Search Results (1,087)

Background/Objectives: Halitosis in geriatric patients is multifactorial, but the joint contribution of prosthetic rehabilitation type and polypharmacy after routine dental procedures has rarely been quantified. We investigated how prosthesis type, polypharmacy, and salivary function were associated with volatile sulfur compound (VSC) burden and self-perceived halitosis in elderly dental patients. Methods: This cross-sectional study enrolled 88 patients aged ≥65 years, four weeks after completing routine dental procedures. Participants were stratified into three groups: complete denture wearers (n = 30), partial removable denture wearers (n = 28), and fixed prostheses/implants (n = 30). We measured unstimulated salivary flow rate (uSFR), tongue coating index (TCI), denture biofilm index, total VSCs (Halimeter^®), organoleptic score (0–5), and self-perceived halitosis. Polypharmacy, comorbidities, and the Geriatric Oral Health Assessment Index (GOHAI) were recorded. Analyses included one- and two-way ANOVA, Spearman correlations, theory-informed multivariable linear and logistic regression, exploratory mediation analysis, and ROC curves. Results: Forty-two participants (47.7%) reported halitosis. Mean VSC differed across groups (complete dentures 278.2 ± 38.6 ppb; partial 211.2 ± 46.3 ppb; fixed 164.4 ± 43.9 ppb; ANOVA p < 0.001). uSFR correlated inversely with VSC (ρ = −0.61, p < 0.001) and TCI correlated positively (ρ = 0.56, p < 0.001). A significant prosthesis × polypharmacy interaction was observed (F = 3.74, p = 0.029, η²_p = 0.082): polypharmacy was associated with higher VSC most clearly among partial and fixed prostheses wearers, whereas complete denture wearers showed high VSC levels regardless of polypharmacy status. Exploratory mediation findings were consistent with partial indirect association, with 45.9% of the polypharmacy–VSC association statistically explained by reduced uSFR; however, the cross-sectional design precludes causal or temporal interpretation. The full multivariable model showed apparent discrimination for self-perceived halitosis (AUC = 0.92), while the simplified four-item chairside composite model showed AUC = 0.89; neither estimate was optimism-corrected or externally validated. Conclusions: In elderly post-procedure patients, complete denture wearing, polypharmacy, and salivary hypofunction were independently and jointly associated with higher halitosis burden. Reduced salivary flow was consistent with a partial indirect statistical pathway in the polypharmacy–VSC association, supporting hydration counseling and meticulous prosthesis hygiene as low-cost geriatric interventions. Sensitivity analyses excluding implant-supported restorations, participants with MMSE scores of 24–26, and expanded mediation models including TCI and biofilm/plaque did not materially change the main inference. Full article

Background/Objectives: This study aimed to verify a prediction model identifying the relationships and pathways among factors associated with Korean nursing students’ provision of person-centered care to patients with dementia. Methods: This was a covariance structure analysis study to establish a hypothetical model of 313 Korean nursing students located in a metropolitan area. IBM SPSS version 18.0 (Chicago, IL, USA) and AMOS version 5.0 (Chicago, IL, USA) were used to analyze the data. Structural equation modeling analysis was applied to verify convergent and discriminant validity using higher-order factor analysis in the final model analysis. Results: The model fit indices of the research model were as follows: χ²/df = 1.83 (p < 0.001), GFI = 0.91, AGFI = 0.88, NFI = 0.91, CFI = 0.90, RMR = 0.04, and RMSEA = 0.05. The factors affecting person-centered care, nursing professionalism (γ = 0.45, p = 0.024), and empathy (γ = 0.21, p = 0.036) showed significant associations, whereas clinical practice adaptation (γ = 0.21, p = 0.013) and nursing professionalism (γ = 0.08, p = 0.004) had indirect effects. These factors explained 40% of the variance in person-centered care. Conclusions: This study is significant because it provides basic data for developing an educational program that can improve the person-centered care capacity of domestic nursing students by confirming that clinical practice adaptation, nursing professionalism, and empathy are important factors related to person-centered care. Full article

The role of financial institutions in climate governance is increasingly being recognized, particularly in relation to Scope 3 emissions. While existing research has focused primarily on lending and investment activities, the potential influence of insurance operations on lifecycle emissions remains underexplored. This study examines electric vehicle (EV) insurance underwriting as a form of indirect climate governance, with particular attention being paid to claim-related decision processes that affect repair-, replacement-, and battery-related outcomes. A decision-analytical, scenario-based portfolio model is developed to analyze how underwriting and claims parameters may influence lifecycle emissions exposure. The model incorporates literature-informed and scenario-based parameter ranges derived from the lifecycle assessment literature and industry-relevant assumptions, while explicitly accounting for regulatory, technical, and behavioral constraints that limit insurer decision making. An exposure-based attribution framework is applied to link insurance-mediated outcomes to emissions associated with vehicle and battery manufacturing. The results suggest that claim-related parameters—particularly total-loss probability—are associated with variations in modeled emissions exposure within the analytical framework. Scenario analysis indicates that, under plausible parameter configurations, differences in claims decision structures may contribute to variation in lifecycle emissions at the portfolio level. Sensitivity analysis further indicates that these relationships appear stable across a range of parameter assumptions. The findings should be interpreted as scenario-based insights rather than empirical estimates, highlighting potential pathways through which insurance operations may influence emissions outcomes within existing constraints. The study contributes to the literature by extending Scope 3 governance analysis to insurance and by proposing an operational framework for interpreting insurance-associated emissions in lifecycle terms. Full article

Leisure space configuration has been recognized as a spatial approach to reducing carbon emissions from recreational travel, but the role of perceptual factors in linking inter-facility distance to travel behavior is not fully clear. This paper adopts a “relative distance–perceived time cost (PTC)–carbon emissions” framework to explore their associations. Based on 20 recreational hotspots in Tianjin and 2372 valid questionnaires, we apply correlation analysis, mediation tests and regression tree segmentation for empirical exploration. Results indicate that the maximum distance between commercial and other leisure facilities (ShopMax) correlates significantly with PTC and shows a potential indirect association with carbon emissions. The indirect effect is significant for single-point trips (p = 0.006), while only directional trends exist for chained trips due to sample constraints. Optimal distance intervals present nonlinear differences across facility types: scenic facilities (ScenicMax) have overlapping perception- and emission-friendly intervals, whereas ShopMax shows divergent intervals for chained trips. The 200–300 m range is consistently found to be a high-carbon zone. This exploratory analysis suggests perceived time cost may connect spatial configuration to low-carbon travel. Differentiated layout strategies warrant further exploration for various facilities and travel contexts. Full article

Stream sediment geochemistry is a widely used reconnaissance tool in early-stage mineral exploration, particularly in regions where direct evidence of mineralisation is limited. Because stream sediment anomalies provide indirect geochemical signatures and are typically constrained by limited ground-truth information, labelled datasets are often scarce and spatially biased. This limitation restricts the applicability of supervised learning approaches and highlights the need for robust unsupervised methods. In this study, six unsupervised techniques, Principal Component Analysis (PCA), Non-negative Matrix Factorisation (NMF), Uniform Manifold Approximation and Projection (UMAP), Autoencoder (AE), Deep Embedded Clustering (DEC), and an Averaged Ensemble Index (AVE), were evaluated for integrating multivariate stream sediment geochemical data and delineating gold prospectivity zones. Eight gold-related elements (Au, As, Ag, B, Hg, Mo, Sb, and W) were selected based on regional metallogenic characteristics and previously reported geochemical associations. To facilitate direct comparison, all model outputs were normalised to a fuzzy membership scale ranging from 0 to 1. Model performance was quantitatively assessed using Receiver Operating Characteristic–Area Under the Curve (ROC–AUC) and Matthews Correlation Coefficient (MCC) metrics based on independently verified mineralised and non-mineralised locations. The results indicated that DEC and AE consistently outperformed the other methods investigated, achieving the highest ROC–AUC and MCC values, whereas UMAP exhibited comparatively weaker performance. The findings demonstrated that unsupervised representation learning approaches, particularly DEC and AE, provided a more effective framework for integrating multivariate geochemical data and delineating gold-related anomalies in data-limited exploration environments than conventional dimensionality reduction and heuristic integration methods. Full article

Background/Objectives: Adherence to the 24-h movement guidelines is generally low in preschool children, and less is known about how proximal family support for children’s physical activity (family PA support) is associated with physical fitness and 24-h movement behaviors. This study aimed to describe guideline adherence and to examine the associations among family PA support, 24-h movement behaviors, and physical fitness in Chinese preschool children. Methods: This cross-sectional study included 2386 Chinese preschool children (4.50 ± 0.86 years, 46.8% girls). Family PA support and 24-h movement behaviors were assessed using parent-reported questionnaires, and physical fitness was assessed using the Chinese National Physical Fitness Evaluation Standard for preschool children. Path analysis was used to examine the overall association pattern, including direct and indirect association estimates, among family PA support, movement behaviors, and physical fitness. Results: Only 12.7% of preschool children met all three 24-h movement recommendations. Compliance was 24.7% for physical activity, 82.7% for screen time, and 76.8% for sleep, indicating that insufficient physical activity was the main barrier to full guideline adherence. Family PA support was positively associated with physical fitness (β = 0.048, p = 0.021), and the combined indirect association estimate involving the three movement behaviors was also statistically significant (β = 0.024, p < 0.001). Among the three movement behaviors, family PA support was most strongly associated with higher MVPA (β = 0.150, p < 0.001), and MVPA showed the clearest positive association with physical fitness (β = 0.155, p < 0.001). Screen time was negatively associated with family PA support (β = −0.088, p < 0.001) but not significantly associated with physical fitness (p = 0.091), whereas sleep showed a small negative association with physical fitness (β = −0.056, p = 0.005). These findings suggest a comparatively stronger role for MVPA within the observed association pattern. Conclusion: Chinese preschool children showed low adherence to the 24-h movement guidelines, with insufficient physical activity appearing to be the main limiting factor. Family PA support may represent a potentially modifiable family-level correlate of preschool children’s physical fitness, with MVPA appearing to play a comparatively stronger role within the observed association pattern. Full article

Background: The increasing use of e-cigarettes among adolescents is a growing public health concern in Thailand, where they are prohibited but remain accessible. This study aimed to examine the psychosocial correlates of preventive behaviors regarding e-cigarettes among adolescents in central Thailand. Methods: A cross-sectional correlational study was conducted with 383 secondary school students (Grades 7–12) selected through proportionate stratified random sampling from two government schools in Ongkharak District, Thailand. Data were collected using a validated self-administered online questionnaire assessing attitudes toward e-cigarettes, peer influence, family attachment, and preventive behaviors. Item analysis, confirmatory factor analysis (CFA), and factor-score regression with bootstrapped indirect-association analysis (k = 5000) were performed to examine direct and indirect associations. Results: The four-factor measurement model demonstrated acceptable absolute fit (SRMR = 0.069) but weaker incremental fit (CFI = 0.70), expected given the large number of ordinal indicators estimated via maximum likelihood, with standardized factor loadings ranging from 0.621 to 0.926 (p < 0.001). The structural model explained 44.2% of the variance in preventive behaviors (R² = 0.442). Family attachment showed the strongest total association (β = 0.456), including both direct and indirect associations through attitudes (β = 0.116) and peer influence (β = 0.162), consistent with a pattern of statistically significant indirect associations. Conclusions: Family attachment was associated with self-reported e-cigarette preventive behavior, with statistically significant indirect associations through attitudes and peer influence. Given the cross-sectional design, these findings should be interpreted as model-consistent associations rather than causal mediation, and may inform future family- and peer-oriented prevention research in comparable settings. Full article

This study examined the associations of self-reported emotional intelligence and self-regulation with children’s well-being among fourth-grade elementary school students in Mersin, Türkiye. The sample comprised 627 students, predominantly aged 9 to 10 years, from seven public elementary schools selected to reflect different district and school contexts. Data were collected in person after ethics committee approval, institutional permissions from the Turkish Ministry of National Education, and written parental consent. The Children’s Emotional Intelligence Scale, the Self-Regulation Scale, and the Stirling Children’s Well-Being Scale were administered. Descriptive statistics, Pearson correlations, simple and multiple linear regressions, and a cross-sectional indirect association analysis using PROCESS Model 4 with 5000 bootstrap resamples were conducted. Emotional intelligence was positively associated with children’s well-being and self-regulation, while self-regulation showed a weaker positive association with well-being. Emotional intelligence explained 31.4% of the variance in well-being, self-regulation explained 8.6% when examined alone, and both variables jointly explained 31.9%, indicating only a marginal increase over emotional intelligence alone. Thus, most of the explained variance was accounted for by emotional intelligence, whereas self-regulation made a very small incremental contribution beyond it. The indirect association analysis indicated a small but statistically supported pattern of indirect association between emotional intelligence and well-being through self-regulation within this cross-sectional design; the association between emotional intelligence and well-being remained significant after self-regulation was included in the model. The findings suggest that emotional intelligence is the stronger socio-emotional correlate of children’s well-being in this sample, whereas self-regulation shows a limited complementary association. Given the cross-sectional design and reliance on self-report measures, the findings should be interpreted as correlational associations rather than evidence of causal effects, temporal ordering, or developmental change. Future studies should use longitudinal, intervention-based, and multi-informant designs to further examine these associations. Full article

Background and Objectives: Halitosis is a prevalent oral concern that meaningfully affects oral health-related quality of life (OHRQoL), yet how active dental treatment is associated with short-term changes in the objective–subjective halitosis–QoL nexus remains poorly quantified. Interpretation is complicated by the multifactorial nature of malodor and by baseline differences between patients selected for different dental procedures. We compared changes in volatile sulfur compound (VSC) emissions, organoleptic ratings, tongue-coating burden, and OHIP-14 across three contrasting treatment modalities and explored whether VSC change statistically accounted for OHRQoL change. Methods: In a non-randomized prospective comparative study, 119 adults (18–67 y) commencing one of three procedures were assessed at baseline and at 8 weeks: scaling and root planing (Group A, n = 42), fixed prosthodontic rehabilitation (Group B, n = 38), or fixed orthodontic appliance bonding (Group C, n = 39). Outcomes included Halimeter^® VSC (ppb), Rosenberg organoleptic score (0–5), Winkel tongue-coating index (TCI), self-perceived halitosis, and OHIP-14 total and seven-domain scores. Mixed-design ANOVA, ANCOVA, prespecified multivariable regression, mediation (5000 bootstrap resamples), receiver operating characteristic analysis, and four-class latent class analysis were performed. A sensitivity-analysis framework including expanded covariate adjustment, propensity-score overlap weighting, and baseline-severity strata was also applied to address residual baseline imbalance. Secondary mediation, ROC, and latent-class analyses were considered exploratory. Results: At 8 weeks, VSCs fell by 116.4 ± 38.7 ppb in Group A and 35.4 ± 29.1 ppb in Group B but rose by 34.3 ± 28.6 ppb in Group C (p < 0.001). OHIP-14 improved by 10.3 and 4.9 points in A and B and worsened by 3.7 in C (p < 0.001). ΔVSC correlated with ΔOHIP-14 (ρ = 0.51, p < 0.001) and most strongly with the psychological discomfort domain (ρ = 0.58). VSC change mediated 35.1% of the periodontal-versus-orthodontic association on QoL (indirect β = −4.7; 95% CI −6.3 to −3.1). Because VSC and OHIP-14 changes were measured over the same interval, mediation was interpreted cautiously. A ΔVSC threshold of −63 ppb predicted clinically meaningful OHIP-14 improvement (AUC = 0.81). Latent class analysis identified four distinct responder phenotypes. The cutoff and responder classes were internally derived and require external validation. Sensitivity analyses preserved the direction of the primary contrasts, but residual confounding remains possible. Conclusions: Treatment modality was associated with the direction and magnitude of halitosis and QoL change, with orthodontic patients constituting a vulnerable subgroup. Targeted oral-hygiene reinforcement during fixed-appliance therapy is warranted. Full article

Background/Objectives: Spiritual care is core to holistic patient care, yet a persistent implementation gap exists in Chinese hospitals. This study examines the association between spiritual leadership and nurses’ spiritual care behavior, with career calling as mediator and empathy as moderator. Methods: A cross-sectional design was adopted. Data were collected from 323 frontline nurses in 10 public hospitals across five provinces in China from June to September 2025 using validated Likert scales. Analyses included confirmatory factor analysis, hierarchical regression, and a second-stage moderated mediation model with 5000 bootstrap resamples using SPSS 26.0 and Mplus 8.3. Results: Spiritual leadership was positively associated with both nurses’ spiritual care behavior and career calling. Career calling partially mediated the relationship between spiritual leadership and nurses’ spiritual care behavior. Furthermore, empathy significantly strengthened the positive association between career calling and spiritual care behavior, and amplified the indirect effect of spiritual leadership on nurses’ spiritual care behavior via career calling. Conclusions: Spiritual leadership, career calling, and empathy are key factors associated with nurses’ spiritual care delivery. Targeted interventions for these factors can bridge the spiritual care implementation gap and enhance holistic patient care. Full article

Background: Women undergoing in vitro fertilization (IVF) often experience poor well-being. Social support and family resilience are considered protective factors, but their combined roles in the anxiety–fertility-related quality of life (FertiQoL) relationship remain unclear. Design: A cross-sectional study was conducted with women undergoing IVF at the reproductive medicine department of a tertiary hospital in Shanghai, China, between March and December 2024. Methods: Participants completed validated measures of anxiety, social support, family resilience, and QoL. Associations and indirect effects were examined using mediation analysis, and sensitivity analyses were conducted. Results: A total of 419 women participated in the study (response rate = 98.6%; mean age = 33.3 ± 4.7 years). Anxiety was negatively associated with social support, family resilience, and FertiQoL (all p < 0.001). The total indirect association between anxiety and FertiQoL involving social support and family resilience was statistically significant (B = −0.15, p = 0.03). However, the specific indirect effects, including the hypothesized sequential pathway through social support and family resilience, were not statistically significant. The total association between anxiety and FertiQoL was significant (β = −0.32, p < 0.001). Conclusions: Anxiety was associated with poorer FertiQoL among women undergoing IVF. Although the findings suggest an overall indirect association involving social support and family resilience, the hypothesized sequential mediation pathway was not supported. Therefore, the results should be interpreted cautiously, and longitudinal studies are needed to clarify the temporal and causal relationships among these psychosocial factors. Full article

Background and Motivation: Foreign direct investment (FDI) has been widely examined as a potential driver of economic growth, yet empirical evidence for Morocco remains inconclusive due to methodological limitations and endogeneity concerns. This study re-examines the FDI–growth relationship in Morocco over the period 1977–2022 using a five-equation simultaneous system estimated by Two-Stage Least Squares (2SLS). The framework jointly models GDP growth, FDI, exports, human capital, and domestic investment in order to account for bidirectional relationships among the main variables. Methods: Unit root and Johansen cointegration tests support the existence of long-run equilibrium relationships among the series, while a Chow test identifies a significant structural break in 2003 (F = 11.43, p = 0.003). Diagnostic tests confirm instrument relevance (Cragg–Donald F > 10) and fail to reject over-identification validity (Hansen J p > 0.10). Results: The results indicate a positive but statistically fragile association between FDI and economic growth—positive in sign across all specifications but sensitive to sample size and instrument choice (β = 2.179, t = 1.728, p = 0.092; 90% CI: [−0.341, 4.699] in constant 2015 USD billions). FDI is associated with growth primarily through indirect channels—particularly export expansion and human capital accumulation—rather than through direct capital deepening alone, consistent with an absorptive-capacity interpretation. The estimated structural break in 2003 reflects a broader package of concurrent institutional and macroeconomic reforms; the model cannot isolate the independent contribution of FDI within this composite effect. The results should therefore be interpreted as evidence of long-run reduced-form associations rather than definitive causal effects. Conclusions: Overall, the study contributes to the Morocco-specific literature by integrating simultaneous equations, indirect transmission channels, and structural break analysis within a unified long-run framework. Full article

In the strategic context of China’s efforts to promote agricultural power and modernization, the key to achieving sustainable development for agricultural enterprises lies in fostering breakthrough innovations and enhancing their market competitiveness. This paper uses Chinese agricultural enterprises listed on the A-share market from 2009 to 2024 as its research sample. From the perspective of breakthrough innovation in agriculture-related enterprises, it examines the association between agricultural new quality productivity and the sustainable development of agricultural enterprises. The regression results show that, first, agricultural new quality productivity is positively associated with breakthrough innovation in agricultural enterprises. After a series of robustness tests, these findings remain valid. Second, the bootstrap mediation results indicate that this relationship operates mainly through government policy orientation and enterprise knowledge creation capacity, while the indirect effects of government resource support and independent R&D capacity are weaker and not statistically robust. Furthermore, a heterogeneity test revealed that agricultural new quality productivity has a more pronounced positive association with breakthrough innovation in regions with strong intellectual property protection and high environmental regulations, as well as in samples where corporate executives demonstrate greater environmental awareness and companies achieve higher overall ESG scores. Finally, further analysis shows that as the level of corporate green transformation increases, the enabling effect of agricultural new quality productivity on breakthrough innovation in agricultural enterprises becomes more pronounced, providing evidence on how ANQP may support the sustainable development of agricultural enterprises. Full article

Islamic banking is increasingly expected to align Sharia-based intermediation with sustainability objectives, yet empirical evidence remains limited on how sustainability disclosure links financing structures with bank performance. This study examines whether Islamic Sustainable Banking (ISB) functions as a mediating mechanism between profit-sharing financing, debt-based financing, and financial performance in Islamic banks in Indonesia and Malaysia. ISB is measured using an Islamic Sustainable Banking Disclosure Index that integrates Maqasid al-Shariah principles with SDG-oriented disclosure indicators. Using panel data from 23 Islamic banks over 2018–2023 and applying partial least squares structural equation modeling, mediation analysis, PLS-MGA, and permutation tests, the study finds that both profit-sharing and debt-based financing are negatively associated with ISB disclosure, while ISB is positively associated with net profit margin but not return on assets. The mediation results indicate statistically significant negative indirect associations through ISB, suggesting that sustainability disclosure operates as a conditional transmission mechanism rather than an automatic performance driver within the specified PLS-SEM model. Cross-country tests reveal significant differences between Indonesia and Malaysia, particularly in the associations between financing structures and profitability. The study contributes to Islamic sustainable finance by clarifying how Maqasid-oriented disclosure connects financing composition, governance capacity, and profitability, while offering practical implications for bank managers, regulators, and policymakers seeking to integrate sustainability into Islamic banking governance and financing decisions. Full article

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). However, the limited predictive value of PD-L1 expression as a biomarker underscores the urgent need for more reliable predictors of ICI response. Interferon regulatory factor 1 (IRF1) is a transcription factor that lies downstream of interferon-γ signaling and directly regulates CD274 (PD-L1) transcription. Here, we performed a comprehensive bioinformatic analysis to identify microRNAs (miRNAs) that may be associated with IRF1 expression in lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC). Using data from The Cancer Genome Atlas (TCGA), we identified 20 miRNAs whose expression levels consistently and negatively correlated with IRF1 mRNA levels in both LUAD and LUSC. Among these, only hsa-miR-301b possesses conserved binding sites in the 3′UTR of IRF1 mRNA, suggesting direct post-transcriptional repression. For the remaining 19 miRNAs, we hypothesized an indirect mechanism of action. Further analysis revealed that hsa-miR-183 and hsa-miR-141 may target the transcription factor genes NFKB1 and STAT4, respectively, both of which positively correlate with IRF1 expression and are themselves associated with improved survival in ICI-treated patients. This study delineates a multi-layer miRNA regulatory network associated with IRF1 expression in NSCLC and identifies hsa-miR-301b, hsa-miR-183 and hsa-miR-141 as candidate upstream regulators of IRF1. Direct survival analysis for these miRNAs in ICI-treated cohorts was not feasible due to the lack of publicly available miRNA-seq data with treatment annotations; therefore, their clinical predictive value remains hypothetical, and experimental validation is required to assess their potential as predictors of ICI response. Full article