Search Results (11,137)

Background: Transitioning from hospital to home presents substantial challenges for patients with chronic obstructive pulmonary disease (COPD), often leading to difficulties maintaining self-management, functional independence, and psychological well-being after discharge. Although transitional care programs are increasingly implemented, their effects on multidimensional patient-centered outcomes remain insufficiently examined. This study aimed to evaluate the effectiveness of a nurse-coordinated transitional care service for patients with COPD during the transition from hospital to home and to examine its broader implications for improving continuity of care and patient-centered outcomes within the healthcare system. Methods: This randomized controlled trial was conducted in three university hospitals in South Korea between November 2022 and December 2024. A total of 465 patients were randomly assigned to either a nurse-coordinated transitional care intervention group or a usual care group. The intervention included structured self-management education during hospitalization, post-discharge home visits, and follow-up telephone consultations during the first month after discharge. Outcomes were assessed at baseline, 1 month, and 3 months. Statistical analyses included linear mixed-effects models for continuous outcomes and chi-square tests and independent t-tests for group comparisons. Results: Patients in the Transitional Care Group (TCG) showed marked improvements: disease awareness increased from 27.9% to 94.3% (vs. 35.7% in the Usual Care Group [UCG], RR = 2.64, 95% CI: 2.19–3.18, p < 0.001) and exercise adherence to 76.3% (vs. 43.0%, RR = 1.78, 95% CI: 1.49–2.11, p < 0.001). After adjusting for age, cognitive function declined in both groups but showed significantly smaller decreases in the TCG than in the UCG at 3 months (mean difference = −0.92, p < 0.001), and IADL demonstrated significantly better preservation in the TCG (mean difference = −1.77, p < 0.001). Self-efficacy declined in both groups but remained significantly higher in the TCG (mean difference = 2.65, p < 0.001). Anxiety and depression were significantly reduced in the TCG compared with the UCG (anxiety: −1.45, p < 0.001; depression: −2.72, p < 0.001). After adjusting for age, discharge preparedness and post-discharge management capacity were significantly higher in the TCG than in the UCG (adjusted mean differences = 3.25 and 4.93, respectively; both p < 0.001). Conclusions: These findings indicate that nurse-coordinated transitional care enhances patients’ self-management capacity and improves patient-centered outcomes during the transition from hospital to home. Full article

Objectives: This study aims to evaluate burnout and job satisfaction levels among audiologists in Türkiye and the factors that contribute to them. Methods: The study included 152 female (59.80%) and 102 male (40.20%) audiologists aged 20–30 (n = 133, 52.40%), 31–40 (n = 82, 32.30%), and 41 and over (n = 39, 15.40%). Participants were required to have at least 1 year of experience and be an active audiologist. Analysis was performed using Structural Equation Modeling (SEM) and correlation statistics to assess the predictive relationship between burnout sub-dimensions and job satisfaction components. Results: The results showed that burnout and job satisfaction among audiologists differed according to demographic data. In Türkiye, audiologists reported high burnout and low job satisfaction. A significant relationship was found between burnout and job satisfaction. The exhaustion subscale of the Maslach Burnout Scale statistically significantly and negatively predicted the Job Satisfaction Scale scores (β = −0.35; p < 0.05). Furthermore, it was determined that audiologists working in implant centers experienced less burnout, while those working in rehabilitation centers had lower job satisfaction. Conclusions: In conclusion, addressing burnout levels among audiologists is expected to not only improve individual well-being but also contribute to the overall enhancement of hearing health services in Türkiye. Full article

Efficient path planning and trajectory tracking are central to the safe and autonomous navigation of autonomous underwater vehicles (AUVs) in complex and unknown environments. In this paper, we propose an integrated framework that couples enhanced path planning, curvature-adaptive trajectory tracking, and sonar-constrained 3D exploration. First, the path planner is improved by incorporating safety margin-based collision detection, 3D obstacle avoidance weights, and online replanning. Second, the tracking module is enhanced with B-spline optimization and curvature-adaptive speed control to ensure smooth and dynamically feasible trajectories. Third, the exploration strategy is augmented with frontier clustering, multi-dimensional information gain evaluation, and TSP path optimization. Our framework jointly addresses practical constraints including forward-looking sonar field-of-view limitations, safety clearance margins, and the coupling of dynamic replanning with low-level tracking feasibility, while supporting both modular decoupling and integrated collaborative operation. Simulations using ArduSub SITL and Gazebo demonstrate that our integrated approach achieves a superior performance in path safety and tracking accuracy, along with an exploration coverage of 79.08%, validating its effectiveness for robust AUV autonomy in unknown 3D underwater scenarios. Full article

Grain production resilience forms a critical foundation for national food security, and the ongoing development of land transfer provides essential momentum for establishing a more resilient grain production system. Using panel data from 30 provincial-level regions from 2013 to 2024, this study constructs a multi-dimensional evaluation system for grain production resilience and calculates the comprehensive grain production resilience index using the entropy value method. This study applies two-way fixed effects and mediation models to empirically analyze the impact of land transfer on grain production resilience and its underlying mechanisms. The results show the following: (1) Land transfer significantly enhances grain production resilience: a 1 percentage point increase in the land transfer rate leads to a 0.0014-point increase in the resilience index, equivalent to 0.64% of the sample mean, and this finding remains robust after model replacement, extreme value trimming, and variable substitution. (2) Land transfer exerts its positive effect through three mediating pathways: agricultural insurance (scale dimension), specialized farmer cooperation, and agricultural mechanization. (3) Heterogeneity analysis reveals significant regional differences: the enhancing effect is more pronounced in non-major grain-producing regions and areas with underdeveloped agricultural service systems; while in major grain-producing regions and high-service-level regions, the relationship presents an inverted U-shape, with turning points at 66.794% and 71.921% of the land transfer rate respectively. Accordingly, this study proposes that China should further improve the institutional design of land transfer to systematically support the development of grain production resilience, optimize relevant policy pathways, and implement region-specific measures for targeted and effective intervention. Full article

To address the critical industry challenges of insufficient thermal safety and reliability in the stacking design of lithium-ion battery (LIB) modules, as well as the lack of accurate traceability methods for LIB fire accidents, this study takes commercial 18650-type lithium, nickel cobalt aluminum (NCA) LIBs as the research object. First, we systematically investigated the thermal runaway (TR) behavior of single cells under thermal and electrical abuse conditions, identified the significant discrepancies in TR behavior between the two abuse scenarios, quantitatively revealed a positive correlation between TR risk and state of charge (SOC), and determined that the core feature is that the maximum heat release occurs in the negative electrode of the battery. Subsequently, we quantitatively analyzed the influences of the initial TR trigger position and module stacking structure on the TR propagation characteristics within the module, and obtained the key conclusions that center-triggered TR exhibits a faster propagation rate and that the vertical stacking structure significantly aggravates the TR chain reaction. Finally, based on the TR process, this paper summarizes the burn mark characteristics caused by different triggers of thermal runaway in LIBs. The results of this study provide critical fundamental data for optimizing the thermal safety design of LIB modules, and offer a scientific basis for the formulation of LIB fire rescue schemes and the implementation of fire investigation. Full article

Background/Objectives: Existing literature has consistently identified perfectionism as a core feature of anorexia nervosa (AN). However, much of the research has focused primarily on its association with eating disorder-related symptoms. At the same time, less attention has been paid to understanding how perfectionism affects the overall psychological functioning of individuals with eating disorders, and in particular AN. The present study aimed at investigating the association between perfectionism and both eating disorder-specific symptomatology and general psychological symptoms in a sample of young adult Italian women diagnosed with AN. Methods: Thirty-five Italian females diagnosed with AN (mean age ± SD: 21.9 ± 4.18 years; mean body mass index: body mass index ± SD: 14.5 ± 1.77 kg/m²) were consecutively recruited at the Division of Eating and Nutrition Disorders, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania, a third-level clinical centre for the rehabilitation of obesity and eating disorders located in northern Italy. Once informed about the research, screened for inclusion/exclusion criteria, and enrolled, participants were asked to complete the Eating Disorder Inventory—third edition, the Symptoms Checklist-90 revised, and the Frost Multidimensional Perfectionism Scale to collect demographic and clinical variables of interest for the study. Three hierarchical linear regression models were tested to explore the role of perfectionism in both eating disorder-specific symptomatology and general psychological symptoms. Results: The analyses showed a significant influence of perfectionism in all tested models, suggesting that perfectionism was significantly associated with both eating disorder-specific symptomatology and general psychological symptoms in a sample of young adult Italian women diagnosed with AN. Conclusions: The findings of this study provide further support for the role of perfectionism in the psychopathology of eating disorders, particularly among young adult women with AN. Consistent with prior research, perfectionism was associated with both disorder-specific symptoms and broader psychological symptoms. Notably, its association remained robust even after controlling for key variables such as age and body mass index, underscoring its potential as an independent risk factor. Full article

In high-demand financial environments, employees’ capacity to regulate and sustain personal energy may constitute a critical yet underdeveloped organizational resource. Drawing on the Job Demands–Resources (JD-R) model and Conservation of Resources (COR) theory, this study conceptualizes energy management as a multidimensional personal resource that may support adaptive functioning and innovation under demanding work conditions. Despite increasing conceptual attention to energy-related constructs, systematic scale validation and cross-level performance evidence remain limited. This research adopts a two-study design to develop and validate a multidimensional Energy Management Scale within financial institutions. Study 1 (N = 299 employees from 11 financial institutions) examines the factorial structure, reliability, and nomological validity of the scale. Confirmatory factor analysis is used to examine the proposed four-dimensional configuration of physical, emotional, mental, and spiritual energy. The scale demonstrates acceptable internal consistency reliability and evidence of structural validity, including convergent and discriminant validity. Structural modeling results reveal that overall energy management is positively related to innovative behavior and organizational citizenship behavior. However, perceived workload was significantly associated only with physical energy, suggesting that demand-related mechanisms of energy may not operate uniformly across energy components. Additionally, exploratory institution-level aggregation analyses showed preliminary, counterintuitive negative associations between mean organizational energy levels and return on equity (ROE) in some years. Given the limited number of institutional clusters, these cross-level findings are preliminary and intended to provide initial external criterion evidence rather than confirmatory causal inference. Study 2 (N = 148 employees from two institutions) further examines alternative scale versions and external validity through stress coping capacity, job satisfaction, and life satisfaction. Results were discussed to examine the robustness and predictive validity of the scale across samples. Collectively, this study advances energy management research by providing a psychometrically supported measurement instrument and preliminary multilevel evidence of its organizational relevance. The findings position energy management as a measurable human-capital resource with implications for sustainable workforce innovation and performance in financial institutions. Full article

This study selects five numerical methods: the explicit Leap-Frog scheme, the implicit Crank–Nicolson scheme, the explicit second-order Runge–Kutta scheme, the implicit Newmark-β scheme, and the implicit Bathe scheme. These methods are compared through representative dynamic cases in terms of solution accuracy and computational efficiency. The results demonstrate that implicit schemes maintain numerical convergence even with relatively large time steps. The findings also indicate that, although the actual convergence accuracy of the given schemes varies slightly among motion models of different dimensions, it remains close to the theoretical second-order accuracy. Different time integration schemes exhibit distinct numerical accuracies when applied to multi-dimensional motion problems. Overall, under identical time step sizes, the Bathe time integration scheme demonstrates slightly superior computational accuracy and error stability compared to other schemes considered. The numerical efficiency of time integration schemes also varies across dimensions and problem types. The actual computational time does not scale linearly with the time step size and is partially influenced by the complexity of the solution algorithm employed. In general, when solution accuracy is comparable, the Leap-Frog scheme shows marginally higher efficiency in explicit simulations, whereas the Crank–Nicolson scheme proves more efficient in implicit simulations. Full article

To address the rapid performance deterioration and secondary maintenance challenges of highway asphalt pavements that have undergone a first-round hot in-place recycling, this study investigates the feasibility of secondary recycling. Using the Yangzhou section of the G40 Expressway (Class II mild aging) and the Lianyungang section of the G30 Expressway (Class VI severe aging) as engineering backgrounds, three recycling schemes were designed and evaluated: Scheme A (100% RAP control), Scheme B (RAP with rejuvenator and virgin aggregate), and Scheme C (Scheme B reinforced with toughening basalt fibers). A comprehensive multi-dimensional testing protocol—including dynamic stability, semi-circular bending (SCB), low-temperature beam stripping, and Hamburg wheel-tracking—was employed to systematically evaluate the pavement performance of the second-time hot in-place recycled asphalt mixtures. The results indicate that while secondary recycled mixtures (Schemes A and B) maintain acceptable high-temperature stability, their intermediate-to-low temperature cracking resistance serves as the critical bottleneck, failing to meet standard specifications. In contrast, compared with Scheme A (100% RAP control), Scheme C (with basalt fibers) increased the flexibility index by 646.2–946.7%, the low-temperature fracture energy by 96.7–261.0%, and the Hamburg wheel-tracking stripping point by 48.1–62.2%, effectively mitigating the brittle fatigue common in aged recycled binders. According to the Jiangsu Expressway Maintenance Design Guidelines, the incorporation of basalt fibers elevated the comprehensive performance grade of the mixture from below Grade C to Grade A. This research provides a robust scientific basis and a “digital filter” for the large-scale engineering application of sustainable secondary recycling technology in heavy-traffic environments. Full article

(1) Background: Psoriasis is increasingly recognized as a systemic inflammatory disease associated with metabolic comorbidities. However, the hierarchical relationship between inflammatory activation and insulin resistance in driving metabolic syndrome (MetS) remains incompletely defined. This study aimed to characterize the integrated inflammatory–metabolic architecture of psoriasis using multivariate and latent domain modeling. (2) Methods: In this cross-sectional hospital-based study (2020–2022), 235 adult patients with psoriasis were evaluated. Systemic inflammatory markers (NLR, SII, CRP, ESR) and composite metabolic indices (TyG, AIP, METS-IR) were assessed. Correlation analysis, multivariable linear and logistic regression, interaction modeling, and principal component analysis (PCA) were performed to examine independent associations and underlying domain structure. (3) Results: Inflammatory and metabolic markers showed modest but significant correlations. In multivariable logistic regression, the TyG index was the strongest independent predictor of MetS (OR = 5.15, p < 0.001), whereas inflammatory markers did not retain independent significance. An interaction between adiposity and insulin resistance further improved model discrimination (AUC = 0.830). PCA identified two distinct latent domains explaining 69.9% of total variance: an immune–inflammatory domain (NLR, SII, ESR, CRP) and a metabolic–insulin resistance domain (TyG, AIP, METS-IR). Only the metabolic domain independently discriminated MetS. (4) Conclusions: Psoriasis exhibits a multidimensional systemic architecture characterized by partially independent inflammatory and metabolic domains. Although systemic inflammation and metabolic dysfunction coexist, insulin-resistance-related indices were more strongly associated with metabolic syndrome in this cohort. Full article

User interface evaluation remains fragmented across performance metrics, subjective assessments, and user-dependent factors, limiting the comparability and interpretability of results across methodological traditions. This paper proposes a multidimensional evaluation framework that integrates these perspectives into a coherent analytical structure. The framework consists of three dimensions—Functional–Objective, Cognitive–Perceptual, and Contextual–Individual—each capturing a distinct facet of interface quality. A key feature of the proposed approach is the use of profile-dependent weighting, which enables evaluation results to reflect the specific priorities of different user groups. The framework’s operational logic is demonstrated through structured illustrative scenarios, showing how the model can be applied in practice to support more informed design and evaluation decisions. By aligning heterogeneous evaluation logics within a unified structure, the proposed approach provides a systematic basis for more consistent, transparent, and context-sensitive assessment of user interfaces. Full article

Mixed Reality (MR) technologies are increasingly used in construction to support inspection, visualization, and coordination. Despite growing adoption, the scientific understanding of how construction professionals evaluate the perceived value of MR technologies remains limited, particularly in the early stages of implementation. This study addresses the research gap by examining the scientific and applied dimensions of MR value, with a focus on usability and adaptability in construction environments. A cross-sectional survey of 129 construction professionals was conducted, and the data were analyzed using statistical methods including T-tests, exploratory factor analysis, and regression modelling. The results show that perceived value is not significantly influenced by device modality but is strongly determined by usability factors, particularly ease of use (β = 0.330, p = 0.003) and adaptability to site conditions (β = 0.206, p = 0.029). These findings contribute to scientific literature by conceptualizing perceived value as a multi-dimensional construct and provide practical insights for optimizing MR adoption in construction workflows. The study provides exploratory empirical evidence supporting user-centered design considerations for MR implementation and highlights the importance of contextual robustness for technology adoption in construction environments. Full article

Understanding how sustainable urban competitiveness evolves within megaregions has become a central concern in urban and regional studies, particularly under the pressures of carbon neutrality, spatial inequality, and network-driven urbanization. This study develops a multidimensional framework to assess the sustainable competitiveness of cities in the Beijing–Tianjin–Hebei “2 + 36” urban agglomeration and examines its spatio-temporal evolution and relational structure. Using a 30-indicator system grounded in factor foundations, economic performance, innovation capacity, openness, and environmental livability, we construct a composite competitiveness index through principal component analysis (PCA). Kernel density estimation reveals a pattern of overall improvement accompanied by widening disparities, characterized by selective agglomeration and the emergence of a pronounced high-value tail. Spatial autocorrelation consistently indicates significant spatial dependence, while LISA analysis identifies persistent low–low clusters and limited spillover absorption around core cities. A modified gravity model further uncovers a transition from a linear, corridor-based linkage structure to a more polycentric and networked competitiveness system, albeit with enduring peripheral weak nodes. The study contributes theoretically by conceptualizing sustainable urban competitiveness as a multidimensional nexus shaped jointly by territorial attributes and relational network structures. It demonstrates that competitiveness dynamics in megaregions emerge from the interplay of hierarchical consolidation, spatial divergence, and network reconfiguration—challenging the traditional assumption of simple core-to-periphery diffusion. The findings offer broader global implications, showing that the Beijing–Tianjin–Hebei case mirrors worldwide megaregional patterns, where proximity alone is insufficient to ensure functional integration, and where coordinated governance, network embeddedness and sustainability transitions increasingly determine regional competitiveness. This research provides a comprehensive analytical foundation for understanding and governing megaregional competitiveness in the era of sustainable development. Full article

This study examines the preservation of cultural landscapes in Asian heritage villages, using the Qiaonan Village in China as a case study. The study proposes an integrated model that combines macro-level planning, meso-level governance and micro-level community participation. Key findings show that only 32% of residents perceive the distribution of tourism benefits as fair, while a GIS analysis revealed a 28% increase in commercial land use within the heritage core between 2019 and 2022, indicating rising commercialisation pressures. The study explores the tensions between heritage conservation and tourism-driven development, with a focus on spatial integrity and local identity. It suggests that co-management and equitable benefit-sharing could strike a balance between economic growth, preservation, and community well-being. Rather than offering validated solutions, the research provides a diagnostic lens and generates hypotheses for other heritage villages. The transferability of these findings depends on local governance capacity, regulatory clarity, and the stage of tourism development, factors that will require systematic assessment in future comparative research. Full article

Objectives: Myelodysplastic syndromes (MDSs) are a heterogeneous group of clonal hematopoietic disorders characterized by ineffective hematopoiesis, genomic instability, and a high risk of progression to acute myeloid leukemia. Oxidative stress (OS) has emerged as a central factor in MDS pathophysiology, contributing to DNA damage, altered cellular signaling, and disease progression. Recent advances in artificial intelligence (AI) and machine learning (ML) offer a transformative approach for integrating multidimensional datasets including oxidative stress markers, hematologic parameters, and molecular profiles to enhance diagnosis, prognostication, and therapeutic monitoring in MDS. Methods: A comprehensive literature search was conducted in PubMed and Scopus, using the keywords “OS biomarkers,” “AI,” and “MDS’’. Results: Modified redox biomarkers can be correlated with oxidative imbalance and disease progression. ML models such as neural networks, decision trees, and support vector machines effectively capture complex relationships among redox biomarkers, enhancing risk stratification and prediction of treatment response. AI-driven proteomic analyses further revealed OS-related protein signatures linked to MDS pathophysiology. Overall, AI and ML enable the transformation of multidimensional OS data into clinically actionable tools for personalized management in MDS. Conclusions: Integrating biomarker research with AI-based analytics holds promise for advancing personalized diagnostics, prognostication, and therapeutic strategies in MDS, paving the way toward precision medicine. Full article