Search Results (11,876)

Under growing geopolitical uncertainty and rising expectations for responsible development, regional governance increasingly functions as a cross-border signal that shapes how region brands are evaluated in international markets. Drawing on moral legitimacy theory, this study examines whether morally legitimatized regional governance is associated with region brand reputation and, in turn, host-country consumer trust. We conceptualize morally legitimatized regional governance through three dimensions—governance vision altruism, governance procedural transparency, and governance structural compatibility—and test the proposed model using survey data from 975 consumers who had purchased or intended to purchase foreign brands. Structural equation modeling shows that all three dimensions are positively associated with region brand reputation, which is subsequently associated with higher host-country consumer trust. Among the three governance dimensions, procedural transparency shows the strongest association with region brand reputation, followed by structural compatibility and vision altruism. Multi-group analyses further show that perceived economic distance and cultural distance significantly condition the associations between morally legitimatized regional governance and region brand reputation. These findings indicate that responsible regional governance is not only a public governance issue but also a sustainability-relevant intangible asset associated with reputation spillovers in international markets. The study extends moral legitimacy theory to the regional governance context, clarifies the reputational transmission mechanism from governance to host-country consumer trust, and shows that the effectiveness of governance signals depends on host-country context. The results also suggest that regions seeking to build reputation in international markets should move beyond symbolic sustainability narratives and invest in verifiable transparency, governance capability, and context-sensitive communication. Full article

Background: Patients with limited English proficiency (LEP) in the United States face significant barriers to safe and equitable healthcare despite federal protections guaranteeing access to qualified interpreter services at no cost. Many patients with LEP remain unaware of these rights, relying instead on informal learning through clinical encounters and community networks which are unreliable pathways that may perpetuate language access disparities. Point-of-care educational interventions grounded in just-in-time and situated learning theory represent a promising but understudied approach to bridging this gap. Objective: The aim was to examine Spanish-speaking emergency department patients’ interpreter access patterns, baseline knowledge of federal language rights, and immediate responses to a brief multilingual point-of-care educational video intervention. Methods: A pre–post survey design was used with a convenience sample of 40 Spanish-speaking adult patients presenting to a large, level 1 trauma center ED in the Southeastern United States between February and April 2025. Participants completed a 22-item iPad-administered Spanish-language survey that included baseline knowledge questions, an embedded 2 min educational video about federal language access rights, and post-video response questions. Descriptive statistics were calculated for quantitative data and thematic analysis was conducted for open-ended responses, with two independent coders achieving substantial inter-rater agreement (κ = 0.75, p < 0.001). Fisher’s exact tests examined associations between interpreter access mode and patient demographic characteristics. Results: Most participants (70%) accessed interpreters passively rather than by self-request, a pattern that did not vary significantly by patient status, age, or length of time in the United States. At baseline, 57.5% knew that federal laws prohibit language discrimination in healthcare and 77.5% knew they were entitled to a free qualified interpreter. Most participants (80%) reported learning something new from the video, with responses centering on rights awareness and anti-discrimination protections. Most participants (70%) reported that knowing their federal rights was helpful, describing increased confidence and reduced anxiety. All participants (100%) reported difficulty communicating without an interpreter and nearly all (97.5%) felt more confident asking questions when one was present. Conclusions: Significant knowledge gaps persist even among patients with some baseline rights awareness; a brief culturally appropriate point-of-care video may meaningfully increase awareness and confidence. The consistently passive pattern of interpreter access across all demographic subgroups underscores the need for proactive institutional practices and patient-facing education that empowers LEP patients to advocate for themselves in healthcare settings. Full article

The use of artificial intelligence (AI) in the radiological field has been extensively investigated from the radiologists’ perspective. Existing studies have primarily focused on AI’s contribution to diagnostic processes and on how its introduction has transformed—and continues to transform—radiologists’ professional practice. The perspectives of radiographers remain underrepresented in the literature, despite their central role in image acquisition and their position as the primary “on-the-ground” operators and managers of imaging technologies. The objective of this study was to analyze the perceptions, attitudes, and expectations of Italian radiographers regarding the introduction of AI, and to provide insights to inform professional training and organizational strategies within healthcare systems. A cross-sectional survey study with qualitative enhancement was adopted as the study design. A survey was administered to a convenience sample, comprising 222 respondents. The findings reveal a high level of familiarity with AI in everyday life, accompanied by an almost complete absence of cultural resistance, suggesting a workforce that is both receptive and ready to evolve. Nevertheless, this individual readiness is contrasted with a substantial institutional and operational gap, characterized by the lack of standardized protocols, regulatory uncertainty, and an uneven distribution of technological resources. The effective integration of AI therefore requires a comprehensive and coordinated approach. Educational reform is necessary to integrate AI and radiomics into university curricula and continuing professional development programs, encompassing not only technical competencies but also ethical, deontological and communication skills. Finally, national and European regulatory frameworks must evolve to clearly define radiographers’ responsibilities within AI-assisted workflows, to establish robust guidelines for data governance and the management of algorithmic outputs. Full article

Digital technologies are increasingly recognized as key tools for improving productivity and supporting rural development in agricultural systems. However, their effective adoption by small-scale producers remains limited in many developing regions. This study analyses the determinants of mobile application adoption among livestock farmers in Amazonas, Peru. Using a structural equation model (PLS-SEM) based on survey data from 160 producers in rural areas, the results show that perceived ease of use is the main driver of adoption, directly influencing farmers’ intention to use mobile applications and significantly determining perceived usefulness, which acts as a key mediating factor. Despite widespread smartphone ownership, their use is largely limited to communication and social media rather than production management, mainly due to barriers such as mistrust, limited rural connectivity, and insufficient digital knowledge. The findings suggest that effective adoption requires integrated strategies that combine the development of user-friendly applications, the demonstration of their economic benefits for producers, and public policies aimed at improving digital infrastructure and strengthening digital skills. By identifying the key determinants of adoption, this study contributes to understanding how mobile technologies can support productivity improvements and promote rural development in livestock systems in the Peruvian Amazon. Full article

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services. Full article

Background: With the rapid aging of populations worldwide, strengthening the professional capacity of long-term care (LTC) workers has become a critical priority for health systems. While competency-based training frameworks are widely implemented, it remains unclear which domains of competency are most closely associated with ethical professionalism in daily care practice. Methods: A cross-sectional survey was conducted with 268 LTC workers across home-based, community-based, and institutional settings in Taiwan. Multiple linear regression analyses were performed to examine the associations between core competency domains and perceived ethical professionalism. Results: Participants reported relatively high levels of overall competency and ethical professionalism. Among the competency domains, interpersonal communication (β = 0.345, p < 0.001), psychological support (β = 0.184, p = 0.020), and teamwork (β = 0.111, p = 0.045) were significantly associated with ethical professionalism. In contrast, technical competencies, including physical care, daily living care, and emergency management, were not significantly associated (p > 0.05). Conclusions: The findings suggest that ethical professionalism in LTC practice is more strongly associated with relational and psychosocial competencies than with technical skills. These results highlight the importance of incorporating communication, emotional support, and teamwork training into workforce development programs. Prioritizing these competencies in training frameworks may be associated with improved care quality, workforce sustainability, and person-centered care delivery in aging societies. Full article

Background: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may support healthcare access, continuity of care, and disaster preparedness in underserved settings. This study examined the Texas A&M University (TAMU) nurse-led mobile clinic model with respect to rural service delivery, health equity, operational considerations, and disaster preparedness. Methods: A mixed-methods descriptive program evaluation was conducted using programmatic operational data, survey responses, and preparedness-planning records. The TAMU mobile clinic serves six rural counties through primary, preventive, and behavioral healthcare delivery using in-person care, telehealth, and home visits. Disaster preparedness activities were integrated through the annual Disaster Day interprofessional simulation involving approximately 600–700 learners. A 2025 Central Texas flooding event served as a case study to evaluate operational preparedness and system readiness. Results: Mobile clinic operations supported healthcare access, continuity of care, and community engagement in rural settings. Interprofessional education simulation findings demonstrated perceived gains in teamwork, triage, communication, and rapid decision-making. During the 2025 flooding event, activation protocols were initiated; however, deployment was not authorized, highlighting system-level constraints related to administrative approval pathways despite operational readiness and workforce preparedness. Conclusions: Nurse-led mobile clinics may serve as an adaptable infrastructure for improving rural healthcare access, supporting continuity of care, and strengthening disaster preparedness. Findings further emphasize that clinical preparedness alone is insufficient without coordinated administrative processes, interoperable systems, and governance structures capable of supporting rapid emergency deployment. Full article

Even with the rise in concern over suicide and drug overdose mortality in the United States, gaps in research on at-risk populations still exist. The purpose of this study was to investigate disparities in suicide and drug overdose mortality risk among Washington State workers. Using 2014–2023 Washington State death records and American Community Survey (ACS) data, we calculated rates of suicide and drug overdose mortality by usual industry and occupation while adjusting for age and stratifying by sex and race/ethnicity. We compared the mortality risk among workers in specific industries and occupations to all workers within the same sex and race/ethnicity strata to understand how work differentially affects risk. Working in Construction & Extraction occupations was associated with an increased risk for suicide and drug overdose death for males across all race/ethnicity categories and for drug overdose death among White females. The suicide risk for Asian/Pacific Islander males had the largest increase—Asian/Pacific Islander males working in Construction & Extraction occupations had a rate 4.59 times higher than all Asian/Pacific Islander male workers. The Education, Training, & Library occupation group had significantly lower crude rates and rate ratios. Although the causal pathways that may lead someone to die by suicide or drug overdose are complex, understanding risk profiles among different industries and occupations may lead to more appropriate prevention strategies. Full article

The growing environmental crisis and rapid urbanization have made the shift to renewable energy systems even more important for smart city development. In today’s cities, such renewable energy sources as solar photovoltaics, wind energy, hybrid systems, and battery energy storage are no longer just separate assets. They are now important parts of smart grids, intelligent buildings, and urban infrastructure that work together. However, putting these systems in cities on a large scale makes it harder to monitor, control, integrate, scale, and work with them in real time. In this setting, the Internet of Things (IoT) and edge computing are technologies that make it possible to turn traditional renewable energy systems into smart, responsive, and self-sufficient urban energy systems. IoT-based monitoring and control systems let city operators, utilities, and policymakers gather real-time data, improve grid stability, optimize energy flows, and better integrate distributed renewable energy sources into smart city ecosystems. Edge computing makes these features even better by allowing for low-latency processing, more localized decision-making, and less reliance on centralized cloud infrastructures. This paper offers a thorough and methodical examination of contemporary IoT- and edge-enabled technologies used to monitor, control, and integrate renewable energy systems; specifically highlighting their significance in smart city and smart grid applications. The review combines the most recent research on hardware platforms, communication protocols, data processing architectures, and edge–cloud coordination mechanisms used in solar, wind, and hybrid energy systems. Additionally, this review synthesizes architectural design principles extracted from analyzed studies to guide the development of scalable, resilient, and cost-efficient renewable energy monitoring systems. This study offers a structured foundation for the design of scalable, resilient, and cost-effective renewable energy management systems that align with the sustainability, efficiency, and intelligence goals of future smart cities by analyzing cutting-edge solutions and pinpointing significant technological trends, challenges, and research deficiencies. This review also highlights its contribution vis-à-vis previous surveys by stressing the inter-domain comparison across solar, wind, and hybrid systems. It focuses, in particular, on edge–cloud coordination and architecture-level trade-offs pertinent to smart grid and smart city deployments. Full article

With rapid urbanization, community-level governance has become an important aspect of urban sustainability, increasing the need to understand how non-traditional actors participate in local affairs. Although food delivery riders possess a unique spatial proximity to local neighborhoods, empirical research on their willingness to participate in community governance remains limited. This study examines the relationship between policy perception (cognition, trust, and gain) and riders’ willingness to participate in community governance, analyzing the parallel mediating roles of institutional, social, and spatial embeddedness. Survey data from 441 food delivery riders in Beijing were analyzed using ordinary least squares (OLS) regressions and bootstrap-based mediation analysis. The results show that policy cognition, trust, and benefit perceptions positively predict participation willingness. Furthermore, institutional, social, and spatial embeddedness significantly mediate this relationship, with social embeddedness showing the largest indirect effect. Heterogeneity and dimensional analysis indicate that policy gain is associated with basic volunteering but lacks a significant relationship with high-tier advice-giving. The findings suggest that sustaining high-tier civic participation depends on normative institutional trust and value identification within rights-protective frameworks. Full article

To scientifically evaluate the health of river aquatic ecosystems in the Qianxinan Buyi and Miao Autonomous Prefecture, southwestern Guizhou, systematic surveys of benthic macroinvertebrate and periphytic algal communities were conducted in representative rivers during October 2024 (autumn) and April 2025 (spring), coupled with concurrent water quality monitoring. Reference sites were selected based on water quality indicators and habitat conditions. Core parameters were identified through correlation analysis, discriminatory ability analysis, and distribution range analysis to construct a Benthic Index of Biotic Integrity (B-IBI) and a Periphytic Algae Index of Biotic Integrity (P-IBI) suitable for the region. These indices were then applied to assess the ecological health of the rivers. Additionally, stepwise regression analysis was employed to investigate the key environmental drivers influencing the two biotic integrity indices. The results indicated that: (1) In terms of species composition, the benthic macroinvertebrate community structure was relatively simple, dominated by arthropods, particularly chironomid larvae. Bacillariophyta and Cyanophyta consistently dominated the periphytic algae community. (2) Assessments using both B-IBI and P-IBI showed that the overall river health in spring was slightly better than in autumn. However, more than half of the sampling sites were rated as “fair” or worse in both seasons. The reference sites (S2, S10) consistently exhibited “excellent” or “good” health, while the impaired sites showed significant spatial heterogeneity. Discrepancies between B-IBI and P-IBI ratings at some sites revealed differential responses of the two biological communities to environmental stressors. (3) Stepwise regression analysis unveiled a seasonal shift in key environmental drivers. The primary factor affecting the B-IBI in autumn was biochemical oxygen demand (BOD₅), which shifted to total phosphorus (TP) and ammonia nitrogen (NH₄⁺-N) in spring. For the P-IBI, the main factor changed from dissolved oxygen (DO) in autumn to chemical oxygen demand (COD) in spring. These findings confirm the applicability of the B-IBI and P-IBI systems in this region, and indicate that multi-assemblage integrated assessments can contribute to understanding the health status of river ecosystems in the Qianxinan Prefecture. This study could serve as a scientific reference for the protection, management, and restoration of local river ecosystems. Full article

Developing translation competence among non-English-major students at Chinese universities remains a pedagogical challenge, especially given the rising demands of cross-cultural communication. This quasi-experimental study examined whether first-year medical students at a Chinese university could improve their translation skills using the constructivist–objectivist theoretical approach (COTA), which combines constructivist learning theories (e.g., active student participation, collaboration, analysis of real-world issues) with objectivist learning methodologies (e.g., sequential skill development, explicit knowledge transfer). In total, 110 students participated in this mixed-methods study. The research methods included (a) pre- and post-tests of students using College English Test Band 4 criteria to evaluate vocabulary, grammar, and accuracy; (b) student perception surveys; (c) semi-structured interviews with instructors; and (d) classroom observations of students, using Gagné’s nine instructional events to ensure faithful implementation of the COTA framework. The COTA-trained students showed statistically significant improvements in translation skills compared to the control group. Additionally, increased student participation and engagement, positive attitudes toward learning, instructors’ ability to implement COTA effectively, and areas for future development were identified in the qualitative findings. These results suggest that integrating constructivist and objectivist teaching philosophies can benefit curriculum designers, language and translation instructors, and policymakers aiming to enhance translation education in Chinese universities and other Asia-Pacific institutions. However, the modest sample size from a single institution limits generalizability, and future studies with larger, more diverse samples are recommended. Full article

Residential outdoor spaces serve as the most important venue for outdoor activities of home-based older adults. Their livability and age-friendliness have become a hot topics of active discussion in recent years and a key aspect of urban residential renewal. From an interactive perspective (i.e., the bidirectional dynamic causal effect between older adults’ behaviors and the residential outdoor space environment), this study explores the theoretical methods of interactive renewal of residential outdoor spaces, including concepts, principles, and an age-friendly design framework. Through field investigations of two typical communities (multi-row type and row-point combined type), and using methods such as behavioral observation, GPS tracking, questionnaire surveys (216 valid responses), space syntax, and kernel density analysis, this research examines the interaction process between residential outdoor spaces and older adults, analyzes existing problems, demonstrates the feasibility of integrating interactive renewal design with outdoor space design, and proposes design strategies for age-friendly renewal of residential outdoor spaces. This study supplements research on outdoor “space-behavior” interactions and contributes to improving the age-friendliness of communities. Full article

Background/Objectives: Access to specialists and diagnostic resources continues to limit differential diagnosis of cognitive impairment in primary care. This pilot study examined the feasibility, usability, and clinical integration of a digitally supported Remote Cognitive Assessment (RCA) model embedded in general practice settings. Methods: A mixed-method design was used, combining structured quantitative surveys from patients (n = 10; mean age = 77.03; SD = 14.1) and neuropsychologists (10 RCAs completed by three neuropsychologists) with qualitative interviews from general practitioners (GP; n = 4). Patients were assessed remotely via a secure videoconference system operated by trained neuropsychologists. Assessments were conducted in the GP’s office, supported by local staff, to facilitate the process. Results: Patients reported high satisfaction with audio (M = 8; SD = 2.28) and video quality (M = 9.17; SD = 1.17) and expressed a strong willingness to recommend RCA (M = 8.83; SD = 1.17) on a 10-point Likert scale. Despite moderate scores for perceived simplicity (M = 5; SD = 3.41) and effectiveness (M = 5.83; SD = 2.14), overall acceptance (M = 8.33; SD = 0.82) was favorable, especially given the older age of participants. Neuropsychologists rated technical functionality positively (audio quality M = 8.17; SD = 1.18; video quality M = 8; SD = 1.67) but raised concerns about clinical utility and diagnostic depth (effectiveness M = 2.83; SD = 2.71). GPs highlighted the benefits of local facilitation, early screening, and improved access to specialist input while also noting space limitations, communication gaps, and the need for sustainable infrastructure. Conclusions: The RCA model was well accepted by patients and GPs, and technically feasible for neuropsychologists. However, neuropsychologists reported important reservations regarding usability and effectiveness. The results suggest an important mismatch between patient satisfaction and clinical confidence and RCA cannot yet be recommended for routine clinical implementations based on patient acceptability alone. This model holds promises for hybrid cognitive care, particularly in underserved or rural areas, but future development must prioritize diagnostic confidence and clinician workflow usability before scalable integration into rural cognitive care pathways can be established. Full article

Inflation, recognized as a social determinant of health (SDOH), significantly affects the daily lives of individuals through the rising costs of food, housing, and other basic needs, all of which are public health concerns. Since the COVID-19 pandemic, inflation has become a prominent concern in the U.S. and has been linked to increased stress and poor mental health among adults. While data on inflation is tracked routinely, how it is discussed publicly is understudied. Social media platforms provide insights into how inflation is framed and experienced by the public, and these assessments may be used to determine public health needs and policy advocacy. In this study, we conducted a time-bound, platform-specific case study of inflation-related discourse on X (formerly Twitter). Analysis revealed a predominance of negative sentiments (68.5%) including frustration and distrust. Posts primarily concerned monetary policy/government spending (31.6%), Federal Reserve interest rates/financial markets (24.5%), and U.S. presidential politics (12.9%). The users did not explicitly discuss personal-level hardships, and the discussions largely focused on macro-level issues framed in polarized political perspectives. These patterns matter for public health because institutional trust shapes support for social and health policies. Our study findings suggest a fragmented social environment that may exacerbate community-wide anxiety and challenge health promotion efforts and the need for public health surveillance through surveys or personal interviews to identify and address the psychological burden of inflation. Full article