Search Results (4,275)

Background and Objectives: Rising malpractice litigation and the strengthening of patient-rights legislation have changed the way hospital staff approach informed consent and legal risk. This study aimed to (i) assess the distribution of informed-consent knowledge, malpractice anxiety, and defensive practice across professional and departmental groups; (ii) identify independent predictors of high defensive practice; and (iii) evaluate experience-related moderation of the legal-literacy–anxiety association and predictor consistency across defensive-practice severity. Methods: We conducted a cross-sectional survey of 146 healthcare workers (physicians, nurses, midwives, and allied health professionals) from four departments of a tertiary academic hospital network, using a 46-item pilot-tested instrument measuring informed-consent knowledge (0–20), malpractice anxiety (0–100), and defensive-practice behaviors. Results: Physicians showed higher informed-consent knowledge than nurses (14.1 vs. 12.0 points, p < 0.001) but also higher malpractice anxiety (63.4 vs. 57.6, p = 0.015). High defensive practice was associated with a prior malpractice claim (adjusted odds ratio 3.24), surgical specialty (2.47), low consent literacy (2.21), physician role (2.10), and knowing a sued colleague (1.88). Anxiety was highest in emergency medicine; predictors also operated across ordered defensive-practice severity, and the legal-literacy–anxiety association was stronger at lower experience (interaction p = 0.023). Conclusions: Knowledge, anxiety, and defensive practice were unevenly distributed; defensive practice reflected professional context and direct or vicarious litigation exposure, while the legal-literacy–anxiety association varied with experience. Medico-legal education may therefore be best paired with structured consent procedures and experience-sensitive support; larger multi-center studies are needed. Full article

Historic university campuses increasingly face simultaneous demands for functional renewal and heritage conservation amid rapid urbanization. However, the relationship between campus landscape perceptions and students’ built heritage conservation intention, together with the psychological pathways underlying this relationship, remains insufficiently understood. This cross-sectional study examines the association between Campus Landscape and Built Heritage Conservation Intention, focusing on the mediating roles of Place Identity and Place Dependence. Using a multidimensional place-attachment framework, the proposed model was tested with structural equation modeling (SEM) based on 569 student questionnaires collected at the Jungong Road Campus of the University of Shanghai for Science and Technology (formerly Hujiang University), which contains the Hujiang University modern architectural complex, designated as a major historical and cultural site protected at the national level in China. Campus Landscape was positively associated with Built Heritage Conservation Intention. Place Identity showed a significant positive indirect association, whereas the indirect association through Place Dependence was not statistically significant. In subgroup analyses, the estimated indirect association through Place Dependence was positive among undergraduates and negative among postgraduates, but it was not statistically significant in either subgroup and should therefore be interpreted as exploratory. These findings highlight the significant indirect association through Place Identity and offer illustrative implications for campus landscape planning that is attentive to place identity and for the conservation of historic campuses in active use. Full article

Transnational higher education (TNE) partnerships between Chinese and UK universities continue to expand. However, the structural conditions that shape teaching quality and the governance arrangements through which they are managed remain under-theorised from a faculty-centred perspective. Drawing on a survey-based mixed-methods cross-sectional study of 56 teaching staff (80% response rate) at a Sino-British dual-degree engineering programme in western China, this study provides single-case evidence that teaching workload was the strongest observed negative correlate of perceived institutional support/satisfaction. Total weekly teaching load was moderately and negatively associated with the overall support/satisfaction composite (Spearman’s ρ = −0.49, p < 0.001). Non-parametric paired comparisons showed that teaching facilities were the only support dimension that differed significantly between the two institutional contexts, with a moderate effect; the remaining dimensions showed no significant differences. Internal consistency was acceptable to good. Qualitative thematic analysis identified three faculty adaptation strategies: simplifying and contextualising course materials, using bilingual instructional resources, and scaffolding peer-based discussion. Exploratory teaching-method comparisons involving 13 paired tests, interpreted descriptively, indicated higher reported use of reflection exercises and project-based learning at the joint school campus. An exploratory, perception-based engagement paradox also emerged: faculty reported a higher proportion of students showing >75% active participation at the joint school campus (85.7%) than at the parent institution (70.4% of valid responses), despite rating joint-school infrastructure lower. This finding requires student-level validation. The study contributes an empirically grounded, faculty-centred account of workload governance in transnational partnerships, using the Sino-British case as an illustrative test site. Full article

This single-institution case study examined faculty acceptance and instructional use of social media at the United Arab Emirates University (UAEU), with emphasis on individual-level demographic associations and faculty perceptions of technology-enhanced learning. A cross-sectional survey of 246 faculty members was analyzed using descriptive statistics and contingency-table methods. Female faculty reported higher instructional use than male faculty (88.0% vs. 75.3%; χ²(1, N = 246) = 5.07, p = 0.024; Φ = 0.144; OR = 2.41, 95% CI [1.16, 5.00]), indicating a small association. For age, the omnibus 5 × 2 chi-square test was not statistically significant (χ²(4, N = 246) = 8.17, p = 0.085), although an ordered trend test suggested increasing non-use with age (z = 2.34, p = 0.019); descriptively, this pattern was driven mainly by the 61–70 group rather than a steady increase across all age categories. Academic rank differed overall (χ²(3, N = 246) = 8.70, p = 0.034), but the pattern was non-monotonic, and the prespecified junior-versus-senior comparison was not significant (χ²(1, N = 246) = 2.00, p = 0.157). Faculty reported benefits related to communication, collaboration, audiovisual learning, mobile access, and academic networking, alongside concerns about distraction and reduced interpersonal interaction. Because the study was conducted at one university with a 26.25% response rate, the findings are context-specific and should not be generalized to all UAE or Gulf higher-education institutions. Full article

Financial media risk is jointly driven by multisource content, including news reports, corporate announcements, social media posts, short videos, and livestreams, while content authenticity, propagation velocity, asset relevance, and trading infrastructure conditions can simultaneously influence short-term market fluctuations. To address the limitations of existing methods, including their reliance on either textual information or market sequences, insufficient source verification, and inadequate alignment of asynchronous multimodal signals, FMRP-Net is proposed for artificial intelligence-driven sensing. Event semantics, risk categories, and asset association information are first extracted through a pretrained financial language model and cross-modal consistency analysis. A dual-layer hardware reliability perception module is then employed to integrate sensing evidence from cameras, microphones, terminal inertial signals, server temperature, power consumption, network traffic, and transmission latency. Heterogeneous temporal propagation graphs, cross-frequency alignment, and bidirectional propagation–market coupling are further incorporated to jointly predict market direction, volatility, risk level, and propagation trends. Experimental results demonstrate that FMRP-Net achieved an Accuracy of $0.832$, a Macro-F1 of $0.824$, a ROC-AUC of $0.891$, an MCC of $0.665$, and a PR-AUC of $0.883$ for market direction prediction over future horizons of 5, 15, 30, and 60 min, indicating a balanced performance in terms of Precision and Recall. For volatility prediction, MAE, RMSE, and MAPE values of $0.0178$, $0.0271$, and $12.46\%$ were obtained, respectively, together with an $R^2$ of $0.812$. In the ablation study, the media risk Macro-F1 and source reliability AUC reached $0.842$ and $0.929$, respectively, while the propagation-scale prediction error was reduced to $0.109$ and the average early-warning lead time reached $10.6$ min. These results demonstrate that the integration of multimedia semantics, hardware sensing evidence, and propagation structures can effectively improve the accuracy, stability, and interpretability of financial market prediction and risk early warning. Full article

Background: The number of vaccines recommended for adults and older people has increased in recent years, and same-visit coadministration represents a potential strategy to improve vaccination coverage and timeliness. However, its implementation in primary care may depend on general practitioners’ (GPs) attitudes, vaccination experience, and organisational factors. This study investigated knowledge, attitudes, and practices (KAP) regarding vaccine coadministration among GPs in Apulia, Southern Italy. Methods: We conducted an anonymous cross-sectional online survey between January and June 2026 among practicing GPs and general practice trainees working in outpatient primary care settings in Apulia. The questionnaire assessed vaccination activity, intended coadministration practices, perceived effects on vaccine effectiveness and coverage, safety in very old adults or patients with multimorbidity, and perceived barriers to vaccination. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to identify factors independently associated with a positive perception of coadministration safety in very old or multimorbid patients. An additional sensitivity analysis excluded respondents reporting insufficient information to assess safety. Results: A total of 256 physicians completed the survey; 71.1% were aged ≥50 years. Most respondents had administered adult vaccines during the previous year, and 68.0% were classified as high vaccinators, having administered three or more different vaccine types. Although 68.0% believed that coadministration could increase vaccination coverage, only 13.3% reported willingness to administer three or more vaccines during a single visit. Overall, 50.0% considered coadministration very or fairly safe in very old or multimorbid patients, 24.2% considered it slightly or not at all safe, and 25.8% reported insufficient information to assess its safety. In the fully adjusted model, high vaccination activity was associated with higher odds of a positive safety perception (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.01–3.70), whereas difficulties using vaccination IT platforms were associated with lower odds (aOR 0.48, 95% CI 0.26–0.86). Age ≥ 50 years was not independently associated with the outcome after adjustment (aOR 0.66, 95% CI 0.35–1.26). Conclusions: GPs in Apulia showed generally favorable attitudes toward vaccine coadministration, although substantial uncertainty remained regarding its use in very old and multimorbid patients. Confidence in coadministration was primarily associated with greater vaccination activity and fewer difficulties with vaccination IT platforms, whereas age-related differences observed in bivariate analyses were attenuated after multivariable adjustment. Educational, organisational, and digital-support interventions may facilitate broader implementation of same-visit adult vaccination in primary care. Full article

Sustainable historic-town conservation requires preserving historical patterns and cultural memory while understanding how spatial environments shape everyday perception. Using Yun’an Ancient Salt Town in Chongqing, China, this study develops a three-layer framework of spatial topology, scene interfaces, and historical semantic elements. Space syntax, deep-learning image recognition, rule-based coding, image-based questionnaires, Spearman correlation, random forest regression, and SHAP were used to examine perceived historicity, safety, attractiveness, and comfort. The analysis combined axial models for 1985, 2004, and 2024 with 140 images—55 human view and 85 aerial view—each evaluated by 264 valid respondents. Yun’an’s street network shifted from a salt-production and transport structure toward modern traffic corridors; integration declined in the historic core, and intelligibility fell from 0.13 in 2004 to 0.07 in 2024. At the human-view scale, modern interference was negatively associated with historicity and attractiveness, whereas stairs, traditional components, and micro-historical objects were positively associated with historicity. At the aerial-view scale, historical visibility, character integrity, and blue-green-space indicators were associated with historicity, attractiveness, and comfort. Cross-validated random forest performance was strongest for aerial-view historicity and limited for other outcomes. The findings support a human-centered, culturally sustainable renewal pathway linking historical-street continuity, townscape integration, blue-green quality, and heritage-node activation. Full article

Background: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)—communication, therapeutic relationship, patient expectations, and environmental cues—are increasingly recognized yet remain inconsistently integrated into routine practice. Objective: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. Methods: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). Results: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. Conclusions: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains. Full article

(1) Background: This pilot study compared restorative practices, material-selection criteria, digital workflow adoption, and perceptions of hybrid restorative materials among 100 Romanian and foreign dentists; (2) Methods: Participants completed a 15-item questionnaire covering three domains: knowledge and clinical practice, material selection and professional perspectives, and Katana Avencia evaluation. Statistical analysis examined both item-level differences and multivariate response patterns; (3) Results: Although foreign dentists tended to favor zirconia restorations, responses within the knowledge and clinical practice domain were comparable between groups. Within the material selection and professional perspectives domain, professional perceptions of glass-ceramic restorations differed significantly between groups (p = 0.005, V = 0.45). Romanian dentists were more likely to identify translucency and durability as their main advantages, whereas foreign dentists emphasized optical and adhesive performance. Perceived barriers to CAD/CAM adoption also varied significantly (p < 0.001, V = 0.50), with Romanian dentists reporting structural barriers and foreign dentists reporting educational barriers. Significant differences in the perceived role of continuing professional education (p = 0.012, V = 0.38) reflected the greater importance assigned to continuing professional education by foreign dentists. The remaining items in this domain showed no significant differences. Both groups similarly evaluated the clinical reliability and esthetic performance of Katana Avencia restorations. However, they differed significantly in their preferred clinical indications (p < 0.001, V = 0.50), with foreign dentists favoring definitive anterior restorations and Romanian dentists favoring provisional and stress-absorbing applications. Multivariate analysis revealed distinct response profiles, with Romanian dentists associated with structural barriers to digital adoption and foreign dentists associated with continuing professional education and esthetic-oriented practice; (4) Conclusions: These findings suggest broad professional convergence within this pilot cohort, with the observed differences being associated with respondents’ perceptions of practice-related barriers, digital infrastructure, and continuing professional education. Given the exploratory, cross-sectional, and self-reported nature of the study, these associations should not be interpreted as evidence of causal or objectively measured differences between healthcare environments. Full article

Background: Pharmaceutical waste presents significant economic and environmental challenges, necessitating systemic interventions for sustainable healthcare. Community pharmacists are pivotal in mitigating this waste through optimized dispensing, patient education, and facilitating safe disposal. Methods: A nationwide cross-sectional survey was conducted to evaluate the perceptions, practices and perceived barriers of community pharmacists in Saudi Arabia. Data regarding barriers and mitigation strategies were collected using a five-point Likert scale. Results: A total of 275 pharmacists participated, with an average age of 33.86 ± 7.46 years. Pharmacists showed strong understanding of the economic impact of medication waste, with an average score of 4.41 ± 0.85. The lowest score, 2.80 ± 1.25, reflected poor public awareness about proper disposal practices. The most identified source of waste was the discarding of unopened medication packages, scoring 3.80 ± 1.05. The top barrier was the lack of national guidelines, with a score of 3.82 ± 1.01. Unified patient records and e-prescribing were viewed as the most effective strategies, scoring 4.17 ± 0.94. Practice gaps were clear, as 27.64% of pharmacies did not provide any disposal service. Conclusions: Saudi community pharmacists demonstrate high readiness but are hindered by logistical gaps and fragmented frameworks. Achieving sustainable pharmaceutical stewardship requires standardized national guidelines, formalized take-back pathways, and the expansion of digital tools like Wasfaty to align clinical practice with Saudi Vision 2030 sustainability goals. Full article

Background/Objectives: Home-based telemedicine requires patients to perform technical tasks independently, whereas assisted public health center (PHC)-based telemedicine transfers some of these tasks to on-site personnel. This study describes model-specific perceptions and estimates the difference in intention to use between the two scenarios among relatively digitally capable, community-dwelling older adults. Methods: A cross-sectional, fixed-order, scenario-based online survey was completed by 300 adults aged 65 years or older in South Korea. Home-based barriers and PHC-based facilitators were analyzed as non-equivalent descriptive domains. The primary paired comparison used three conceptually matched intention items. Internal consistency, exploratory factor evidence, 95% confidence intervals (CIs), Pearson and Spearman correlations, and multivariable linear regressions with HC3 robust standard errors were reported. Results: The seven-item home-based barrier score was 2.80 (SD 0.76; 95% CI 2.71–2.89), and the seven-item PHC facilitator score was 3.58 (SD 0.58; 95% CI 3.52–3.65). Intention scores were 3.91 (SD 0.64) for home-based and 3.88 (SD 0.66) for PHC-based telemedicine. The paired mean difference (PHC minus home) was −0.030 (95% CI −0.107 to 0.047; p = 0.441; Cohen’s dz = −0.045, bootstrap 95% CI −0.155 to 0.071). Preferences were home-based 42.7% (95% CI 37.2–48.3%), PHC-based 41.3% (95% CI 35.9–47.0%), and unsure 16.0% (95% CI 12.3–20.6%). After adjustment, digital literacy remained positively associated with both intention outcomes. Conclusions: No statistically detectable difference in intention to use was observed between the two hypothetical scenarios; this finding does not establish equivalence. The item-level results generate a hypothesis that staff-supported PHC delivery may be useful for some older adults, but actual uptake, effectiveness, accessibility, and equity require evaluation in real-world studies that include less digitally capable and more vulnerable populations. Full article

Immersive virtual reality (VR) is increasingly used in higher education, yet evidence on how perceived presence, fidelity, immersion and usability co-occur in authentic learning objects—and how they relate to prior experience and gender—remains limited. This cross-sectional study examines these four perceptual dimensions in 250 undergraduate students of Early Childhood and Primary Education at the University of Seville immediately after interacting with an immersive VR learning object built around the Future Classroom model. All variables are self-reported perceptions collected at a single post-experience time point; no learning outcomes were assessed. Data were collected with the Igroup Presence Questionnaire (IPQ), a fidelity–immersion scale and the System Usability Scale (SUS). Reliability was high across instruments (α = 0.881–0.931). Students reported moderate-to-high presence, realism, fidelity and immersion, and a notable usability score (SUS = 71.18). Presence, fidelity and immersion correlated strongly and positively, although their conceptual proximity and the shared measurement method preclude treating these associations as evidence of empirically distinct constructs. Associations with usability were weak and heterogeneous. Gender differences were absent except for involvement, an isolated result reported as exploratory. Prior experience with VR and with head-mounted displays was associated with differences in the ratings, with small effect sizes and a non-monotonic pattern: the intermediate-experience group scored lowest, whereas the low- and high-experience groups did not differ significantly from one another. The study characterises students’ perceived experience of an immersive VR learning object; it does not test its effects on learning. Full article

Ensuring the safety of produce is essential for protecting consumers and preventing foodborne illnesses. Regulatory frameworks, such as the Food Safety Modernization Act’s Produce Safety Rule (FSMA PSR), contribute to the decision-making process of produce growers in ensuring the production of safe foods. However, little research has explored the role of growers’ perceptions of responsibility for produce-associated outbreaks, and how these may influence their decisions. Using a cross-sectional online survey of 500 US small- or medium-sized produce growers, this study examined perceptions of stakeholder responsibility for two produce-related outbreaks involving jalapeños and a spinach–spring mix blend. The implications of the PSR exemptions were also investigated. Responsibility attribution differed among stakeholder groups for each produce commodity. Packing houses were identified as a common denominator responsible for both produce commodities. Medium-sized produce growers agreed that the PSR exemptions provide direct market access and reduced time commitment to exempted farms (p < 0.001). However, small-sized produce growers expressed concerns about the potential limitations of the exemptions for qualifying farms. The results provide insights to policymakers, educators, and industry stakeholders to incorporate programs that foster shared responsibility for produce safety across the food system. It also informs future evaluations of the implications of the PSR exemptions. Full article

Multi-modal image fusion integrates complementary information from different modalities to generate a unified representation that is informative for human perception and beneficial to downstream vision tasks. However, existing methods often inefficiently model global features and their cross-modal interaction is insufficient, resulting in the suboptimal preservation of structural details and modality-specific information. To address these issues, we propose SACMFuse, a structure-aware cross-modal interaction network for multi-modal image fusion. SACMFuse is built upon the linear complexity attention mechanism of LAMA, which enables efficient and effective global feature modeling. In this study, LAMA is extended into a CrossLAMA mechanism to facilitate deep-level information interaction among modalities. Within this framework, we propose a Frequency–Spatial Rectification Module (FSRM) that jointly models spatial-domain structures and frequency-domain representations in a unified manner. By perceiving and adaptively rectifying structural features across modalities, FSRM enhances the structural consistency and discriminability of the fused features. Furthermore, to strengthen cross-modal complementarity, we design a Difference-driven Cross-modal Interaction Module (DCIM), where inter-modal discrepancies explicitly guide information exchange among modalities. This mechanism encourages the network to focus on complementary structures while suppressing redundant responses. Extensive experiments on multiple datasets demonstrate that the performance of SACMFuse is competitive for the majority of metrics, providing a robust and advanced solution for image fusion tasks. Full article

Objectives: This study aimed to assess pharmacy students’ curricular exposure to deprescribing, their attitudes and preparedness to perform core deprescribing steps, and their understanding of interprofessional roles in the deprescribing process. Methods: A cross-sectional online survey that included undergraduate pharmacy students in their fifth or sixth year of study, who were enrolled in Saudi universities during the academic year 2025/2026. A 43-item self-administered validated questionnaire was used. The independent-samples t-test was used to examine differences in attitudes and preparedness among participants via SPSS 27. Results: In total, 367 students from 23 universities participated in the study; 54.0% were female, and 62.1% were in their fifth year. Familiarity with the term ‘deprescribing’ was reported by 55.3% of participants. Participants demonstrated highly positive attitudes toward the benefits of deprescribing, moderate toward misconceptions, and low toward barriers, with mean percentage scores of 85.08%, 66.50%, and 41.93%, respectively. Participants indicated moderately positive perceptions toward the non-experiential curriculum preparedness to identify and practice deprescribing and self-perception of the ability to perform core deprescribing steps, with mean percentage scores of 70.2% and 77.24%, respectively. Statistically significant differences were observed in the perception of curriculum preparedness by gender (p = 0.038), familiarity with the term deprescribing (p < 0.001), and exposure to deprescribing in the required pharmacy curriculum (p < 0.001). Participants perceived clinical pharmacists as having the greatest role across most stages of the deprescribing process. Conclusions: Undergraduate pharmacy students in Saudi Arabia recognize the value of deprescribing but have limited curricular exposure and moderate perceived preparedness to deprescribe. Full article