Search Results (31,761)

Viticulture is highly vulnerable to weather variability and climate change. Growers increasingly face risks associated with extreme weather events, water scarcity, and emerging pests and diseases. To address these challenges, this study presents the development and implementation of the first operational digital decision support platform (DSP) tailored to Montenegrin vineyards within the MONTEVITIS project. The platform integrates IoT sensor data, national meteorological records and high-resolution global climate datasets to provide real-time monitoring and climate projections for vineyard management. The system was piloted in four vineyards representing diverse microclimatic and soil conditions of Montenegro. Key functionalities include phenology, irrigation and disease alerts supported by a user-friendly dashboard, map-based visualisation tools and data export functions. The pilot deployment demonstrated that combining heterogeneous data streams increases the reliability of outputs and enables timely, site-specific recommendations. Challenges identified during implementation include connectivity limitations, gaps in data and variable levels of digital expertise among growers; however, lessons learned point to the importance of continuous stakeholder engagement and institutional support for sustained use. The MONTEVITIS experience demonstrates how digital agriculture tools can bridge tradition and innovation in viticulture. By fostering collaboration between growers, researchers and policy makers, the platform enables adaptive strategies for climate resilience and sustainable vineyard management. Although the platform has been successfully deployed and tested under pilot conditions, a comprehensive long-term validation of its performance and impact on vineyard decision-making remains part of ongoing future work. Full article

In the United States, access to healthcare is shaped not only by patient need but also by payer policies that determine which providers are reimbursable, how care is sequenced, and what constitutes a legitimate entry point into the system. These gatekeeping functions, while valuable for supporting clinical prioritization, risk stratification, and continuity of care, can also unintentionally reinforce structural inequities and credential hierarchies that delay or limit timely and equitable care, particularly for historically marginalized populations. While reform efforts often focus on expanding benefits or provider networks, fewer address the underlying design of access itself or the rules that govern how patients enter care. It is argued in this paper that a more equitable and efficient healthcare system requires multi-entry care models, in which nurses, behavioral health clinicians, pharmacists, and community health workers may serve as condition-appropriate, reimbursable first points of contact within coordinated care teams. Drawing on evidence from Medicare, Medicaid, the Veterans Health Administration, and commercial payers, these models may support cost containment, improve care coordination, facilitate appropriate utilization, and promote earlier patient engagement. While findings from these models are not uniform across all settings, evidence suggests that outcomes are highly dependent on implementation context, system design, and supporting infrastructure. When implemented with appropriate safeguards (such as interoperable health records, team-based care requirements, and coordinated referral tracking), multi-entry systems can preserve continuity while expanding access. Payers are uniquely positioned to lead this transformation by aligning reimbursement policy with patient needs, supporting team-based care infrastructure, and embedding accountability into access pathways, thereby creating a system that can be more responsive, inclusive, and sustainable. Full article

Eosinophils are multifunctional granulocytes that reside constitutively within mucosal tissues, where they engage in bidirectional communication with the epithelial cells lining the respiratory and gastrointestinal (GI) tracts. Once regarded solely as terminal effectors of the type 2 immunity, eosinophils are now recognized as key regulators of epithelial homeostasis and barrier integrity. Epithelial cells initiate crosstalk by releasing the alarm cytokines such as interleukin (IL)-33, thymic stromal lymphopoietin (TSLP), and IL-25, which drive eosinophil recruitment, activation, and tissue retention. Conversely, eosinophils modulate epithelial function through the release of granule proteins, cytokines, and growth factors with both damaging and reparative consequences. In the airway, this crosstalk underpins the pathogenesis of eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), in part via eosinophil-derived mediators that disrupt tight junction integrity and fuel remodeling. In the GI tract, homeostatic eosinophils support villous architecture, epithelial turnover, and goblet cell differentiation through microbiota-driven IL-33 signals and neuropeptide-mediated neuroimmune pathways, whereas dysregulated crosstalk promotes eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD). This review synthesizes recent research to delineate the molecular mechanisms of eosinophil–epithelial crosstalk across mucosal compartments, highlight tissue-specific differences and shared mechanistic themes, and discuss the implications of these findings for targeted therapy. Full article

Background/Objectives: Digital parent training (DPT) programs offer scalable solutions for childhood disruptive behaviors but face significant engagement challenges. Although content tailoring may enhance outcomes, its clinical impact remains under-examined. This study aimed to (a) describe the correspondence between program recommendations, parental choices and engagement, and (b) examine how initial decisions are associated with subsequent engagement and therapeutic outcomes. Methods: A secondary analysis of three randomized trials included 151 parents of children (ages 3–7) with disruptive behaviors. Participants were classified as ‘Recommendation-Adherent’ (n = 63) or ‘Beyond-Recommendation’ (n = 88) based on whether initial content selections matched or exceeded program recommendations. Clinical outcomes (child behavior, parenting styles) and objective usage metrics were assessed at baseline and post intervention. Results: Many parents chose to expand the intervention scope beyond clinical recommendations (e.g., 91.5% selected the non-recommended Emotion Regulation module). However, this proactive initial intention did not increase objective engagement; groups did not differ significantly in total usage time, login days, or module completion rates. Although both groups showed comparable improvements in child behavior, intending to adhere to the recommended pathway was associated with significantly greater reductions in permissive parenting (laxness; p = 0.029) after adjusting for baseline differences. Conclusions: The findings highlight a discrepancy between parents’ intent to expand intervention scope and their actual engagement capacity. While the decision to adhere to a tailored pathway was associated with specific improvements in permissive parenting, the observational nature of the study precludes causal claims. Nevertheless, the results suggest that guided tailoring may serve as a protective function against choice overload. Aligning program demands with the practical realities of parental effort could help families focus finite energy on essential clinical targets. Full article

The therapeutic alliance is widely recognized as a central mechanism of change in psychotherapy; however, much existing research risks reifying it as a measurable and static construct, obscuring its fluid, co-constructed nature and the ways it is shaped by power, identity, and social context. This study aimed to explore how psychotherapists understand, construct, and enact the therapeutic alliance in their everyday practice, with particular attention to diversity, anxiety, rupture, and the reciprocal impact of the therapeutic relationship on the therapist. Using a qualitative design, semi-structured interviews were conducted with 14 psychotherapists primarily working in private practice, and the data were analyzed using reflexive thematic analysis. Six interrelated themes were identified: moving from technique to relational presence; diversity as relational negotiation; anxiety as a co-created relational process; rupture as inevitable and generative; therapist transformation through the therapeutic relationship; and navigating professional role and human authenticity. The findings suggest that effective therapeutic work relies less on rigid adherence to technique and more on reflexivity, emotional attunement, and a willingness to engage with discomfort, difference, and relational rupture. The study highlights the need for psychotherapy training to prioritize relational, ethical, and reflexive capacities alongside technical skills, and contributes a more process-oriented understanding of the therapeutic alliance from therapists’ lived perspectives. Full article

Revisit intention is increasingly recognized as a key indicator of sustainable heritage tourism, as it reflects long-term visitor engagement rather than one-time consumption. However, limited attention has been paid to how tourism preferences shape perceived heritage quality and subsequently influence revisit intention, particularly in industrial heritage contexts undergoing urban regeneration. This study develops a structural model linking tourism preferences, perceived quality, and revisit intention, using Shanghai’s waterfront industrial heritage as an empirical case. Based on 335 valid questionnaires, structural equation modeling (SEM) is employed to examine the relationships among environmental preference, cultural and social sustainability preferences, situational perception, and behavioral intention. The results indicate that preference for a sustainable public space environment significantly enhances both physical and atmospheric perception, which in turn positively affects revisit intention. In contrast, social sustainability shows limited influence, suggesting that visitors’ behavioral responses are more strongly driven by environmental quality and experiential engagement in regenerated industrial heritage settings. This study contributes to sustainable heritage tourism research by integrating preference-based perception mechanisms into revisit intention analysis. It also provides practical implications for enhancing long-term attractiveness through experience-oriented adaptive reuse strategies. Full article

With globalization and rapid changes in the international research environment from technological advancement, political instability, and economic crisis, knowledge management (KM) is crucial to help research institutions operate international research collaboration (IRC) effectively and sustainably. This study uses systematic literature review to extract key KM factors for IRC enhancement. Exploratory factor analysis and structural equation modeling methods are performed to confirm KM factors and explore how key KM and IRC factors relate to each other. Several KM strategies are established based on study results to achieve sustainable IRC development. The results show that five key KM factors, including knowledge sharing (KS), knowledge creation (KC), knowledge retention (KR), knowledge storage (KT), and knowledge utilization (KU), influence each other. They have both direct and indirect impacts on IRC. The KU factor is crucial for immediate IRC improvement. Research institutions can use existing knowledge and resources to address current IRC opportunities. For example, personnel with IRC experience can act as coaches and mentors to facilitate activities, and integrating IRC into career paths can be beneficial. Activities related to KC, KR, and KT should support KU implementation. Setting up a task force, improving organizational structure, and engaging management in KM can help achieve better IRC performance. The KS factor should be emphasized for sustaining IRC. The plan should involve activities to raise the processes of knowledge sharing effectively. The study results provide guidelines for research institutions aiming for sustainable IRC in the long term. Full article

Engineering programs in the United States continue to struggle with high attrition and limited diversity. This study investigates an unconventional solution: a narrative-based intervention where students write and perform their own engineering stories to build resilience and improve retention. While engineering curricula typically emphasize technical rigor, this research explores how a storytelling intervention influenced undergraduate students’ perceptions of their sense of belonging, professional identity, and persistence. The intervention, implemented across six semesters in diverse engineering disciplines, engaged students in developing and performing personal stories about their engineering journeys. Utilizing inductive thematic analysis of semi-structured interviews with 17 participants, we investigated how the narrative process influenced student perceptions. Results: Participants reported that the intervention positively influenced their identity development. Most participants reported a strengthened or reaffirmed intention to remain in the field. Our findings suggest that storytelling provided students with a structured way to discuss struggle, connect with peers, and see themselves more clearly as part of engineering. Those shifts may matter for retention, especially for students who otherwise feel isolated. Full article

Background: Osteopathy’s integration into contemporary healthcare requires clear articulation of its theoretical and practical foundations and active engagement in interprofessional practice. Despite growing institutional recognition, conceptual ambiguity remains regarding foundational principles and their operationalization. Osteopathy is broadly described as a person-centered, evidence-informed discipline promoting health through manual and educational strategies within systemic and biopsychosocial contexts. Objectives: This Perspective critically examines osteopathic principles, proposes a shared conceptual model for interdisciplinary care, and outlines a structured research agenda for empirical validation, aiming to enhance person-centered, preventive, and sustainable practice. Methods: A narrative review synthesized historical, theoretical, and contemporary evidence. Records were thematically analyzed through expert collaborative brainstorming to achieve consensus, ensuring both conceptual and empirical rigor. Results: Twenty-two studies were included, forming two thematic areas: (1) historical evolution of osteopathic principles, encompassing foundational definitions, early interpretive divergences, codifications, and adaptations; and (2) contemporary reconceptualization for interdisciplinary care, integrating systems-oriented and biopsychosocial frameworks. Emphasis was placed on self-regulation, structure–function relationships, and holistic care. This synthesis bridges historical and modern insights, highlighting osteopathy’s relevance in integrative, pediatric, and preventive healthcare. Conclusions: Reconceptualizing osteopathic principles strengthens professional identity and supports sustainable, evidence-informed, person-centered practice. The proposed framework informs interprofessional collaboration and guides a research roadmap to validate and integrate osteopathy globally within contemporary healthcare systems. Full article

This study explores the sustainability of pedagogical innovation in higher education by examining a faculty-collaborative, ADDIE-based selective flipped learning framework in an engineering education context. It addresses a persistent challenge in engineering classrooms, namely the mismatch between traditional teaching approaches and the diverse learning needs of students, while also considering whether such innovations can be realistically sustained over time. A mixed-methods sequential explanatory design was implemented in a foundational Circuits I course at Princess Sumaya University for Technology (PSUT), involving 110 undergraduate students and eight faculty members. The ADDIE model guided the design and implementation of selectively flipped instructional materials. Quantitative data were analyzed using independent samples t-tests, while qualitative data from surveys, interviews, and focus groups were examined through thematic analysis to better understand faculty experiences and implementation processes. The findings show statistically significant improvements in student performance. Independent samples t-tests indicated significant differences in overall scores and final exam performance (p < 0.001), while additional analyses of formative assessment components also demonstrated statistically significant improvements. At the same time, the results reveal important implementation challenges. Although the course was collaboratively designed, implementation varied across instructors, and faculty were divided in their willingness to continue using the approach. This highlights a clear gap between instructional design and classroom practice, shaped by both human and institutional factors. Overall, the study suggests that well-structured instructional design models such as ADDIE can support improved learning outcomes. However, the findings do not provide conclusive evidence of long-term sustainability; rather, they highlight the conditions under which pedagogical innovations may be sustained, including institutional support, faculty engagement, and alignment with teaching realities. Full article

American Indian and Alaska Native (AI/AN) populations experience disproportionately high kidney cancer incidence and mortality compared to other groups in the United States. Literature was reviewed to explore the factors contributing to the unequally higher kidney cancer burden in AI/AN communities and to develop recommendations to reduce these disparities. The incidence of kidney cancer has been rising over the past few decades, and this increase has been especially steep among AI/AN populations. Death rates in AI/AN populations are roughly twice those of the non-Hispanic White population. The elevated kidney cancer burden in AI/AN populations may be driven by both clinical and behavioral risk factors (obesity, diabetes, hypertension, chronic kidney disease, smoking, and environmental factors) and structural drivers of health, which can critically shape these disparities. Systemic inequalities limit AI/AN patients and community members’ access to chronic disease management, smoking cessation programs, primary and specialty care for early detection, and ultimately, treatment. AI/AN patients may have mistrust or other cultural barriers to engaging with the healthcare system and providers, while implicit bias in healthcare providers may lead to undertreatment. Therefore, key interventions and tailored programs aimed at reducing kidney cancer incidence and mortality are needed. Here we highlight some current interventions, including access to disease management and smoking cessation programs, facilitating healthcare access and quality, adopting patient navigation and culturally competent education, and developing strategies for early detection. In partnership with AI/AN communities, a combination of prevention, early detection, and healthcare system improvements is needed to close the kidney cancer gap. Full article

In recent years, the development of generative artificial intelligence, particularly diffusion models such as Stable Diffusion (SD), has provided new opportunities for the digital representation and creative dissemination of cultural heritage. This study takes Shanghai revolutionary cultural heritage as a case study and develops an application-oriented integrated workflow for generating revolutionary cultural images. By introducing Low-Rank Adaptation (LoRA) into the SD framework and combining structural control with local refinement strategies, this study enhances the style expression and structural quality of the generated images. Furthermore, an interactive creation platform is constructed to support the generation and creation of revolutionary cultural images. The evaluation results, including subjective assessment and SSIM/LPIPS metrics, indicate that the proposed workflow achieves higher style consistency and structural reliability while improving the structural integrity and detail reliability of facial regions. The proposed workflow and platform are intended to support revolutionary cultural venues in practical digital production and dissemination of heritage content while also promoting public engagement with revolutionary culture, especially among younger audiences. This study highlights the application potential of generative Artificial Intelligence (AI) in enhancing the accessibility, digitalization, and sustainable dissemination of revolutionary cultural heritage. It also provides a practical reference for interdisciplinary research in the field of cultural heritage and AI-assisted digital communication. Full article

Emotional intelligence and teaching self-efficacy are essential competencies for teachers’ professional and personal development. The aim of this study was to evaluate the effectiveness of a psychoeducational intervention to enhance both areas in future teachers. A quasi-experimental design with pretest and posttest measures was implemented, including an experiment. An eight-week program was conducted using active, reflective, and participatory methodologies to promote emotional awareness and confidence in teaching abilities. The OSTES instrument was used to measure teaching self-efficacy, the TMMS-24 to assess perceived emotional intelligence, and the EQ-i to evaluate socioemotional competencies, and. Results revealed significant improvements in the experimental group in emotional attention, clarity, and repair; in instructional strategies, classroom management, and student engagement; as well as in adaptability, interpersonal skills, stress management, and overall emotional intelligence. These effects ranged from moderate to large in magnitude and contrasted with the stable scores in the control group. The findings confirm that psychoeducational interventions focused on emotional competencies can be effective in strengthening emotional intelligence and self-efficacy in pre-service teachers. These outcomes suggest that such programs may contribute to the promotion of well-being and teaching effectiveness during initial teacher education, offering implications for future curricular development in teacher training programs. Full article

Background: Shoulder injury is common among athletes who engage in sports where the upper limb is actively involved. These injuries can affect an athlete’s performance and ability to return to sports at the preinjury level. This study aimed to cross-culturally adapt the Subjective Patient Outcome for Return to Sports score in Greek (SPORTS-GR) and evaluate its reliability and construct validity. Methods: Sixty-five Greek athletes (18–40 years) diagnosed with shoulder pathology were included. The SPORTS-GR was adapted according to standard procedures, and its construct validity was examined via associations with the Shoulder Pain and Disability Index (SPADI-GR) questionnaire, which assesses pain and disability related to shoulder pathologies. Test–retest reliability was tested by repeating the SPORTS score questionnaire administration after 6–8 days. Eligible athletes were selected from the Hellenic Supreme Council of Military Sports. Results: Face validity was excellent with a ceiling effect of 35.4%. The construct validity was high, with strong negative correlations between the SPORTS-GR score and the SPADI-GR total score (r = −0.91, p < 0.001), pain subscale score (r = −0.84, p < 0.001), disability subscale score (r = −0.90, p < 0.001), and age (r = 0.26, p = 0.04). Test–retest reliability was also excellent (ICC = 0.98) with no significant systematic error (SEM = 0.09). Conclusions: The SPORTS-GR is valid and reliable for evaluating athletes’ return to sports with shoulder pathologies. Full article

Workplace irritation is a prevalent phenomenon in the hospitality industry and has detrimental effects on both individual and organisational outcomes. Whereas prior research has examined this toxic phenomenon, how irritated employees recover from such status has received limited attention. Based on the principles of attention restoration theory, the current study conceptualises the recovery process from workplace irritation as the restoration of attention and develops a dual-path, moderated-mediation model. Irritated employees may engage in dual parallel recovery paths: positive solitude and social interactions, which thereby enhance their subjective well-being. Furthermore, we employ extraversion as a moderator to regulate engagement across the dual paths. Using a multi-wave survey data collected from 356 hotel employees in China, our findings reveal that both positive solitude and social interactions mediate the relationship between workplace irritation and subjective well-being. Furthermore, our findings also support the moderating role of extraversion within the social interactions path. However, this study does not support a moderating role for this variable within the positive solitude path. Full article