Search Results (6,958)

Rural communities face persistent challenges in accessing timely, culturally relevant, and trustworthy health information due to inadequate communication infrastructures, workforce shortages, and infrastructural constraints. As generative artificial intelligence (GenAI) tools become increasingly accessible, rural serving organizations are often pushed to explore their use to expand communication reach and reduce staff burden through funding incentives, vendor offerings, and policy signals, even when adoption is misaligned with local capacity or priorities. However, guidance is lacking on how rural systems should approach GenAI adoption in ways that strengthen, rather than undermine, trust and equity. This Opinion offers a systems-oriented and community-centered perspective on rural GenAI readiness by distinguishing between non-agentic applications that support human communicators and agentic systems that introduce varying degrees of autonomy. We propose a staged maturity framework tailored to rural health communication ecosystems, outlining opportunities, risks, and governance needs at each stage of adoption. By centering on rural context, communication trust, and system readiness, this Opinion aims to support the intentional, ethical, and sustainable integration of GenAI into rural health communication systems. Full article

This study examines how mothers raising children with disabilities in American Samoa experience the processes of seeking diagnosis, navigating special education, and advocating for services within an insular rural context. American Samoa, an unincorporated U.S. territory located 2600 miles from Hawaiʻi with a population under 50,000, represents a case of what we term insular rurality—a condition in which the structural disadvantages of rurality are intensified by oceanic isolation, territorial governance, and colonial history. Data were collected through three focus groups with fifteen mothers whose children hold a range of disability diagnoses, with a card sort activity at the outset of each session serving as an idiographic anchor to protect individual voice within the group format. Analysis followed Interpretative Phenomenological Analysis adapted for focus groups (IPA-FG), proceeding from line-by-line exploratory noting through Personal Experiential Themes and Group Experiential Themes within each focus group case to cross-case convergence and divergence analysis, interpreted through the Fonofale model of Pacific wellness. Findings reveal two overarching themes: systemic invalidation, in which mothers encountered deficit-based assumptions, stagnant educational goals, and institutional disengagement; and parent peer support as the primary infrastructure, in which mothers became de facto experts, built community-driven solutions, and envisioned more inclusive futures. Technology emerged as a contradictory force—valuable for parent learning but largely ineffective for children’s remote therapy. These findings suggest how workforce shortages and geographic isolation create conditions in which maternal advocacy becomes a systems-level necessity rather than a personal choice. Implications for rural education policy, IDEA implementation in U.S. territories, and culturally grounded family support are discussed. Full article

As the largest inter-basin water diversion project in eastern China, the Eastern Route of China’s South-to-North Water Diversion Project (ER-SNWDP) plays a crucial role in alleviating water shortages and ensuring regional ecological security. However, large-scale water diversion that uses natural lakes as impounded lakes across different basins has impacted on the structure and function of the original ecosystems. To explore the changes in the food web and ecosystem structure of the impounded lakes during different operation periods of the ER-SNWDP, we constructed Ecopath models for Hongze Lake in 2010–2011 (pre-operation), 2017–2018 (initial operation), and 2023–2024 (operational period). Our results showed that the trophic energy flow in Hongze Lake was dominated by the detrital food chain, with the highest trophic level ranging from 3.06 to 3.50. Energy flows at trophic levels I and II accounted for a high proportion of the total throughput, and the interactions between trophic levels were relatively simple, indicating that Hongze Lake is approaching a mature ecosystem. Compared with the pre-operation period, the average trophic level, food chain length, and energy conversion efficiency of Hongze Lake declined during the initial operation period, but rebounded during the operational period, though still remaining lower than the pre-operation period. Ecosystem stability followed a similar trajectory: the total primary production/total respiration (TPP/TR) and the system omnivory index (SOI) indicated that ecosystem maturity decreased during the initial operation and increased during the operational period. Fishing activities had negative effects on most functional groups during the pre-operation and initial operation periods, whereas the negative effects from zooplankton and non-native species groups increased during the operational period. Based on changes in the food web structure and ecosystem of Hongze Lake across different water diversion periods, we suggest that the management of Hongze Lake should establish precautionary fishing management measures targeting the effects of filter-feeding functional groups and non-native species, optimize the species and quantities of restocking initiatives, prioritize the protection of critical habitat integrity, and implement long-term ecological monitoring. Full article

Background: Sustainable head and neck cancer (HNC) surgery is challenged by environmental impact, workforce shortages, inequitable access to advanced techniques, and policy constraints. Addressing these areas is critical for equitable, high-quality care. Methods: This structured narrative review synthesizes evidence on environmental sustainability, workforce development, technological innovation, health policy, and socioeconomic determinants in HNC surgery, without aiming to provide a systematic or exhaustive evidence synthesis. Sources included peer-reviewed literature, global workforce surveys, and international policy reports, with a focus on disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: Operating rooms produce up to 70% of hospital solid waste and consume 3–6 times more energy than other units; reusable instruments and improved waste segregation can reduce carbon footprints by over 50%. Workforce shortages are severe in LMICs, where subspecialty training is scarce; global partnerships, bidirectional education, and simulation-based learning can expand local capacity. Telemedicine, artificial intelligence, and three-dimensional printing enhance surgical planning, training, and access but may widen disparities without equitable deployment. Policy tools—including diagnosis-related groups, bundled payments, and universal coverage—affect access and innovation uptake. Pandemic preparedness underscores the value of resilient systems with flexible staffing and telehealth integration. Conclusions: HNC surgery requires coordinated action across environmental, workforce, technological, socioeconomic, and policy domains; however, future systematic reviews are needed to comprehensively map the evidence base and assess its methodological quality. Embedding sustainability in clinical practice, ensuring equitable innovation access, and aligning reimbursement with high-value care can strengthen system resilience, improve outcomes, and support long-term surgical service viability. Full article

The availability of critical spare parts is essential for maintaining the reliability and operational continuity of combined cycle power plants. However, demand for critical spare parts is typically sparse, intermittent, and highly non-linear, which limits the effectiveness of conventional forecasting approaches based on historical averages or expert judgment. Inaccurate demand estimation may lead to excessive inventory, high holding costs, or stock shortages that increase downtime risks. To address these challenges, this study applies ensemble learning methods to improve demand forecasting accuracy for critical spare parts in a combined cycle power plant. Procurement and usage data from 2020 to 2024 were analyzed using a time-series splitting approach, with model performance assessed using Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE). To avoid bias caused by zero-demand periods, zero actual values were excluded from MAPE calculations. The results show that the tuned XGBoost model consistently performs better than Random Forest by producing lower forecasting errors and more stable predictions under intermittent demand conditions. These findings indicate that ensemble learning can support more effective procurement planning, inventory control, and maintenance decision-making in combined cycle power plant operations. Full article

Fruit harvesting is labor-intensive and increasingly challenged by the shortage of agricultural labor. To address viewpoint planning under occlusion, this paper proposes a mapless picking guidance framework that directly predicts the next viewing direction and estimates fruit occlusion without relying on pre-built maps or candidate-viewpoint sampling. Unlike conventional active vision methods that enumerate and evaluate multiple candidate viewpoints, the proposed method generates feasible viewpoints by jointly leveraging occlusion estimation and global picking direction supervision, thereby reducing computational cost and alleviating local optimum bias. An adaptive approach strategy is further introduced to balance viewpoint exploration and target approach during planning. Simulation results show that the proposed method achieves average success rates of 80.46% on the in-distribution test set and 77.58% on the unseen-fruit test set, with corresponding occlusion reductions of 80.56% and 79.16%, respectively. These results demonstrate the effectiveness of the proposed framework for occlusion-aware fruit viewpoint planning in unstructured orchard environments. Full article

Operational labor shortages have become a pressing challenge for hospitality organizations, especially in highly seasonal tourism destinations such as Greece, where service experiences are deeply tied to cultural identity and authentic hospitality. While much of the existing research has examined understaffing from operational or human resource management perspectives, limited attention has been paid to its impact on the organizational capacity to sustain authentic hospitality experiences. Using Service-Dominant Logic (SDL) as an interpretive framework, this study views authentic hospitality as an organizational process shaped by employee interaction, cultural transmission, and service delivery practices. Drawing on survey data from 201 hotel employees in Greece, it investigates the relationship between operational labor shortages, organizational pressures, and perceived threats to authentic hospitality within hotel operations. The findings reveal significant positive relationships between work stress and service quality decline, as well as between cultural knowledge and perceived challenges in maintaining authentic hospitality. Multiple regression analysis further shows that reactive hiring, serious understaffing, and payroll cost pressure are significantly linked to perceived challenges in sustaining authentic hospitality, while service quality decline exhibits a positive but statistically non-significant effect in the final model. The study contributes to hospitality authenticity literature by emphasizing employee perceptions of authenticity as an organizationally supported process rather than merely a guest-centered outcome. The results also highlight the importance of workforce planning, recruitment quality, and cultural onboarding in supporting authentic hospitality within Greek hotel operations. Full article

Background/Objectives: In February 2024, a nationwide medical crisis in South Korea caused a massive withdrawal of resident physicians. We described changes in patient characteristics and early clinical outcomes among emergency department (ED)-admitted inpatients during this disruption. Methods: We retrospectively analyzed 8149 internal medicine admissions via the ED at a tertiary hospital, 6 months pre- and post-crisis. Multivariable logistic regression evaluated early clinical outcomes, adjusting for baseline confounders. Results: Post-crisis, the internal medicine physician workforce decreased by 36%. Total admissions dropped, while patient acuity increased. After adjustment, the post-crisis group exhibited higher odds of Orders for Life-Sustaining Treatment documentation (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.34–1.74), inter-hospital transfers (aOR 1.71, 95% CI 1.49–1.96), and 48 h mortality (aOR 1.81, 95% CI 1.25–2.61). However, adjusted overall in-hospital mortality did not significantly differ (aOR 1.10, 95% CI 0.95–1.27). Conclusions: The crisis led to decreased admissions and higher patient acuity. Despite these shifts, adjusted in-hospital mortality did not significantly differ. This suggests that during severe workforce shortages, acute care was concentrated on a highly selected, high-acuity patient cohort, accompanied by an increased reliance on inter-hospital transfers. Full article

Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article

Rural youth often face barriers to accessing mental health services, including workforce shortages, limited resources, and persistent stigma. Schools are well-positioned to address these gaps through comprehensive school mental health systems (CSMHSs) embedded within multi-tiered systems of support (MTSSs). This study evaluated the implementation and effectiveness of a CSMHS in a small Midwestern rural school district over seven years. A longitudinal case study design was used to describe implementation across seven years. Universal mental health screening data were analyzed to determine the proportion of students receiving tiered supports over time. Implementation fidelity was assessed annually using the School Health Assessment and Performance Evaluation (SHAPE) system. Across seven years, more than 80% of students consistently demonstrated mental wellness within Tier I supports, with Tier II and Tier III needs aligned with expected MTSS distributions. SHAPE data indicated steady implementation improvement, particularly in universal screening, teaming, and tiered support. Ongoing challenges included monitoring Tier II intervention fidelity and demonstrating system-level impact. Findings suggest that CSMHSs can be effectively implemented and sustained in rural school settings when aligned with existing MTSS frameworks, supported by strong partnerships, and adapted to local contexts. This study provides evidence supporting the feasibility of rural CSMHS implementation and offers implications for practice and sustainability. Full article

Background: Despite being considered a country with a larger health workforce in Africa, the South African health workforce continues to experience shortages and a maldistribution of health workers across regions and sectors. Current projections suggest that the workforce is expected to decline further, especially among doctors, nurses and midwives, in large part, due to attrition—which could compromise the delivery of primary health and maternity services. These health workforce shortages and uneven distribution threaten the sustainability and effectiveness of health services in South Africa and drives the need to investigate the factors that may be influencing career choice and change decisions among health professionals in South Africa. Methods: A qualitative exploratory study, making use of purposive sampling and semi-structured interviews, was conducted to investigate the factors influencing career choice and change decisions among health professionals in South Africa. The participants were qualified health professionals in the fields of medicine, nutrition, pharmacy, nursing, and psychology working in the private, public, and academic sectors. Data was collected until saturation was achieved and then thematically analyzed using MAXQDA 24. Results: A total of 10 participants made up of three males and seven females were interviewed. These participants worked in different employment sectors with some having dual roles in private practice, public sector, and academia. The analysis revealed three major themes that capture the nature of and factors influencing career choice and career changes occurring in South Africa. The first theme related to factors influencing career choice (including altruism, family influence, personal experiences, financial/job security, academic achievement, career guidance, and opportunity for change). The second theme focused on career change dynamics (nature of career changes and career transitions occurring in the form of specialization, switching health professions, exiting health professions, adding non-health interests, and shifting focus areas). The third theme revealed factors influencing career change. These were categorized into personal and individual factors, workplace or job-specific factors, and administrative factors. This study has contributed to understanding the career choices and career changes taking place within the health professions in South Africa. It has also revealed a need for reforms in policy and practice for the current health professionals who have no intention of changing their careers while highlighting implications for future training of health professionals. Also, addressing the challenges of poor working conditions, lack of support, unemployment and placement delays, and other administrative barriers will help mitigate some of the issues leading to health workforce shortages and inequities in the South African context. Conclusions: The strongest motivator for choosing a career in health professions is the desire to care for others, while retention of the health workforce is challenged by personal, workplace, and administrative factors. Enhancing workplace conditions and support systems, implementing policy reforms, and minimizing administrative barriers is essential for achieving universal health coverage and sustaining a resilient health workforce in South Africa. Full article

Introduction: Intravenous push (IVP) beta-lactam antibiotics have been adopted during parenteral solution shortages to conserve resources. Data evaluating the safety and efficacy of cefepime administered IVP versus intravenous piggyback (IVPB) infusion in Gram-negative bacteremia remain limited. We compared clinical outcomes of cefepime administered IVP versus IVPB in hospitalized patients with Gram-negative bacteremia. Methods: This was a retrospective cohort study across a five-hospital health system from 1 January 2014 through 31 December 2021. Adults receiving cefepime for Gram-negative bacteremia were included. The primary outcome was a tailored desirability of outcome ranking (DOOR) composite assessed through 30 days or hospital discharge, integrating clinical cure and cefepime-associated neurologic adverse effects. Clinical cure was defined as absence of recurrent bacteremia with the index pathogen after 48 h, no antibiotic escalation, and no in-hospital mortality. Results: A total of 254 met the inclusion criteria (127 IVPB; 127 IVP). Baseline severity was similar between groups. The primary outcome assessed by DOOR revealed no difference between IVPB and IVP groups (p = 0.656). Vasopressor support during therapy was more frequent in the IVP group (22.0% vs. 10.2%, p = 0.011), and median hospital length of stay was longer (10 vs. 7 days, p = 0.020). No differences were noted in other endpoints. General ward admission (OIR [aOR] 2.563, 95% CI 1.271–5.168; p = 0.009) and genitourinary source of bacteremia (aOR 3.398, 95% CI 1.509–7.652; p = 0.003) independently predicted clinical cure. Conclusions: In patients with Gram-negative bacteremia, cefepime administered IVP demonstrated similar safety and efficacy to IVPB infusion. Full article

Precision feeding is an important foundation for improving production efficiency in aquaculture, reducing feed waste, mitigating water pollution, and promoting the intelligent development of aquaculture. Conventional feeding practices remain heavily dependent on operator experience and are typically executed at predetermined times or fixed ration levels. Such approaches frequently result in extensive feeding management, poor adaptability, low feed utilization efficiency, and delayed responses to environmental changes. Advances in machine vision, the Internet of Things, machine learning, deep learning, and automatic control have progressively shifted aquaculture feeding research beyond standalone automatic feeders toward integrated systems encompassing demand perception, intelligent decision-making, precise control, and equipment coordination. This paper reviews the state of the art in precision feeding technologies and equipment in aquaculture. At the technical level, it summarizes advances in feeding demand perception, intelligent feeding decision-making, and precise control and execution. At the equipment level, it reviews the main types, design features, and field application status of precision feeding equipment in intensive aquaculture, pond aquaculture, and offshore aquaculture scenarios. Despite the considerable progress achieved, the practical deployment of precision feeding still faces several limitations. Environmental disturbances, water turbidity, illumination variation, and sensor drift may compromise the reliability of feeding demand perception. Existing decision-making models frequently exhibit limited generalizability across species, growth stages, and aquaculture scenarios. Moreover, insufficient integration of sensing, decision-making, and execution restricts the development of fully closed-loop feeding systems. High initial investment, maintenance costs, and the shortage of skilled personnel further constrain the adoption of precision feeding equipment, particularly in resource-limited regions. On this basis, the main challenges including sensing accuracy, model practicability, closed-loop control, equipment reliability, and standardization, are examined. Future development trends are also discussed, covering multi-source information fusion, synergy between mechanistic models and data-driven methods, system-level closed-loop control, equipment modularization, and industrial application. This review is expected to provide a reference for subsequent research and engineering applications. Full article

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways. Full article

Background: Type 2 Diabetes Mellitus (T2DM) is associated with a vascular-executive cognitive decline profile that early impacts complex daily tasks. Despite the increased risk of Mild Cognitive Impairment (MCI) in this population, there is a critical shortage of instruments specifically validated for this group. This scoping review aims to identify the instruments used to assess functionality in individuals with T2DM and MCI and to map their psychometric properties. Methods: We conducted a scoping review based on the JBI methodology and PRISMA-ScR guidelines. The search was performed across several electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and SciELO), up to March 2026, focusing on the intersection of T2DM, mild cognitive impairment, and the psychometric properties of functional scales. Results: Our search identified only three studies meeting the eligibility criteria. The functional instruments evaluated across these publications were the ADCS-ADL scale, the A-FAQ, and a predictive nomogram including the Lawton-Brody scale. Methodological approaches, sample configurations and reported outcomes varied substantially within the included literature, with no comparative validation studies conducted among homogeneous T2DM cohorts. Conclusions: The notable scarcity and marked heterogeneity of the available literature prevent any definitive conclusions regarding the comparative diagnostic superiority of current functional scales. While gradated instruments show conceptual compatibility with the executive-vascular cognitive decline profile of T2DM, their psychometric properties remain unvalidated in this specific population. Future research should prioritize longitudinal validation designs in homogeneous diabetic cohorts to standardize screening protocols calibrated to metabolic and vascular variations. Full article