Search Results (3,467)

Background: Otoplasty is a commonly performed cosmetic ear procedure, yet patient-reported outcome data remain limited. This study analyzes otoplasty reviews on RealSelf, a widely used aesthetic review platform that provides insight into patient experiences and outcomes. Methods: A retrospective review of otoplasty-related posts on RealSelf from January 2009 to March 2025 was performed. Reviews were manually screened and coded independently by reviewers. Extracted variables included demographics, procedure location, surgeon specialty, anesthesia type, postoperative pain, satisfaction rating (“Worth It,” “Not Worth It,” “Not Sure”), cost, motivations for surgery, and reasons for choosing the surgeon. Results: A total of 615 reviews met inclusion criteria, and 90.7% rated the procedure as “Worth It.” Protruding ears were the most common motivation for surgery (55.1%), followed by ear asymmetry (17.0%). Surgeon selection was most influenced by the consultation experience (34.4%), credentials (24.8%), and online reviews (21.6%). Positive surgeon comments emphasized comfort (32.3%), personality (27.9%), and communication (25.1%). Satisfaction was significantly associated with postoperative pain level (p < 0.001) and improved confidence after surgery (p = 0.032), but not with age, gender, procedure location, anesthesia type, or cost. Improved confidence (38.5%), enhanced ear shape (27.8%), and natural-appearing results (17.4%) were the most frequently cited reasons for being satisfied with otoplasty. Conclusion: Patient-reported satisfaction with otoplasty on RealSelf is high and is associated with favorable aesthetic results, improved self-confidence, and positive surgeon–patient interactions. In this cohort, effective communication, realistic expectation setting, and postoperative pain management were central to optimizing the patient experience. Full article

This study examines changes associated with a guided introspective intervention in self-reflection, introspection, and motivational competences among future teachers. Conducted within a Master’s course in Teacher Training, the ten-session program employed the “Casa Vital” framework, a metaphorical and visual model representing personal and professional development through structured introspective exercises. Eighty-two participants completed the Self-Reflection and Insight Scale (SRIS-SF) and selected subscales of the Motivated Strategies for Learning Questionnaire (MSLQ) in a pre–post quasi-experimental design. Findings reveal significant increases in introspection, intrinsic goal orientation, control of learning beliefs, and self-efficacy for learning and performance (small–moderate effects), while self-reflection, extrinsic goal orientation and task value remained stable. These results suggest that guided introspection enhances motivational competences by promoting self-awareness, value clarification, and alignment of personal and professional goals. The intervention also seems to support autonomy-oriented engagement and purpose-driven decision-making, contributing to the development of reflective and resilient educators. Integrating structured introspective practices into teacher education may strengthen professional identity, psychological flexibility, and internal-driven motivation. The study underscores the practical potential of reflective frameworks such as Casa Vital to foster meaningful, self-determined, and adaptive teaching practices, offering an accessible and scalable approach for enhancing teacher preparation programs. Within the limits of a single-group pre–post design, these findings provide descriptive, theory-consistent indications that introspection may be associated with the cultivation of purposeful, motivated, and competent educators. Full article

This study examines crash involvement, safety training exposure, and e-learning readiness among commercial heavy goods vehicle (HGV) drivers in Ethiopia. Data were collected through a cross-sectional survey of 202 male drivers operating along the Addis Ababa–Djibouti trade corridor, a high-risk freight route that carries approximately 95% of Ethiopia’s international trade and serves as the country’s primary gateway to global markets. The survey assessed crash history, safety training experiences, perceived safety challenges, and barriers to and motivators for e-learning adoption. Results indicate persistently high crash involvement despite widespread participation in conventional classroom-based training, suggesting a gap between training provision and real-world safety outcomes. Older and mid-career drivers exhibited higher crash involvement, highlighting a gap between training provision and behavioral or operational safety outcomes, while younger and more educated drivers showed greater readiness for technology-enhanced training. Although most drivers valued safety training, many perceived existing programs as repetitive, insufficiently interactive, and poorly aligned with operational demands. Key facilitators for e-learning adoption included flexible schedules, ease of use, and motivational support, whereas limited digital skills and low perceived usefulness remained barriers for some groups. The findings highlight the need for age-responsive, flexible, and interactive e-learning approaches to complement traditional training and address persistent safety risks, such as fatigue and unsafe driving behaviors. These approaches also support scalable, technology-enhanced interventions tailored to Ethiopia’s high-risk freight corridors, while guiding future research directions. Full article

Background: The COVID-19 pandemic significantly disrupted health systems, including the delivery of childhood immunizations. This study assessed COVID-19 vaccination coverage in families of children with incomplete routine immunization and explored why adults accepted COVID-19 vaccines despite skipping routine vaccination for their children in the district of Swat, Khyber Pakhtunkhwa, Pakistan. Methods: A mixed-methods study was conducted in Swat District during March 2022–April 2023. A cross-sectional survey assessed COVID-19 vaccination in household members of children under 2 years of age for whom vaccination registries showed missed routine vaccinations. In-depth interviews with 18 household members explored motivations for vaccine acceptance through thematic analysis. Results: Among 249 families of children with incomplete immunization found through vaccination records, 237 families (88% response) were interviewed. Among 382 children below 2 years of age in these families, 29.5% (n = 113) were fully vaccinated, 67.5% (n = 258) were incompletely vaccinated according to age, and 2.9% (n = 11) had not received any vaccine. Data from 237 of the defaulter children—one per household—was included in further analysis. Among household members above 12 years of age, 87% (964/1103) of males and 82% (n = 901/1093) of females were vaccinated against COVID-19. Households with at least one fully vaccinated child were significantly more likely to have vaccinated family members. Multivariable analysis showed maternal COVID-19 vaccination (AOR 2.08, 95% CI: 1.15–3.76) and urban residence (AOR 2.08, 95% CI: 1.14–3.79) were associated with full childhood vaccination. In-depth interviews revealed that key motivators for COVID-19 vaccination included the perception that it was mandatory, house-to-house vaccination, and fear of hospitalization or death. Conclusions: Vaccine requirements and ease of access to vaccination services enhanced coverage with COVID-19 vaccines among families of children with incomplete routine immunization. Ethical use of vaccine requirements and community education to enhance levels of risk perception of vaccine-preventable diseases could potentially improve childhood immunization. Full article

Accurate forecasting of agricultural commodity prices is essential for managing market volatility, improving supply chain coordination, and supporting food security-related decision-making. Recent advances in deep learning have demonstrated strong potential for capturing nonlinear and temporal dependencies in commodity price dynamics. In this study, we propose a hybrid long short-term memory–multi-head attention (LSTM–MHA) framework for agricultural commodity price forecasting using global futures market data. The model is trained and evaluated on multivariate global commodity futures prices, reflecting internationally traded benchmark markets rather than region-specific domestic prices. While the empirical analysis is based on global data, the study is motivated by the relevance of international price movements for import-dependent regions, particularly West Africa, where global price transmission plays a critical role in domestic market dynamics. The experimental results demonstrate that the proposed model effectively captures short-term temporal dependencies and provides interpretable attention-based insights into lag relevance. An ablation study further highlights the trade-offs between forecasting accuracy and interpretability across different model configurations. The hybrid architecture combines the time-based pattern identification and weighting capabilities of multi-head attention with the sequential learning capabilities of LSTM. Mean absolute error (MAE), root mean squared error (RMSE), and mean squared error (MSE) were used to evaluate the model’s performance. With an MSE of 0.0124, an RMSE of 0.1114, and an MAE of 0.1097, the model outperformed conventional models like ARIMA and standalone LSTM by three to four times in error reduction. The findings suggest that attention-enhanced deep learning models can serve as valuable analytical tools for understanding global price dynamics and informing policy analysis and risk management in West African agricultural markets. Full article

As global value chains integrate firms operating under varied institutional contexts and distinct technological capabilities, the uniform adoption of green standards becomes challenging. A “one-size-fits-all” sustainability approach often fails to account for the voids faced by firms in different contexts participating in one value chain, particularly in developing economies an area where academic research remains limited and fragmented. This research gap is the motivation for the present study. Through a systematic review of 56 articles, this paper examines how technological gaps and institutional voids in global value chains (GVCs) affect firms’ capacity to leverage environmental performance across different national and organizational contexts. Building on this synthesis, we develop an integrative conceptual framework that elucidates these dynamics and offers actionable insights for managers seeking to navigate environmental performance in heterogeneous institutional and technological settings. Our findings contribute to the literature on sustainable GVCs and guide practitioners aiming to foster effective cross-border collaborations that enhance environmental performance. Full article

Background: The piezoelectric saw is a technology used in osteotomies, providing precise and minimally invasive cuts, especially in areas close to vital structures. Despite its advantages, limitations such as prolonged surgical time and restrictions in use for larger bones have motivated the development of ultrasonic tips with more efficient geometries. Methods: A laboratory trial was conducted with 40 ultrasonic tips (n = 40), divided into 2 groups: the test group (n = 20), with an ultrasonic tip featuring a multidirectional angular cutting-tooth geometry, and the control (n = 20), with a straight-tooth ultrasonic tip. Two operators performed standardized osteotomies on synthetic bone blocks, with monitoring of variables including cutting time (in seconds), maximum block and blade temperature (in °C), and bone mass loss (in grams). Sample randomization was block-based, and blade coding ensured operator and evaluator blinding. Results: The results showed a statistically significant reduction of approximately 26% in cutting time with the multidirectional ultrasonic tips (Test = 52.85 s; Control = 71.55 s; p < 0.001), regardless of the operator. No significant differences were observed between groups regarding maximum bone temperature (Test = 30.45 °C; Control = 29.40 °C; p = 0.337), blade temperature variation (Test = 5.30 °C; Control = 4.10 °C; p = 0.337), overall temperature variation (Test = −0.19 °C; Control = 0.06 °C; p = 0.285), or bone mass loss (Test = 0.1355 g; Control = 0.0350 g; p = 0.387). A significant interaction between operator and blade type in some variables, such as bone temperature variation (p = 0.001), reinforces the influence of technical experience on the results. Conclusions: The multidirectional angular geometry of the ultrasonic tip significantly improves cutting efficiency without compromising thermal safety, representing a promising advancement for optimizing osteotomies in surgical settings. The use of this new geometry may enhance productivity, particularly in complex procedures, and deserves future clinical investigation to expand its applicability across different surgical specialties, including orthopedics. Full article

Sovereign wealth funds enhance the international movement of capital and often facilitate economic development in domestic and host countries. However, the lack of transparency and accountability of SWFs varies, and state ownership gives rise to suspicions and realizations of political motivations, unfair commercial advantages, opportunities for corruption, and national security threats, thereby challenging the liberal economic order. This paper provides an overview and identifies major concerns and policy options associated with SWFs. Defining SWFs, measuring their size and transparency, domestic, cultural, and political origins, and policies for oversight and mitigation of geopolitical risk are discussed. The goals and behavior of SWFs are too diverse to draw broad, general conclusions. The growth in the number of funds and assets under management has increased their diversity, but the essential defining characteristic is that they are state-owned financial investment vehicles not subject to the hard budget constraints or regulations of comparable private sector, market-oriented entities. Transparency varies, with democratic country SWFs more transparent and less problematic than those of autocracies. SWFs have evolved into unbounded state-owned entities ushering in a new era of financial statecraft. Policies to guide their behavior and enforcement mechanisms are host-country specific and highly variable. An often-discussed international regulatory framework to mitigate geopolitical risk has not emerged and is not likely. Full article

Sexual harassment (SH) remains widespread in workplaces and academic settings. Traditional compliance-based training has shown limited success in preventing SH or motivating bystander intervention. This study developed and tested a brief online empathy training module that can be completed in under 30 min that aims to help participants better understand and support people who experience SH and increase their willingness to intervene. Two experiments were conducted with U.S. adults recruited from the CloudResearch Connect platform (Study 1: 122 men and 140 women; Study 2: 132 men, 112 women, 4, other gender) who were randomly assigned to complete the SH empathy module, another empathy training module (burglary empathy training), time management training, a standard SH training module, or a waitlist control condition. Measures assessed empathy, perspective taking, and bystander intervention intentions. In Study 1, empathy correlated with bystander intentions, but there were no significant group differences; women reported higher empathy and bystander intentions than men. In Study 2, participants who received SH empathy training demonstrated higher empathy and perspective taking than those in other groups, and empathy improvements were associated with greater willingness to intervene. Gender did not moderate these effects. Overall, findings suggest that integrating a short empathy module into SH prevention programs can enhance readiness to act as supportive bystanders. Future research should assess the longevity of these effects and whether they translate into real-world behavioral change. Full article

This study investigates students’ motivation and engagement when participating as pedagogical partners in co-creating assessment rubrics for English language learning. Grounded in self-determination theory, this research explores how students’ sense of autonomy, competence, and relatedness influence their motivation to engage in co-created assessment practices. Data was collected from 143 undergraduate students at a university in Dubai. Findings showed generally positive perceptions of autonomy, with many students valuing opportunities to contribute ideas to assessment design and reporting that co-creation enhanced their ownership of learning. Students also believed that co-created assessments improved their understanding of learning objectives. Students reported that co-creation clarified expectations, reduced anxiety, and allowed them to develop broader academic and soft skills. Despite these benefits, unfamiliarity with assessment design at times hindered effective participation. These findings suggest that co-created assessment can strengthen motivation by enhancing competence, autonomy, and relatedness, but it is also important for the students to have clear guidelines to support meaningful student involvement. Full article

The application Strava is widely used among runners, yet its influence on motivational processes remains unclear. This study examined endurance sport self-efficacy, achievement goals, fitness indicators, and Strava use in 225 active club runners using validated quantitative instruments and qualitative survey data. Self-efficacy and achievement goal scores were generally high. Greater endurance capacity was associated with higher self-efficacy and task-approach goals. Strava settings and subscription status were not associated with motivational outcomes; however, runners who had deleted training sessions due to perceived slow running pace scored higher on other-avoidance goals. Qualitative findings showed that Strava can enhance training through feedback, routine building, and social connection, while also introducing pressure, comparison, and stress, particularly during injury or reduced performance. Several participants reported adapting their use of the app to preserve motivation. Overall, Strava’s motivational impact appears context dependent and shaped by both its features and individual usage patterns. Full article

Student engagement is a key predictor of academic achievement and retention in higher education. This study investigated the impact of personalised behavioural nudges, delivered through structured phone calls and supported by personalised email/Microsoft Teams messaging, on student engagement with a Learning Management System (LMS) and academic outcomes among 192 at-risk STEM undergraduates identified by initial low LMS activity. Students received up to five phone call nudges from an academic buddy, weekly, over an eight-week period, coupled with personalised email/MS Teams follow-ups, designed to provide informational and relational support. Results showed a significant improvement in LMS engagement (p < 0.01) among students who responded to at least one phone call nudge compared to non-responders. Although LMS engagement was not significantly associated with module outcomes within the sample, academic outcomes, measured by module results, improved for students who engaged with the nudges; improvements were statistically significant for those who responded to two, three, and five phone call nudges (p < 0.05) compared to non-responders, with the highest gains observed in the five (highest nr. nudges) response group. Content analysis of student feedback highlighted four themes: Valuing Supportive Journeying with an Academic Buddy, Improved Academic Engagement, Motivation Triggered by Intervention, and wider Challenges. Findings suggest that while an initial personalised telephone call can enhance student engagement with their studies, achieving measurable academic success requires sustained intervention. This study underscores the value of relationally grounded nudges in promoting success among at-risk students. Full article

Exposure to violence (physical, domestic, or sexual assault) increases risk for alcohol problems and alcohol use disorder (AUD), consistent with self-medication and drinking-to-cope theories of alcohol use, which posit that some individuals may misuse alcohol to alleviate distress associated with trauma. Yet how violence exposure and coping motives interact to influence objective AUD risk markers remains unclear. Emerging evidence suggests that trauma type affects psychiatric outcomes, but its role in moderating AUD risk via coping motives remains unknown. We examined these gaps in the literature in a cohort of youth (ages 16–19; n = 157) over-sampled for violence exposure. Participants completed a structured trauma interview and an assessment of drinking motives. A total of 60 participants reported experiencing sexual assault (SA), 54 physical assault (PA), and 32 domestic violence (DV). AUD risk was captured using the alcohol cue reactivity paradigm. Participants were exposed to images of alcoholic beverages, high-calorie foods (reward-related control), and neutral objects. The late positive potential (LPP), an event-related potential captured via electroencephalogram, was used to index cue reactivity. We ran two linear regression analyses to assess the relationship between trauma type and coping motives to drink on LPP to alcohol and food cues (>neutral). For alcohol cues, there was a significant SA and coping interaction. At high levels of coping motivations, SA was associated with enhanced LPP to alcohol cues. At low levels of coping motivations there was no association. No effects were observed for food cues. Our results demonstrate that heightened coping motives to drink are associated with enhanced alcohol cue reactivity among SA victims, indicating increased vulnerability for AUD risk. Full article

Financial education is critical for fostering inclusive, resilient societies by reducing inequalities and promoting sustainable development. Despite growing interest, there is a notable gap in research on effective pedagogical approaches for financial literacy in primary education. Early intervention is essential to shape financially literate, active citizens capable of contributing to sustainable communities. This study addresses this gap by comparing the effectiveness of two distinct implementation packages involving active pedagogies—cooperative learning (CL) with high autonomy and stable groups, and game-based learning (GBL) featuring stronger teacher orchestration and dynamic grouping—in enhancing financial literacy among primary school pupils. Using a multiple case study design, two fifth-grade classes in Northern Italy participated in six 2 h financial education sessions, each employing a different instructional implementation package. Quantitative data from pre- and post-tests revealed significant improvements in financial literacy in both groups, confirmed by Wilcoxon signed-rank tests, with CL-based implementation showing a larger observed effect size (Hedges’g = 1.84) than GBL-based implementation (g = 1.20). Qualitative analysis of focus groups showed that CL-based implementation, characterized by high autonomy and group stability, fostered deeper learning through collaboration, shared responsibility, and relational skills vital for social sustainability. In contrast, GBL-based implementation, with structured teacher facilitation, promoted context-specific knowledge and relied more on extrinsic motivation and competition. These findings suggest that the observed benefits may be associated with the combined features of the cooperative learning-based implementation package, particularly high autonomy and stable group structures, which appear to support more socially embedded financial literacy. They also highlight both the potential and the limitations of game-based approaches. The study offers evidence-based insights for designing effective financial education programs that support both cognitive and social competencies in primary education. Full article

The heavy use of digital images across network systems has become a major concern regarding data confidentiality and unauthorized access. Conventional image encryption techniques hardly achieve high security levels efficiently, especially in real-time and resource-constrained environments. These challenges motivate the development of more robust and efficient encryption mechanisms. In this paper, a dual-chaotic image encryption framework is developed where two complementary chaotic systems are combined to effectively realize confusion and diffusion. The proposed method uses a chaotic permutation mechanism to find the pixel positions and enhanced chaotic diffusion to change the pixel values for eliminating the statistical correlations. An extended family of piecewise affine chaotic maps is designed to enhance the dynamic range and complexity of the diffusion process for strengthening the resistance capability against cryptographic attacks. Intensive experimental validations confirm that the proposed scheme well obscures the visual information and strongly reduces the pixel correlations in the encrypted images. High entropy values, uniform histogram distributions, high resistance to differential attacks, and improved robustness are further evidenced by statistical and security analyses compared to some conventional image encryption techniques. The results also show extremely low computational overheads, hence allowing for efficient implementation. The proposed encryption framework provides more security for digital image transmission and storage, and the performances are still practical. Given its robustness, efficiency, and scalability, it is equally adequate for real-time multi-media applications and secure communication systems, hence promising to offer a reliable solution for modern image protection requirements. Full article