Search Results (7,379)

Flooding is an increasing climate risk in the UK, yet schools remain marginal in resilience planning. Flood events disrupt education, heighten pupil anxiety, increase staff workload and unsettle communities, but these experiences are rarely documented in ways that inform policy. This study examines how schools in the East and West Midlands regions of the UK have experienced and adapted to flooding. Eight qualitative case studies were undertaken in flood-affected schools using semi-structured interviews with key staff, site visits and documentary evidence. Interview transcripts were thematically analysed using NVivo to explore past flood events, levels of preparedness, and readiness for measures such as Property Flood Resilience, Sustainable Drainage Systems and Climate Action Plans. Findings show wide variation in awareness, emergency procedures and engagement with local authorities. Most schools had faced flooding or near misses but lacked formal guidance or flood-specific plans, leading to improvised responses led internally by staff. Despite limited funding, inconsistent communication and exclusion from wider planning, schools demonstrated adaptive potential and willingness to support community preparedness. The study offers evidence to guide headteachers, policymakers and local authorities in strengthening school-based flood resilience and supporting the development of a resilience innovation blueprint for flood-prone schools in the UK. Full article

Municipal solid waste management (MSWM) remains a critical environmental governance challenge in rural and peri-urban regions of the Global South, where service delivery gaps exacerbate illegal dumping and public health risks. Geographic Information Systems (GIS) are increasingly promoted as decision-support tools to improve waste collection efficiency and environmental monitoring; however, their adoption in resource-constrained municipalities remains limited. This study investigates the institutional and policy barriers shaping GIS readiness in four rural municipalities within South Africa’s Vhembe District. Using a qualitative case-study design, semi-structured interviews were conducted with 29 municipal officials across managerial and operational levels, complemented by 399 community responses to an open-ended survey question. Thematic analysis, guided by Institutional Theory and the Technology Acceptance Model (TAM), identified five interrelated themes: waste production and disposal behaviours, collection and infrastructure constraints, institutional and operational challenges, policy and standardisation gaps, and technology readiness. The findings reveal that weak service reliability, fragmented governance structures, limited human and financial capacity, and inconsistent policy enforcement collectively undermine GIS adoption, despite its high perceived usefulness among officials. The study demonstrates that the effectiveness of GIS as an environmental management tool is contingent on institutional readiness rather than technological availability alone and highlights the need for integrated reforms in service delivery, institutional capacity, and policy implementation to enable GIS-supported sustainable waste management. Full article

As municipalities increasingly adopt artificial intelligence (AI) and generative AI (GenAI) to automate self-service technologies (SSTs), concerns related to fairness, transparency, accountability, and citizen trust have become central to sustainable public-sector governance. While existing studies emphasize either AI adoption or high-level ethical principles, limited empirical research explains how governance mechanisms translate into user-level outcomes in municipal services, particularly in the context of emerging GenAI capabilities. This study addresses this gap by examining how governance antecedents and system design attributes shape user satisfaction, trust, and perceived fairness in AI-enabled municipal SSTs in the United Arab Emirates (UAE). A mixed-methods research design was employed, combining a comparative analysis of international and UAE AI governance frameworks with semi-structured interviews (n = 16) and a survey of municipal employees and service users (n = 272). Qualitative findings reveal persistent concerns regarding data privacy, fairness, explainability, and the absence of standardized municipal-level accountability instruments. Quantitative analysis shows that perceived helpfulness significantly increases user satisfaction, while perceived fairness strongly predicts continued usage intentions. In contrast, system responsiveness exhibits a negative association with satisfaction, highlighting an expectation–performance gap in automated service delivery. Based on these findings, the study proposes a governance–implementation–outcomes model that operationalizes ethical AI principles into measurable governance and service-design mechanisms. Unlike prior adoption-focused or purely normative frameworks, this model empirically links governance instrumentation to citizen-centered outcomes, offering practical guidance for inclusive and sustainable AI and GenAI deployment in municipal self-service systems. The findings contribute to debates on sustainable digital governance by demonstrating how ethically governed AI systems can reinforce public trust, service equity, and long-term institutional resilience. Full article

Background: Health education is a vital component of preventative care; however, rural Filipino adults often face structural, linguistic, and access barriers to obtaining reliable health information. Designing equitable and culturally relevant health education programs requires understanding which sources are most significant and how context affects them. Objective: To identify preferred sources of health education among adults in rural Philippine communities and investigate the contextual factors that influence these preferences. Methods: A cross-sectional mixed-methods study included 1203 adults from disadvantaged Luzon and Visayas barangays. Participants completed a self-administered survey on the importance of neighborhood health fairs, native-language instructional tools, and social media. Descriptive statistics (mean ± standard deviation) were used to aggregate importance ratings, and exploratory comparisons were made using paired and independent-samples t-tests. A subsample of 60 semi-structured interviews was analyzed using thematic analysis to interpret qualitative data. Results: Community health fairs were identified as the primary source of health education, with a mean rating of 8.5 ± 1.6, followed by native-language educational materials, which received a mean rating of 5.5 ± 2.4. In contrast, social media was rated the lowest, with a mean of 3.5 ± 2.3. Preference patterns were consistent across regions and sociodemographic groups, with only slight variation in rating magnitudes. Qualitative analysis revealed four themes influencing source preferences: accessibility and proximity, cultural and linguistic relevance, confidence in local health providers, and structural obstacles to digital access. Conclusions: In rural Philippine communities, intimacy, confidence, and cultural congruence influence health education preferences more than online platforms do. Strengthening community-based, locally integrated health education strategies may enhance the reach and contextual relevance of preventive health communication in underserved settings. Full article

This research aims to analyze strategic risks from financial digitalization, highlighting the disruptive role of Fintech firms and Neobanks, the associated challenges and opportunities, and how traditional banks can adapt to remain competitive and stable in a rapidly evolving financial ecosystem. A qualitative methodology was employed, involving semi-structured interviews with 10 executives and risk management experts from the financial sector. The study employed a concurrence analysis to identify semantic relationships among categories. The unit of analysis was the paragraph, and concurrence was computed based on the frequency with which two categories appeared within the same segment. Key findings indicate that the most significant risks are linked to technological competition, regulatory shifts, cybersecurity, and consumer trust. Conversely, notable opportunities exist in technological modernization, enhanced regulatory compliance, collaboration with digital players, and the development of user-centric products and services. This study introduces the concept of a cultural gap in strategic adaptation, distinct from resistance to change, by emphasizing misalignment between organizational culture and the pace of digital transformation. This gap poses a strategic risk by delaying execution, increasing exposure to regulatory and technological risks, and reducing competitiveness. Full article

Inclusive education is at the forefront of transnational policy agendas. Yet, normative, deficit-oriented disability discourses and institutional gaps continue to shape how inclusion is enacted in schools, often displacing extensive and unacknowledged labour onto families, especially mothers. Drawing on feminist theories of invisible work, this article critically examines the everyday labour performed by mothers of disabled children as they navigate inclusive education systems in Alberta, Canada. Situated within a broader collective case study, this analysis asks: What forms of invisible work do mothers undertake in pursuit of inclusion within education systems labelled as inclusive? Semi-structured interviews were conducted with nine mothers of disabled children. Reflexive thematic analysis illuminated four intersecting dimensions of invisible work: (1) working within the system, (2) working to fit the system, (3) crafting system workarounds, and (4) working above and beyond the system. These forms of work reveal how inclusive education systems rely on mothers to bridge the gap between policy rhetoric and lived experiences. Findings illuminate how mothers’ invisible work simultaneously sustains, negotiates, and resists systemic ableism, highlighting the need to recognize and redistribute this work and reimagine inclusion as a shared structural responsibility rather than an individual, maternal pursuit. Full article

Background/Objectives: Community violence remains a pervasive public health challenge that disproportionately affects Black youth, with lasting impacts on physical and mental health. Traditional models often conceptualize resilience as individual “bounce back” capacity, overlooking how adaptation unfolds amid chronic violence and structural inequity. This study examined how Black youth and trauma clinicians understand, navigate, and redefine resilience within contexts of ongoing community violence exposure. Methods: Using a phenomenological qualitative design, the study drew on semi-structured interviews and focus groups with Black youth and clinicians participating in a community violence trauma recovery program in Chicago, Illinois. Data were analyzed thematically to identify patterns in how resilience was described, practiced, and supported. Results: Black youth redefined resilience through adaptive survival strategies—such as hypervigilance, avoidance, and emotional regulation—that functioned as protective responses to continuous threat. Clinicians recognized resilience as relational and context-dependent but reported limited training to address trauma rooted in chronic, community-level conditions. Both groups highlighted the role of collective and structural supports, including family, peers, and community networks, in sustaining adaptation. Conclusions: Findings highlight the need to expand trauma-informed care beyond individual treatment to address structural conditions that perpetuate community violence. Integrating ecological and culturally grounded models of resilience into clinical training and community programming can improve support for Black youth navigating chronic exposure to violence. Full article

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice. Full article

Background: Radspherin^® is a novel α-emitting radiopharmaceutical administered intraperitoneally following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal metastases. It delivers short-range radiation aimed at eliminating residual microscopic disease. This qualitative study explored how participants with colorectal cancer experienced participating in an early-phase clinical trial involving CRS-HIPEC followed by Radspherin^®. Materials and Methods: Semi-structured interviews were conducted with ten participants enrolled in a phase 1/2a trial involving CRS-HIPEC and intraperitoneal Radspherin^®. The analysis was guided by a phenomenological and interpretive approach using reflexive thematic analysis. Results: Participants expressed a strong sense of motivation and hope tied specifically to receiving Radspherin^®, which they perceived as an opportunity to improve their prognosis. Many also viewed participation as a contribution to future cancer research. None attributed complications or side effects to Radspherin^®. Clear and supportive verbal communication from healthcare professionals was highly valued, while the written information was described as overwhelming. Despite fears of recurrence, most participants remained optimistic about regaining a meaningful life. While experiences with Radspherin^® were largely positive, participants also described pain, fatigue, and prolonged recovery related to CRS-HIPEC, including ongoing functional and psychosocial challenges. Conclusions: Participants associated Radspherin^® with hope and a therapeutic benefit but did not link it to their adverse events. Their willingness to participate in experimental treatment was shaped by trust in clinicians, clear communication, and a desire for extended survival. However, the burden of CRS-HIPEC-related side effects underscores the importance of tailored follow-up and support. Full article

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP. Full article

This paper investigates how Scottish rural schools engage with their broader educational landscape, particularly through collaborative practices and capacity-building efforts. It examines how these schools cultivate a culture of partnership, both among institutions and within their communities, to strengthen leadership and enhance teaching and learning. Guided by Place-Based Education (PBE) as its conceptual framework, the study emphasises equity challenges rooted in local contexts and situates rural education within Scotland’s historical, societal, and policy landscape. Drawing on qualitative case studies of five schools, data were collected through semi-structured interviews with principals and supported by documentary evidence and student attainment data from national assessments. The findings showcase school leaders’ efforts to enhance social and educational outcomes and build sustainable, equity-driven systems. The paper concludes with implications for policy and practice, addressing equitable access, workforce recruitment and retention, and the potential for schools to collaborate with local and regional stakeholders to strengthen rural education. Full article

Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized at a university center completed semi-structured interviews on perceived efficacy, adverse effects, and daily functioning. Neurologists and geriatricians attending training sessions completed a structured questionnaire on prescribing patterns, attitudes toward clozapine, and perceived treatment burden. Data were analyzed thematically and triangulated across cohorts. Eleven patients (mean age 81 years; nine treated with quetiapine, two with clozapine) were included. Most quetiapine-treated patients reported persistent hallucinations, sedation, dizziness, and reduced autonomy. Fourteen physicians completed the survey and most preferred quetiapine, citing monitoring logistics and agranulocytosis risk as barriers to clozapine. Overall, patient priorities centered on symptom control and independence, whereas physician decisions emphasized feasibility and safety. Facilitating clozapine monitoring and incorporating patient-reported outcomes into routine care may improve patient-centered PDP management. Full article

With the advancement of digital technology, serious games have become an essential tool for disseminating and educating individuals about cultural heritage. However, systematic empirical research remains limited with respect to how visual elements influence users’ cognitive and emotional engagement through interactive behaviors. Using the “Macau Historic Centre Science Popularization System” as a case study, this mixed-methods study investigates the mechanisms by which visual elements affect user experience and learning outcomes in digital interactive environments. Eye-tracking data, behavioral logs, questionnaires, and semi-structured interviews from 30 participants were collected to examine the impact of visual elements on cognitive resource allocation and emotional engagement. The results indicate that the game intervention significantly enhanced participants’ retention and comprehension of cultural knowledge. Eye-tracking data showed that props, text boxes, historic buildings, and the architectural light and shadow shows (as incentive feedback elements) had the highest total fixation duration (TFD) and fixation count (FC). Active-interaction visual elements showed a stronger association with emotional arousal and were more likely to elicit high-arousal experiences than passive-interaction elements. The FC of architectural light and shadow shows a positive correlation with positive emotions, immersion, and a sense of accomplishment. Interview findings revealed users’ subjective experiences regarding visual design and narrative immersion. This study proposes an integrated analytical framework linking “visual elements–interaction behaviors–cognition–emotion.” By combining eye-tracking and information dynamics analysis, it enables multidimensional measurement of users’ cognitive processes and emotional responses, providing empirical evidence to inform visual design, interaction mechanisms, and incentive strategies in serious games for cultural heritage. Full article

The ideals of community and collective action are key tenets of the environmental justice (EJ) movement. Yet the pervasive grind culture that underpins capitalist societies makes it challenging to embrace these core values. EJ convenings are organized by a variety of entities, including grassroots organizations, government agencies, environmental non-governmental agencies, and academic institutions, and often reflect the tone of the organizing entity. This work explores the impact of a community and academic partnered EJ summit in addressing ecological grief (eco-grief) and ecological anxiety (eco-anxiety), supporting collective action, and attending to healing justice. We interviewed thirteen participants who attended the 2024 Pittsburgh Environmental Justice Summit using semi-structured, open-ended questions. Drawing on insights from lived experiences with the environment and environmental harms, we sought to understand how participants perceived EJ, health, and healing, as well as the role of summits and community efforts in shaping these perspectives. Emotional impacts like eco-grief, eco-anxiety, and intergenerational trauma were other common themes established through the interviews. Despite negative emotions being more commonly expressed than positive emotions, hope emerged as the most widely expressed theme. The summit was viewed as a space for reflection, support, establishing new contacts, and promoting growth and resilience. The results underscore the importance of integrating emotional and psychological aspects into EJ frameworks as well as the value of community-based approaches that combine EJ and healing practices to foster resilience, promote equitable health outcomes, and cultivate hope through collective action and support. Full article

Migration through Central America continues to rise, yet limited research examines how people make migration decisions, especially among those traveling in transit. This study addresses that gap by analyzing the motivations of migrants passing through Casa del Migrante San José in Ocotepeque, Honduras, to examine how long-term pressures interact with immediate triggers during migration. A mixed-methods approach was used, integrating two data sources: 3934 registration records from the Human Mobility Pastoral database (2021–2022) and 75 semi-structured interviews conducted in December 2022. The Push-Pull Plus (PPP) framework was applied to interpret how persistent conditions, immediate triggers, and available support networks influence decisions to migrate. Quantitative results show a marked increase in arrivals during 2022, especially among Venezuelan migrants, with a peak in October following a U.S. policy announcement. Most participants were men aged 21–40 with incomplete secondary education, and economic hardship was the most frequently cited reason for leaving. However, interviews indicate that financial motives were often intertwined with insecurity, family obligations, and unexpected opportunities to travel. Overall, the findings suggest that migration decisions are complex, dynamic, and timing-sensitive, underscoring the need for policies that address the root causes while providing support for migrants in transit. Full article