Search Results (20,511)

Background: Diabetic foot ulcers (DFUs) and lower extremity amputations are major contributors to morbidity and mortality in individuals with diabetes. Among patients undergoing active cancer treatment, the risks are compounded by immunosuppression, peripheral neuropathy, and vascular complications. Even minor foot infections or wounds in these patients can necessitate the suspension of cancer therapy, with potentially lifethreatening consequences. This study evaluated the impaqt of integrating symptom-focused patient education with coordinated podiatric care to reduce DFUs and amputations in this highrisk population with concurrent cancer and diabetes. Methods: A five-year retrospective review was conducted at a National Cancer Institute (NCl)designated comprehensive cancer center as part of the Novel Limb Preservation Initiative. The cohort included patients with Type II diabetes undergoing treatment for prostate, breast, colorectal, lymphoma, leukemia, thyroid, or lung cancers. Patients were assigned targeted educational modules based on self-reported diabetic foot symptoms. Podiatric care was individualized according to each patient's signs and symptoms, including routine diabetic foot examinations and close, timely monitoring when indicated. Results: The intervention yielded a DFU incidence of 2. 8% and an amputation rate of 0. 43%, both lower than national benchmarks. Enhanced patient engagement through diabetic foot symptom-focused education and earlier detection of foot complications-including diabetic foot ssues that may appear minor to laypersons-contributed to these improved outcomes. Conclusion: Integrating diabetic foot symptom-focused education with proactive podiatric monitoring significantly reduced DFUs and amputations in this high-risk population. This model, developed under the Novel Limb Preservation Initiative, offers a scalable strategy for broader implementation, particularly in high-risk communities, including Hispanic, African American, low socioeconomic, and rural populations across the United States. Full article

This paper presents the design and implementation of a low-profile remote monitoring and control system for water level management in storage tanks located in rural communities. The system was developed to ensure a reliable water supply, prevent spills, reduce electrical energy consumption, and mitigate theft and vandalism risks posed by a previously installed, highly exposed commercial system. The proposed system employs LoRa technology to transmit water level data from the storage tank to a receiver located 6 km from the water well. When the water level drops below a predefined threshold, the system transmits an activation signal through the LoRa network to start the well pump and trigger tank refilling. In addition, an SMS monitoring module enables users to remotely verify water level and pump operational status at any time. System notifications and operational data are automatically delivered via SMS to predefined phone numbers, enabling continuous supervision without requiring internet connectivity. The implementation of the proposed system thus provides an efficient and reliable solution for water resource management in rural environments, ensuring continuous water availability and preventing supply shortages. LoRa communication enables robust long-range data transmission, while SMS-based monitoring offers real-time operational awareness for end users. The system was validated through field testing in a pilot rural community, demonstrating operational robustness, improved water management efficiency, and measurable positive impacts on residents’ water service continuity. The low-profile physical design significantly reduced theft and vandalism incidents reported by the local water authority. Experimental results showed an average monthly reduction of 41.2% in electrical energy consumption while maintaining high system reliability, physical security, and real-time monitoring capability. Full article

In the current context of the complexity of municipal management, the sustainable development of communities and compliance with the “2030 Agenda” objectives are essential. These objectives aim to reduce the negative environmental impact of cities by the year 2030, with special attention to issues such as air quality and municipal waste management, among other UN actions. The main objective is to verify the impacts on the residents around the São João monument, located in a city in the interior of Brazil, with its installation following the principles of sustainable development, Agenda 2030, and SDG 8. It is relevant to verify, with the rural community, the positive and negative impacts on the quality of life and development of families who reside around the São João monument. The research method was a single case study, and the data collection techniques were qualitative. Finally, the results point to benefits for the community with the implementation of the São João monument, such as the generation of income and jobs, the development of tourism, and compliance with SDG 8, goal 8.9. However, improvements in local planning and development are still needed. Full article

Yam is a tuberous crop with great potential for enhancing food security and rural development thus contributing significantly to the lives of people in production areas. Despite its importance, productivity is low, with poor adoption rates of released commercial varieties. Yam exhibits complex growth patterns, including tuberization and dormancy. The yield, food quality and consumer preferences differ by variety. Understanding the dynamics of yam production system and best practices is critical for its improvement. Our review delved into the flowering dynamics as well as yield determinants. We dissected the phenomena of dormancy, photosynthesis, photoperiodism and food quality with a view to adding values on crop improvement efforts. Yam production systems can be repositioned to play a greater role in sustainable food security and poverty alleviation through the development and deployment of more productive, profitable and resilient yam varieties and sustainable technologies that will improve the current yam cropping system and value chain. Future research perspectives focusing on yield improvement, climate-smart adaptations/cultivation practices, and value chain development to ensure sustainable yam production and utilization are thus highlighted. Full article

With the increasing constraints of resource and environmental factors and the prominent issues of regional development imbalance, how to scientifically measure the level of agricultural sustainable development and reveal its spatial-temporal differentiation patterns has become a key scientific question that urgently needs to be addressed in optimizing land use layout and promoting rural revitalization. This study takes the human-land spatial systems coupling theory as the core framework and constructs an evaluation index system for agricultural sustainable development covering five dimensions: economy, society, resources, ecology, and technology. Based on provincial panel data in China from 2001 to 2024, the entropy method is employed to measure agricultural sustainable development, while Dagum’s Gini coefficient, kernel density estimation, and convergence models are applied to analyze its spatial–temporal evolution. Furthermore, the fuzzy-set qualitative comparative analysis (fsQCA) method is introduced to identify multi-factor configurational driving pathways. The results indicate that the overall level of agricultural sustainable development in China shows a steady upward trend, exhibiting a regional gradient pattern characterized by “central region leading, eastern region steadily advancing, and western region gradually catching up”. The overall disparity presents a weak convergence trend, with inter-regional differences as the primary source, although their contribution is gradually declining. The development structure has evolved from regional fragmentation to a more complex spatial interaction pattern. The overall distribution shifts rightward with evident stage-based differentiation, accompanied by significant positive spatial dependence, with “high–high” and “low–low” clustering coexisting over the long term. Convergence analysis shows that σ-convergence exists at the national level. After accounting for spatial effects, significant absolute β-convergence is observed in the eastern and western regions, while the central region does not exhibit significant convergence. Conditional β-convergence further confirms the existence of regional convergence trends, although the convergence speeds vary. The fsQCA results indicate that agricultural sustainable development is not driven by a single factor but by multiple configurational pathways formed through the interaction of various conditions. These findings provide empirical evidence for optimizing agricultural spatial layout, strengthening land factor support, and promoting regionally coordinated agricultural sustainable development. Full article

Urban expansion in Europe is accelerating, increasing impermeable surfaces and intensifying climate-related pressures, while reducing the capacity of natural and semi-natural habitats to regulate climate. Despite growing interest in ecosystem service (ES), the assessment of resilience, and thus the stability of ES providers, as well as their integration into spatial planning tools, remain limited. This study develops and tests a comprehensive assessment framework that (i) evaluates the current performance of selected ecosystem functions underpinning key regulating ES important for climate adaptation using a look-up table method; (ii) assesses ecosystem resilience by quantification its preconditions; and (iii) applies spatial prioritization to identify and prioritize climate adaptation measures that enhance ecosystem functions and strengthen resilience. The framework was applied to the cadastral area of Liberec (Czech Republic). Results indicate that areas with the highest urgency for intervention were identified consistently across urban and peri-urban zones. However, proposed measures were more diverse and spatially differentiated in peri-urban and rural areas, whereas a single dominant measure prevailed in urban areas, suggesting higher practical applicability outside densely built environments. The approach supports evidence-based spatial planning and contributes to the implementation of the EU Adaptation Strategy by promoting resilient green infrastructure in urban and peri-urban landscapes. Full article

Background: The Canada Health Act (CHA), enacted in 1984, guarantees universal access to medically necessary care, yet inequities in hospital use persist. Acute length of stay (ALOS) is a key indicator of hospital efficiency, patient recovery, and healthcare system performance, with prolonged stays linked to higher costs, avoidable infections, and strain on acute care capacity. Understanding patterns in ALOS is critical not only for hospital management but also for public health, as extended stays can limit timely access to care and exacerbate population-level health inequities. Objective: This study examines social, geographic, and clinical gradients in ALOS and investigates whether the effects of admission urgency vary by sex, neighbourhood income, and rural–urban residence within a universal healthcare system. Methods: Using 2024–2025 hospital discharge data from the Canadian Institute for Health Information, this study examined ALOS as a function of comorbidity, sex, socioeconomic status, rural–urban residence (geography), and admission type (urgent versus elective). Interaction effects between admission urgency and key social and geographic variables were evaluated to assess subgroup differences in ALOS. Results: Disparities in ALOS were evident. Older age, male sex, urgent admission, and greater comorbidity were associated with longer stays, whereas higher neighbourhood income and urban residence were linked to shorter stays. Interaction analyses revealed substantial heterogeneity: compared with elective rural admissions, urgent urban admissions had 30.4% longer ALOS. Urgent admissions also amplified socioeconomic and sex-based differences, with male patients experiencing 27.9% longer stays than females. Conclusions: From a public health perspective, these findings highlight how system capacity constraints and social inequities jointly shape hospital use. Reducing avoidable variation in ALOS will require policies that strengthen acute care surge capacity, improve coordination for urgent admissions, and address upstream socioeconomic and geographic barriers to care, thereby promoting more equitable and efficient hospital services. Full article

Efficiently converting natural capital into economic assets is a critical challenge in urban–rural transformation, yet the interactive mechanism between institutional land reform and physical spatial restructuring remains underexplored. While traditional frameworks emphasize institutional design, this study identifies a “Spatial-First” mechanism where physical reconfiguration serves as a spatial mediator to catalyze property rights breakthroughs. Using an entropy-weighted coupling coordination model, we analyzed policy dynamics in Nanhai District, China, a unique “dual-pilot” zone, from 2020 to 2024. The results indicate a nonlinear leap in the Coupling Coordination Degree (D) from 0.100 to 0.978. We interpret this surge as a policy-driven shock during the intensive pilot phase, where substantive spatial integration (0.719) effectively bypassed high transaction costs inherent in collective tenure, outpacing institutional progress (0.281). However, an Ecological Lag was observed; the disproportionately low weighting of the ecological carrier index (7.09%) suggests that current gains are primarily driven by green industrialization rather than the expansion of absolute ecological stock. This study concludes that while spatial tools can effectively unlock natural capital value in the short term, long-term sustainability necessitates a strategic shift from administrative-led economic efficiency to market-based ecological restoration. Full article

Background: Mindful eating strategies have shown promise in addressing obesity and food insecurity among children. However, limited research has examined the acceptability of mindful eating programs among low-socioeconomic families in rural areas. This study evaluated caregivers’ and teachers’ acceptability and satisfaction with a 14-week, school-based mindful eating program for preschoolers to inform future implementation. The program effectively improved home eating environment, household food insecurity, and child body mass index. Methods: A convergent parallel mixed methods study design was used to evaluate the 14-week mindful eating intervention among 200 preschoolers from 26 Head Start classrooms in rural Michigan, United States. After intervention completion, acceptability and satisfaction data were collected and assessed from 192 caregivers and 23 classroom teachers via (1) quantitative online survey data analyzed using descriptive statistics, and (2) qualitative data from individual interviews completed with a subset of parents and teachers that were analyzed with thematic analysis. Results: Both quantitative and qualitative data showed high acceptability and satisfaction. Caregivers (survey: 88.9%, interview: 94.1%) and teachers (survey: 87.0%, interview: 100%) were satisfied with the program. Teachers (survey: 82.6%, interview: 87.5%) agreed the program improved children’s eating behaviors. Most surveyed caregivers (81.0%) agreed the completion of child letters sent home after the program session helped caregiver–child communication. Several barriers and suggestions for implementation were also identified by interviewed teachers and caregivers, including the limited availability of specific fruits and vegetables in local areas, concerns about preschoolers’ comprehension of curriculum, and recommendations on improving recruitment strategies. Conclusions: This study highlighted the high acceptability and satisfaction of a mindful eating program among caregivers and classroom teachers. The findings offered implications for future interventions to integrate mindful eating programs into early childcare organizations to help address child obesity and food insecurity. Future research exploring nutrition-related policies to sustain implementation of mindful eating programs is needed. Clinical Trial Registration: The clinical trial was registered at ClinicalTrials.gov (NCT05780008) on 27 February 2023. Full article

The Common Agricultural Policy (CAP), as one of the most prominent European Union policies, has increased concerns about the environmental sustainability of farms, particularly since its major reform in 1992. The changes implemented since this reform have intended to promote more integrated rural development, with deeper interrelationships between the agricultural sector and other rural activities, including agritourism, from the perspective of diversification of the activities that can be developed on farms and in rural areas. The idea of this strategy is to bring more income for farmers by changing the policy measures and enhancing a more sustainable agricultural and rural development. Nonetheless, the interrelationships between the diversification of activities in the agricultural sector and the characteristics of the farms have not yet been fully explored. In this context, this research aims to bring more insight into how agritourism revenues can be predicted by the farm characteristics in the European Union (UE) agricultural regions, considering data from FADN (Farm Accountancy Data Network), for 2023, using machine learning algorithms (following IBM SPSS Modeler Version 18.4 procedures). The results obtained show that agritourism output is higher in EU countries with larger farms (Slovakia and Czechia) and that are more economically dynamic (Netherlands and Denmark). Slovenia, Austria, Italy, and Finland are countries in which farms have a higher part of agritourism revenues in the total output. There is space to better explore agritourism potentialities and to improve the availability of data. When the total crop output increases by 1%, agritourism revenue grows by 0.719%. Full article

There is a gap in knowledge regarding the school food environment in small-sized municipalities. Thus, this study aims to analyze the anthropometric status of schoolchildren and the school and community food environments in a small Brazilian municipality. This is a cross-sectional, exploratory, and ecological study conducted in elementary schools and food retail outlets in Jerônimo Monteiro, Espírito Santo, Brazil. Anthropometric indicators were assessed using the students’ weight and height. The school food environment was analyzed by evaluating the National School Feeding Program (PNAE) menu using the IQ-COSAN index, classifying foods brought in lunchboxes and sold at schools according to the Brazilian Dietary Guidelines, and auditing food retailers outside schools using the ESAO-S and ESAO-R instruments. Food establishments were categorized according to the Locais-Nova classification and scored using the Healthy Food Store Index (HFSI) and Healthy Meal Restaurant Index (HMRI). The study included 2 schools and 266 schoolchildren (5–11 years), of whom 33.1% had excess weight. The PNAE menu was classified as “needing improvement,” and 81% of schoolchildren’s lunchboxes contained processed/ultra-processed foods. In the external food environment around schools, low levels of access to healthy foods and predominance of ultra-processed food sales were observed. Full article

Land use change is the most direct factor driving the supply and alteration of ecosystem services. This study employed the Dyna-CLUE tool to simulate future land use distributions under two scenarios—the Constrained Trend (CT) and Optimized Target-driven (OT) scenarios—based on land use data from 2010. Subsequently, their corresponding ecosystem service values (ESVs) were calculated, with the simulation outcomes revealing distinct land use layouts under each scenario. Under the CT scenario, grassland and urban areas expanded, whereas farmland and water bodies declined, reflecting a trend of urbanization at the expense of rural landscapes. In contrast, the OT scenario demonstrated a cessation of built-up land expansion, accompanied by marked increases in forest and water coverage, changes that facilitated the restoration of coastal watersheds, enhancing wetland provision and improving overall ESV. Consequently, per capita ESV increased substantially—from 1751 CNY in 2018 to 2356 CNY, matching the 2010 level—primarily due to the conversion of grasslands and farmlands into forests and wetlands. The OT scenario also improved the spatial distribution of ESVs, forming interconnected ecological zones around urban areas. The results underscore that policies restraining built-up expansion, promoting afforestation, and restoring wetlands can significantly improve ecosystem services and contribute to sustainability. Full article

In ecologically fragile and geomorphologically complex mountainous regions, ensuring a smooth transition from poverty alleviation to multidimensional sustainable rural development remains a key issue in regional governance. Focusing on the Qinba Mountains, a typical former contiguous poverty-stricken region in China covering 18 prefecture-level cities in six provinces, this study uses 2009–2023 prefecture-level panel data to examine the spatiotemporal evolution and driving mechanisms of coordinated rural revitalization. An integrated framework of “multi-dimensional evaluation–spatiotemporal tracking–attribution diagnosis” is developed by combining the improved AHP–entropy-weight TOPSIS method, the Coupling Coordination Degree (CCD) model, spatial Markov chains, spatial autocorrelation, and the Geodetector. The results show pronounced subsystem asynchrony. Livelihood and Well-being Security (U5) improves steadily, while Level of Industrial Development (U1), Civic Virtues and Cultural Vibrancy (U3), and Rural Governance (U4) also rise but with clear spatial differentiation; by contrast, Quality of Human Settlements (U2) fluctuates in stages under ecological fragility. Overall, the coupling coordination level advances from the Verge of Imbalance to Intermediate Coordination, yet the regional pattern remains uneven, with eastern basin cities leading and western deep mountainous cities lagging. State transitions display both policy responsiveness and path dependence: the probability of retaining the original state ranges from 50.0% to 90.5%; low-level neighborhoods reduce the upward transition probability to 25%, whereas medium-to-high-level neighborhoods raise the upward transition probability of low-level cities from 36.36% to 53.33%. Spatial dependence is also evident, with Global Moran’s I increasing, with fluctuations, from 0.331 in 2009 to 0.536 in 2023; high-value clusters extend along the Guanzhong Plain–Han River Valley corridor, while low-value clusters remain relatively locked in mountainous border areas. Driving mechanisms show clear stage-wise succession. At the single-factor level, the explanatory power of Road Network Density (F6) declines from 0.639 to 0.287, whereas Terrain Relief Amplitude (F1) becomes the dominant background constraint in the later stage (q = 0.772). Multi-factor interactions are generally enhanced. In particular, the traditional infrastructure-led pathway weakens markedly, with F1 ∩ F6 = 0.055 in 2023, while the interaction between terrain and consumer market vitality becomes dominant, with F1 ∩ F7 = 0.987 in 2023. On this basis, three major pathways are identified: government fiscal intervention and transportation accessibility improvement, capital agglomeration and market demand stimulation, and human–earth system adaptation and ecological value realization. These findings provide quantitative evidence for breaking spatial lock-in and improving cross-regional resource allocation in ecologically constrained mountainous regions. Full article

This study presents a comprehensive comparative analysis of the performance, combustion, and emission characteristics of a single-cylinder, four-stroke spark-ignition engine fueled by commercial gasoline and raw biogas enhanced with cerium oxide (CeO₂) nanoparticles. Raw biogas containing 58% methane was tested without carbon dioxide removal to reflect practical rural applications, while CeO₂ nanoparticles were ultrasonically dispersed in the fuel to promote homogeneous suspension and catalytic activity. Experiments were conducted under wide-open and part-throttle conditions across a range of engine speeds, with simultaneous measurement of brake thermal efficiency, brake-specific fuel consumption, volumetric efficiency, in-cylinder pressure, heat release rate, combustion phasing, and regulated emissions. The results showed that while gasoline consistently outperformed biogas in torque and power due to its higher heating value and flame speed, the addition of CeO₂ significantly reduced the performance gap. For the biogas mode, CeO₂ addition increased brake thermal efficiency by up to 5%, lowered brake-specific fuel consumption by up to 8%, and shifted the start of main combustion to earlier crank angles, indicating faster and more complete combustion, particularly at high loads where higher temperatures activate CeO₂’s catalytic behavior. Emission analysis revealed that CeO₂-blended biogas reduced carbon monoxide emissions by approximately 25% and unburned hydrocarbons by up to 55% compared with gasoline, while nitrogen oxide emissions were consistently 15–22% lower. These reductions were observed across both wide-open and part-throttle conditions, confirming improved combustion completeness and lower peak flame temperatures. These improvements are attributed to CeO₂’s oxygen-storage capability, catalytic oxidation activity, and enhanced thermal conductivity, which collectively strengthen combustion completeness and cyclic stability. The findings demonstrate that nanoparticle-enhanced biogas can substantially improve the environmental and operational viability of spark-ignition engines, offering a practical pathway for integrating renewable gaseous fuels into existing transportation systems. Full article

Purpose: Anemia remains a major public health concern among vulnerable rural adolescent girls in many countries, including India. This study aimed to assess the prevalence of anemia, nutritional status, and anemia-related knowledge, attitudes, and practices (KAP) among school-going rural adolescent girls, along with predictors of KAP score, complemented by stakeholder perspectives. Methods: A mixed-methods cross-sectional study was conducted among 553 school-going adolescent girls aged 14–19, selected through a multi-stage stratified random sampling technique from three rural districts of Andhra Pradesh, India. Quantitative data were collected using a structured questionnaire assessing KAP, anthropometric measurements to collect Body Mass Index (BMI) and middle upper arm circumference (MUAC), dietary assessments using a dietary diversity score, and hemoglobin estimation using standardized procedures. Qualitative insights were obtained through focus group discussions (FGDs) with teachers, parents, frontline health workers, and community leaders and analyzed thematically. Logistic regression analysis was performed to identify predictors of KAP. Results: The prevalence of anemia among the participants was 55.3%, and 30.7% were underweight. Although over half of the girls demonstrated adequate knowledge of anemia, only 39.6% reported good anemia-preventive practices, indicating a significant gap between knowledge and practice. Dietary scores indicated micronutrient-deficient diet consumption by participants (36.2%), which might be contributing to anemia. Multivariable analysis revealed that maternal education, hemoglobin status, diet patterns, and type of school attended were significantly associated with KAP scores. Qualitative findings highlighted challenges related to health-seeking behavior, cultural misconceptions, gaps in awareness and implementation of existing adolescent health programs. Conclusions: Anemia remains highly prevalent among rural school-going adolescent girls in Andhra Pradesh, with suboptimal anemia-preventive practices despite moderate levels of knowledge. Strengthening school-based nutritional education, improving dietary diversity, and enhancing the reach and effectiveness of adolescent health programs through community engagement may help combat anemia. Full article