Search Results (37)

Background/Objectives: Dietary supplements (DSs) and over-the-counter (OTC) medications for mood improvement and stress relief are widely used, but little is known about how their use relates to coping preferences, trust in physicians, and communication with doctors. This exploratory cross-sectional study compared users and non-users of such products in Poland. Methods: Data were collected between October 2024 and May 2025 and included 798 adults recruited through a mixed-mode convenience sampling strategy (636 online and 162 in person). Participants were classified as current users (CUs; n = 184), past users (PUs; n = 297), or never-users (NUs; n = 317). The outcomes included hypothetical future coping strategies (under an assumption of unlimited resources), trust in physicians using an author-translated adaptation of the Trust in Doctors in General (T-DiG) scale and three-category communication-related attitudes. Multivariable models were adjusted for age, gender, education, medical or health science background, and recruitment mode. Results: Overall, 60.3% of respondents reported current or past use. Compared with NUs, both CUs and PUs had higher adjusted odds of selecting future DS/OTC use (CUs: aOR = 5.60, 95% CI 3.44–9.14, p < 0.001; PUs: aOR = 2.44, 95% CI 1.52–3.93, p < 0.001). PUs also had higher adjusted odds of selecting psychotherapy (aOR = 1.50, 95% CI 1.04–2.17, p = 0.031; overall p = 0.018). Product-use status was associated with selected items of T-DiG: communication competency (overall p = 0.031) and global trust (overall p < 0.001). Compared with NUs, CUs had lower adjusted scores on both subscales (aMD = −0.19, 95% CI −0.33 to −0.04, p = 0.010 and aMD = −0.40, 95% CI −0.59 to −0.21, p < 0.001, respectively). Overall product-group effects were also observed for the first two communication items: CUs had lower relative risk ratios than NUs for discussing product-related doubts first with their physician (RRR = 0.52, 95% CI 0.35–0.78, p = 0.001) and for feeling free to raise such doubts (RRR = 0.57, 95% CI 0.36–0.92, p = 0.022). Conclusions: Product-use status showed selective associations with hypothetical coping preferences, physician trust, and communication-related attitudes rather than a uniform pattern of reluctance to seek professional support. Current use was most strongly associated with lower trust and less favorable product-related communication attitudes. Given the cross-sectional design and hypothetical nature of the coping outcomes, these findings do not establish causality, temporal ordering, or actual healthcare-seeking behavior. Full article

The growing deployment of European Data Spaces requires more than advanced technical infrastructures; it also demands specialised human competencies to ensure interoperability, governance, and trust. This paper redefines organisational readiness as a key indicator of the transition from experimental deployments to large-scale, governed data exchange. Although technical solutions provide the necessary foundation, training is essential to ensure that the digital transition is supported by professionals capable of operating these ecosystems effectively. To address the research question, “Which competencies are required to enable data reuse within Data Spaces?”, with a specific focus on spatial data and Urban Digital Twins, this study proposes a hybrid methodology. This approach combines a top-down analysis of reference architectures (e.g., EIF and DSSC Blueprint) with a bottom-up diagnosis based on an expert-based qualitative survey. Preliminary results suggest that, although 58% of organisations identify technical integration between BIM and GIS as the main obstacle, 47% identify the shortage of specialised skills as the primary bottleneck preventing operational maturity. The analysis reveals a Maturity Plateau that hinders the transition from technical connectivity (Data Space Maturity Model Level 2) to full operational maturity (Level 3). To overcome this barrier, the study presents a convergence matrix based on the DIS4SME initiative, mapping knowledge gaps to a competency roadmap. This framework identifies urgent training needs in the semantic and legal domains, and provides an operational guide for supporting organisational maturity across Data Spaces and strengthening professional expertise. Full article

The current paper examines how individual/personality factors are associated with the political legitimacy of government restrictions at the onset of the COVID-19 pandemic. A total of 1262 US-based participants completed an online survey comprising several scales (predictor factors), such as the Just World Scale, the Police Legitimacy Scale, and the Authoritarianism Scale measuring aggression, submission, and conventionalism. In addition, they completed scales measuring their Fear of COVID and Perceptions of Government (outcome factors). The results suggest that those who viewed the president or federal government as most responsible had lower legitimacy scores than those who reported their governor, state government, or local official or government to be responsible. Also, those who aligned with the Republican party had the lowest mean for fear of COVID, while the highest was in the “Other” political affiliation, followed by the Democrats, who had the second highest. It also turned out that whereas one’s relationships with those who have been hospitalized or died as a result of COVID and individual risk factors for COVID were not significant variables in predicting perceptions of the federal government’s handling of the pandemic, the most significant factors were Authoritarianism, Fear of COVID-19, (older) Age, Change in Federal Trust and Political Ideology. Fear of COVID-19 was the only significant factor predicting government legitimacy and individual decisions to engage in protection measures during the pandemic. Theoretical and practical implications are discussed. Full article

This paper is the empirical validation companion to our prior methodology paper introducing the Automated Zero Trust Risk Management with DevSecOps Integration (AZTRM-D) methodology, conducted through multi-vector adversarial testing on physical NVIDIA Jetson Orin Nano hardware. AZTRM-D unifies DevSecOps automation, the NIST Risk Management Framework, and Zero Trust architecture with AI orchestration via Cybectr Sentinel, featuring six AI subsystems with formal specifications. Testing spanned three progressive hardening stages across seven attack categories under a blind three-tester protocol with inter-rater agreement analysis. Factory-default devices were fully compromised in under five minutes. After full hardening, zero successful breaches were recorded across any tested vector. The CI/CD pipeline achieved a vulnerability detection rate of 96.8% (Wilson 95% CI: [0.891, 0.991]). Sentinel delivered 94.1% precision, 91.8% recall, and 4.2 min average detection time within 12–18% CPU overhead on edge hardware. A 14-capability comparative analysis against five established frameworks found seven capabilities unique to AZTRM-D. The 93.7% adversarial detection rate is reported against DiCE-generated counterfactual inputs and is bounded by the black-box threat model used in evaluation; gradient-based white-box attack evaluation is documented as a scoped Stage 4 future-work item. All three testers are affiliated with Cybectr LLC, the developer of AZTRM-D and Cybectr Sentinel; this conflict of interest is the most significant limitation of the present work, and independent third-party laboratory validation is the highest-priority Stage 4 deliverable. Full article

“Can ChatGPT become a general purpose technology?” “How does the “privacy paradox” play a role in adopting ubiquitous AI technologies in a humane AI ecosystem?” To answer these research questions, this study examined the roles of AI equality, trust in the large language model (LLM) ChatGPT, the need to belong, perceived benefits of ubiquitous AI, and privacy concerns about potentially ubiquitous generative artificial intelligence (GenAI) in a human-centered AI ecosystem. Drawing from the emerging literature on the AI divide (vs. AI equality) and AI-powered digital transformation, cross-sectional survey data were collected from current ChatGPT users. The results of testing PROCESS macro models with 5000 bootstrap samples showed the relationship between AI equality and purchase intention is mediated by trust in ChatGPT and is moderated by the need to belong. Privacy concerns about ChatGPT moderate the relationship between AI equality and perceived benefits of ubiquitous GenAI, which, in turn, mediates the relationship between AI equality and purchase intention. Ethical dilemmas in developing an equitable AI ecosystem, practical implications of the “privacy paradox” for designing trustworthy and ubiquitous AI interfaces in the dynamically evolving AI-powered digital transformation landscape and electronic marketplaces, and theoretical implications of the ChatGPT epidemic in a humane AI ecosystem for the literature on general purpose technology (GPT) are discussed. Full article

Background: Although digitalization is recognized to improve the food supply chain, its effect pathways have not been thoroughly researched, especially in the context of developing countries. This study examines the association of three digitalization practices: digital internal practice (DIP), digital integration with suppliers (DIS), and digital integration with customers (DIC) with nine supply chain performance metrics: efficiency, flexibility, food safety/quality, reliability, traceability, food loss, and sustainability, mediated by operational efficiency, trust, and transparency, using food processing company case in Ethiopia. Methods: Using an explanatory approach, data from 153 respondents were analyzed through mediation-based structural equation modeling (SEM) in JASP (v.0.95.4.0). The analysis involved 27 direct and 81 indirect effect paths. Results: The results demonstrated a fundamental comprehension that while digital practices manifest direct positive (improvement) effects, a purely direct-impact assessment is insufficient. Statistically, more than half of the suggested direct paths were not significant. The total effects, on the other hand, were significant for all 27 paths tested with much stronger positive associations. Conclusions: The mediation-based examination of the relationship of digitalization practices on food supply chain performance offers essential insight, indicating that the impact of digitalization on supply chain performance is primarily indirect, functioning through the enhanced capabilities it fosters. Full article

The transition to circular models in fashion and textiles requires changes that go beyond technical innovation. The literature recognises that systemic change depends on the transformation of shared meanings around consumption and production, and that spaces for co-design and collaborative learning are crucial to generating this transformation. This article documents how Living Labs operate in this capacity, analysing the Madeback Circular Fashion Festival (May–November 2025), a pilot project of the Fashion & Textile Living Lab at the Politecnico di Milano. The study employs the Living Lab Integrative Process (LLIP) as both a design framework and an analytical lens. Adopting a qualitative and participatory method, the study documents how the three spaces of the LLIP—Problem Space, Solution Space and Implementation Space—simultaneously structured both design innovation and empirical analysis. The results point to three main contributions: (i) Living Labs can function as cultural infrastructures in which performative and narrative dimensions may contribute to the gradual normalisation of alternative practices; (ii) the Quadruple Helix operates as a living process characterised by distributed intentionality and emerging trust; and (iii) transformative learning appears through the co-production of knowledge in embodied and relational practices. The article identifies contextual factors that enabled the project—from its location in a design university to its multi-year funding—and the related constraints on transferability, concluding that Living Labs are promising infrastructures for sustainable transitions when they consciously integrate performative, cultural and relational dimensions. Full article

Metaverses have been hailed as the next arena for a wide spectrum of technovation and business opportunities. This research (∑ N = 714) focuses on the three underexplored areas of virtual commerce in AI-enabled metaverses: blockchain-powered cryptocurrencies, non-fungible tokens (NFTs), and AI-powered virtual influencers. Study 1 reports the mediating effects of (dis)trust in AI-enabled blockchain technologies and the moderating effects of consumers’ technopian perspectives in explaining the relationship between blockchain transparency perception and intention to use cryptocurrencies in AI-powered metaverses. Study 1 also reports the mediating effects of Neo-Luddism perspectives regarding metaverses and the moderating effects of consumers’ social phobia in explaining the relationship between AI-algorithm awareness and behavioral intention to engage with AI-powered virtual influencers in metaverses. Study 2 reports the serial mediating effects of general perception of NFT ownership and psychological ownership of NFTs as well as the moderating effects of the investment value of NFTs in explaining the relationship between acknowledgment of the nature of NFTs and intention to use NFTs in AI-enabled metaverses. Theoretical contributions to the literature on digital materiality and psychological ownership of blockchain/cryptocurrency-powered NFTs as emerging forms of digital consumption objects are discussed. Practical implications for NFT-based branding/entrepreneurship and creative industries in blockchain-enabled metaverses are provided. Full article

Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p < 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field. Full article

For this article, we reviewed and synthesized narratological theories on reliability and unreliability and used them as the basis for an exploratory study, examining how real readers respond to a literary short story that contains several unreliable or conflicting narrative accounts. The story we selected is “In a Grove” by Ryūnosuke Akutagawa (orig. 藪の中/Yabu no naka) from 1922 in the English translation by Jay Rubin from 2007. To investigate how readers evaluate trustworthiness in narrative contexts, we combined quantitative and qualitative methods. We analyzed correlations between reading habits (i.e., Author Recognition Test), cognitive traits (e.g., Need for Cognition; Epistemic Trust), and trust attributions to characters while also examining how narrative sequencing and character-specific reasons for (dis)trust shaped participants’ judgments. This mixed-methods approach allows us to situate narrative trust as a context-sensitive, interpretive process rather than a stable individual disposition. Full article

Background: Malnutrition and systemic inflammation are prevalent among older hospitalized patients and are associated with increased morbidity and mortality. The C-reactive protein to albumin (CRP/Alb) ratio reflects inflammatory and nutritional status and may serve as a useful prognostic biomarker. Objective: To evaluate the prognostic value of the CRP/Alb ratio in predicting early in-hospital mortality in a large cohort of elderly patients, independent of the admission diagnosis. Methods: This retrospective observational study examined the clinical data and serum values of serum C-reactive protein (CRP), albumin, and the CRP/Alb ratio, detected at the time of admission, in a cohort of 2780 patients over sixty-five admitted to the Internal Medicine and Aging Department of the “Policlinico Riuniti” University Hospital Trust in Foggia, between 2019 and 2024. The predictive power of the CRP/Alb ratio for 7- and 30-day hospital mortality was evaluated by ROC curve analysis, Cox regression, and Kaplan–Meier survival analysis. Results: In total, 444 patients died (16%) during their in-hospital stay. The CRP/Alb ratio was significantly higher among deceased subjects (p < 0.001) than in non-deceased patients. The CRP/Alb ratio was strongly associated with mortality, particularly during the first 7 days from admission (AUC = 0.888). A CRP/Alb ratio >8 was an independent and significant predictor of mortality within 30 days (HR = 3.82, 95% CI: 2.91–5.01), but particularly within the first 7 days from hospitalization (HR = 10.17, 95% CI: 6.05–17.08). Similar results were observed among re-hospitalized patients. Conclusions: The CRP/Alb ratio is a significant and independent predictor of early in-hospital mortality in elderly patients, regardless of admission diagnosis. A threshold value >8 identifies individuals at high risk, particularly within the first week of hospitalization. This simple, cost-effective biomarker may support early risk stratification and guide targeted interventions in geriatric care. Full article

The complexity of large-scale group decision-making (LSGDM) in the digital society is becoming increasingly prominent. How to achieve efficient consensus through social networks (SNs) has become a core challenge in improving the decision quality. First, conventional clustering methods often rely on a single-distance metric, neglecting both numerical assessments and preference rankings. Second, ensuring the decision authenticity requires considering diverse behaviors, such as trust propagations, risk preferences, and minority opinion expressions, for scientific decision-making in SNs. To address these challenges, a consensus-reaching process (CRP) method based on an enhanced K-means++ clustering is proposed. The above method not only focuses on minority opinion handling (MOH), but also incorporates decision indicator sets (DISs) to analyze the degree of opinion divergences within groups. First, the Hamacher aggregation operator with a decay factor completes trust matrices, improving the trust representation. Second, a personalized distance metric that combines cardinal distances with ordinal distances is incorporated into the enhanced K-means++ clustering, enabling more precise clustering. Third, weights for decision-makers (DMs) and subgroups are determined based on trust levels and degree centrality indices. Fourth, minority opinions are appropriately handled via considering the diverse backgrounds and expertise of DMs, leveraging a difference-oriented DIS to detect and adjust these opinions via weight modifications until a consensus is reached. Fifth, the alternative ranking is objectively generated via DIS scores derived from multigranulation rough approximations. Finally, the feasibility of the proposed method is validated via a case study on unmanned aerial vehicle (UAV) selection using online reviews, supported by a sensitivity analysis and comparative experiments demonstrating superior performances over existing methods. The result shows that the proposed model can enhance clustering accuracies with hybrid distances, objectively measure the consensus via DISs, handle minority opinions effectively, and improve LSGDM’s overall efficiencies. Full article

Research about the lived experiences of asylum-seeking and refugee youth can evoke powerful emotions for those involved. Young people who escaped perilous situations often bear strong emotions linked to their experiences of migration and displacement, as well as their encounters with disorientation, insecurity, isolation, discrimination and racism in unfamiliar contexts in the host society. Such emotions and emotionally charged places can be challenging to work with as researchers and require reflexive and situated methodological and ethical judgements. This paper investigates the emotional complexities of fieldwork with vulnerable young people by reflecting on (dis)comfort and discusses how to negotiate these issues with care and consideration. It draws from qualitative participatory and creative fieldwork experiences using story mapping, photovoice, walk-along and community theatre approaches in Amsterdam, Brussels, Leipzig and Newcastle-Upon-Tyne. It reports on a range of critical ethical and methodological issues that arose in our work that address meaningful relationships, reciprocity and trust, understanding the field, positionality and reflexivity, and challenges around the co-production of knowledge and leaving the field. Throughout, the paper flags various complex and, at times, ambiguous ethical and methodological issues that emerged throughout the research process and argues for research approaches that are sensitive to the contextual and multi-faceted nature of investigating young refugees and asylum seekers in European cities. Full article

This study examines the structural relationship between a destination’s image (DI), social influence (SI), and tourists’ brand trust (BT) and brand loyalty (BL) in the destination of Tozeur, a Tunisian town located at the gateway to the Sahara and rooted in the Atlas Mountains, where George Lucas set scenes for the Star Wars saga. The structural correlations between the variables in the model were tested through structural equation modeling (SEM). Data from 1405 tourists, who had visited Tozeur, were analyzed through SEM using AMOS software (version 25). The results showed that DI significantly affects BT (β = 0.924, p < 0.001) and significantly affects BL (β = 0.481, p < 0.01). Additionally, SI significantly affects BT (β = 0.274, p < 0.001) and significantly affects BL (β = 0.234, p < 0.001). Furthermore, BT significantly affects the BL (β = 0.461, p < 0.01). Tourist’s trust in a brand was found to act as a partial mediator on the link between destination image and brand loyalty and between social influence and brand loyalty. The findings demonstrate the importance of the tourism destination as well as social influence in boosting tourism trust and increasing destination loyalty among tourists. The results have many practical implications for destination marketers. Full article

Demographic data pertain to people’s identities and behaviors. Analyses of demographic data are used to describe patterns and predict behaviors, to inform interface design, and even institutional decision-making processes. Demographic data thus need to be complete and correct to ensure they can be analyzed in ways that reflect reality. This study consists of interviews with 40 people in STEM and addresses how causes of relational (dis)trust in demographic data collection contribute to pervasive problems of missing and incorrect responses and disobliging responses (e.g., non-disclosure, false responses, attrition, and hesitancy to use services). The findings then guide a preliminary set of recommendations for cultivating trustworthiness based on recent developments in trust theory and designing for responsive and trustworthy systems. Specifically, we explore how demographic questionnaire design (e.g., item construction and instructions) can communicate necessary reassurances and transparency for users. The ongoing research provides interview-based recommendations for improving the quality and completeness of demographic data collection. This research adds to other recommendations on improving demographic questionnaires. Full article