Search Results (402)

Economic growth, especially in emerging economies, has altered the composition of international tourism. It is therefore essential to possess the skills necessary to understand the influence of culture on human behaviour, thereby enabling an appropriate response to the traveller. This research aims to develop a tool for identifying openness, flexibility, awareness, and intercultural preparedness. It focuses on the metacognitive and cognitive aspects of cultural intelligence that shape the development of empathy in customer service staff in hotels in Quintana Roo. The variables were validated and incorporated into a quantitative study using multivariate analysis and inferential statistics. A sample of 77 questionnaires was analysed using simple random sampling under a proportional design. Multiple Correspondence Analysis (MCA) was employed as a discriminatory technique to identify the most significant independent variables. These were subsequently entered as regressors into ordinal logistic regression (OLR), along with age and work experience, in order to estimate the probabilities associated with each level of the dependent variable. The results indicated that age had minimal influence on the metacognitive and cognitive variables, whereas years of experience among tourism staff exerted a significant effect. Full article

Certain industries will bear a disproportionate share of the burden of climate change. Climate change risk perceptions can impact workers’ mental health and well-being; increased climate change risk perceptions are also associated with more favourable adaptive attitudes. It is, therefore, important to understand whether climate risk perceptions differ across workers between industries. We conducted an online survey of British Columbians (16+) in 2021 using social media advertisements. Participants rated how likely they believed their industry (Natural Resources, Science, Art and Recreation, Education/Law/Government, Health, Management/Business, Manufacturing, Sales, Trades) would be affected by climate change (on a scale from “Very Unlikely” to “Very Likely”). Ordinal logistic regression examined the association between occupational category and perceived industry vulnerability, adjusting for socio-demographic factors. Among 877 participants, 66.1% of Natural Resources workers perceived it was very/somewhat likely that climate change would impact their industry; only those in Science (78.3%) and Art and Recreation (71.4%) occupations had higher percentages. In the adjusted model, compared to Natural Resources workers, respondents in other occupations, including those in Art and Recreation, Education/Law/Government, Management/Business, Manufacturing, Sales, and Trades, perceived significantly lower risk of climate change-related industry impacts. Industry-specific interventions are needed to increase awareness of and readiness for climate adaptation. Policymakers and industry leaders should prioritize sectoral differences when designing interventions to support climate resilience in the workforce. Full article

Video surveillance systems have become pervasive in contemporary society, prompting growing concerns about their psychological and behavioral effects on individuals. This study investigates how perceived surveillance influences self-censorship and behavioral regulation in monitored environments, drawing on the conceptual framework of panoptic self-regulation and surveillance-induced anxiety. A structured questionnaire was administered to 358 university students, and data were analyzed using exploratory and confirmatory factor analysis to validate latent constructs, followed by ordinal logistic regression and mediation analysis to test key hypotheses. The results indicate that individuals who perceive higher psychological pressure due to surveillance are more likely to modify their behavior, exhibiting heightened self-awareness and restraint. Additionally, belief in the active monitoring of surveillance footage significantly amplifies behavioral vigilance. The perception of the technological omnipresence of surveillance further intensifies psychological discomfort, which mediates behavioral change. These findings conceptualize video surveillance as a socio-technical system that exerts behavioral influence through internalized psychological mechanisms. The study highlights the importance of considering the unintended consequences of surveillance technologies on autonomy and freedom, and it suggests that regulatory frameworks should account not only for legal compliance but also for the psychological impact of surveillance. The results provide empirical support for viewing surveillance systems as dynamic regulators of human behavior. Full article

The global shift toward sustainable transportation has gained increasing interest, promoting the use of electric vehicles (EVs) as an environmentally friendly alternative to conventional vehicles as a result of a complex interaction between economic incentives, social dynamics, and environmental imperatives. This study is based on the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) to understand the key factors influencing consumers’ intentions in the Sultanate of Oman toward adopting electric vehicles. It is based on a mixed methodology combining quantitative data from a questionnaire of 448 participants, analyzed using ordinal logistic regression, with qualitative thematic analysis of in-depth interviews with 18 EV owners. Its results reveal that performance expectations, trust in EV technology, and social influence are the strongest predictors of EV adoption intentions in Oman. These findings suggest that some issues related to charging infrastructure, access to maintenance services, and cost-benefit ratio are key considerations that influence consumers’ intention to accept and use EVs. Conversely, recreational motivation is not a statistically significant factor, which suggests that consumers focus on practical and economic motivations when deciding to adopt EVs rather than on their enjoyment of driving the vehicle. The findings of this study provide valuable insights for decision-makers and practitioners to understand public perceptions of electric vehicles, enabling them to design effective strategies to promote the adoption of these vehicles in the emerging sustainable transportation market of the future. Full article

Urban tourism has experienced significant growth driven by platforms such as Airbnb, yet the relationship between short-term rental (STR) location and guest mobility remains underexplored. In this study, a structured survey of STR guests in Madrid during 2024 was administered face-to-face through property managers and luggage-storage services to examine factors influencing public transport (PT) use. Responses on bus and metro usage were combined into a three-level ordinal variable and modeled using ordered logistic regression against tourist demographics, trip characteristics, and accommodation attributes, including geocoded location zones. The results indicate that first-time and international visitors are less likely to use PT at high levels, while tourists visiting more points of interest and those who rated PT importance highly when choosing accommodation are significantly more frequent users. Accommodation in the central almond or periphery correlates positively with higher PT use compared to the city center. Distances to transit stops were not significant predictors, reflecting overall network accessibility. These findings suggest that enhancing PT connectivity in peripheral areas could support the spatial dispersion of tourism benefits and improve sustainable mobility for STR guests. Full article

Multi-agent large language models promise flexible, modular architectures for delivering personalized educational content. Drawing on a pilot randomized controlled trial with middle school students (n = 23), we introduce a two-agent GPT-4 framework in which a Profiler agent infers learner-specific preferences and a Rewrite agent dynamically adapts science passages via an explicit message-passing protocol. We implement structured system and user prompts as inter-agent communication schemas to enable real-time content adaptation. The results of an ordinal logistic regression analysis hinted that students may be more likely to prefer texts aligned with their profile, demonstrating the feasibility of multi-agent system-driven personalization and highlighting the need for additional work to build upon this pilot study. Beyond empirical validation, we present a modular multi-agent architecture detailing agent roles, communication interfaces, and scalability considerations. We discuss design best practices, ethical safeguards, and pathways for extending this framework to collaborative agent networks—such as feedback-analysis agents—in K-12 settings. These results advance both our theoretical and applied understanding of multi-agent LLM systems for personalized learning. Full article

Background: Physical inactivity among adolescents, particularly females in conservative societies like Saudi Arabia, poses significant risks to both physical and psychological health. Cultural norms, environmental constraints, and limited access to gender-appropriate sports facilities further exacerbate the problem. Understanding these factors is essential for developing effective, context-sensitive interventions. Aim: This study aimed to examine the relationship between daily physical activity behaviours and health outcomes, both physical and psychological, among adolescent females in Saudi Arabia. This paper also explores the impact of socio-environmental variables such as income, household size, and urban/rural residence on activity levels and wellbeing. Methods: A cross-sectional survey of 636 adolescent females aged 13–21 was conducted using validated instruments. The Physical Activity Questionnaire for Adolescents (PAQ-A) measured physical activity levels, and the Self-Rated Health (SRH) assessed psychological wellbeing and health-related quality of life. The analysis employed an Ordinal Logistic Model (OLM) guided by the Social Ecological Model (SEM) to assess predictors of physical activity participation. Results: The OLM results indicated that higher income levels, smaller household size, urban residence, and older age categories were significantly associated with higher levels of physical activity (p < 0.05). Participants with higher PAQ-A scores reported better psychological health and quality of life. The model showed a good fit, with a pseudo-R² of 0.36. Cultural and environmental barriers, particularly in rural areas, were identified as significant deterrents to participation. Conclusions: The findings highlight the urgent need for culturally adapted, gender-sensitive health promotion programs that target both individual and structural barriers to physical activity among adolescent girls in Saudi Arabia. Enhanced societal support and accessible sports infrastructure could significantly improve health outcomes and quality of life. Full article

Background: Textural interface opacities (TIOs) following Descemet’s stripping automated endothelial keratoplasty (DSAEK) have become a significant postoperative concern. Studies have explored possible links such as stromal irregularities and viscoelastic usage, but the exact cause of TIOs remains unclear. PURPOSE: To evaluate the relationship between microkeratome dissection parameters and the development of textural interface opacities in DSAEK grafts utilizing the “M-TIO” grading scale for standardized assessment. Methods: Optical coherence tomography (OCT) images of DSAEK-processed corneal grafts, prepared with the same microkeratome and technique for transplantation at Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale termed “M-TIO”. This analysis aimed to evaluate and categorize the occurrence of TIO, explore its potential correlation with graft characteristics prior to DSAEK preparation, and assess specific stages of the DSAEK dissection process. Data collected included the size of the microkeratome head used, the difference between the head and the actual stromal cut, and the difference between the pre-cut graft thickness and post-cut DSAEK lenticule thickness. Results: The study retrospectively included 422 donor corneas transplanted from 2019 to 2023. Variables associated with TIO in the final multivariable ordinal logistic model included the difference between the pre-cut graft thickness and the post-cut DSAEK lenticule thickness (OR: 1.57 [99% CI: 1.22 to 2.06] per 50 µm) and microkeratome head (OR: 6.95 [99% CI: 1.04 to 36.60] 300 µm, OR: 4.39 [99% CI: 0.76 to 19.00] 350 µm, and OR: 18.86 [99% CI: 2.35 to 175.91] 400 µm vs 450 or 500 µm, respectively). Conclusions: This study identified a statistically significant association between TIOs and the microkeratome DSAEK preparation, proposing several factors that could help prevent its occurrence. Specifically, creating an ultra-thin DSAEK lenticule from an initially thick graft using a smaller microkeratome head with the slow single-pass technique may increase the risk of TIOs. In contrast, utilizing a larger microkeratome head can improve stromal thickness consistency, reduce technical challenges during graft preparation, and lower the risk of TIOs. Full article

Aim: To investigate the knowledge of and attitudes towards herpes zoster (HZ) and its vaccination, as well as the vaccination status of Chinese patients with rheumatic disease. Method: A face-to-face questionnaire survey was conducted among patients visiting the Department of Rheumatology and Clinical Immunology, Peking University First Hospital from 1 March to 30 April 2024. Information on HZ infection and vaccination status was recorded. The questionnaire assessed their knowledge of HZ and the HZ vaccine with nine questions, scoring one point for each correct answer, resulting in a total score ranging from zero to nine. Attitudes toward HZ and vaccines were measured by a five-point Likert scale, with scores ranging from one (“strongly disagree”) to five (“strongly agree”). Factors associated with knowledge and attitude scores were analyzed using an ordinal logistic regression. Results: A total of 1036 patients completed the questionnaire, with a mean age of 47.1 years, and 79.3% were females. The three most prevalent diseases were systemic lupus erythematosus (32.4%), rheumatoid arthritis (26.3%) and Sjögren’s syndrome (9.9%). A total of 243 patients (23.5%) reported a history of HZ or current HZ infection. Only 2.0% of the patients had been vaccinated, while 51.0% expressed willingness to be vaccinated in the future. The median knowledge score was four (2, 5) (ranging from zero to nine), and the median attitude score was 19 (17, 20) (ranging from 5 to 25). Factors associated with higher knowledge scores included being female (β = 0.448, p = 0.001), having a higher educational level (β = 0.355, p < 0.001), having a higher monthly income (β = 0.191, p = 0.008) and having comorbidities (β = 0.275, p = 0.023). Factors associated with higher attitude scores included being female (β = 0.279, p = 0.035), having a higher monthly income (β = 0.196, p = 0.037) and possessing a higher education level (β = 0.310, p = 0.045). Conclusions: Patients with rheumatic disease in China exhibit a low level of cognition regarding HZ as well as its vaccine, and the vaccination rate is very low. To improve the understanding and prevention awareness of HZ, health education should be intensified, particularly targeting males, those with lower levels of education and lower-income patients. Full article

(1) Background: Benzene, environmental pollutant, is linked to various adverse health effects, but its impact on oral health remains under-explored. This study examines the association between blood benzene levels and periodontitis, a progressive oral inflammatory condition, using a nationally representative sample of U.S. adults. (2) Methods: Cross sectional data from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Periodontitis was defined per CDC/AAP. Three weighted multivariable logistic regression models determined the association between blood benzene levels and periodontal severity, adjusting for potential confounders. A structural equation modeling (SEM) analysis evaluated cotinine, smoking biomarker, as a mediator in the relationship between benzene and severe periodontitis. (3) Results: The ordinal logistic regression showed a statistically significant association (AOR = 2.0, p = 0.02) between blood benzene levels and periodontal severity. A one unit increase in blood benzene was associated twice the odds of progressing to a higher category of periodontitis. Benzene exposure was significantly linked to severe periodontitis (AOR = 2.9, p = 0.001). SEM analysis indicated cotinine mediates the relationship between blood benzene and sever periodontitis. (4) Conclusions: This study provides evidence that higher blood benzene levels are associated with severe periodontitis. The findings suggest that cotinine, a biomarker of smoking, mediates the relationship between benzene exposure and severe periodontitis. Full article

Individual mobility behavior continues to pose a challenge to achieving climate goals, as motorized individual transportation is still favored over public transportation. The present study examines five possible drivers of more sustainable transportation mode choices: two infrastructural factors, specifically city center accessibility and railway accessibility, and three psychological variables: adaptability, climate change perception, and car orientation. A sample of N = 187 participants was collected in a German city in the Lower Rhine region. Our findings, based on ordinal logistic regression models, indicate that railway accessibility and car orientation are associated with both the use of motorized and public transportation. While center accessibility and adaptability predicted the use of motorized individual transportation, these variables did not significantly relate to the use of public transportation. Also, our results indicate that climate change perception does not relate to transportation use. This surprising finding is discussed in detail. On a more general level, the study’s insights reinforce previous findings and stress the importance of considering not only infrastructural factors in urban spaces but also the characteristics and attitudes of their inhabitants. Full article

Background: Health-related quality of life (HRQoL) questionnaires are essential for understanding the physical, psychological, lifestyle, and social factors that impact patients’ well-being. Causal discovery demonstrates significant potential in this direction; however, it has not yet been thoroughly assessed. This study aimed to explore the perspective of utilizing causal discovery as a methodological tool for binary classification of patients based on HRQoL questionnaire data. Methods: The focus was on questionnaire structures similar to the EQ-5D-5L, which includes both ordinal and quantitative items. A customized classification algorithm is proposed, which utilizes the differences between the causal structures derived from the HRQoL questionnaire answers of patients who belong to two distinct groups. This algorithm was evaluated using the correct classification rate (CCR) and the misclassification rate (MR) based on simulated data under conditions of varying sample size and causal structures’ complexity, and within a real-world data application. Results: In both the simulation and application, the CCR exhibited larger values compared to the MR; however, the percentages that the algorithm could not result in a decision were, in general, not negligible. The adjusted CCR (algorithm yields a decision) exhibited substantially improved values compared to the CCR in both analyses. Within the application, the algorithm showed mixed performance compared to a standard stepwise binary logistic regression approach. Conclusions: The proposed algorithm has the potential to correctly classify patients, but further investigation is needed to evaluate its performance under different scenarios in a large-scale real-world setting. Determining the necessary conditions for successful classification would result in effectively exploiting causal discovery to further advance the role of HRQoL questionnaires in patient care and management. Full article

Economic transformations in emerging countries have resulted in an increase in the volume of international travellers from diverse geographical regions. In the tourism sector, service providers must possess cultural competencies that foster a flexible and appropriate attitude, which in turn affects the perception of service. The present study aims to shed light on the motivational factors and cultural behaviours that influence intercultural empathy among staff working in the tourism sector in Quintana Roo. To this end, a comprehensive literature review has been conducted, during which the variables have been validated, and a quantitative study has been undertaken, employing multivariate analysis through a Multiple Correspondence Analysis and inferential statistics with an Ordinal Logistic Regression. The findings of this study demonstrate a positive correlation between motivation and cultural behaviour, which is contingent on experience and age, and its impact on empathy in understanding and meeting the diverse needs of tourists. Cultural motivation is defined as the interest in learning and interacting in multicultural situations, and its impact on behaviour is reflected in appropriate personal management for effective cultural interactions. The probabilities estimated by ordinal logistic regression models of consistently or predominantly exhibiting intercultural empathy increase with age and experience for the most significant variables obtained by the Multiple Correspondence Analysis. Full article

Background: This study aimed to assess patient satisfaction with the quality of healthcare services at selected public primary healthcare facilities in Almaty during the COVID-19 pandemic and to identify associated demographic and facility-related factors. Methods: A cross-sectional, quantitative study was conducted over a period of 6 months, from 30 June to 31 December 2021, through a web-based survey. An adapted questionnaire was employed to survey the respondents. In total, 1035 respondents participated in the study. To examine the relationship between demographic and facility characteristics and patient satisfaction, we utilized the proportional odds model for ordinal logistic regression. Results: A total of eight primary healthcare organizations from the public sector in Almaty participated in the survey. The analysis identified significant demographic predictors of patient satisfaction, such as marital status, social status, self-perceived health, and the use of online consultations. Among the facility-related factors, only the availability of a cross-ventilation system emerged as a significant predictor. Conclusions: This study provides evidence for the factors influencing patient satisfaction with primary healthcare services in Almaty during the COVID-19 pandemic. Both demographic characteristics and facility-level attributes were found to significantly affect satisfaction levels. These findings underscore the need for targeted structural and organizational improvements in primary healthcare settings, especially during public health emergencies. Addressing these gaps through infrastructural upgrades, enhanced preparedness, and the integration of patient-centered care models can help to bolster trust and resilience within Kazakhstan’s healthcare system. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a growing global health threat, requiring an approach that integrates human, animal, and environmental health. Public awareness and responsible antibiotic use are key to combating AMR. This study examines the knowledge, attitudes, and practices related to antibiotic use among the general population in Serbia, exploring their impact on antimicrobial stewardship efforts. Methods: A cross-sectional study was conducted in December 2022 using a three-stage stratified random sample of the Serbian population. The Eurobarometer questionnaire was utilized with permission from the European Commission. Statistical analyses included multivariate ordinal logistic regression to identify predictors of desirable attitudes and behaviors related to antibiotic use. Results: Almost two-thirds of respondents (61.6%) reported not receiving any advice on rational antibiotic use, underscoring the need for education of the general population and raising awareness. A Higher Antibiotic Knowledge Score was associated with a 60% greater likelihood of favorable attitudes and a 21% greater likelihood of rational antibiotic use. Pharmacists were identified as the primary source of antibiotic-related information for the general population in Serbia, but there is limited public interest and awareness of antibiotic use in animals, as well as of the bans on using antibiotics to stimulate growth in farm animals within the EU. Conclusions: Through targeted educational interventions, strengthening interdisciplinary collaboration and AMR control measures is necessary for human and veterinary medicine. Although pharmacists are the primary source of information about antibiotics for the population in Serbia, collaboration with physicians and their empowerment should be introduced to strengthen antimicrobial stewardship further. Full article