This study examines how national-level digital development – measured by the ICT Development Index (IDI) – affects university students’ use of ChatGPT. Special emphasis is placed on mediating factors that may influence this relationship, including technical access, institutional and linguistic support, and individual background characteristics, particularly in relation to educational equity and sustainability (SDG 4). The analysis is based on survey data from 20,242 students across 58 countries and applies multivariate statistical methods, including logistic regression, PLS-SEM modeling, and cluster analysis. The results indicate that students in countries with higher IDI scores are more likely to use ChatGPT, primarily because of more advanced digital competencies and greater technological access. The country of study proved to be a stronger predictor than citizenship, underscoring the key role of the local educational environment. Functional access emerged as the most decisive mediating factor, while institutional and linguistic support had a more indirect effect on usage. Cluster analysis identified three distinct student profiles and highlighted that a high level of digital infrastructure alone does not ensure the widespread adoption of generative AI tools. The study proposes a multi-level interpretive framework: at the macro level, national digital infrastructure; at the meso level, institutional and linguistic support; and at the micro level, individual characteristics – connected by functional access as a mediating dimension. This context-sensitive approach contributes to a more comprehensive and practice-oriented understanding of digital inequalities and the integration of generative AI in higher education, offering guidance for promoting inclusive and sustainable technology use.

Household Water Treatment and Safe Storage (HWTS) technologies play a crucial role in ensuring safe drinking water and preventing waterborne diseases. However, among pastoral communities, in Tanzania, the adoption of these technologies remains low due to various socio-economic and cultural challenges. Therefore, the present study examines the factors influencing the adoption of HWTS technologies among rural households in Tanzania. Using a cross-sectional research design, data were collected from 350 respondents across two villages, Oleng’wadu and Ilikirimuni, in Meru district, through structured questionnaires, and analyzed by descriptive and Probit regression model. Findings revealed that most households rely on public tap water (49%), followed by rainwater (22%) and private taps (18%). Adoption of HWTS is mainly due to microbial contamination (32%) and visible dirtiness of water (31%). Non-adoption is linked to absence of illness from water (26%) and perceived water cleanliness (20.7%). Boiling is the most common HWTS method (49.5%), followed by settling (19.7%) and filtering (8.9%). Regression results show HWTS adoption increases with education (0.5039), age (0.2037), and loan access (5.3578). Adoption is also influenced by awareness (0.4372), unsafe water perception (0.4585), and disease experience like amoeba (0.6436). These results suggest that to increase the uptake of HWTS, it is essential to promote community-based education that enhances awareness and corrects risk perceptions about unsafe water. Financial support mechanisms such as subsidies and microloans should be introduced to improve affordability. Strengthening distribution systems will ensure HWTS products are consistently available, especially in rural areas. Lastly, integrating HWTS into public health policies and encouraging community participation will foster long-term adoption.

Xylazine, a non-opioid sedative not approved for human use, poses serious health risks. It is primarily found in illicitly manufactured fentanyl, but xylazine-fentanyl combinations also appear as illicit stimulant adulterants. Although strategies exist to reduce the risk of xylazine-related harms, some high-risk populations may be unaware of the drug, including people with recent criminal legal system involvement who use illicit stimulants. A cross-sectional electronic survey was conducted in Ohio in October 2024 to assess xylazine-related knowledge, attitudes, and behaviors among people with criminal legal system involvement and prior illicit stimulant use. Participants were recruited from Ohio courts. Among 229 respondents (43.5% response rate), 42.4% had heard of xylazine. The sample was 54.6% female, 83.3% White, 3.1% Hispanic or Latino, and mean age was 38.5 years (SD = 9.4). Individuals who had heard of xylazine were more likely to have used fentanyl (35.1% vs. 7.1%) or heroin (35.5% vs. 2.4%) in the past 6 months than those who had not heard of it. Most respondents (75.1%) indicated it was "very important" to know if xylazine is in their drugs and 66.4% would be "very" or "somewhat likely" to use xylazine test strips, if available at no cost. Among people who had heard of xylazine, 83.5% did not want to use xylazine and try to avoid it. Most respondents were unaware of xylazine, despite its prevalence in Ohio. Xylazine education and easy access to harm reduction tools are critical for preventing xylazine-related harms among this high-risk population.

Addressing financial and health-related social needs among patients with cancer: Study protocol for CAN-ASSIST pilot clinical trial.

Recent regulatory and guideline changes have established pretreatment DPYD genotyping as a critical strategy to prevent severe fluoropyrimidine toxicity. Following earlier European leadership by the European Medicines Agency, the US Food and Drug Administration added boxed warnings to capecitabine and 5-fluorouracil labels recommending genetic testing before therapy. Concurrent updates from the National Comprehensive Cancer Network and ASCO align US with European practice supporting universal testing. Fluoropyrimidines remain foundational treatments across multiple cancers but can cause life-threatening toxicity in patients with dihydropyrimidine dehydrogenase (DPD) deficiency, most commonly because of inherited DPYD variants. DPYD variant carriers receiving standard doses experience markedly increased risk of severe toxicity and treatment-related mortality, emphasizing the clinical importance of DPYD testing and genotype-guided dosing. Evidence demonstrates that dose individualization based on guidance from the Clinical Pharmacogenetics Implementation Consortium reduces toxicity risk while maintaining treatment effectiveness and potentially reducing overall costs. Patient advocacy, particularly efforts led by Advocates for Universal DPD/DPYD Testing, has accelerated policy change, increased clinician awareness, and highlighted ethical implications of preventable harm. Despite growing adoption, implementation challenges persist, including workflow integration, clinician education, and equitable access. Integrated health systems such as the Veterans Health Administration demonstrate how centralized infrastructure and clinical decision support can facilitate uptake. Barriers are more pronounced in resource-constrained settings, where limited infrastructure, reimbursement uncertainty, and insufficient pharmacogenomic education hinder implementation. Regional initiatives illustrate education-focused, context-adapted strategies to expand testing and address population-specific variant knowledge gaps. Collectively, emerging evidence, regulatory alignment, and advocacy efforts position DPYD genotyping as a patient-safety imperative necessary to achieve safer, more equitable fluoropyrimidine therapy worldwide.

Suture the Future: Evaluating the Impact of Early Surgical Exposure for High School Students.

Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impacts quality of life. Therapeutic patient education (TPE) improves disease outcomes, but traditional in-person programs are often inaccessible. Video- and handout-based TPE offer more feasible alternatives, though their comparative efficacy remains unclear, particularly in diverse linguistic populations. This study compared the effectiveness of video- and handout-based TPE in pediatric AD patients and their caregivers, including both English- and Spanish-speaking participants. Interventions in English or Spanish included handouts as an active control (our standard of care) or short captioned videos addressing core AD management practices. Outcomes measured at baseline and 1-10 weeks post-intervention included Patient-Oriented Eczema Measure (POEM), Child Dermatology Life Quality Index (CDLQI), and Investigator's Global Assessment (IGA), and caregiver AD confidence. Educational accessibility and viewership were assessed at follow-up. Fifty-two dyads were randomized at an academic pediatric dermatology clinic; 22 (42%) completed both baseline and follow-up assessments. Across all participants, there were no statistically significant differences between handout and video groups in POEM, CDLQI, or IGA, educational accessibility, or caregiver confidence in AD management. English- and Spanish-speaking participants demonstrated comparable outcomes across all measures. These findings suggest that videos and handouts are both viable educational tools and support the use of well-constructed handouts as a viable, resource-conscious option, including in Spanish-speaking populations. Larger studies with improved enrollment and retention are needed to further define optimal TPE strategies.

This study aims to evaluate the implementation of a scholarship program established through a Memorandum of Understanding (MoU) between the Government of Labuhanbatu Utara Regency and partner universities, and to analyze its impact on the educational quality of scholarship recipients. The study is motivated by the low participation rate in higher education in the region, despite the government’s efforts to improve human resource quality through scholarship initiatives. Fluctuations in the number of recipients and implementation challenges highlight the need for a comprehensive evaluation. This research employs a mixed-methods approach combining qualitative and quantitative data. Qualitative data were collected through in-depth interviews, observations, and document analysis involving key informants such as program administrators and scholarship recipients. Quantitative data were obtained through surveys using questionnaires. The evaluation uses the CIPP model (Context, Input, Process, Product) to assess policy context, resources, implementation processes, and program outcomes. The findings indicate that the MoU-based scholarship program positively contributes to improving access and quality of education, although some limitations remain. Overall, the program represents a strategic effort to enhance human resources, reduce educational disparities, and strengthen the competitiveness of the younger generation.

Purpose: School-based speech-language pathologists (SLPs) increasingly address feeding and swallowing disorders, such as pediatric feeding disorder and dysphagia, within educational settings. These conditions require interventions that are clinically effective, ethically defensible, legally compliant, and educationally relevant. Ethical tensions arise when balancing safety, educational access, and scope of practice. This tutorial uses the structured ethical decision-making model from Power-deFur that guides SLPs and interdisciplinary teams to identify ethical dilemmas, apply ethical and legal standards, consider possible courses of action, implement decisions, and reflect on outcomes. Grounded in the American Speech-Language-Hearing Association Code of Ethics and aligned with federal mandates such as the Individuals with Disabilities Education Act and the Americans with Disabilities, as Amended (Americans with Disabilities Act of 1990, as Amended, 2008), this framework supports clinicians in navigating common challenges related to competence, interprofessional collaboration, and family–school dynamics. Case examples illustrate the model's application, equipping SLPs with a practical, evidence-informed tool for real-world ethical dilemmas in feeding and swallowing.

<p class="ql-align-justify">This article examines parents’ lived experiences concerning their secondary and senior secondary school children during the COVID-19 pandemic in India. Employing the Interpretative Phenomenological Analysis (IPA) approach, the study highlights parental involvement in mitigating the challenges of remote learning. Findings reveal that parents’ involvement was pivotal in addressing technological and educational challenges, with disparities evident between rural and urban households. The primary reasons for the pronounced and widened educational access gap between children from rural and urban regions included challenges in arranging technological tools and differences in parental awareness concerning online education. Based on the findings, we propose a Parental Involvement Matrix (PIM) that categorizes parental roles based on their engagement in problem identification and resolution. Parents reported that online learning strengthened children’s technical skills and self-reliance but highlighted issues such as reduced teacher-student interaction and increased screen time. Finally, the parents emphasized the importance of physical learning environments in cultivating holistic educational experiences.</p>

ABSTRACT In higher education institutions, as the number of online language courses continues to grow, it is essential to equip faculty with the support and tools necessary to enhance learning experiences for students with visual impairments. Grounded in Culturally Relevant Disability Pedagogy and Disability Studies Theory, this study advocates for more equitable and accessible course design for underrepresented learners. Using a qualitative Interpretative Phenomenological Analysis (IPA) approach, the study examines online language faculty’s lived experiences teaching students with visual impairments. A purposive sample of 10 language faculty members across the United States participated in in-depth, semi-structured interviews conducted via videoconferencing. Interviews were audio-recorded, transcribed verbatim, and analyzed iteratively through close reading, initial coding, and the development of emergent and superordinate themes. The study was guided by the following research questions: 1) What are faculty experiences in delivering online language courses to students with visual impairments? 2) How do faculty describe the support and training they receive in delivering accessible online language courses? 3) What are the strategies and tools faculty use when teaching languages to students with visual impairments online? Findings indicate that Americans with Disabilities Act (ADA) compliance in online language instruction requires greater prioritization. Participants described limited institutional support and insufficient training in accessible course design, often relying on self-directed learning and reactive adaptations. These findings underscore the need for more systematic and proactive approaches to accessibility in online language education to ensure that visually impaired learners can fully engage and succeed academically.

ABSTRACT In this paper, we delve into the multifaceted process of designing inclusive curricula in post-secondary education for students with intellectual disabilities, using a Universal Design for Learning (UDL) approach. We begin by conceptualising an inclusive curriculum, discussing the theoretical foundations and key principles that underpin this approach. Following this, we explore the diversity of curricula in post-secondary education, with a specific focus on Ireland’s perspective, highlighting the unique challenges and opportunities faced by Irish institutions. We then examine the UDL-based inclusive curriculum within an inclusive programme for students with intellectual disabilities in an Irish higher education institution, providing a detailed analysis of how UDL principles are implemented to cater to diverse learning needs. The paper then addresses curriculum design from methodological perspectives, discussing various strategies and frameworks that can be employed to create effective and inclusive educational environments. Finally, we review examples of inclusive curriculum implementations, illustrating the practical applications and outcomes of UDL-based curriculum design in enhancing educational accessibility and quality for all students. This paper offers a contribution to the current debate around curriculum for students with intellectual disabilities through the examples of UDL-based implementations that show inclusive teaching and learning practices in the post-secondary education context.

Abstract Child sexual abuse (CSA) has severe psychological, social, and developmental consequences, yet resilience—the ability to adapt positively despite adversity—offers a pathway for recovery. This study evaluates predictors of resilience among CSA survivors in rural and urban Zimbabwe and assesses the impact of a structured resilience-building program on individual, social, institutional, and community factors over 5 years. A longitudinal quasi-experimental design was used, tracking 1,573 CSA survivors aged 12–19 at enrolment and 1,021 at post-test. Linear Mixed-Effects Modelling (LMM) was applied to account for individual variability and non-randomized group differences. Resilience scores significantly improved from M = 3.0 (baseline) to M = 4.5 (post-test), β = 12.45, p < .001. Strong predictors included self-esteem (β = 3.58), mentorship (β = 2.78), psychological support (β = 3.45), and educational access (β = 3.02, all p < .001). Urban survivors benefited more from institutional support, whereas rural survivors relied on coping mechanisms and traditional healing. The program effectively enhanced resilience, but individual variability suggests a need for personalized interventions. Strengthening institutional support in rural areas and integrating cultural healing practices into formal programs can improve accessibility and effectiveness. These findings inform policy and programmatic strategies for the recovery of CSA survivors.

This study evaluates two non-visual methods, Natural Language (NL) descriptions and Haptic exploration with NL Overview (H + O), for interpreting STEM graphical representations using a multimodal diagram system. Conducted with blindfolded sighted participants (N = 40), the study examined accuracy, time, and user feedback across pie charts, Venn diagrams, and line graphs. Results revealed functionally equivalent accuracy between NL and H + O methods, although NL was faster and preferred by 70% of participants. Venn diagrams yielded the highest accuracy and shortest interaction times, while line graphs posed greater challenges resulting in lower accuracy and longer times. Despite initial unfamiliarity with haptics (H + O), participants effectively built mental models for graphical data, highlighting the potential for multimodal learning systems to enhance inclusivity and accessibility in STEM education. These findings support the theory of functional equivalence and underscore the value of Universal Design for Learning (UDL) in fostering equitable access to STEM content.

Female genital mutilation is a major public health and human rights concern, with the highest burden reported in countries of the Horn of Africa. Despite long-standing legal bans and prevention efforts, the practice remains nearly universal in Somaliland, driven by deeply rooted social and cultural norms. Evidence on the prevalence, types, and population-level determinants of female genital mutilation in Somaliland remains limited. This study assessed the prevalence, types, and associated factors of female genital mutilation among women of reproductive age in Somaliland. This population-based study analyzed data from 5,143 women aged 15-49 years who participated in the 2020 Somaliland Demographic and Health Survey. A two-stage cluster sampling design was used, involving the selection of enumeration areas followed by households. Descriptive analyses were conducted to estimate prevalence and types of female genital mutilation. Binary logistic regression was used to identify factors associated with the pharaonic type of female genital mutilation in comparison with other types. The overall prevalence of female genital mutilation was 99.49% (95% confidence interval: 99.30-99.70). The most common form was type three (pharaonic), affecting 66.97% of women, followed by type one (sunni) at 22.01% and type two (intermediate) at 9.50%. Women from nomadic communities, those with no formal education, those in lower wealth households, women who had never used the internet, and those circumcised by traditional practitioners had significantly higher odds of experiencing the pharaonic form of female genital mutilation. Female genital mutilation remains nearly universal among women of reproductive age in Somaliland, with severe forms predominating. Social disadvantage, limited access to education and information, and reliance on traditional circumcisers are key population-level drivers of harmful practices. Interventions that expand educational and digital access and engage traditional practitioners may be critical to reducing the persistence and severity of female genital mutilation in Somaliland.

ABSTRACT This study investigated the extent to which Doctor of Education (EdD) students at Northeastern University integrated social justice principles into their dissertations in practice. To guide this inquiry, the research team developed an operational social justice framework through an iterative process of refinement. The initial aim of the study was to critically evaluate the degree to which students’ research aligned with a comprehensive conception of social justice, particularly in advancing equity and fostering transformative educational practices. As the study evolved, it assumed a dual focus: a) assessing the depth of students’ engagement with social justice and b) serving as a methodological case study on the iterative development and application of the framework itself. Content analysis was used to examine 186 dissertations operationalizing social justice across four dimensions: Educational Access and Equity, Instructional Practice, Community Engagement, and Professional Development. Findings revealed variations in applying social justice frameworks across an EdD program and identified facilitating or hindering factors. Drawing on action research, critical theory, and transformative learning, the study developed an iterative approach prioritizing methodological adaptability specific to social justice. Findings suggest EdD programs should integrate equity-focused action research into curriculum and mentorship to develop socially conscious educational leaders.

Racial and Ethnic Disparities in Social Determinants of Health and Health Outcomes in Individuals with Traumatic Spinal Cord Injury: A Scoping Review.

Towards primary health care education reform: A reflexive thematic analysis of nursing supervisors' perceptions, experiences and challenges.

ABSTRACT This study investigates the decision-making process of Indigenous Australian students in pursuing higher education, addressing a gap in understanding their educational choices. It identifies the key factors influencing university enrolment decisions and how these shape students’ educational pathways. Using a narrative-inquiry approach, the study explored the lived experiences of Indigenous students from two Western Australian universities. Through written autobiographies, yarning sessions and one-on-one interviews, participants shared rich, nuanced insights into their journeys to higher education. Findings reveal the pivotal role of ‘sparks’ in normalising higher education as a viable option. Students relied minimally on formal information search, depending heavily on trusted reference groups and institutional choice was guided by a set of key attributes. This study presents an adapted consumer decision-making framework grounded in Indigenous worldviews and highlights the need for tailored, culturally responsive marketing strategies. By centring Indigenous voices and adopting a strength-based approach, this research advances theoretical understanding and offers practical solutions to increase Indigenous student access, participation and equity in higher education.

Women empowerment became a fresh debatable subject once again in the context of recent attempts to pass the women reservation bill in the Lok Sabha in India in April 2026. Empowering women through education is crucial for inclusive and sustainable development, especially in relation to Sustainable Development Goal 5 (SDG-5), which centers on gender equality and the empowerment of all women and girls. This research examines the latest government initiatives in India aimed at improving women's empowerment, particularly in educational achievement. Using a descriptive-analytical research approach, this study relies on secondary data from sources such as UDISE+, government reports, and international datasets. The analysis employs a capability-based framework to evaluate how policy measures convert into real educational opportunities and results for women. The findings show that while India has made significant progress in increasing girls' access to education, as evidenced by high enrollment at the primary and elementary levels, serious challenges persist regarding retention, progression to secondary education, and completion rates. Structural barriers, including socio-cultural attitudes, financial difficulties, digital divides, and institutional gaps, continue to hinder the effective translation of educational access into true empowerment. The research also highlights regional disparities and intersectional inequalities that intensify these challenges. The paper concludes that achieving SDG-5 in India requires a shift from policies focused merely on access to strategies that boost capabilities, prioritising retention, digital inclusion, and socio-cultural change. It recommends introducing targeted, context-sensitive policies and improving monitoring systems to ensure that educational progress leads to lasting empowerment. Women's Educational Empowerment, Sustainable Development Goal 5, Gender Inequality in Education, Public Policy Analysis.