Search Results (3,192)

Creativity has been frequently explored in artists’ work. However, this concept has also been studied in the economic context of business and management. The concept of creativity has also recently become a subject of tourism research, as tourism is considered an important industry. Tourism classifications that include experiences are becoming more widespread. Alternative and special-interest tourism encompasses a range of tourism types presenting unique experiences. Within the classifications of sport, adventure, and experiential tourism, commercial tandem paragliding can be examined through a creative tourism lens in terms of perceived learning, interaction, and unique involvement. Hence, this research was conducted in Babadağ, Fethiye, a renowned paragliding destination. A total of 360 visitors were included as the participants. PLS-SEM was used to estimate a structural equation model. The results clearly demonstrate the centrality of the creative tourist experience. Firstly, the direct effect of the creative tourist experience on behavioral intentions was found to be quite strong and significant. The results show that the creative tourist experience is strongly and positively associated with behavioral intentions (revisit, recommendation, and positive word of mouth). The effect of the creative tourist experience on memories indicates that creative experiences leave a strong impression on visitors’ memories. Similarly, the creative tourist experience had a significant and positive effect on satisfaction. Considering these three results together, it can be said that creative experiences strengthen cognitive/affective memories, increase overall evaluative satisfaction, and directly affect behavioral intentions. This finding is consistent with the experiential and creative tourism literature on the determinative role of experience quality in memory value and satisfaction. These findings reveal that creative tourist experiences strengthen both memories and satisfaction; that memories are positively related to satisfaction and behavioral intentions; and that satisfaction is positively related to behavioral intentions, thereby extending fundamental assumptions in the experience economy and creative tourism literature to the specific context of commercial tandem paragliding as a guided air-based adventure activity. The study’s unique contribution to the literature is that it not only examines creative tourism through cultural/workshop-based experiences, but also conceptualizes creative tourism through adventure activities involving high involvement and high arousal, and empirically demonstrates the importance of creative-experience quality in explaining behavioral intentions through “memorability” and “satisfaction”. Full article

Falls are one of the most common and devastating effects of neurological diseases, especially in patients with stroke outcomes, Parkinson’s Disease (PD), and Multiple Sclerosis (MS). To prevent negative outcomes and guide tailored rehabilitation, it is necessary to identify risk factors early. The current study aims to assess whether and how the risk of falling is related to spatiotemporal and kinematic parameters in stroke, PD, and MS. It also seeks to determine how these factors can help manage patients and identify more personalized and appropriate rehabilitation treatments. Ninety patients with neurological disorders (stroke, PD, and MS) underwent eight weeks of home-based rehabilitation using the ARC Intellicare device or following a paper-based protocol. At baseline (T0) and at the end of the protocol (T2), they were assessed using the Silver Index of the hunova^® robotic platform to evaluate fall risk, and instrumental gait analysis to record spatiotemporal and kinematic parameters of walking. Statistical analysis showed moderate and significant correlations between the Silver Index and gait spatiotemporal parameters such as stance and swing phase, both in affected (T0, p = 0.007; T2, p = 0.017) and unaffected side (T0, p = 0.022; T2, p = 0.008), double support in affected side (T0, p = 0.002; T2, p = 0.005), cycle length in affected (T0, p = 0.007; T2, p = 0.003) and unaffected side (T0, p = 0.008; T2, p = 0.003), and cadence (T0, p = 0.025; T2, p = 0.003) in stroke patients. No significant results emerged in the PD and MS. No population showed significant correlations between the Silver Index and gait kinematic parameters. The Silver Index may reflect distinct patterns of instability in post-stroke gait, but in PD and MS, multiple factors influence the risk of falling that instrumental gait analysis cannot fully capture, requiring a more extensive and multidimensional approach that includes cognitive aspects. Full article

Background/Objectives: Family caregivers of individuals with dementia frequently experience substantial psychological distress, yet their emotional responses are heterogeneous. Depression, anxiety and psychological well-being may co-occur in distinct patterns, and socio-economic resources such as education and income are often hypothesized to buffer caregiver distress. This study aimed to identify latent psychological profiles among dementia caregivers and to examine whether education and income moderate the association between affective symptoms and well-being. Methods: A cross-sectional study was conducted with 73 family caregivers of dementia patients attending the Neurology–Psychiatry Department of C.F.2 Clinical Hospital, Bucharest (November 2023–April 2024). Participants completed the PHQ-9 (depression), the COVI Anxiety Scale and Ryff’s Psychological Well-Being Scales. Care recipients’ cognitive status was extracted from medical records using the MMSE. Gaussian Mixture Modeling was used for latent profile analysis (LPA). Between-profile differences were examined using one-way ANOVAs and Tukey post-hoc tests and Pearson correlations were used to assess associations between affective symptoms and psychological well-being, and examined whether education and income were associated with profile membership and psychological well-being. Results: LPA supported a three-profile solution: (1) lower depressive symptoms with moderate anxiety (33%), (2) severe combined depression and anxiety (18%) and (3) moderately severe depression with severe anxiety (49%). Profiles differed significantly in depressive symptom severity, whereas anxiety severity did not differ significantly across profiles. Caregivers in Profile 3 (moderately severe depression–severe anxiety) reported significantly higher overall psychological well-being than those in Profile 1 (moderate depression–moderate anxiety). In contrast, caregivers in Profile 2 (severe depression–severe anxiety), who exhibited the highest affective symptom burden, showed intermediate levels of overall well-being, with comparatively lower scores on specific dimensions such as purpose in life. Depressive symptoms were weakly but significantly associated with autonomy and self-acceptance, whereas anxiety symptoms showed no significant associations with psychological well-being. Education level and household income were not significantly associated with profile membership or psychological well-being. Conclusions: Family caregivers of individuals with dementia can be meaningfully described as forming three exploratory psychological profiles characterized by different configurations of depressive and anxiety symptoms. These findings indicate that caregiver distress does not follow a simple severity gradient and that psychological well-being is not solely determined by symptom burden. Socio-economic characteristics did not account for differences in caregiver adjustment, underscoring the importance of individualized psychological assessment and tailored interventions to support caregiver mental health. Full article

Unique fractal characteristics are significantly controlled by shale lithofacies, mineralogical characteristics, and OM features, which in turn determine reservoir properties and gas-bearing capacity. However, a comprehensive understanding of fractal features has remained insufficient. This study presents a systematic investigation into the full-scale pore size distribution for the Wufeng–Longmaxi shales in Sichuan Basin which employed low-pressure CO₂ adsorption (CO₂GA), N₂ adsorption (N₂GA), and mercury injection capillary pressure (MICP), as well as field emission scanning electron microscope (FE-SEM) techniques. The fractal dimensions of pores across different pressure ranges were revealed by different fractal models. The results demonstrate that the shale pores are dominated by micro- to mesopores and partial extremely larger pores, contributed primarily by organic matter (OM) pores and microcracks, respectively. Fractal dimensions follow a consistent increasing order: D_C < D_N1 < D_N2 < D_M or D_C < D_N1 < D_M < D_N2, suggesting that larger pores with diameters lager than 5 nm are more heterogeneous and complex compared to the pores less than 5 nm (smaller pores). This is because smaller pores are predominantly composed of OM pores, while larger pores comprise a mixture of OM pores, mineral-related pores, and microcracks. Different fractal dimensions, in turn, are influenced by distinct factors. The D_C value exhibits a positive correlation with micropore volume. D_N1 and D_N2 values are positively correlated with the content of brittle minerals and TOC, while they show negative correlations with the content of clay minerals. Notably, D_M values do not demonstrate a significant correlation with shale compositions, primarily owing to the development of microcracks. Fractal dimensions, particularly D_N1 and D_N2, are significantly controlled by the lithofacies of shale. The highest D_N1 and D_N2 values occur in the siliceous shale lithofacies, and the mixed shale lithofacies exhibit moderate D_N1 and D_N2 values, whereas the lowest D_N1 and D_N2 values primarily occur in clay-rich shale lithofacies. Different fractal dimensions show various correlations with shale gas content. The Langmuir volume as well as total gas content exhibit significant correlations with D_N1 and D_N2 values, while they exhibit no obvious correlations with D_C and D_M values. This implies that pores with diameters of 1.8–55 nm serve as primary storage sites for both adsorbed and free gas. The findings can significantly improve the cognition of adsorbed gas and free gas behavior in shale reservoirs. Full article

The rapid emergence of generative artificial intelligence (GAI) is reshaping academic work in higher education. While classical technology acceptance models primarily emphasize cognitive and instrumental determinants, the adoption of GAI also raises ethical concerns related to trust in AI systems and the protection of personal and institutional data. To address this gap, this study examines the determinants of GAI acceptance and use among academic staff in Slovenian higher education institutions by applying a UTAUT-based model that integrates trust and privacy. In this study, GAI is conceptualized as a class of text-based generative AI tools commonly used in academic practice, including applications such as ChatGPT, Copilot, Scholar AI, Gemini, Consensus, and similar systems. A quantitative research design was employed, based on a structured online survey administered to academic staff across 20 higher education institutions in Slovenia (n = 201). Data were analyzed using multilevel confirmatory factor analysis and generalized estimating equations. The results indicate that performance expectancy and attitude toward using significantly predict behavioral intention to use GAI (B = 0.49, p < 0.001 for both), while behavioral intention is the primary predictor of actual use behavior (B = 0.93, p < 0.001). Effort expectancy is positively associated with use behavior independent of behavioral intention (B = 0.23, p = 0.012), whereas trust does not show a statistically significant association with use behavior (B = 0.05, p = 0.458) or behavioral intention (B = −0.01, p = 0.840). Privacy exhibits a positive, but non-statistically significant, association with use behavior (B = 0.12, p = 0.058). The findings highlight the relevance of considering both cognitive and ethical factors when examining generative AI adoption in academic contexts and provide initial empirical insights for refining UTAUT-based frameworks in the context of emerging AI technologies. Full article

Background/Objectives: White matter degeneration is a significant and early mediator of cognitive impairment in Alzheimer’s disease (AD), yet the critical pathologic features remain poorly understood, under-detected, and therapeutically untargeted. Herein, we characterize molecular features of white matter glial cells in AD brains and assess the utility of non-invasive approaches for detecting related abnormalities in extracellular vesicles (EVs) isolated from serum (SEV). In addition, results from unfractionated (SEV-T) and O4 sulfatide-selected SEVs were compared to determine whether white matter abnormalities were detected with greater sensitivity in oligodendrocyte-specific SEVs (SEV-O4). Methods: Oligodendrocyte glycoprotein and astrocyte mRNA levels were measured in postmortem human AD and control frontal lobe white matter by RT-PCR. Immunoreactivity to oligodendrocyte glycoproteins, astrocyte structural proteins, neurofilament light chain (NfL), and aspartyl-asparaginyl-β-hydroxylase (ASPH) was measured by ELISA in SEV-T and SEV-O4 from patients with moderate AD or normal aging. Results: AD brain pathology was associated with significantly reduced mRNA expression of multiple oligodendrocyte glycoproteins and increased mRNA expression of astrocytic structural genes. SEV analyses demonstrated significantly increased immunoreactivity to 2′,3′-cyclic nucleotide 3′ phosphodiesterase (CNPase), myelin-associated glycoprotein 1 (MAG1), astrocyte proteins, and ASPH, a potent activator of Notch and myelin-regulated homeostatic functions. There were no significant benefits of measuring SEV-O4 compared with SEV-T immunoreactivity. Conclusions: AD is associated with significant molecular abnormalities in oligodendrocyte and astrocyte function in brain tissue. The abnormalities detected in SEVs likely reflect oligodendrocyte injury and degeneration, as well as astrocytic activation. The findings suggest that low-invasive SEV approaches, including the novel analysis of ASPH upregulation, can be used to detect and monitor AD white matter degeneration. Full article

Background/Objectives: Screening instruments are relevant for assessing the mental health of older adults, favoring clinical practice and research. However, there is a need for instruments with sufficient evidence of validity for use in Latin America and the Caribbean (LAC), where they are growing. This scoping review aims to evaluate the existing evidence regarding the psychometric properties of mental health measurement instruments used with older adults from LAC. Methods: Eight databases (PubMed, CINAHL, Medline, Embase, Scielo, Scopus, Web of Science, PsycINFO) were searched to extract relevant articles about instruments to measure mental health outcomes in older adults in English, Spanish, and Portuguese. After the first screening and duplicate removal, 6307 were retrieved. Results: The full-text screening identified 312 articles for inclusion in the review. Most of the articles were from Brazil (49.04%). One hundred eighty instruments (52.79%) assessed cognition, mainly using the Mini-Mental State Examination (MMSE), followed by 11.14% for depression, most commonly with the Yesavage Depression Scale (GDS). The assessment of validity was predominantly based on two criteria (34%), and 56% of the evidence was published in the last 10 years. To improve usability, we have provided a practical guide to help LAC clinicians and researchers identify and select robustly validated and contextually appropriate assessment instruments. Conclusions: There is still little evidence of the validity of instruments that measure other aspects of mental health beyond cognitive functioning. There seems to be no unified set of criteria in Latin America for determining whether an instrument has sufficient valid evidence. More work is needed on cross-cultural validity evidence within the region. Full article

Background: The acceptance of new vaccines under uncertainty—such as during the COVID-19 pandemic—poses a major public health challenge because efficacy and safety information is still evolving. Methods: We propose an integrative analytical framework that combines a theory-based model of vaccine acceptance—the cognitive–affective–normative (CAN) model—with machine-learning techniques (decision tree regression, random forest, and Extreme Gradient Boosting) and SHapley Additive exPlanations (SHAP) integrated into an importance–performance map (IPM) to prioritize determinants of vaccination intention. Using survey data collected in Spain in September 2020 (N = 600), when the AstraZeneca vaccine had not yet been approved, we examine the roles of perceived efficacy (EF), fear of COVID-19 (FC), fear of the vaccine (FV), and social influence (SI). Results: EF and SI consistently emerged as the most influential determinants across modelling approaches. Ensemble learners (random forest and Extreme Gradient Boosting) achieved stronger out-of-sample predictive performance than the single decision tree, while decision tree regression provided an interpretable, rule-based representation of the main decision pathways. Exploiting the local nature of SHAP values, we also constructed SHAP-based IPMs for the full sample and for the low-acceptance segment, enhancing the policy relevance of the prioritization exercise. Conclusions: By combining theory-driven structural modelling with predictive and explainable machine learning, the proposed framework offers a transparent and replicable tool to support the design of vaccination communication strategies and can be transferred to other settings involving emerging health technologies. Full article

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder. It is estimated that AF affects over 52 million people worldwide, with its prevalence expected to double in the next four decades. AF significantly increases the risk of stroke and heart failure, contributing to 340,000 excess deaths annually. Beyond these life-threatening complications, AF results in limitations in physical, emotional, and social well-being causing significant reductions in quality of life and resulting in 8.4 million disability-adjusted life-years per year, highlighting the wide-ranging impact of AF on public health. Moreover, AF is increasingly recognized for its association with cognitive decline and dementia. AF is a chronic and progressive disease characterized by rapid and erratic electrical activity in the atria, often in association with structural changes in the heart tissue. AF is often initiated by triggered activity, often from ectopic foci in the pulmonary veins. These triggered impulses may initiate AF via: (1) sustained rapid firing with secondary disorganization into fibrillatory waves, or (2) by triggering micro re-entrant circuits around the pulmonary venous-LA junction and within the atrial body. In each instance, AF perpetuation necessitates the presence of a vulnerable atrial substrate, which perpetuates and stabilizes re-entrant circuits through a combination of slowed and heterogeneous conduction, as well as functional conduction abnormalities (e.g., fibrosis disrupting tissue integrity, and abnormalities in the intercalated disks disrupting effective cell-to-cell coupling). The re-entry wavelength, determined by conduction velocity and refractory period, is shortened by slowed conduction, favoring AF maintenance. One major factor contributing to these changes is the disruption of the extracellular matrix (ECM), which is induced by atrial fibrosis. Fibrosis-driven disruption of the ECM, especially in the heart and blood vessels, is commonly caused by conditions such as aging, hypertension, diabetes, smoking, and chronic inflammatory or autoimmune diseases. These factors lead to excessive collagen and protein deposition by activated fibroblasts (i.e., myofibroblasts), resulting in increased tissue stiffness, maladaptive remodeling, and impaired organ function. Fibrosis typically occurs when cardiac fibroblasts are activated to myofibroblasts, resulting in the deposition of excessive collagen and other proteins. This change in ECM interferes with the normal electrical function of the heart by creating irregular, fibrotic regions. AF and atrial fibrosis have a reciprocal relationship: AF promotes fibrosis through fibroblast activation and extracellular matrix buildup, while atrial fibrosis can sustain and perpetuate AF, contributing to higher rates of AF recurrence after treatments such as catheter ablation or cardioversion. Full article

Background and aims: Amid global aging, the role of diet in cognitive health is crucial. The healthful plant-based diet index (hPDI) is linked to cardiometabolic benefits, but its association with cognitive function in older adults, particularly through nutritional status and across different socio-geographic contexts, remains unclear. This study investigated the association between hPDI and multidimensional cognitive function, the mediating role of nutritional status, and potential associated modifications by urban–suburban location and gender. Methods: A community-based cross-sectional study was conducted in Shanghai, China, involving 2079 older adults (aged ≥60). Dietary intake was assessed by a validated food frequency questionnaire (FFQ) to calculate hPDI. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Basic (MoCA-B), and Clinical Dementia Rating (CDR). Nutritional status was measured by the Mini Nutritional Assessment (MNA). Hierarchical regression, interaction, and mediation analyses were performed, adjusting for comprehensive covariates based on social determinants of health (SDoH). Results: Higher hPDI was significantly associated with better cognitive scores (MMSE: β = 0.083, p < 0.001; MoCA-B: β = 0.069, p < 0.001) and lower odds of worse CDR (OR = 0.944, p < 0.001) in fully adjusted models. In the cross-sectional mediation analysis, MNA statistically mediated a significant proportion of the observed associations (MMSE: 41.25%; MoCA-B: 53.68%; CDR: 38.98%). The protective association was consistent across urban and suburban areas. However, a significant three-way interaction (hPDI × Gender × Area, p < 0.01) was found, with no cognitive benefit observed for males in suburban areas. Conclusions: Adherence to a healthful plant-based diet is associated with better cognitive function in older adults, partly statistically mediated by improved nutritional status. While this association is geographically equitable in Shanghai, suburban males do not appear to benefit, highlighting the need for gender- and context-sensitive dietary interventions. Full article

This study examines the relationship between perceived employee environmental, social, and governance (ESG) behavior and consumer meaningfulness by exploring the mediating role of moral elevation and perceived authenticity, as well as the moderating role of consumers’ skepticism. The study draws upon the integration of self-determination theory and social cognitive theory. Prior research has often neglected the outcomes of interaction between employee behaviors and consumer perceptions. Th study used a sequential explanatory research design to understand the observable perceived ESG behaviors of the employees and the psychological outcomes of the consumers. The study involved 390 consumers from five-star hotels in Addis Ababa, Ethiopia. The data was gathered through a survey and analyzed using a structural equation model via the Smart-PLS tool. The interview data were collected from 16 frontline employees of five-star hotels and analyzed through thematic analysis. The quantitative results confirmed perceived employee ESG behavior is positively and significantly associated with consumers’ sense of meaningfulness, moral elevation, and perceived authenticity. Additionally, moral elevation and perceived authenticity significantly mediate the link between perceived employee ESG behavior and consumer sense of meaningfulness. Furthermore, consumer ESG skepticism negatively moderates the link between employee ESG behavior and both moral elevation and perceived authenticity. The qualitative study indicated that internal motivation of the company predicts employee behaviors, promoting voluntary actions to build consumers’ meaningfulness. The study advances theories and suggests implications for policymakers and managers regarding ESG behaviors among employees and the way consumers perceive them. Full article

The objective of this study was to analyze social perception, trust, and vaccine hesitancy through a combined approach of bibliometric analysis and qualitative synthesis, based on the most cited articles in the recent scientific literature. A systematic search was conducted in indexed databases, identifying patterns of production, collaboration, citation, thematic networks, and conceptual trends associated with the study of public trust in vaccines. The results reveal a marked geographic concentration of scientific production, dominated by the United States and the United Kingdom, as well as a strong articulation of thematic clusters linked to digital disinformation, health communication, risk perception, and psychosocial determinants of vaccine acceptance. The qualitative synthesis of the most influential studies reveals that vaccine hesitancy is a multidimensional phenomenon, determined by sociocultural, cognitive, emotional, and structural factors that interact dynamically according to each context. Disinformation, institutional trust, community narratives, and the credibility of sources emerge as central components in individual decision-making. Together, the integrated results enable a deeper understanding of vaccine hesitancy beyond traditional cognitive models, highlighting the need for contextualized communication strategies, intercultural approaches, and health policies based on trust and social participation. This study provides an integral view of the scientific landscape and establishes priority lines for future research and the design of effective public health interventions. Full article

Background and Objectives: Cognitive disorders are a significant health problem in patients undergoing peritoneal dialysis and can profoundly impair both quality of life and treatment outcomes. Early identification of risk factors for the development of cognitive disorders in this population is therefore essential. This study aimed to (1) determine the prevalence of cognitive dysfunction in patients on peritoneal dialysis, (2) examine its association with sociodemographic characteristics, and (3) assess whether anaemia is associated with cognitive dysfunction in these patients. Materials and Methods: A cross-sectional study was conducted in November 2024 at the University Clinical Centre of Vojvodina, Clinic for Nephrology and Clinical Immunology, and included 36 patients on peritoneal dialysis. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function, while a structured questionnaire was used to collect sociodemographic data. Anaemia was determined based on haemoglobin levels. Results: Cognitive dysfunction was present in 69.4% of patients on peritoneal dialysis, while anaemia, as indicated by haemoglobin values, was present in 58.3% of the sample. Older age, rural residence, and lower haemoglobin levels were significantly associated with cognitive dysfunction in patients on peritoneal dialysis. Conclusions: Preserved cognitive function is a key prerequisite for the adequate implementation of peritoneal dialysis and for maintaining patients’ quality of life. The findings indicate the need for further research to identify effective strategies for preventing and treating anaemia, a factor associated with cognitive dysfunction in this patient population. Full article

In extreme scenarios, to prevent the leakage of jamming coordination information, the jammers must proactively terminate their communication functions and implement jamming resource scheduling via Non-Networked Cooperation. However, current research on this non-networked jamming approach is relatively limited. Furthermore, existing algorithms either rely on networked interactions or lack cognitive strategies for the surrounding communication countermeasure situation. For example, they fail to adapt to dynamic changes in electromagnetic noise and struggle to determine jamming effectiveness, leading to low jamming efficiency and severe energy waste in non-networked scenarios. To address this issue, this paper establishes a game process and corresponding algorithm for non-networked communication countermeasures and designs cognitive, cooperative, and scheduling strategies for individual jammers. Meanwhile, a novel performance metric called the “Overall Communication Suppression Ratio (OCSR)” is proposed. This metric quantifies the relationship between “sustained full-suppression duration” and “ operating duration of the jamming system,” overcoming the defect that traditional metrics cannot evaluate the dynamic jamming effectiveness in non-networked scenarios. Experimental results indicate that although the OCSR of the proposed Intelligent Concentric Circle Algorithm (ICCA) is significantly lower than that of the Full-Power Jamming Algorithm (FPJA), ICCA extends the operating duration of the jamming system by 4.8%. This achieves non-uniform power setting of jammers, enabling flexible and dynamic jamming in non-networked scenarios and retaining more battery capacity for jammers after overall jamming failure. Full article

The present exploratory study investigates how pre-primary and primary student teachers (STs) at the Universidad Autónoma de Madrid (UAM) perceive the impact of bilingual education programs (BEPs) on children’s learning experience. Specifically, it examines student teachers’ views on the benefits and challenges of implementing Content and Language Integrated Learning (CLIL) in pre-primary and primary education and explores whether there are differences between the opinions of the two groups. The analysis is based on data from six items of a structured questionnaire, validated in previous studies and completed by 170 prospective pre-primary and primary teachers at the UAM. The results suggest a shared perception among STs that BEPs enrich the learning experience of students in both pre-primary and primary education. Most STs recognize that CLIL enhances language proficiency and supports cognitive development, although they also point to insufficient teacher training and the low motivation of children with learning difficulties as major challenges. While no major differences emerged between the views of pre-primary and primary STs, subtle variations point to the existence of two distinct trainee profiles that determine their views on BEPs and that would require further mid-term investigation. The findings highlight areas for targeted support in teacher training programs. Full article