This study evaluates the long-term impact of a gender-transformative intervention that provided bicycles to adolescent girls in rural Zambia to enhance school attendance and empowerment. Implemented in 2017 across 100 schools, the intervention aimed to reduce travel barriers and improve educational access. Using an experimental design with a final sample of 1615 adolescent girls (676 treatment, 939 control) in 92 school clusters, we estimate the causal impact of bicycle ownership on sexual, reproductive, maternal and child health indicators five years post-intervention. Our findings indicate a statistically significant 11.5 percentage point increase in adolescent motherhood among the treatment group compared to the control group. However, the intervention did not significantly affect antenatal care visits, iron and folic acid use, institutional deliveries, birth weight, or exclusive breastfeeding (n=382). For sexual reproductive health outcomes, girls in the treatment group were 11 percentage points more likely to report sexual debut and eight percentage points more likely to report wanting the pregnancy. Causal mediation analysis suggests increased empowerment partially mediated the observed rise in adolescent motherhood. Complier analysis indicates a higher likelihood of adolescent childbearing for girls who use the bicycle for school as intended by the programme. These findings highlight the complexities of gender-transformative interventions in low-resource settings. While aiming to empower adolescent girls, increased mobility and decision-making power may intersect with unintended reproductive health consequences. This underscores the need for integrated program designs that complement empowerment initiatives with comprehensive sexual health education and services to mitigate adverse outcomes.

Development of palliative care in countries participating in the iLIVE project. Spain and Argentina case studies.

This study presents a systematic review on the integration of Universal Design for Learning (UDL) in mathematics education to advance inclusive and equitable Scholarship of Teaching and Learning (SoTL) in South African higher education. Guided by the PRISMA 2020 framework, 126 records published between 2010 and 2025 were identified across Scopus, Web of Science, ERIC, Sabinet, and Google Scholar, with 42 studies meeting the inclusion criteria after quality appraisal. The review synthesises empirical and conceptual evidence on how UDL principles—multiple means of engagement, representation, and action/expression—are applied to promote participation, accessibility, and epistemic justice in mathematics education. Findings highlight persistent barriers, including curricular rigidity, inequitable assessment practices, resource limitations, and linguistic exclusion. However, enabling conditions such as culturally responsive pedagogy, multilingual instruction, and reflective professional communities demonstrate promise for inclusive transformation. The review concludes that integrating UDL within SoTL offers a rigorous and contextually responsive pathway to institutionalise inclusive pedagogical practices, particularly within the policy landscape shaped by the Language Policy Framework for Public Higher Education Institutions (2020). Recommendations emphasise curriculum redesign, flexible assessment, sustained professional development, and alignment of institutional policy with inclusive design principles. By situating UDL within SoTL, this study reframes inclusive mathematics education as both pedagogically robust and socially just, contributing to a more equitable higher education landscape.

With the rapid expansion of digital learning in education, Massive Open Online Courses (MOOCs) have emerged as valuable platforms for enhancing access and quality in teacher education. This study investigates the perception of secondary grade prospective teachers towards MOOCs, with a focus on how gender and academic stream influence these perceptions. The study employed a quantitative cross-sectional survey research design. A total of 259 B.Ed. students from Mysore were selected using a stratified random sampling technique and surveyed using a validated 30-item perception scale covering five domains: study habits, learning outcomes, benefits and accessibility, usability and experience, and multimedia and resource sharing. The instrument demonstrated good reliability (Cronbach’s alpha = 0.843). The data were analyzed using descriptive statistics and independent samples t-tests followed by Cohen’s d for effect size. Results indicated that a majority of participants (79.9%) held a moderate perception of MOOCs. While gender differences in overall perception were not statistically significant, female participants rated higher in benefits and multimedia-related domains. Science stream students exhibited significantly more positive perceptions across multiple dimensions compared to their humanities counterparts. The findings suggest integrating structured MOOC orientation within B.Ed. programs, curricular integration of platforms such as SWAYAM for supplementary learning, and institutional initiatives to strengthen the digital competencies of prospective teachers for effective engagement with online learning environments.

Equity, Diversity, Inclusion and Accessibility (EDIA) are recognised as core principles in higher education, yet their practical integration into pharmacy education remains underexplored. This review aims to identify the scope of existing research, highlight knowledge gaps and provide valuable insights for pharmacy educators, researchers and policymakers seeking to enhance EDIA integration within pharmacy education. This protocol describes the methodology for a scoping review to systematically map the existing peer-reviewed literature on EDIA in pharmacy education, focusing on three critical areas: faculty development, curriculum content and teaching strategies. Using the Population, Concept and Context framework, the review will include studies examining faculty members, students and administrators within formal pharmacy education contexts worldwide. The scoping review will adhere to the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include peer-reviewed academic studies, accessed through databases such as MEDLINE, Embase, CINAHL, APA PsycINFO, ERIC and Web of Science. Backward snowballing will also be employed. Data will be charted using a predefined extraction tool, and findings will be synthesised and presented in tabular and narrative formats. A pilot search took place in March 2025, and the final search, study selection and data extraction will be conducted from May to December 2025. The subsequent analysis, presentation and interpretation of results are planned thereafter. Ethics approval is not required. We plan to share findings through a variety of means including professional networks, peer-reviewed journal publications, conference presentations, invited workshops and webinars, on the FPD-Include project website and on our research groups' university websites.

Vision problems and education access challenges among school-aged children in Tanzania: a review of available evidence

This study examines the role of African languages in South African higher education, highlighting the intersection of language policy, identity, and equity. Despite progressive language policies promoting multilingualism, English remains the dominant medium of instruction, creating barriers for both local and international students. Using Ruiz’s (1984) Language Orientations Framework and Barkenbus’s Four-Stage Policy Model, this study investigates the policy-practice gap in the implementation of African languages at the University of Cape Town (UCT). The findings reveal institutional, pedagogical, and ideological barriers hindering effective multilingual education. The paper argues that the marginalization of African languages contributes to epistemic injustice and proposes strategies to enhance linguistic inclusivity, including translanguaging pedagogies, policy enforcement mechanisms, and the development of African-language instructional resources. The study contributes to intersectional language studies by exploring how linguistic hierarchies shape access and identity in higher education for both local and international students.

This randomized controlled study compared the effectiveness of histological preparations embedded in glycol methacrylate-based JB4 plastic resin with traditional paraffin blocks in digital histology education. A total of 297 second-year medical students at Sivas Cumhuriyet University participated. After a theoretical lecture on epithelial histology, students completed a pre-test and an immediate post-test before being randomly assigned to JB4 or paraffin groups. Both groups received laboratory instruction with their respective preparations displayed on a large screen, followed by a post-intervention test, a drawing-based performance assessment, and a follow-up test administered 3 months later. Quantitative results showed that the JB4 group achieved significantly higher scores in the post-intervention test compared to the paraffin group (6.0 ± 2.1 vs. 4.7 ± 1.7, p < 0.001) and exhibited lower knowledge loss in the follow-up test (-1.2 ± 1.3 vs. -2.5 ± 1.7, p < 0.001). No significant difference was observed between groups in drawing-based performance (p = 0.183), although female students outperformed male students in practical drawing (p = 0.001). Qualitative findings from focus group interviews revealed that students valued JB4 sections for their clarity, visibility of details, and preservation of cellular structure, while preparation difficulty, excessive detail, and higher cost were noted as disadvantages. Overall, the results suggest that JB4 sections may improve both immediate and long-term learning outcomes compared to paraffin sections. Despite challenges related to preparation workload and cost, the use of JB4-derived digital materials represents a promising complementary approach to enhancing the quality and accessibility of histology education.

The relation between socioeconomic status and societal development with cardiovascular disease - A systematic review and meta-analysis on global data.

From 2011 to 2021, drowning caused over 2.5 million preventable deaths, with Asia carrying the highest burden of drowning deaths. India and Vietnam are among the top 10 birth countries of people who drown in Australia. This study aimed to understand how Asian adults living in Australia develop health literacy in relation to swimming ability and water safety and how these skills are implemented in different aquatic environments. Three men and nine women between 20 and 79 years old born in India and Vietnam and living in Victoria, Australia were recruited using convenience and snowball sampling. Semi-structured online interviews were audio recorded, transcribed and thematically analysed using a deductive approach. Three interrelated themes emerged. First, there were cultural differences in how participants related to aquatic environments in their birth countries compared to Australia and the impact this had on their health literacy. Secondly, family influence on perceptions of aquatic environments determined participants' perception of risk and safety in aquatic environments. The last theme related to the differences in access, affordability and availability of swimming and water safety education and how this impacted participants' swimming ability. A multisectoral approach is recommended involving councils, key multicultural organisations and community leaders to increase awareness of drowning prevention related health literacy within Asian communities and to implement targeted water safety education and swimming programmes. Targeted education, engagement and co-designing programmes with community leaders are needed to respond to the emerging trend of fatal drowning in Asian communities in Australia.

Problem statement. The use of information and communication technologies during the pandemic ensured the continuity of the educational process and led to the acceleration of the digital transformation of education. At the same time, problems were identified that need to be solved to ensure the accessibility and quality of education. Differences in the material and technical support and information base of general education organizations in the regional and territorial context, the lack of high-speed Internet connection in a certain part of schools can lead to limited access to the full use of digital educational content and digital inequality. Analysis of the current state and dynamics of digitalization of general education is an urgent research problem. Methodology. The information base includes statistical data from the Federal State Statistics Service and the Ministry of Education of the Russian Federation. Calculations and analysis of data for 2016-2024 were carried out for regions, urban and rural settlements, state (municipal) and non-state general education organizations. Results. In 2024, electronic learning covered 26.7% of students in general education organizations in Russia as a whole, and distance learning technologies covered 20.5%, which is 14.3 and 18.1 p.p. higher than in 2016, respectively. The share of coverage by distance learning technologies is higher in cities than in rural areas and slightly lower in state (municipal) schools than in non-state ones. The share of coverage by electronic learning is higher in cities and state (municipal) schools. In 2024, the share of schools with high-speed Internet connection in Russia as a whole was 78.3%. Conclusion. Formation of uniform requirements for school infrastructure and competencies in information and communication technologies of teaching staff, as well as coordination of measures to ensure them, will contribute to the development of digitalization in the standard activities of each school. To improve the efficiency of digitalization, it is advisable to provide incentive payments in the unified system of teacher remuneration being formed in connection with the active use of electronic educational resources. If problems with the speed of the Internet connection persist, it is advisable to provide organizational, legal and technical capabilities to download educational digital resources to personal computers for use offline.

The Kidney Failure Risk Equation (KFRE) is a validated tool for assessing the risk of progression to kidney failure requiring renal replacement therapy (RRT). A 2-year KFRE risk threshold of ≥40% may support timely vascular access planning. To compare the utility of KFRE with traditional estimated glomerular filtration rate (eGFR) thresholds for guiding vascular access planning in an Australian cohort. This single-centre observational cohort study retrospectively reviewed 580 adult patients referred to a Kidney Disease Education Clinic (KDEC) between 2016 and 2021. Among these, 211 patients who underwent dialysis access formation were analysed. Patient trajectories, including eGFR and 2-year KFRE scores at referral, access formation and dialysis initiation, were described alongside rates of emergency access. Of 211 patients with access created, 204 commenced dialysis. A median 2-year KFRE of 46% predicted dialysis within 12 months, supporting its use for access planning. Compared with eGFR < 15 mL/min/1.73m2, KFRE thresholds (≥40% or ≥ 50%) better identified those at risk. A 2-year KFRE ≥ 50% offered the best balance of sensitivity (70%) and specificity (68%) for predicting dialysis within 12 months, whereas ≥40% was more accurate for forecasting dialysis at 24 months and guiding early education. Emergency access was required in 31.5% of haemodialysis patients with lower eGFR at referral (11 vs 15 mL/min/1.73 m2), higher 2-year KFRE (87% vs 62%) and more preceding hospitalisations (95.4% vs 38.5%) than others. KFRE-based thresholds improve risk-stratified access planning compared with eGFR alone. A KFRE ≥ 40% supports early referral for modality education and vascular access, tailored to patient and institutional needs.

Abstract Elementary school and early education are crucial for children's cognitive and social development, as well as lifetime health and well-being. For children in cities, urban schools present numerous advantages in education quality and access to resources and opportunities that stimulate learning and improve health. In Sub-Saharan African (SSA) cities, the complexity of the urban environment requires careful consideration of school environments in enhancing child health and development. Yet, little is known about environmental conditions in schools and schoolchildren's health in rapidly urbanizing SSA cities. This paper describes the various datasets captured within the Accra School Health and Environment Study (ASHES), a study platform designed to characterize air and noise pollution at elementary schools and for schoolchildren, and their influence on key markers of childhood health and development. We outline environmental exposures and health and developmental outcomes among children living in a major metropolitan area in SSA, along with preliminary results and planned analyses. ASHES was implemented in Accra, one of the fastest growing metropolises in SSA. Between July 2022 and May 2023, 1,037 children (~60% female) aged 8-12 were recruited from 90 public (74%) and private primary schools. Weeklong fine particulate matter (PM 2.5 ), black carbon (BC), and sound pressure levels were measured in schoolyards. Homes of the children were geocoded and linked with spatial prediction models to estimate ambient pollutant concentrations at each child's residence. Data were also captured on anthropometry, blood pressure, respiratory function, cognitive and behavioral functions, and sleep quality. Questionnaires gathered additional information on school, household, and sociodemographic factors. Preliminary results suggest that a third of children were hypertensive, 30% were overweight or obese, and 14% had behavioral problems. PM2.5 and noise levels across schools exceeded local and international standards. Several ongoing epidemiologic analyses will examine the key exposures in relation to the major outcomes.

Sex and gender disparities in ischemic heart disease: The role of social and clinical factors in long-term outcomes from the RECORVAL registry.

The Primary Care Exception (PCE) clinic is a care delivery model approved by CMS that enables resident-led primary care encounters to be billed to Medicare without the constant presence of a teaching physician, as long as specific supervision, service-level, and documentation requirements are followed. This model benefits medical education, improves patient and community access, and promotes financial sustainability, but its success relies on adherence to regulatory guidelines, structural safeguards, disciplined supervision, and ongoing oversight.

ABSTRACT This study rethinks the discourse of the inclusive city through the concept of spatial profit. Drawing on qualitative research in two socioeconomically contrasting neighborhoods of Ankara, Mutlu and Ayrancı, it demonstrates that inclusivity, despite egalitarian rhetoric, operates through selective and exclusionary mechanisms. In Mutlu, lower-class residents pursue educational access with limited economic, social, and cultural capital. In Ayrancı, middle and upper-middle classes protect accumulated spatial profit through symbolic boundaries, property relations, and institutional support. Based on participant observation and in-depth interviews with forty-five residents, the study shows that inclusivity often reproduces exclusion unless spatial profit is redistributed through urban policy.

How early adversity shapes adult physical health: Structural disadvantage and gendered pathways to cardiovascular risk.

This scholarly article examines shortcomings in Liberia's educational regulatory framework, emphasizing their impact on quality assurance, access, and fairness in education. A mixed-methods approach highlights systemic inefficiencies, regulatory gaps, and enforcement challenges exacerbated by limited resources and institutional capacity. The findings reveal that although frameworks exist to regulate and oversee the educational sector, enforcement is often inconsistent. Additionally, corruption, inadequate teacher training, and poor infrastructure hinder effective implementation. The recommendations focus on strengthening governance, increasing accountability, and encouraging collaboration among stakeholders to ensure equitable, high-quality educational opportunities for all Liberian citizens.

This study explored nutritional awareness, perceptions and feeding behaviors among pregnant and lactating women in Ngozi province, Burundi, and identified determinants influencing these outcomes. A community-based cross-sectional survey of 1,620 women was conducted using a structured questionnaire adapted from FAO guidelines. Data analysis involved descriptive statistics and logistic regression to determine associations between KAP and socio-demographics. Results showed that less than half of participants had good knowledge on infant feeding (44.6%), with even lower knowledge for young child feeding (30.2%) and malnutrition (28.5%). Positive attitudes toward dietary diversity were noted in 63.7% of respondents, but only 57% practiced adequate dietary diversity. Significant predictors of better knowledge and attitudes included economic engagement, education levels, marital status, and age. The study highlights the need for integrated interventions addressing education, economic empowerment, and food access to improve dietary diversity and reduce maternal and child malnutrition in this setting.

This study was carried out to examine the effectiveness of financing options in the adoption of climate smart agriculture practices among farmers in delta state, Nigeria. Survey questionnaire was administered to 210 respondents in the study area through the use of multistage sampling technique. Descriptive statistics such as, means, percentage and frequency count was used to achieve the objectives and hypotheses were tested using binary logistics regression. The study shows that most respondents were female (71.0%), married (60.5%), aged 30–49 (62.9%), and operated small farms under 3 hectares (80.5%). Education varied, but 27.1% had secondary education. Many relied on personal savings (45.2%) and leased land (49.5%). Contact with extension agents was minimal (76.2% had none), and only 34.8% belonged to cooperatives. Access to CSA financing was highest through youth and women’s schemes like N-Power Agro (91.9%) and commercial bank green loans (64.3%), while access to schemes like NIRSAL, Anchor Borrowers’ Programme, and CBN Agricultural Credit Guarantee Scheme Fund remained low (&lt;30%). Effectiveness ratings of existing financing schemes were generally below average (mean &lt; 2.5), indicating weak support for CSA adoption, hindered by bureaucratic bottlenecks and poor outreach (Abioye et al., 2021; Oladipo et al., 2022). Severe challenges included high collateral, interest rates, and limited insurance (Food and Agriculture Organization, 2021). Innovative strategies like results-based financing and blended finance showed modest support (≈30%), while digital and insurance-based tools had low acceptance due to trust gaps (Adeagbo et al., 2022). Regression results showed education, farm experience, and credit access positively influenced CSA adoption. Based on the findings of this study it was recommended that Financial institutions such as NIRSAL, Anchor Borrowers’ Programme, and CBN Agricultural Credit Guarantee Scheme Fund should lower collateral requirements, reduce interest rates, and extend repayment periods to make credit accessible to smallholders.