Introduction: Bronchial anthracosis is a chronic respiratory condition characterised by the deposition of carbon particles in the bronchial mucosa. It is frequently associated with prolonged exposure to environmental pollutants, biomass smoke, and occupational dust, particularly in low-resource and rural settings. Aim: To elucidate the clinical and microbiological profile of patients with bronchial anthracosis in the mountainous valley of Kashmir, India. Materials and Methods: This cross-sectional study involved 88 patients diagnosed with bronchial anthracosis who were recruited from a tertiary care hospital. Data were collected on demographics, co-morbidities, exposure history, and microbiological findings through Bronchoalveolar Lavage (BAL). Statistical analysis was performed using percentage distribution and logistic regression analysis. Results: The mean age of the patients was 62.4±8.7 years, with females comprising 59.0% of the study population. Biomass fuel exposure (34.1%) and smoking (39.8%) were identified as significant risk factors. Common co-morbidities included Chronic Obstructive Pulmonary Disease (COPD) and hypertension. The chief complaints were cough (26.1%) and breathlessness (13.6%). BAL analysis revealed various pathogens, with Mycobacterium tuberculosis identified in 10.2% of cases. Logistic regression analysis demonstrated significant associations between bronchial anthracosis and age, smoking, and biomass fuel exposure, emphasising the influence of environmental risk factors. Conclusion: The findings highlight the significant role of environmental and occupational exposures—particularly biomass fuel use and smoking—in the development of bronchial anthracosis. Older adults, especially housewives and farmers, were the most affected groups, emphasising the need for targeted public health interventions. The association of bronchial anthracosis with respiratory infections and comorbidities such as COPD underscores the importance of early detection and appropriate management. Preventive strategies, including reduction of indoor air pollution and implementation of smoking cessation programmes, are essential to mitigate the disease burden in the ethnic population of Kashmir, India.

To strategically optimize diagnostic capacity in a low-resource, rural hospital setting, we developed a systematic evaluation of diagnostic tool needs and associated costs. This local data-driven method, accounting for patient characteristics and disease prevalence, can be adapted to other contexts. A retrospective patient record analysis was conducted at San Miguel Hospital (SMH) in Sucumbíos, Ecuador, which provides outpatient and emergency care to inhabitants of the Ecuadorian and Colombian Amazon basin. Ethics approval was granted retrospectively by the Research Ethics Committee on Human Beings of the Universidad San Francisco de Quito.Data was retrieved from electronic medical records (EMRs) of the first 796 patients seen after hospital opening. For each of the 1975 diagnoses made, patient characteristics and the presence or absence of appropriate diagnostic tools were recorded. Unavailable tools were further evaluated for accessibility within the local context. Serving a population primarily of mixed and indigenous ethnicities, SMH confirmed 66% of diagnoses using existing resources, with potassium hydroxide (KOH) fungal microscopy, chikungunya and influenza rapid tests, and access to anatomical pathology identified as the diagnostic tools offering the highest return on investment. Data from SMH's EMRs suggest which diagnostic tools would offer the greatest return on investment through increased diagnostic confirmation. This evaluation tool supports improved health care delivery at SMH and, with adaptation, can be applied in comparable health care settings. N/A.

To compare facility characteristics between rural and urban assisted living facilities (ALFs). A descriptive, cross-sectional study. A convenience sample of 517 ALFs (143 rural) that included facilities from all public health regions in Texas. Survey data were collected from administrative staff at each facility. Data were analyzed using descriptive statistics, χ2 analysis, and Mann-Whitney U tests. Overall, rural areas had relatively more Type A and fewer Type B facilities (the latter require 24-hour attendants) than did urban areas. Rural facilities (vs urban) also had significantly fewer Alzheimer's disease certifications and licensed beds. Provided services differed significantly between rural and urban facilities: urban facilities more often offered concierge, medical, and nursing services, whereas rural facilities more often provided transportation, wound care, and physical/occupational therapy. Antipsychotic use was high across all facilities (26.6%), but only 38.5% reported initiating gradual dose reductions. Findings highlight rural-urban differences in service availability and dementia care. Combined with high rates of antipsychotic use, these findings suggest a need for policy reforms, especially as resident acuity in ALFs increases. Additional research is needed to improve ALF quality measurement and to better understand factors influencing care quality in rural and urban settings.

BackgroundVery few studies have been conducted to explore psychological capital (combined hope, self-efficacy, resilience, and optimism known as PsyCap) and mental health among rural U.S. adolescents.PurposeThe purpose of this study was to explore the relationship between PsyCap and mental health using a health equity lens.MethodsA sample of 59 rural U.S. adolescents completed the survey packet. Descriptive and inferential statistics were conducted on the RStudio platform.FindingsPsyCap was significantly associated with wellbeing and anxiety. Non-binary adolescents reported significantly lower PsyCap. While the overall sample reported perceived rejection above the national norm, non-binary adolescents reported the highest levels.DiscussionPsychological capital theory served as a useful framework for exploring mental health among rural adolescents. More research needs to be conducted with large inclusive samples of rural adolescents who live on the margins. Examination of mental health services in rural settings should be considered.

Bone is the second most frequently transplanted human tissue worldwide. In sub-Saharan Africa, donor and recipient consent for bone allograft donation and transplantation remains uncertain due to diverse sociocultural, religious, and socioeconomic contexts. This study assessed public attitudes toward bone allograft donation and transplantation in Cameroon, the Democratic Republic of Congo, and the Republic of Côte d'Ivoire to support the planning and implementation of bone banking programs. A multicountry cross-sectional survey was conducted between January and December 2024. Six hundred adults were recruited using a non-probabilistic, stratified convenience sampling in urban and rural settings. After informed consent, participants completed a structured questionnaire, self-administered whenever possible capturing sociodemographic data, willingness to donate and receive bone allografts, and perceived reasons for refusal. Descriptive analyses and univariate and multivariate logistic regression models were used to identify factors associated with willingness. The mean age of participants was 36.2years. Overall, 72.5% reported willingness to donate bone allografts and 72.8% reported willingness to accept transplantation. The main reasons for refusal included belief-related or religious considerations, fear of trafficking, and expectations of financial compensation. In multivariable analyses, willingness to donate was independently associated with country of residence, religious affiliation, and occupation, while willingness to accept transplantation was associated with country and religious affiliation. Willingness to donate and receive bone allografts in the surveyed sub-Saharan Africa settings was relatively high although marked heterogeneity existed between countries. Key barriers include religious beliefs, mistrust of health systems, and socioeconomic vulnerability. The development of bone banking programs in the region will require culturally sensitive education, transparent governance, and active community engagement to transform expressed willingness into effective donation practices.

Point-of-care testing (POCT) represents a breakthrough technology in laboratory medicine that has expanded rapidly over the past three decades. Today, it accounts for approximately 25 % of all laboratory tests performed worldwide. POCT was initially implemented in critical care settings due to its substantial reduction in turnaround time (TAT), enabling more timely clinical decision-making and prompt therapeutic interventions. For selected measurands of high clinical value in critical care settings (e.g., blood gases, electrolytes, thromboelastography), the analytical performance of POCT is comparable to-and in some cases even exceeds-that of central laboratory testing. Subsequently, the adoption of POCT has expanded beyond critical care to encompass primary care, chronic disease management, community-based services, home care, and rural or remote healthcare settings, with the aim of improving access to laboratory testing. However, concerns have been raised regarding the accuracy and reliability of POCT results, as well as the compliance of their analytical performance specifications (APS) with current recommendations and clinical requirements. The aim of this paper is to discuss the current challenges in POCT and to develop a proposal grounded in a robust scientific and organizational rationale. This proposal is based on the distinction between Type A and Type B measurands and on the different roles of POCT for diagnosis and/or monitoring, according to the degree of APS compliance with established recommendations. For Type B measurands, the balance between improved access to diagnostics, acceptable analytical performance, and demonstrated benefits in clinical outcomes supports the adoption of POCT, particularly in selected settings where timely diagnosis and linkage to care are critical. Laboratory professionals must lead the appropriate and evidence-based adoption of this technological breakthrough by establishing fit-for-purpose and flexible quality control strategies, rigorously evaluating analytical performance specifications, and ensuring comprehensive oversight and governance across the entire testing process-from pre-analytical to post-analytical phases.

ABSTRACT With the Bourbon Restoration, Spain achieved – at a high political cost – a degree of stability that enabled the consolidation of the liberal state-building process initiated by the Moderates in the 1840s. This situation led political forces, both within and outside government, to reflect on the direction in which the state should develop, on the meaning of the nation, and on how its institutions were to be conceived, from the political centre of the nation-state to local administrations. These issues were closely connected to the processes and mechanisms of nationalisation with which they were intertwined. This article aims to analyse how processes of nationalisation unfolded at the local level, particularly in rural settings, departing from the premise that local life was permeated by elements of nationalisation operating across different spheres, specifically the public and semi-public spheres. Methodologically, the research is focused on a case-study approach, using documentary evidence – primarily from press sources – to test the proposed hypothesis. Ultimately, the article is intended to show how local and municipal life played a significant role in processes of nationalisation, not only because it represented the lowest tier of the state’s administrative structure, but also because it provided everyday and banal experiences of politics to the people with

BackgroundSpecialist palliative care remains highly uneven in rural and remote settings for patients with life-limiting illness and their families. This review aimed to examine the implementation characteristics, clinical and service-level outcomes, and patient experiences of tele-palliative care interventions for individuals living in rural or remote settings with limited access to specialist palliative care.MethodsA systematic review was conducted in accordance with the PRISMA 2020 guidelines across PubMed, Scopus, CINAHL, and Google Scholar (August-October 2025). Eligible studies were published within the past 20years and evaluated tele-palliative care interventions among rural populations. Data were extracted and outcomes were narratively synthesized.ResultsThirteen primary studies were included, conducted in the United States (n = 8), Australia (n = 2), Canada (n = 1), Japan (n = 1), and England (n = 1). Interventions included video consultations, hybrid tele-palliative programs, and remote symptom monitoring. Across studies, reported outcomes included implementation and process outcomes, patient and caregiver experiences and communication outcomes, clinical and care-process outcomes and health service utilization and economic outcomes. Challenges included technological instability, internet access limitations and inconsistent implementation fidelity.ConclusionsTele-palliative care can extend specialist palliative care to rural and remote communities by reducing travel burden and supporting continuity, particularly when delivered through hybrid models embedded in local care pathways. However, the evidence base remains limited and concentrated in high-income settings, with heterogeneity in intervention models and outcome reporting. Future studies should use standardized implementation outcomes, evaluate equity impacts, and compare hybrid tele-palliative models with usual care in diverse rural contexts.

Business closure, though complex to define, generally refers to the point at which a company ceases operations due to financial instability, managerial inefficiency, or external constraints. While extensive research has explored the causes of closure among larger enterprises, there remains a notable research gap concerning micro-businesses, particularly those operating in rural settings with limited resources and institutional support. This study aims to identify and analyze the key factors influencing the closure of micro-businesses in Townsite, Cabanglasan, Bukidnon. Specifically, it examines the effects of inappropriate location, lack of customer relations, lack of entrepreneurial skills, and poor business planning on the sustainability of micro-enterprises. Employing a quantitative research design, data were collected from 165 micro-business owners through a structured survey using a 4-point Likert scale. The data were analyzed using regression analysis to determine the extent to which each variable influences business closure. Results revealed that all four factors significantly contribute to micro-business closure (p < 0.05), with inappropriate location emerging as the most influential determinant. Businesses situated in remote or low-traffic areas experienced greater risks of failure. Additionally, a lack of customer relations and entrepreneurial skills further heightened closure risks, while poor business planning was also found to be a substantial contributor. The study provides practical implications for micro-business owners and policymakers. It underscores the importance of strategic location selection, enhanced entrepreneurial training, and customer engagement initiatives to improve business survival. Furthermore, collaboration among local stakeholders is essential to create a more sustainable and supportive business environment, ultimately reducing closure rates and promoting economic resilience in rural communities.

Tourists’ environmentally responsible behavior (ERB) is a key requirement in the promotion of the sustainable development of tourism destinations. Although extensive studies have explored the antecedents of tourists’ ERB, research within the context of rural tourism remains limited. Addressing this gap and guided by the Stimulus–Organism–Response theory, this study develops an integrated model in which nature relatedness and place attachment serially mediate the effect of the rural tourscape on tourists’ ERB. Based on 398 valid questionnaires collected from Huangling Village in Wuyuan, China—a UNWTO Best Tourism Village—data were analyzed using structural equation modeling. The findings reveal that (1) the ambience and agricultural products dimensions of the rural tourscape have a direct positive impact on tourists’ ERB, and (2) both nature relatedness and place attachment serve as independent mediators between the rural tourscape and tourists’ ERB. Furthermore, there exists a serial mediating pathway of “nature relatedness → place attachment” between them. This study uncovers the complex mechanisms underlying the formation of tourists’ ERB in rural tourism settings. By introducing nature relatedness as a mediator, it offers new insights for both theoretical advancement and the practical management of tourists’ ERB.

Purpose This research aims to reveal the lived experiences of a novice facilitator within the Irish context with a particular focus on the different facilitator roles assumed when guiding lesson study (LS) in a rural primary school. Design/methodology/approach To gain in-depth insights into the various facilitator roles within this case study, interviews were conducted both before and after each cycle, complemented by data from the researcher's field notes across collaborative meetings and reflective journal entries. Findings This study offers empirical insights into the multifaceted role of facilitators, with a particular focus on the challenges encountered in rural settings. The analysis reveals various obstacles the facilitator must negotiate, including teacher resistance, building trust, coordinating external professional development and fostering a research-oriented culture among staff, all while prioritising children's learning. The findings also underscore the critical role of supportive leadership in facilitating these processes. Research limitations/implications Despite being a case study focused on the novice facilitator in one LS group, the findings regarding the diverse roles of the facilitator in the rural school setting and the theoretical insights gained offer valuable contributions to other researchers and novice facilitators generally, most particularly in rural settings. Originality/value This study addresses the need to explore how novice LS facilitators can be supported to effectively enact their many roles. This paper also contributes findings to a currently under-researched area, unpacking the LS facilitator role in a rural context.

In recent years, stress has increasingly become a significant concern for healthcare professionals. It is widely documented that stress arises from an individual's perception of stressful situations and affects both the individual and the organization, often leading to absenteeism, decreased quality of care, and high employee turnover. However, problems caused by stress can be counteracted by focusing on the components of emotional intelligence (EI). This study examined the relationship between EI and perceived stress (PS) among doctors and nurses. A cross-sectional survey was conducted among 287 healthcare professionals from public and private hospitals, Community Health Centres, Primary Health Centres (PHCs), and Sub-Centres in the West Garo Hills District of Meghalaya. Standardized questionnaires were used to measure EI and PS. Data collected were analysed using correlation, multiple regression, and ANOVA techniques. The results shed light on the presence of considerable workplace stress among doctors and nurses, with statistically significant differences observed between the groups. The findings also revealed that EI significantly moderates PS, indicating that doctors and nurses with higher EI are more capable of dealing with workplace stressors. Based on this study's findings, EI significantly reduces PS among healthcare professionals, making it a crucial soft skill for improving resilience, communication, and job satisfaction. Individuals can benefit by engaging in EI development through targeted training. Institutions should integrate EI into recruitment and staff development while fostering emotionally supportive workplaces to lower burnout and turnover. Educational bodies are encouraged to embed EI training in healthcare curricula to prepare students for emotionally demanding roles. Overall, these implications support building a more emotionally intelligent, patient-centered healthcare system that values both provider wellbeing and quality care. These observations emphasize EI as an essential soft skill that can increase workforce resilience, enhance healthcare delivery, and reduce burnout. Strengthening EI among healthcare professionals can therefore serve as an effective strategy for managing occupational stress and promoting better organizational outcomes. Enhancing EI in healthcare professionals can contribute to stronger and more resilient rural health systems. By reducing stress and improving emotional regulation, EI development may help prevent burnout, lower absenteeism, and enhance the quality of interactions between providers and communities. In underserved regions, emotionally competent professionals are better equipped to manage patient needs, communicate effectively, and maintain trust in the healthcare system. Supporting EI through training and organizational policies can therefore improve staff well-being and strengthen public confidence in rural health services. Over time, this can promote healthier work environments and better health outcomes for the communities they serve. This study contributes to the literature by providing empirical evidence on the role of EI in managing PS among doctors and nurses in a rural healthcare setting, a context that remains underexplored despite persistent workforce shortages and resource constraints.

Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across cognition levels was 44.61% for dementia, 37.76% for cognitive impairment, and 32.16% for normal cognition. Having at least one fall exposure in the last 24 months significantly increased odds of having dementia by 42%, while the relationship between fall exposure and cognitive impairment was non-significant. Depressive symptoms were also associated with cognitive impairment and dementia. The stratified analysis by residential areas revealed that having a fall exposure increased the likelihood of having cognitive impairment by 26% and dementia by 73% in urban residents. However, the association between fall exposure and cognitive outcomes was not significant in rural settings. Depressive symptoms increased the odds of cognitive impairment in both strata, with a larger effect size in rural settings (OR = 2.23, 95% CI [1.41, 3.54]). Conversely, the association between depressive symptoms and dementia was only significant in urban settings (OR = 3.20, 95% CI [1.99, 5.15]). Conclusions: Falls and depressive symptoms were significantly associated with the odds of cognitive impairment and dementia, with significant differential effects between rural and urban older adults.

Background: Stunting remains a persistent public health problem in Indonesia, particularly in rural areas. Objective: To examine the association between nutrient intake and breastfeeding practices with stunting and motor development among children aged 6–24 months in rural Indonesia. Methods: An unmatched case–control study was conducted involving 70 stunted and 70 non-stunted children. Nutrient intake was assessed using a single 24-hour dietary recall and compared with age-specific Recommended Dietary Allowances. Stunting was defined as height-for-age z-score (HAZ) < −2 SD based on WHO standards. Motor development was assessed using a standardized screening tool. Associations were analyzed using chi-square tests and multivariable logistic regression. Sensitivity analysis excluding low birth weight infants was also performed. Statistical significance was set at p < 0.05. Results: In bivariate analysis, inadequate calcium intake showed the strongest association with stunting (OR = 4.76; 95% CI: 2.33–9.72), followed by inadequate energy and protein intake. In multivariable analysis, inadequate calcium intake remained independently associated with stunting (aOR = 12.01; 95% CI: 3.23–44.60; p < 0.001). Sensitivity analysis excluding low birth weight infants attenuated the estimate but the association remained significant (aOR = 8.4; 95% CI: 2.6–27.1). For motor development, inadequate calcium intake (aOR = 2.77; 95% CI: 1.23–6.22; p = 0.014) and non-exclusive breastfeeding (aOR = 2.32; 95% CI: 1.05–5.14; p = 0.037) were independently associated with suspected motor delay. Conclusion: Inadequate calcium intake was independently associated with both stunting and suspected motor delay among children aged 6–24 months in this rural setting.

Homestay tourism is increasingly recognised as a pathway to sustainable tourism development, especially in community-based destinations. This study examines the roles of local community attitudes and environmental sustainability in shaping perceived value and tourist satisfaction within Nigerian homestay tourism. Using a cross-sectional survey design, data were collected from 386 homestay tourists across south-western Nigeria and analysed with Partial Least Squares Structural Equation Modelling (PLS-SEM). The results reveal that local community attitude significantly boosts tourists’ perceived value, while environmental sustainability positively influences both perceived value and tourist satisfaction. However, perceived value does not strongly predict tourist satisfaction, and the moderating effect of community attitude on the relationship between value and satisfaction appears weak. This study contributes to the literature by integrating and extending the Theory of Planned Behaviour (TPB) beyond behavioural intention, demonstrating its relevance to understanding the formation of value–satisfaction in community-based tourism. It also challenges dominant tourism assumptions by showing that perceived value may serve as a supporting rather than primary determinant of satisfaction in rural homestay settings. In practice, the findings suggest that homestay operators and policymakers should focus on environmental sustainability practices and on enhancing experiential service quality, rather than relying solely on value-for-money propositions. By providing context-specific evidence from sub-Saharan Africa, this study advances sustainable tourism scholarship and offers strategic insights for inclusive rural tourism development.

<div><table cellspacing="0" cellpadding="0" align="center"><tbody><tr><td align="left" valign="top"><p><em>Access to safe household drinking water remains a major environmental health concern in riverine rural communities that rely on untreated groundwater and refill water sources. Buluh Cina Village, located along the Kampar River in Riau Province, depends largely on shallow wells and refilled drinking water stations, many of which lack adequate disinfection and routine monitoring. This study aimed to conduct an integrated environmental health surveillance of household drinking water quality in Buluh Cina Village to identify microbiological and physicochemical risks relevant to local public health action. A cross-sectional surveillance study was conducted by collecting 30 water samples from points of access (supply) and 30 samples from points of use (ready-to-drink) in selected households using stratified random sampling. Laboratory analyses assessed microbiological parameters (Escherichia coli and Total Coliform), physical parameters (turbidity, color, and pH), and chemical parameters (iron, manganese, and residual chlorine), following the Indonesian Ministry of Health Regulation No. 2/2023. </em><em>Overall, 91.7% of samples did not meet national drinking water quality standards. Microbiological contamination was detected at both sampling points, with Escherichia coli present in 33.3% of PA samples and 46.7% of PU samples, and total coliform contamination in 53.3% of PA samples and 63.3% of PU samples. However, the differences between PA and PU were not statistically significant. Residual chlorine was absent or below the recommended level in 70% of samples, while turbidity, abnormal pH, and elevated iron and manganese were also observed.</em><em> These findings indicate significant environmental health risks associated with household drinking water in this riverine rural community. Priority public health actions include improving safe household water storage practices, increasing uptake of point-of-use disinfection, strengthening routine monitoring of refill drinking water depots, and integrating drinking water surveillance into primary health care center (puskesmas)-based environmental health workflows. This study provides locally grounded evidence to support targeted interventions for improving drinking water safety in riverine rural settings</em><em></em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: </em></strong><strong><em> Buluh Cina Village, Drinking Water Quality, Environmental Health Surveillance, Household Water Safety, Kampar River</em></strong>

Sudden unexplained death (SUD) has been reported in localized rural settings worldwide, raising questions about whether drinking-water geochemistry may contribute to population-level health anomalies. The enigmatic occurrence of sudden unexplained death (SUD) in villages of the Ailao Mountains, China, represents one such case, yet the role of drinking water chemistry remains poorly constrained. This study presents the first comparative hydrochemical and health-risk assessment of drinking water from SUD-affected villages (SUDV) and neighboring non-affected villages (NSUDV), aimed at evaluating the potential role of groundwater geochemistry. A total of 63 water samples were analyzed for major ions and trace elements. Results show that waters from both village types are predominantly low-mineralization Ca-HCO3 type, controlled by carbonate weathering, with negligible anthropogenic influence, and all measured parameters comply with Chinese drinking water standards. Multivariate analyses reveal no fundamental compositional differences between SUDV and NSUDV waters. Critically, health risk assessments indicate negligible non-carcinogenic and carcinogenic risks for all SUDV samples, whereas a subset of NSUDV samples exhibits low-to-moderate risks primarily associated with geogenic arsenic and lithium. An Integrated Water Quality Index classifies all SUDV waters as excellent. These findings provide robust geochemical evidence excluding conventional groundwater contamination or elemental toxicity as the direct cause of the SUD phenomenon, thereby redirecting etiological inquiry toward interdisciplinary integration of genetic, biomedical, and other environmental cofactors.

Wind turbines can affect perceived landscape quality, particularly in open rural settings where their scale and distinctive form make them a strong visual dominant. This article presents model-based research on how turbine setback distance from residential buildings influences the visual perception of rural landscapes in Poland. A modified Scenic Beauty Estimation (SBE) method was applied, using standardized computer-generated visualizations instead of real-world photographs of seven rural landscape types. For each type, four variants were assessed: a reference view and three scenarios with turbines located 500, 750, and 1000 m from residential buildings. Shorter setback distances significantly reduced visual ratings (ANOVA, p < 0.001). The lowest ratings occurred at 500 m, particularly in the large-scale arable farming landscape (Z = −0.886), while the highest ratings were recorded for reference variants, especially in the mountain agricultural landscape (Z = 1.20). Landscape type was also significant, with open areas proving more sensitive to turbine presence than structurally complex landscapes. Linear trend analysis confirmed that increasing setback distance is associated with higher visual ratings (F(1, 2140) = 31.60; p < 0.001; R2 = 0.01). These findings indicate that perceptual landscape assessment supports wind turbine siting and, when combined with geographic information systems (GIS) and Landscape and Visual Impact Assessment (LVIA), enables a more comprehensive evaluation of project-related environmental effects.

ABSTRACT Problem Programs that identify people with a low‐risk allergy who can be safely delabeled by a direct oral challenge have emerged but are mostly reported in tertiary centres. There is limited information in the rural setting where resources are more constrained. Setting A medium‐sized rural health service in Victoria (Australia). Key Measures for Improvement The outcome measure was the number of patients with a low‐risk penicillin allergy who completed a penicillin oral challenge. Strategies for Change The penicillin oral challenge program developed considered four critical workflows: choice of allergy assessment tool, identifying those with a low‐risk penicillin allergy who were interested in an oral challenge, oral challenge supervision and communication of the outcome. These were tested through Plan, Do, Study, Act (PDSA) cycles. Effects of Change Of 23 allergy assessment tools completed, fifteen revealed a low‐risk allergy (PEN‐FAST score 0, 1 or 2). Six people were not interested in the oral challenge and three did not have their interest recorded. Of the remaining six, four had an oral challenge (27%). Lessons Learnt Utilizing teamwork and the broad skill set of generalist rural staff, this rural health service was able to complete a penicillin oral challenge for over 25% of inpatients with a low‐risk penicillin allergy.

ABSTRACT As art tourism develops, painting landscapes—blending artistic expression with visitor experience – have gained increasing attention in studies of cultural space and perception. However, quantitative tools for systematically evaluating their perceived value remain limited. This study develops and validates a five-dimensional perceived value scale for painting landscapes, comprising Artistic Value, Aesthetic Value, Emotional Value, Place Promotional Value, and Tourism Economic Value, which together capture the artistic, experiential, cultural, and economic aspects of tourists’ value perceptions. On-site surveys conducted in the 798 Art District and Tian’ao Village confirm the reliability and applicability of the scale across different spatial contexts. The findings demonstrate the scale’s effectiveness in capturing tourists' perceived value of painting landscapes and provide a validated conceptual and measurement framework to support future empirical research. Moreover, the results reveal variations in perceived value dimensions between urban and rural settings, offering practical implications for product development, audience segmentation, and cultural branding in art tourism.