Search Results (4,893)

Background/Objectives: The COVID-19 pandemic exposed global weaknesses in healthcare preparedness and highlighted the pivotal role of the World Health Organization (WHO) in coordinating responses and issuing technical guidance. Among these, the document “Rational use of personal protective equipment (PPE) for COVID-19 and considerations during severe shortages” (December 2020) aimed to standardize PPE use amid global scarcity. This study assessed the awareness, implementation, and perceived usefulness of this WHO guidance among Polish healthcare personnel and evaluated discrepancies between the WHO expectations and workplace realities. Methods: A cross-sectional, anonymous online survey was conducted between July and September 2025 among employees of 243 randomly selected healthcare facilities in Poland (constituting 20% of all hospitals). The original 24-item questionnaire covered the demographics, awareness and implementation of the WHO PPE guidelines, and perceptions of their effectiveness during and after the pandemic. Data were analyzed descriptively. Results: A total of 542 healthcare workers participated, predominantly nurses (56.8%) and physicians (12.2%), with 86.8% being female and 59.3% having over 20 years of experience. Most respondents (76.5%) reported familiarity with the WHO PPE document, and 63.1% confirmed its implementation in their institutions. Over two-thirds (68.0%) reported that the guidelines improved their sense of safety at work. The main barriers to implementation included staff shortages (52.9%) and insufficient local guidance (20.6%). In 2025, 52.3% continue to apply the WHO recommendations, and 70.8% believe they remain relevant in current practice. However, 80.2% indicated that the WHO guidance should be more closely adapted to local conditions. Conclusions: The WHO PPE guidance was widely recognized and reported as implemented by respondents from participating healthcare facilities, contributing to improved preparedness. Nonetheless, limited institutional support and inadequate local adaptation reduced implementation effectiveness. Future WHO recommendations should better align with national healthcare contexts to enhance preparedness for future crises. Full article

This study investigates the crucial role energy leaders play in driving strategic energy management (SEM) and accelerating cost savings within a manufacturing organization and consequently, the industrial sector. Whereas energy efficiency can be seen as an innovative business practice with irrefutable cost benefits, its effective implementation requires strategic leadership and a structured approach. This research analyzes data collected from 120 participants representing 71 companies attending the Energy Bootcamp events organized by the U.S. Department of Energy’s (DOE) Better Plants program. The collected data focused on the state of SEM implementation, the presence and responsibilities of energy leaders, and the formation and function of energy teams. The findings reveal a significant gap between the perceived importance of SEM and its actual adoption, highlighting the need for strong leadership to drive behavioral changes by championing energy efficiency initiatives. Results indicate that effective energy leaders possess a diverse skill set, including the ability to secure top management buy-in, foster a culture of energy consciousness, and collaborate across departments. This study emphasizes the importance of empowering energy leaders with clearly defined roles and responsibilities as well as the authority to build and lead cross-functional energy teams. Furthermore, integrating energy management into existing organizational structures and leveraging readily available resources are identified as key factors for successful implementation. This research underscores how dedicated leadership and effective SEM practices help achieve industrial energy efficiency goals, providing practical insights for organizations seeking to improve performance and contribute to a resilient future. Full article

Agentic artificial intelligence (AI) is emerging as a paradigm for next-generation smart grids, enabling autonomous decision-making, adaptive coordination, and resilient control in complex cyber–physical environments. Unlike traditional AI models, which are typically static predictors or offline optimizers, agentic AI systems perceive grid states, reason about goals, plan multi-step actions, and interact with operators in real time. This review presents the latest advances in agentic AI for power systems, including architectures, multi-agent control strategies, reinforcement learning frameworks, digital twin optimization, and physics-based control approaches. The synthesis is based on new literature sources to provide an aggregate of techniques that fill the gap between theoretical development and practical implementation. The main application areas studied were voltage and frequency control, power quality improvement, fault detection and self-healing, coordination of distributed energy resources, electric vehicle aggregation, demand response, and grid restoration. We examine the most effective agentic AI techniques in each domain for achieving operational goals and enhancing system reliability. A systematic evaluation is proposed based on criteria such as stability, safety, interpretability, certification readiness, and interoperability for grid codes, as well as being ready to deploy in the field. This framework is designed to help researchers and practitioners evaluate agentic AI solutions holistically and identify areas in which more research and development are needed. The analysis identifies important opportunities, such as hierarchical architectures of autonomous control, constraint-aware learning paradigms, and explainable supervisory agents, as well as challenges such as developing methodologies for formal verification, the availability of benchmark data, robustness to uncertainty, and building human operator trust. This study aims to provide a common point of reference for scholars and grid operators alike, giving detailed information on design patterns, system architectures, and potential research directions for pursuing the implementation of agentic AI in modern power systems. Full article

Nail clipping can cause fear, anxiety, and stress (FAS) in dogs and cats and possibly long-term aversion to veterinary care. We conducted an anonymous, online, mixed-methods survey to characterise the knowledge, attitudes, and practices of Australian veterinary nurses, technicians, and other veterinary staff regarding nail clipping in dogs and cats. Among 242 valid responses, 71.9% (n = 174/242) performed nail clipping multiple times per week. Dogs (72.4%, n = 165/228) and cats (59%, n = 134/227) frequently displayed FAS (score > 2/5) during nail clipping. Most respondents (79.8%, n = 193/242) reported being injured while performing nail clipping. Respondents reporting a negative attitude towards nail clipping were 5.5 times (95% CI = 1.7–17.8) more likely to report being injured during a nail clip compared to those with a positive attitude. Respondents reported feeling pressure to persevere with nail clipping when it was unnecessary or when animals exhibited severe FAS. Where used, pre-visit pharmaceuticals and sedation were reported to effectively reduce FAS (dog: p = 0.015; cat: p = 0.152), along with non-pharmaceutical interventions such as gentle handling and counter-conditioning. Respondents perceived nail-clipping to be a difficult, undervalued task. Increased training of veterinary team members regarding nail clipping could improve animal welfare and the safety of veterinary team members. Full article

The concept of neuroception of psychological safety, rooted in Polyvagal Theory, offers a framework for understanding how individuals perceive safety at a physiological and psychological level. Illness may disrupt this perception and affect bodily regulation, emotional resilience, social connection, and self-compassion. This study aims to explore how experiences of being unwell, across both acute and chronic contexts, affect individuals’ neuroception of psychological safety. Semi-structured interviews were conducted with eleven adult participants aged 20–79, including individuals with both acute and chronic illness experiences. Interview questions were informed by the Neuroception of Psychological Safety and Polyvagal Theory. Data were analysed using reflexive thematic analysis, following Braun and Clarke’s six-step process. Four key themes were identified: dysregulation and the narrowing window of tolerance (reduced emotional resilience and heightened bodily sensitivity); distrust and disappointment (a rupture in bodily and self-trust); responsibility and internalised guilt (moral and emotional burdens around illness and recovery); and illness demands attention and disrupts social connection (withdrawal, emotional depletion, and compromised compassion). Across these themes, participants described a diminished sense of psychological safety when unwell, shaped by both internal physiological changes and altered social dynamics. Illness can profoundly undermine psychological safety by disrupting neurobiological regulation, altering relational engagement, and eroding trust in one’s body and self. These findings highlight the importance of integrating psychological safety principles into models of care, particularly in how individuals experience and recover from illness. Full article

Sustainable diet transitions are required to protect human and planetary health, and consumers are important food systems actors who can foster positive changes. However, little is known about how consumers perceive the concept of sustainable diets. This study explored perceptions of sustainable diets across five high- and middle-income countries: Japan, Indonesia, Italy, Canada, and Mexico. Semi-structured interviews were conducted with 184 young adults (30–45 per country), and transcripts were analyzed using values coding to understand the values, attitudes, and beliefs that shape behaviours related to sustainable diets. Results revealed that defining “sustainable eating” was challenging for participants across all countries. While participants’ values regarding sustainable diets were often context-specific with marked differences across countries, common themes across countries included concern about food waste and packaging and the belief that sustainability should be the responsibility of all actors across the food system, not just the individual. These findings indicate that food policy should address both individual and systemic dimensions of food sustainability, specifically prioritizing strategies for waste and packaging infrastructure. Furthermore, public health strategies must be values-oriented and culturally tailored to ensure they resonate with local consumer priorities. Full article

Background/Objectives: This study examines prisoners’ quality of life by investigating which aspects of imprisonment conditions—including perceptions of the physical environment—best predict overall satisfaction with the prison (OSP). A key question is whether the staff–prisoner relationship is the single most important dimension, which is frequently emphasized in the literature but has scarcely been tested quantitatively. Methods: Data stemmed from a survey conducted in three closed prisons in Norway in 2022 (response rate: 63%, n = 163). The dependent variable was assessed by asking: “Generally speaking, on a scale from 1 to 10, how satisfied are you with this prison?” This outcome was regressed on seven subscales from the Prison Climate Questionnaire and four single-item measures of the physical environment that have been shown to influence health and well-being. Results: As expected, the quality of staff–prisoner relationships had a unique statistical impact on OSP. Ratings of the outdoor areas and the view from the cell were about equally strong predictors. No statistically independent effects were observed for perceived quality of relationships with fellow prisoners, reintegration measures, receiving visits, personal safety, autonomy, access to natural light and a global rating of the prison building (noise, temperature, layout, etc.). Conclusions: This study further emphasizes the importance of staff–prisoner relationships in shaping prisoners’ experiences and perceptions of imprisonment. Moreover, it provides new insights into the significance of the physical environment for prisoners’ overall perceptions of prison quality, which is likely to affect their mental health and well-being. These findings have potential implications for the design and siting of new correctional facilities and for improving the quality of existing ones. Full article

This classroom-based case study examines how an AI-mediated Socratic dialogue, implemented through ChatGPT, can support students’ engagement and perceived learning in undergraduate thermodynamics. Conducted in a first-year engineering physics course at a private university in northern Mexico, the activity invited small student groups to interact with structured prompts designed to promote inquiry, collaboration, and reflective reasoning about the adiabatic process. Rather than functioning as a source of answers, ChatGPT was intentionally positioned as a mediating scaffold for Socratic questioning, prompting students to articulate, examine, and refine their reasoning. A mixed-methods approach was employed, combining a 10-item Likert-scale survey with construct-level statistical analysis of two focal dimensions: perception of learning and engagement, including an exploratory comparison by gender. Results indicated consistently high levels of perceived learning and engagement across the cohort, with average scores above 4.5 out of 5. At the construct level, no statistically significant gender differences were observed, although a single item revealed higher perceived learning among female students. Overall, the findings suggest that the educational value of ChatGPT in this context emerged from its integration within a Socratic, inquiry-oriented pedagogical design, rather than from the technology alone. These results contribute to ongoing discussions on the responsible and pedagogically grounded integration of generative AI in physics education and align with Sustainable Development Goal 4 (Quality Education). Full article

Empathic behavior is increasingly incorporated into socially assistive robots, yet little is known about how older adults’ personality-based self-regulatory processes shape responses to such designs. The present study examined a recognition-based “mirror effect” framework of narcissistic self-regulation, referring to the ways individuals maintain a valued self-image through social feedback and acknowledgment. We focused on two core dimensions: narcissistic admiration, characterized by self-promotion and the pursuit of affirmation, and narcissistic rivalry, characterized by defensiveness, antagonism, and sensitivity to threat. Community-dwelling older adults (N = 527; M_age = 72.73) were randomly assigned to view a video of a socially assistive robot interacting in either an empathic or a cold manner. Participants reported their perceived recognition by the robot, defined as the subjective experience of feeling seen, acknowledged, and valued, as well as multiple robot evaluations (anthropomorphism, likability, perceived intelligence, safety, and intention to use). At the mean level, empathic robot behavior increased perceived recognition, anthropomorphism, and likability but did not improve perceived intelligence, safety, or intention to use. Conditional process analyses revealed that narcissistic admiration was positively associated with perceived recognition, which in turn predicted more favorable robot evaluations, regardless of robot behavior. In contrast, narcissistic rivalry showed a behavior-dependent pattern: rivalry was associated with reduced perceived recognition and less favorable evaluations primarily in the empathic condition, whereas this association reversed in the cold condition. Importantly, once perceived recognition and narcissistic traits were accounted for, the cold robot was evaluated as more intelligent, safer, and more desirable to use than the empathic robot. Studying these processes in older adults is theoretically and practically significant, as later life is marked by shifts in social roles, autonomy concerns, and sensitivity to interpersonal evaluation, which may alter how empathic technologies are experienced. Together, the findings identify perceived recognition as a central psychological mechanism linking personality and robot design and suggest that greater robotic empathy is not universally beneficial, particularly for users high in rivalry-related threat sensitivity. Full article

Psychological stress is increasingly investigated as a potentially modifiable factor in male infertility, in part through oxidative stress. This narrative review synthesizes mechanistic and translational evidence linking stress-related neuroendocrine activation and coping behaviors with redox imbalance in the male reproductive tract. Chronic activation of the hypothalamic–pituitary–adrenal axis and sympathetic outflow elevates glucocorticoids and catecholamines. In controlled animal stress paradigms, this is accompanied by suppression of the hypothalamic–pituitary–gonadal axis and by immune and metabolic changes that favor reactive oxygen species generation. The resulting oxidative stress may reduce Leydig cell steroidogenesis, impair testicular and epididymal function, and induce lipid peroxidation, mitochondrial dysfunction, and sperm DNA fragmentation. In such models, these lesions, together with apoptosis of germ and supporting cells, are associated with lower sperm concentration, reduced motility, compromised viability, and diminished fertilizing potential. Overall, preclinical animal studies using defined stress paradigms provide experimental evidence consistent with causal effects of stress on oxidative injury and reproductive impairment in preclinical settings. Human studies linking perceived stress, anxiety/depression, and disturbed sleep to adverse semen parameters and oxidative biomarkers are summarized. However, the human evidence is predominantly associative, and the available studies are cross sectional and remain vulnerable to residual confounding and reverse causality. Potential effect modifiers, including smoking, alcohol use, and circadian disruption, are also discussed as contributors to heterogeneity across clinical studies. Standardized assessment of stress biology and redox status, longitudinal designs aligned with spermatogenic timing, and well-powered intervention trials are needed to define dose–response relationships and support individualized prevention and care. Full article

Background/Objectives: Childhood obesity remains a major public health issue, particularly in Mediterranean countries such as Greece. Although parental influences on children’s weight have been extensively studied, fewer studies have jointly examined parental mental health, feeding practices, sociodemographic factors, and biological stress markers. This study aimed to investigate associations between psychological status, educational level, feeding behaviors, and children’s Body Mass Index (BMI) in a Greek sample. A pilot assessment of salivary cortisol was included in evaluating its feasibility as an objective biomarker of parental stress. Subjects and Methods: A total of 103 parent–child dyads participated in this cross-sectional study. Children’s BMI was classified using World Health Organization (WHO) growth standards. Parental stress, anxiety, and depressive symptoms were assessed using the Perceived Stress Scale-14 (PSS-14) and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaires. Feeding practices were evaluated with the Comprehensive Feeding Practices Questionnaire (CFPQ). Statistical analyses included Pearson correlations, independent samples t-tests, one-way ANOVA, Mann–Whitney U, and Kruskal–Wallis tests. A subsample provided saliva samples for cortisol analysis to assess feasibility and explore the potential associations with parental stress indicators. Results: Parental BMI showed a strong positive association with child BMI (p = 0.002). Higher parental anxiety (p = 0.002) and depression (p = 0.009) were also associated with increased child BMI. Restrictive (p < 0.001) and emotion-driven (p < 0.001) feeding practices were associated with higher child BMI, whereas monitoring (p = 0.013) and health-promoting feeding practices (p = 0.001) appeared protective. Lower parental education was related to a higher BMI in both parents (p = 0.001) and children (p = 0.002) and to more frequent use of restrictive feeding strategies (p = 0.001). WHO charts identified a greater proportion of children as overweight or obese compared with the Centers for Disease Control and Prevention (CDC) criteria. The analysis showed statistically significant differences between the two classification systems (χ² (4) = 159.704, p < 0.001), indicating that BMI categorization varies considerably depending on the reference system used. No significant associations were observed with residential environment or salivary cortisol, likely due to the limited size of the pilot biomarker subsample. Conclusions: The findings highlight the combined effect of parental mental health status, educational level, and feeding practices on child BMI within the Greek context. The preliminary inclusion of a biological stress marker provides added value to the existing research in this area. These results underscore the importance of prevention strategies that promote parental psychological wellbeing and responsive feeding practices while addressing socioeconomic disparities to reduce the childhood obesity risk. Full article

Pedestrian safety in developing countries faces critical challenges from rapid urbanization and infrastructure deficiencies. This study investigates how visual context influences pedestrian crossing preferences through a controlled stated preference experiment in multiple Ecuadorian cities. A sample of 875 participants was randomly assigned to view either non-compliant (mid-block crossing) or compliant (signalized crosswalk) imagery before evaluating six hypothetical scenarios involving three crossing alternatives. Multinomial logit models reveal that waiting time, traveling with a minor, and walking distance are primary determinants of choice. Visual context showed systematic associations with choice patterns: compliant imagery was associated with increased preference for safer alternatives (50.5% versus 43.8% prediction accuracy) and larger safety-related parameter magnitudes. Principal Component Analysis identified two latent perception constructs, safety/security and bridge-specific convenience, providing behavioral interpretation of choice patterns. Substantial spatial heterogeneity emerged across cities (χ² = 124.10 and 84.74, p < 0.001), with larger urban centers showing stronger responsiveness to formal infrastructure cues. The findings demonstrate that visual stimuli systematically alter choice distributions and attribute sensitivities through normative activation and perceptual recalibration. This research contributes methodologically by establishing visual framing effects in stated preference frameworks and provides actionable insights for pedestrian infrastructure design, emphasizing alignment of objective safety improvements with perceived risk and contextual behavioral cues. Full article

Public schools often operate with shared devices, unstable connectivity, and limited support for digital tools, which can make feature-heavy platforms difficult to adopt and sustain. This study reports the first formal design iteration and formative evaluation of VLEPIC, a school-centred virtual learning environment (VLE) developed to support secondary English as a Foreign Language in a low-resource Ecuadorian public school. Using a design-based research approach with a convergent mixed-methods design, one Grade 10 cohort (n = 42; two intact classes) used VLEPIC for one month as a complement to regular lessons. Data were collected through questionnaires on perceived usability and motivation, platform usage logs, and open-ended feedback from students and the teacher; results were analysed descriptively and thematically and then integrated to inform design decisions. Students reported high perceived usability and strong motivational responses in attention, relevance, and satisfaction, while confidence was more heterogeneous. Usage logs indicated recurrent but uneven engagement, with distinct low-, medium-, and high-activity profiles. Qualitative feedback highlighted enjoyment and clarity alongside issues with progress tracking between missions, navigation on mobile devices, and task submission reliability. The main contribution is a set of empirically grounded, context-sensitive design principles linking concrete interface and task-design decisions to perceived usability, motivation, and real-world usage patterns in constrained school settings. Full article

The study explores how consumer buying behavior is influenced by artificial intelligence (AI) personalization, with a specific focus on responsible and sustainability-aligned digital marketing. Using an explanatory sequential mixed-methods design, the study analyzes a quantitative survey and qualitative interviews. Results show that purchase behavior is strongly affected by exposure to AI messages—especially when recommendations are relevant, timely, and emotionally appealing—and by trust in AI, while perceived lack of trust inhibits purchasing. Qualitative findings underscore affective responses alongside ethical concerns, perceived transparency, and perceived control over data. Overall, the study shows that effective personalization depends not only on algorithmic sophistication but also on users’ sense of relevance and autonomy and on ethical data governance. The conclusions highlight sustainability-consistent implications for marketers: increase data transparency, segment customers by privacy sensitivity, and adopt accountable, consent-based personalization to build durable trust and loyalty. Future research should examine longitudinal effects and cultural differences, acknowledging limits of small purposive qualitative samples for generalization and exploring how consumer trust, ethical perceptions, and responses to AI personalization evolve over time. Full article

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article