Search Results (289)

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

This study investigates the foundational causes of unsustainability that obstruct efforts to address global challenges such as climate change, environmental degradation, water crises, and public health deterioration. Using qualitative research with in-depth expert interviews from education, environmental studies, and business, it finds that these global challenges, while visible on the surface, are deeply rooted in worldviews that shape human behavior, societal structures, and policies. Building on this insight, the thematic analysis manifests three interrelated systemic paradigms as the fundamental drivers of unsustainability: a crisis of wholeness, reflected in fragmented identities and collective disorientation; a disconnection from nature, shaped by human-centered perspectives; and the influence of dominant political-economic systems which prioritize growth logics over ecological and social concerns. These paradigms underlie both structural and cognitive barriers to systemic transformation, which influence the design and implementation of education for sustainability. By clarifying a body of knowledge and systemic paradigms regarding unsustainability, this paper calls for transformative education that promotes a holistic, value-based approach, eco-empathy, and critical thinking, aiming to equip future generations with the tools to challenge and transform unsustainable systems. Full article

Persons with disabilities face barriers to accessing sexuality education. For those who identify as queer, these challenges are compounded by stigma, ableism, and heteronormativity, resulting in distinct and overlooked experiences. This study explored the sexuality education needs of persons with disabilities who identify as queer in Kenya—a neglected demographic—using a phenomenological approach. Data were collected through a focus group discussion with six participants and analyzed thematically. Three themes emerged: invisibility and erasure; unprepared institutions and constrained support networks; and agency and everyday resistance. Educational institutions often overlook the intersectional needs of persons with disabilities who identify as queer, leaving them without adequate tools to navigate relationships, sexuality, and rights. Support systems are often unprepared or unwilling to address these needs. Societal attitudes that desexualize disability and marginalize queerness intersect to produce compounded exclusion. Despite these challenges, participants demonstrated agency by using digital spaces and informal networks to resist exclusion. This calls for policy reforms that move beyond tokenism to address the lived realities of multiply marginalized groups. Policy reform means not only a legal or governmental shift but also a broader cultural and institutional process that creates space for recognition, protection, and participation. Full article

Background/Objectives: Sudden cardiac arrest (SCA) is a major global health concern with high mortality despite advances in resuscitation techniques. Achieving return of spontaneous circulation (ROSC) represents merely the initial step in the extensive rehabilitation journey. This review highlights the critical role of structured, multidisciplinary rehabilitation following ROSC, emphasizing the necessity of integrated physiotherapy, neurocognitive therapy, and psychosocial support to enhance quality of life and societal reintegration in survivors. Methods: This narrative review analyzed peer-reviewed literature from 2020–2025, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. Emphasis was on clinical trials, expert guidelines (e.g., European Resuscitation Council 2021, American Heart Association 2020), and high-impact journals, with systematic thematic analysis across rehabilitation phases. Results: The review confirms rehabilitation as essential in addressing Intensive Care Unit–acquired weakness, cognitive impairment, and post-intensive care syndrome. Early rehabilitation (0–7 days post-ROSC), focusing on parameter-guided mobilization and cognitive stimulation, significantly improves functional outcomes. Structured interdisciplinary interventions encompassing cardiopulmonary, neuromuscular, and cognitive domains effectively mitigate long-term disability, facilitating return to daily activities and employment. However, access disparities and insufficient randomized controlled trials limit evidence-based standardization. Discussion: Optimal recovery after SCA necessitates early and continuous interdisciplinary engagement, tailored to individual physiological and cognitive profiles. Persistent cognitive fatigue, executive dysfunction, and emotional instability remain significant barriers, underscoring the need for holistic and sustained rehabilitative approaches. Conclusions: Comprehensive, individualized rehabilitation following cardiac arrest is not supplementary but fundamental to meaningful recovery. Emphasizing early mobilization, neurocognitive therapy, family involvement, and structured social reintegration pathways is crucial. Addressing healthcare disparities and investing in rigorous randomized trials are imperative to achieving standardized, equitable, and outcome-oriented rehabilitation services globally. Full article

Intermittent claudication is the most common manifestation of peripheral arterial disease as well as a lifestyle-limiting disease with a favorable prognosis. Despite societal guideline recommendations, most claudicants do not trial optimal medical therapy (OMT) and supervised exercise therapy (SET) or receive a quality-of-life (QoL) assessment prior to intervention. In this review, we discuss the components of OMT and SET and the trials establishing their clear benefits in claudicants. We assess adherence rates to OMT/SET and qualitative and quantitative studies attempting to understand the barriers to adoption. We also review how patient-reported outcome metrics were developed to assess QoL in claudicants and reasons for their underutilization in daily clinical practice. Last, we describe novel initiatives seeking to improve adherence to OMT, SET, and QoL assessment. Full article

Obstructive sleep apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with significant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alternative therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review synthesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods such as the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it performs favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

This study examines the challenges that general education teachers face in implementing inclusive education for students with intellectual disabilities in Qatar. Employing a mixed-methods approach, quantitative data were collected from 255 teachers via a structured questionnaire, complemented by qualitative insights from semi-structured interviews with five participants. The findings indicate that teachers encounter moderate to high levels of difficulty, particularly in areas related to the school environment and the availability of educational resources. Significant demographic differences were observed, with male teachers and those working in primary schools reporting greater perceived barriers. Thematic analysis revealed six key factors influencing teachers’ perceptions: student diversity, instructional practices, teacher preparedness, school culture and environment, family and community involvement, and logistical challenges. Despite national policy support for inclusive education, the study reveals ongoing deficits in teacher training, institutional backing, and resource provision. These findings underscore the complex intersection of individual, institutional, and societal factors shaping inclusive education efforts. The study offers valuable insights for localizing inclusive education efforts in Qatar and similar contexts, with implications for educators, policymakers, and educational leaders committed to fostering equitable learning environments. Full article

Global refugee flows’ increasing scale and complexity pose significant challenges to national education systems. Turkey, hosting one of the largest populations of refugees and individuals under temporary protection, faces unique pressures in ensuring equitable educational access for refugee students. Addressing these challenges requires a shift from linear, fragmented interventions toward holistic, systemic approaches. This study applies a Community-Based System Dynamics (CBSD) methodology to explore the systemic barriers affecting refugee students’ participation in education. Through structured Group Model Building workshops involving teachers, administrators, and Non-Governmental Organization (NGO) representatives, a causal loop diagram (CLD) was collaboratively developed to capture the feedback mechanisms and interdependencies sustaining educational inequalities. Five thematic subsystems emerged: language and academic integration, economic and family dynamics, psychosocial health and trauma, institutional access and legal barriers, and social cohesion and discrimination. The analysis reveals how structural constraints, social dynamics, and individual behaviors interact to perpetuate exclusion or facilitate integration. This study identifies critical feedback loops and leverage points and provides actionable insights for policymakers and practitioners seeking to design sustainable, systems-informed interventions. Our findings emphasize the importance of participatory modeling in addressing complex societal challenges and contribute to advancing systems thinking in refugee education. Full article

The integration of Artificial Intelligence (AI) into manufacturing is transforming the industry by advancing predictive maintenance, quality control, and supply chain optimisation, while also driving the shift from Industry 4.0 towards a more human-centric and sustainable vision. This emerging paradigm, known as Industry 5.0, emphasises resilience, ethical innovation, and the symbiosis between humans and intelligent systems, with AI playing a central enabling role. However, challenges such as the “black box” nature of AI models, data biases, ethical concerns, and the lack of robust frameworks for trustworthiness hinder its widespread adoption. This paper provides a comprehensive survey of AI trustworthiness in the manufacturing industry, examining the evolution of industrial paradigms, identifying key barriers to AI adoption, and examining principles such as transparency, fairness, robustness, and accountability. It offers a detailed summary of existing toolkits and methodologies for explainability, bias mitigation, and robustness, which are essential for fostering trust in AI systems. Additionally, this paper examines challenges throughout the AI pipeline, from data collection to model deployment, and concludes with recommendations and research questions aimed at addressing these issues. By offering actionable insights, this study aims to guide researchers, practitioners, and policymakers in developing ethical and reliable AI systems that align with the principles of Industry 5.0, ensuring both technological advancement and societal value. Full article

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited environments. Methods: We evaluated the economic and health impacts of Egypt’s recent initiative aimed at decreasing surgical waiting lists. The study conducts a CE analysis of the initiative by estimating incremental costs (expressed in Egyptian Pounds—EGP) and outcomes (expressed in quality-adjusted life years—QALYs) before and after its implementation, performs a benefit–cost analysis to quantify the initiative’s return on investment, and employs a budget share method to evaluate catastrophic health expenditure (CHE). The analysis included five elective surgical interventions: open-heart surgery, cardiac catheterization, cochlear implantation, ophthalmic surgery, and orthopedic (joint replacement) surgery. Results: The main research outcomes of the study are as follows. The initiative resulted in incremental cost-effectiveness ratios of EGP 46,795 (societal perspective) and EGP 56,094 (payer perspective) per QALY, both within acceptable CE thresholds. Most of the evaluated interventions demonstrated substantial returns on the investment. Without public funding, more than 90% of patients faced CHE, indicating considerable financial barriers to elective surgeries. Conclusions: Egypt’s initiative to reduce waiting times was deemed cost-effective. Our adaptable modeling framework could be practical for similar evaluations in low/middle-income countries, especially where data is limited. Scaling up the initiative to include additional curative and preventive services and integrating it with broader health system reforms in Egypt is strongly recommended. Full article

Background: Increasing evidence suggests that visiting the coast benefits mental health and that coastal prescribing is a promising societal endpoint. General practitioners (GPs) are the pivotal access point for patients to receive diagnosis and treatment, but little is known about their perspective on recommending patients to visit the coast. Methods: This study applied qualitative semi-structured interviews to explore GPs’ perspectives on coastal prescribing in Flanders. We interviewed eleven GPs (aged 32–69 years) and inspected their responses using inductive thematic analysis. Results: Results show that the interviewed GPs generally believed in the therapeutic benefits of the coast, but also acknowledged risks associated with crowding and patient-specific effects. Six barriers were identified for coastal prescribing: feasibility concerns, lack of awareness, prioritizing physical exercise or visiting nearby green nature, anticipating low motivation of the patient, feeling pressure to prescribe medication, and needing more scientific evidence. As solutions, they proposed gathering more scientific evidence and raising awareness. Finally, the GPs regarded their field expertise as valuable in helping to recruit patients for follow-up research on the health effects of the coast. Conclusions: Our findings highlight the importance of engaging GPs, patients, and other stakeholders to identify key knowledge gaps before co-creating coastal prescribing in healthcare. Full article

This review investigates the influence of European Union regulations on the adoption of artificial intelligence in smart city solutions, with a structured emphasis on regulatory barriers, technological challenges, and societal benefits. It offers a comprehensive analysis of the legal frameworks in effect by 2025, including the Artificial Intelligence Act, General Data Protection Regulation, Data Act, and sector-specific directives governing mobility, energy, and surveillance. This study critically assesses how these regulations affect the deployment of AI systems across urban domains such as traffic optimization, public safety, waste management, and energy efficiency. A comparative analysis of regulatory environments in the United States and China reveals differing governance models and their implications for innovation, safety, citizen trust, and international competitiveness. The review concludes that although the European Union’s focus on ethics and accountability establishes a solid basis for trustworthy artificial intelligence, the complexity and associated compliance costs create substantial barriers to adoption. It offers recommendations for policymakers, municipal authorities, and technology developers to align regulatory compliance with effective innovation in the context of urban digital transformation. Full article

Introduction: The effective and meaningful use of anonymized personal data, including open data, is globally significant across various sectors. Enhancing data utilization aims to generate substantial societal benefits and added value through innovations, products, and services. However, several legal, ethical, and technical challenges currently hinder the development and broader adoption of open data. Furthermore, the availability of technical support tools with high usability is especially desirable to facilitate the anonymization process effectively. Methods: As part of the EAsyAnon research project, preliminary insights were gathered through a scoping review that identified factors promoting or impeding the anonymization and use of personal data. Based on these findings, a structured interview guide was developed. Following a pretest, 19 interviews were conducted with diverse stakeholders from healthcare institutions, research organizations, public authorities, and private companies. The collected data were analyzed using Kuckartz’s structural content analysis methodology, supported by qualitative analysis software. Results: The content analysis yielded five overarching categories and 21 subcategories. These encompassed stakeholder experiences related to anonymization and open data processes, the various types and formats of personal data, identified barriers and enabling factors, support services, and the ethical and legal considerations associated with anonymization. Discussion: The findings highlight significant uncertainty among stakeholders regarding the anonymization of personal data. Although the importance and potential applications of open data for innovation and continuous improvement are widely acknowledged and supported, numerous challenges persist at both the macro and micro levels. The results emphasize a clear need for targeted support measures to address these challenges effectively. Full article

Adeno-associated virus (AAV) vectors have emerged as the leading platform for retinal gene therapy due to their favorable safety profile, low immunogenicity, and ability to mediate long-term transgene expression within the immune-privileged ocular environment. By integrating diverse strategies such as gene augmentation and gene editing, AAV-based therapies have demonstrated considerable promise in treating both inherited and acquired retinal disorders. However, their clinical translation remains limited by several key challenges, including restricted packaging capacity, suboptimal transduction efficiency, the risk of gene therapy-associated uveitis, and broader societal concerns such as disease burden and ethical oversight. This review summarizes recent advances aimed at overcoming these barriers, with a particular focus on delivery route-specific disease applicability, multi-vector systems, and capsid engineering approaches to enhance payload capacity, targeting specificity, and biosafety. By synthesizing these developments, we propose a conceptual and technical framework for a more efficient, safer, and broadly applicable AAV platform to accelerate clinical adoption in retinal gene therapy. Full article