Structured care protocols such as Parent and Caregiver Training (PACT) frameworks have emerged as a promising strategy to address the substantial multidimensional burden experienced by caregivers of individuals with Cerebral Palsy (CP). Caregivers frequently face physical, emotional, social, and financial stressors, compounded by inadequate information, poor access to services, and limited structured support, particularly in low‑resource settings. This narrative review synthesises current literature on the concept, characteristics, and impact of structured care protocols for CP caregivers, with specific emphasis on educational, psychosocial, skill‑building, and resource‑navigation components. A focused search of major databases identified studies and reviews describing caregiver‑focused interventions, structured programs, and multidisciplinary models of care relevant to CP. The evidence indicates that PACT‑type protocols can enhance caregiver knowledge, practical caregiving skills, self‑efficacy, and perceived competence, which in turn are associated with reduced stress, lower caregiver burden, and improved quality of life for both caregivers and children. Key elements include systematic education on CP and home‑based management, training in daily care and therapeutic activities, facilitation of access to medical, rehabilitative, social, and financial resources, and integration of psychosocial support and peer networks. Emerging work also highlights the potential of digital health platforms to improve scalability, continuity of support, and personalisation of these interventions across diverse sociocultural contexts. Nonetheless, gaps remain regarding standardised PACT models, culturally adapted content, and robust long‑term outcome data, especially in developing countries. Future research should prioritise the development, implementation, and controlled evaluation of context‑appropriate structured care protocols to optimise caregiver well‑being and child outcomes in CP.

Development and initial validation of a video-mediated listening test based on multimodal generative AI.

Bibliometric analysis of the top 100 most cited articles related to pathological fractures.

Drought is a prolonged period of abnormally low precipitation, leading to a significant water deficit that adversely affects the environment, agriculture, and various socio-economic activities. Severe weather phenomena, including droughts, floods, wildfires and hurricanes inflict rapid and significant economic losses among businessmen and women. They interrupt commercial activities, harm critical infrastructure, wipe out agricultural production, and force many communities to relocate. The aim of this study was to assess the economic effects of drought and identify strategic adaptation mechanisms employed by Small and Medium Enterprises (SMEs) in Lusaka District, Zambia. A cross-sectional research design was used in this study. This study used a stratified random sampling method to select 384 participants (owners and managers of SMEs) from SMEs within such targeted sites as Town Centers, Soweto market, City Market, and Buseko Market. Approval was obtained from the University of Zambia Biomedical Research Ethics Committee (UNZABREC) REF. No. 5913-2024 and the Lusaka City Council to ensure ethical compliance for the study. Respondents were informed that participating in this study was completely voluntary and that, they were free to withdraw from the study at any time without any consequence. The participants were informed that taking part in the study would not put them at risk of harm and that they would not gain any immediate personal benefits from their involvement. Respondents were also assured that the collected data would not be disclosed to anyone and that confidentiality and anonymity would be maintained throughout the study. After all aspects of the study had been clearly explained and the participants had demonstrated understanding, written informed consent was obtained from each respondent prior to the commencement of data collection. Primary data was collected using a structured questionnaire with closed-ended questions. The collected primary data was analysed using SPSS version 28, and the analysed data were presented using pie charts and tables. The results from this study demonstrated that, most of the respondents (63.2%) reported that drought lead to reduced operational costs and increased profitability among Small and Medium Enterprises (SMEs) in Lusaka District. The study also found that, few study participants (20%) indicated that, drought decreased revenue, increased operational costs, and caused challenges to the continuity of businesses. The findings from this study found that, most of the respondents (52.1%) diversified their products and services to meet changing demands of their customers during droughts. In contrast, increasing staff wages emerged as the second most significant strategy adopted by 27.1% (104) of SMEs. The study further disclosed that, the majority of respondents (82.1%) reported that limited access to financial resources and credit facilities emerged as a major challenge faced by small and medium enterprises in implementing effective drought adaptation strategies in Lusaka District of Zambia. While the majority of SMEs reported increased profitability and reduced operational costs due to strategic adaptations, a notable minority highlighted challenges such as revenue loss, increased expenses, and operational disruptions. The author recommends that, to enhance resilience, SMEs in Lusaka District should build on adaptive strategies such as product diversification and wage adjustments, while policymakers and financial institutions should work to overcome the critical barriers of limited access to credit and financial resources.

The research investigates the relationship between green finance and sustainable industrialization based on 268 countries from the period 2001- 2024 via statistical regression models. The findings show the positively impact of green finance on sustainable industrialization. Overall, the findings confirm that green finance is a vital tool for promoting sustainable industrialization and supporting long-term sustainable development at the global level by aligning financial resources with environmental objectives. The findings provide valuable guidance for policymakers and financial institutions seeking to advance sustainable industrial development at the global level by supporting more informed policy formulation, stronger regulatory frameworks, and better-targeted investment choices that balance economic growth with environmental sustainability.

ABSTRACT Air pollution is widely recognized as a major public health concern, and emerging evidence suggests an association with dementia. Establishing a causal relationship, however, is difficult. Economic cycles affect both dementia prevalence and pollution levels: during economic booms, financial resources for treatment rise, but so do air pollution and work-related stress. In South Korea, air quality has generally improved, even as Alzheimer’s cases have increased with population aging, indicating a time-series relationship that biases regression results. Air pollution and vascular dementia also temporarily declined during COVID-19, reflecting omitted variable bias. To address these endogeneity concerns, we use wind speed and direction as instruments for air pollution in South Korea. Our estimates show that higher concentrations of PM10, PM2.5, and NO2 significantly increase dementia cases, with instrumental variable results substantially larger than ordinary least squares, underscoring the importance of correcting for bias. These findings carry important policy implications. Because air pollution is a negative externality, its health consequences—including dementia—extend beyond individual responsibility and represent broader social costs. Reducing pollution could therefore not only improve health outcomes but also ease the considerable economic burden of dementia care. As air pollution disproportionately affects vulnerable groups—individuals with dementia who are unable to sustain employment or income—targeted social support is also essential to address their combined medical and financial challenges. Implications: We underscore the importance of addressing endogeneity issues when evaluating the relationship between air pollution and dementia. Conventional approaches may produce biased estimates due to spurious time-series-correlations and omitted variables. By using wind speed and direction as instruments, we identify LATE-based causal effects of air pollution on the number of dementia patients. Our findings suggest important policy implications: reducing air pollution can lower the substantial social and economic costs associated with dementia. Improved administrative data linking clinical records with environmental exposures would support effective monitoring and policy evaluation. Furthermore, international cooperation is needed to address transboundary nature of air pollution.

Low vision (LV) services are likely to become more in demand as the prevalence of vision impairment increases. Primary eye care clinicians represent a substantially underutilised resource for LV service provision and increasing their participation could considerably improve service capacity and accessibility. This study aimed to gain a comprehensive in-depth theory-based understanding of factors influencing participation of primary eye care clinicians in LV services to inform the evidence base for future behaviour change intervention design. Semi-structured one-to-one interviews using topic guides based on the capability, opportunity, motivation - behaviour (COM-B) system were conducted with a maximum variation sample of primary eye care clinicians and other relevant stakeholders. Thematic data analysis was undertaken; codes were inductively generated then mapped to domains of the theoretical domains framework (TDF) to generate themes and subthemes, which were mapped back to the COM-B system. A total of 31 individual interviews were conducted. Multiple TDF domain themes and subthemes were found to influence primary eye care clinicians' participation in LV services, including knowledge (knowledge gaps); memory, attention and decision processes (case identification); social influences (professional support and influences, clinician-patient relationships, interprofessional relationships); environmental context and resources (funding and commissioning, practice resources); intentions (passion); beliefs about consequences (LV outcome expectations); beliefs about capabilities (confidence); goals (profitability); professional role and identity (scope of practice); reinforcement (rewards) and emotion (enjoyment, clinician wellbeing). This is the first study to qualitativelyexplore factors influencing participation of primary eye care clinicians in LV services and to explicitlyapply behaviour change theory to do so. It provides a novel, comprehensive, in-depth and theory-based understanding of influences on primary eye care clinicians' participation in LV services. This evidence base is fundamental to designing successful theory-informed behaviour change interventions which aim to increase primary eye care clinicians' participation and facilitate LV service expansion.

Haemophilia is a bleeding disorder with implications beyond clinical symptoms, affecting patients' and caregivers' personal, social, and economic well-being and quality of life. Limited data exist from low- and middle-income countries like India, where access to care and societal awareness may differ significantly from high-income settings. We aimed to explore the personal, social, and economic impacts of haemophilia on persons with haemophilia (PwH) and their caregivers in India, using a mixed-method approach. This multicentric, mixed-method study included semi-structured in-depth interviews with 30 participants (15 PwH A - (Non-inhibitor) and 15 caregivers). Transcribed interviews were analysed using grounded theory, and participants also completed the EQ-5D-5L and EQ-VAS instruments. Data were analysed using descriptive statistics and thematic analysis to identify key burden areas RESULTS: Ten themes emerged, including PwH-specific (chronic pain, disrupted education/employment, strained relationships), caregiver-specific (coping with diagnosis, social isolation), and shared challenges (financial burden, stigma, limited treatment access). The grounded theory of Transformative Resilience described coping strategies of PwH and caregivers. EQ-5D-5L showed greatest impairment in mobility (2.47 ± 0.92), with mean utility and VAS scores of 0.678 ± 0.280 and 0.630 ± 0.206, indicating moderate-to-severe QoL compromise. Haemophilia profoundly affects patients and caregivers, extending beyond physical symptoms to social, emotional, and economic challenges. The study underscores unmet needs arising from financial burden, stigma, and limited resources, emphasizing the need for patient-centred, holistic care models that integrate medical, psychosocial, and economic support in resource-limited settings.

Egypt's rapidly growing, and predominantly young population presents both opportunities and challenges for its healthcare system, particularly in addressing the rising burden of non-communicable diseases. Pharmacists, as accessible and trusted healthcare professionals, are well-positioned to support public health efforts, medication optimization, and chronic disease management. Despite the country's large pharmaceutical workforce and expanding pharmacy education sector, research engagement across the profession remains limited and fragmented. To address this gap, this commentary outlines key strategies aimed at strengthening research capacity and integrating the clinician-researcher identity across the pharmacy profession. These include revising admissions criteria for entry onto pharmacy educational programs, expanding research participation to community and hospital settings, enhancing research skills through training and mentorship, increasing access to funding and institutional resources, and formalizing national research initiatives to align with public health goals. Together, these measures propose a comprehensive and coordinated approach to advancing pharmacy-led research in Egypt. By embedding research into both professional practice and educational structures, Egypt can cultivate a more evidence-driven pharmacy workforce capable of contributing meaningfully to healthcare innovation, policy, and system-wide improvement.

This article provides a comprehensive literature review on the impact of Enterprise Risk Management (ERM) implementation on the performance, resilience, and sustainability of Micro, Small, and Medium Enterprises (MSMEs). MSMEs are vital contributors to economic growth, employment, and innovation, yet they are particularly vulnerable to external shocks due to limited financial resources, weak internal controls, and dependence on owner-managers’ intuition. Traditional silo-based risk management approaches are considered inadequate in increasingly volatile and uncertain business environments. ERM is presented as an integrated and strategic framework that aligns risk management with corporate governance, objective setting, and performance management. The reviewed empirical evidence, especially from emerging economies, indicates that ERM adoption is generally associated with improved financial performance, sales growth, revenue stability, enhanced access to external financing, and stronger organizational resilience during crises such as global pandemics. However, the literature emphasizes that the benefits of ERM depend on the maturity level of implementation and the extent to which risk management is embedded in organizational culture and daily decision-making processes, rather than adopted merely as a formal compliance mechanism. The article also discusses commonly used ERM frameworks, determinants and barriers to adoption, including resource constraints and lack of expertise, and highlights managerial and policy implications. It concludes by identifying research gaps and calling for more longitudinal and cross-country studies to better understand the long-term value creation of ERM in MSMEs.

ABSTRACT Using secondary data from the Annie E. Casey Foundation's OPPS JCYOI, we examined the relationship between financial capability and mental health outcomes among 2635 young people aged 14–26 with current or prior out‐of‐home care experience. Key findings indicated that financial capability was a protective factor for mental health, whereas owing money and holding multiple jobs were linked to worse mental health and higher unmet service needs. While 69% reported that their health insurance covered mental health services, 15% did not. Over half (54%) had a paid job, and 44% were enrolled in school. Notably, female and LGBTQIA+ individuals, along with those facing financial hardship, reported lower mental health ratings and greater unmet service needs. The results underscore the urgent need for financial education and support programs for this population, suggesting that economic stability can safeguard against mental health challenges. Integrating financial capability education and resources into transition services and postcare supports could improve mental health outcomes and decrease disparities in service access.

This study investigates the diversity of attitudes toward climate change risk (ACCR) among older adults in England. This demographic, both vulnerable to climate impacts and influential in shaping climate policy, has often been overlooked in terms of its specific ACCR. The study aims to identify distinct attitudinal profiles and explore the sociodemographic, economic, health, and civic factors associated with them. Using data from Wave 11 (2023-2024) of the nationally representative English Longitudinal Study of Ageing, we analysed responses from 6,572 individuals aged 50 and older. Latent class analysis was employed to identify typologies of ACCR based on six climate-related statements. Multinomial logistic regression was used to examine associations between class membership and individual characteristics. Five distinct ACCR profiles were identified: "Highly engaged with climate change risk" (30.3%), "Engaged with CCR" (31.3%), "Risk-aware but fatalistic" (11.1%), "Ambivalent/uncertain about CCR" (21.5%), and "CCR dismissive" (5.8%). Younger age, higher education, greater financial resources, and higher levels of public engagement were associated with a higher likelihood of being "Highly engaged" about climate change. Conversely, lower education, economic hardship, and lack of civic engagement were linked to "ambivalent/uncertain" attitudes. Notably, older adults were more likely to be risk-aware but fatalistic. Contrary to common assumptions, most older adults are engaged with CCR, but there is notable heterogeneity, with ∼27% reporting ambivalent/uncertain, or dismissive views. Inclusive and effective climate policy should recognise this diversity, employing outreach and communication strategies that stress personal relevance and actionable solutions, especially targeting those with ambivalent/uncertain views.

An Interpretive Descriptive Study on Exploring Barriers to, and Facilitators of, Diabetes Self-Management: Perspectives from Dialysis Patients with Diabetes.

Abstract China's iron and steel industry is confronting a major challenge in its low-carbon transition. Despite the necessity of investing in low-carbon technologies, the current financial resources available are insufficient to meet the demands of this transition. Therefore, implementing carbon finance policies is necessary to effectively direct capital toward low-carbon technologies. We constructed an innovative model combining AIM/Enduse and a climate finance model for the iron and steel industry in China. The model identifies the financing needs for the sector's low-carbon transition and examines the support mechanisms associated with various carbon finance policies. Our findings reveal that financing costs represent a substantial portion of total expenses. Concessional financing policies and carbon revenue recycling can substantially lower these costs for low-carbon technologies. Additionally, technological advances are essential for reducing the initial costs of these technologies. In the early stages of decarbonization, initial research and development (R&D) funding yielded far more impactful results than additional investment, necessitating policies such as government innovation grants and carbon revenue recycling that provide interest-free funding to support early research and deployment. In the mature stage, concessional financing policies gradually became the primary funding source. Furthermore, the study highlighted that a combination of policies generated a synergistic effect, outperforming the effects of individual policies.

This article examines, through a systematic literature review, the application of corporate governance practices in small and medium-sized enterprises (SMEs). The investigation focuses on scientific production from the last five years, seeking to understand the inherent limitations of traditional governance models — originally designed to meet the demands of large publicly traded corporations — and to map the adaptation alternatives being developed by the academic community. The research was conducted through a structured search in Scopus, Web of Science, SciELO, and Google Scholar databases, employing qualitative analysis of the selected works. The findings reveal that, although the adoption of formal governance mechanisms in SMEs is still in an embryonic stage, the implementation of adapted practices — notably the promotion of transparency, the establishment of accountability mechanisms, and the constitution of advisory boards — produces significant positive effects. Such practices not only expand the possibilities for raising financial resources but also enhance innovative capacity, strengthen organizational resilience, and increase the competitiveness of these companies. The conclusion points to the absence of a universal governance model applicable to SMEs, making it essential to adopt flexible and gradual approaches that consider the specificities of this business segment: ownership concentration, the lack of distinction between management and ownership, family ties, and resource constraints. Future investigations should prioritize longitudinal studies and behavioral analyses of the actors involved in governance processes.

The purpose of the study was to investigate the functions of the African Court of Justice and Human Rights in advancing and safeguarding human rights, specifically in relation to cases from Mali and Tanzania. The research analyzed literature from thirty-three published sources. The primary findings indicated that the types of cases brought before the court were alleged violations of civil and political rights, as well as economic, social, and cultural rights. The importance of the court lies in its role in arbitration, review, and interpretation of cases. Nevertheless, the court faces challenges related to financial resources, noncompliance, and lack of cooperation. The study also highlighted the necessity for the court to enhance cooperation as a strategy to improve its effectiveness. It concluded that the withdrawal of member states from the Court distances their citizens from the enjoyment of their freedoms, and the advancement of human rights is hindered by the misalignment of domestic laws with regional and international human rights instruments. Furthermore, the study recommends that the Court should bolster collaboration to tackle financial constraints, that nation states should ratify the protocol, and that the Court should be empowered with the authority to detain government officials who violate human rights. Received: 11 February 2026 / Accepted: 27 February 2026 / Published: March 2026

Background: Fingertip injuries, particularly unstable distal phalanx fractures and open mallet-type extensor tendon injuries, impose a significant socioeconomic burden, especially on working-age adults in precarious employment. While internal fixation is often required to preserve alignment and function, the gold standard—Kirschner wire (K-wire) fixation under fluoroscopic guidance—is frequently inaccessible in emergency settings or for patients with limited financial resources. Methods: We present two patients presenting to the emergency department with unstable distal phalanx injuries. In the absence of intraoperative fluoroscopy and orthopedic power drills, stabilization was achieved using standard sterile hypodermic needles (18–21 gauge) as intramedullary or transarticular fixation devices. Results: Successful immediate stabilization was achieved in both cases. The needle fixation technique effectively reduced fracture displacement and, in the tendon injury case, restored the continuity of the extensor mechanism. At the final follow-up, all patients demonstrated maintained alignment and clinical fracture union. Functional outcomes were favorable, with patients regaining a pain-free range of motion at the distal interphalangeal joint and returning to daily manual labor without significant delay. Conclusion: Hypodermic needle osteosynthesis is a safe, accessible, and highly cost-effective technique for damage-control fixation of selected fingertip injuries.

Forest and landscape restoration (FLR) represents a critical nexus of climate change mitigation, biodiversity conservation, and sustainable development. Despite substantial federal investments and commitments, empirical subnational research quantifying the relationships between governance structures, funding mechanisms, and restoration outcomes remains scarce, and integrated implementation frameworks bridging institutional, technical, and socio-economic dimensions are largely absent from the literature. This study presents a mixed-methods analysis of FLR implementation gaps across Maryland, Virginia, and West Virginia. Three Mid-Atlantic Appalachian states selected for their contrasting ecological conditions, governance structures, and restoration trajectories that collectively represent the heterogeneity of subnational restoration challenges. We examined 147 restoration projects (2019–2024), conducted 25 stakeholder interviews, and analyzed federal funding allocations ($428 million) through spatial and temporal frameworks. Our findings reveal five critical implementation barriers: (1) policy incoherence across federal–state–local jurisdictions creating 34% project delays; (2) chronic underfunding with 63% of projects receiving less than 60% of planned budgets; (3) technical capacity deficits affecting 71% of rural communities; (4) inadequate stakeholder engagement mechanisms reducing project sustainability by 45%; and (5) insufficient monitoring frameworks limiting adaptive management. We introduce an Integrated Restoration Implementation Framework (IRIF) that uniquely integrates policy coordination, sustainable financing, technical capacity building, and community engagement within a unified adaptive management cycle, operationalized through empirically derived thresholds, to guide evidence-based interventions. Quantitative analyses demonstrate that multi-stakeholder governance models increase restoration success rates by 2.3-fold (p < 0.001), while integrated funding mechanisms improve long-term sustainability by 67%. Theoretically, this study advances socio-ecological systems scholarship by providing empirical evidence that multi-scalar governance configurations and integrated stakeholder engagement mechanisms are principal determinants of restoration success, advancing the evidence base for adaptive governance approaches in complex federal systems. Our findings provide actionable intelligence for policymakers and practitioners, while underscoring that sustainable FLR in complex federal systems depends on coherent multi-level governance architectures coordinating institutional mandates, financial resources, technical capacity, and community agency across jurisdictional scales.

ABSTRACT Background This study aimed to validate the French version of the Well-being in Pregnancy (WiP) scale, a 12-item instrument assessing three dimensions of well-being during pregnancy: positive pregnancy, concerns over support after birth, and confidence in motherhood. Method A sample of 299 pregnant women (second and third trimesters) in the French-speaking part of Switzerland completed an online survey. Results Confirmatory factor analysis supported the original three-factor structure of the WiP and showed good internal consistency. Differences in the WiP scores were found according to women’s employment status, financial resources, pregnancy trimester, pregnancy complications, parity, and previous childbirth complications. However, given the nature of the data, measurement invariance could not be examined and group comparisons should be interpreted with caution. The WiP scores were positively correlated with life satisfaction, positive affect, and negatively correlated with negative affect, anxiety and depression symptoms. Conclusion The French WiP is a valid tool for assessing well-being during pregnancy and represents a valuable resource for both research and antenatal care.

ABSTRACT This article examines how social class and gender intersect to shape educational experiences and aspirations of Chinese international postgraduate students’ in the UK. Drawing on qualitative longitudinal research with 25 Chinese taught postgraduate students, the study explores how family socio-economic background structures access to financial, cultural and social resources over one academic year. Using the concepts of ‘privileged dependence’ and ‘precarious autonomy’, the findings demonstrate that middle-class students benefit from sustained parental support, whereases working-class students experience autonomy as economically constrained and risk-laden. Beyond the influence of social class, these dynamics are also shaped intersectionally by sociocultural expectations around gender. The study thus conceptualises ‘privileged dependence’ and ‘precarious autonomy’ as dynamic ‘classed’ and ‘gendered’ processes, contributing to intersectional research on international student mobility.