Search Results (717)

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

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches. Full article

Background/Objectives: Pain assessment scales provide a clear clinical benefit in patients who are unable to self-report. The Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) was developed to assess pain in patients with acquired brain injury who are unable to self-report. However, this instrument has not yet been translated and validated for use in Spain. The objective was to translate the Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) into Spanish and to assess the reliability and validity of the Spanish version in patients with brain injury. Methods: This study was carried out in two phases. First, the scale was translated into Spanish. Next, a psychometric analysis was performed to determine the reliability and validity of the Spanish version of the NCS-R-I in 207 critically ill patients with acquired brain injury and disorders of consciousness. Two blinded observers administered the scale at three time points: 5 min before, during, and 15 min after a series of nociceptive and non-nociceptive procedures. Results: The internal consistency of the NCS-R-I was acceptable (ordinal alpha = 0.60–0.90). Interobserver agreement was good (kappa = 0.80; intraclass correlation coefficient = 0.90). In terms of discriminant validity, the AUC was 0.952 (95% CI: 0.931–0.973). NCS-R-I scores increased significantly during performance of nociceptive procedures compared to scores obtained before and after these procedures, confirming the scale’s sensitivity to change. Similarly, during the performance of nociceptive procedures, scores on the NCS-R-I were significantly higher (p < 0.001) than those observed during non-nociceptive procedures. Conclusions: The results of this study demonstrate that the NCS-R-I is a valid, reliable tool for the assessment of pain in patients with acquired brain injury who are unable to self-report. Full article

This study aims to develop a preliminary list of indicators suitable for green restaurants in Taiwan. The research methodology includes expert consensus (Delphi method) and incorporates interviews with field experts. An analysis of the responses provided by these industry experts led to the identification of five dimensions of evaluation indicators for green restaurants. The K–S test involves using a z-test on ordinal variables for single samples to determine whether the sample distribution diverges from the frequency distribution. This study analyzed the responses provided by the interviewed experts to identify and extract evaluation indicators for green restaurants. The extracted indicators comprise five dimensions (resource management, ingredient and product selection, environmental and indoor quality, green certification and management, and customer awareness and participation), 15 sub-dimensions, and 70 detailed indicators. The research results can serve as a reference for course planning in related programs at universities and colleges, as well as for industry planning of green restaurants, and as a reference for the promotion of national sustainable environmental policies in Taiwan. Therefore, based on the results of this study, recommendations are provided for educational institutions related to green restaurants, official organizations related to green restaurants, the industry related to green restaurants, and future researchers. 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

Monsoon evergreen broad-leaved forests (MEBFs) represent one of the most species-rich and structurally complex vegetation types, and one of the most widely distributed forests in Yunnan Province, Southwest China. However, they have yet to undergo a comprehensive analysis on their community diversity, spatial differentiation patterns, and underlying drivers across Yunnan. Based on extensive field surveys during 2021–2024 with 548 MEBF plots, this study employed the Unweighted Pair Group Method for forest community classification and Non-metric Multidimensional Scaling for ordination and interpretation of community–environment association. A total of 3517 vascular plant species were recorded in the plots, including 1137 tree species, 1161 shrubs, and 1219 herbs. Numerical classification divided the plots into 3 alliance groups and 24 alliances: (1) Castanopsis–Schima (Lithocarpus) Forest Alliance Group (16 alliances), predominantly distributed west of 102°E in central-south and southwest Yunnan; (2) Castanopsis–Machilus (Beilschmiedia) Forest Alliance Group (6 alliances), concentrated east of 101°E in southeast Yunnan with limited latitudinal range; (3) Castanopsis–Camellia Forest Alliance Group (2 alliances), restricted to higher-elevation mountainous areas within 103–104° E and 22.5–23° N. Climatic variation accounted for 81.1% of the species compositional variation among alliance groups, with contributions of 83.5%, 57.6%, and 62.1% to alliance-level differentiation within alliance groups 1, 2, and 3, respectively. Precipitation days in the driest quarter (PDDQ) and precipitation seasonality (PS) emerged as the strongest predictors of community differentiation at both alliance group and alliance levels. Topography and soil features significantly influenced alliance differentiation in Groups 2 and 3. Collectively, the interaction between the monsoon climate and topography dominate the spatial differentiation of MEBF communities in Yunnan. Full article

A syntaxonomical revision of the plant communities of the Isoëto-Nanojuncetea class occurring in Sardinia is provided. Within this class, the ephemeral herbaceous hygrophilous associations linked to temporarily submerged surfaces occur, which are widespread in the European, Mediterranean, and Macaronesian countries. It groups plant communities floristically characterized by a rich set of annual hygrophytes or more rarely hemicryptophytes and geophytes, which are also physiognomically, ecologically, and structurally well differentiated. Within this class, two orders are recognized in Sardinia, such as Isoëtetalia and Nanocyperetalia, which are represented by several alliances. In particular, four alliances can be referred to as Isoëtetalia (Isoëtion, Menthion cervinae, Cicendio-Solenopsion laurentiae, and Agrostion pourretii), while a single alliance (Verbenion supinae) belonging to Nanocyperetalia has been identified. Within these alliances, several associations already described have been surveyed, while several other unpublished ones, are here proposed as new to science. Overall, 35 associations are recognized, 18 of which are described for the first time. Each higher-rank syntaxa and related associations are examined from a nomenclatural, floristic, ecological, and chorological point of view. In particular, the more significant phytosociological relevés regarding the examined associations were processed using cluster analysis, DCA ordination, optimclass diagram in order to highlight the correlations between them. As regards the floristic aspects, a checklist of the species occurring in the phytosociological relevés is provided. Full article

A partially ordered set (or a poset, for short) is a set endowed with a partial order relation, i.e., with a reflexive, anti-symmetric, and transitive binary relation. As mathematical objects, posets have been intensively studied in the last century, coming to play essential roles in pure mathematics, logic, and theoretical computer science. More recently, they have been increasingly employed in data analysis, multi-criteria decision-making, and social sciences, particularly for building synthetic indicators and extracting rankings from multidimensional systems of ordinal data. Posets naturally represent systems and phenomena where some elements can be compared and ordered, while others cannot be and are then incomparable. This makes them a powerful data structure to describe collections of units assessed against multidimensional variable systems, preserving the nuanced and multi-faceted nature of the underlying domains. Moreover, poset theory collects the proper mathematical tools to treat ordinal data, fully respecting their non-numerical nature, and to extract information out of order relations, providing the proper setting for the statistical analysis of multidimensional ordinal data. Currently, their use is expanding both to solve open methodological issues in ordinal data analysis and to address evaluation problems in socio-economic sciences, from multidimensional poverty, well-being, or quality-of-life assessment to the measurement of financial literacy, from the construction of knowledge spaces in mathematical psychology and education theory to the measurement of multidimensional ordinal inequality/polarization. Full article

As an ecological transition zone, the ecosystem of the Qin River Basin in the middle reaches of the Yellow River is of great significance to the regional ecological balance. With the rapid socio-economic development, land use changes are significant, and the spatial and temporal patterns of ecosystems are evolving. Exploring its dynamics and driving mechanisms is crucial to the ecological protection and sustainable development of watersheds. This research systematically examines the spatiotemporal dynamics and driving mechanisms of ecosystem patterns in the middle Yellow River’s Qin River Basin (1990–2020). Quantitative assessments integrating ecosystem transition metrics and redundancy analysis reveal three critical insights: (1) dominance of agricultural land and woodland (74.81% combined coverage), with grassland (18.58%) and other land types (6.61%) constituting secondary components; (2) dynamic interconversion between woodland and grassland accompanied by urban encroachment on agricultural land, manifesting as net reductions in woodland (−13.74%), farmland (−6.60%), and wetland (−38.64%) contrasting with grassland (+43.34%) and built-up area (+116.63%) expansion; (3) quantified anthropogenic drivers showing agricultural intensification (45.03%) and ecological protection measures (36.50%) as primary forces, while urbanization account for 18.47% of observed changes. The first two RDA ordination axes significantly (p < 0.01) explain 68.3% of the variance in ecosystem evolution, particularly linking land-use changes to socioeconomic indicators. Based on these findings, the study proposes integrated watershed management strategies emphasizing scientific land-use optimization, controlled urban expansion, and systematic ecological rehabilitation to enhance landscape stability in this ecologically sensitive region. The conclusions of this study have important reference value for other ecologically sensitive watersheds in land use planning, ecological protection policy making, and ecological restoration practice, which can provide a theoretical basis and practical guidance. 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

The research on teaching scaffolding for preschool children’s oral language development (OLD) has become an important topic in the academic world. However, there remains a lack of evidence-based research on the integration of scaffolding strategies integrated into creative art contexts to support children’s creative expression and language production. In this study, a qualitative case study was conducted to analyze the non-participatory observation and artwork analysis of five-year-old children’s drawing activities in a kindergarten in China based on socio-cultural and scaffolding theories. Three types of core scaffolding strategies were summarized. The findings reveal that the three strategies work together dynamically within the children’s Zone of Proximal Development (ZPD): (1) the visual prompt strategy enriches the vocabulary diversity of metaphors, adjectives, and ordinal words; (2) dialogic narrative co-construction effectively improves narrative coherence across exposition, rising action, climax, and resolution; and (3) emotional engagement strategies foster a safe expressive environment, promoting the integration of affective vocabulary with intrinsic motivation. Accordingly, a three-dimensional integrated “visual-linguistic-emotional” scaffolding model was constructed, emphasizing the practical guidelines of simultaneous scaffolding and gradual scaffolding withdrawal during the warm-up, creation, and sharing sessions of the drawing activity. This study expands the application of scaffolding theory in unstructured art contexts, and provides a systematic practical framework for the design of cross-contextual language support strategies and teacher training in preschool education. Full article

Questionnaire data plays a key role in social research, especially when evaluating public attitudes using Likert-type scales. Yet, traditional analyses often merge some ordinal categories and exclude responses such as Don’t Know, No Answer, or Refused—risking the loss of valuable information. This study introduces BS-TOSIE (Belief Structure-Based TOPSIS for Survey Item Evaluation), a novel method that preserves and integrates all response types, including ambiguous ones. By combining the Belief Structure framework with the TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) method, BS-TOSIE offers a structured approach to ranking and evaluating individual survey items measured on an ordinal scale, even in the presence of missing or incomplete data. Response distributions are transformed into a belief structure vector, enabling comparison against ideal and anti-ideal benchmarks. We demonstrate this approach using data from the Quality of Life in European Cities survey to assess perceptions of local governance in European cities. This study analyzes changes in citizen satisfaction with local public administration across five key dimensions—timeliness, procedural clarity, fairness of fees, digital accessibility, and perceived corruption—in 83 European cities between 2019 and 2023. The findings reveal persistent regional disparities, with Northern and Western European cities consistently outperforming those in Southern and Eastern Europe, although some cities in Central Europe show signs of improvement. Zurich consistently received high satisfaction scores, while other cities, such as Rome and Palermo, showed lower scores. Unlike traditional methods, our approach preserves the full spectrum of responses, yielding more nuanced and interpretable insights. The results show that BS-TOSIE enhances both the clarity and depth of survey analysis, making a methodological contribution to the evaluation of ordinal data and offering empirical insights into public perceptions of local city administration. 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