transition technologies. Together, they represent replicable models for sustainable development and energy resilience across Europe and beyond. Full article

Loneliness and social isolation are pressing public health concerns, prompting interest in how rural and urban environments shape social wellbeing. However, evidence remains mixed—perhaps because loneliness is a distal psychological outcome with complex, trait-like stability. To address this, we examined geographic variation in upstream patterns of social activity using data from the 2023 Canadian Social Connection Survey (N = 1556). The principal component analysis identified five domains of social behavior, which we analyzed using multivariable regression and supplemented with a series of sensitivity and stratified analyses. Our findings suggest that while broad differences across rural and urban geographies are modest, specific domains of behavior show some variation. For example, residents in rural areas reported lower casual social interaction (b = −0.19, p = 0.019) but similar or even greater engagement in intimate and supportive behaviors. Emotional loneliness was slightly lower in small towns (b = −0.17, p = 0.029), indicating possible protective effects of some smaller community contexts. While the overall structure of social behavior was not invariant across settings, general patterns of engagement appeared largely resilient to geographic differences. These findings underscore the importance of place-sensitive strategies that respond to specific forms of social behavior affected by geography while avoiding overgeneralized assumptions about rural–urban disparities. Full article

Background/Objectives: The INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) network introduces an innovative model of psychogeriatric care, combining tertiary mental healthcare with primary care for older adults in low-resource settings in Greece via telemedicine. This study explores viewpoints of healthcare professionals on care delivery within the frames of old-age mental telehealth services in low-resource settings. Methods: All healthcare professionals, including 13 medical and 11 non-medical professionals from diverse healthcare units in urban, rural, and insular areas, participated in a semi-structured survey. Thematic analysis identified key insights. Results: Most participants (N = 19) highlighted the high usability of the INTRINSIC services and their high satisfaction for being members of the network (N = 17) was attributed to the collaborative delivery of integrated, specialized healthcare services in primary healthcare (N = 17). Further identified advantages of the services included the positive impact on timely care delivery (N = 6), cost effectiveness, and alleviation of hospital strain. Healthcare professionals valued the holistic approach of the INTRINSIC services to psychogeriatric care (N = 8) and their role in the improvement of it in communities in low-resource settings (N = 13). However, challenges were also reported, including the low openness and reluctance of service users (N = 7), difficulties in using the INTRINSIC digital platform (N = 5), and increased workload (N = 5). Conclusions: Despite these issues, the INTRINSIC services embody an innovative telehealth model for delivering high-quality, tertiary, mental, and cognitive healthcare services to older adults in underserved areas. Full article

Background/Objectives: Cognitive deficiency associated with chronic alcohol consumption in older people remains an under-investigated public health issue in Romania, particularly concerning rural–urban disparities and the impact of reversible hepatic dysfunction on cognitive performance. To evaluate cognitive function at hospital admission and discharge using the Mini-Mental State Examination (MMSE); to identify rural–urban disparities; and to analyze the relationship between hepatic markers and MMSE scores in older people with chronic alcohol consumption. Methods: This retrospective, single-center observational study was conducted on 152 patients aged ≥55 years, hospitalized between January 2021 and December 2023 at the “Elisabeta Doamna” Psychiatric Hospital, Galați. Demographic variables, MMSE scores (at admission and discharge), and hepatic parameters (AST, ALT, GGT, total bilirubin, and ammonia) were collected. Statistical analysis included descriptive statistics, chi-square tests for categorical variables, paired t-tests or ANOVA for MMSE scores, and Pearson correlations between MMSE and hepatic markers (α = 0.05). Results: At admission, 94% of patients had an MMSE score < 24. The mean MMSE score increased from 23.4 ± 4.1 to 25.0 ± 3.7 at discharge (Δ = +1.6; p < 0.001). Patients from rural areas (63.8% of the sample) had significantly lower MMSE scores at admission compared to urban patients (22.6 ± 3.9 vs. 24.8 ± 4.2; p = 0.02). However, no statistically significant difference was observed between rural and urban patients regarding cognitive improvement during hospitalization (p = 0.88), indicating that the initial gap persisted at discharge. GGT levels were inversely correlated with MMSE scores (r = −0.41; p < 0.001), suggesting a contribution of hepatic dysfunction to cognitive decline. Conclusions: Alcohol-related cognitive impairment is highly prevalent among older patients hospitalized for withdrawal, with partial reversibility observed through inpatient management. The observed rural disparities and the association between hepatic dysfunction and cognitive performance highlight the need of concurrent MMSE and hepatic screening, with prioritized interventions in rural settings. Prospective, multicenter studies are warranted to validate these findings and to identify additional prognostic biomarkers. Full article

Background/Objectives: The COVID-19 pandemic exposed critical vulnerabilities in healthcare systems, especially in ensuring continuity of care for patients with chronic diseases. Rehabilitation services, essential for recovery following SARS-CoV-2 infection, were among the most disrupted. This exploratory study aimed to assess Romanian patients’ perceptions of the accessibility and quality of post-COVID-19 rehabilitation services, focusing on individuals with chronic conditions. Methods: This exploratory cross-sectional study was conducted over a 12-month period in 2024. Data were collected from 76 adult patients diagnosed with at least one chronic condition (hypertension, diabetes mellitus, ischemic heart disease, cancer, or chronic obstructive pulmonary disease) and with confirmed prior SARS-CoV-2 infection. Most participants were recruited during outpatient specialty consultations, with a smaller number included from hospital settings, all located in Bucharest. A structured questionnaire was administered by the principal investigator after obtaining informed consent. Quantitative data were analyzed using non-parametric methods following confirmation of non-normal distribution via the Shapiro–Wilk test (p < 0.05). Satisfaction scores were reported as medians with interquartile ranges (IQR), and group comparisons were performed using the Mann–Whitney U test. A mixed-methods approach was employed, including thematic analysis of open-ended responses. Results: Patient satisfaction with rehabilitation services was consistently low. The median satisfaction scores [IQR] were accessibility 1.0 [0.0–2.0], quality of services 0.0 [0.0–4.0], staff empathy 0.0 [0.0–5.0], and perceived effectiveness 0.0 [0.0–5.0]. The median score for perceived difficulties in access was 1.0 [1.0–2.0], indicating widespread barriers. No statistically significant differences were observed between urban and rural participants or across chronic disease categories. Thematic analysis (n = 65) revealed key concerns including lack of publicly funded services, cost barriers, limited physician referral, service scarcity in rural areas, and demand for home-based rehabilitation options. Conclusions: Romanian patients with chronic illnesses and previous SARS-CoV-2 infection continue to face substantial barriers in accessing post-COVID-19 rehabilitation services. These findings highlight the need for more equitable and integrated recovery programs, especially for vulnerable populations in underserved settings. Full article

Access to safe, clean drinking water is a critical challenge across many resource-constrained settings, especially in developing economies. Large-scale water treatment technologies are often available in urban areas, whereas such centralized systems are unavailable in rural and remote areas due to high infrastructure costs, rugged terrains, and maintenance challenges. To address this challenge, point-of-use (PoU) water treatment systems can fill this critical gap. This study critically evaluates the role low-cost PoU water treatment solutions play as a promising alternative to address water access and quality aspects in remote rural areas. The study explores the present state of global water sources, the challenges of water scarcity and pollution, and the limitations of existing large-scale treatment technologies. It highlights the motivation behind PoU systems and provides an in-depth analysis of various low-cost technologies, including operational principles, performance efficiency, and economic viability. Embedded in this study is a concise evaluation of the sustainability of these solutions in addressing water access and quality challenges in resource-limited regions. Finally, the study proposes solutions and perspectives on improving PoU systems and scale-up of the systems for large-scale applications to facilitate increased access to clean and safe water. Full article

Background: Breast cancer poses a significant health challenge in Bangladesh, where limited screening and unique reproductive patterns contribute to delayed diagnoses and subtype-specific disparities. While reproductive risk factors such as age at menarche, parity, and contraceptive use are well studied in high-income countries, their associations with hormone-receptor-positive (HR+) and triple-negative breast cancer (TNBC) remain underexplored in low-resource settings. Methods: A case-control study was conducted at the National Institute of Cancer Research and Hospital (NICRH) including 486 histopathologically confirmed breast cancer cases (246 HR+, 240 TNBC) and 443 cancer-free controls. Socio-demographic and reproductive data were collected through structured interviews. Machine learning models—including Logistic Regression, Lasso, Support Vector Machines, Random Forest, and XGBoost—were trained using stratified five-fold cross-validation. Model performance was evaluated using sensitivity, F1-score, and Area Under Receiver Operating Curve (AUROC). To interpret model predictions and quantify the contribution of individual features, we employed Shapley Additive exPlanation (SHAP) values. Results: XGBoost achieved the highest overall performance (F1-score = 0.750), and SHAP-based interpretability revealed key predictors for each subtype. Rural residence, low education (≤5 years), and undernutrition were significant predictors across subtypes. Cesarean delivery and multiple abortions were more predictive of TNBC, while urban residence, employment, and higher education were more predictive of HR+. Age at menarche and age at first childbirth showed decreasing predictive importance with increasing age for HR+, while larger gaps between marriage and childbirth were more predictive of TNBC. Conclusions: Our findings underscore the value of machine learning coupled with SHAP-based explainability in identifying context-specific risk factors for breast cancer subtypes in resource-limited settings. This approach enhances transparency and supports the development of targeted public health interventions to reduce breast cancer disparities in Bangladesh. Full article

Background: Rural patients, including those with rectal cancer, continue to be underrepresented in research and medically underserved with unique challenges to accessing care. Like the rest of America, rural patients are experiencing rising rates of rectal cancer; however, unlike the rest of the country, they also have rising rectal cancer-related mortality. This study aims to review the literature regarding care for patients with rectal cancer in rural settings, from presentation and diagnosis to treatment algorithms, oncologic outcomes, their unique preferences, and the goals of care. Methods: A literature search was performed on PubMed, on 31 October 2024, using synonyms of “rural” and “rectal cancer” to identify relevant articles. Articles from outside the USA and Canada and those offering only commentary were eliminated during the initial screening/retrieval. A full-text review was performed on the remaining articles; all the studies that did not address the identified primary or secondary outcomes in rural rectal cancer patients were then excluded. All the primary and secondary outcomes are briefly summarized in narrative form, with more detail on the primary outcomes provided in tables. The variability in the key criteria between the studies is also summarized in the tables and appendices provided. Results: Thirty studies were identified that addressed the outcomes of interest in rural rectal cancer patient populations. The total number of participants could not be assessed given the use of overlapping databases. Of the articles, 21 addressed treatment modalities (surgery, chemotherapy, radiation), 13 addressed oncologic outcomes, and a mix of additional studies addressed the diagnostic work up, costs, and patient preferences. The studies addressing treatment demonstrated similar practices in regard to chemotherapy and surgical management, aside from lower rates of minimally invasive surgery, along with decreased neoadjuvant radiotherapy use and increased under-dosing in rural patients. The oncologic outcomes were overall similar to worse for rural patients as compared to urban patients, even for those receiving treatment at high-volume urban centers. Additionally, rural patients have higher healthcare costs for rectal cancer care. Discussion/Conclusions: Rural patients are an at-risk group, with a rising disease burden and worsening rectal cancer outcomes, despite advances in rectal cancer care and improving oncologic outcomes in the general population. Analysis of the situation is complicated due to the underrepresentation of rural patients in research and the lack of uniformity in the definition of “rural”. Moreover, significant gaps in the literature remain, such that the evaluation of guideline-concordant care is incomplete, including an absence of literature about watch-and-wait approaches in rural populations. While regionalization of rectal cancer care has shown promise, the improvements in outcomes may not be commensurate for rural patients. Thus, a specific focus on the impact of this shift for rural patients is necessary to mitigate unintended consequences. Full article

With the rapid development of urbanization in rural areas of China, various environmental issues have become increasingly prominent, particularly the water pollution problems in small rural watersheds, which have garnered considerable attention. Comprehensive management of small watersheds requires an initial analysis of the sources and characteristics of water pollution. This study focuses on small rural watersheds in the Pearl River Delta. Based on the characteristics of the watersheds, 35 water quality monitoring stations were set up to collect water quality data. Cluster analysis was used to study the spatial distribution characteristics of water quality indicators at each monitoring point. Further, factor analysis methods (PCA/FA) and Absolute Principal Component Scores-Multiple Linear Regression (APCS-MLR) models were employed to identify water quality influencing factors and quantify pollution source contributions. Finally, the comprehensive index method for eutrophication assessment was used to evaluate and analyze the potential eutrophication pollution risk in the watersheds. The results indicate significant pollution in the water quality of rural small watersheds in the study area, with varying degrees of pollution over time and space. During the wet season, water quality is mainly influenced by agricultural nutrients, followed by biochemical factors. In the normal and dry seasons, water quality is primarily affected by oxygen-consuming organic pollutants, followed by eutrophication factors. The comprehensive eutrophication evaluation shows that the overall water quality in the watershed is better during the wet season, with a lower risk of eutrophication; during the normal season, the overall water quality is poorer, with the highest eutrophication risk in the midstream; during the dry season, the upstream and midstream water quality is better, while the downstream water quality is poorer. In contrast, the pond water exhibits a higher risk of eutrophication during the wet season compared to the normal and dry seasons. This is mainly due to the peak of fish farming during the wet season, which results in a heavier load on the water body. This study provides effective data support for the water environment management of rapidly developing rural small watersheds. Full article