Search Results (85,020)

This study aimed to examine the impact of online social support on sleep quality and the potential roles of psychological resilience and digital literacy in this relationship. A cross-sectional survey was conducted with 606 university freshmen from a college in Hengyang City, Hunan Province, China, using cluster random sampling. Data were collected using the Online Social Support Questionnaire, Pittsburgh Sleep Quality Index (PSQI; note that higher PSQI scores indicate poorer sleep quality), Connor–Davidson Resilience Scale, and Domestic College Student Digital Literacy Assessment Scale. Statistical analysis was conducted using SPSS 27.0, with mediation effects tested via the PROCESS macro. The analytical results demonstrated that online social support showed a significant negative predictive effect on the sleep quality of university freshmen (β = −0.11, p < 0.01); psychological resilience exhibited a suppression effect (i.e., opposing direct and indirect effects) between online social support and sleep quality; and digital literacy moderated the first half of the mediation pathway (β = 0.18, p < 0.001). Collectively, this study shows that online social support directly harms sleep quality but indirectly benefits it by enhancing psychological resilience. Digital literacy serves as a key moderator that amplifies this beneficial indirect effect. These findings provide significant theoretical and practical insights for developing campus health promotion initiatives. Full article

Background/Objectives: Dietary sweetener use is common among individuals with diabetes, yet little is known about the socioeconomic and dietary factors that influence the choice between caloric and artificial sweeteners in Central and Eastern Europe. This study examined the determinants of caloric and artificial sweetener use among adults with diabetes mellitus (DM) in Hungary. Methods: We conducted a cross-sectional analysis using frequency-based self-reported dietary measures of 542 adults with self-reported DM from the 2019 European Health Interview Survey (EHIS). Weighted descriptive statistics and multivariable logistic regression models were used to evaluate associations between sweetener use and sociodemographic, lifestyle, and dietary characteristics. Results: Overall, 28.0% of participants reported daily use of caloric sweeteners, and 45.2% reported daily use of artificial sweeteners. Higher educational attainment and healthier dietary patterns, including greater fruit and vegetable consumption, were associated with lower odds of caloric sweetener use. Individuals with lower fruit and vegetable intake, less frequent fruit juice consumption, and poor adherence to diabetic diet recommendations were more likely to use caloric sweeteners. In contrast, artificial sweetener use was strongly associated with daily fruit consumption, lower intake of fruit juice, and adherence to a diabetic diet. Vegetable intake showed a positive association with artificial sweetener use, which may reflect compensatory patterns in dietary self-management. Conclusions: Caloric and artificial sweetener use were associated with distinct socioeconomic and dietary profiles. Caloric sweetener use was linked to less healthy dietary behaviors, whereas artificial sweetener use appeared to be consistent with sugar-reduction strategies. These findings highlight the need for tailored dietary counseling that addresses both sweetener use and broader dietary patterns among individuals with diabetes in Hungary. Full article

Objective: Existing deep learning (DL) studies on brain metastasis have largely focused on algorithm or reader performance in controlled settings, whereas its role in routine teleradiology quality support remains unestablished. We evaluated the report-level impact of DL assistance on brain metastasis interpretation in a real-world teleradiology workflow using dual-sequence MRI. Materials and Methods: In this retrospective study, 600 patients who underwent contrast-enhanced dual-sequence brain MRI during two consecutive 3-month periods before (pre-DL, n = 286) and after (post-DL, n = 314) DL integration into teleradiology workflow were analyzed. Ten board-certified teleradiologists interpreted all the cases with or without DL-generated overlays. Report-level diagnostic metrics were assessed against a consensus reference standard established by faculty neuroradiologists. Subsequently, exploratory case-level stratified sensitivity analyses were performed for metastasis-positive examinations based on lesion multiplicity and the largest lesion size. Teleradiologists’ perceptions were assessed using a post-interpretation survey. Results: Compared with the pre-DL group, the post-DL group showed higher sensitivity (77.7% vs. 90.8%, p < 0.001), specificity (82.3% vs. 90.8%, p = 0.002), accuracy (80.8% vs. 90.8%, p < 0.001), positive predictive value (68.2% vs. 85.7%, p < 0.001), and negative predictive value (88.3% vs. 94.2%, p = 0.011). False-positive and false-negative rates were lower after DL implementation (11.9% vs. 5.7%, p = 0.009; 7.3% vs. 3.5%, p = 0.045). Sensitivity gains were most pronounced for cases with single metastasis (74.6% vs. 91.2%, p = 0.007) and with the largest lesion ≤ 5 mm (74.3% vs. 92.0%, p = 0.004), whereas sensitivity was similar for multiple metastases and for cases with a largest lesion > 5 mm. Survey responses suggested favorable usability and diagnostic support. Conclusions: In this real-world teleradiology workflow, DL implementation was associated with higher report-level diagnostic metrics and fewer false interpretations. DL assistance may help support quality control for brain metastasis interpretation, particularly in more subtle and diagnostically challenging cases, although radiologist judgment remains essential for subtle or borderline lesions. Full article

Background: Sustaining measles elimination in the post-elimination era presents increasing challenges due to global resurgence and waning vaccine-induced immunity. We aimed to evaluate epidemiological trends, vaccination strategies, and population immunity associated with achieving and maintaining measles elimination in Taiwan. Methods: We conducted a comprehensive analysis of national surveillance data from 1991 to 2024, including case notifications, viral genotypes, vaccination coverage rates, and surveillance performance indicators. Three population-based seroprevalence surveys conducted between 2002 and 2020 were reviewed to assess age-specific immunity. Descriptive analyses were performed to characterize long-term epidemiological and immunological trends. Results: From 1993 to 2024, the annual number of measles cases remained consistently below 50, except in 2019. Vaccination coverage for both MMR1 and MMR2 has exceeded 95% since 1998, with MMR1 coverage remaining above 97% between 2009 and 2024. Genotyping evidence confirms the interruption of endemic transmission since 2006; furthermore, as of 2024, no continuous chains of transmission lasting longer than 12 months have been recorded. National seroprevalence surveys monitoring measles-specific IgG antibodies revealed declining antibody levels among adolescents and young adults, with seropositivity as low as 36.7% in specific cohorts. Despite this, transmission following importations has remained limited, with minimal secondary spread. Conclusions: Taiwan has successfully sustained measles elimination through high vaccination coverage, robust surveillance, and targeted interventions. Although serological evidence indicates waning immunity, epidemiological data suggest preserved population-level protection, likely mediated by immunological memory. Targeted booster strategies for high-risk groups may be more appropriate than universal additional dosing in post-elimination settings. Full article

Nepal’s National Health Insurance Program (NHIP), launched in 2016, continues to show low enrollment rates and substantial socio-economic and geographical inequalities hinder the progress towards universal health coverage (UHC). This study uses a composite indicator of intersectional disadvantages to examine how multiple equity markers (wealth quintile, education status and ethnicity) interact to shape inequalities in NHIP coverage. Data were drawn from the nationally representative 2022 Nepal Demographic and Health Survey. Key predictors are wealth status, education, ethnicity, residence, province, ecological zone and marginalization status. A composite measure of intersectional disadvantage was constructed using three socioeconomic dimensions: wealth, education, and ethnicity. Binary logistic regression, concentration indices, and concentration curves were used to assess the patterns of inequality in NHIP coverage. Results show that only 10.2% of men and 10.8% of women were enrolled in the NHIP. Enrollment varied markedly by province, with highest in Koshi (21.8% for men and 22.9% for women) and lowest in Madhesh (3.1% for men and 2.7% for women). Enrollment was disproportionately higher among wealthier, more educated, and ethnically advantaged groups. This disparity is starkest for those with an intersection of triple disadvantage (poor, illiterate, and disadvantaged ethnicity) and had substantially lower coverage (3.0% for men and 3.4% for women) compared to those facing no disadvantage (18.4% for men and 22.9% women). The concentration curve analysis confirmed that wealthier women and men had greater access to NHIP. Multivariable analysis showed that women and men with no disadvantages were more likely to be enrolled in NHIP than individuals in triple-disadvantage groups. These findings highlight persistent inequities in NHIP, which undermine its contribution to financial risk protection. Targeted interventions are urgently required, including effective implementation of existing subsidies for poor households, expansion of health facility networks in underserved provinces like Madhesh, and tailored outreach programs that address the intersection of ethnicity, wealth, and education in both genders to accelerate equitable progress towards UHC. Full article

Corporate sustainability has emerged as a critical strategic imperative for organizations seeking to mitigate their environmental impacts amid escalating climate pressures and growing stakeholder demands. This study examines corporate strategies aimed at reducing environmental footprints—including circular economy models, energy efficiency measures, and digitalization—and investigates how young adults perceive and evaluate corporate sustainability commitments, with particular emphasis on greenwashing skepticism. A cross-sectional quantitative survey was administered to 150 university students and young professionals aged 18–25 years in Spain. Data were analyzed using descriptive statistics, analysis of variance (ANOVA), and linear regression to examine the influence of prior sustainability knowledge, academic background, age, and sectoral context on perceived corporate sustainability commitment, greenwashing perception, and willingness to consume sustainable products. The findings reveal that prior sustainability knowledge significantly and positively predicts higher evaluations of corporate environmental commitment, while age and academic background—particularly among students in Economics and Business—are associated with heightened greenwashing skepticism. Perceived corporate sustainability commitment is found to exert a significant positive influence on sustainable consumption intention, and production-intensive sectors are consistently perceived as more environmentally harmful than service-oriented industries. These findings underscore the importance of transparent, credible, and verifiable sustainability strategies in building legitimacy and trust among younger generations, and contribute to the growing literature on stakeholder perceptions of corporate environmental responsibility. Full article

Background: The Democratic Republic of the Congo accounts for approximately 12–13% of the global malaria burden. While international guidelines oppose the use of Artemisia annua infusions due to risks of sub-therapeutic dosing and resistance selection, the plant remains widely used in resource-limited regions. This study evaluates the clinical acceptability and perceptions of healthcare providers regarding the integration of Artemisia annua tea into formal malaria control in the Maniema province. Methods: A cross-sectional survey was conducted among 337 healthcare professionals in the Kalima health district using the KoboCollect digital platform. Multivariate logistic regression was employed to identify the primary socio-professional determinants of clinical acceptability. Results: The overall clinical acceptability of Artemisia annua integration was 81.0%, with 82.8% of providers perceiving the preparation as effective. Rural residency was the strongest predictor of adherence (AOR = 6.847; p = 0.003), reflecting a pragmatic response to frequent ACT stockouts and high treatment costs. Despite high acceptability, 49.0% of providers identified the lack of clinical evidence as a major barrier, and 91.4% demanded formal training on standardized dosage and biological mechanisms. Conclusions: A significant “policy–practice gap” exists between international guidelines and field realities in the DRC. Healthcare providers demonstrate high readiness for integration but emphasize the absolute necessity of galenic standardization to mitigate resistance risks. To address these concerns, a complementary genomic investigation is currently underway in the same study area, comparing PfKelch13 mutation prevalence among Artemisia tea users versus ACT-treated patients. This molecular surveillance will provide essential evidence to define safety parameters for future phytopharmaceutical integration. Full article

This study investigates the structural misalignment between official wage benchmarks and actual market wages in the Republic of Korea to establish an independent, forestry-specific wage system essential for labor sustainability. Historically, the Republic of Korea forestry project costs have relied on construction industry benchmarks, leading to a “diverging hypothesis” where official rates fail to reflect the specialized risks and technical skills required in forest operations. To address this, a comprehensive wage survey was conducted in 2025 across 13 specialized forestry occupations. Utilizing a sampling frame of 7555 sites, 1044 units were selected via stratified sampling with square-root proportional allocation, ensuring a relative standard error (RSE) of 2.5%. The findings reveal that market wages consistently exceed construction benchmarks by 4.5% to 41.0%. The most significant disparities were observed in leadership and mechanized roles, reflecting substantial “risk–responsibility” and “skill premiums”. Furthermore, the study identifies a structural shift toward risk-transfer strategies, such as stumpage sales, in response to the Serious Accidents Punishment Act (SAPA). These results underscore the urgent need for a specialized wage framework to ensure safety and long-term resilience. Ultimately, such institutional refinement is a prerequisite for securing the high-quality human capital necessary for a sustainable circular bioeconomy. Full article

Existing scholarship on Sino-Western hybrid architecture (yanglou) has often treated Chinese elements as marginal, overlooking the agency of indigenous spatial logic. This study examines how traditional Chinese feng shui mediated the localization of Western architecture in the late Qing Dynasty through the case of the Tianjin Postal Museum. The research has three objectives: to distinguish Western architectural features from Chinese spatial rationales, to analyze the mediating mechanisms of feng shui, and to interpret the implications of this case for indigenous knowledge systems in the process of modernization. Using spatial semantic analysis based on UAV mapping and field surveys, the study finds that although the museum displays Western structural systems and proportional canons, its underlying spatial organization follows Chinese logic. This organization includes an enclosed courtyard, a north–south axis that structures dynamic and static zones, and re-signified elements such as the octagonal tower and parapet, which were repurposed to regulate qi and mitigate sha. The findings suggest that feng shui functioned as a pragmatic indigenous framework that enabled the creative appropriation of Western forms and challenged passive diffusion models of architectural modernization. Full article

The sixth-generation (6G) mobile communication systems are anticipated to be operational by 2030, prompting extensive research efforts by governments and private entities. Designed to meet societal, economic, and technological demands unaddressed by fifth-generation (5G) networks, 6G integrates scalability, security, and reliability with ubiquity and resource-intensive artificial intelligence. Envisaged as multi-band, decentralized, autonomous, flexible, and user-centric, 6G networks incorporate innovative technologies, including cell-free (CF), three-dimensional heterogeneous networks (3D HetNet), reconfigurable intelligent surfaces (RIS), integrated sensing and communication (ISAC), as well as artificial intelligence/machine learning (ML). In 6G 3D HetNets, the densification of access points (APs) continues, accommodating increased connections and traffic volumes, alongside the use of higher frequency bands. Although 6G networks are not fully standardized, they target demanding Quality of Service (QoS) standards, such as a peak data rate of 1.0 Tbps and latency of 0.1 ms. This paper conducts a comprehensive literature review on radio resource management (RRM) in 6G cell-free and 3D HetNet systems, emphasizing challenges such as interference mitigation. It presents a taxonomy of RRM approaches, systematically studying, categorizing, and qualitatively analyzing recent techniques, outlining the current state, and indicating future trends, technologies, and challenges shaping 6G systems. Full article

Background: Male college students are at risk for weight gain due to unhealthy dietary habits. This study assessed the dietary habits of undergraduate college males. Methods: Online cross-sectional survey (n = 235) of randomly sampled male undergraduate college students. Results: The mean age was 21.15 ± 3.21. Most were enrolled full-time (91.5%), lived off-campus (77.4%), upper class (59.6%), had a campus meal plan (52.8%), and white (51.9%). Mean body mass index (BMI) was 25.02 ± 4.86. Males gained an average of 10.81 ± 13.01 lbs while in college. Most ate one to two servings of fruits (67.1%) and vegetables (65.1%). Significant differences in weight gained during college and fruit consumed was significant [p = 0.02 *]. Male students reported on 20 different foods and drinks they consumed at least “a few times per week.” Most ate fresh fruits (76.1%), prepared a hot meal at home (72.7%), ate fresh vegetables (68.1%). Males also ate at fast-food restaurants (47.7%) and drank coffee (44.4%). Males that reported they drank alcohol (p = 0.03*), diet soda (p = 0.03 *), coffee (p = 0.01 *), and ate at fast-food restaurants (p = 0.02 *) “a few times per week” were found to have significantly gained more weight. Conclusions: Increased intake and consumption of alcohol, diet soda, and fast-food was associated with increased weight gain among college males. Full article

Background/Objectives: To evaluate construct (convergent and divergent) validity and conduct confirmatory factor analysis (CFA) of the National Center on Health, Physical Activity and Disability (NCHPAD) Wellness Assessment (NWA) tool. Methods: A cross-sectional survey validation study utilizing secondary data. We assessed Spearman correlations between NWA and 36-Item Short Form Health Survey (SF-36), NWA and Godin Leisure-Time Exercise Questionnaire (GLTEQ) and NWA and Modified Fatigue Impact Scale (MFIS) scores to determine construct validity. A CFA was conducted to test the appropriateness of a three-factor model for NWA. Results: Data from 149 participants were used to assess construct validity and from 180 participants for CFA. Both correlations between NWA mental wellness domain and SF-36 mental component scores and between NWA emotional/spiritual wellness domain and SF-36 emotional well-being scores were 0.61 (p < 0.001 for both). The correlation between NWA physical wellness domain and SF-36 physical component score was −0.06 (p = 0.45). The correlations of NWA with GLTEQ overall and with health contribution scores were 0.26 and 0.30, respectively (p < 0.001 for both). The correlations of all NWA domain and MFIS subscale scores ranged between −0.42 and −0.25 (p < 0.05). The CFA model’s comparative fit index was 0.90. Conclusions: The NWA physical wellness domain did not demonstrate strong convergent validity, as mental and emotional/spiritual wellness domains did. All domains showed strong divergent validity, and CFA showed evidence supporting a three-factor model. Future efforts will emphasize refining and reevaluating the physical wellness domain until it achieves strong psychometric properties. Full article

Micro-public space (MPS) regeneration is typically evaluated at the point of delivery, yet long-term performance depends on whether everyday stewardship can be sustained thereafter. This study reframes neighbourhood social capital as a governance–environment signal reflecting coordination capacity and examines whether residents’ willingness to participate in post-regeneration co-management is primarily appraisal-driven (perceived value, attitude, and perceived behavioural control) or coordination-driven via a residual direct channel consistent with routine governance. A cross-sectional survey of adults residing within walkable catchments of five regenerated MPS sites in Nan’an District, Chongqing, China ($N=477$), was conducted. An integrated Stimulus–Organism–Response × TPB model was estimated using WLSMV with ordered categorical indicators; indirect effects were assessed via bias-corrected bootstrap confidence intervals. Coordination capacity was strongly associated with perceived value, participation attitude, and perceived behavioural control. In the joint model, only perceived value retained a statistically reliable positive association with stewardship willingness, whereas the incremental contributions of attitude and perceived behavioural control were negligible once the stimulus was included. A residual direct association from coordination capacity to willingness persisted beyond the appraisal block, supporting a direct-dominant interpretation; bootstrap analyses yielded no robust evidence for mediation (BCa 95% CIs crossed zero). These findings suggest that sustaining regenerated micro-spaces requires low-friction governance designs that minimise coordination costs, reinforce soft accountability, and render institutional responsiveness visible to residents. Full article

The accelerated low-carbon transition of power systems and the widespread integration of Electric Vehicles (EVs) present both severe operational challenges and substantial flexible regulation potential for Active Distribution Networks (ADNs). This paper provides an integrative review of the coordinated control and multi-market bidding mechanisms for EV-centric Technical Virtual Power Plants (TVPPs). Moving beyond descriptive surveys, this review systematically synthesizes the fragmented literature across three critical dimensions: (1) the physical-economic bidirectional mapping, which considers nonlinear power flow constraints and node voltage limits within the TVPP framework; (2) multi-market coupling mechanisms, evolving from unilateral energy bidding to coordinated participation in carbon trading and ancillary services; and (3) real-time control strategies, critically evaluating the trade-offs between optimization techniques (e.g., Model Predictive Control) and cutting-edge artificial intelligence approaches (e.g., Deep Reinforcement Learning) in mitigating battery degradation. Furthermore, a transparent review methodology is adopted to ensure literature rigor. By explicitly outlining the boundaries between TVPPs, Commercial VPPs (CVPPs), and EV aggregators, this paper identifies core unresolved trade-offs among aggregation fidelity, market complexity, and communication latency, providing evidence-backed pathways for future engineering demonstrations and V2G applications. Full article