Search Results (14,318)

Background/Objectives: Population aging in Europe presents significant healthcare, economic, and social challenges, particularly in the care of individuals with chronic diseases and frailty. Advance Care Planning (ACP) fosters patient autonomy and aligns end-of-life care with individual preferences. This study aimed to evaluate the acceptability and feasibility of an ACP model in nursing homes. Secondary objectives included exploring clinical characteristics of participants and assessing how frailty is associated with residents’ care goals and preferences. Methods: A prospective observational study was conducted among long-term residents of a Spanish nursing home in 2023. ACP was offered to all new permanent residents, with outcomes assessed through quarterly follow-ups. Acceptance rates, care preferences, and resident satisfaction were primary measures. Clinical data, frailty, functional status, cognitive assessments, and nutritional status were analyzed. The model of ACP is structured into three progressive levels: (1) identification of patients’ values, preferences, and global goals of care; (2) decision-making regarding specific clinical interventions in acute situations; and (3) end-of-life care preferences, including preferred place of death, desired companionship, and comfort-focused measures. Results: From 79 new residents admitted, 93.7% accepted ACP. The process required an average of 139 min to complete, distributed over 3–4 sessions. The main documented preferences included do-not-resuscitate orders (CPR) (79%), hospital transfer decisions (50%), and other individualized care choices. When stratified by frailty level, which was categorized as low, moderate, or high—we observed a clear gradient in care preferences. CPR preference increased from 59.3% (Low) to 87.5% (Moderate) and 95.2% (High). Preference to avoid hospital transfer rose from 22.2% to 50.0% and 85.7%, respectively. Avoidance of instrumentalization increased from 56.2% to 85.0% and 95.0%. Conclusions: ACP in nursing homes is highly acceptable and feasible, with benefits in aligning care with patient preferences and enhancing satisfaction. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

The Agricultural Park Integrated Energy System (APIES) is a key platform for integrating distributed renewable energy (DRE) with agricultural production. However, its economic operation and the stability of crop growth environments are severely challenged by bidirectional uncertainties from external meteorology. These include the inherent variability of wind-solar generation and critical agricultural loads, such as supplementary lighting and temperature control, a challenge that existing models with static environmental parameters fail to address. To solve this, a bi-level optimization scheduling model for APIES considering meteorological uncertainty is proposed. The upper layer minimizes operation costs by quantifying uncertainties via triangular fuzzy chance constraints, with core constraints on DRE output, energy storage charging-discharging, and load shifting, solved by YALMIP-Gurobi linear programming. The lower layer maximizes crop growth environment satisfaction using a dynamic weight adaptive mechanism and NSGA-II multi-objective algorithm. The two layers iterate alternately for coordination. Using a small agricultural park in Xinjiang, China, as a case study, the results indicate that the proposed two-layer optimal scheduling model reduces costs by 10.8% compared to the traditional single-layer optimization model, and improves environmental satisfaction by 4.3% compared to the fixed-weight two-layer optimization model. Full article

The COVID-19 pandemic introduced significant shifts in educational delivery, leading to widespread adoption of hybrid and remote instructional modalities. This study investigates the relationship between these modalities and teacher job satisfaction during the 2020–2022 academic year in the U.S., while also examining how teacher, classroom, and school characteristics predict satisfaction within each modality. Using data from the 2020–2022 National Teacher and Principal Survey (NTPS) on 31,160 full-time public school teachers, linear regression analyses were employed to assess the relationship between instructional modalities and a composite measure of teacher satisfaction, controlling for various teacher, classroom, and school characteristics. The analysis revealed that hybrid teaching was significantly associated with lower teacher satisfaction compared to in-person teaching; however, remote teaching’s initial association with lower satisfaction became non-significant after accounting for school-level factors. Specific teacher characteristics (e.g., female, experienced, younger, holding an advanced degree) and school characteristics (e.g., school level, size, student characteristics) exhibited varying associations with satisfaction across modalities. These findings suggest that hybrid teaching posed unique challenges during the pandemic and highlight the importance of understanding modality-specific risk factors to inform targeted support for teachers in future crises. Full article

Background: Gamification is an innovative pedagogical strategy for improving learning outcomes, motivation, engagement, and knowledge retention. Nevertheless, evidence on the effectiveness of gamification remains heterogeneous. Methods: A systematic review was conducted. Searches were performed across PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Google Scholar, and grey literature (2015–2025). Eligible studies included quantitative, qualitative, and mixed-methods research involving undergraduate nursing students exposed to gamification interventions. Data extraction and quality assessment were independently performed using RoB-2, ROBINS-I, and JBI tools. Narrative synthesis was adopted due to the heterogeneity of interventions and outcome measures. Results: A total of 48 studies were included. Gamification strategies varied widely and included interactive quizzes, gamified flipped classroom models, serious games with explicit game elements, escape rooms, digital badges, and audience-response systems. For learning outcomes, most studies reported improvements in knowledge or performance, particularly when gamification included immediate feedback and repeated practice. While the knowledge retention was evaluated less frequently (12%), it was generally maintained or improved up to 2–4 weeks and across semester assessments. Strong positive trends of motivation and engagement were found across most studies, especially with competitive quizzes, missions, and narrative-based activities. Self-efficacy and satisfaction frequently improved, particularly in gamified simulations and team-based activities. Risk of bias was variable, with many quasi-experimental and descriptive studies limiting causal inference. Evidence certainty ranged from low to moderate according to GRADE criteria. Conclusions: Gamification is a promising educational approach in undergraduate nursing programs. Effects on long-term retention and practical skills remain less clear due to methodological variability and limited follow-up data. Future research focused on standardized outcome measures and longer follow-up intervals is required to consolidate evidence and guide educational policy. Protocol registered on PROSPERO (CRD420251117719). Full article

Objective: This study aimed to assess the psychosocial impact of stainless steel crowns (SSCs) among primary school children in Dammam, Saudi Arabia, focusing on bullying experiences, child satisfaction, and parental perception. Methods: A cross-sectional survey was conducted in June 2025 among 123 children (mean age 7.8 years; 52% male) from two randomly selected schools. Schools were chosen using simple random sampling from a Ministry of Education-approved list. All children aged 6–10 years with at least one SSC placed for six months or more were eligible. A validated, self-administered questionnaire completed by children and their parents assessed bullying related to SSCs, satisfaction with the crown’s appearance, and perceived impact. Statistical analyses included descriptive statistics, Chi-square tests, and logistic regression to evaluate associations between variables (p < 0.05). Results: Bullying was reported by 39.0% of children, primarily verbal (58.1%), followed by social exclusion (29.1%). Although gender differences in bullying were not statistically significant (p = 0.829), boys more often reported nickname-based teasing (p < 0.001). Only 35.0% of children were satisfied with the crown’s shape and 29.3% with its color. Nearly half (48.8%) felt uncomfortable when asked about it. In contrast, parental satisfaction was higher (69.1%), though only 42.3% believed their child had fully accepted the crown. Conclusions: While SSCs are clinically effective and accepted by most parents, a notable proportion of children experience bullying and aesthetic dissatisfaction. These findings highlight the need for child-centered care and consideration of esthetic alternatives. Full article

Stroke is a leading cause of disability, often resulting in motor, cognitive, and language deficits, with significant impact on upper-limb function. Robotic therapy (RT) has emerged as an effective strategy, providing intensive, repetitive, and adaptable practice to optimize functional recovery. This pilot study aimed to describe and evaluate the effects of robotic rehabilitation as a complement to conventional therapy, using a biomimetic activities-of-daily-living (ADL)-based protocol, on upper-limb function in post-stroke patients. Three participants (aged 30–80 years) undergoing occupational and/or physiotherapy received individualized robotic training with a lightweight cable-driven upper-limb exoskeleton, m-FLEX™, twice a week for ten weeks (30 min per session). Movements were designed to mimic natural upper-limb actions, including elbow flexion-extension, forearm pronation-supination, tripod pinch, and functional tasks such as grasping a cup. Assessments included the Fugl-Meyer (FM) scale, the Functional Independence Measure (FIM), and device satisfaction, performed at baseline, mid-intervention, and post-intervention. Descriptive analysis of the tabulated data revealed improvements in range of motion and functional outcomes. These findings suggest that biomimetic protocol of robotic rehabilitation, when combined with conventional therapy, can enhance motor and functional recovery in post-stroke patients. Full article

Country parks are an important instrument for implementing China’s strategies on ecological civilization and integrated urban–rural development. This study conducted field surveys in seven country parks of Shanghai. Meanwhile, stakeholder seminars were organized with local residents and park authorities. To assess visitor satisfaction, a questionnaire survey was administered both on-site and online. Through case analysis and a policy review, this study systematically identifies key challenges in leveraging country parks for rural revitalization. The findings indicate that visitors highly value the ecological qualities of the parks, and basic infrastructure like roads and resting facilities generally meets expectations. However, shuttle services and smart guiding systems remain notable shortcomings that hinder the overall visitor experience. Moreover, gaps in service quality, local cultural representation, and the depth of nature education constitute the primary weaknesses affecting visitor satisfaction. Regarding rural revitalization, this study identifies four main limitations in the contribution of country parks: (1) Inadequate functional positioning and weak integration with surrounding resources; (2) Low land use efficiency and an unbalanced provision of supporting facilities; (3) Homogenized industrial formats with limited innovation and integration capacity; and (4) Restricted participation of local farmers and underdeveloped multi-stakeholder governance mechanisms. To address these issues, this study proposes four strategic recommendations: (1) Develop distinctive local brands and strengthen synergies with surrounding resources; (2) Promote mixed land use and enhance supporting service facilities; (3) Foster diversified business formats and facilitate the value realization of ecological products; and (4) Expand income-generation channels for farmers and improve multi-stakeholder governance frameworks. The research demonstrates that optimizing the functions of country parks can improve ecological and recreational services and help establish an integrated “ecology–industry–community” framework through industrial chain extension and community participation, thereby supporting rural revitalization. Full article

Digital well-being refers to the subjective balance between the benefits and drawbacks of technological connectivity. Although it is a relatively recent construct, research has shown that it can be measured reliably. The Digital Well-Being Scale, comprising three dimensions—Digital Satisfaction, Digital Wellness, and Safe and Responsible Behavior—has been validated in other countries, but not yet in Argentina. This study aimed to adapt and validate the scale in the Argentine context and to examine its associations with Fear of Missing Out (FoMO) and identity bubbles, two variables previously linked to digital experiences. A total of 895 participants (55.2% women; aged 18–65) completed an online survey including the Digital Well-Being Scale, the FoMO Scale, and the Identity Bubble Reinforcement Scale (IBRS-9). Exploratory and confirmatory factor analyses supported the original three-factor structure, and all dimensions showed an adequate internal consistency. A significant negative correlation was found between FoMO and the Digital Wellness dimension, suggesting that individuals with higher FoMO experience lower emotional balance in their digital lives. In contrast, associations between identity bubble dimensions and digital well-being were modest and selective. Only Digital Satisfaction and Digital Wellness were weakly related to social identification and homophily; no relationship was observed with safe digital behavior. These findings support the adapted scale’s psychometric soundness in the Argentine context and provide initial insights into how FoMO and digital identity processes may influence digital well-being. Further research is needed to explore these relationships in more diverse populations and cultural contexts. Full article

There is a global documented rise in depressive symptoms among adolescents. The cross-sectional assessments in representative samples of adolescents would help explore their correlates, which may serve as resources for intervention. Our cross-sectional survey entitled “Békés County Youth Study 2024” involved a representative sample of grade-9 high school students (N = 1590, aged 15–17 years, 56.4% females) from public high schools in the region, Hungary. Besides depressive symptoms (measured by a validated, shortened version of the Children’s Depression Inventory, CDI), a set of psychosocial variables (psychosomatic symptoms, internet addiction, future orientation, social support from family and friends, marks, gender, school satisfaction, and religiosity) was included in the survey. Gender differences in the summary score for CDI were significant: t(1588) = −12.062, p < 0.001, showing a higher rate of females. A total of 22.6% (males: 13% and females: 30%) belonged to the group at risk of depression. All potential predictors proved significant, with the strongest contribution of psychosomatic symptoms (Beta = 0.306, p < 0.001), and the most relevant protective role of family support (Beta = −0.265, p < 0.001). Other than further exploring contextual factors that increase risk for and protect against adolescent depression, mental health promotion in schools should include well-being training. Full article

The accelerated expansion of telework, driven by the COVID-19 pandemic, has transformed global work dynamics. Despite this, limited research exists on the implications of Indoor Environmental Quality (IEQ) on home workspaces. Factors like thermal comfort, lighting, air quality, and noise significantly influence the well-being, productivity, and health of teleworkers. Home spaces are often not designed to meet the environmental quality standards of traditional offices, altering indoor conditions. This scoping review investigates the IEQ–telework relationship, analyzing 41 studies from 18 countries. Findings show that elevated noise levels and insufficient lighting increase stress and fatigue, while inadequate air quality reduces cognitive performance and creativity. Conversely, access to natural light, pleasant views, and thermal comfort improves overall satisfaction and productivity. The study identifies a fragmented and poorly connected research network, with few active global groups studying IEQ in home workspaces. These results underscore the need for interdisciplinary research to address the societal and environmental challenges of teleworking and develop equitable, healthy remote environments. Future studies must consider cultural diversity and underrepresented regions to bridge existing knowledge gaps. Full article

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Flight delay serves as a pivotal metric for assessing service quality in the aviation industry. Accurately estimating flight delay duration is increasingly acknowledged as a cornerstone of aviation management, with significant implications for operational efficiency, passenger satisfaction, and economic outcomes. Most existing approaches often focus on single airports or airlines and overlook the complex interdependencies within the broader aviation network, limiting their applicability for system-wide planning. To address this gap, this study proposes a novel integrated framework that combines deep learning and complex network theory to predict flight arrival delay duration from a multi-airport and multi-airline perspective. Leveraging Bayesian optimization, we fine tune hyperparameters in the XGBoost algorithm to extract critical aviation network features at both node (airports) and edge (flight routes) levels. These features, which capture structural properties such as airport congestion and route criticality, are then used as inputs for a deep kernel extreme learning machine to estimate delay duration. Numerical experiment using a high-dimensional flight dataset from the U.S. Bureau of Transportation Statistics reveals that the proposed framework achieves superior accuracy, with an average delay error of 3.36 min and a 7.8% improvement over established benchmark methods. This approach fills gaps in network-level delay prediction, and the findings of this research could provide valuable insights for the aviation administration, aiding in making informed decisions on proactive measures that contribute to the sustainable development of the aviation industry. Full article

In supply chain management practices, supplier selection (SS) is a critical strategic planning activity that usually constitutes an ex ante decision made under uncertainty, whereas order allocation (OA) represents a subsequent operational decision determined ex post, contingent upon both the selected suppliers and actual operational conditions observed during the execution phase—specifically, the realized scenarios of uncertain circumstances. The practical performance of an SS decision inherently depends on its subsequent OA outcomes, while the OA decision itself is constrained by the preceding SS choices. Nevertheless, existing studies typically tackle the SS and OA problems separately or formulate them within a single-stage programming model, failing to adequately capture their sequential interdependence and the impact of OA on SS evaluation. To address this gap, this study develops novel two-stage bi-objective stochastic programming models in which the first-stage SS decisions are evaluated based on two key criteria—total cost and purchasing value—both of which depend on the second-stage OA decisions in response to realized operational scenarios. The stochastic performance of a given SS scheme, arising from adaptive OA decisions under uncertainty, is measured by expected value and conditional value-at-risk. An integrated approach combining weighted-satisfaction sum, linearization, Monte Carlo simulation, and genetic algorithm is developed to solve the models. Computational experiments demonstrate the effectiveness of the proposed methodology and reveal the influence of objective preferences and risk-aversion levels on the optimal supplier selection. Full article

Against the backdrop of economic recovery and ongoing market restructuring, China’s hotel industry is undergoing a significant shift from being service-based to becoming strategy-driven and competitive. This study aims to identify the key factors driving hotel competitiveness utilizing a multidimensional quantitative perspective. Based on a structured questionnaire survey administered to hotel managers across provinces and cities in China, primary data was collected from a total of 727 valid responses. As such, exploratory factor analysis, comprising 31 ranked items, and multiple regression analysis were performed using SPSS, identifying four dimensions that significantly affect hotel competitiveness: namely, operational characteristics, service quality, customer satisfaction, and competitive performance. The results show that operational characteristics are the primary determinants of hotel competitiveness. Specifically, sustainable development strategy, digital technology adoption, product and service innovation, and pricing strategies were the most significant factors leading to competitive advantage. Unlike previous studies that emphasized service quality and customer satisfaction as the dominant drivers of competitiveness, this study finds that a hotel’s competitive advantage relies heavily on developing strategic operational innovation and resource allocation capabilities. This study’s novelty lies in its use of national empirical data to validate the multidimensional composition and inherent logical relationships for competitive advantage. It also proposes a multidimensional framework for analyzing hotel competitiveness, specifically designed for the developmental characteristics of China’s hotel industry, highlighting the need to transform from a service-oriented to a strategy-driven operational approach. The findings of this paper offer empirical evidence for hotel enterprises to refine management structures, foster innovation, and thereby develop strong capabilities for a sustainable competitive advantage. Full article