Physician Perspectives on Diagnostic Uncertainty in Radiographic Imaging Reports for Pulmonary Embolism: A Qualitative Study.

Inter-centre heterogeneity, temporal evolution, and factors associated with treatment selection and outcomes in chronic inflammatory demyelinating polyradiculoneuropathy: a multicentre, combined prospective and retrospective observational study.

Science and Social Studies (IPAS) learning in elementary schools still faces challenges in strengthening students’ scientific literacy and critical thinking skills because the learning process tends to be textual, less contextual, and has not optimally integrated local culture and digital technology. This study aims to develop an ethnoscience-based digital student worksheet (LKPD) that is valid, practical, and effective in improving elementary school students’ scientific literacy and critical thinking skills. The research employed a Research and Development (R&D) method using the ADDIE model, which consists of analysis, design, development, implementation, and evaluation stages. The research subjects involved 28 elementary school students. Data were collected through observation, interviews, questionnaires, tests, and documentation, and then analyzed using descriptive statistics and the N-gain test. The results showed that the ethnoscience-based digital LKPD obtained an average validation score of 91.1%, categorized as highly valid. The implementation of the product demonstrated an improvement in scientific literacy with an N-gain score of 0.71 and critical thinking skills with an N-gain score of 0.69. The integration of local culture, interactive multimedia, and project-based learning proved to enhance students’ engagement, scientific reasoning, and problem-solving abilities. These findings confirm that the ethnoscience-based digital LKPD is effective in supporting contextual IPAS learning and 21st-century learning in elementary schools.

This study examines how Ruma Bolon-based IPAS instruction can strengthen elementary students' critical thinking skills while sustaining Toba Batak cultural values as learning resources. Using an explanatory mixed-methods design, the study involved 30 fourth-grade students in Medan Helvetia District. Quantitative data were gathered through a validated critical-thinking test, supported by interviews, classroom observations, questionnaires, and documentation. Instrument validation showed strong content validity (CVI = 0.91), valid item coefficients (0.42-0.81), and high reliability for the critical-thinking test (Cronbach's alpha = 0.88) and student perception questionnaire (Cronbach's alpha = 0.86). The quantitative findings showed increases in analytical skills from 40% to 70%, synthesis skills from 50% to 75%, and evaluation skills from 60% to 80%; the average score rose from approximately 65% to 85%. A paired-sample t-test confirmed the improvement, t(29) = 16.84, p < 0.001, with a large effect size (Cohen's d = 1.92) and a normalized gain of approximately 0.60. Qualitative findings indicated that Ruma Bolon symbols, spatial organization, and values such as cooperation and social harmony helped students relate IPAS concepts to familiar cultural experiences. The integration of local culture made classroom discussion, project work, and evaluation tasks more meaningful. These findings suggest that culturally grounded IPAS instruction can support critical thinking, creativity, and cultural appreciation when it is designed through clear learning indicators and valid assessment procedures.

The focus of this study is to identify various potential tourist attractions in Tidore Islands City as part of efforts to implement regional tourism development. This study uses a qualitative method with a descriptive approach. The data collection techniques used include document analysis, interviews, and observation. The data analysis technique employed is an interactive model comprising the stages of word condensation, data presentation, and conclusion/verification. The results of the study indicate that Tidore Islands City possesses a wealth of diverse and abundant tourism potential and attractions. The sources of Tidore Islands City’s tourism potential are: first, its status as an archipelago. It is this archipelagic nature that has endowed Tidore Islands City with a wealth of natural resources, including natural tourist attractions; second, the city’s current existence is a legacy of the historical civilization of the Islamic Sultanate Kingdom from the past. Consequently, this has enriched the city’s historical tourism sites, as well as its local arts and culture. Third, Tidore Islands City was one of the regions colonized during the colonial era, leaving behind various historical relics. These historical relics further enrich the historical tourism sites in the area.

Neurosurgical workforce inequities remain a major barrier to timely access to essential neurosurgical care in low- and middle-income countries (LMICs). Because workforce capacity depends not only on the number of trainees but also on the quality, geographic distribution, and sustainability of training systems, neurosurgical training is a critical determinant of global neurosurgical equity. We aimed to synthesize the principal barriers and scalable solutions in neurosurgical training across LMICs and to illustrate these patterns through a national case study of adult neurosurgery residency positions in Peru. We conducted a structured narrative review of the literature on neurosurgical training in LMICs, focusing on historical development, residency training, mentorship, digital education, simulation, and international collaboration. In parallel, we performed a descriptive national case study of adult neurosurgery residency positions available in Peru in 2025, assessing their geographic and institutional distribution. Across the reviewed literature and the Peruvian national case study, barriers to neurosurgical training appeared to be predominantly related to structural and institutional factors, including geographic centralization, limited educational infrastructure, inconsistent subspecialty exposure, financial constraints, and unequal access to mentorship. This does not exclude the role of individual motivation or institutional culture, but suggests that trainee interest alone is insufficient to overcome system-level barriers. Promising scalable strategies included competency-based curricula, structured virtual learning, low-cost simulation models, and partnership frameworks centered on local capacity-building. In Peru, 31 adult neurosurgery residency positions were identified across 20 hospitals in 7 regions, with marked concentration in Lima and repeated clustering within a small number of high-complexity referral institutions. This distribution reflects a centralized training model with limited regional expansion. Neurosurgical training inequities in LMICs appear to be strongly shaped by the structural concentration of training capacity, although local institutional culture, trainee motivation, and national policy contexts may also influence access to high-quality training. Expanding the neurosurgical workforce will require coordinated national planning, investment in regional training hubs, and sustainable educational partnerships that strengthen local ownership and workforce sustainability.

ABSTRACT Research shows the use of trees by farmers in agroforestry systems improves household nutrition consistent with local culture and food traditions. Additionally, it enhances climate change adaptation while contributing to environmentally friendly agricultural products. Nonetheless, some scientists argue that trees reduce soil moisture content in agricultural settings and that associated water demand could effectively compete with crops over limited available moisture. This research explored these competing claims in the context of Burkina Faso through the lens of farmer managed natural regeneration (FMNR). To assess FMNR’s impacts on soil moisture, a citizen science approach was used to collect soil matric potential data and measure crop yield near and away from trees using the crop-cutting technique. Results demonstrate that FMNR increases soil water availability and crop yield. Trees significantly increased soil moisture throughout the growing season, and crop yields were consistently higher in the canopy zone compared to outside it. These findings highlight FMNR as a sustainable strategy for managing water resources and boosting agricultural productivity. Beyond improving resilience to climate variability, FMNR contributes to addressing food insecurity and water scarcity in Burkina Faso, underscoring its importance as a nature-based solution for sustainable development.

ABSTRACT Culinary traditions play a vital role in shaping and preserving the cultural heritage of local communities. This study explores the influence of culinary education and public awareness on social norms, with local people's culinary culture as a mediator variable, specifically within the context of rural tourism in Guizhou, China. An exploratory mixed-method approach was adopted to address the research questions. 959 participants completed questionnaires, and structural equation modelling (SEM) was employed to test the research hypotheses. Furthermore, in-depth interviews were conducted with 10 selected participants to further validate the quantitative findings. The results demonstrate that culinary education significantly enhances public awareness and contributes positively to the development of local culinary culture. Local people's culinary culture positively benefited from both culinary education and public awareness. Although the culinary culture of local people does not significantly impact tourists’ social norms, both culinary education and public awareness have a strong and direct influence on these norms, as well as an indirect effect through the medium of culinary culture. Furthermore, the findings emphasize the necessity of strengthening educational programmes and conducting awareness campaigns centred on local culture to reinforce positive social norms and support sustainable rural tourism development.

ABSTRACT This study analyses how renewable energy transitions, intertwined with rural revitalisation, evolved into energy tourism at a hot spring (onsen) tourism destination in rural Japan, where onsen water has long been part of local culture and everyday life. Using social practice theory, the study demonstrates how geothermal energy was integrated into tourism not by introducing disruptive new infrastructure but by building on traditional onsen practices, such as bathing, snow melting, and building heating. Our results reveal that traditional onsen practices were reinterpreted as sustainability initiatives and assembled into a coherent form of geothermal energy tourism. This process enabled the onsen village to link renewable energy transitions to rural revitalisation through destination branding, while preserving local culture and livelihoods. The study advances tourism planning by illustrating how renewable energy transitions and rural revitalisation can emerge through continuity and adaptation within long-standing, locally embedded tourism practices, leading to a form of energy tourism.

Rural communities face poor health outcomes due to limited health care access and provider shortages. Physical therapists are increasingly recognized as potential contributors to primary care delivery, yet little is known about their actual roles in rural settings. The objective of this study was to explore the unique professional experiences of physical therapists in the rural Upper Midwest. A qualitative, exploratory case study design was used. Data was collected through semi-structured interviews and field observations. Analysis included inductive, in-vivo coding methods and thematic analysis guided by the Culturally Sustaining Pedagogy theoretical framework. This study was situated in 5 communities in a rural, Upper Midwest state. Five physical therapists with over 4.5 years of rural clinical experience were included in this study. Four key themes and associated subthemes were derived regarding the role of rural physical therapists: (1) operating as a primary care provider: physical therapists filled primary care roles through rurality-imposed autonomy, health care coordination, and health education; (2) employing a wide breadth of practice: therapists required broad generalist knowledge across practice settings; (3) patient-centeredness: patient-centered care involved fostering cultural norms and decentering of the therapist's own values; and (4) Community integration: Community engagement beyond their role as a physical therapist and understanding local culture were crucial for community acceptance and providing appropriate care. Physical therapists in rural communities in an Upper Midwest state are fulfilling expanded primary care roles to address health care shortages, while deeply integrating within communities to provide appropriate and acceptable care. Their experiences highlight the complexity of rural health care delivery and potential for physical therapists to help alleviate provider shortages. As health care shortages persist in rural areas and the understanding the role of the primary care physical therapist continues to grow, this study shows that physical therapists are uniquely positioned to support primary care delivery.

Scoping reviews are widely used across the health sciences to map evidence, clarify concepts, and identify knowledge gaps. Although protocol development and registration are increasingly encouraged, empirical evidence describing contemporary registration practices remains limited. This study aimed to evaluate current practices in scoping review protocol registration and reporting in high-impact health sciences journals published between 2024 and 2025. We conducted an empirical meta-research study of scoping reviews published in first-quartile journals according to the Journal Citation Reports and indexed in PubMed. Data were extracted independently using a standardized form and included protocol registration status, registry platform, public accessibility, peer-reviewed protocol publication, reported protocol components, and methodological guidance cited. Descriptive analyses were used to assess registration patterns and methodological consistency. Multivariable logistic regression models were fitted to explore factors associated with protocol registration reporting and the presence of a peer-reviewed protocol. Among 2,546 screened records, 1,267 scoping reviews underwent full data extraction. Overall, 549 reviews reported a registered protocol, of which 483 were publicly accessible and included in the analysis. Protocol registration was identified in 43.3% of scoping reviews, while peer-reviewed protocol publication was rare (5.1%). Most protocols were registered on the Open Science Framework (OSF) (n = 478). Protocol content frequently included core methodological elements but also reported additional items beyond those addressed in the JBI Manual for Evidence Synthesis. Although many methodological documents were cited, only two provided explicit guidance for scoping review protocol development. Post hoc analyses identified substantial heterogeneity in protocol registration practices across journals, publishers, and corresponding author countries, suggesting that registration practices are influenced by a combination of editorial policies, local research cultures, and differing methodological perspectives. Protocol registration practices in scoping reviews remain heterogeneous across high-impact health sciences journals. The findings demonstrate substantial variability in protocol content, registration approaches, and use of methodological guidance, while reinforcing ongoing methodological discussions regarding protocol registration and standardization in scoping reviews.

ABSTRACT This study investigates the role of community theatre in raising awareness about poor parenting in Nigeria, focusing on Ikire Community, Osun State. Poor parenting manifesting as neglect, lack of moral guidance, and excessive authoritarianism has been linked to juvenile delinquency, substance abuse, and declining educational outcomes. Through participatory performance and interactive storytelling, community theatre serves as a powerful medium for social education, engagement, and change. This paper examines how theatre practitioners in Ikire employ drama for sensitization and dialogue, highlighting the consequences of inadequate parenting and suggesting alternative child-rearing approaches. By involving community members as both actors and audience, performances mirror societal realities and create platforms for collective reflection. Methodology includes field observation, interviews with parents and children, and performance analysis. Findings reveal that community theatre fosters empathy, promotes parental responsibility, and inspires community-led initiatives for better parenting. The paper concludes that theatre rooted in local culture and values can address deeply embedded social issues. It recommends increased institutional support for community-based theatre and collaborative efforts among educators, cultural workers, and policymakers to maximize its impact, contributing to scholarship on applied theatre as a grassroots development tool in Nigeria.

ABSTRACT As digital streaming became the dominant mode of music consumption, the New Brunswick, New Jersey, music scene of the 1990s served as a pocket of resistance to the decline of vinyl records. This article uses a case study approach to examine how localized practices sustained vinyl culture through community-based production and distribution. Drawing on theories of diffusion of innovation, communities of practice, and the social construction of technology, this article explores how this scene’s attachment to analog formats helped lay the groundwork for vinyl’s cultural persistence and its broader resurgence in the 21st century.

This study explored the lived experiences of Junior High School teachers in Lucena City in integrating cultural mapping outputs and media-based cultural documentation into contextualized instruction. Grounded in the principles of culture-based education and guided by Republic Acts 10533 and 11961, the study sought to address the gap between policy and classroom practice, particularly the limited accessibility and use of local cultural resources in lesson design. Using a qualitative phenomenological design, the research captured teachers’ authentic perspectives, teaching strategies, and reflections as they utilized media-based cultural resources to create culturally responsive lessons. Data were collected through structured in-person and online interviews, supplemented with optional visual documentation, following a systematic and ethical process including institutional clearances and participant consent. Findings revealed that teachers accessed cultural materials through various sources such as online platforms, community narratives, and personal research, although formally documented resources specific to Lucena City remained limited. Teachers utilized these materials by integrating local examples, storytelling, multimedia resources, and culturally relevant discussions to contextualize lessons and enhance students’ understanding of academic content. However, participants also reported challenges including limited documentation of local cultural resources, difficulty validating information from digital sources, and the additional time required to locate and adapt cultural materials for classroom use. Despite these challenges, teachers observed positive outcomes, including increased student engagement, active participation, enhanced creativity in learning tasks, and improved awareness and appreciation of local culture. The findings highlight the potential of media-based cultural documentation and cultural mapping outputs as valuable resources for promoting contextualized and culturally responsive teaching practices in public secondary schools.

Health literacy is an established determinant of health and a key tool in the development of public health interventions. It plays an important role in improving the health and equity of individuals and populations. The Health Literacy Questionnaire (HLQ) is a widely used multidimensional instrument designed to assess various domains of health literacy across diverse populations. However, no culturally and linguistically adapted version of the HLQ is currently available for the Moroccan context, where Moroccan Arabic (Darija) is the primary language of everyday communication, including interactions with healthcare professionals. Therefore, the objective of this study was to carry out the socio-cultural and linguistic adaptation of the HLQ into Darija. The HLQ was culturally and linguistically adapted for Morocco through a collaborative process with the HLQ developers, community members, healthcare professionals, and the project team from the Higher Institute of Health Sciences (ISSS). Forward and backward translation and cognitive interviews with 28 primary healthcare users recruited from two Moroccan provinces (Kenitra and Settat) maximized that each item reflected its intended meaning. Data were analyzed using thematic analysis to refine the adapted version for the Moroccan context. The 28 participants (71.4% women) were aged 18 to 70, with diverse educational backgrounds and resided in both urban and rural areas. Of the 44 translated items, 19 (43%) required further linguistic or cultural adaptation for Darija speakers (Moroccan Arabic dialect). Participants generally understood and responded to the items per each item's intent, but qualitative analysis highlighted important nuances. A marked dependence on medical authority appeared to limit participants' ability to manage their own health and was associated with persistent difficulties navigating the healthcare system and critically appraising health information. In contrast, items related to social support were more readily understood, highlighting the central role of family networks. Collectively, these findings underscore the interplay between cultural norms and structural barriers in shaping perceptions of health literacy in Morocco. The cognitive and cultural adaptation of the HLQ into Moroccan Darija supported the relevance of the nine scales and provided insight into locally grounded conceptions of health. This process highlights the importance of a participatory and context-sensitive approach to achieving conceptual fidelity and cultural appropriateness. However, it should be emphasized that this study represents an initial yet essential step in the overall validation process. While the adapted Darija version of the HLQ cannot yet be considered a fully validated instrument for use in the general population, it provides a robust foundation for subsequent psychometric evaluation. Further research is required to evaluate its psychometric properties, including internal structure and reliability, to determine its suitability for assessing health literacy in the Moroccan context. This study is important because health literacy development is critical to helping individuals and populations access and use health information and services to manage their health. The first step in measuring health literacy is to adapt tools to local languages and cultures. The study focuses on adapting the Health Literacy Questionnaire (HLQ) to the Darija language (Moroccan Arabic dialect) so that the health literacy needs of people in primary healthcare settings in Morocco can be assessed. The methods used in the study helped ensure that the Darija HLQ is relevant and understandable in the Moroccan context. The study found that the Darija HLQ was well understood by most users, though some with lower education levels found certain questions unclear. This means that the tool is adequate for use in Morocco, but further refinement may be needed for certain groups. The questionnaire was translated and adapted through a collaborative translation process to maximize its cultural and linguistic appropriateness for Moroccan users.

Forensic statements produced by forensic pathologists in murder and attempted murder cases must communicate complex medical assessments to diverse audiences, such as forensic pathologists, but also to groups who are not medical experts such as police, lawyers, judges, jury members and lay judges. This article examines how forensic pathologists navigate the communicative tensions that arise when their written statements must address audiences with widely differing levels of medical knowledge and genre familiarity. Through a qualitative study design, the study explores the perspectives and priorities that shape the linguistic choices in these statements. Two focus groups with a total of ten forensic pathologists were conducted, and data were analysed using thematic analysis. Six key themes were identified: 1) The internal target group, where statements are primarily written to the forensic pathologist themselves or other forensic pathologists; 2) The balancing act between precision and comprehensibility; 3) Objectivity as a decisive factor in linguistic choices; 4) The role of tradition and the local linguistic culture; 5) Authority and how this is constructed through language; and 6) The difficulties of assessing the lay audience’s understanding. The study shows how forensic pathologists navigate the tension between expert precision and lay comprehensibility. While the internal target group is prioritized, efforts are made to accommodate lay understanding—though often constrained by institutional language traditions, perceptions of authority, and a rhetorical preference for objectivity. The findings suggest a strong linguistic culture and highlight challenges related to the “curse of expertise”.

Recent multicenter studies have explored the current and desired clinical work for acute care surgeons. Acute care surgeons oversee and provide comprehensive care in trauma, surgical critical care, emergency general surgery, and burn patients. While these studies provide crucial data to guide planning at individual institutions to help address understaffed programs, translating this research into local practice and culture requires nuance and consideration of system (regional, institutional, department, and divisional) factors and individual surgeon goals. This opinion piece confronts the paradox at the heart of academic acute care surgery: how can surgeons deliver on educational and research missions when staffing models place the highest prioritization on clinical work? We present a practical, evidence-based framework that aligns sustainable clinical staffing with preservation of the tripartite academic mission in acute care surgery. Level V.

This community service activity aims to enhance the visibility and attractiveness of Pencak Silat Walet through the use of a Google Sites–based digital profile as a promotional medium. In the digital era, online platforms play an important role in introducing and preserving local culture, including traditional martial arts such as pencak silat. The main problem identified is the limited use of effective and modern promotional media, resulting in low public awareness of Pencak Silat Walet. To address this issue, a digital profile was developed using Google Sites, accompanied by training for members and administrators. The implementation method included needs analysis, content design, website development, and training sessions. The website content consists of organizational profiles, history, activities, documentation, and membership registration information. The results of this activity indicate that the digital profile serves as an effective promotional tool, improves participants’ digital literacy, and increases public interest in Pencak Silat Walet. Therefore, this initiative not only supports promotional activities but also contributes to the preservation of local culture through the use of digital technology

This study aims to develop a sustainable entrepreneurship model in the creative industry in Mataram City through a grounded theory approach based on the Triple Bottom Line (TBL), which encompasses the aspects of profit, people, and planet. The study employed a qualitative method with a grounded theory approach to explore in depth the experiences, strategies, and sustainability practices implemented by creative industry entrepreneurs. The research informants consisted of creative business actors in the culinary, handicraft, fashion, and digital industries selected using purposive sampling techniques. Data were collected through in-depth interviews, observations, and documentation. Data analysis was conducted through the stages of open coding, axial coding, and selective coding. The findings reveal that the sustainable entrepreneurship model in the creative industry in Mataram City is built through the integration of three main dimensions. The economic dimension is reflected through product innovation, digital adaptation, and the strengthening of market networks. The social dimension is manifested through the empowerment of local workers, community collaboration, and the preservation of local culture. Meanwhile, the environmental dimension is implemented through the use of environmentally friendly materials, reduction of production waste, and resource efficiency. This study produces a conceptual model of sustainable entrepreneurship that positions innovation and local values as the core foundations of sustainability in the creative industry business

A Capacity-Building, Multisite, Quality Improvement Project Aimed at Respectful Maternity Care.