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BACKGROUND: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. METHODS: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. RESULTS: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. CONCLUSIONS: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

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The burgeoning illegal trade in succulents in southern Africa presents a critical conservation and social development challenge. Drawing parallels with the trajectory of the response to rhinoceros poaching, we considered the consequences of conservation law enforcement measures, particularly the militarization of antipoaching efforts. The response to rhinoceros poaching not only resulted in so-called green militarization, but also led to extrajudicial killings, human rights abuses, and the disproportionate targeting of low-level poachers. The nature of wildlife trade prohibition is complex and often contested, and many actors operating in illegal wildlife trades dispute the label of illegal for socioeconomic, cultural, historical, or political reasons. This contestation is crucial when considering Indigenous cultural and medicinal values of succulents, with Indigenous Peoples and local communities questioning the criminalization of traditional plant harvesting practices. As the illegal trade in succulents continues to grow, it is imperative for conservationists to consider a nuanced approach. We call for a socioecological harm reduction approach that emphasizes community engagement, sustainable use, and codesigned interventions. Such an approach could help balance the scales of ecological conservation and human dignity in the face of growing wildlife trade challenges.

La necesidad de una estrategia socioecológica de reducción de daño para disminuir el mercado ilegal de fauna Resumen El emergente mercado ilegal de suculentas en el sur de África representa un reto importante para la conservación y el desarrollo social. Partimos de las similitudes con la trayectoria de la respuesta a la caza furtiva de rinocerontes para considerar las consecuencias de la aplicación de las leyes de conservación, en particular la militarización de los esfuerzos contra la caza furtiva. La respuesta a la caza furtiva no sólo derivó en la llamada militarización verde, sino también llevó a ejecuciones extrajudiciales, abuso de los derechos humanos y a la selección desproporcionada de cazadores de bajo nivel. La naturaleza de la prohibición del mercado de fauna es compleja y con frecuencia se impugna, y muchos actores que operan en los mercados ilegales disputan la etiqueta ilegal por razones socioeconómicas, culturales, históricas o políticas. Esta impugnación es crucial cuando consideramos los valores culturales y medicinales que los indígenas dan a las suculentas, sobre todo cuando los pueblos indígenas y las comunidades locales cuestionan la criminalización de las prácticas tradicionales de recolección de plantas. Conforme el mercado ilegal de suculentas sigue creciendo, es imperativo que los conservacionistas consideren una estrategia con matices. Pedimos una estrategia socioecológica de reducción de daños que resalte la participación comunitaria, el uso sustentable y las intervenciones con co­diseño. Dicha estrategia podría ayudar a equlibrar la balanza de la conservación ecológica y la dignidad humana de cara al incremento de retos en el mercado de fauna.

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The Man and the Biosphere Program (MAB) responds to challenges of the Anthropocene through an explicit social-ecological approach. Implemented as a world network of biosphere reserves, MAB aims to increase [eco]system sustainability and resilience globally, via individual model sites for learning and sustainable development. This research provides an in-depth case study of MAB implementation in South Africa using the Cape Winelands Biosphere Reserve (CWBR), established in 2007 when a key MAB guiding policy, the Madrid Action Plan came into effect. The study utilized semi-structured in-depth interviews with strategic and operational management, and document analysis. The CWBR prioritizes their role as a landscape coordinator, a driver of socio-economic development and site in which humans derive benefits from healthy natural environments. The CWBR have adopted a non-profit organization cooperative governance model in support of this vision, fulfilling the socio-economic development function primarily through successful international partnerships. Challenges faced include a perceived lack of sufficient government support, limited stakeholder awareness and insufficient resources for project implementation. Over reliance on the pillar of their model, the chief executive officer in the current governance form, is an instrument in their effectiveness, yet carries significant risk. These are learnings useful for other biosphere reserves translating an international designation for a local context.

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BACKGROUND: HIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China. METHODS: A cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels. RESULTS: A moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48-3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48-0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01-2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13-0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma. CONCLUSIONS: HIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.

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Local social and ecological contexts influence the experience of poverty and inequality in a number of ways that include shaping livelihood opportunities and determining the available infrastructure, services and environmental resources, as well as people's capacity to use them. The metrics used to define poverty and inequality function to guide local and international development policy but how these interact with the local ecological contexts is not well explored. We use a social-ecological systems (SES) lens to empirically examine how context relates to various measures of human well-being at a national scale in Ghana. Using a novel dataset constructed from the 100% Ghanian Census, we examine poverty and inequality at a fine population level across and within multiple dimensions of well-being. First, we describe how well-being varies within different Ghanian SES contexts. Second, we ask whether monetary consumption acts a good indicator for well-being across these contexts. Third, we examine measures of inequality in various metrics across SES types. We find consumption distributions differ across SES types and are markedly distinct from regional distributions based on political boundaries. Rates of improved well-being are positively correlated with consumption levels in all SES types, but correlations are weaker in less-developed contexts like, rangelands and wildlands. Finally, while consumption inequality is quite consistent across SES types, inequality in other measures of living standards (housing, water, sanitation, etc) increases dramatically in SES types as population density and infrastructural development decreases. We advocate that SES types should be recognized as distinct contexts in which actions to mitigate poverty and inequality should better incorporate the challenges unique to each.

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BACKGROUND: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. RESEARCH AIM: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. METHOD: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. RESULTS: Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). CONCLUSION: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

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Scientists and managers seek to implement more inclusive and effective conservation strategies by incorporating plural valuations of nature and nature's contributions to people (NCP) into research and decision-making. For Argentina's threatened Espinal ecoregion, this need is particularly acute. In Entre Ríos province, practically all of these forests are devoted to production, and the expanding agricultural frontier increases their conversion to crops. We surveyed family ranchers and agricultural/environmental specialists, two key stakeholders for managing Espinal forests used for cattle grazing. Employing a sociocultural valuation, we determined i) stakeholder recognition of the Espinal's NCP and its support for quality of life, ii) similarity between stakeholder valuations (importance: 0 = none; 4 = very) of NCP and dimensions of well-being derived from the Espinal, and iii) relationship between ecological (e.g., forest degradation) and social (e.g., place of residence) factors and perceptions of the forest. Ranchers recognized more NCP and quality-of-life aspects, and the importance to their well-being tended to be greater than specialists. Both groups valued regulating and non-material NCP above material contributions and considered that forests are very important for physical and mental health. Finally, only rancher perceptions varied with tested variables, depending on degradation levels of forests with which they have the most contact and/or carry out their activities, the number of uses and recreational activities they carry out in forests, their knowledge of forests, and their place of residence. This study illustrates common ground upon which to promote synergies between production and conservation in Espinal-cattle agroecosystems.

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There is concern that agrobiodiversity is being irreversibly eroded in the face of agricultural industrialization. While academic and policy debates stress loss of landraces, little attention has been paid to evaluating how agricultural knowledge systems endure in response to broader social-ecological changes (i.e., "system's resilience"). For being resilient, agricultural knowledge systems should incorporate new information (modern seed varieties) whilst maintaining its traditional components (landraces) and functions. However, the loss or continuing utilization of landraces may be influenced by several social-ecological filters, which are processes that selectively remove varieties according to their phenotype, local uses, or value. We examined the resilience of agricultural knowledge systems in the southern Andes. These systems include the knowledge of landraces and modern varieties by campesinos and lifestyle migrants. We further assessed the association of social-ecological filters with the knowledge of agrobiodiversity. Over four years (2018-2022), we used mixed-methods including semi-structured interviews with gardener experts and conducted knowledge exercises of seed varieties and surveys of gardeners (n = 132). We assessed the association of 'knowledge score on varieties' (general, landraces, and modern) with a priori-defined social-ecological filters. Gardeners with more proficient knowledge of landraces were more knowledgeable of modern varieties too. The general knowledge of agrobiodiversity and the knowledge of landraces, but not of modern varieties, was higher for campesinos than migrants. The main seed source of gardeners, the participation in seed exchanges, gardeners' origin, and gardeners' age were the social-ecological filters that influenced gardeners' knowledge of agrobiodiversity. We highlight that social-ecological, small-scale farming systems, are being resilient when they have the capacity of incorporating new information (knowledge of modern varieties) whilst maintaining their identity (knowledge of landraces) without undergoing a major shift in their basic structures and functions in this Important Agricultural Heritage Site and Global Biodiversity Hotspot, and beyond.

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Purpose: This study aimed to identify the risk predictors of non-adherence to inhaler therapy and construct a nomogram prediction model for use in Chinese elderly patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: A cross-sectional study was conducted with 305 participants recruited from a tertiary care hospital in Anhui, China. Adherence was analyzed using the Test of Adherence to Inhalers. Potential predictive factors were incorporated based on the social ecological model, and data were collected through a questionnaire method. R version 4.3.3 was utilized to perform the least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis to identify risk factors and establish a nomogram prediction model. Results: The results of the multivariable analysis revealed that medication beliefs, illness perception, the COPD Assessment Test score, smoking status, and education level were significant risk factors for non-adherence to inhaler therapy in elderly COPD patients (all P < 0.05). The nomogram prediction model for non-adherence to inhaler therapy in elderly COPD patients demonstrated a good discriminative ability, with an area under the receiver operating characteristic curve of 0.912. The C-index was 0.922 (95% CI: 0.879 to 0.965), and the Brier value was 0.070, indicating good consistency and calibration. Decision curve analysis indicated that the use of the nomogram would be more beneficial in clinical practice when the threshold probability of non-adherence exceeds 17%. Conclusion: This study identified predictive factors regarding non-adherence among elderly patients with COPD and constructed a predictive nomogram. By utilizing the nomogram model healthcare professionals could swiftly calculate and comprehend the non-compliance level of COPD patients, thus guiding the development of personalized interventions in clinical practice.

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Socio-ecological systems (SESs) in arid regions have experienced multiple transformations throughout history due to human activities and natural forces. However, few studies have used the resilience cycle model to explain the resilience status and determinants of SESs over the past two millennia. This study proposes the adaptive cycle resilience (ACR) perspective to investigate regime shifts of socio-ecological system interactions in the Tarim River Basin (TRB) over the past two millennia. An ACR framework combining a piecewise linear regression model (PLR), ACR theory, and physical resilience models has been built to assess and quantify socio-ecological system resilience. Key indicators such as climate variability, settlement numbers, war frequency, glacier accumulation, and oasis area changes are identified and quantified to evaluate SESs adaptability and transformability. Glacier accumulation serves as a proxy for long-term climate change, while oasis area changes reflect the direct impact of human activities and environmental feedback on ecosystem productivity. Population and war indicators provide insights into social system stability and the impact of conflicts on SESs dynamics. The findings reveal that the 7th century and 1850s are critical points of regime shifts in the ACR. 200s BC-350s AD and 700s AD-900s AD are in the forward loop (r-K) period of the ACR. 350s AD-700s AD and 900s AD-1850s AD are the adaptive resilience backward loop (Ω-α) phase. Assessing the historical socio-ecological system resilience and identifying key transition points can inform proactive measures to mitigate potential regime shifts. Combining historical data with resilience theory provides a deep understanding of the ACR of SESs and their driving factors. This enriches the theoretical understanding of SESs and offers a robust case study for future resilience assessments and scenario analyses in arid regions.

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Mesopelagic fishes are a vital component of the biological carbon pump and are, to date, largely unexploited. In recent years, there has been an increased interest in harvesting the mesopelagic zone to produce fish feed for aquaculture. However, great uncertainties exist in how the mesopelagic zone interacts with the climate and food webs, presenting a dilemma for policy. Here, we investigate the consequences of potential policies relating to mesopelagic harvest quotas with a dynamic social-ecological modeling approach, combining system dynamics and global sensitivity analyses informed by participatory modeling. Our analyses reveal that, in simulations of mesopelagic fishing scenarios, uncertainties about mesopelagic fish population dynamics have the most pronounced influence on potential outcomes. The analysis also shows that prioritizing the development of the fishing industry over environmental protection would lead to a significantly higher social cost of climate change to society. Given the large uncertainties and the potential large impacts on oceanic carbon sequestration, a precautionary approach to developing mesopelagic fisheries is warranted.

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Systems theory and complex science, especially knowledge of social-ecological interdependencies, are urgently needed in planning and decision-making on sustainable urban development due to the intensification of the contradiction between human development and nature conservation. Here, we present an analytical framework, the "social-ecological coupling trajectory", that integrates the social-ecological coupling, multi-stability, causal feedbacks and sustainable management through understanding the evolution of the urban social-ecological system (SES). This framework is applied to a typical urban SES, i.e., China's rapidly prosperous Pearl River Delta (PRD). Our results indicate that the SES evolution in the PRD is a phased process, which is accompanied by a continuous decline in major ecosystem services (ESs) and the disproportionate decline of ecological management performance. Further analysis shows that social and economic policies have a decisive role in driving the evolution of SES and the cumulative effect of sustained human interference is directly linked to the disproportionate increase in sustainability challenges. The findings of critical slowing down and evolution patterns of SES in the PRD may provide evidence for the threshold recognition and regime shift prediction in SES. In sum, this study expands the theoretical framework and empirical knowledge of SES evolution and provides a pathway for sustainable development of regions seeking prosperity from the social-ecological coupling perspective.

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PURPOSE: Assistive technology (AT) can increase or maintain the quality of life and overall well-being of people with disabilities. Nevertheless, access to AT is limited among Hispanics with disabilities in the United States (U.S.). AT research representing the experiences of Hispanics is limited, potentially leading to disparities in AT use. Moreover, poor inclusion of Hispanics neglects the needs of this population, resulting in discrepancies in research, practice, and policy related to AT. To address these limitations, this study aimed to identify and explore multilevel environmental barriers to AT use among a sample of Hispanics in the U.S. METHODS: This was a descriptive qualitative research design study guided by the Social Ecological Model framework using in-depth interviews to collect data. Nine Hispanic individuals with disabilities and their caregivers who received AT services at the University of Illinois at Chicago Assistive Technology Unit outpatient clinic were interviewed. Data was analyzed using a qualitative thematic analysis approach. RESULTS: Barriers to AT use were found to exist in all levels of the Social Ecological Model. The most common barriers to AT use were identified in the community domain, which was related to the lack of AT information, and in the societal domain, which was related to sociocultural norms and the availability of AT funding, policies, and regulations. CONCLUSIONS: The participants' lived experiences and perspectives underscored that environmental barriers to AT use are not isolated occurrences; rather, systemic attitudes permeate across all levels of the Social Ecological Model.

Limited availability of assistive technology information and services in Spanish is a challenge that can impact assistive technology usage.Bridging language and cultural gaps is crucial to ensuring equitable access to assistive technology and rehabilitation services.Multilevel environmental barriers impact assistive technology use, adversely impacting the quality of life and overall well-being of Hispanics with disabilities.

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BACKGROUND: Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations. METHODS: Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. RESULTS: The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). CONCLUSION: Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.

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BACKGROUND: Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services. METHODS: We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent's self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model. RESULTS: Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team's person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation. CONCLUSIONS: In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT's effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

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PURPOSE: This study aims to comprehensively examine the determinants of depression among urban older adults in Seoul, utilizing the social-ecological model to address multifaceted influences. METHODS: A comprehensive analysis was conducted using data from the 2022 Seoul Aging Survey, which surveyed 2,914 individuals aged 65 and above. A multiple logistic regression analysis was performed to identify factors contributing to depressive symptoms, including socio-demographic characteristics, health behaviors and status, research accessibility, social support, and environmental influences. RESULTS: This study revealed that poor subjective health (OR = 1.47) and the presence of multiple chronic diseases (OR = 1.59) significantly increased the risk of depressive symptoms among urban older adults. From a social support standpoint, living alone was associated with a higher risk of depression (OR = 1.66), low food security (OR = 2.56), and low digital competency (OR = 2.70) were all significant predictors of depressive symptoms. Additionally, a lack of engagement with cultural facilities (OR = 2.15) was identified as a critical environmental factor contributing to depression. CONCLUSIONS: The findings underscore the need for comprehensive policy and practical interventions aimed at preventing chronic disease, enhancing social support networks, improving digital literacy, ensuring food security, and expanding access to healthcare and cultural facilities. Such measures are crucial in mitigating depression among urban older adults, thereby enhancing their overall well-being and quality of life.

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Human-driven land use change can result in unequitable outcomes in the provision and appropriation of ecosystem services (ES). To better address equity-related effects of land use change in decision-making, analyses of land use and ES changes under different land use management alternatives should incorporate ecological and social information and take a disaggregated approach to ES analysis. Because such approaches are still scarce in the literature, we present a generalized social-ecological approach to support equitable land use decision-making (in terms of process and outcomes) and an example of its application to a case study in southwestern Ethiopia. We propose a six-step approach that combines scenario planning with equity-focused, disaggregated analyses of ES. Its application in our study area made equity-related effects of land use change explicit through the recognition of different beneficiary groups, value types, and spatial locations. We recommend the application of our approach in other contexts, especially in the Global South.

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To effectively manage water constraints (WCs) within a basin, it is crucial to first scientifically delineate their spatial distribution and thoroughly understand the interactions between WCs. Investigating the complex driving mechanisms at multiple scales is also essential. In this study, a basin WC evaluation framework is constructed using a conflict risk assessment model. The spatiotemporal variations of four types of WCs across three spatial scales in the Taihu Lake Basin (TLB) are thoroughly investigated. Furthermore, the study quantifies the trade-offs, synergy effects, and bundle patterns of these water constraints. The study employs the Optimal Parameters-based Geographic Detector (OPGD) and multivariate linear regression to identify the key socio-ecological drivers of WCs. Our findings indicate that between 2010 and 2020, water resource constraint (WREC), water environment constraint (WENC), water safety constraint (WSAC), water ecology constraint (WECC), and the comprehensive WC (CWC) displayed varying degrees of heterogeneity. Particularly, the mean values of WSAC, WECC, and CWC witnessed an increase over the decade. Additionally, all WCs exhibited a strong positive spatial autocorrelation. Synergistic interactions among WCs were predominantly observed in pairs such as WREC-WSAC, WREC-WECC, and WSAC-WECC, while a weaker trade-off effect was noted in the WENC-WECC pair. At multiple scales, we identified eight types of WC bundles capable of undergoing mutual transformations, especially at the basin scale. The primary drivers of WCs varied across different stages and scales, with most factors collectively exerting a more significant impact than individually. Notably, factors like secondary and tertiary industry GDP (X2), population density (X3), precipitation (X6), and elevation (X7) were identified as core drivers influencing the evolution of WCs in the TLB. Integrating these spatiotemporal characteristics and driving mechanisms of WC interactions into basin planning and management can significantly support the alleviation of multidimensional water constraints in territorial spaces.

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BACKGROUND: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. METHODS: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. DISCUSSION: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. SYSTEMATIC REVIEW REGISTRATION: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ.

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When reasoning about causes of sustainability problems and possible solutions, sustainability scientists rely on disciplinary-based understanding of cause-effect relations. These disciplinary assumptions enable and constrain how causal knowledge is generated, yet they are rarely made explicit. In a multidisciplinary field like sustainability science, lack of understanding differences in causal reasoning impedes our ability to address complex sustainability problems. To support navigating the diversity of causal reasoning, we articulate when and how during a research process researchers engage in causal reasoning and discuss four common ideas about causation that direct it. This articulation provides guidance for researchers to make their own assumptions and choices transparent and to interpret other researchers' approaches. Understanding how causal claims are made and justified enables sustainability researchers to evaluate the diversity of causal claims, to build collaborations across disciplines, and to assess whether proposed solutions are suitable for a given problem.