Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. Although scoping and systematic reviews of digital training have been conducted for medical professionals in high-income countries (HICs), none have been conducted with lay professionals in LMICs, a population with different considerations. This review describes the characteristics of digital training for CHWs and identifies their impact on health services outcomes in LMICs. A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review, and analyze existing literature. We searched 10 foremost databases using keywords and Medical Subject Headings terms for CHWs, LMICs, and digital learning to identify primary, peer-reviewed studies published up to and including November 26, 2024. An updated search of studies in all the databases was conducted on January 12, 2026, by the research team. No registries were searched. Articles that focused on the provision of digital or blended learning training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the eligibility criteria. Two reviewers (TAT and FA) screened the articles at the title and abstract levels and at full-text review. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted using a data-charting form. Descriptive analysis was conducted of the population, training characteristics, and reported outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting scoping reviews were used. A total of 892 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used nonrandomized study designs. The most common attributes included synchronous (n=8), accessible in the community (n=14), use of smartphones (n=6), and accessible online (n=9). The majority reported learning outcomes (n=14), about half reported implementation outcomes (n=10), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW's acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness. We found few evaluations of digital training for CHWs in LMICs, in spite of a proliferation of such trainings. Digital trainings had a broad range of attributes. Many evaluations had knowledge, acceptability, and feasibility outcomes. However, other learning outcomes (eg, attitudes and skills), implementation outcomes (eg, appropriateness and fidelity), and clinical outcomes were rare. Most lacked experimental designs. Although the existing evidence suggests that digital training can impact knowledge in lay health workers in LMICs, more rigorous studies with a broader range of outcomes are needed.

Dragon Boat rowing demands a high level of strength, endurance, technique, and team cohesion. Problems encountered among female rowers in West Tanjung Jabung include mid-race fatigue, slowing of their paddling technique, and the lack of regular and systematic training evaluations. This study aims to analyze training evaluations to improve the performance of female rowers using the CIRO (Context, Input, Reaction, Outcome) evaluation model. The study used a descriptive qualitative approach, with the participants being the head of the board, coaches, assistant coaches, and athletes. Data were collected through field observations, semi-structured interviews, and documentation of training programs and performance data. Data analysis was conducted using NVivo 12 Pro through thematic coding. The results show: (1) Context: coaches design periodization based on four pillars (physical, technical, mental, and competition simulation) with the vision of making West Tanjung Jabung a regional barometer; (2) Input: infrastructure is adequate but requires equipment upgrades, with funding support from KONI and private sponsors; (3) Reaction: all stakeholders demonstrated a positive and supportive response; (4) Outcome: The women's team won second place at the 2025 Jambi Provincial Championship and is targeting advancement towards PORPROV and PON. It was concluded that the CIRO-based evaluation effectively identified strengths and areas for improvement in the training program and supported sustainable performance improvement.

Tunnel environments exacerbate the acoustic discomfort of high-speed train passengers, yet traditional evaluation methods fall short in capturing passengers’ true perceptual responses. This study proposes a novel approach integrating electroencephalogram (EEG) signals with subjective annoyance ratings to assess acoustic comfort in tunnel scenarios. A total of 114 noise samples—recorded from real-world high-speed rail operations at speeds ranging from 160–300 km/h under both tunnel and open-line conditions—were replayed to 20 participants in a semi-anechoic chamber. EEG signals were collected using dry electrodes and analyzed through wavelet-based preprocessing, rhythm decomposition, and feature extraction (relative power and sample entropy). Statistical analyses revealed that tunnel noise significantly increases subjective annoyance scores (mean = 7.67 vs. 4.39 in open-line, paired t-test, p < 0.01), which correlated with annoyance across stimuli (Pearson r = 0.79 for β relative power; r = 0.73 for β sample entropy), indicating heightened cognitive stress and emotional agitation. The findings demonstrate that β-rhythm activity serves as a robust indicator of acoustic discomfort, and EEG-based metrics offer objective insights into passenger experience, surpassing traditional sound level assessments. This work provides a foundation for neuro-informed railway noise control strategies and opens new directions for evaluating complex acoustic environments.

The limited availability of contextual and technology-integrated teaching materials highlights the need for innovative resources to enhance students’ critical thinking skills in ecosystem learning. This research focuses on developing an integrated e-book that incorporates the local wisdom of the Kungkum Sinden tradition in Sendang Made into ecosystem learning to enhance junior high school students’ critical thinking skills. The research addresses the limited availability of contextual teaching materials and the need for digital resources that support 21st-century learning, particularly critical thinking and technology integration. A Research and Development (R&D) method was employed using the ADDIE framework, consisting of analysis, design, development, implementation, and evaluation stages. Data were collected through expert validation involving science education lecturers and a science teacher, as well as readability testing. The e-book achieved high validation scores: 3.18 for presentation (valid), 3.32 for content feasibility (very valid), and 3.41 for language appropriateness (very valid), with an overall validity of 83% and a rating of very valid. The product integrates ecosystem concepts with local ecological values and interactive features designed to train interpretation, analysis, inference, evaluation, explanation, and self-regulation skills. In conclusion, the developed e-book is highly feasible and valid for supporting contextual science learning and improving students’ critical thinking skills.

Hospitals in earthquake-prone regions must evacuate heterogeneous occupants rapidly while preserving operational continuity under disrupted conditions. However, many hospital-evacuation studies still rely on static routing assumptions or narrowly defined behavioral rules, which limits their value for building-level resilience planning. This paper develops a comparative hospital-campus evacuation framework that combines GIS-based geodesic routing, heterogeneous agent-based modeling, and reinforcement-learning-based decision policies. Puge County People’s Hospital in Sichuan, China, is used as the case study. Six algorithms are evaluated: three rule-based baselines—Shortest Path (SP), Random Walk (RW), and the Social Force Model (SFM)—together with a training-free density-aware heuristic, Density-Aware Gradient Routing (DAGR), and two reinforcement-learning approaches, Density-Aware Q-Learning (DAQL) and SARSA. Experiments cover three population scales (N∈{50,100,200}), normal daytime conditions, staffing-variation scenarios, and a blocked-exit disruption scenario, with 30 independent runs for each main condition. The results show that the rule-based and training-free methods remain the most reliable under full multi-agent evaluation: the SFM and RW achieve the highest completion ratios (approximately 100% and 93.5%, respectively), while DAGR provides the strongest balance between completion and evacuation efficiency among the non-trained methods. In contrast, the trained RL agents perform substantially worse in direct multi-agent deployment with DAQL reaching approximately 37% completion and SARSA approximately 17%, highlighting a train–evaluation distribution shift associated with independent Q-learning. The ablation analysis further shows that collision avoidance is the most critical reward component, whereas density-avoidance shaping can unintentionally induce collective deadlock when all agents execute the learned policy simultaneously. Among the enhanced variants, DAQL_RoleAware yields the best overall improvement, increasing the completion ratio to approximately 52% and reducing the 90th-percentile evacuation time to approximately 363 s. Overall, this paper clarifies both the promise and the present limitations of density-aware reinforcement learning for hospital evacuation while providing a more building-centred and reproducible basis for future coordination-aware evacuation design and emergency-planning research.

Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic working-height recommendations in orthopaedic surgery remains limited. Methods: A simulated left total knee arthroplasty (TKA) was divided into twelve critical surgical steps and analysed across four commonly used surgeon positions (A-D). Two conditions were compared: uncorrected working height (N) and working height corrected according to Canadian Centre for Occupational Health and Safety (CCOHS) recommendations (C). Joint angles were measured from standardized photographs using Kinovea software, and postural load was quantified with the Rapid Entire Body Assessment (REBA) method. Two trained evaluators conducted three independent assessments, yielding 288 REBA scores. Results: Mean REBA scores decreased across all surgeon positions following ergonomic correction, with statistically significant reductions observed in positions A, B, and D. When pooled across all position-step combinations (n = 48), the mean reduction was 0.92 REBA points (95% CI 0.50-1.33; p < 0.001). Notably, 27 of the 48 position-step comparisons exceeded the minimal detectable change threshold. The largest reductions occurred during force-intensive surgical steps, including bone cutting, drilling, and implant impaction. Conclusions: Adjusting working height in accordance with CCOHS ergonomic recommendations reduces surgeons' postural load during TKA. These findings support the integration of evidence-based ergonomic adjustments into routine orthopaedic surgical practice.

Routine systematic collection of social determinants data can inform improvements to health service delivery and system and policy planning. This cohort study reports on the implementation of the SPARK tool to collect and integrate demographic and social needs data in primary care. The 20-question SPARK tool was implemented from September 2022 to October 2023 at five primary care clinics. Implementation was evaluated using the following outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, and sustainability. Data included: clinic checklists (n = 5), training evaluations (n = 33), SPARK tool responses (n = 2063), patient surveys (n = 1368), and provider and staff surveys (n = 36). Survey responses were analyzed using frequency (%) and mean (SD). Open-ended responses were analyzed to identify key themes. There was strong acceptability and adoption of the tool. Collection methods contributed to variation in perceived relevance, compatibility and barriers. Among patients, 90.5% indicated the tool was clear and easy to complete, and 84.5% had a positive experience. A minority of patients (7.8%) indicated difficulty answering ≥1 question on SPARK. Among clinic staff and providers, 96.7% reported the tool was useful, and 81.8% had a positive experience. Clinics highlighted concerns with resource allocation and suggested adjustments to collection, integration, and personnel to support implementation. The SPARK tool is acceptable and feasible for adoption in primary care clinics. This study provides practical insight into implementing demographic and social needs data collection, including adaptations to clinic workflows, enhanced integration platforms, and supports that ensure the sustainability of social needs screening in primary care.

This study aimed to evaluate the impact of structured team training on teamwork, communication and resuscitation performance among undergraduate nursing students in simulated cardiac arrest scenarios. A nonrandomized pretest-posttest intervention study with a control group. Sixty-seven third-year nursing students from two accredited nursing programmes were assigned to either an intervention group (n = 34), which received advanced life support training integrated with five structured team training sessions based on the TeamSTEPPS framework, or a control group (n = 33), which received life support training alone. Teamwork and communication were measured before and after training using validated tools. Resuscitation performance was assessed posttraining through standardized simulation scenarios rated by trained evaluators. The intervention group demonstrated significant improvements in teamwork and communication scores compared to the control group. Posttraining resuscitation performance was also higher in the intervention group. These findings indicate that the integration of structured team training enhances both technical and nontechnical competencies in high-pressure clinical situations. Structured team training is an effective educational strategy to improve communication, collaboration and resuscitation performance among nursing students.

School leadership in Spain faces notable complexity arising from bureaucratization, limited autonomy, and the insufficient professionalization of the role. This study, grounded in perspectives from distributed, transformational and instructional leadership, analyses leadership teams’ perceptions regarding access to the position, training, the competencies required, and the satisfaction associated with these functions. To this end, a qualitative design was employed, based on semi-structured interviews conducted with 24 teachers holding leadership positions. The data were examined through categorical content analysis with the support of NVivo, ensuring both inter- and intra-rater reliability. The study offers an original contribution by providing updated empirical evidence on how structural and organizational conditions shape motivations, training relevance, and the relational competencies that underpin participatory leadership models. The thematic analysis identified several recurring themes: positive evaluations of initial training, diverse motivations for assuming the role (from vocation to compulsory appointment), the emphasis on communicative, collaborative and organizational competencies, and ambivalent professional satisfaction, combining fulfilment with administrative overload. In conclusion, the study underscores the need for more contextualized, practical, and sustainable policies and training programs that strengthen effective and humane pedagogical leadership, addressing the persistent gap between current training and real school demands.

Electrical impedance tomography (EIT) is a validated tool for monitoring patients receivingmechanical ventilation. The performance of EIT in quantifying regional ventilation in non-intubated subjects remains unknown. We aimed to compare the agreement of EIT regional ventilation distribution with computed tomography (CT) scans in spontaneously breathing subjects. In addition, we assessed the influence of patient-related factors on measurement error and the reproducibility of EIT ventilation quantification. Healthy adults under spontaneous breathing underwent simultaneous EIT measurements and whole-lung CT scans. Changes in thoracic impedance by EIT and air content by CT during end-expiratory and end-inspiratory pauses were compared using standard anterior-posterior and right-left regions of interest (ROI). The intra- and inter-evaluators reproducibility of ventilation distribution was assessed using 2 trained evaluators. EIT and CT images were collected from 32 subjects. The best combination of bias and limits of agreement for regional ventilation distribution was achieved with a CT lung length of 15 cm. At this lung length, we found a bias of 0.80% with limits of agreement ranging from -9.26% to 10.87% in the posterior ROI and a bias of -1.33% with limits of agreement from -9.15% to 6.47% in the right ROI. Biological sex, body mass index, fat percentage, or thoracic and abdominal circumferences did not affect EIT-CT measurement differences. The maximum intra- and inter-examiner bias was below 1.5%, with limits of agreement lower than 10% for both antero-posterior and right-left lung regions. EIT wasa valid and reliable instrument for assessing ventilation distribution in non-intubated subjects during spontaneous breathing.

Green human resources (HR) is a crucial tactic for incorporating environmental management into HR procedures as businesses look for more sustainable ways to solve environmental issues. Thus, the main aim of this paper is to examine the influence of green HR practices on organizational sustainability, with a focus on the mediating roles of organizational culture, employee engagement, and top management commitment in the Saudi banking sector. To achieve these objectives, a questionnaire was designed and distributed to a study sample of 125 managers from Saudi banks at various levels. The results show that integrating green HR practices into Saudi banks contributes to enhancing organizational sustainability. Furthermore, the results show that organizational culture, employee engagement and top management commitment mediate the relationship between green HR and organizational sustainability in the Banking Sector of Saudi Arabia. Given the aforementioned conclusions, this study advises HR managers at Saudi banks to promote an environmentally conscious culture and incorporate sustainability into hiring, training, and performance evaluations. Additionally, it suggests enhancing organizational sustainability through green training for staff members and promoting eco-friendly innovations like remote meetings and energy-efficient offices.

Introduction: Despite the growing emphasis on inclusion, evidence on the longitudinal effects of consecutive training pathways in physical activity remains limited, particularly within initial university-level education. Objective: To assess the impact of a consecutive inclusive physical activity training pathway on the academic and professional development of Physical Activity and Sport Sciences students, focusing on academic self-concept, perceptions of educational inclusion, and evaluations of theoretical and practical training. Method: A longitudinal, quantitative repeated-measures design was employed across one full academic year. University students responded to questionnaires at three time points (R1, R2, and R3), corresponding to key phases of the training pathway. Within-subject analyses were conducted to examine changes over time throughout the complete course sequence. Results: Significant reductions were observed in academic self-concept, perceived academic performance, and academic self-efficacy across the training pathway. Concurrently, significant improvements were found in key dimensions of inclusive practice, particularly in methodology, supports, and community participation, whereas the conception of diversity remained stable. Perceived adequacy of theoretical training increased progressively over time, while perceived adequacy of practical training improved following the first course and subsequently stabilized. Conclusions: The training pathway positively influences students' preparedness for inclusive education. However, the findings suggest the need to strengthen structured practical experiences that facilitate the transfer of learning to professional practice.

Chronic neuropathic pain following lumbar spine surgery remains a common and challenging clinical problem in pain medicine, often persisting despite surgical intervention and injections. This case-based educational review describes a 62-year-old man with multiple prior lumbar surgeries who developed persistent bilateral lower-extremity neuropathic pain consistent with persistent pain after spinal surgery. Initial treatment with gabapentin, titrated to therapeutic doses, resulted in minimal clinical improvement, prompting transition to pregabalin with moderate symptom relief. The addition of tramadol for breakthrough pain further improved functional status and sleep quality. Through this clinical scenario, key pharmacologic principles are reviewed, including the mechanisms of action, pharmacokinetics, safety considerations, and practical differences between gabapentin and pregabalin, as well as the role of tramadol as a dual-mechanism analgesic for mixed neuropathic and nociceptive pain. This teaching case is of particular educational value for trainees in orthopedics, pain management, anesthesiology, and primary care, where stepwise pharmacologic decision-making and longitudinal management of complex post-surgical pain syndromes are frequently encountered.

Measurement properties of the Premature Infant Pain Profile-Revised applied at the bedside by physical therapists in the NICU.

Comparative evaluation of a hybrid membrane treatment train versus full-scale aerobic/anoxic activated sludge system: C-N removal performances, syntrophic microbial dynamics, and energy savings

Neuroergonomics evaluation of teamwork in a fast-paced communication and shared decision-making task

Decoding vision transformer variations for image classification: A guide to performance and usability

Introduction: The International Federation of Medical Students’ Associations (IFMSA) organizes the International Training on Disaster Management (ITDM) workshops to equip medical students and future health professionals with the knowledge and skills necessary to contribute effectively to disaster risk management and humanitarian response. This abstract reviews the outcomes of international training workshops conducted over three years, focusing on disaster risk reduction, international humanitarian law, and the right to health in disaster scenarios. Methods: Three-day international training sessions targeted medical students from various countries. Key outcomes were assessed through attendance records, post-training evaluations, and engagement in global networks and fieldwork opportunities. Results: Eight international trainings were conducted, engaging over 70 medical students from diverse backgrounds. Post training evaluations indicated a significant increase in participants’ understanding of disaster preparedness, response, and advocacy skills. Participants reported enhanced capabilities to engage in meaningful youth participation and contribute to policy discussions regarding health rights during emergencies. Furthermore, participants successfully joined international networks, leading to collaborative initiatives in disaster management. Conclusion: The ITDM workshops have equipped future health professionals with the skills and knowledge necessary for disaster response. Through this program, participants are empowered to advocate for ethical standards in health emergencies and strengthen global collaboration among youth in the medical field. Such outcomes demonstrate the urgent need to include education on disaster risks in the training curriculum for medical students worldwide, ultimately contributing to more resilient health systems in the face of disasters.

Introduction: Disasters impose significant challenges on global health systems, especially in vulnerable populations with limited resources and disaster preparedness training. The International Federation of Medical Students’ Associations (IFMSA) Emergency, Disaster Risk, and Humanitarian Action (EDHA) program addresses these issues by equipping medical students and communities with essential disaster resilience and preparedness skills. Methods: The EDHA program facilitated 46 targeted activities over three years, including 21 disaster-response training sessions for medical students and healthcare professionals. Nine humanitarian campaigns aided disaster-affected areas, while partnerships with local NGOs and health ministries supported advocacy and policy engagement. Data were collected through reports on activities reached, training outcomes, and policy influence. Results: The EDHA program reached over 82,000 individuals, comprising 57,000 community members who gained public health information and 25,000 medical students and professionals who enhanced their disaster preparedness skills. Training evaluations showed a 65% increase in knowledge retention and a 70% improvement in disaster response skills. Policy discussions in five countries led to local advancements in disaster preparedness. The humanitarian campaigns delivered critical aid, including medical supplies, to areas affected by crises, ensuring direct community benefit and strengthening local health resilience. Conclusion: The IFMSA EDHA program builds disaster resilience in vulnerable populations through education, advocacy, and community aid. This program also empowers future healthcare leaders to create effective and responsive health systems in times of crisis.

YouTube as a source of autism treatment information: A quality and reliability assessment.