Search Results (4,629)

Tourism is carbon-intensive, with transport and mobility driving much of its greenhouse-gas emissions, yet destination-level evidence on carbon hotspots and decarbonization from a supply-chain perspective remains scarce, especially in developing regions. This study examines low-carbon tourism supply chain management in seven purposively selected provinces of Northeastern Thailand (Isan) using a qualitative-dominant convergent mixed-methods design that integrates demand- and supply-side evidence. A visitor survey yielded 74 open-ended responses (60 complete questionnaires), alongside seven semi-structured key-informant interviews with tourism supply chain operators across the seven provinces. Quantitative data were analyzed with descriptive statistics, and qualitative data with thematic analysis using qualitative data analysis software, drawing on code-frequency and co-occurrence analysis; the two strands were triangulated in joint displays. Visitors reported moderate satisfaction (grand mean 3.91 on a five-point scale) but rated environmental management and safety lowest, engaging with sustainability through visible service cues rather than emissions. Key informants identified perceived carbon hotspots, carrying capacity, and seasonality as dominant concerns, attributing the destination’s footprint chiefly to transport dependence (informant-reported estimates ranging from approximately 80% to nearly 100% private-car arrivals, amid limited public transport) and accommodation energy; these hotspots reflect stakeholder perceptions rather than measured emissions, as no carbon accounting, environmentally extended input–output analysis, or life-cycle assessment was conducted. Integration revealed a demand–supply perception gap and five proposed, interdependent low-carbon pathways: coordinated mobility, accommodation energy efficiency, strengthened local procurement, carrying-capacity and waste management, and multi-stakeholder governance. The findings offer a developing-region, supply-chain-oriented basis for future tourism decarbonization research and practice. Full article

Preparing future educators for technology-enhanced learning environments has become increasingly important as artificial intelligence (AI) continues to influence teaching and learning. Guided by the Intelligent Technological Pedagogical Content Knowledge (i-TPACK) framework, this mixed-methods study examined preservice teachers’ perceptions of AI and the competencies they considered necessary for effective AI integration. Participants included 108 preservice teachers enrolled in a teacher preparation program at a public university in the southeastern United States. Data were collected using a survey containing Likert-scale and open-ended questions. Quantitative data were analyzed using descriptive statistics, exploratory factor analysis, and independent-samples t-tests, while qualitative responses were analyzed using thematic coding. The exploratory factor analysis identified a four-factor empirical structure that partially corresponded with the original theoretical domains, with varying levels of internal consistency. Preservice teachers generally viewed AI favorably and recognized its potential to support teaching and learning. Participants with internship experience reported significantly higher scores for perceived changes brought by AI and reasons for using AI than those without internship experience. Qualitative findings identified five competencies considered important for responsible AI integration: AI literacy, prompt engineering, critical evaluation, ethical AI use, and pedagogical balance. Participants also expressed concerns about academic dishonesty, misinformation, overreliance on AI, reduced critical thinking, and loss of human interaction. The findings highlight the importance of preparing preservice teachers to integrate AI in pedagogically meaningful and ethically responsible ways. Full article

Michelin Green Star restaurants combine sustainability with high-end dining, yet it remains unclear whether motivation to visit and willingness to pay reflect the same psychological process. Across two studies, we examined differentiated consumer responses to this hybrid context and the role of sustainability communication. Study 1 used survey data from 526 participants and structural equation modeling. Visit intention was positively associated with descriptive norms (β = 0.254), perceived behavioral control (β = 0.356), and positive anticipated emotions (β = 0.302). Green consumer orientation, luxury restaurant hedonism, and perceived sustainability were indirectly associated with intention, mainly through positive anticipated emotions. Willingness to pay showed a narrower pattern, being positively associated with perceived behavioral control (β = 0.171) and luxury restaurant hedonism (β = 0.359), whereas sustainability-related distal antecedents showed no significant direct or indirect associations with this outcome. Study 2 experimentally compared practice-based and experience-based messages among 102 participants. The messages did not differ in their average effects, although intention increased overall following exposure. The interaction between message condition and green consumer orientation predicted post-message positive anticipated emotions (b = 0.447), and the index of moderated mediation through positive anticipated emotions was significant (index = 0.200, 95% bootstrap CI [0.069, 0.418]). Overall, motivational readiness and stated monetary allocation appear to reflect partly distinct processes, while the preliminary experimental findings suggest that communication effects depend on the alignment between communication orientation and consumers’ environmental orientation. Full article

After the 2021 military coup in Myanmar, many people sought safety, decent work, and social protection in neighboring Thailand. This study examines how legal documentation status and Sense of Place (SOP) are associated with the workplace retention intentions of irregular Myanmar migrant workers in Mae Sot, Thailand. SOP is conceptualized through three key dimensions: emotional bonds to the surrounding environment (place attachment), the extent to which the place meets everyday needs (place dependence), and the way migrants identify with their host context (place identity). To explore these dynamics, we adopted an explanatory sequential mixed-methods approach, surveying 101 respondents between January and April 2024 and subsequently conducting in-depth interviews with 30 individuals between June and July 2024. Given the sensitivity of irregular migration and undocumented legal status, obtaining survey responses was challenging because many potential participants were concerned about privacy, identification, and possible legal exposure. Quantitative data were analyzed using descriptive comparisons, bivariate association tests with Goodman-calibrated minimum Bayes factors, LASSO-assisted variable screening, principal component analysis, and Bayesian mixed-effects ordinal probit models. The descriptive and bivariate results show that legal documentation status is positively associated with all SOP dimensions, job satisfaction, and willingness to remain in the current job. In the candidate model comparison, the Bayesian specification without legal status showed slightly better predictive performance than the corresponding specification with legal status. The primary five-category Bayesian mixed-effects model indicated positive conditional associations of Job Satisfaction, Place Attachment, and the structural workplace index with willingness to stay. It also indicated heterogeneity in the Place Attachment association across observed job tenure groups; this pattern is interpreted as a cross-sectional between-group difference rather than as evidence of individual change over time. Complementary Bayesian sensitivity analyses evaluate the multidimensional SOP construct, the incremental predictive contribution of legal status, sensitivity to alternative priors, and model diagnostics. The qualitative interviews further show that legal documentation is widely perceived as enabling broader employment opportunities, safer access to basic services, employer support, labor rights protection, and reduced exposure to exploitation. Overall, this study highlights the complementary roles of legal recognition, workplace satisfaction, and emotional rootedness in shaping migrant retention, offering implications for decent work, migrant well-being, reduced inequalities, and sustainable labor and migration policies in Thailand’s border regions, particularly in relation to SDG 8 and SDG 10. Full article

Generative artificial intelligence (GenAI) now produces synthetic text, images, audio, and video at a quality and cost that place convincing synthetic fabrication within reach of non-specialist users. Deepfakes, synthetic media that alter a person’s appearance, voice, or behavior through machine learning (ML), are one of the most contested applications of this capability, yet public willingness to accept them under regulation remains less understood. This study examines how perceived benefits, perceived risks, privacy concerns, and demographic characteristics relate to trust in deepfake technology under regulatory safeguards. Survey data from 924 respondents from several countries were analyzed using descriptive statistics, independent-samples t-tests, analysis of variance, multiple regression, and thematic analysis of open-ended responses. Respondents recognized the potential benefits of deepfake technology for digital content creation and education while expressing widespread concern about misinformation, privacy violations, and criminal misuse. When respondents evaluated deepfake technology under an assumed privacy-protecting regulatory scenario, perceived risks did not independently predict trust, while perceived benefits were the strongest predictors. The findings indicate that institutional confidence may contribute to public acceptance of beneficial applications of generative AI, although the cross-sectional design does not establish a causal effect of regulation. Full article

Background/Objectives: There is continuing debate regarding the association between added sugars (AS) consumption and overall diet quality, which remains a research gap within the Canadian population. This study aimed to assess the association between intakes of added sugars and the Healthy Eating Food Index (HEFI) 2019 that measures adherence to Canada’s Food Guide as an indicator of diet quality. Methods: The first 24 h dietary recalls of Canadians 2 years and older (n = 19,532) from the 2015 Canadian Community Health Survey—Nutrition were used. Added sugars intakes were calculated based on a systematic 10-step algorithm. Descriptive statistics were obtained for total HEFI and component scores across different AS intake categories. The association between AS categories and HEFI scores was tested using a generalized linear model adjusted for age, sex, education level, type of smoker, and misreporting status. Results: The association between continuous AS intake and HEFI scores was non-linear. In the categorical model, AS intake categories were inversely associated with HEFI scores among Canadians (R² = 0.32, p < 0.001). Large overlaps in HEFI scores were observed among individuals with similar AS intakes for the whole population and each age group. Among high AS consumers (>15% EI), lower HEFI scores were largely due to higher proportions of sweetened beverages (i.e., low beverage scores) and lower intakes of vegetables and fruit and plant-based proteins. Scores for protein food and whole grains were low across all AS intake categories. Conclusions: Large variations in overall HEFI scores were observed amongst those with similar AS intakes, suggesting that added sugars alone may not fully capture overall diet quality or adherence to Canada’s Food Guide. Full article

Background/Objectives: Age-related hearing loss (ARHL) is a major and growing public health concern, yet awareness of its nature, consequences, and management options remains inadequately studied in the Middle Eastern context. In Saudi Arabia, cochlear implantation is provided free of charge through the public healthcare system; however, adult uptake remains critically low, suggesting that awareness—rather than access—constitutes the primary barrier to timely intervention. In collective healthcare cultures, family members play a central role in healthcare decision-making for older individuals, making family-level awareness a critical determinant of early identification and treatment. This study aimed to assess public awareness, beliefs, and attitudes toward ARHL and its management options among adults in Saudi Arabia, applying the Health Belief Model (HBM) as a theoretical framework. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire adapted from a previously validated survey, with cultural modifications for the Saudi context. The questionnaire was distributed electronically to adults aged 18 years and above across Saudi Arabia. A total of 506 consenting responses were included in the final analysis. Descriptive statistics were used to analyse frequencies, percentages, means, and standard deviations. Results: The majority of participants correctly identified hearing loss as a reduction in the ability to hear (84.6%), and 95.3% regarded good hearing as personally important. However, significant knowledge gaps were observed, with 53.8% believing hearing loss can be cured and 50.4% believing it can be halted. Notably, 34.2% believed cochlear implants benefit children exclusively. Doctors and the internet were the primary sources of medical information, yet 39.3% reported no preventive healthcare visits and 23.9% did not seek any information about hearing problems. When faced with a hypothetical hearing loss, 75.3% indicated they would consult an ENT specialist. Conclusions: Adults in Saudi Arabia demonstrate good awareness of the signs and consequences of hearing loss but exhibit significant knowledge gaps regarding its clinical course and available management options, most notably the belief that cochlear implantation is exclusively a pediatric intervention. These findings highlight the urgent need for culturally adapted awareness campaigns targeting family members of older adults, and support the development of community-based hearing health promotion strategies in Saudi Arabia and comparable collective healthcare societies. Full article

Sub-Mediterranean ecosystems along the northeastern Black Sea coast remain insufficiently studied despite their importance for the regional carbon cycle and their sensitivity to human disturbance. This study presents an exploratory case study of aboveground biomass carbon stocks in two contrasting plant communities at the carbon-monitoring supersite of the Southern Branch of the Shirshov Institute of Oceanology RAS in Gelendzhik, Russia. The aboveground observations were interpreted together with soil carbon stocks and greenhouse gas fluxes previously reported for the same permanent plots. The investigated communities comprised a terraced pine–oak plantation (SP1) and a natural pubescent-oak shiblyak (SP2). Vegetation was surveyed using the Braun-Blanquet approach. Tree biomass was estimated using the generalized allometric equation of Chave et al., while aboveground biomass was converted to carbon using carbon concentrations determined by elemental analysis of sampled plant tissues. Herbaceous vegetation and forest-floor material were quantified by elemental analysis. Within-plot spatial heterogeneity was visualized using Python-based radial-basis-function (RBF) interpolation for exploratory mapping of local carbon distribution. Because each vegetation type was represented by a single 400 m² plot, all comparisons are site-specific and exploratory and should not be extrapolated beyond the investigated communities. The aboveground carbon density was 64.1 t C ha⁻¹ in the terraced pine–oak stand and 16.1 t C ha⁻¹ in the natural shiblyak. Woody biomass dominated the plantation, whereas litter and herbaceous vegetation contributed proportionally more to the carbon pool in the shiblyak. Previously published soil organic carbon stocks at the terraced site exceeded the measured aboveground carbon pool, whereas the natural rendzinas were characterized by substantial carbonate-associated inorganic carbon stocks. C/N ratios of organic substrates ranged from 11 to 100, indicating a pronounced variation in substrate quality: higher C/N values in woody and coniferous fractions were consistent with slower decomposition, whereas lower C/N values in herbaceous material were consistent with faster mineralization. Exploratory spatial mapping revealed within-plot variation in aboveground carbon of up to two orders of magnitude. Together, these site-specific observations provide the first integrated description of aboveground biomass carbon together with previously reported soil carbon pools for contrasting sub-Mediterranean vegetation on the northeastern Black Sea coast. Despite its exploratory nature, this study establishes a baseline for future replicated, spatially explicit investigations of ecosystem carbon dynamics in sub-Mediterranean ecosystems along the northeastern Black Sea coast. Full article

Background/Objectives: Provisional restorations are essential for maintaining oral function, esthetics, periodontal health, and patient comfort during prosthodontic treatment. This study evaluated current clinical practices, material preferences, fabrication techniques, and digital technology adoption among Romanian dental practitioners. Methods: A cross-sectional survey was conducted between January and March 2025. The questionnaire was sent directly to a predefined closed list of 150 licensed dental practitioners, of whom 95 submitted complete responses (response rate: 63.3%). The questionnaire assessed professional characteristics, materials and fabrication techniques used for provisional restorations, attitudes toward digital technologies, educational sources, and clinical complications. Data were analyzed using descriptive statistics, association tests, and exploratory multivariable logistic regression. Results: Composite resin (77.9%) and acrylic resin (65.3%) were the most frequently reported materials. Direct fabrication was used by 51.6% of respondents, while 42.1% used indirect techniques. An affirmative response to the general item concerning current digital technology use was provided by 47.4% of participants. Faster and more efficient fabrication and superior intraoral adaptation were the principal perceived advantages of 3D-printed restorations, whereas high equipment and material costs represented the main perceived disadvantage. The exploratory multivariable analysis identified no statistically significant independent associations with digital technology utilization. Debonding (44.2%) and fracture (42.1%) were the most frequently reported complications. Conclusions: Among the surveyed practitioners, conventional materials and fabrication techniques remained widely used, while digital workflows showed incomplete integration. Larger, representative studies using clearly defined technology-specific outcomes are needed to evaluate the determinants and clinical implications of digital adoption in provisional prosthodontics. Full article

Background: Healthcare professionals are frequently exposed to serious work-related events that may adversely affect their psychological well-being, work ability, and professional retention. Peer support systems have been proposed as a low-threshold organizational approach to providing psychosocial support following such job-inherent events. This study examined the incidence of serious work-related events among healthcare workers, employees’ perceptions of an implemented peer support system, and the potential relevance of psychosocial support for employer attractiveness. Methods: A multicenter cross-sectional survey was conducted following the implementation of peer support structures in three German hospitals in 2022. A total of 295 healthcare workers completed an anonymous questionnaire assessing experiences with serious work-related events, perceptions of the peer support system, preferred support services, and the potential influence of psychosocial support on employer choice. Descriptive statistics and bivariate correlations were performed. Results: Overall, 46.4% of participants reported experiencing at least one serious work-related event within the previous two years. The peer support system was perceived as a valuable resource for supporting staff and managing psychosocial stress. Participants reported benefits not only from direct use of peer support but also from knowing that support was available when needed. Negative perceptions of the peer support system were uncommon. Approximately 27% of respondents indicated that the availability of psychosocial support could influence their choice of employer. Conclusions: Peer support systems are perceived as an acceptable and beneficial approach to addressing psychosocial stress among healthcare professionals. Beyond their supportive function, such systems may be perceived as part of employer attractiveness and a feasible organizational strategy to support workforce well-being and workforce stability in healthcare settings. Full article

The financial services sector is undergoing rapid digital transformation, yet the adoption of online financial services (OFS) remains uneven due to perceptual barriers such as security concerns and limited digital and financial literacy. Existing research, often based on aggregate models such as the Technology Acceptance Model (TAM), tends to overlook heterogeneity in user perceptions and leaves unresolved whether the digital divide is primarily generational or socio-economic. This study addresses these gaps through a quantitative, descriptive–analytic, and exploratory design based on a cross-sectional survey of 225 respondents. Integrating TAM, UTAUT, Diffusion of Innovations, Perceived Risk, and Trust, the analysis combines correlational assessment, non-parametric group comparisons, and hierarchical cluster analysis. Three main findings emerge. First, Perceived Risk appears statistically decoupled from the core adoption-related perceptions of usefulness and ease of use, suggesting a more latent role among current users. Second, two distinct divides are identified: an age-based divide affecting perceived ease of use, and a stronger education- and income-based divide affecting perceived usefulness and facilitating conditions. Third, three perceptual profiles are identified, challenging the “average user” assumption. Profile membership is significantly associated with education, but not age, suggesting that the main barrier to inclusive digital finance is increasingly one of literacy rather than generation. Full article

Background: Burnout, defined by emotional exhaustion, depersonalization, and reduced personal accomplishment, is a major occupational health concern among healthcare professionals. Burnout has been linked to depression, anxiety, and medical errors, but its association with suicidality in healthcare settings remains insufficiently explored. Objective: To investigate the association between burnout dimensions and suicidality among healthcare professionals, and to identify occupational and demographic factors influencing this relationship. Methods: A cross-sectional study was conducted among 195 healthcare professionals in Romania, recruited through voluntary participation in an anonymized online survey. Burnout was assessed using an adapted tool inspired by the Maslach Burnout Inventory, while suicidality outcomes included suicidal ideation, self-harm, and suicide attempts. Descriptive statistics were calculated for demographic and professional variables. Pearson correlations and multivariable linear regression analyses, adjusted for age, professional experience, and shift work, were performed to evaluate associations between burnout dimensions and suicidality. Results: Emotional exhaustion (r = 0.42, p < 0.001) and depersonalization (r = 0.37, p < 0.001) were positively correlated with suicidality, while reduced personal accomplishment was negatively correlated (r = −0.29, p = 0.002). In multivariable regression, emotional exhaustion remained the only statistically significant independent predictor of suicidality after adjustment for demographic and occupational characteristics. Younger age and rotating/night-shift work were associated with higher suicidality in unadjusted analyses but were not independent predictors after multivariable adjustment. Strong correlations between burnout dimensions and physical symptoms highlighted the interplay between psychosocial strain and somatic health. Conclusions: Burnout, particularly emotional exhaustion, was independently associated with suicidality among healthcare professionals, while depersonalization demonstrated a significant unadjusted association that did not remain statistically significant after multivariable adjustment. Younger clinicians, shift workers, and those with less experience appear especially vulnerable. These findings emphasize that burnout is a multifactorial construct with both psychological and somatic dimensions, shaped by systemic workplace stressors. These findings support further evaluation of systematic screening, organizational reforms, mentorship programs, and confidential mental health support as potential components of suicide-prevention strategies for healthcare professionals. Full article

Background/Objectives: Members of the LGBTQ+ community often have poorer health outcomes and less access to health services than cisgender and heterosexual populations, and many healthcare professionals remain insufficiently aware of the barriers faced by these patients. Community nurses, given their skills and competencies, can help patients overcome barriers and achieve greater inclusion. The aim of this project is to identify the barriers and facilitators detected by the primary care nursing team of the Málaga-Valle del Guadalhorce Health District (MVGHD) when providing holistic care to LGBTQ+ individuals. Methods: A sequential explanatory mixed-methods design (DEXPLIS) will be employed to robustly combine a quantitative baseline of professional attitudes with an in-depth qualitative exploration of institutional discourses. Phase I consists of a pilot cross-sectional study with cluster allocation of questionnaire versions in which primary healthcare nursing staff in the MVGHD will complete the validated Sexuality Attitudes and Beliefs Survey (SABS) with one group completing a version framed around LGBTQ+ patients and the other around the general population. Phase II consists of a qualitative descriptive study based on discourse analysis (DA) using in-depth semi-structured interviews, analyzed with ATLAS.ti 23. Conclusions: This study protocol is expected to provide an empirical framework to identify potential institutional barriers and attitudinal biases in nursing care, highlighting the potential need for targeted training programmes in sexual and reproductive health. The resulting protocol aims to contribute to health equity by offering practical resources to optimize ongoing clinical education in primary care settings. Full article

The Koktau Mountains, located within the Kalba Highlands of Eastern Kazakhstan, represent an important yet insufficiently studied center of plant diversity in the Kazakhstan Altai. Field surveys conducted between 2018 and 2025 yielded more than 2700 herbarium specimens and were complemented by a revision of collections deposited in the ABG, AA, LE, and MW herbaria. Taxonomic, ecological, and incidence-based comparative analyses were used to characterize the flora and evaluate its relationships with neighboring regions. We recorded 817 accepted vascular plant taxa at species and infraspecific ranks, belonging to 356 genera and 79 families. The flora combines boreal, Mediterranean, and Turanian elements, reflecting the transitional position of the Koktau Mountains between the Altai mountain systems and the steppes of Eastern Kazakhstan. Twenty-seven rare and threatened taxa were identified, including 16 species listed in the Red Data Book of Kazakhstan and two species endemic to Kazakhstan, one of which, Elymus sibinicus, is currently known only from the Koktau Mountains. Floristic similarity was greatest with the Bukhtarma Mountains and Ulba Range. Because the compared inventories differ in area and survey history, these incidence-based relationships are interpreted descriptively. Together with the low number of endemic taxa, these relationships are consistent with the interpretation of the Koktau Mountains as a transitional flora influenced by regional floristic exchange. Full article

Background/Objectives: School-age athletes occupy a paradoxical position in the adolescent opioid crisis, combining health-oriented activity with elevated risk of sports-related injury and prescription opioid exposure. In response to the opioid epidemic, states enacted opioid prescribing limit laws (OPLLs) beginning in 2016–2017, yet whether these supply-side policies reached high-risk youth subgroups remains unclear. This study evaluated national temporal trends in prescription opioid misuse among U.S. high school students during the period of OPLL implementation and examined differences across athletic participation, concussion history, sex, grade, race/ethnicity, and substance-use profiles. Methods: Using four biennial waves of the Youth Risk Behavior Surveillance System with a consistent prescription pain-medicine measure (2017, 2019, 2021, and 2023; total N = 44,501), we conducted survey-weighted multivariable logistic regression models producing adjusted odds ratios (aORs) for lifetime prescription opioid misuse, controlling for survey year, sports participation, sex, grade, race/ethnicity, alcohol use, and other illicit drug use. Interaction and stratified models examined differences associated with sports participation, concussion history, demographic characteristics, and substance use. Results: Weighted prescription opioid misuse declined from 13.9% in 2017 to 12.0% in 2023, with a significant unadjusted linear decline per two-year survey wave (OR = 0.936; 95% CI: 0.879–0.997; p = 0.040). This overall trend was attenuated after adjustment (aOR = 0.967; 95% CI: 0.914–1.024; p = 0.248). Temporal patterns differed significantly across race/ethnicity, sex, grade, and selected substance-use groups. White and male students demonstrated significant adjusted linear declines, whereas Hispanic/Latino and female students remained flat. Black/African American students showed significant year-to-year variation, with elevated adjusted odds in 2019 and 2021 relative to 2017. Concussion history was independently associated with misuse among athletes (aOR = 1.645; 95% CI: 1.417–1.909; p < 0.001), with significant associations observed among White, Asian, Black/African American, and Hispanic/Latino athletes. The pooled concussion-by-race/ethnicity interaction, however, was not significant (p = 0.295). Conclusions: Although prescription opioid misuse declined descriptively between 2017 and 2023, adjusted analyses did not identify a significant overall national temporal change. Since subgroup patterns diverged, prevention planning and surveillance should be disaggregated by race/ethnicity and sex rather than guided by national totals, and groups whose misuse did not decline may require strategies extending beyond clinical prescribing controls. Full article