Search Results (3,361)

A system of initial teacher education must incorporate instruments capable of capturing the complexity of professional learning. In this context, national diagnostic assessments have become central mechanisms for monitoring outcomes in initial teacher education. This study examines student performance in Initial Teacher Education in Physical Education (ITEPE) programs using the themes assessed by the National Diagnostic Assessment (NDA) 2024, comparing achievement levels and analyzing differences according to the type of higher education institution in Chile. A quantitative, cross-sectional, and comparative design was employed, using official data from 1102 students enrolled in all Chilean universities offering the program. Descriptive and nonparametric inferential analyses were conducted to examine differences by sex and type of institution. The results show relatively homogeneous performance across standards, with higher percentages of achievement in dimensions related to didactic organization and assessment, and lower results in the standard associated with understanding student characteristics. Although statistically significant differences were identified according to administrative dependency, the effect sizes were small. Consequently, the NDA is positioned as a formative input to guide contextualized curricular improvements rather than as a mechanism for institutional ranking. Full article

Background/Objectives: Critical limits define quantitative thresholds for life-threatening diagnostic test results that require immediate clinician notification and may prompt urgent intervention to prevent adverse outcomes. This study aims to (1) characterize point-of-care (POC) critical limits for adults and newborns using a comprehensive U.S. national database, (2) identify POC instruments associated with these limits, and (3) support harmonization of point-of-care testing (POCT) practices. Methods: We gathered critical limit notification lists from 417 hospitals across all 50 states and Washington D.C., comprising university hospitals, trauma and heart centers, centers of excellence, community hospitals, and network hospitals. We extracted POC and central laboratory critical limits (at hospitals with POC), adult international normalized ratio (INR) data, and instrument usage. Results: Low and high glucose critical limits were the most frequently listed POC thresholds, with median values of 50 and 450 mg/dL, respectively, reported by 73 hospitals (17.5%). Troponin was listed by ten hospitals, specified as troponin (n = 4), troponin I (n = 5), or “troponin TnI” (n = 1). A few hospitals assigned instrument-specific critical limits for the same analyte, and 55 hospitals did not specify instrument usage for any measurand. Median differences in matched pairs of laboratory versus POC critical limits differed significantly (Wilcoxon signed-rank, p < 0.05) for low and high ionized calcium (n = 21), low hemoglobin (n = 23) and high INR critical limits for adults (n = 27) and newborns (n = 10). In some cases, matched pair analytes demonstrated identical critical limits. Conclusions: Harmonizing critical limit notification thresholds across point-of-care testing and different devices may improve consistency in clinical decision-making and patient outcomes. Despite the potential of POCT to shorten time to urgent intervention, relatively few hospitals currently include POCT critical limits on notification lists. Establishing standards, annual updating, and enforcing risk mitigation could enhance adoption and reliability. Broader inclusion and transparent sharing of POCT critical values could harmonize practices across institutions, facilitate inter-institutional collaboration, and promote more timely and reliable responses to life-threatening diagnostic results. Full article

Background: Physical literacy is a multidimensional construct encompassing physical competence, confidence, motivation, knowledge, and lifelong engagement in physical activity. The Perceived Physical Literacy Instrument (PPLI) has been widely used internationally; however, previous adolescent validations have been based on a reduced 9-item version originally developed for teachers. This study aims to evaluate the validity and test–retest reliability of a Spanish adaptation of the original 18-item PPLI in Spanish adolescents aged 11–18 years. Methods: A multi-phase validation study was conducted with 869 Spanish adolescents (421 females). The procedure included: (1) translation and cultural adaptation, (2) Exploratory Factor Analysis (EFA; n = 290), Confirmatory Factor Analysis (CFA; n = 579) and invariance analyses, and (3) test–retest reliability assessment. Results: EFA supported a three-factor solution comprising 15 items. CFA showed standardized factor loadings ranging from 0.62 to 0.89, indicating that the latent constructs were adequately represented. Although the 15-item model showed acceptable fit, a 5-item unidimensional short form was developed due to limitations in the three-dimensional models. This short form demonstrated good model fit (scaled RMSEA = 0.073; scaled CFI = 0.992; SRMR = 0.026), adequate convergent validity (AVE = 0.558), high reliability (ω = 0.821), moderate test–retest stability (ICC = 0.69), and full configural, metric, and scalar longitudinal invariance. Conclusions: The 15-, 9-, and 5-item versions of the PPLI are valid and reliable options. The 15-item version allows comprehensive assessment and domain-level interpretation. The 9-item version facilitates comparability with previous international research. The 5-item version may be useful in contexts with time constraints but may not be the preferred choice for comprehensive assessment of physical literacy in clinical or detailed pedagogical diagnostic settings. Full article

This study examines whether economic diplomacy—proxied by KOF-based indicators of political globalisation and economic policy openness—is associated with multidimensional sustainable development (SD) across 208 countries over the period 2000–2023. Using two-way fixed-effects panel models with Driscoll–Kraay standard errors, complemented by instrumental-variable and dynamic panel checks, we find a positive but modest within-country association between diplomatic embeddedness and Sustainable Development Goal (SDG) performance. The association is driven primarily by political globalisation—reflecting diplomatic networks, international organisation membership, and treaty engagement—rather than trade policy openness. De facto integration exhibits stronger links to SDG outcomes than de jure policy indicators. The relationship is concave, with diminishing marginal returns beyond a diplomacy proxy value of approximately 60. A latent-class framework identifies two institutional archetypes: the association is more pronounced and robust under stronger governance (71 countries), while it attenuates under weaker governance (85 countries). Goal-level estimates reveal systematic trade-offs—gains in inequality reduction (SDG 10) and innovation (SDG 9) alongside adverse associations with climate outcomes (SDG 13)—and a structural breakpoint around 2017 consistent with the onset of slowbalisation. The results suggest that diplomacy can support SD, but its payoff depends on governance capacity and the management of cross-goal externalities. Full article

Background/Objectives: The Parenting Sense of Competence (PSOC) scale is one of the most widely used instruments to assess perceived parental competence, understood as the degree to which parents feel capable of adequately fulfilling their parental role. Despite its widespread use, studies seeking to determine PSOC normative scores are scarce, especially in specific populations such as mothers with infants younger than 9 months, which limits the interpretation of its scores in applied contexts. This study establishes PSOC normative scores in a nonclinical sample of 522 Spanish mothers with infants aged between 3 and 37 weeks who attended a public early intervention program. Methods: Regression and ANOVA analyses were performed to examine the effect of infant and maternal age, as well as educational level and occupation, on the dimensions of Efficacy, Satisfaction, and Total score of the PSOC. Results: The results show a significant decline in parental competence starting when their infants reach 9 months of age, and lower levels of self-efficacy in mothers over 35 years of age. No significant differences were found according to the educational level or occupation of the mothers. Normative scores are presented by percentiles, offering specific criteria for this stage of child development. Z- and T-scores are included, useful for standardized comparisons between subscale and studies. Conclusions: These findings provide useful information for early detection and psychoeducational interventions within the framework of early intervention. Full article

Patients with head and neck cancer (HNC) face a high risk of malnutrition and sarcopenia, often exacerbated by the toxicities of chemoradiotherapy, such as dysphagia, xerostomia, and mucositis. These Nutritional Impact Symptoms significantly compromise oral intake and negatively affect quality of life. This paper presents a conceptual framework designed to support clinicians in optimizing oral intake through personalized nutritional management. Central to this approach is the integration of systematic screening using MUST, the Malnutrition Universal Screening Tool (MUST), and the Nutritional Risk Screening 2002 (NRS-2002). Furthermore, functional assessment of swallowing via instrumental studies (VFSS/FEES) is essential for tailoring dietary textures according to the International Dysphagia Diet Standardization Initiative framework. Key nutritional strategies include high-energy and high-protein oral fortification, the use of oral nutritional supplements, and specific dietary adjustments addressing pain management and sensory alterations. A multidisciplinary approach involving nutritionists, speech-language pathologists, and oncologists is paramount to transition from reactive symptom management to proactive “adaptive nutrition,” ultimately improving clinical outcomes and patient survival. Full article

This study reconstructs annual streamflow variability in the Yenice Stream Basin (northwestern Türkiye) for the period 1809–2020 using tree-ring data, substantially extending the short instrumental record (1979–2020). Three moisture-sensitive conifer chronologies were integrated using principal component analysis (PCA), and the first two principal components were employed as predictors in a multiple linear regression model calibrated against observed streamflow. The model explains a significant proportion of interannual variability (R² = 0.39; adjusted R² = 0.36; p < 0.001). Temporal stability was assessed using a 30-year moving-window correlation analysis, which reveals consistently positive and statistically significant relationships across all subperiods, indicating a stable and persistent calibration relationship through time. Years exceeding ±1 standard deviation account for approximately 24% of the record, while extreme events (±2 standard deviations) represent about 5%. The reconstruction identified several extreme events, including severe drought years (e.g., 1840, 1887, and 1907) and extremely wet years (e.g., 1896 and 1936). Among these, 1887 stands out as one of the most severe drought years, while the period 1927–1928 represents a persistent low-flow episode. The reconstruction provides a long-term perspective on streamflow variability and contributes baseline information for regional water resource planning and hydroclimatic risk assessment. Full article

Background/Objectives: Autonomy and the ability to live independently are priority goals for older adults and are closely linked to healthy aging and quality of life (QoL). However, nutrition, although a crucial and modifiable determinant, remains undervalued. Cardiovascular diseases are highly prevalent in middle-aged and older adults and increase the risk of functional impairment, burdening the economy and limiting the patient’s autonomy. This study aimed to analyse the quality of life in older adults and its relationship with functional impairment and nutritional status. Methods: This was a cross-sectional study that included 359 patients with a mean age of 71.52 years who were admitted to the National Institute of Gerontology and Geriatrics “Ana Aslan”, between January 2024 and April 2025. Data were collected through interviews, medical records, and standardized instruments, including the Up and Go Test, Tinetti Test, Downton Fall Risk Index, and handgrip strength assessment. Quality of life was assessed using the EQ-5D-5L and the visual analog scale (VAS). Results: Nutritional status assessed using MNA showed significant moderate-to-strong correlations with EQ-5D-5L mobility (r = −0.326, p = 0.007 in the ≥80 years’ group), anxiety/depression (r = −0.544, p < 0.001 in the ≥80 years’ group), self-care (r = −0.271 to −0.311, p < 0.05 in patients over 65), and usual activities (r = −0.294, p = 0.016 in the ≥80 years’ group). In contrast, BMI showed moderate positive correlations with EQ-5D-5L pain/discomfort across all age groups (r = 0.365 to 0.524, p < 0.002). Functional assessment revealed strong negative correlations between EQ-5D-5L mobility and the Tinetti Test (r = −0.583 to −0.728, p < 0.001), with weaker correlations for pain/discomfort and anxiety/depression dimensions. While BMI-EQ-5D-5L pain/discomfort correlations were consistent across age groups, a stronger correlation was observed in the ≥80 years’ group for MNA-EQ-5D-5L anxiety/depression. Conclusions: In this exploratory cross-sectional study, MNA and BMI were associated with different quality of life domains. Lower MNA scores were more frequently associated with anxiety/depression and certain functional domains, particularly in the ≥80 years’ group, whereas higher BMI was more consistently associated with pain/discomfort across age groups. Full article

International tourism plays an important role in the global service economy, contributing to trade, employment, and regional development. For this reason, identifying the factors that influence tourist flows is an important issue for tourism policy, market strategy, and infrastructure planning. A large body of research has applied gravity models to analyze tourism flows between countries. While this approach provides a clear economic interpretation, it is usually based on linear specifications and may therefore capture only part of the relationships present in tourism data. This study examines the economic and geographic determinants of international tourism flows to Mongolia using a framework that combines a traditional gravity model with machine learning techniques. Mongolia serves as an instructive empirical setting, a landlocked, geographically peripheral destination whose inbound demand determinants have received limited systematic empirical attention. The analysis uses panel data for 27 origin countries covering the period from 2000 to 2024. In the first stage, a gravity model is estimated to assess how tourism flows relate to economic size and geographic distance. The results show that tourism flows tend to increase with the economic size of origin and destination countries, while greater geographical distance is associated with lower tourism flows. The estimated distance elasticity ranges from approximately −1.85 to −2.10 across model specifications, which is larger in absolute terms than the values typically reported in cross-country studies. This result is consistent with the relatively high travel cost barriers associated with Mongolia’s geographic location. These findings are consistent with the distance decay relationship commonly reported in the tourism literature. In the second stage, machine learning algorithms, including Random Forest, LightGBM, and XGBoost, are used as complementary interpretive instruments rather than forecasting tools to explore possible nonlinear relationships among the explanatory variables. To make the results more interpretable, the contribution of individual variables is examined using SHAP (Shapley Additive Explanations). The machine learning results indicate that some relationships in tourism demand may be nonlinear and not fully captured by the linear gravity specification. Specifically, distance sensitivity is approximately 6.5 times greater in nearby markets than in long-haul markets, with a structural inflexion at around 5700 km. Further analysis suggests that the influence of geographical distance is not uniform across all markets. In particular, tourism flows originating from middle-income countries appear to be more sensitive to increases in travel distance than those from higher-income countries. Overall, the findings indicate that economic size and geographical distance remain key determinants of international tourism flows to Mongolia. At the same time, the use of machine learning methods provides additional insight into potential nonlinear patterns in tourism demand. By combining econometric modelling with explainable machine learning techniques, the study offers an integrated analytical perspective for examining international tourism flows at geographically peripheral destinations where standard gravity assumptions may be insufficient. Full article

Polymer-modified bituminous binders are widely used in road construction due to their enhanced mechanical performance; however, the effectiveness of these materials critically depends on the actual concentration of polymer modifiers, particularly styrene-butadiene-styrene (SBS). This study aims to develop and validate a rapid, reproducible Fourier Transform Infrared Spectroscopy—Attenuated Total Reflectance (FTIR-ATR) spectroscopy method for the quantitative determination of SBS content in polymer-modified bitumen (PMB). Since, to date, there is no clearly defined method for controlling the quantitative content of polymers in PMB, this creates difficulties in accepting the roadway into operation. Calibration PMB samples containing 1–4% SBS were prepared, tested for physical and mechanical properties, and analyzed spectroscopically to identify characteristic absorption bands at 966 cm⁻¹ and 699–760 cm⁻¹. A first-order calibration model was constructed to relate peak intensity to polymer concentration. The results demonstrate a clear linear correlation between SBS content and IR absorption features, confirming the suitability of FTIR as an instrumental method for routine laboratory control. Application of the model allowed determination of actual polymer mass fraction with high accuracy and reproducibility. The findings also showed that increased SBS levels improve softening point, elasticity, and low-temperature resistance, with 3–4% representing a performance-optimal range. Overall, the proposed FTIR-based approach provides an objective and efficient tool for quality control of polymer-modified binders and supports broader standardization efforts in the field. Full article

Background/Objectives: Low back pain (LBP) is one of the most common musculoskeletal conditions globally and a leading cause of disability. University populations may be particularly vulnerable due to prolonged sitting, academic stress, and frequently suboptimal ergonomics, especially in rapidly expanding higher education systems such as those in Saudi Arabia. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence of LBP among university attendants in Saudi Arabia and to quantify its associations with key demographic and environmental risk factors. Methods: We systematically reviewed observational studies reporting LBP prevalence and/or risk factors among university students and faculty in Saudi Arabia published in English, following Cochrane methodological guidance and PRISMA 2020 reporting recommendations. The protocol was prospectively registered in PROSPERO (CRD420250654048). We searched PubMed, Embase and CINAHL from inception to February 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Random effects meta-analyses were used to pool prevalence estimates across recall periods, regions, populations, and measurement tools, and to calculate pooled odds ratios (ORs) for age, sex, smoking, family history of LBP, and college seating conditions. Heterogeneity, subgroup, and sensitivity analyses were undertaken. Results: Thirteen cross-sectional studies were included. The overall pooled prevalence of LBP was 57% (95% confidence interval [CI] approximately 43–71), with substantial heterogeneity. Prevalence varied by recall period, region, population group, and measurement instrument; pooled prevalence was 58% among students and 50% among faculty. Increasing age (OR 1.17, 95% CI 1.01–1.34) and poor college seating conditions (OR 1.42, 95% CI 1.07–1.76) were significantly associated with LBP. Male gender, smoking, and family history showed non-significant pooled effects. These estimates are limited by substantial between-study heterogeneity, variable measurement tools, and exclusively cross-sectional designs, which restrict causal inference. Conclusions: LBP is prevalent among university attendants in Saudi Arabia, affecting both students and faculty. The consistent associations with age and seating ergonomics highlight the need for ergonomic classroom redesign and age-sensitive preventive strategies. Future work should adopt standardized LBP measures and longitudinal designs to clarify causal pathways and evaluate targeted interventions. Funding: This work was supported by the Deanship of Graduate Studies and Scientific Research at Jouf University (grant DGSSR-2026-NF-01-002). Full article

Although financial statements are increasingly recognised as containing rich economic and governance information, the existing research on zero-carbon factory certification has primarily focused on external policy instruments, technological pathways, and governance mechanisms, while generally overlooking the role of internal corporate financial information systems in carbon emissions measurement and certification. To address this research gap, this study examines the validity, representational capacity, and underlying mechanisms of financial-statement-based carbon emission intensity as a proxy for actual corporate carbon emissions, using Shanghai and Shenzhen A-share listed companies from 2010 to 2022 as the sample. Findings reveal a significant positive correlation between the two, with this relationship positively moderated by the sustainability of corporate innovation outputs and market competitive position. This effect operates through optimising resource allocation efficiency and strengthening financing constraints. Heterogeneity analysis indicates that explicit environmental signals and engagement levels enhance this representational effect, whereas high green technology levels inhibit it. Furthermore, using the steel industry as a case study, this paper constructs a four-dimensional, nine-indicator zero-carbon factory evaluation system. Employing Entropy-VIKOR model to certify 37 A-share listed steel enterprises in 2022. Carbon emission intensity was identified as the core metric, with C₆ and C₁₅ serving as zero-carbon benchmarks. Evaluation results demonstrated high alignment with official certifications, providing empirical evidence and policy implications for assessing carbon emissions through financial information and establishing zero-carbon factory certification standards. Full article

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to >80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform ‘fistula-first’ approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams. Full article

This cross-sectional exploratory study aimed to explore the association between inflammatory biomarkers and multidimensional psychological burden in informal primary caregivers of dependent older adults in an emergency department. We included 78 caregivers and up to 89 controls. Multidimensional psychological burden (perceived stress, depression, anxiety, and caregiver burden) was assessed using standardized instruments. Morning serum levels of cortisol, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive Protein, were measured. Statistical analyses included between-group comparisons (Mann–Whitney U test), correlations (Spearman rank correlation coefficient), and hierarchical block regression adjusted for obesity, diabetes, and hypertension in the caregiver group. Multiplicity was addressed using the False Discovery Rate (FDR) procedure, and the findings were validated through 1000 bootstrap resamples. Caregivers had significantly higher levels of TNF-α compared to controls (p = 0.021), a finding confirmed by bootstrap analysis (95% CI: −2.6730 to −0.2940). IL-6 levels were positively correlated with trait anxiety (p = 0.007) and caregiver burden (p = 0.019). Comorbidity-adjusted hierarchical regression confirmed significant associations between IL-6 levels and trait anxiety and caregiver burden (ΔR² = 0.123, p = 0.007), although these associations did not remain significant after adjustment for FDR. Caregivers showed elevated levels of TNF-α and exploratory associations between IL-6, trait anxiety, and caregiver burden, justifying confirmation in studies with a larger number of participants. Full article

Background: Occupational exposure to cytotoxic drugs remains a major concern for pharmacy personnel, due to their well-established, carcinogenic, mutagenic and organ-specific effects. Despite the existence of robust international guidelines, evidence suggests substantial variability in compliance, training quality and operational conditions across healthcare settings. Objective: This study aimed to characterise current handling practices, assess working conditions, training, safety procedures, exposure patterns, and perceived risk factors among pharmacy technicians involved in the preparation of cytotoxic drugs in Portugal. Methods: A cross-sectional descriptive study was conducted using a structured questionnaire grounded in international standards (ISOPP, NIOSH, ASHP, USP <800>). The instrument was developed through literature review, expert panel validation (n = 42), and pre-testing. Data were collected electronically between April and May 2025 from pharmacy technicians actively handling cytotoxic drugs in Portugal. Results: A total of 124 valid responses were analysed. Most participants were female (78%) and under 50 years, with nearly one-third having less than one year of experience. Prolonged daily exposure (31.5% participants worked ≥ 5 h/day) extended uninterrupted handling periods (28.2% worked > 120 min), and high preparation workloads were common. While adherence to core protective measures—such as reinforced gowns, double gloves, and Class II B2 biological safety cabinets—was high, important gaps were identified, including incomplete use of closed system transfer devices, inconsistent respiratory and foot protection, limited automation, and insufficient environmental monitoring. Structured competency assessment, periodic training, and formal documentation were frequently absent. Institutional policies on reproductive risk showed strong protection for women but less clarity for male workers. Conclusions: Cytotoxic drug handling practices in Portugal demonstrate satisfactory adherence to fundamental protective measures but reveal significant structural and organisational gaps related to workload management, environmental monitoring, and continuous training. The absence of unified national guidance contributes to variability across institutions. These findings highlight the need for greater standardisation of occupational safety practices. Full article