Search Results (20,034)

Background/Objectives: Sexual health is frequently under-addressed after stroke, despite its relevance to intimacy, identity, relationships, and rehabilitation. This convergent mixed-methods study integrated sex-specific screening with descriptive narrative material to examine sexual functioning and patient-reported concerns in clinical rehabilitation. Methods: Twenty-six adults were assessed: ten with the Female Sexual Function Index (FSFI), sixteen with an International Index of Erectile Function six-item field (IIEF-6), and ten with analyzable semi-structured interview responses. The sex-specific measures were analyzed separately. Continuous variables were summarized by median and interquartile range; nonparametric correlations and group comparisons underwent Benjamini–Hochberg false discovery rate correction. Quantitative and qualitative findings were integrated in a participant-level joint display. This integration yielded case-level meta-inferences rather than inferential mixed-methods testing in this sample. Results: Nine of ten FSFI profiles and nine of sixteen IIEF-6 profiles met the respective exploratory threshold for possible dysfunction. No association or group comparison remained statistically significant after correction. Six of eighteen threshold-positive profiles had analyzable interviews, twelve represented narrative silence, and four interviewed participants were threshold-negative. Narratives documented fear, embarrassment, reduced desire or sexual frequency, relational or communication change, support needs, clinical sequelae, and positive or neutral adaptation. Screening and narratives showed convergence, complementarity, and divergence: low scores did not establish personal distress, whereas concerns could occur above a threshold. Conclusions: Responsive sexual rehabilitation should combine confidential, permission-based, patient-led screening and narrative inquiry with individualized information, optional support, appropriate referral, and reassessment according to readiness. These preliminary, hypothesis-generating findings do not validate an intervention or support confirmatory inference. Full article

Growing evidence positions the built environment as an active component of the developmental experience of children with Autism Spectrum Disorder (ASD). In this population, architectural elements such as lighting, acoustics, spatial configuration, and sensory stimuli are consistently associated with learning processes; however, empirical evidence quantifying these relationships through proxy informant instruments remains scarce, particularly in Latin American urban contexts with infrastructure gaps. This study addresses that gap by examining the association between neuroarchitecture, understood as evidence-based sensory design, and learning in children with ASD attending therapeutic centers in the district of Comas, Metropolitan Lima. A quantitative, non-experimental, cross-sectional, and correlational design was adopted. The final sample comprised 98 proxy informants, family members with daily and sustained contact with children with ASD, recruited from four therapeutic centers in Comas (zones 3, 5, 6, and 8), following an instrument validation process that included a pilot test with 15 additional participants. Data were collected through a structured questionnaire of 24 Likert-scale items with five response options, organized around two variables and six dimensions. Content validity was established through expert judgment by five architecture specialists. Construct validity was assessed using Exploratory Factor Analysis (KMO = 0.744; Bartlett’s sphericity test: ${\chi }^2$ = 665.96, df = 276, p < 0.001). Instrument reliability was confirmed through Cronbach’s alpha coefficient ($\alpha$ = 0.844). Given the non-normal distribution of the data across all constructs (Shapiro–Wilk, p < 0.05), Spearman’s rho coefficient was used for inferential analysis. A positive and statistically significant association was identified between neuroarchitecture and learning ($\rho$ = 0.599, p < 0.001). Dimensional analysis revealed a hierarchical pattern: the strongest association corresponded to cognitive processing ($\rho$ = 0.492, p < 0.001), followed by social interaction and communication ($\rho$ = 0.460, p < 0.001) and sensory regulation and adaptive behavior ($\rho$ = 0.460, p < 0.001). A total of 99.0% of proxy informants perceived adequate neuroarchitectural conditions and associated adequate learning outcomes. The findings confirm that neuroarchitectural design is significantly associated with the learning of children with ASD, with cognitive processing emerging as the dimension most sensitive to spatial conditions. The evidence supports the formulation of preliminary design orientations that prioritize sensory stimuli management, spatial legibility, and programmatic differentiation of therapeutic environments, in alignment with Sustainable Development Goals (SDGs) 4 and 11. Full article

This study examines green skills and sustainability readiness in Albania’s tourism sector using survey data from 224 tourism organizations operating across five subsectors and several regions of the country. The analysis focuses on current environmental management capabilities, future skill requirements, environmental training, and green investment. The conceptual framing combines the literature on green skills and Green Human Resource Management. Descriptive statistics, reliability analysis, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, Spearman correlations, and ordinary least squares regression were employed. The findings show that current green skills are moderate, while future skill requirements are significantly higher, indicating a substantial skills gap. The largest gaps are observed in sustainable transport promotion and climate change knowledge. Organizations providing environmental training report stronger current green skills and greater sustainability readiness than those that do not. Green investment is also positively associated with current environmental capability. In addition, significant differences emerge across tourism subsectors, while size effects appear less consistent. The regression results confirm that environmental training and green investment are important predictors of current green skills. The study contributes to the literature by extending empirical evidence on green skills to an underexplored Southeast European context and by linking green skills with sustainability readiness in tourism organizations. The findings suggest that the green transition in tourism depends not only on environmental intent but also on organizational learning and investment. Full article

Image encryption schemes based on chaotic maps offer strong statistical properties but are vulnerable to quantum attacks, and their integration with post-quantum cryptography has not been sufficiently explored. This paper presents a post-quantum secure image encryption framework integrating ML-KEM (FIPS 203), standardized by NIST in 2024, with a two-dimensional Sinh-Logistic chaotic map, HKDF-SHA256 nonce-based key derivation, feedback diffusion, and a novel Seismic Wave Permutation (SWP). The scheme derives channel-specific encryption keys from ML-KEM shared secrets using random, channel-specific nonces via HKDF-SHA256, ensuring plaintext independence and avoiding metadata-based leakage. The proposed SWP effectively breaks spatial correlations by displacing pixels according to a chaotic SWP model. RGB images are processed with independent ML-KEM encapsulation and HKDF-derived key material per channel, enabling multi-channel encryption without cross-channel leakage. Experiments on 512 × 512 test images have demonstrated Shannon entropy exceeding 7.999 bits per pixel across all channels, NPCR of at least 99.59%, UACI between 33.41% and 33.53%, and near-zero pixel correlations, further validated across 14 standard SIPI test images. An IND-CPA game simulation using four independent distinguishers, including a learned classifier trained via chosen-plaintext oracle access, over 5000 rounds per image, showed a maximum adversary advantage of 0.0186, consistent with random prediction. ML-KEM encapsulation contributes between 3.9% (ML-KEM-512) and 8.0% (ML-KEM-1024) of total encryption latency at 512 × 512 resolution, remaining a minority cost across all security levels while keeping the total encryption time within a narrow 227–258 ms range. The proposed architecture bridges standardized post-quantum cryptography with chaos-based image security for privacy-preserving image transmission. Full article

This paper examines the moderating effect of corporate digital transformation in the relationship between audit quality and aggressive tax avoidance in the sample of industrial companies listed on the ASE and operating during the 2020–2025 period. They were based on data of a balanced panel of 30 industrial companies listed on the ASE 180 observations. The primary estimator used was the feasible generalized least squares (FGLS) method that was employed after it was established that first-order autocorrelation, groupwise heteroskedasticity, and partial cross-sectional dependence existed. System-GMM estimator was used to confirm the robustness of the results, and to deal with the endogeneity that may arise due to reverse causality between auditor selection and result. There are three key findings of the study. First, there is a strong and consistent negative relationship between affiliation with one of the Big Four audit firms and aggressive tax avoidance in all the models studied, confirming that reputation-based audit quality is an effective institutional deterrent a finding of particular importance given that 73.3% of the Jordanian industrial firms in the sample rely on local auditors and therefore lack similar governance controls. Second, aggressive tax avoidance is positively related to higher audit fees, which are indicative of a more complex client base and an economic dependence on clients by the auditor, rather than a signal of greater monitoring rigour and, therefore, as a challenge to the fee-as-quality assumption common to the developed-market framework. Third, although digital transformation demonstrates a direct positive correlation with aggressive tax avoidance—indicating that firms can use digital capabilities to enhance tax planning and not compliance in the pre-JoFotara regulatory environment—its moderating effect on Big Four affiliation is not statistically significant. It is important to note that the relationship between the intensity of audit fees and digital transformation is positively significant, which is in line with the economic dependence argument. The implications of the findings are important to the Jordan Securities Commission, the tax authorities as well as regulatory bodies who are looking to enhance corporate tax compliance in a dynamic digital regulatory environment, and raise important questions of the portability of audit quality assumptions across institutional settings. Full article

Introduction: Survival at high altitudes requires efficient energy management. Although hypobaric hypoxia alters thermodynamic efficiency, the independent impact of altitude versus demographic factors on basal and exertional caloric costs remains uncertain. We evaluated these variables in chronic residents across four Peruvian altitudes. Methodology: A cross-sectional study was conducted involving 141 healthy adults (aged 18–38 years) residing in Lima (154 m), Arequipa (2335 m), Puno (3827 m), and La Rinconada (5100 m). Resting energy expenditure (REE) and physical activity energy expenditure (PAEE) were estimated using continuous photoplethysmography; PAEE was assessed following the 6-min walk test (6MWT). Hemodynamic parameters, oxygen saturation (SpO₂), and hemoglobin (Hb) levels were evaluated. An analysis of covariance (ANCOVA) was employed to adjust metabolic variations for age, sex, and body mass index (BMI). Results: Unadjusted data demonstrated a progressive increase in REE and PAEE proportional to altitude. However, the ANCOVA revealed that the independent effect of the city of residence was no longer statistically significant after adjusting for anthropometric and demographic covariates. Physiologically, the SpO₂ deficit imposed a high metabolic demand (an increase of approximately 1.29 kcal in REE for every 1% drop in SpO₂). Hb concentrations above 18 g/dL were associated with an exponential increase in caloric cost driven by blood hyperviscosity. A positive correlation was identified between Hb levels and energy expenditure (EE), which proved to be statistically stronger in the female cohort. Under extreme hypoxia conditions (5100 m), men exhibited a significantly higher PAEE (50.60 ± 10.17 kcal vs. 40.78 ± 5.21 kcal). Despite the increased biological effort, mechanical performance in the 6MWT remained constant across cities. Conclusions: There is no independent relationship between REE and the altitude of residence. The initial unadjusted relationship between altitude and EE was negated by covariates, particularly body mass index (BMI). The preservation of functional capacity at the expense of the energy economy underscores the profound physiological burden of Andean acclimatization. Full article

Background/Objectives: Our aim is to describe the clinical, imaging, and histopathological features of odontogenic keratocyst in a Mexican cohort. Methods: This is a retrospective, descriptive, and cross-sectional study. Clinical records and histopathology reports (2015–2025) from multiple laboratories were reviewed. Slides stained with hematoxylin and eosin were evaluated by pathologists using standardized criteria. Descriptive statistics were performed. Results: A total of 106 cases were included. Ages ranged from 10 to 86 years (mean 33.4 ± 17.7). There was a predominance of males (61/106; 57.5%). The most frequent location was the posterior mandible (49/106; 46.2%), followed by anterior mandible (30/106; 28.3%), posterior maxilla (19/106; 17.9%), and anterior maxilla (8/106; 7.5%). Most cases were asymptomatic (73/106; 68.9%). Association with an impacted tooth was documented in 37/106 (34.9%) and root resorption in 26/106 (24.5%). Satellite epithelial islands were observed in 8/106 (7.5%), satellite cysts in 17/106 (16.0%), and both findings in 4/106 (3.8%). Chronic inflammation was present in 62/106 (58.5%). Conclusions: In this Mexican series, odontogenic keratocyst predominated in males and, in the posterior mandible, was frequently asymptomatic, and showed satellite foci and chronic inflammation in a relevant proportion, reinforcing the need for clinical-imaging and histopathological correlation, as well as follow-up. Full article

This study evaluated the reliability of five treadmill protocols that assess heart rate (HR) and blood lactate (Bla) responses in Thoroughbred horses to determine their effectiveness in serving as potential tools for monitoring fitness and the wellbeing of racehorses. Of the five exercise tests, four consisted of repeated interval gallops at constant speeds (8 m/s and 10 m/s) and grade (6°) and one test of a continuous gallop at constant speeds (8 m/s) and grade (6°). Eight hundred and twenty-three gallops in total were performed by 64 horses. The test–retest reliability and absolute agreement between treadmill tests were assessed using Intraclass correlation coefficient (ICC) with a two-way mixed-effect model. Statistical significance was set at p < 0.05. Overall, the mean of the mean HR for each of the five test gallops was 203 ± 11.3 bpm. The mean HR ICC of the five tests of 0.756 indicates good reliability of the tests, as HRs during each gallop were consistent between tests. Protocol comparison showed that all protocols have good reliability with gallops 1 and 5 scoring highest (0.79: 0.81) and gallop 4 lowest at 0.621. The recovery mean HR ICC for 30 s, 60 s, 90 s and 120 s recovery were 0.421, 0.504, 0.595 and 0.571 respectively. Overall, the data suggests that gallop HR is the more reliable variable with recovery HRR reliability improving to an acceptable level at 60 s and 90 s recovery. Together, the treadmill tests demonstrated acceptable reliability to measure both gallop HR and HHR responses, whereas BLa responses were less consistent. Full article

Geometric uniformity in lignocellulosic furnish plays a central role in determining the mechanical reliability and density stratification of engineered wood products. This study presents a comprehensive morphological assessment of wood strands produced from indigenous poplar (Populus nigra L.) and hybrid poplar (Populus × euramericana (Dode) Guinier) strands under full industrial flaking conditions. A total of 600 strands were characterized for weight, length, width, and thickness and analyzed using a multivariate statistical framework integrating Principal Component Analysis (PCA) and bivariate correlation modeling. Despite being processed to the same nominal target length (120 mm), the two provenances exhibited markedly different dimensional behaviors. Hybrid poplar strands were substantially heavier (mean 0.536 g vs. 0.291 g) and slightly thicker on average, while indigenous strands were marginally wider; strand length did not differ significantly between provenances (p = 0.354). PCA applied to four variables (weight, length, width, and mean thickness) revealed that weight and width were the dominant contributors to PC1 (57.0% of total variance), enabling clear separation of the two provenances into distinct multivariate clusters. These findings indicate that hybrid furnish, due to its coarser and more variable geometry, may require enhanced mat densification during hot pressing to minimize internal voids and achieve a stable vertical density profile (VDP). The dataset and analytical approach presented here provide actionable insights for optimizing flaker calibration, strand classification, and resin dosing strategies in the production of Oriented Strand Board (OSB) and Laminated Strand Lumber (LSL), particularly when integrating fast-growing hybrid poplar resources into industrial manufacturing lines. Full article

Bio-based packaging is receiving increasing attention due to the environmental impact of fossil-based plastics. However, its practical implementation requires further evidence on material processing and functional performance. This study evaluated the thermal properties of expanded polylactic acid (E-PLA) prototypes blended with raw, minimally processed agroforestry residues. Specifically, spruce bark and grape stalks were used as waste wood fibers. This study focused primarily on the thermal characterization of the materials by measuring thermal conductivity and resistance. To evaluate the distribution of the two fractions (polymer and fibrous), samples were created with various volumetric ratios between the parts. Simultaneous pressure and microwave heating of the sample were used to stabilize the material. To characterize the raw materials used in this study, bulk density and moisture content were measured. To characterize the mixed materials samples, thermal conductivity and resistance, bulk density, and pressure were measured. To investigate the variables that influence thermal characteristics, statistical analyses such as regression models, ANCOVA, and Spearman correlation were applied. These analyses showed that increasing the biofiber content significantly reduced thermal resistance and increased thermal conductivity. However, negligible effects were observed for the type of fiber used and the duration of the heat treatment. These results describe the thermal properties of blends containing E-PLA and agroforestry residues. The results also show a marked effect of the biofiber content on thermal performance. This study does not provide a comprehensive characterization of the new materials, as it focuses on the prototyping methodology and the laboratory-scale production feasibility of E-PLA/agroforestry-residue prototypes. Full article

The performance of visual detection models in industrial applications is strongly influenced by training dataset quality. Although imaging scheme design and algorithm optimization are often emphasized, systematic dataset quality evaluation remains insufficient. To address this gap, this study proposes a dataset quality evaluation framework for industrial object detection. It includes four dimensions and thirteen quantifiable indices: three for acquisition environment, two for image quality, three for dataset scale, and five for annotation quality. Normalization based on theoretical maximum scores is used to reduce biases caused by different score ranges, and dimension weights are assigned using Taguchi orthogonal experiments. Validation is performed on five public and three self-constructed datasets using YOLOv12n and RT-DETR-R18. A positive correlation trend is observed between the proposed scores and detection accuracy, with PLCC/SRCC/Kendall’s tau values of 0.685/0.850/0.764 and 0.656/0.826/0.691, respectively. After second-level weight optimization, the correlations increase to 0.775/0.922/0.837 and 0.748/0.898/0.764. Corresponding p-values and 95% confidence intervals are reported to quantify statistical uncertainty. Sensitivity analysis and ablation comparisons further verify the robustness and necessity of the proposed multidimensional framework. The proposed framework provides a quantifiable method and practical acquisition guidelines for improving industrial image dataset quality. Full article

Background/Objectives: Nutrition is essential in healthcare and rehabilitation, although the readiness of physiotherapists in Saudi Arabia to integrate nutritional assessment and counseling remains ambiguous. This study aimed to assess their knowledge of nutrition, lifestyle choices, and attitudes towards incorporating nutrition into practice. Methods: This cross-sectional study included 500 licensed physiotherapists practicing across Saudi Arabia and used a culturally adapted questionnaire derived from previously validated instruments. The survey assessed background characteristics, nutrition knowledge, nutritional lifestyle, and attitudes toward integrating nutrition into physical therapy. Descriptive statistics, analysis of variance, Pearson correlation, and multiple linear regression analyses were performed. Results: Participants demonstrated moderate nutrition knowledge (59.68 ± 17.25) and favorable nutritional lifestyles (20.67 ± 3.79), with positive attitudes toward integrating nutritional assessment and counseling into their practice (13.63 ± 4.64). A significant positive correlation was observed between nutritional lifestyle scores and nutrition integration scores (r = 0.29, p < 0.01). Because lower nutritional lifestyle scores indicate healthier lifestyles and lower integration scores reflect greater integration, participants with healthier nutritional lifestyles tend to show greater nutrition integration. Nutrition knowledge scores were negatively correlated with integration scores (r = −0.37, p < 0.01). Multiple linear regression analysis identified professional seniority, nutritional lifestyle, and nutrition knowledge as significant predictors of nutrition integration score, explaining 22.8% of the variance (F = 29.24, R² = 0.22, p = 0.001). Conclusions: Saudi physiotherapists showed positive attitudes toward integrating nutritional assessment and counseling into the practice, but their nutrition knowledge was moderate, with knowledge gaps. Nutrition integration correlated significantly with nutritional lifestyle scores, nutrition knowledge, and professional seniority. The findings indicate the need to improve nutrition-related competencies and interdisciplinary collaboration in rehabilitation practice. Full article

Background/Objectives: A taller-than-wide shape is considered a suspicious ultrasound feature in the assessment of thyroid nodules. Although previous studies indicate an association with malignancy, its predictive value may vary depending on the population, methodology and measurement criteria. This study aimed to evaluate the diagnostic significance of the TTW feature and selected nodule dimensions in predicting malignancy risk. Methods: A retrospective observational study was conducted including 367 patients with thyroid nodules referred for fine-needle aspiration biopsy. Nodule height, width and the height-to-width ratio were assessed and compared with cytological outcomes according to the Bethesda classification. Spearman rank correlation and logistic regression analyses were performed, and the predictive value of the TTW ratio was evaluated using receiver operating characteristic analysis. Results: A statistically significant but weak positive correlation was observed between Bethesda category and both nodule height and the product of height and width (p < 0.05; r < 0.3). No significant association was found between the TTW ratio and lesions requiring further clinical evaluation and potential surgical management (OR = 1.03; p = 0.931). The area under the ROC curve for the TTW ratio was 0.497, indicating limited discriminatory performance between benign and potentially malignant lesions. Conclusions: In this cohort, the TTW feature showed limited predictive value in assessing malignancy risk. It should not be used as a standalone criterion for biopsy or surgery, but interpreted as part of a comprehensive ultrasound-based risk assessment together with cytological findings. Further studies in larger populations and with standardized ultrasound measurement protocols are warranted. Full article

The prediction of specialty coffee quality remains a central challenge for value addition in the agricultural sector. This study presents a computational approach to model the complex sensory quality of Arabica coffee (Coffea arabica L.) using synthetic data grounded in real-world statistics. A synthetic dataset (identical to the real dataset with a number of samples = 207) was generated using Cholesky decomposition based on the descriptive statistics and Pearson correlation matrix extracted from the Coffee Quality Institute (CQI) Arabica 2023 database, comprising 17 numerical variables including sensory attributes, defect counts, and Total Cup Points. The synthetic dataset achieved a Kolmogorov–Smirnov similarity of 89.55% with the real data, with the target variable Total Cup Points preserved with high fidelity (real mean: 83.71; synthetic mean: 83.65). An ordinal classification model (Random Forest) trained exclusively on the synthetic data and validated against real-world samples achieved an overall accuracy of 87.92% and a Quadratic Weighted Kappa (QWK) of 0.9502, indicating excellent agreement and confirming the model’s ability to capture the ordinal hierarchy of coffee quality. SHAP (SHapley Additive exPlanations) analysis revealed consistent feature importance rankings between real and synthetic domains, with Aftertaste, Overall, and Flavor emerging as the top three most influential predictors. This study validates the use of statistically grounded synthetic data for training robust machine learning models in agricultural research, demonstrating that synthetic environments can effectively replicate empirical patterns and enable cross-domain generalizability. The complete code and datasets are publicly available for reproducibility. Full article

Objectives: This study aimed to investigate imaging features associated with malignancy and to differentiate true non-mass lesions from transient non-mass ABUS findings on automated breast ultrasound (ABUS). Methods: This retrospective study included 133 women with non-mass lesions, each contributing a single lesion assessed as BI-RADS categories 0, 4, or 5 on ABUS between January 2020 and October 2022. We analyzed multiple ABUS imaging features, including background echotexture, distribution, microcalcification-like echogenic foci, posterior shadowing, architectural distortion on axial and coronal views, and volume change. These findings were statistically compared according to pathologic results for malignancy and ultrasonographic correlation for true versus transient non-mass ABUS findings. Results: Among the 133 lesions, 15 (11.3%) were malignant and 65 (48.9%) were transient non-mass ABUS findings. Segmental distribution (odds ratio [OR] = 40.42; 95% confidence interval [CI], 4.45–367.27; p = 0.001) and coronal architectural distortion (OR = 53.59; 95% CI, 6.26–458.90; p < 0.001) showed exploratory associations with malignancy. A non-heterogeneous background echotexture (OR = 0.07; 95% CI, 0.02–0.33; p = 0.001), lack of posterior shadowing (OR = 0.14; 95% CI, 0.03–0.60; p = 0.008), and volume change (OR = 15.79; 95% CI, 1.47–170.12; p = 0.023) were associated with true lesions. Conclusions: Segmental distribution and coronal architectural distortion were associated with malignancy on ABUS in this exploratory study. Lack of posterior shadowing and the presence of volume change were associated with true lesions, while heterogeneous background echotexture was associated with transient non-mass ABUS findings. These ABUS findings may contribute to the characterization of non-mass lesions but, given the small number of malignant lesions, require cautious interpretation and validation in larger studies. Full article