Search Results (7,689)

Background/Objectives: The health status of institutionalized older adults is determined by the interaction of functional, cognitive, nutritional, anthropometric, and biochemical factors, which may not be adequately captured through single-domain assessments. Within the framework of the VIVA Project (Vulnerability Index: Valencia institutionalized Adults), this study aimed to characterize institutionalized older adults during the COVID-19 pandemic using an integrated multidimensional approach and to explore clinically interpretable vulnerability profiles. Methods: This cross-sectional study included 124 residents from 10 nursing homes of Valencia, Spain. Data were obtained from institutional records and included age, sex, body mass index (BMI), Barthel Index, Mini-Examination of Cognition (MEC), Tinetti scale, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers related to protein status, lipid metabolism, micronutrient availability, and renal function. An exploratory VIVA multidimensional index was constructed from nine standardized variables, and k-means clustering was applied to these variables rather than to a single summed score to identify residents’ phenotypes. An exploratory logistic regression model was used to assess the internal discrimination of the high-vulnerability phenotype. Results: The cohort showed marked heterogeneity across functional, cognitive, nutritional, anthropometric, and biochemical domains. Cluster analysis identified three clinically interpretable phenotypes ranging from lower to higher vulnerability. Functional impairment, particularly the Barthel Index and Tinetti score, was the main driver of separation between phenotypes, while biochemical markers contributed to refining profile discrimination. The exploratory logistic regression model showed high internal discrimination for the high-vulnerability phenotype, supporting the internal coherence of the integrated framework. Conclusions: An integrated multidimensional framework may be useful for characterizing vulnerability among institutionalized older adults and supporting risk stratification in long-term care settings. The logistic regression findings, including the high AUC, should be interpreted only as evidence of internal discrimination and internal coherence of the exploratory construct, not as evidence of external validity, reproducibility, diagnostic accuracy, or future predictive utility. Full article

To address the dilemma of ‘non-grain use of cultivated land’ and support China’s requisition–compensation balance policy, this study developed a multi-dimensional assessment framework integrating the production, ecological, and economic dimensions (3D evaluation model), using Shenyang City as a case study to demonstrate the framework’s operational application and policy relevance. Based on 34,704 Third National Land Survey (TNLS) parcels (27,408.39 ha), we applied the constraint factor assessment method and entropy-weighted composite index model. The results show that non-cultivated agricultural land (NCAL) is generally marginally suitable (citywide average score: 2.50/4), with highly suitable areas accounting for only 4.04% (1106.30 ha). These areas exhibit a triangular spatial pattern distributed across northeastern Faku County, central Sujiatun District, and southern Xinmin City. Sensitivity tests using equal weights and ±20% dimension-weight perturbations confirm that high-suitability area remains limited (3.37–5.63% under entropy-weight scenarios; 8.54% under equal weights). Primary limiting factors include severe organic matter deficiency (average 19 g/kg), shallow soil depth, unfavorable pH, land requiring engineering restoration (94%), and punctiform heavy metal contamination (7.53% of plots, 2065.05 ha as spatially excluded areas). Consequently, we propose a five-tier sequential restoration framework: (1) near-term priority recultivation of highly suitable areas; (2) mid-term topsoil reconstruction for moderately suitable areas; (3) medium-to-long-term topsoil stripping and thickening for low-suitability areas; (4) long-term soil amelioration and slope-to-terrace conversion for marginally suitable areas; and (5) strict prohibition of restoration in unsuitable areas. This study establishes a spatially explicit decision-making system integrating “evaluation–classification–sequencing”, and distinguishes technical suitability from economic, institutional, and policy feasibility, providing a decision-support framework for scientifically implementing the cultivated land requisition–compensation balance policy. Future empirical studies using post-restoration monitoring data are needed to test its predictive accuracy against observed restoration outcomes. Full article

This study presents the design and implementation of a single-institution intelligent diagnostic system to identify low mid-period academic performance, aimed at activating proactive and preventive tutoring before a final assessment. The system features an integrated analytical architecture comprising an inferential framework, a predictive framework, an explainability framework, a validation framework, and a Streamlit-based web prototype. The sample uses 18,604 longitudinal academic records from 1264 unique students enrolled across 7 consecutive academic periods (2017–2020) at an Ecuadorian university. Results indicate that curricular level is the structural predictor with the greatest independent contribution (semi-partial R² = 0.044), followed by academic period (semi-partial R² = 0.026). Random Forest achieved the best overall performance (MAE = 1.267 ± 0.04; RMSE = 1.714 ± 0.05; R² = 0.551 ± 0.02), outperforming other algorithms. SHAP explainability confirms the primacy of curricular level and academic period as individual-level risk-associated factors, enabling the generation of interpretable alerts for tutors. The equity analysis revealed that students aged 30–50 years (ratio = 1.375) and the province with code 18 (ratio = 1.395) constitute priority subgroups for data enrichment prior to institutional deployment. External validation with real users is identified as the next research stage. Full article

Background/Objectives: Retention of healthcare professionals in the workforce, their employment, and the improvement of working conditions largely depend on identifying the factors that influence their departure and their health. The study was conducted during the period from January to June 2021. This study aimed to examine the association between specific work-related stressors and work ability. The initial hypothesis was that general and specific occupational stressors negatively associate with work ability among healthcare professionals in emergency medical intervention teams. Methods: The study was designed as a cross-sectional comparative study. It was conducted among nurses and physicians in pre-hospital emergency medical services, employed full-time in intervention teams, while the control group consisted of employees from dispatch and call-receiving units. The study was conducted on the 840 participants, representing 43.3% of all healthcare professionals employed in pre-hospital emergency medical services in the Republic of Croatia. In addition to questions on participants’ personal characteristics, the following instruments were used: 1. a validated Questionnaire on Workplace Stressors among hospital healthcare professionals; and 2. the international standardized Work Ability Index (WAI) questionnaire for assessing work ability. Participants completed the questionnaires in paper form. Results: On average, the participants demonstrated lower levels of stress compared to reference values, both for overall stress and for individual stress factors, while their work ability, assessed using the Work Ability Index (WAI), ranged from very good to excellent. The control group showed higher levels of stress across all factors and lower work ability. However, the control group was older on average, generally had lower levels of education, and consisted more often of women—personal characteristics that may influence the examined variables. Lower stress levels and better work ability were associated with job satisfaction, ambition, and the fact that participants were working in their desired profession. Frequent sick leave (absenteeism) was highly correlating with both higher stress levels and poorer work ability. Conclusions: Greater job satisfaction and higher motivation have a positive impact on stress levels and employees’ work ability. The study results can serve as a starting point for institutional management in designing feasible decisions aimed at improving satisfaction, health, the work environment, and the work ability of emergency medical service personnel, as well as making these institutions more attractive for recruitment and retention of employees both in their positions and within the profession. Full article

Background/Objectives: Chiropractors serve as first-contact practitioners in South Africa and frequently encounter patients with systemic conditions that may mimic musculoskeletal complaints. Non-musculoskeletal (non-MSK) examinations are essential for identifying red flags, ruling out serious pathologies, and facilitating timely referrals. Despite their importance for patient safety and integration into primary healthcare, limited research exists on the frequency with which South African chiropractors perform these assessments. This study aimed to describe the frequency and indications for non-MSK examinations performed by South African chiropractors and to explore variations across examination types, demographic factors, years of experience, and training institutions in secondary analyses. Methods: A cross-sectional online survey was distributed to 898 registered chiropractors, yielding 186 responses (20.7%). The questionnaire assessed the frequency of non-MSK examinations using a five-point Likert scale. Data were analysed using descriptive statistics (frequencies, percentages, medians, interquartile ranges). Exploratory subgroup comparisons were conducted using nonparametric tests, but these findings should be interpreted with caution due to small and uneven sample sizes in some subgroups. Ethical approval was obtained (REC-3366-2025). Results: Most respondents were female (57.5%) and practising in Gauteng (49.5%). Blood pressure (84.4%) and heart rate (81.2%) were the most frequently performed examinations, while respiratory rate (12.4%), oxygen saturation (9.7%), and temperature (11.8%) were the least frequently performed vital signs. Breast (3.8%), abdominal (10.2%), and genitourinary (1.1%) examinations were rarely conducted. Exploratory subgroup observations suggested provincial variation: chiropractors in KwaZulu-Natal performed non-MSK examinations more frequently than those in Gauteng and the Western Cape (mean differences ranging from 0.21 to 1.19 on a five-point scale), whereas no meaningful differences were found across years in practice. Conclusions: South African chiropractors perform a selective range of non-MSK examinations, supporting their role as first-contact practitioners. However, many systemic examinations are conducted infrequently, with observed provincial variation. These descriptive findings highlight the need for greater consistency and standardisation in non-MSK screening to enhance patient safety and interdisciplinary care. Future adequately powered studies are needed to confirm the exploratory subgroup observations. Full article

This article examines how artificial intelligence (AI), conceptualized as a general-purpose technology (GPT), shapes economic growth and structural transformation through a structured literature review covering the period from 2015 to 2025. The study adopts a structured, mechanism-oriented synthesis approach grounded in transparent search, screening, and thematic classification procedures rather than formal meta-analytic protocols. It develops an integrative innovation ecosystem framework that links three core transmission channels: (i) total factor productivity (TFP), (ii) task reallocation and labor-market restructuring, and (iii) innovation and knowledge-generation dynamics. The findings indicate that AI adoption does not generate uniform or automatic growth effects. Empirical evidence remains heterogeneous, and estimates of AI’s macroeconomic contribution vary across institutional and structural contexts. In most cases, outcomes depend less on the technology itself and more on complementary conditions—human capital formation, digital and data infrastructure, institutional coordination, and governance capacity—that enable effective diffusion. Interpreting task-based automation models alongside endogenous-growth and open-innovation frameworks clarifies why similar AI investments may lead to divergent structural outcomes. Rather than proposing a deterministic growth model, the study advances a conditional and ecosystem-centered interpretation of AI-led development. The study contributes by distinguishing foundational theoretical perspectives from the contemporary 2015–2025 evidence base, clarifying the relationship between task transformation and structural transformation, and emphasizing institutional complementarity as the key mechanism shaping AI-driven growth outcomes. Full article

The open sharing of data as a factor of production is an important institutional mechanism for promoting sustainable innovation in the digital economy. Using Chinese A-share listed firms as the research sample and exploiting the staggered rollout of government open data (GOD) platforms across prefecture-level cities as a quasi-natural experiment, this paper constructs a staggered difference-in-differences (DID) model to examine the effect of GOD on green collaborative innovation (GCI) and its underlying mechanisms. The results show that GOD significantly promotes GCI, indicating that open government data can help firms strengthen collaboration in green innovation and contribute to more sustainable development. Mechanism analysis shows that GOD promotes GCI through four channels: increasing government subsidies, reducing information asymmetry, raising public environmental awareness, and advancing corporate digital transformation. Heterogeneity analysis reveals that the innovation-promoting effect of GOD is more pronounced in large cities, non-resource-based cities, and southern cities, and is more salient among state-owned enterprises, capital-intensive firms, and mature firms. This paper provides empirical evidence on the microeconomic effects of market-oriented data allocation and highlights the role of GOD in supporting GCI, corporate sustainable transformation, and the sustainable development of the digital economy. Full article

While individual determinants of students’ well-being are well established, less is known about the association with the institutional context. This study evaluates institutional-level factors associated with students’ mental health while controlling for individual characteristics. The cross-sectional analysis used data from 12 German institutions (n = 13,715) collected in the StudiBiFra survey on study conditions and student mental health. Individual-level variables included gender, age, study subject group, and four mental health variables (general well-being, depressiveness, cognitive stress, and exhaustion). Institution-level variables comprised institution type, excellence status, multi-campus structure, size, and satisfaction with the quality of health promotion services. Multilevel binary logistic regression models were applied to examine associations between institutional characteristics and mental health outcomes, adjusting for individual factors. Students enrolled at universities of applied sciences showed a lower likelihood of reporting depressiveness and exhaustion. Higher levels of depressiveness and cognitive stress were observed among students at medium-sized institutions compared to small ones. Students not enrolled at institutions with excellence status had lower risks of depressiveness, stress, and exhaustion. Additionally, higher satisfaction with institutional health promotion services was associated with reduced odds of depressiveness. Institutional factors are related to students’ mental health beyond individual characteristics, highlighting the need for a holistic, setting-based approach. Full article

Bioenergy crops are widely regarded as a promising approach to support renewable energy production, diversify farm income, and enhance land-use efficiency. Despite these potential benefits, adoption rates remain low, and empirical understanding of landowners’ decision-making processes is still emerging. This study examines landowners’ interest in and likelihood of adopting bioenergy crops, explicitly differentiating between early-stage interest and near-term adoption intentions. Survey data from 207 landowners are analyzed using a bivariate probit model to identify key factors influencing both outcomes. The results reveal a marked disparity between expressed interest and adoption likelihood, with a significantly greater proportion of landowners indicating interest than those willing to adopt in the near term. Economic orientation increases adoption interest by 9.5 percentage points, while identity orientation increases adoption likelihood by 6.6 percentage points. Determinants such as increased awareness, land size, experience, and participation in conservation programs exert varying influences across different decision stages. These findings suggest that stated interest and stated near-term adoption likelihood represent related but distinct dimensions of adoption readiness, shaped by different economic, identity-based, and institutional factors. Effective promotion of bioenergy crops requires more than general awareness campaigns. Policies should combine financial incentives, technical assistance, market development support, and outreach strategies that present bioenergy crops as compatible with landowners’ economic goals, stewardship values, recreational uses, and long-term attachment to their land. Full article

This study investigates the pedagogical landscape of state language instruction in Hungarian-medium schools in Slovakia. Situated within the wider context of European minority language policies, this study explores the institutional ecosystems, didactic approaches and teaching strategies, and the relationship between teacher- and student-centered methodologies in state language instruction. A questionnaire survey based on a self-developed Multi-Level Diagnostic Model was administered to a representative sample of teachers, accounting for 23% of the total Slovak teacher population working in this distinctive sociolinguistic setting (N = 112). Although the results indicate that the educational process is shaped by various factors and there is an endeavor to promote communicative practice, the competence–use gap persists due to the reliance on conventional teacher-centered teaching approaches. This trend is driven by a methodological vacuum, the absence of specialized L2 teaching materials and the lack of modern digital resources; it also suggests that teachers are forced to prioritize instructional security rather than being resistant to innovation. The findings suggest that the current educational system is ready for change, but it requires systemic investment in resources to promote the balanced development of intercultural communicative competence. Addressing the linguistic distance between Hungarian L1 and Slovak L2 through specialized materials may promote a model of additive bilingualism that ensures professional credibility and the protection of minority cultural identity. Full article

Nectin-4 has emerged as a clinically relevant target in muscle-invasive bladder cancer (MIBC), primarily because of its role in antibody–drug conjugate-based therapies. However, the broader biological context of Nectin-4 expression and its association with tumor-promoting signaling pathways in MIBC remain insufficiently characterized. In this single-institution study, Nectin-4 expression (H-score 0–300) was assessed by immunohistochemistry in two independent MIBC cohorts. Associations between Nectin-4 expression and key markers related to growth signaling, metabolic regulation, and inflammation were analyzed alongside clinicopathological characteristics. Nectin-4 expression was significantly higher in malignant tissue than in non-malignant tissue (p = 0.0016 and p = 0.0302, respectively). Nectin-4 expression was not associated with demographic or clinicopathological parameters; however, a trend toward lower expression in more advanced disease stages was observed. Significant positive correlations were identified between Nectin-4 expression and protein kinase B (p = 0.0004), cytoplasmic (p = 0.0115) and membranous somatostatin receptor 2 (p = 0.0125), insulin receptor substrate 1 (p = 0.03), and interleukin-1 receptor antagonist (IL-1RA; p = 0.0045). In contrast, a negative correlation was observed with the IL-1β/IL-1RA ratio (p = 0.0246). Although Nectin-4 expression was not significantly associated with cancer-specific or overall survival, a trend toward shorter relapse-free survival was observed in patients with lower Nectin-4 expression (p = 0.0531). In multivariate analysis, patient age, but not Nectin-4 expression, emerged as an independent prognostic factor. Although Nectin-4 expression does not appear to have independent prognostic value, its biological associations suggest that it reflects an integrated tumor-related signaling context. These findings support further investigation of Nectin-4 as part of rational, biology-driven therapeutic strategies in bladder cancer. Full article

Background: Intraoperative periprosthetic femoral fractures (IPFF) represent a concerning and often under-recognized complication in total hip arthroplasty (THA). Although several risk factors have been reported, their association with specific femoral morphology and stem geometry has not been fully addressed. This study aimed to identify the incidence and risk factors for IPFF in THA using cementless tapered stems. Methods: A retrospective review was conducted on 3137 primary THAs (2622 patients) performed with cementless tapered stems at a single institution between February 2011 and August 2018. Femoral morphology was classified according to the Dorr types; A (1425 hips, 45.4%), B (1542, 49.2%), and C (170, 5.4%). Femoral stems were categorized as flat, rectangular, or quadrangular tapered designs. The occurrence of IPFF was identified through surgical records and postoperative radiographs. Multivariate regression analysis was performed to identify independent risk factors for IPFF. The mean age at THA was 55 years (range, 15–96), and 52.9% of the patients were women. Results: The overall incidence of IPFF was 2.2% (69 hips). Non-displaced cracks in the proximal metaphysis (58 hips, 84.1%) were the most common type of fracture. The incidence of IPFF was significantly higher in Dorr type A (3.0%) and type C (4.7%) femurs compared with type B (1.2%) femurs. Multivariate regression revealed that female sex (odds ratio [OR], 1.752; p = 0.032) and Dorr type A (OR, 2.898; p < 0.001) and type C (OR, 4.530; p < 0.001) were significantly associated with IPFF. Additionally, the use of quadrangular tapered stems was associated with a higher risk compared with flat tapered stems (OR, 7.382; p < 0.001). Conclusions: Dorr type A and C femurs, along with female sex and the use of quadrangular tapered stems, were significant risk factors for IPFF. Our findings suggest that preoperative consideration of individual femoral morphology and careful selection of stem design are essential to mitigate the risk of IPFF in THA using cementless tapered stems. Full article

Background: Several factors have been reported to influence the prognosis of medullary thyroid cancer (MTC). This study aimed to identify prognostic variables associated with progression-free survival (PFS) and overall survival (OS) in a cohort of patients treated at our institution. Patients and Methods: We performed a retrospective analysis of 107 consecutive patients with histologically confirmed MTC who were followed for at least 12 months. Demographic, clinical, and pathological data were retrieved from medical records. The association between baseline variables and survival outcomes was evaluated using univariate Cox proportional hazards regression models. The study was approved by the local ethics committee. Results: The median age at diagnosis was 56 years (range, 10–80 years), and 63% of the patients were female. Germline REarranged during Transfection (RET) mutations were identified in 10% of cases. The median follow-up duration was 100 months (range, 12–464 months). At diagnosis, disease stages were distributed as follows: stage I, 52%; stage II, 12%; stage III, 17%; and stage IV, 19%. Female patients showed significantly longer PFS compared with males (Hazard Ratio (HR) = 0.41, 95% Confidence Interval (CI) (0.21–0.82); p = 0.012). Factors associated with PFS by Cox regression models were post-operative serum calcitonin (CT) values after 1 and 3 months of surgery (HR = 0.08, 95% CI (0.03–0.20); p < 0.001; HR = 0.03, 95% CI (0.01–0.11); p < 0.001, respectively), Tumor, Node, and Metastasis (TNM) stage III–IV (HR = 16.86, 95% CI (5.87–48.44); p < 0.001), presence of lymph nodes metastasis at diagnosis (HR = 9.6, 95% CI (3.59–25.63); p < 0.001), multifocal disease (HR = 2.37, 95% CI (1.07–5.28); p = 0.034) and capsular invasion (HR = 10.72, 95% CI (4.45–25.87); p < 0.001). Factors associated with OS by Cox regression models were age at diagnosis (HR = 1.07, 95% CI (1.01–1.12); p = 0.019) and TNM Classification of Malignant Tumours stage III-IV (HR = 6.69, 95% CI (1.42–31.62); p = 0.016). Although lymph node metastasis and capsular invasion were not significantly associated with overall survival (p = 0.178 and p = 0.094, respectively), both variables showed a trend toward an association with OS. Conclusions: The study confirmed that post-operative serum CT values, male sex, lymph nodes metastasis at diagnosis, TNM stage III and IV and capsular invasion were all associated with a lower PFS. Factors associated with OS were age at diagnosis, presence of lymph nodes metastasis, TNM stage III–IV and capsular invasion. Full article

Spanish journalists do not suffer from work-related anxiety because they lack resilience; they suffer from it because they work in environments structurally designed to produce it. Based on this premise, this study develops the first empirically grounded multilevel governance model to reduce work-related anxiety among journalists, drawing on 23 in-depth interviews with Spanish professionals who have experienced it through either a diagnosis or self-report, analyzed using reflective thematic analysis. The findings are organized into three interconnected levels—micro, meso, and macro—and identify, respectively, pre-existing protective factors, reactive coping strategies, and advice and recommendations aimed at structural change. Anchored in Job Anxiety Theory and evidence from equivalent complex interventions, the model demonstrates that individual resources only produce sustainable effects when the organizational and sectoral levels actively support them. The asymmetry between the density of the micro level and the precariousness of the meso and macro levels constitutes the study’s central finding. Our model redefines anxiety in journalism as an institutional design challenge and offers a scalable, modular, and contextualized architecture for the Spanish media ecosystem. Full article

Background/Objectives: Artificial Intelligence (AI) integration in healthcare promises improved diagnostic accuracy, patient safety, and operational efficiency. However, AI acceptance among healthcare workers remains limited due to knowledge gaps, risk concerns, and governance challenges, particularly in developing countries like Saudi Arabia, where rapid healthcare modernization faces unique infrastructure, organizational, and cultural challenges. This research investigates the factors influencing AI acceptance among medical practitioners, nurses, administrators, and students in Saudi Arabian hospitals to identify key determinants and barriers to adoption. Methods: This cross-sectional study employed an extended Unified Theory of Acceptance and Use of Technology (UTAUT) framework integrated with ethical considerations from the Model for Ethical Assessment and Analysis of AI in Medicine (MEAAM). A structured bilingual questionnaire was administered to 119 healthcare professionals and students across Saudi Arabia, measuring constructs including Awareness and Knowledge, Performance Expectancy, Effort Expectancy, Facilitating Conditions, Social Influence, Trust, Perceived Risk, Ethical Governance, and Price Value. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed for quantitative analysis, supplemented by thematic analysis of open-ended qualitative responses. Results: The PLS-SEM analysis explained 59.8% of variance in behavioral intention to adopt AI (R² = 0.598). Awareness and Knowledge emerged as the strongest predictor (β = +0.505, p < 0.001), followed by Performance Expectancy (β = +0.229, p < 0.05) and Social Influence (β = +0.123). Perceived Risk functioned as the primary barrier (β = −0.185, p < 0.05). Qualitative findings identified infrastructure gaps, regulatory ambiguities, and training deficiencies as major implementation barriers, while emphasizing opportunities in diagnostic accuracy and remote monitoring. Conclusions: AI acceptance in Saudi healthcare is primarily driven by knowledge, with perceived usefulness and peer support as secondary facilitators, while safety and accountability concerns remain substantial obstacles. Successful AI integration requires coordinated efforts in education, transparent governance frameworks, and institutional support. This study contributes theoretically by validating extended UTAUT in a non-Western healthcare context and practically by providing evidence-based strategies for sustainable AI adoption that enhance healthcare quality while respecting professional roles and ethical principles. Full article