Search Results (11,632)

Flushing planning requires utilities to prioritize pipes and service blocks using heterogeneous structural and hydraulic information. This study proposes a data envelopment analysis (DEA)-assisted framework that links pipe-level screening, service-block prioritization, and candidate flushing-segment planning. The framework separately evaluates sedimentation and detachment conditions using input-oriented Banker–Charnes–Cooper (BCC) models based on seven indicators, while avoiding the need to prescribe a common expert-defined weighting vector. The framework was applied to a real water distribution system with 481 pipes and 394 junctions, identifying 88 sedimentation-priority pipes and 12 detachment-priority pipes. Length-weighted aggregation within the existing block structure ranked Blocks 1, 7, 2, and 4 highest, whereas length-normalized analysis identified Block 2 as having the greatest concentration of priority pipes. The leading four-block group remained unchanged across the tested pipe-length exponents, and the top-12 detachment set was retained when the velocity-difference screening level was varied from 0.5 to 2.0 m/s. Additional model-form, preprocessing, indicator-omission, and equal-weight comparisons were used to characterize the sensitivity of pipe-level priorities. Finally, existing valve and hydrant locations were used to delineate five candidate flushing segments in a representative block. The framework provides a systematic basis for directing detailed hydraulic verification and field implementation. Full article

Industry–education integration is the core direction of the practical teaching reform of urban and rural planning in the new era. Taking Fengqing College Students’ Social Practice Teaching Base for Rural Planning as the research object, this paper discusses the internal mechanism and implementation path of industry–education integration in the practical teaching of rural planning. Aiming at the pain points of the traditional teaching mode, such as the disconnection between theory and practice, the mismatch between talent training and local needs, and the separation between social services and the teaching system, this paper constructs three core systems based on the long-term local practice of the base: the integrated management mechanism of local action and professional teaching, the undergraduate–postgraduate integrated curriculum system, and the government–enterprise–university collaborative education community. This research realizes the two-way empowerment of university education and rural revitalization, promotes the transformation of the planning teaching mode, and tempers students’ professional ability and professional literacy. It provides a practical paradigm for the practical teaching reform of urban and rural planning and university–local collaboration in serving rural revitalization. Full article

Background: Adolescents and young adults in Jordan experience high levels of psychological distress amid persistent stigma, limited mental health literacy, and shortages of specialist services. Although task-shared interventions have expanded access, their dependence on in-person delivery and sustained human resources constrains scalability. Guided digital interventions may extend reach, but evidence regarding their system integration and sustainability in low- and middle-income countries remains limited. Purpose: This study explored how the WHO-developed Scalable Technology for Adolescents and youth to Reduce Stress (STARS), a non-generative, rule-based chatbot intervention supported by trained e-helpers, was experienced and implemented in Jordan. It also examined the system-level tensions shaping its potential for sustainable scale-up. Methods: We conducted a qualitative multiple-case study nested within a randomized controlled trial of STARS in Jordan. Semi-structured interviews were conducted with 21 individuals, including STARS completers and non-completers, trained non-specialist e-helpers, a clinical supervisor, and policy and implementation stakeholders. Data were analyzed using a hybrid approach combining inductive thematic analysis with deductive coding informed by a system-innovation perspective and the culture–structure–practice framework. Results: Participants described STARS as culturally resonant, accessible, and adaptable to everyday life. Four recurring system-level tensions emerged: individualized support versus standardized protocols; privacy and anonymity versus institutional and parental trust; non-specialist support versus expectations for professionally qualified providers; and innovation within research settings versus integration into routine service systems. These tensions reflected competing priorities shaping implementation and perceptions of sustainable scale-up. Conclusions: STARS shows promise as a scalable guided digital mental health intervention for young people in Jordan. However, scale-up will require navigating recurring tensions across cultural, structural, and practice domains rather than addressing implementation barriers in isolation. This will require policy alignment, sustained investment in digital infrastructure and supervision, and cross-sector collaboration. Full article

The continued expansion of digital payment technologies has encouraged Tanzanian district councils to use Point-of-Sale (POS) systems to collect service fees. In current POS systems, authorized POS terminals capture payment details, and through the centralized server, transactions are recorded on the POS database, with receipts printed as confirmation. Although this architecture supports recording and monitoring transaction revenue, it provides limited support for verifying the identity of the actor authorizing the transaction and for independent confirmation of transaction integrity during auditing. To address these limitations, this study investigated the essential requirements, standards, and protocols for integrating a Self-Sovereign Identity (SSI) as a blockchain-based identity solution with existing POS systems and for using a permissioned blockchain platform to verify integrity. To achieve the study objectives, an exploratory qualitative approach was used, involving 32 semi-structured interviews with POS operators, revenue accountants, internal auditors, Information and Communication Technology (ICT) administrators, a regulator, and blockchain experts. A hybrid deductive–inductive thematic analysis was used to establish three requirement themes, namely, security and identity management, legal and regulatory compliance, and data management and integrity assurance; two standard themes, namely, security and cryptographic standards, and identity and decentralized identification; and two protocol themes, namely, security and user authentication protocols, and data management and identity portability protocols. The findings were mapped to applicable legal obligations, compliance standards, technical specifications, and implementation controls, indicating how these requirements were translated into the conceptual SSI-POS integration for district-council POS systems. The proposed solution separates credential issuance, credential holder, and device POS management; verifier and POS transaction processing; blockchain and integrity evidence; and the assurance domain across defined trust boundaries. After a signed transaction is approved by the verifier, a complete transaction receipt remains in the existing POS database, while receipt hashes or the corresponding Merkle roots are anchored on the permissioned blockchain to provide tamper-evident verification. Hyperledger Besu with Quorum Byzantine Fault Tolerance (QBFT) was selected for its fit with permissioned, multi-organizational governance and for independent replication of receipt-hash evidence. The study provides a stakeholder-derived, regulatory-aligned conceptual foundation for SSI-POS integration without replacing the existing POS system workflow. Full article

Emergency Medical Services (EMS) personnel require exceptional spatial awareness and rapid decision-making within the confined environment of an ambulance. While Virtual Reality (VR) offers a safe alternative to traditional training, the lack of high-fidelity, regionally accurate, and VR-optimized 3D ambulance models limits its application. This study presents a scenario-driven methodology for developing a VR-ready 3D ambulance environment prototype tailored for Emergency Medical Technician (EMT) training. Utilizing reality-capture techniques, terrestrial laser scanning was performed to accurately document the interior of a standard Hungarian ambulance simulator. The resulting point cloud underwent systematic processing, manual retopology, PBR shading, and the implementation of a custom dual-rigging animation system to optimize complex mechanical movements—such as stretcher operations—for standalone VR platforms. The workflow successfully reduced the vertex count to 25,373 while maintaining millimeter-level spatial fidelity. Technical evaluation confirmed that geometrical, functional, and material objectives were fulfilled, whereas pedagogical implementation remains incomplete. Structural accuracy and animation readiness were verified through preliminary inspection within Blender’s VR viewport inspector. However, interactive game-engine integration remains future work, and educational effectiveness has not yet been tested with EMT learners. Overall, this workflow delivers a 3D asset foundation that establishes the necessary technical basis for subsequent software implementation and clinical evaluation. Full article

Newborn screening (NBS) in Pakistan remains limited by fragmented service delivery, uneven provincial capacity, and the absence of an implementation pathway that links policy intent to operational planning. This study aimed to co-design a provincial NBS implementation framework for Punjab. To do so, we used a sequential blended workshop model supported by visual planning methods. We conducted a qualitative, three-phase co-design process with 19 participants from laboratory medicine, pediatrics, obstetrics, public health, academia, and policy. Phase I consisted of pre-work and an online workshop to establish a shared knowledge base and identify implementation barriers and enablers. Phase II used an in-person, visually facilitated planning workshop to translate these findings into a provincial NBS implementation framework. Phase III involved a asynchronous email-based review to refine the framework and reach consensus. Content analysis from Phase I identified five implementation domains: physical and technical infrastructure, operational systems, clinical integration, workforce and engagement, and governance and policy. In Phase II, these domains were translated into a visual implementation framework that specified priorities, stakeholders, risks, enablers, and action areas for phased rollout. Congenital hypothyroidism was identified as the most feasible entry-point condition. The final framework positioned NBS not as a stand-alone pilot, but as a coordinated provincial system requiring governance, financing, referral pathways, quality assurance, and workforce development. This study contributes an implementation-oriented model for moving from fragmented NBS initiatives to a provincial implementation framework in a low- and middle-income setting. It also offers a practical foundation for broader national scale-up. Full article

Timely vehicular sensing is important for traffic monitoring, cooperative driving, and road-safety management. High mobility, time-varying wireless conditions, and limited edge resources nevertheless make information freshness difficult to maintain. This paper studies age of information (AoI) minimization in a three-layer UAV-assisted edge network comprising vehicle devices (VDs), unmanned aerial vehicles (UAVs), and a cloud center (CC). VDs periodically generate sensor-data packets, UAVs provide mobile edge processing and data-relaying services, and the CC coordinates system-wide resource allocation. The joint optimization of sensor-data transmission, UAV movement, packet processing, computation offloading, and bandwidth allocation is formulated within a cooperative multi-agent framework. To solve this problem, we propose a collaborative heterogeneous federated actor–critic (CHFAC) framework. Its significance-aware federated learning mechanism evaluates local model updates according to update significance, alignment with the global learning direction, and training stability and uses the resulting contribution scores for non-uniform agent selection and contribution-weighted aggregation. In the considered simulation setting, evaluation over 1000 test episodes yields an average AoI of $7.45\pm 1.65$ and a worst-case AoI of $38.72\pm 24.06$. The average AoI is $79.0\%$, $63.9\%$, and $29.2\%$ lower than that obtained by the implemented HF-MARL, H-MAAC, and non-federated baselines, respectively. These results demonstrate the effectiveness of CHFAC for freshness-aware vehicular sensing in dynamic UAV-assisted edge environments. Full article

Sustainability is increasingly recognised as a key priority in tourism development. Based on stakeholder theory, sustainable tourism implicates the involvement of diverse destination stakeholders. However, the roles of local residents and tourism providers as stakeholders who play an important role in achieving sustainability have largely been examined separately. This study addressed the dual role of local resident tourism providers operating in rural areas by exploring their perceptions, implementation, and recommendations related to sustainable tourism practices (STPs). By integrating stakeholder theory with systems theory, the study considered local resident tourism providers as embedded within a complex destination system. Data were collected through an online and offline survey of local resident tourism providers in the rural area of Istria County, Croatia, with 82 valid responses obtained. A qualitative approach based on an interpretive research paradigm was applied, and reflexive thematic analysis (RTA) was used to analyse the data. The findings indicate that respondents have an understanding of the concept of STPs and implement them, mainly in an environmental context, in their tourism activities. A focus on the quality of tourism services, presentation of local identity and heritage, and relationships and communication with guests emerged as important to respondents, while stakeholder cooperation between providers was limited in their responses. These findings suggest that resident tourism providers may be unaware of the importance of stakeholder collaboration, including their own role, in achieving sustainable tourism development. However, the findings also highlight the importance of adopting a systems approach: respondents’ identification of STPs and recommendations for improving their implementation point to the need for appropriate enabling conditions at destination system level. The findings are intended to be of interest to researchers, destination management organisations, local authorities, and tourism policymakers working in the field of sustainable tourism. Full article

Background: Community pharmacy-based influenza vaccination may improve access, but healthcare professionals may evaluate the service differently according to professional role, previous vaccination behaviour, and awareness. This study assessed the association between personal influenza vaccination behaviour and willingness to receive influenza vaccination in a community pharmacy among pharmacists and family physicians in Northwestern Romania. Methods: We analysed a cross-sectional, voluntary, non-probability convenience sample of 700 returned questionnaires from professionals active in six Northwestern Romanian counties. After exclusion of 22 blank records, 678 responses remained (340 pharmacists and 338 family physicians); one out-of-range willingness response was excluded from outcome analyses (n = 677). The study-specific anonymous questionnaire included demographic, professional, vaccination behaviour, awareness, and willingness items. Formal expert-panel content validation, pilot testing, test–retest reliability, construct validation, and a content-validity index were not documented; the primary outcome was a single Likert item, for which internal consistency is not estimable. Between 1 October 2025 and 30 April 2026, 761 questionnaires were distributed, and 700 were returned. After exclusion of 22 blank records, 678 completed questionnaires remained. Because recruitment was non-probability-based and a complete sampling frame was unavailable, the return proportion should not be interpreted as a population response rate. Ordinal comparisons used the Mann–Whitney U and the Kruskal–Wallis tests; high willingness (scores 4–5) was analysed with multivariable logistic regression. A 10-fold internal cross-validation and a sensitivity ordinal-logistic model were also performed. Results: Women comprised 85.5% of respondents. Annual influenza vaccination was more frequent among family physicians than pharmacists (71.9% vs. 32.6%), whereas mean willingness to be vaccinated in a pharmacy was higher among pharmacists (3.41 ± 1.40 vs. 2.08 ± 1.28). High willingness was reported by 201/339 pharmacists (59.3%) and 57/338 family physicians (16.9%). In the adjusted binary model, pharmacist profession (aOR 7.39, 95% CI 4.60–11.89), awareness of pharmacy vaccination (aOR 3.71, 95% CI 2.01–6.85), and annual personal vaccination (aOR 2.07, 95% CI 1.16–3.69) were associated with high willingness. Apparent discrimination was good (AUC 0.804), while mean 10-fold cross-validated AUC was 0.789. The profession × vaccination behaviour interaction was not statistically significant (likelihood-ratio p = 0.472). Conclusions: In this regional, non-probability sample, pharmacists were more willing than family physicians to receive influenza vaccination in a community pharmacy despite lower annual personal uptake. Professional category, service awareness, and annual vaccination were associated with willingness, but measurement validity, causality, and generalisability cannot be established. The findings support profession-specific implementation hypotheses and require confirmation with a formally validated instrument, transparent sampling, and multi-region prospective studies. Full article

Background/Objectives: The integration of generative artificial intelligence (AI) into healthcare has expanded the competencies required of clinical nurses. However, existing nursing informatics education programs do not adequately prepare nurses to use generative AI effectively and ethically in clinical practice. This study aimed to develop and evaluate a metaverse-based generative AI nursing informatics competency education program for clinical nurses. Methods: A randomized controlled pretest–posttest design was employed. Forty-eight clinical nurses were randomly assigned to an intervention group (n = 24) or a control group (n = 24), and 46 participants completed the study. The six-week education program was developed using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model and Bandura’s self-efficacy theory. It was delivered through a metaverse platform using a flipped learning approach. Outcomes were measured at baseline, immediately after the intervention, and four weeks after the intervention. Data were analyzed using repeated-measures analysis of variance (ANOVA). Results: Compared with the control group, the intervention group demonstrated a significantly greater improvement in nursing informatics competency, the pre-specified primary outcome (p < 0.01), sustained at the four-week follow-up. Greater improvements were also observed for the secondary outcomes—general self-efficacy, ethical awareness of AI use, and evidence-based practice (all p < 0.01)—though these findings should be interpreted as hypothesis-generating given the absence of multiplicity adjustment. Conclusions: The metaverse-based generative AI education program improved self-reported nursing informatics competency and other key competencies among clinical nurses. Trial Registration: Clinical Research Information Service (CRIS) KCT0011821 registered on 8 April 2026. Full article

Operational redundancies in Nigeria’s airport logistics, including duplicated clearance procedures, fragmented data systems, and repeated physical inspections, generate substantial inefficiencies that hamper service delivery, increase costs, and raise sustainability concerns. Despite growing interest in blockchain technology (BCT) as a logistics innovation, empirical evidence from Sub-Saharan African aviation contexts is largely limited. This study examines how stakeholders perceive BCT as a potential mechanism for reducing procedural, informational, and structural redundancies across Nigerian airport operations. A qualitative research design was employed, drawing on 45 semi-structured interviews with airport managers, airline officials, regulatory bodies, and aviation experts. Data were analyzed using Leximancer, yielding eight thematic clusters across 115 concepts. To augment thematic rigor, three quantitative measures—Normalized Pointwise Mutual Information (NPMI), Jaccard similarity, and degree centrality—were applied to the exported Concept Co-occurrence Matrix (CCMatrix; 6555 pairwise relationships). The blockchain theme exhibited the highest intra-theme cohesion (mean NPMI = 0.615) and the second highest normalized centrality (0.638), suggesting that it functions as a semantically tight, cross-cutting concept in participants’ discourse. The strongest concept pair, inefficiency–reliability (NPMI = 0.989; Jaccard = 0.909), is consistent with participants’ recurring association of service failures with procedurally generated redundancies. Stakeholders perceived BCT as potentially addressing these redundancies through shared ledger architectures, smart contract automation, and consolidated identity management, with anticipated sustainability co-benefits across energy, documentation and processing domains. The study offers an exploratory, contextualized application of the Technology–Organization–Environment (TOE) framework, the Unified Theory of Acceptance and Use of Technology (UTAUT), and the Dynamic Capabilities Framework (DCF) to a resource-constrained developing-country aviation context and proposes a stakeholder-informed, phased BCT adoption framework—not yet tested through implementation—with direct policy and managerial implications for the Nigerian airport administration. Full article

Rural maternity care in the United States faces an unprecedented crisis. As of 2022, more than half of rural hospitals lacked obstetric services, leaving many rural communities without local maternity care. This descriptive case study documents the implementation of maternity services at a 25-bed rural critical access hospital in North Carolina. We reviewed and coded data derived from the following sources from 2020–2025: institutional planning documents, clinical protocols, standard workflows, operational procedures, administrative records, meeting minutes, presentations and summaries, and published commentaries, manuscripts and articles related to the new maternity unit. We identified six critical domains for sustainability: (1) hospital and community engagement, (2) stable multidisciplinary staffing models, (3) emergency preparedness, (4) anesthesia service delivery, (5) financial sustainability, and (6) risk-appropriate scope of care. Successful implementation required integrated approaches across organizational dimensions facilitated by committed institutional leadership; community advocacy; innovative staffing models with family physicians, certified nurse-midwives, and certified registered nurse anesthetists; competency-based emergency training; Medicaid-based financial sustainability; and explicit risk stratification with clear interfacility communication protocols. Workforce sustainability emerged as the most significant ongoing challenge. Rural maternity service sustainability requires multifaceted, evidence-based approaches integrating workforce development, organizational infrastructure, financial mechanisms, and clear scope definitions. This case study demonstrates a model of perinatal regionalized and risk-appropriate care with replicable strategies that can inform efforts to address maternal health equity and strengthen rural health care systems. Full article

The 2021 eruption of Cumbre Vieja on La Palma, Canary Islands, produced extensive lava flows and major landscape transformation, providing an opportunity to evaluate remote sensing approaches for mapping the extent of an emplaced lava flow. This study assessed direct spectral, classic Rao’s quadratic entropy (RaoQ), and multidimensional RaoQ approaches using satellite observations acquired before and after the eruption. Optical, radar, thermal infrared, and night-time radiance datasets were evaluated within a common change-detection framework implemented in Google Earth Engine. Difference maps were converted into binary change maps using a histogram-based thresholding procedure calibrated on the reference delineation and evaluated against the Copernicus Emergency Management Service (CEMS) lava-flow reference and no-change validation areas derived from ESA WorldCover using multiple accuracy metrics. Because the change reference is the final CEMS lava-flow delineation and the no-change samples lie outside a 100 m buffer around it, the accuracy figures reported here quantify the mapping of lava-flow extent and not of other eruption-related effects such as ash deposition or vegetation damage beyond the flow margins. Among the direct spectral approaches, the NHI_SWIR index achieved the highest overall classification performance. Among the individual Sentinel-2 bands, B12 achieved the highest overall accuracy, whereas B8A achieved the highest true skill statistic; both exceeded the multidimensional RaoQ configurations in mean prevalence-independent discrimination. Within the classic RaoQ approach, MIRBI produced the strongest single-variable heterogeneity-based results. The best multidimensional configurations combined Sentinel-2 B8A and B12 with Sentinel-1 VV, demonstrating that radar backscatter provided complementary information to optical observations. Although multidimensional RaoQ did not surpass the best direct spectral variables, it produced competitive and spatially coherent representations of lava-flow disturbance. The evaluated thermal infrared and night-time radiance products did not provide competitive discrimination under the selected spatial and temporal conditions for different reasons: a thresholding limitation in the case of the Landsat thermal product, and an unfavourable ratio of pixel size to flow width in the case of the night-time radiance products, while the MODIS product returned no valid validation points and could not be evaluated. These product-specific explanations rest on a small number of comparisons and are provisional. These results show that carefully selected Sentinel-2 SWIR variables remain the strongest benchmark for detailed mapping of fresh lava-flow disturbance, while multidimensional RaoQ provides a framework for optical–radar integration that requires no training data or prior classification. Because the evaluation covers a single eruption in a single landscape, transfer of the framework to other events and settings remains to be demonstrated. Full article

In the U.S., youth face barriers to high-quality culture-centered health education and healthcare, leading to unintended pregnancy and sexually transmitted infections. This health burden falls disproportionately on youth of color in Southern states. Researchers partnered with Fact Forward to design, implement, and evaluate the “Chat About It: We’re in your corner” 10-week health communication campaign. The culture-centered health communication campaign aimed to increase awareness and use of sexual health services with a focus on youth of color in South Carolina. The study implemented a campaign evaluation pretest–posttest web-based survey among young people (ages 18–24) in South Carolina. The campaign resulted in over one million total impressions. Over two-thirds of respondents who saw the campaign indicated that it prompted them to perform a positive health behavior, with the most common behavior being discussing sexual health with a partner. Respondents with a higher PME score were over seven times more likely to seek sexual health services after seeing messages from the campaign. Findings highlight the importance of formative audience research and message testing in campaign design. By developing health communication campaigns in partnership with the target audience, health communicators can enhance engagement and improve perceived message effectiveness and campaign acceptability. Health communication campaigns may help address knowledge gaps in sexual health education. Full article

The successful deployment of shared autonomous vehicle (SAV) technologies is of great significance for improving road traffic safety and road capacity. Nevertheless, the practical implementation of SAV technologies is hindered by ambiguous user acceptance intentions and complicated multi-stakeholder decision-making processes. Existing studies mostly conduct static analyses of user willingness with fragmented variable selection, lacking integrated frameworks that integrate public opinion mining, behavioral modeling, and evolutionary game theory. Different from existing studies that predominantly rely on static questionnaire-based willingness analysis with subjectively selected variables, this study integrates social-media text mining, an extended Theory of Planned Behavior, and a tripartite evolutionary game model to jointly investigate user psychological mechanisms and multi-stakeholder dynamic interactions. To explore the long-term development trajectory of SAVs, this study crawls 23,943 short-video comment datasets. The Latent Dirichlet Allocation (LDA) topic model is adopted to preliminarily identify eight core factors affecting users’ adoption of SAVs, based on which a questionnaire survey on SAV adoption intention is designed. A total of 724 valid questionnaires were collected. Expanding the classic Theory of Planned Behavior (TPB), this study incorporates additional latent variables including perceived risk, employment impacts, and government attitudes to construct an extended TPB model, which quantifies the correlations between latent constructs and adoption intention. The empirical results reveal that government attitudes (β = 0.497, p < 0.001) and employment conditions (β = 0.434, p < 0.001) exert significantly positive effects on perceived risk. Perceived ease of use indirectly determines adoption intention through three mediating paths: attitude toward behavior, subjective norm, and perceived behavioral control. Furthermore, stakeholders are categorized into three groups (users, enterprises, and governments), and a tripartite evolutionary game model for SAV stakeholders is established to derive evolutionary stable strategies (ESS) via numerical simulation. The simulation results indicate that the strategy combination of economic incentives and small-scale pilot programs (adopted by governments) paired with the adoption strategy (adopted by potential SAV users) constitutes the evolutionary stable strategy. Variations in governments’ economic incentive costs and small-scale pilot operation costs significantly alter the decision-making behaviors of potential SAV users. This study integrates behavioral modeling and game-theoretic analysis. It delivers theoretical foundations for research on SAV adoption behaviors and provides quantitative decision-making evidence for governments to formulate phased incentive policies and for service platforms to control pilot operation costs. Full article