Indigenous peoples experience significant health inequities compared to non-Indigenous peoples. The reasons for this are multi-faceted. Access to healthcare for marginalised Indigenous peoples is made more difficult by living rurally; urban counterparts have improved healthcare access and health outcomes. This review aimed to further understand the healthcare experiences of rural Indigenous peoples residing in New Zealand (Aotearoa), Australia, Canada or the United States of America (USA). Participants were required to self-identify as Indigenous consumers of healthcare aged 18 years or older, with personal or family experiences of receiving healthcare. Contextually, rural healthcare service access in any healthcare setting was chosen. The countries chosen for inclusion were New Zealand, Australia, Canada, and the USA. Exclusion criteria included studies with non-Indigenous participants with healthcare experiences that were unable to be isolated and extracted, as well as studies involving both rural and urban healthcare experiences where the urban experiences were unable to be isolated and removed. The electronic databases Scopus (Elsevier), CINAHL Complete (EBSCOhost) and Medline (OVID) were searched. Articles were screened by one author (TC) to identify primary research studies that reported patient lived experiences and included Indigenous participants who live rurally. Searches were completed in June 2024 and limited to full text, English language and date limited to 2004-2024. Articles were then analysed via thematic analysis. Seven articles were analysed. The articles were located in Aotearoa, Australia, and Canada. No suitable studies from the USA were identified or included. Five themes were identified as having impacted the healthcare experiences of Indigenous peoples: distance to care; quality of care and racism; support from and impact on, whānau (family); health professional communication and knowledge sharing; and Indigenous solutions and holistic care. Ensuring that patient-centred care also involves wider family members has been shown to be beneficial, as has the engagement of Indigenous health professionals and health workers in providing culturally inclusive healthcare. Health professionals should consider language and communication techniques when engaging with people seeking healthcare and not make assumptions, for example around health knowledge.

Pedagogy first, technology second: Cross-level relationships between teacher professional knowledge and student learning in artificial intelligence (AI) education

Occupational therapists engage in continuing professional development (CPD) through various means, including workplace experiences. Workplace discussions between peers can promote reflection and foster learning. However, the specific contribution of peer support in occupational therapists' CPD remains underexplored. This study aimed to explore the role of peer support in clinical occupational therapists' CPD. A constructivist grounded theory approach was employed to develop an explanatory, substantive theory of the peer support process among occupational therapists working in clinical settings. Participants were occupational therapists who had received or provided peer support within the past 2 years. Semi-structured interviews lasting approximately 60 minutes were conducted. Qualitative data were analysed using a constant comparative method involving initial, focussed, and theoretical coding. There is no consumer or community involvement. The 15 occupational therapists recruited had either only received (n = 4) or both offered and received (n = 11) peer support. Clinical reasoning, emotional support, professional growth, and career trajectories all acted as triggers for engaging in peer support. Analysis of participants' interview data informed the conceptualisation of peer support as an ongoing, non-linear process shaped by three interrelated sets of conditions: (1) mobilisation (timely access, being grounded in practice, and access to relevant peer expertise), (2) interaction (navigating hierarchy, feeling safe, and dialogical conditions), and (3) practice context (workplace culture and protected time). Engagement in peer support was associated with a range of CPD-related outcomes, including broadening perspective, embracing risk-taking and practice-based experimentation, building self-efficacy, and transferring professional knowledge. The theory explains how the process of peer support contributes to multiple effects of CPD and fosters transformative learning at individual and organisational levels.

This study investigates the divergent performance outcomes of two digital health business models in the clear aligner market. It contributes to the healthcare performance management literature by proposing the Business Model-Institutional Strategy (BM-IS) Fit framework, explaining how a firm's approach to knowledge integration and value creation determines its success. This study employs a qualitative-dominant mixed-methods approach. The core analysis is a longitudinal comparative case study (2014-2023) of SmileDirectClub (SDC) and Align Technology, supplemented by an exploratory consumer survey (N=277) and illustrative professional interviews (N=5). A firm's business model dictates its approach to knowledge integration. Align's platform model integrated professional knowledge, creating a cooperative strategy that built an "institutional moat" and generated ecosystem-wide value. In contrast, SDC's pipeline model disintegrated professional knowledge from the care process, creating a "trust vacuum" that destroyed value and led to performance failure, despite apparent cost advantages. Survey evidence from a naive market and professional interviews further show that models lacking direct clinical oversight face structural resistance and struggle to cross the legitimacy threshold in high-trust healthcare systems. The paper's primary contribution is the BM-IS Fit framework, which reconceptualizes business model fit as a challenge of knowledge integration across institutional boundaries. It offers the "legitimacy threshold" as a critical, non-financial performance metric for digital health. It also provides a new lens for managing digital health ventures by linking the removal of trusted intermediaries to value destruction and performance failure.

The provision of aid services in the context of disasters can also give rise to a range of physical and psychological issues among healthcare professionals. Such circumstances have the potential to negatively impact both their well-being and professional performance. However, their difficulty in expressing all of their experiences makes it difficult to understand this situation in depth. This study aims to explore in depth the experiences and mental challenges faced by Turkish health professionals during the Libyan flood disaster. This was a qualitative study involving 10 health workers who had been involved in disaster response following the floods. The flood occurred on 10 September 2023. Data were collected between March and August 2024 through semi-structured interviews conducted either online or face-to-face in the participants' homes. This timeframe enabled participants to articulate both their immediate reactions to the disaster and its longer-term effects on their personal and professional lives. An interpretive phenomenological approach was employed using Colaizzi's phenomenological analysis technique. The analysis revealed four principal themes. First, healthcare professionals emphasised the essential knowledge and skills required to provide effective care and treatment in the context of the flood. Second, they reported substantial physical challenges in the disaster zone, such as limited resources and disrupted infrastructure. Third, they described the profound mental challenges they faced, including stress, fear and emotional exhaustion. Finally, participants highlighted various coping strategies they employed to manage these difficulties and sustain their professional performance. The study revealed that Turkish healthcare professionals who volunteered after the floods in Libya experienced not only physical challenges such as lack of resources, infrastructure problems and security concerns, but also psychological challenges such as secondary trauma and burnout. Furthermore, it was observed that not only professional knowledge and skills but also the capacity to cope with traumatic experiences are decisive in the effectiveness of disaster response processes. The study underscores the necessity for the implementation of psychosocial support and training programmes for professionals, with the objective of accelerating both individual and societal recovery processes following disasters.

This study aimed to validate the Portuguese version of the Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale to assess knowledge of radiation protection among healthcare workers exposed to ionizing radiation. The increasing use of radiation in medicine raises concerns about potential side effects, not only for patients but also for professionals operating the equipment. Appropriate and well-constructed instruments are essential to generate structured and interpretable findings and quantifiable outcomes that support improvements in knowledge, attitudes, and practices.&#xD;Methods: A descriptive correlational cross-sectional study was conducted electronically using a Google Forms survey between March 2025 and July 2025. Participants included nurses, doctors, dentists, and radiographers who use a personal dosimeter. The Portuguese version of the HPKRP was developed using translation and back-translation procedures, followed by statistical validation. Internal consistency, item-total correlations, and regression analyses were performed using IBM SPSS (version 30).&#xD;Results: A total of 247 valid responses were analysed. The scale demonstrated very high internal consistency (Cronbach's alpha = 0.983). Item-total correlations ranged from 0.568 to 0.890, confirming strong internal consistency. Radiographers reported the highest perceived knowledge, while nurses scored lowest. Knowledge gaps were identified particularly in areas related to radiation physics (formulas and units of measurement) and reporting of adverse events. Training in radiation protection was significantly associated with higher scores (p < 0.001).&#xD;Conclusions: The Portuguese version of the HPKRP scale demonstrates high internal consistency and provides preliminary evidence of reliability for assessing healthcare professionals' self-perceived knowledge of radiation protection. However, as a subjective measure, it does not reflect objective knowledge or clinical competence and should be interpreted with caution. The instrument may be useful for identifying perceived knowledge gaps and supporting educational strategies when used in combination with objective assessment methods.&#xD.

The purpose was to study preschool teachers' preferences and experiences of an applied learning intervention to support children with ESSENCE symptoms. Preschool teachers (n = 164) filled out a questionnaire about their experiences, and 20 participated in individual interviews about preferences and experiences of the intervention. We used descriptive statistics for the questionnaire and inductive qualitative content analysis to analyze the interviews and free text answers in the questionnaire. The results showed that 74% experienced that they increased their understanding of the child's difficulties, while 48% gained ideas that could be helpful in managing children. Specifically, the respondents emphasized the value of talking and reflecting together with guardians about a specific child. To share experiences from different contexts provided an understanding of the challenges the child, and the adults around them, faced in daily life. It also provided insight into the child's opportunities, abilities and resources. The qualitative latent analyses revealed that the preschool teachers' expectations corresponded well to their experiences after completing the training. The main categories Collaboration between guardians and preschool teachers and Professional knowledge about children with special needs describes their needs for supporting children with neurodevelopmental symptoms. Together they form the theme of a child-centered approach. In conclusion, the present findings add insights about collaborative learning, application of professional knowledge, and guardians and preschool teachers sharing experiences and reflecting together to support the child. In this way, the study contributes to the improvement and application of Child and Family Centered Care in practice.

Aims To identify current practice, knowledge and beliefs of medical healthcare professionals working in Scotland, related to the link between periodontal disease and diabetes.Methods A cross-sectional observational study was undertaken in 2021 with endocrinology consultants and registrars, general practitioners, diabetes specialist nurses, practice nurses and healthcare assistants involved in the care of people with diabetes across Scotland. Exploratory interviews were used to inform the development of an online self-report questionnaire. In total, 128 medical healthcare professionals completed the questionnaire. Quantitative data were subjected to frequency calculations. Qualitative data were analysed using thematic analysis.Results The questionnaire revealed that most participants did not discuss the link between diabetes and periodontal disease with their patients with diabetes, nor did they refer patients with diabetes to a dentist or inform the dentist of the diagnosis. Participants reported a lack of awareness of the link, insufficient time to discuss this with patients, and unclear referral pathways.Conclusions Results highlight the need to strengthen education and patient communication by raising awareness, developing resources, and improving referral pathways between medicine and dentistry.

IntroductionThe objective of this study was to explore the factors associated with the knowledge, attitudes, and practices (KAP) of orthopedic theatre nurses with regard to occupational protection when orthopedic power tools (OPTs) are used to provide a reference for ensuring the occupational safety of nurses working in orthopedic surgery rooms.MethodsThis cross-sectional survey involved 272 orthopedic theatre nurses across eight tertiary hospitals in Shanxi Province, China, between September and December 2024. An occupational protection assessment tool that was self-developed and included 3 dimensions (Knowledge, Attitude, and Practice), containing a total of 45 items, was utilized among operating theatre nurses with OPTs.ResultsThe median as the cutoff, 52.9% (144/272) of respondents had an adequate Knowledge score, while 47.1% (128/272) had a good score; 54.0% (147/272) of the respondents had a positive Attitude score, and 46.0% (125/272) had a negative attitude; 53.7% (146/272) of the participants demonstrated good performance in the Practice score, whereas 46.3% (126/272) showed poor performance. Multivariable regression analysis revealed that the knowledge scores of those with a bachelor’s degree (aOR=7.040; 95% CI: 3.204–15.466; p < 0.001), senior professional title (aOR=5.216; 95% CI: 1.228–22.155; p = 0.025), occupational protection training frequency less than 6 months (aOR=10.085; 95% CI: 4.146–24.533; p < 0.001) or 6–12 months (aOR=6.550; 95% CI: 3.262–13.153; p < 0.001) and actively consulting the latest professional protection knowledge (aOR=2.652; 95% CI: 1.426–4.931; p = 0.002) were higher and statistically significant. Senior title (aOR=5.226; 95% CI: 1.409–19.387; p = 0.013), occupational exposure (aOR=2.770; 95% CI: 1.484–5.169; p = 0.001) and Knowledge scores (aOR=2.663; 95% CI: 1.581–4,448; p < 0.001) yielded attitude scores that were higher and statistically significant. Attitude scores (aOR=3.683; 95% CI: 2.106–6.441; p < 0.001), actively consulting the latest professional protection knowledge (aOR=2.962; 95% CI: 1.686–5.201; p = 0.001), and higher Knowledge scores (aOR=2.255; 95% CI: 1.294–3.930; p = 0.004) were independently associated with better practice scores.ConclusionNurses in the orthopedic operating room had a positive attitude toward the occupational protection of using power tools, but their knowledge was insufficient, and their practice behavior was poor. Normative guidelines for occupational protection in the workplace of an orthopedic theatre and a training and evaluation system should be developed. Moreover, future measures should focus on education and training for occupational protection. Additionally, developing and designing occupational protective equipment that is more convenient for orthopedic surgery is important.Reporting methodThis research was designed as a cross-sectional survey study that was conducted in strict accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

ABSTRACT This paper seeks to contribute to unpacking the nuances of the concept of authorised heritage discourse by exploring the different, and even hierarchical, roles of different authorities and what authorises their heritage discourses. I look into a regeneration project in Anyang, a northern Chinese city where only the local state’s discourse was mostly realised, whereas heritage professionals’ discourse was relatively invisible. The immediate reason is that this project was initiated by the local state to pursue its economic and political agenda. The fundamental reason why the local state could ignore the heritage professionals, as I argue, lies in the fact that heritage professionals were only ‘authorised’ due to their cultural authority derived from professional knowledge, yet they did not possess political authority. Political authority derived from political power resided within the local state, which could largely and even solely determine how the project would be implemented. This finding first calls for further reflection on heritage professionals’ role regarding whether they are barriers to or facilitators of democratising heritage. Second, I highlight the importance of situating heritage projects into the political context and deeply understanding where political power comes from and how it operates to expand the investigation of heritage politics.

Simulation is a key teaching tool for preparing medical students for clinical practice. Combining team-based learning with sequential simulation enhances problem-solving skills. The Clinical Learning through Extended Immersion in Medical Simulation (CLEIMS), a week-long program integrating simulated interprofessional education, has shown promising results at Griffith University. However, its application outside Australia remains largely unexamined. This study herein evaluates the feasibility of a modified 'CLEIMS' (mCLEIMS), condensed into a 2-day course, for second-year clinical clerkship (SY-CC) students. We analyze preliminary results, learners' perceptions, and learning efficiency through Advanced Cardiac Life Support (ACLS) certification. This prospective, non-randomized controlled observational study enrolled 108 SY-CC students across three sessions (36 per session) from August to November 2020. All participants completed the 2-day mCLEIMS program, which included simulated patient assessment, on-call modules, handoff/briefing, suturing, interprofessional ward rounds, and high-fidelity ACLS training for cardiac arrest. Afterward, they completed a questionnaire assessing satisfaction, learning perception, and core competencies. All SY-CC students, including those in mCLEIMS, underwent ACLS training and exams before January 2021. Questionnaire and ACLS exam results were analyzed using appropriate statistical tests, with statistical significance set at a two-sided p value < 0.05. Open-ended responses were analyzed using thematic analysis, in which recurring concepts were coded and grouped into major themes through investigator discussion and consensus. The questionnaire response rate was 99.1% (n = 107), with a global satisfaction score of 4.93 (5-point Likert scale). Most participants reported gaining competencies in interprofessional education (87.0%), communication and clinical needs (84.1%), teamwork and empathy (84.1%), and professional knowledge and skills (76.6%). Open-ended responses highlighted mCLEIMS' role in providing real-world medical experience (51.5%), particularly through simulation patients (32.0%) and interprofessional education (20.6%). ACLS pass rates were higher for mCLEIMS participants (96.8% vs. 84.7%, p = 0.012), who also scored better on the exam (83.1 ± 7.4 vs. 76.8 ± 18.1, p = 0.007). Our experience suggests that mCLEIMS is a practical teaching tool for SY-CC students, integrating team-based sequential simulation to enhance learning perception and ACLS skill retention before clinical practice.

Acquired brain injuries (ABI) cause cognitive impairments that significantly affect occupational performance and quality of life. Despite their prevalence in the Middle East, ABIs are underexplored in Lebanon, particularly in terms of cognitive assessment and rehabilitation. This study provides the first insights from Lebanon and the Arab region into Lebanese healthcare professionals' knowledge, attitudes, and practices (KAP) regarding cognitive impairments following ABI. A cross-sectional study was conducted in Lebanon between January and April 2025 using a self-administered online questionnaire assessing KAP. The sample included 61 healthcare professionals actively working with adults with ABI. Participants demonstrated an overall level of knowledge (mean score: 72.76%). Attitudes were favorable toward continuing education, cultural adaptation of assessment tools, and combining standardized and non-standardized methods. Key barriers included limited specialized training, absence of locally validated tools, and insufficient context-adapted resources. Professional practices align with international recommendations; however, gaps remain in training and the availability of context-specific resources. These findings highlight the need for targeted training, culturally adapted tools, and structured clinical guidance to improve practice and inform policy.

Pharmacists in Chinese public hospitals face multiple challenges, including a rapidly increasing workload and a severe human resource shortage, driven by the continuous advancement of healthcare reform. This study systematically investigated the content and responsibilities of hospital pharmacy work as well as the current state of workload and human resource allocation in pharmacy departments, and then analyzed the challenges and optimization strategies. A work list of pharmacy departments in public hospitals was developed for the investigation and then a structured questionnaire was designed based on the work list. A survey was conducted to collect and analyze the data on various duties within the pharmacy departments of 22 representative tertiary and secondary public hospitals covering all 7 regions of China. A work list for pharmacy departments in public hospitals was compiled. The proportion of pharmacists accounted for only 3.60% of all health technicians in the surveyed public hospitals. Significant disparities in human resource allocation were found between tertiary and secondary hospitals, with their current staffing levels meeting only 40.16% and 25.26% of the actual demand, respectively. Pharmacy departments in public hospitals generally face workload overload, severe human resource shortages, and structural imbalances in personnel, which in turn severely limit the application of pharmacists' professional knowledge and hinder the quality improvement of clinical pharmacy services, ultimately restricting the patient-centered transition of pharmaceutical care. Therefore, it is urgently recommended to refine the corresponding mechanisms for pharmaceutical human resource allocation and value compensation.

Association of microplastic pollution with coral resilience in the presence of sea surface temperature anomalies.

With the gradual enrichment of knowledge types in animal husbandry, the importance of multi-modal knowledge graphs (MMKG) in the field of intelligent diagnosis of animal diseases has become increasingly prominent. However, the construction of multi-modal knowledge graph faces challenges such as lack of professional knowledge, scarcity of multi-modal data and insufficient labeled samples. This paper proposes a construction method of sheep disease multi-modal knowledge graph, which includes three core steps. Firstly, a text knowledge graph is constructed according to the RoBERTa + BiLSTM + CRF sequence labeling model, which provides a framework for multi-modal knowledge alignment; Secondly, the vision-language pre-training two-stream model is introduced and a LoRA fine-tuning method with Bayesian optimization for domain adaptation is used to realize cross-modal representation learning; Finally, the GraphXR tool and the rules proposed by this method were used to realize multi-modal knowledge alignment, storage and visualization. Based on the ViT visual model series, this study carried out experiments on the self-built sheep disease dataset and the public dataset EuroSAT, the image-text matching accuracy reached 81.82% and 93.11%, respectively, which were 40.91% and 38.04% higher than those before fine-tuning. The experimental results show that the method of constructing multi-modal knowledge graph of sheep disease by fusing pre-trained model fine-tuning has significant advantages. This method can significantly improve the model efficiency and generalization ability under the condition of small sample in the vertical field, enhance the semantic representation ability of sheep disease, and provide effective technical support and knowledge basis for the realization of applications like intelligent diagnosis of sheep disease.

This scoping review includes the qualitative literature published from 2013 to 2024 exploring health, healthcare and quality of life among older Autistic adults. Aims were to identify evidence of later life experiences and outcomes for this population. The review was based on Joanna Briggs Institute (JBI) scoping review methodology, with keywords searched within five relevant databases. Studies comprised peer reviewed articles with qualitative or mixed method designs addressing the quality of life, health or healthcare of Autistic adults in mid and later years (50 years and older). Participants in the reviewed studies included Autistic individuals, including those with or without intellectual disability, and/or individuals who support this population (e.g., personal supporters, caregivers, healthcare or service providers). A total of 12 papers were found that had qualitative data and met inclusion criteria. These studies cumulatively identified themes related to (i) aging with autism, with subthemes of sense of self and identity, connection, deriving enjoyment or meaning, and navigating health and healthcare; and (ii) service gaps, with subthemes of service issues, factors that mediate the effectiveness of supports, and professional knowledge gaps. Study authors advocate for increased research on aging and autism, improved services, and enhanced training and capacity-building for professionals in this field.

Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and timely treatment of STEMI patients, the Chest Pain Unit (CPU) program was established to strengthen referral pathways to qualified facilities. This study explores key barriers and facilitators to the CPU implementation and proposes context-specific strategies to optimize its delivery and scale-up. We conducted a qualitative study using semi-structured interviews in three purposively selected, representative counties across eastern, central, and western China. A total of 61 key informants from 36 township hospitals, participated in the study. All interviews were audio-recorded, transcribed verbatim, and thematically coded guided by the Consolidated Framework for Implementation Research (CFIR) 2.0 using Atlas.ti 9. Implementation strategies were mapped and refined using Expert Recommendations for Implementing Change. We identified 46 barriers and 50 facilitators, spanning all 5 domains of CFIR. Technical deficiencies, residents' lack of health-seeking awareness, financial difficulties, inefficient awareness campaign, and limited professional knowledge are respectively the most significant barriers for five domains. We developed a three-pronged strategy framework including innovation optimization, external empowerment and internal improvement to inform future practice. Accordingly, the most urgent strategies encompass enhancing technical capacity, expanding financing mechanisms, empowering communities, implementing mass media campaigns, strengthening patient adherence through structured follow-up, and providing continuous practical training. We recommend the proposed strategies should be taken into full consideration to facilitate timely detection and intervention of ACS in primary healthcare context.

Purpose The purpose of this study is to investigate how tour guides’ professional competencies affect memorable pilgrimage experiences and how these experiences, in turn, contribute to destination brand identification, brand love and loyalty. Design/methodology/approach An online, self-administered questionnaire was used to collect the data from 307 Pakistani Muslims who had participated in a packaged Umrah tour. Data analysis was conducted using SPSS and AMOS, including confirmatory factor analysis and structural equation modeling. Findings All three sub-dimensions of tour guides’ professional competencies significantly affect memorable pilgrimage experiences. In addition, memorable pilgrimage experiences have a positive influence on brand identification and destination brand love, which in positively affect destination loyalty. Originality/value Unlike prior studies, the current research integrates the dimensions of professional knowledge, skills and attitude to provide a comprehensive understanding of how these competencies enhance pilgrims’ experiences and foster destination brand identification, love and loyalty. Accordingly, this study not only addresses a theoretical gap but also enriches scholarly discussions by providing a new lens on how tour guides’ competencies shape pilgrims’ emotional and behavioral outcomes in the context of Islamic tourism. By doing so, this research highlights the strategic significance of qualified tour guides in Muslim pilgrimage tourism and offers meaningful implications for both tour operators and destination marketers.

ABSTRACT Despite the growing relevance of public health approaches to crime prevention, the conceptual problems that arise from their adoption have not been explored in sufficient detail. More specifically, questions around epistemic authority, with whom this is located and how conflicts around it are negotiated and managed have been somewhat overlooked, obscuring struggles over what counts as valid knowledge within these approaches. We put forward three types of knowledge: the professional knowledge of practitioners; the local knowledge of community members; and the lived knowledge of those affected by interventions informed by public health principles. While co-production is extensively used to bring these together, the often-observed unequal power structures within which these practices unfold need to be acknowledged more openly. Finally, we draw on Arendt’s work to imagine how the hidden negotiations and conflicts over meaning within these approaches could be brought out in the open in a deliberative, democratic space. We also suggest that failing to fully acknowledge the messy, contested, and political aspects of crime prevention, both in theory and practice, means that the potential for meaningful change offered by public health approaches to crime prevention is yet to be fully appreciated.

This article examines how generative artificial intelligence (AI) design platforms are reshaping fashion and textile design by mediating creative processes, reconfiguring design roles and influencing aesthetic outcomes. While these design practices have traditionally relied on embodied techniques such as sketching or draping, AI platforms shift the creative process towards prompt-writing, thus transforming the designer’s role into one of linguistic precision. These systems not only facilitate design but also condition imaginaries, authorship and aesthetic norms. Drawing on an AI-augmented walkthrough methodology, we analyse four platforms through two themes: what we term the ‘limits of democratization’ and the ‘myth of the muse’. We show how platforms position themselves as accessible and inspirational while at the same time depending on opaque infrastructures, embedding aesthetic biases and upholding technical gatekeeping. Claims to democratization often obscure the need for professional knowledge and prompt fluency and overlook how defaults marginalize certain bodies, identities and styles. At the same time, the framing of AI as a muse conceals the constrained, algorithmically structured nature of digital creativity. Drawing on theories of ‘cultural infrastructure’, ‘distributed agency’ and ‘market agencements’, we examine how interface design, algorithmic suggestions and user scripts configure what can be created, who is positioned as a designer, and how creative practice is recognized and valued within fashion design culture. These dynamics show that AI design platforms do not simply mediate creativity; they reconfigure design practices and redistribute creative agency. Rather than serving as neutral tools, they function as socio-technical systems embedded in cultural and commercial infrastructures. By offering a critical, design-led perspective, this article contributes to understanding how generative AI reshapes the conditions under which fashion is imagined, produced and valued, thereby advancing emerging debates on AI and creativity in fashion.