Search Results (2,409)

Background: Concerns over women’s mental health have intensified globally, especially among mothers managing dual careers and family responsibilities. Positive Psychology Interventions (PPIs), such as gratitude journaling and well-being workshops, have demonstrated promise in enhancing mental health; however, their applicability in Arab contexts remains underexplored. This study aims to investigate the effectiveness of PPIs on mothers’ well-being, gratitude, depression, anxiety, and stress in Saudi Arabia. Methods: This quasi-experimental, one-group pretest–posttest study assessed the effects of a four-week PPI on 37 Saudi working mothers (aged 21–50 years) employed at a private school in Riyadh. The intervention included guided gratitude journaling thrice weekly and two workshops on positive psychology and gratitude. Pre- and post-intervention assessments used validated Arabic versions of the Depression Anxiety Stress Scale (DASS-21), WHO-5 Well-being Index, and Gratitude Questionnaire (GQ-6). Results: Significant improvements were found post-intervention: depression, anxiety, and stress scores decreased (p < 0.001), while well-being and gratitude increased (p = 0.001). However, participants with lower household income (<50,000 SAR) showed less improvement, indicating a potential moderating effect of socioeconomic status. Conclusions: The intervention demonstrated promising short-term improvements in mental health and well-being among Saudi mothers. The findings underscore the importance of culturally appropriate PPIs and highlight the need for further research using controlled, long-term designs. Limitations include the small, non-random sample, absence of a control group, and restriction to a single geographic region. Full article

Background: Various predisposing factors contribute to the emergence and dissemination of the multidrug-resistant (MDR) phenotype in Escherichia coli and Klebsiella pneumoniae. Understanding these factors is crucial for guiding appropriate antimicrobial therapy and infection control strategies. This study investigated the predisposing factors contributing to the MDR characteristics of E. coli and K. pneumoniae isolated in a community hospital in northeastern Thailand. Methods: This case–control study utilized retrospective data from bacterial culture, as well as demographic, clinical, and antibiotic susceptibility records collected during 5 years (January 2016–December 2020). E. coli and K. pneumoniae isolates were analyzed from various clinical samples, including blood, urine, pus, sputum, and other body fluids. Data were analyzed using descriptive statistics and univariate logistic regression. Results: In total, 660 clinical isolates were analyzed (421 E. coli and 239 K. pneumoniae). Blood was the most common source of the detection of E. coli (63.0%) and sputum was the most common source of K. pneumoniae (51.0%). The median ages of patients were 67 and 63 years for E. coli and K. pneumoniae, respectively. E. coli cases were significantly associated with prior antibiotic use (OR = 1.79, 95% CI: 1.17–2.74 p = 0.008). MDR was observed in 50.1% of E. coli and 29.7% of K. pneumoniae (p < 0.001). E. coli compared to K. pneumoniae had lower resistance to third-gen cephalosporins (64.9% versus 95.8%) and carbapenems (8.0% versus 6.9%). ICU admission was the only factor significantly associated with MDR E. coli (OR = 2.40, 95% CI: 1.11–5.20 p = 0.026). No significant differences were observed in gender, age, or comorbidities between MDR cases. Antibiotic usage patterns also differed, with E. coli more likely to receive third-gen cephalosporins compared to carbapenems (OR = 3.02, 95% CI:1.18–7.74 p = 0.021). Conclusions: The use of third-generation cephalosporin may drive MDR E. coli more than K. pneumoniae. Prior antibiotic exposure was linked to E. coli bloodstream infections, while MDR E. coli showed greater clinical severity. These findings highlighted the need for improved antibiotic stewardship in rural hospitals. Full article

Economic growth, especially in emerging economies, has altered the composition of international tourism. It is therefore essential to possess the skills necessary to understand the influence of culture on human behaviour, thereby enabling an appropriate response to the traveller. This research aims to develop a tool for identifying openness, flexibility, awareness, and intercultural preparedness. It focuses on the metacognitive and cognitive aspects of cultural intelligence that shape the development of empathy in customer service staff in hotels in Quintana Roo. The variables were validated and incorporated into a quantitative study using multivariate analysis and inferential statistics. A sample of 77 questionnaires was analysed using simple random sampling under a proportional design. Multiple Correspondence Analysis (MCA) was employed as a discriminatory technique to identify the most significant independent variables. These were subsequently entered as regressors into ordinal logistic regression (OLR), along with age and work experience, in order to estimate the probabilities associated with each level of the dependent variable. The results indicated that age had minimal influence on the metacognitive and cognitive variables, whereas years of experience among tourism staff exerted a significant effect. Full article

Thailand’s southern border provinces need youth-focused multicultural leadership programs integrating local religious–cultural elements, community involvement, and long-term evaluation to enhance social cohesion and sustainable development. This study aimed to develop and evaluate a program to foster multicultural leadership among youth in Thailand’s three southern border provinces. The research was conducted in two phases. The first phase involved synthesizing key multicultural leadership characteristics, designing a structured program and assessing its relevance and coherence through expert evaluation. The second phase focused on empirical validation by implementing the program with 22 selected youth participants, employing repeated-measures analysis of variance to assess its effectiveness. Additionally, experts evaluated the program’s validity, appropriateness, cost-effectiveness, utility, and feasibility. The resulting program, “EARCA”, comprises five core components: Experiential Exposure, Active Exploration & Engagement, Reflective Thinking & Analysis, Concept Integration & Synthesis, and Application & Extension. Expert assessments confirmed its appropriateness at the highest level, with a consistency index ranging from 0.8 to 1.0. Statistical analyses demonstrated significant improvements in all dimensions of multicultural leadership among participants. Furthermore, the program was rated highly accurate, appropriate, cost-effective, practical, and feasible for real-world implementation. These findings offer valuable insights for policymakers and practitioners seeking to enhance multicultural leadership development through structured, evidence-based interventions. Full article

This study employs a mixed method. In-depth interviews and observational studies are among the data collection approaches used in qualitative research. The quantitative method measures the weight of respondents’ answers to the distributed questionnaire. The questionnaire, containing 82 items, was distributed to 202 tourists to collect their perceptions based on the 4A tourist components. The results indicate that tourists’ perceptions of attractions, accessibility, and ancillary services are generally positive. In contrast, perceptions of amenity services are less favorable. Using the scores from IFAS, EFAS, and the I-E matrix, the total weighted scores for IFAS and EFAS are 2.68 and 2.83, respectively. The appropriate strategy for BTV is one of aggressive growth in a position of strengths and opportunities. The study highlights key techniques, including the application of information technology in service and promotion, the strengthening of community and government roles, the development of infrastructure and facilities, the utilization of external resources, sustainable innovation, and the encouragement of local governments to issue regulations for halal tourism villages. By identifying drivers and barriers from an economic, environmental, social, and cultural perspective, the SWOT analysis results help design strategies that can make positive contributions to the development of sustainable, community-based halal tourism and digital information in the future. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article

Background/Objectives: International students pursuing higher education in the United States face unique challenges that increase their risk of food insecurity, including limited financial resources, employment restrictions, and cultural barriers. While food insecurity among domestic students has been widely studied, limited research focuses on the lived experiences of international graduate students. This study explores the challenges, perceptions, and coping strategies related to food insecurity among international graduate students at a large public university in North Texas. Methods: This qualitative, ethnographic study involved 20 semi-structured interviews with international graduate students who were clients of the university’s food pantry. Participants were recruited using purposive convenience sampling. Interviews focused on students’ experiences with food access, financial constraints, campus resources, and cultural food preferences. Data were analyzed using thematic coding in MAXQDA. Two standardized food insecurity measures—the USDA and FAO scales—were also administered and analyzed using SPSS. Results: Findings revealed that 85% of participants experienced limited access to nutritious and culturally appropriate foods, with 70% reporting hunger due to financial constraints. Themes included lack of cooking skills, limited campus food options, difficulty accessing familiar groceries, and limited job opportunities. Students expressed that food insecurity significantly impacted their physical health, mental well-being, and social lives, though many continued to prioritize academics over personal nourishment. Conclusions: Food insecurity among international graduate students is multifaceted, shaped by financial, cultural, and institutional barriers. Addressing this issue requires culturally sensitive interventions, improved access to diverse food options, tailored student support services, and institutional efforts to better understand and meet the needs of international students. Full article

The article addresses the question of the relative importance of human population size and growth in relation to the environmental problems of planetary heating and biodiversity loss in the current, Anthropocene era. To what extent could policies to encourage lower fertility be justified, while observing that this subject is an inherently contested one. It is proposed that a helpful distinction can be made between specific threats to habitats and biodiversity, as opposed to those related to global energy use and warming. Pressures of over-population can be important in relation to the former. But with regard to the latter—rising per capita energy usage—reduced fertility has historically been positively, not negatively correlated. A case can be made that the high-fertility nations of sub-Saharan Africa could benefit from culturally respectful fertility reduction policies. However, where planetary heating is concerned, it is the hydrocarbon-based, per capita energy-consumption patterns of already low-fertility populations on the other five inhabited continents that is rather more critical. While it will be helpful to stabilise global human population, this cannot be viewed as a solution to the climate crisis problem of this century. That requires relentless focus on reducing hydrocarbon use and confronting the rising inequality since c.1980 that has been exacerbating competitive materialist consumerism. This involves the ideological negotiation of values to promote a culture change that understands and politically embraces a new economics of both human and planetary balance, equity, and distribution. Students of populations can contribute by re-assessing what can be the appropriate demographic units and measures for policies engaging with the challenges of the Anthropocene. Full article

Background/Objective: Dry eye syndrome affects 16 million Americans with USD 52 billion in annual healthcare costs. With large language models (LLMs) increasingly used for healthcare information, understanding their performance in delivering equitable dry eye guidance across diverse populations is critical. This study aims to evaluate and compare five major LLMs (Grok, ChatGPT, Gemini, Claude.ai, and Meta AI) regarding dry eye syndrome information delivery across different demographic groups. Methods: LLMs were queried using standardized prompts simulating a 62-year-old patient with dry eye symptoms across four demographic categories (White, Black, East Asian, and Hispanic males and females). Responses were analyzed for word count, readability, cultural sensitivity scores (0–3 scale), keyword coverage, and response times. Results: Significant variations existed across LLMs. Word counts ranged from 32 to 346 words, with Gemini being the most comprehensive (653.8 ± 96.2 words) and Claude.ai being the most concise (207.6 ± 10.8 words). Cultural sensitivity scores revealed Grok demonstrated highest awareness for minority populations (scoring 3 for Black and Hispanic demographics), while Meta AI showed minimal cultural tailoring (0.5 ± 0.5). All models recommended specialist consultation, but medical term coverage varied significantly. Response times ranged from 7.41 s (Meta AI) to 25.32 s (Gemini). Conclusions: While all LLMs provided appropriate referral recommendations, substantial disparities exist in cultural sensitivity, content depth, and information delivery across demographic groups. No LLM consistently addressed the full spectrum of dry eye causes across all demographics. These findings underscore the importance for physician oversight and standardization in AI-generated healthcare information to ensure equitable access and prevent care delays. Full article

Bioactive glass materials have been used for decades in orthopedic surgery, traumatology, and oral and maxillofacial surgery to repair bone defects. This study aimed to evaluate in vitro the survival and proliferation of MG63 human osteosarcoma-derived cells on S53P4 bioactive glass (BonAlive^® granules). Microscopic visualization was performed to directly observe the interactions between the cells and the material. Osteoblast-like cells were examined on non-adherent test plates, on tissue culture (TC)-treated plates and on the surface of the bioglass to assess the differences. Cell survival and proliferation were monitored using a CCK-8 optical density assay. Comparing the mean OD of MG63 cells in MEM on TC-treated plates with cells on BG, we detected a significant difference (p < 0.05), over each time of observation. The sustained cell proliferation confirmed the non-cytotoxic property of the bioglass, as the cell number increased continuously at 48, 72, 96, and 168 h and even did not plateau after 168 h. Since the properties of bioglasses can vary significantly depending on their composition and environment, a thorough characterization of their biocompatibility is crucial to ensure their effective and appropriate application—for example, during hip and knee prosthesis insertion. Full article

Background: South Asian Americans (SAA) are one of the fastest-growing immigrant groups in the U.S. and face significant health disparities, particularly regarding chronic diseases like diabetes, hypertension, and cardiovascular disease. Dietary patterns play a crucial role in these disparities, with acculturation to Western diets linked to poorer health outcomes. Despite this, the impact of food insecurity on dietary habits among SAAs remains underexplored. This study aims to examine the availability, cost, and quality of ethnic food items and how food insecurity influences dietary practices in Southern California’s SAA population. Methods: The study was conducted in San Bernardino County, California, with field data collection focused on five South Asian ethnicity-specific grocery stores and three Western grocery stores. We assessed the availability and cost of key ingredients for commonly prepared SAA dishes. Additionally, focus group interviews were held with South Asian immigrants to understand food insecurity challenges and dietary adaptations. Results: The study found significant disparities in food availability and cost between SAA-ethnic grocery stores and Western stores. SAA stores were less accessible and more widely dispersed, with an average distance of 10 miles between them. While ingredients like ginger paste and cumin powder were available in both types of stores, items such as ghee, fenugreek seeds, and black gram were harder to find in Western stores. Focus group participants noted that ethnic foods, especially vegetarian ingredients, were more expensive than Western alternatives, leading many to substitute traditional meals with cheaper, less nutritious options. Participants also raised concerns about the poor quality of items in ethnic stores, such as expired produce, which further limited their food choices. Conclusions: Food insecurity, driven by limited availability, high cost, and poor quality of ethnic foods, poses significant challenges to the SAA community’s diet and health. Addressing these barriers could improve food security and health outcomes among SAA immigrants. Full article

Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such as disease-specific quality of life (DsQoL). To date, there has been no validated, standardized instrument for assessing DsQoL in young German CHD patients. This study introduces the Congenital Heart Disease Specific Inventory (CHDSI), the first freely available German-language instrument for measuring DsQoL in children and adolescents with CHD. Materials and Methods: The CHDSI was developed at the German Heart Center Munich in collaboration with affected children and adolescents and validated nationwide via the National Register for Congenital Heart Defects (NRCHD) with 1201 participants (46 kindergarten children, 530 children, 625 adolescents). Two age-specific versions (36/37 items) and a 31-item preschool version were created, alongside a 6-item short form (CHDSI-SF) for rapid screening. Reliability was assessed using Cronbach’s alpha and split-half methods; construct validity via confirmatory factor analysis (CFA) using DWLS; and score interpretation through standardized stanine scales. The small sample size of kindergarten children precluded a model test for this group. The standard values given for this subsample should therefore be interpreted with caution. Results: The CHDSI showed excellent internal consistency (Cronbach’s α = 0.856 to 0.900) and high split-half reliability (>0.95). CFA confirmed a robust six-factor structure with excellent model fit (CFI and TLI ≥ 0.991, RMSEA ≤ 0.05). Subscales showed strong discriminant validity, and significant differences were found by CHD severity and sex. Conclusions: The CHDSI is a psychometrically valid, age-appropriate, and freely available instrument for assessing DsQoL in children and adolescents with CHD. It provides valuable support for clinical decision-making and research. Further studies should explore international validation and cultural adaptation. Full article

The article examines possible amendments to the Australian legislative regime regulating and protecting Indigenous cultural heritage in an offshore, including underwater, context. It suggests that there are significant reforms that are needed to bring the existing domestic legislative regime into conformity with the expectations of contemporary international law, particularly as manifested in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). In reaching this conclusion, the article proceeds by examining recent Australian jurisprudence and archaeological studies, considering offshore Indigenous cultural heritage as well as the current Australian domestic legislative framework. It then proceeds to examine the relevant provisions of both UNDRIP and the 2001 UNESCO Convention on the Protection of Underwater Cultural Heritage (UCH Convention). The article identifies that the UCH Convention operates to ignore any legitimate role for Indigenous peoples and does not provide an appropriate foundation for legislative reform. The article concludes by suggesting the content of appropriate legislative reforms that accord with the expectations in UNDRIP. Full article

Miami, Florida, renowned for its cultural richness and coastal beauty, also faces the concerning challenges created by urban heat islands (UHIs). As one of the hottest cities of the United States, Miami is facing escalating temperatures and threatening heat-related vulnerabilities due to urbanization and climate change. Our study addresses the critical issue of mapping and investigating UHIs in complex urban settings. This study leveraged Planet satellite data and Landsat data to conceptualize and develop appropriate mitigation strategies for UHIs in Miami. Utilizing the Planet satellite imagery and Landsat data, we conducted a combined study of land cover and land surface temperature variations within the city. This approach fuses remotely sensed data to identify the UHI hotspots. This study aims for dynamic approaches for UHI mitigation. This includes studying the status of green spaces present in the city, possible expansion of urban green spaces, the propagation of cool roof initiatives, and exploring the recent climatic trend of the city. The research revealed that built-up areas consistently showed higher land surface temperatures while zones with dense vegetation have lower surface temperatures, supporting the role of urban green spaces in surface temperature reduction. This research can also set a robust model for addressing UHIs in other cities facing rapid urbanization and experiencing mounting temperatures each passing year by helping in assessing LST, land cover, and related spectral indices as well. Full article

Background/Objectives: Sports tourism, particularly international running events such as half marathons and marathons, has rapidly grown due to rising health consciousness and active lifestyles. Runners competing abroad face unique nutritional challenges that extend beyond physiological needs, including adaptation to local food cultures and psychosocial factors. This study aims to explore the nutritional difficulties encountered by international runners during competitions abroad, using participants of the Poznan Half Marathon 2025 as a case example. Methods: A qualitative research design was employed, involving semi-structured in-depth interviews with 12 international runners from the United Kingdom, Germany, and Ukraine. Participants had at least two years of experience competing internationally. Results: Four primary categories of nutritional challenges emerged: (1) quality and availability of food, (2) adaptation to local eating habits and physiological impacts, (3) hydration and access to appropriate fluids, and (4) logistical factors and the interactions between psychological stress, physical well-being, and nutritional choices. These factors influenced runners’ preparation, race-day performance, and recovery, highlighting the complexity of managing nutrition in unfamiliar environments. Conclusions: Nutritional challenges for international runners are multidimensional, requiring flexible and culturally sensitive nutritional strategies. Although these findings offer useful insights, they are based on a small, specific sample and should be generalized with caution. Further research is necessary to explore the broader applicability of the findings and their relevance to diverse athletic populations and contexts. Full article