Search Results (1,374)

Acceptance and Commitment Therapy (ACT) has been widely applied in clinical contexts; however, its systematic adaptation to elite sports, particularly precision-based disciplines such as shooting, remains underexplored. The present study aimed to develop and preliminarily validate an ACT-based psychological training program—the Acceptance and Commitment Performance Training for Shooters (ACPT-S)—by reframing ACT from a therapeutic intervention into a performance-oriented training framework. Using a multiphase formative evaluation design, a needs assessment was first conducted with 28 elite and collegiate shooters to identify sport-specific psychological demands. Based on these findings, a ten-session ACPT-S program was developed by integrating the six core ACT processes with shooter-specific routines, embodied exercises, and performance-relevant metaphors. The program was subsequently examined through two pilot studies: Phase 1 with four collegiate/corporate athletes and Phase 2 with 15 national-level shooters. Data were collected via session reflections, focus group interviews, and expert panel evaluations, and the Content Validity Ratio (CVR) analysis was used to assess conceptual clarity and implementation feasibility. The results indicated that ACPT-S was perceived as both feasible and contextually appropriate, with athletes reporting improvements in attentional focus, emotional acceptance, value-based motivation, and reduced anxiety. Qualitative analyses demonstrated strong engagement with ACT principles and their functional integration into shooting performance contexts, while all program components achieved CVR scores of ≥0.80, indicating a strong expert consensus. Program refinements were guided by feedback related to activity sequencing, metaphor resonance and personalization strategies. Overall, this study reconceptualizes ACT as a performance-enhancement framework rather than a purely clinical approach and introduces the ACPT-S as a novel, theory-driven, and scalable psychological training model for precision sports, providing a robust foundation for future longitudinal and comparative research. Full article

Background: In silico diet design may represent a flexible approach in diet planning and adaptation to a variety of conditions, and it may take advantage from standard diet(s) as reference template(s). The concept of standard diet(s) is, however, quite vague and poorly defined. Objective: The aim of this work was to develop templates of omnivorous (OMN), lacto-ovo-vegetarian (LOV), and vegan (VEG) standard diets, based on data produced in European countries and the USA in 1998–2024, and adapted to an adult subject requiring ≈2200 kcal/day. Design: Online databases were used to identify papers containing experimentally determined (EXP) data of daily food frequencies, or reporting dietary recommendations (REC) from (inter)national agencies or specific studies. Only sources reporting quantitative food data (as g/day) in OMN, LOV, and VEG diets were accepted. Results: Out of >200 publications initially identified, 24 EXP and 20 REC sources complied with the selection criteria. By combining the EXP and REC data within each diet type, total meat intake in OMN diet was 99 ± 36 g/day. Total dairy food in LOV diets (247 ± 107 g/day) tended to be lower (by ≈15%, NS) than in OMN diets (272 ± 100). In VEG diets, total vegetal foods were ≈33% greater than in LOV (p < 0.01), and ≈1-fold greater than in OMN ones (p < 0.00001). Total cereal foods were similar in OMN (272 ± 122) and LOV (264 ± 122) diets, but tended to be ≈20–25% greater in VEG diets (to 326 ± 103, NS). Potato and other starchy foods were not different among the three diets. Legumes and pulses were modestly but insignificantly greater in LOV (55 ± 25) and VEG diets (112 ± 137) than in OMN ones (31 ± 24). Soy products were greater in VEG than in LOV diets. The “nuts, seeds, and spreads” food group in VEG diets was ≈3-fold greater than in OMN (p < 0.0005), and ≈90% greater than in LOV diets (p < 0.002). Fruit intake in VEG diets was ≈14% (p = NS) and ≈ 60% (p < 0.005) greater than in LOV and OMN diets, respectively. Finally, the “protein and energy-rich vegetal alternatives” food group in LOV and VEG diets was ≈5- to ≈6-fold greater than in the OMN diet (p ≤ 0.001). Conclusions: The exclusion of meat, fish, and egg in LOV diets is not compensated by increased dairy foods, rather by more total vegetal foods and protein-rich vegetal alternatives. VEG diets replace animal-derived proteins mainly with nuts, seeds, and spreads, soy products and protein-rich vegetal alternatives. On the basis of these data, templates to design “standard” OMN, LOV, and VEG diets are proposed. Full article

Background: Cyproheptadine-based appetite stimulants (CAS) have been safely used in Korea for over 30 years. However, in older adults who are vulnerable to malnutrition, sarcopenia, and fall-related morbidity, safety of CAS in nutrition care remains uncertain due to limited evidence and its antihistaminic effects. This study aimed to assess the real-world safety of CAS compared with megestrol and other antihistamines to inform safe pharmacologic support within clinical nutrition practice. Methods: A retrospective observational study was conducted using Seoul National University Hospital’s common data model. Patients who were prescribed CAS, megestrol, or antihistamines between 2004 and 2022 were enrolled. To balance covariates, propensity score matching was applied. The primary outcomes—dizziness, sedation, and hypotension—were evaluated within 30 days of drug administration. Additionally, sensitivity analyses and subgroup assessments by age and duration of use were performed to evaluate robustness of the findings. Results: No significant differences were observed in the risk of dizziness, sedation, or hypotension when CAS was compared to megestrol, with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of 1.02 (0.70–1.50) for dizziness, 0.53 (0.19–1.54) for sedation, and 0.70 (0.34–1.44) for hypotension. Similar findings were noted in the comparison with antihistamines, where the aHRs for dizziness, sedation, or hypotension of 0.56 (0.41–0.78), 1.05 (0.46–2.38), and 0.65 (0.36–1.17), respectively. Conclusions: CAS demonstrated an acceptable safety profile in older adults, with safety comparable to both megestrol and antihistamines. Full article

High-quality, interoperable biodiversity information is a prerequisite for effective conservation policy, compliance with European Union (EU) reporting obligations, and efficient environmental decision-making. Greece’s LIFE EL-BIOS (LIFE20 GIE/GR/001317) developed the first National Biodiversity Information System, aiming to aggregate, standardise, and disseminate spatial and non-spatial data for species, habitats, pressures, and trends. This paper provides an economic valuation of this information system as a public, non-market good. We designed a two-stage stated-preference study: (i) a short pre-survey to calibrate initial bids and (ii) the main survey employing double-bounded dichotomous choice (DBDC) contingent valuation with a spike-logit specification. The payment vehicle was a hypothetical monthly subscription in a post-LIFE scenario. The instrument measured time savings (hours), perceived reliability (Likert 1–5), and key demographics/roles. A total of 167 valid responses were collected in September 2025. Participants reported an average of 5.2 h saved per use (median 4; max 14). Among those expressing willingness to pay (WTP), 77% rated EL-BIOS reliability as “High/Very high”. Econometric results indicate time savings as the strongest positive determinant of WTP; perceived reliability is positive and marginally significant; years of experience are negatively associated with acceptance; and cost has a strong negative effect. Mean WTP is estimated at €6.7 per month (median €3.5). Notably, 64% of those unwilling to pay declared protest motives (data should remain public and free). Accordingly, non-payment is decomposed into true zero WTP versus protest-based refusal, i.e., refusal to pay despite acknowledging value. This high protest share reflects principled opposition to paying for public biodiversity data rather than low perceived value of the system. The EL-BIOS database generates measurable productivity gains and social value both through positive WTP and principled protest responses supporting open public data. These findings inform policy on sustainable financing, governance, and long-term operation of national biodiversity information systems. Full article

Background/Objectives: Adults with congenital heart disease (ACHD) are at increased risk for mental health problems, particularly depression and anxiety. Emerging evidence suggests that psychological rather than purely medical factors may play a decisive role in explaining individual differences in emotional adjustment. However, comprehensive models integrating multiple cognitive and emotional domains remain scarce. This study aimed to identify the psychological variables most strongly associated with depressive and anxiety symptoms in ACHD when considered simultaneously to inform priorities for psychosocial interventions. Methods: A total of 1136 ACHD (aged 18–85 years; 59.7% female) from the National Register for Congenital Heart Defects, Berlin, completed an online survey assessing depression, anxiety, emotion regulation, illness perceptions, and illness identity. Correlational and multiple regression analyses were conducted, controlling for sociodemographic characteristics, CHD severity, and secondary diseases. Significance level for regression models was set at p < 0.025 due to Bonferroni correction. Results: Rumination showed the strongest positive correlations with both depression and anxiety, whereas acceptance was most negatively correlated. In multiple regression analyses, rumination (highest unique variance explanation with semi-partial R² = 0.068 resp. 0.072) and illness engulfment emerged as the most strongly associated predictors of depressive and anxiety symptoms. Illness-related concerns were not significant predictors. Conclusions: The findings highlight the key role of repetitive negative thinking and an engulfed illness identity in the development of emotional distress among ACHD. Psychotherapeutic interventions targeting rumination, fostering psychological distance from illness identity, and promoting a multifaceted self-concept may be particularly beneficial in this population. Full article

Tourism, although a key driving force for the flourishing of local/regional and national economies, is also a source of distinct negative repercussions, e.g., the intense use of scarce resources, environmental deterioration, social marginalization, and the degradation of the quality of life of host communities, to name but a few. These repercussions appear to be further exacerbated under overtourism conditions in a number of highly rated tourist destinations around the globe. Identifying host communities’ perceptions of the tourism footprint/burden is essential in contemporary policy research, which seeks to realize local perspectives, values, and expectations regarding the acceptable type/level of tourism development of their land and to highlight potential policy directions for future action that ensure sustainability and resilience objectives. Grounded in an assessment of overtourism impacts in a highly rated insular destination (Santorini Island, Greece), this work aims to gather community perceptions as to the drawbacks of the current tourism trajectory through a questionnaire survey. Results demonstrate that, although respondents recognize the crucial role that tourism plays in the island’s economic profile, they also acknowledge that the rapidly escalating expansion of the sector is unsustainable in the long run, with severe repercussions for both the environment and the quality of the community’s everyday life. Full article

This study investigates the factors that influence the acceptance of 3D concrete printing technology in South Africa. The purpose is to provide evidence-based insights to guide regulators in developing clear standards and certification pathways for 3DCP in South Africa. In a mixed-method research design, the study gathered data from professionals including architects, civil engineers, quantity surveyors, project managers, contractors, regulators, and local municipalities using a modified Unified Theory of Acceptance and Use of Technology framework, adapted to the institutional and infrastructure contextual nuances of South Africa. The findings indicate significant variability in awareness, exposure, and openness to 3DCP across professions and regions. Regulatory actors express caution due to the absence of national standards but also recognize the potential alignment with sustainable construction goals. Major enablers of acceptance include access to demonstrable case studies, technical training, and policy incentives. Barriers include a lack of local performance benchmarks, cost perceptions, and uncertainty regarding compliance pathways. By incorporating institutional variables such as regulatory clarity and policy maturity, the study advances a theoretical understanding of construction technology diffusion in the global south. The study offers a robust, context-specific model that can be adapted in similar economies seeking to balance innovation with regulatory oversight. Full article

Climate change and water scarcity are major threats to the sustainability of wheat production in Mediterranean regions. Thus, timely and reliable water demand assessments are crucial to drive decisions on crop management strategies that are useful for agricultural adaptation to climate change challenges. Although the AquaCrop model is widely used to infer crop yields, it requires continuous field-based observations (mainly soil water content and crop coverage). Often, these areas suffer from a scarcity of in situ data, suggesting the need for remote sensing and model-based decision support. In this framework, this research intends to compare the performance of the AquaCrop model using four different input combinations, with one employing ERA5-Land and crop cover retrieved by satellite images exclusively. A field experiment was conducted on durum wheat (highly sensitive to water stress and playing a strategic role in national food security) in northwest Tunisia during the growing season of 2024–2025, where meteorological variables, green Canopy Cover (gCC), Soil Water Content (SWC), and final yields (biological and grain) were monitored. The AquaCrop model was applied. Four model input combinations were evaluated. In situ meteorological data or ERA5-Land (E5L) reanalysis were combined with either measured-gCC (measured-gCC) or Sentinel-2 NDVI-derived gCC (NDVI-gCC). The results showed that E5L reproduced temperature with RMSE < 2.4 °C (NSE > 0.72) and ETo with RMSE equal to 0.57 mm d⁻¹ (NSE = 0.79), while precipitation presented larger discrepancies (RMSE = 4.14 mm d⁻¹, NSE = 0.58). Sentinel-2 effectively captured gCC dynamics (RMSE = 15.65%, NSE = 0.73) and improved AquaCrop perfomance (RMSE = 5.29%, NSE = 0.93). Across all combinations, AquaCrop reproduced yields within acceptable deviations. The simulated biological yield ranged from 9.7 to 11.0 t ha⁻¹ compared to the observed 10.3 t ha⁻¹, while grain yield ranged from 3.0 to 3.5 t ha⁻¹ against the observed 3.3 t ha⁻¹. As expected, the best agreement with measured yield data was obtained using in situ meteorological data and measured-gCC, even if the use of in situ meteorological data coupled with NDVI-gCC, or E5L-based meteorological data coupled with NDVI-gCC, produced realistic estimates. These results highlight that the application of AquaCrop employing E5L and Sentinel-2 inputs is a feasible alternative for crop monitoring in data-scarce environments. Full article

Background: Dementia is a chronic, multifactorial syndrome with a high incidence and prevalence worldwide. The clinical assessment of these patients is challenging, imposing several barriers related to the system, the healthcare professional and the patient. While numerous assessment tools exist for dementia, few are specifically validated or widely used in palliative care. This study evaluates the relevance of using the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in Portugal. The primary objective is to synthesize evidence on the implementation and clinical performance of IPOS-Dem in people with dementia receiving palliative care—including feasibility, acceptability, validity, reliability, and clinical applicability—while the secondary objective is to assess the instrument’s relevance and potential for cultural/linguistic adaptation to context. Methods: A systematic review of the literature was carried out, with research in evidence-based medicine databases on the use of the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in palliative care, using the terms “dementia”, “alzheimer”, “lewy body”, “cognitive impair”, “outcome”, “IPOS-Dem”, “patient outcome assessment”, “outcome assessment”, “scale”, “palliative care”, and “palliative outcome scale”. Results: The IPOS-Dem was considered to be a useful tool for monitoring patients with dementia while receiving palliative care, allowing for a comprehensive and systematic evaluation of symptoms, as well as involving family members in the care process. It facilitates the identification of previously unknown symptoms and issues, particularly emotional and social concerns. Its use led to an improvement in symptom control and greater family involvement in care. The reduction in missing response rates and the time required to complete the scale with repeated use indicated good adaptation to the scale’s implementation. Difficulties were reported in assessing patients with communication impairments. Some staff also highlighted the need for training in using the scale. The Swiss Easy-Read IPOS-Dem showed significant variation in scores between evaluators, which raises concerns about the reliability and consistency of the scale, indicating that the tool requires further validation. Digital models, although they may present some inconveniences, were suggested as a potential improvement in acceptability. Conclusions: Our review suggests that IPOS-Dem provides initial evidence of feasibility, acceptability, and potential clinical usefulness in dementia palliative care, making its implementation beneficial for the Portuguese population. Translation and adaptation to the Portuguese population and culture will be necessary, but the scale is promising, and we recommend its national use. Full article

This study investigates heavy metal pollution in agricultural soils and its associated health risks in Zhenjiang and Yangzhou in the core of the Yangtze River Delta, China, based on high-density sampling at 449 sites. Although the total concentrations of As and Cd remain below national Risk Intervention Values (GB 15618-2018), the Cd level significantly exceeds the national background, and the potential ecological risk index (PERI) indicates very high ecological risk (>320) at 88.2% of sites, driven primarily by Hg and Cd. The results show acceptable non-carcinogenic risks (HI < 1) for adults and children, but carcinogenic risks are elevated: arsenic alone exceeds the 1 × 10⁻⁶ threshold in 71.7% of adult and 92.1% of child scenarios, with the total carcinogenic risk averaging 1.89 × 10⁻⁶ (adults) and 3.05 × 10⁻⁶ (children). These probabilistic findings justify stricter local action thresholds for As and Cd in this densely populated rice-producing region and demonstrate the value of Monte Carlo simulation for delivering transparent, population-specific risk exceedance probabilities to support evidence-based regional soil management and food-safety policies. Full article

Antimicrobial resistance (AMR) is an increasing concern in food animal production. In swine herds, viral infections often lead to secondary bacterial disease and higher antimicrobial use (AMU). This study describes how U.S. swine veterinarians view the role of viral vaccines in reducing this reliance on antimicrobials. We conducted a national survey of swine practitioners and follow-up semi-structured interviews with a subset of respondents. Across participants, porcine reproductive and respiratory syndrome (PRRS), swine influenza (SIV), and rotaviral enteritis were most often named as viral diseases in urgent need of improved vaccines. These diseases cause substantial economic losses and frequently trigger AMU in commercial herds. Veterinarians reported several recurring challenges with current vaccines, including limited cross-protection against field strains, interference from maternally derived antibodies, and short duration of protection. Despite these limitations, most respondents supported vaccination as a key tool to curb AMU and indicated they would accept higher prices for clearly improved products. These findings reveal both a clear need and specific opportunities for future vaccine development to provide broader and more reliable protection, reduce AMU, and help slow the development of AMR. Full article

The leadership of Sukarno, the first President of post-colonialized Indonesia, stands at the center of this paper. It is commonly accepted that Sukarno played an important role in liberating Indonesia from Dutch colonialism. He was distinguished statesman and respected leader, a “magical verbalizer” and a modern millenarian figure in the Indonesian political cultural context. My purpose in this paper, then, is to analyze Sukarno’s major elements of leadership in order to learn from his biography how educational leaders could manage their educational institution more effectively, particularly in traditional developing nations. A biographical analysis of Sukarno’s leadership reveals four major elements in his leadership: charisma, harmony, and an open-minded view of reality, unity building, guided democracy, and respect. Practical implications for leadership development programs in education are suggested at the end of the paper. Full article

Unprecedented quantities of pelagic sargassum since 2011 have demanded technical and management responses. Inappropriate measures might worsen environmental impacts, particularly in low-income regions and protected natural areas that also require low-cost, socio-ecologically integrated alternatives. This study aims to evaluate the effectiveness and local perception of sargassum clean-up treatments developed through a community–academic collaboration within a socio-ecological systems framework in the marine protected area Xcalak Reefs National Park (PNAX), at the southernmost Mexican Caribbean coast. In 2019 and 2021, clean-up efforts were implemented through the national PROREST program and a self-organized community group of 35–40 members supported by a multidisciplinary research advisory team. Monitoring in 2021 estimated sargassum removal at 4012 m² over 50–75 work hours. Although average shoreline retreat was obtained (δ_mean = −0.22 m), final accretion of ~0.96 m alleviated community concerns about erosion linked to clean-up activities. The most effective and socially accepted clean-up treatment involved sargassum spreading, collection, drying, and revetment-type beach protection, reducing odors and harmful fauna. However, treatments aimed at shoreline stabilization were impractical, raising doubts about their long-term efficacy. These findings highlight the relevance of integrating ecological performance and social perception in sargassum management, especially where co-management with local communities in marine protected areas is needed. Full article

Despite its economic profitability, fur farming in Europe, responsible for half of global production, faces a growing ethical backlash. Animal welfare concerns, particularly regarding mink, foxes, and raccoon dogs kept in restrictive cages, have intensified due to advocacy, scientific reviews, and COVID-19 outbreaks. In response, several EU nations have implemented bans or stricter regulations. However, limited research exists on EU public opinion. This study analyses data from Eurobarometer 533 (March 2023), surveying 26,368 citizens across 27 EU countries, to assess attitudes toward fur farming. Respondents selected from three policy preferences: a full ban, EU-wide regulation, or acceptance of current practices. Multinomial logistic regression and chi-square tests revealed significant socio-demographic and ideological influences. Older individuals were more supportive of current practices (p = 0.001), while higher education levels correlated with support for a ban or stricter regulation (p = 0.003). Income positively influenced support for regulation (p = 0.002), and women (p = 0.008), urban residents (p = 0.001), and those with regular animal contact (p = 0.007) were more likely to support reform. Right-leaning respondents (p = 0.012) and residents of countries without fur farming bans (p < 0.001) were less supportive. These findings suggest that values, demographics, and national legislation significantly shape public opinion. Aligning policy with evolving societal values requires integrated legislative reform, public engagement, and equitable transition strategies to ensure meaningful and sustainable improvements in animal welfare across the EU. Full article

Background/Objectives: Lumbar puncture (LP) remains a vital pediatric procedure for diagnosing neurological and systemic conditions. Despite its clinical significance, parental hesitation to authorize pediatric LP often impedes early diagnosis and care. This study aims to evaluate parental knowledge and attitudes regarding pediatric LP in the Northern Border Region of Saudi Arabia, offering insights to inform targeted education strategies. Methods: A cross-sectional survey was conducted between February and August 2025 using a validated online questionnaire distributed via social media. The survey captured sociodemographic data and assessed awareness and attitudes toward pediatric LP. Univariate and multivariate logistic regression analyses examined factors associated with knowledge and consent. Results: Among 703 respondents, 60.6% were mothers and 95.6% were Saudi nationals. While 64.6% acknowledged the importance of aseptic technique, just 38.1% considered LP a safe practice. Knowledge levels were highest in parents aged 18–25 years (p < 0.001). Physician recommendation was the key factor in parental consent (87.0%), with 59.2% willing to approve the procedure following advice. Parents aged 26–35 years showed greater acceptance (OR = 1.54, 95% CI: 1.02–2.32, p = 0.04), whereas those older than 46 years were less receptive (OR = 0.51, 95% CI: 0.30–0.86, p = 0.01). Conclusions: Overall, parental knowledge regarding pediatric LP is limited. Targeted health education campaigns are needed to improve parental understanding of the procedure’s safety, importance, and benefits. Full article