Search Results (376)

Background: The CAPTRANE trial evaluated the efficacy of randomly assigned high-concentration capsaicin patch (HCCP) versus daily oral pregabalin (PGB) in adults with chronic neuropathic pain (DN4 ≥ 4) post-breast cancer surgery. The objective of its 4-month open-label extension following patient’s self-selection of their second treatment (HCCP, PGB, or none) was to explore efficacy and safety of various strategies. Methods: The study was conducted in France between March 2019 and November 2022. At each clinic visit, we assessed pain intensity (NRS, 0–10), painful area (cm²), mood (HADS), and quality of life (EQ-5D-5L). Standard statistical tests were used. Results: Data from 116 patients (all females; 76% aged < 65 years) were collected. At Month 2, 71% (46/65) of HCCP-treated patients received a second HCCP application and none switched to PGB, whereas 27% (14/51) continued on PGB and 49% (25/51) of PGB-treated patients switched to HCCP. At Month 6, NRS scores had decreased in HCCP-treated patients, including PGB/HCCP-treated patients, with a reduction of −2.0 [−4.0; 0.0] and −3.0 [−4.0; −2.0] in the HCCP/HCCP and PGB/HCCP group, respectively (median[interquartile]). Adverse events aligned with those expected with HCCP and PGB; none were serious. Conclusions: This first study to examine switching between PGB and HCCP treatments for chronic intercostobrachial neuropathic pain after breast cancer surgery showed patients’ preference for HCCP, confirmed the benefit of repeated HCCP applications, and indicated that HCCP could be preceded by PGB without compromising efficacy or safety. These findings suggest that HCCP may be used early in this population, and PGB initiated before HCCP to relieve patients waiting for HCCP application. Full article

Technical and Vocational Education and Training (TVET) is central to Cambodia’s skills-development agenda, but limited evidence explains how students form expectations about public TVET pathways. Grounded in Social Cognitive Career Theory (SCCT), this study examined the factors associated with students’ outcome expectations in public TVET institutions in Phnom Penh, Cambodia. A cross-sectional survey was conducted with 616 bachelor’s-degree students, measuring self-efficacy, perceived social support, perceived government and institutional support, and outcome expectations. Data were analyzed using hierarchical multiple regression and stratified subgroup regressions by sector-based major group. Outcome expectations were positively correlated with all three predictors. Controlling for age and gender, the full model explained 64.9% of the variance in outcome expectations, with perceived government and institutional support showing the strongest association, followed by self-efficacy and perceived social support. In the stratified analyses, self-efficacy and perceived government and institutional support were significant within every sector-based subgroup, whereas perceived social support was significant only in the Engineering/Industrial Technical subgroup. These findings provide associational support for SCCT in a Southeast Asian, lower-middle-income setting and indicate that institutional and government credibility may carry particular weight where a public TVET system is still being established. Full article

Background: Young adults face a convergence of academic, economic, and social pressures that elevates their risk for stress-related psychological disorders. Perceived stress encompasses two theoretically and empirically distinct components, perceived helplessness and perceived self-efficacy, but most research treats it as a single composite score, obscuring the differential mechanisms through which each dimension influences mental health. Aim: The study aimed to (i) quantify the direct effects of perceived helplessness and perceived self-efficacy on psychological distress, (ii) test insomnia and physical activity as concurrent mediators of each dimension’s indirect pathway to distress, and (iii) determine whether the two stress dimensions activate meaningfully distinct mechanisms. Methods: A cross-sectional study enrolled 1688 young adults aged 18–23 years (M = 18.76, SD = 1.01; 41.6% female) from higher education institutions in Tunisia. Participants completed Arabic-validated versions of the Perceived Stress Scale (PSS-10), Insomnia Severity Index (ISI), Depression Anxiety Stress Scales (DASS-21), and the International Physical Activity Questionnaire (IPAQ). Structural equation modeling (SEM) with unweighted least squares estimation and 5000 bootstrap resamples tested direct and indirect pathways. Results: Perceived helplessness exerted strong direct effects on psychological distress (beta = 0.25, p < 0.001) and substantial indirect effects through insomnia (beta = 0.21, p < 0.001) and physical activity (beta = 0.03, p < 0.001). Insomnia was the dominant mediator, showing the strongest bivariate association with distress (r = 0.58, p < 0.01). Perceived self-efficacy produced markedly weaker direct (beta = 0.06, p = 0.002) and indirect effects, a pattern that, like its other associations in the model, runs in the same positive direction as perceived helplessness rather than the inverse direction conventionally expected of a protective factor. Model fit was acceptable (CFI = 0.994, SRMR = 0.018, RMSEA = 0.076, the latter below the conventional 0.08 threshold). Conclusions: Stress management deficits are associated with psychological distress primarily through sleep disruption, consistent with a mediating role for insomnia in this cross-sectional sample. Physical activity provides a meaningful but secondary protective correlate. These findings offer a preliminary, hypothesis-generating basis for stratified, mechanism-based mental health interventions targeting sleep regulation and stress management in young adult populations, pending prospective confirmation. Full article

Artificial intelligence (AI)-driven fraud detection systems in FinTech ecosystems increasingly face a governance tension between high predictive accuracy and limited regulatory transparency, a gap that existing reviews have not addressed through an integrated behavioural, technical, and institutional lens. This study synthesises 99 Scopus-indexed, ABDC-ranked journal articles (2015–2026) using PRISMA 2020 and the SPAR-4-SLR protocol, integrating the Theory of Planned Behaviour (TPB) within an Antecedents–Decisions–Outcomes (ADO) framework to examine organisational adoption of explainable AI (XAI) in financial fraud detection. Three antecedent clusters are identified: attitudinal (algorithmic complexity, model opacity, data imbalance), normative (regulatory compliance, ethical expectations), and control-based (technical self-efficacy, organisational readiness)—which drive decision mechanisms including post hoc interpretability tools (SHapley Additive exPlanations [SHAP], Local Interpretable Model-Agnostic Explanations [LIME]), ethical governance protocols, and human-in-the-loop oversight. These produce outcomes across precision (reduced false positives, improved decision accuracy), compliance (audit transparency, institutional legitimacy), and cognitive (user acceptance, procedural justice) dimensions. The study introduces the Stability–Transparency–Reliability (STR) model, which advances TPB, Socio-Technical Systems Theory, and the Dynamic Capabilities View by reframing XAI from a static interpretability output into a recursive governance capability, formalised through the concept of Interpretative Agility, with direct implications for financial institutions operating under the EU AI Act. Full article

The present study aims to analyze the development of achievement motivation and self-efficacy belief in the context of elite sports schools. A total of 658 athletes (349 female, 309 male) from Year 5 onwards participated in the central trials and performance assessments in track and field for elite sports schools between 2016 and 2025. In addition to the analysis of physical and athletic performance, the following aspects were also documented: achievement motivation, need for achievement motives and general self-efficacy beliefs. Firstly, differences between the genders were measured in terms of fear of failure and confidence, exhibiting a small effect size ranging from 0.175 to 0.25 and a significance of 0.001 and 0.026. A subsequent analysis of the Kruskal–Wallis test, pertaining to the various groups with differing performance levels, revealed significant disparities in self-discipline (p = 0.010), goal setting (p = 0.013) and confidence (p = 0.029). The effect sizes for these differences ranged from 0.08 to 0.14, indicating a modest magnitude of impact. The psychological profile of the top athletes, which is based on the psychological determinants of the study, differs significantly from that of the other groups of athletes at time t₁ (p = 0.001). It is recommended that appropriate training and guidance from coaches and sports psychologists be provided, given that confidence and self-efficacy expectations are key predictors of physical and athletic performance. Full article

Robotics is a useful tool for learning programming, a key skill in STEM education. However, robotics is often perceived as a masculine activity for boys. This study investigated the impact of a robotics intervention on adolescents’ interest, self-efficacy, and expectations in STEM, with a focus on gender differences. Using a between-subjects randomized controlled design, 109 adolescents aged 11 to 16 years (40 boys, 69 girls) were randomly assigned to an intervention or a control condition. In the intervention condition, they participated in a robotics activity involving programming, while in the control condition, they engaged in a storytelling activity. Participants completed a questionnaire following the activity, with the entire procedure lasting approximately 45 min. Separate multivariate analyses of covariance were conducted for interest, self-efficacy, and expectations, with age included as a covariate. The robotics intervention was associated with higher interest in robotics and programming for boys and was associated with higher expectations of mathematics use for both boys and girls. No significant differences were observed for girls’ interest between conditions. Additionally, boys demonstrated higher self-efficacy in robotics and programming than girls. These findings have implications for designing gender-inclusive STEM interventions and addressing gender stereotypes in STEM education. Adolescence is a critical stage for shaping career interests, and interventions may support STEM motivation and diverse career expectations. Full article

Academic motivation and achievement are central to student success in applied STEM, engineering, and technical and vocational education and training (TVET); however, despite extensive research, the evidence remains fragmented across theoretical traditions, educational levels, and disciplinary settings. This structured narrative review synthesizes research on the factors shaping academic motivation, achievement, and career readiness in these contexts. A literature search was conducted in Web of Science, Scopus, ScienceDirect, PubMed, and PsycINFO for studies published between 2010 and 2025. A total of 58 studies met the inclusion criteria from an initial pool of 2184 records. Guided by self-determination theory, achievement goal theory, social cognitive career theory, and expectancy–value theory, this review identifies self-efficacy, perceived competence, task value, intrinsic/extrinsic motivation, goal orientation, metacognitive skills, teacher and peer support, curriculum relevance, and industry-aligned learning opportunities as key factors associated with student engagement, achievement, and career-related development. The synthesis shows that these factors operate through an integrated motivational core linking motivational regulation, self-belief, task value, and goal orientation. The findings suggest that student success is shaped by the interaction between individual beliefs, social support, instructional conditions, and perceived links between learning and future professional pathways. Practical implications are discussed for designing student-centered, career-relevant, and motivation-supportive learning environments in engineering and TVET. Full article

Career adaptability has been linked to academic achievement, yet the mechanisms underlying this association remain insufficiently understood, particularly among adolescents in highly competitive, exam-oriented educational systems. Based on Career Construction Theory (CCT) and the performance model of Social Cognitive Career Theory (SCCT), this study tested whether academic self-efficacy, academic outcome expectations, and metacognitive strategies mediated this association. A three-wave longitudinal study was conducted with 519 students from two general high schools in central China (40.85% boys; mean age = 16.28 years, SD = 0.82). Career adaptability was measured at Time 1, the three mediators were measured at Time 2, and academic achievement was measured at Time 1 and Time 3 using standardized examination scores in Chinese, mathematics, and English. After controlling for baseline achievement and demographic covariates, structural equation modeling with bias-corrected bootstrapping showed that T1 career adaptability had a significant total effect on T3 academic achievement, whereas the direct effect was nonsignificant after the mediators were included. Significant indirect effects were found through academic self-efficacy and metacognitive strategies. Academic outcome expectations did not significantly mediate the association, and the pathway from academic self-efficacy to academic outcome expectations was not supported. These findings indicate that career adaptability may contribute to later academic achievement mainly through students’ academic self-efficacy and metacognitive strategy use. Full article

Digital-intelligence transformation in education has made pre-service teachers’ Technological Pedagogical Content Knowledge (TPACK) a strategic concern in teacher preparation. Survey data from 11,818 pre-service teachers across 17 local normal universities in China were analyzed through hierarchical regression, quantile regression, and structural equation modeling to examine how perceived university ICT support and perceived AI support in education are associated with self-reported TPACK. Both forms of support showed significant direct and model-conform indirect associations with self-reported TPACK, but the quantile coefficients varied across the TPACK distribution: university ICT support showed a modestly fluctuating descriptive pattern, whereas AI support in education peaked at the median and attenuated at upper quantiles. ICT self-efficacy and AI competency expectancy each formed significant indirect pathways in the hypothesized model, although the ICT pathway was more strongly indirect and the AI pathway remained more strongly direct. Additional checks of university-level ICCs, cluster-robust standard errors, and measurement invariance across key subgroups supported the robustness and comparability of the findings. These patterns clarify how perceived ICT and AI support are differentially associated with self-reported TPACK and provide empirical grounds for more precise, human-in-the-loop support designs in teacher education. Full article

While higher education institutions strive for academic excellence, they also bear the responsibility of caring for and ensuring the sustainable well-being of their students. After the COVID-19 pandemic, these institutions have transitioned to hybrid and digital education models and have begun to experience the opportunities and threats of digital learning ecosystems. With the introduction of AI technology, this transformation has taken on a new dimension: while students benefit from the flexibility, instant feedback, and personalized learning offered by AI tools, they have also begun to experience new challenges, including cognitive overload, digital fatigue, and social isolation. In this context, the aim of this research is to assess students’ overall psychological well-being and to provide a support system that promotes sustainable well-being by anticipating potential psychological strain and recommending necessary precautions. Accordingly, the purpose of this study, drawing on Self-Determination Theory and Conservation of Resources Theory, is to examine the direct effects of an AI-enabled student support system on sustainable well-being and academic engagement, as well as its indirect effects through self-efficacy and academic resilience. Data will be collected from undergraduate students from a public university in Istanbul. Data will be analyzed in the R statistical environment. We expect that academic resilience, and self-efficacy will mediate the relationship between an AI-enabled student support system and sustainable well-being. At the end of the study, we propose a conceptual model that can be tested empirically by further research. Managerial and further research directions, as well as limitations, are also discussed. Full article

The emergence of artificial intelligence (AI) tools, particularly generative models, in the last five years has fundamentally transformed the framework and methodologies of learning in higher education. Students are integrating AI for producing new ideas, assisted and personalized search, academic writing, advanced data analysis, and personalized learning. For this reason, an update of the theoretical and conceptual framework regarding the adoption of technologies in the educational environment is required. Based on traditional Technology Acceptance Model/Unified Theory of Acceptance and Use of Technology (TAM/UTAUT) models, we propose a new Partial Least Squares Structural Equation Modeling (PLS-SEM) model developed for the context of AI in higher education. The novelty of the model lies in the integration of the mediating relationship through trust (trust in AI outputs, TAIO) between perceived academic integrity risk (PAIR) and behavioral intention to use (BI), while anchoring perceived learning utility (PUL) and perceived effort expectancy (PEE) in AI literacy-specific self-efficacy (AILSE). The model is tested using a sample of 339 higher education students from economics and computer science specializations and validated using the R environment and the SEMinR package as specific software tools. Our proposed research hypotheses consider six reflective latent constructs and a mediating relationship, which we analyze using validated PLS-SEM techniques. All items included in the model constructs are formulated for use in university educational contexts and are adapted to specific AI tools for learning in the university environment. Full article

This study analyzes the relationships among spiritual leadership, emotion regulation self-efficacy, and service performance in the hotel industry where emotional labor is emphasized. Data were collected through an online survey of hotel employees at three-star or higher-grade hotels in Korea. A total of 347 valid samples were analyzed using confirmatory factor analysis and structural equation modeling. Four hypotheses were established. First, spiritual leadership was expected to positively relate to emotion regulation self-efficacy. Second, emotion regulation self-efficacy would be positively related to service performance. Third, spiritual leadership was hypothesized to have a positive relationship with service performance. Fourth, emotion regulation self-efficacy was expected to mediate a positive relationship between spiritual leadership and service performance. The results of the analysis supported all four hypotheses. The findings indicate that spiritual leadership enhances employees’ emotion regulation self-efficacy, improving emotion regulation and, in turn, service performance. Therefore, hotel organizations should consider improving service performance and competitiveness by developing leadership strategies and educational programs that strengthen employees’ emotion regulation capabilities. Full article

Digital participation depends not only on the formal availability of online engagement channels but also on how citizens interpret the safety, usefulness, and feasibility of participation. This article examines whether willingness to engage digitally is shaped more strongly by procedural platform cues or by underlying behavioral beliefs about security, efficacy, and personal capability. Using a survey of 500 adults in South Korea and a 2 × 2 survey-embedded vignette experiment, the study varies participation threshold (50 vs. 500 supporters) and response specificity (generic response vs. concrete action plan and timeline). The direct experimental effects are small and statistically non-significant, indicating no detectable moderate shift in stated willingness within this vignette design. In contrast, baseline participation intention, perceived outcome efficacy, and digital ability are consistently associated with scenario-based willingness to participate, while security trust is positively associated with baseline readiness to engage. The findings suggest that digital participation is better understood as a behavioral decision shaped by perceived risk, expected consequences, and self-assessed capability than as a simple response to procedural design alone. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article

Teacher coaching is a widely used approach to support teacher professional development, yet the relational and psychological factors that influence coaching outcomes remain underexplored. Guided by the Expectancy-Value Theory and prior literature, this study examined the role of coaching relationships, teacher self-efficacy, and teachers’ motivation for coaching in the coaching process, with two key outcomes: teachers’ acceptability of coaching and perceived stress. A sample of 308 K-12 teachers from the United States completed relevant measures. Structural equation modeling revealed that high-quality coaching relationships were significantly associated with greater acceptability, self-efficacy, and motivation, particularly increased perceived benefits and reduced reservations. Coaching relationships and coaching acceptability were indirectly associated via self-efficacy and perceived benefits. The indirect association between coaching relationships and stress was fully explained through self-efficacy. These findings underscore the importance of fostering strong relationships with teachers and addressing motivational components to enhance the effectiveness of coaching interventions. Full article