Search Results (1,396)

Background/Objectives: Chiropractors serve as first-contact practitioners in South Africa and frequently encounter patients with systemic conditions that may mimic musculoskeletal complaints. Non-musculoskeletal (non-MSK) examinations are essential for identifying red flags, ruling out serious pathologies, and facilitating timely referrals. Despite their importance for patient safety and integration into primary healthcare, limited research exists on the frequency with which South African chiropractors perform these assessments. This study aimed to describe the frequency and indications for non-MSK examinations performed by South African chiropractors and to explore variations across examination types, demographic factors, years of experience, and training institutions in secondary analyses. Methods: A cross-sectional online survey was distributed to 898 registered chiropractors, yielding 186 responses (20.7%). The questionnaire assessed the frequency of non-MSK examinations using a five-point Likert scale. Data were analysed using descriptive statistics (frequencies, percentages, medians, interquartile ranges). Exploratory subgroup comparisons were conducted using nonparametric tests, but these findings should be interpreted with caution due to small and uneven sample sizes in some subgroups. Ethical approval was obtained (REC-3366-2025). Results: Most respondents were female (57.5%) and practising in Gauteng (49.5%). Blood pressure (84.4%) and heart rate (81.2%) were the most frequently performed examinations, while respiratory rate (12.4%), oxygen saturation (9.7%), and temperature (11.8%) were the least frequently performed vital signs. Breast (3.8%), abdominal (10.2%), and genitourinary (1.1%) examinations were rarely conducted. Exploratory subgroup observations suggested provincial variation: chiropractors in KwaZulu-Natal performed non-MSK examinations more frequently than those in Gauteng and the Western Cape (mean differences ranging from 0.21 to 1.19 on a five-point scale), whereas no meaningful differences were found across years in practice. Conclusions: South African chiropractors perform a selective range of non-MSK examinations, supporting their role as first-contact practitioners. However, many systemic examinations are conducted infrequently, with observed provincial variation. These descriptive findings highlight the need for greater consistency and standardisation in non-MSK screening to enhance patient safety and interdisciplinary care. Future adequately powered studies are needed to confirm the exploratory subgroup observations. Full article

Menopause marks a complex biopsychosocial transition defined by the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. South Asian women tend to experience menopause earlier (45–47 years) than North American women, yet limited culturally appropriate interventions exist to address their symptoms. While hormone replacement therapy can reduce discomfort, its associated risks and limited cultural feasibility restrict its use in this population. There is a growing need to explore non-pharmacological and culturally relevant alternatives. Physical activity has been associated with potential well-being benefits during menopause. This study examined the prospective acceptability of a pedometer-based walking intervention, encouraging 10,000 steps daily, among South Asian immigrant women. The study was conducted in 2024 and completed within approximately seven months. A cross-sectional survey was conducted with 64 South Asian women aged 40–70+ years, who completed a questionnaire assessing the prospective acceptability and perceived barriers to participation. Overall, participants reported moderate to high levels of acceptability of the proposed walking intervention. Some participants perceived potential benefits for well-being; however, given the study design, effectiveness and symptom management outcomes were not assessed. Sociocultural factors—such as family responsibilities, modesty concerns, and limited access to supportive environments—were identified as potential barriers to participation. These findings suggest that a pedometer-based walking intervention may be acceptable to some South Asian immigrant women, though acceptability was not uniform and may be influenced by contextual factors, including opportunity costs. Further research using longitudinal or interventional designs is needed to evaluate feasibility, uptake, and effectiveness. Full article

Background and Clinical Significanc: Neuropathic corneal pain is a debilitating condition characterized by ocular pain disproportionate to clinical signs, often resulting from peripheral and central sensitization of the corneal somatosensory pathway. Emerging evidence suggests that chronic involuntary muscle contraction in blepharospasm may lead to irritation of trigeminal afferents and corneal neurogenic inflammation, potentially predisposing patients to neuropathic corneal pain. Given its debilitating nature, early recognition can prevent the progression of neuropathic sequelae. This study examines the potential role of blepharospasm as a predisposing factor contributing to neuropathic corneal pain. Case Presentation: This retrospective case series describes three cases (median age: 50 years) of neuropathic corneal pain in association with blepharospasm and their clinical course following multimodal treatment over a median follow-up period of one year. Ocular surface was evaluated using slit-lamp biomicroscopy, while corneal nerve structure and morphology were assessed with in vivo confocal microscopy. All the three subjects presented with minimal ocular surface staining but disproportionate ocular pain characterized by burning sensation and photophobia. Proparacaine challenge testing was performed to determine the subtype of neuropathic corneal pain. Pain symptoms and quality of life were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. In vivo confocal microscopy demonstrated characteristic corneal nerve abnormalities including reduced corneal nerve density, increased nerve tortuosity, and the presence of microneuromas. Treatment included oral Pregabalin or Gabapentin, topical lubricants, Cyclosporine 0.05% (1 case), and 20% autologous serum eye drops (1 case). Two of the three cases received four to five injections of botulinum toxin for blepharospasm, whereas one had undergone a single injection prior to review. All patients also received weekly periorbital quantum molecular resonance electrotherapy for two months. Improvements were observed across multiple domains of the Ocular Pain Assessment Survey and Ocular Surface Disease Index evaluation, including ocular pain, photophobia, non-ocular pain, and quality-of-life measures following multimodal treatment. The co-existence of blepharospasm and neuropathic corneal pain observed in our cases supports a possible association between chronic periocular muscle hyperactivity and corneal nociceptor sensitization. Proposed mechanisms include chronic trigeminal nerve irritation, neurogenic inflammation, and sensitization mediated by pro-inflammatory neuropeptides. Multimodal treatment targeting both motor hyperactivity and neuropathic pain pathways appeared to provide symptomatic relief, including the use of quantum molecular resonance electrotherapy, which might modulate pain pathways, block nociceptor neurotransmission, and accelerate corneal nerve regeneration. Given the complexity of the neural pathways responsible for ocular discomfort, further studies are required to elucidate the relationship between neuropathic corneal pain and blepharospasm in larger cohorts, as well as refine existing therapeutic approaches, including evaluating the therapeutic role of electrotherapy. Conclusions: Blepharospasm may represent a potential predisposing factor of neuropathic corneal pain. Early recognition and concurrent treatment of blepharospasm and neuropathic corneal pain can effectively relieve symptoms and improve quality of life. Adopting a multimodal treatment approach is therefore recommended. Full article

Rural household energy-saving behavior is central to low-carbon development in ecologically fragile plateau regions. This study explores whether climate risk perception promotes household energy-saving behavior, through which livelihood capital mechanisms this effect operates, and which livelihood capital configurations support high levels of such behavior. Drawing on survey data from 315 rural households in Xining, China, a sustainable livelihood framework is integrated with the pressure–state–response model, and PLS-SEM, an ANN, and fsQCA are applied. The integrated framework regards climate risk perception as external pressure, livelihood capital as the household livelihood state, and energy-saving behavior as the behavioral response. The sustainable livelihood framework identifies the multidimensional resource conditions of rural households, whereas the pressure–state–response model specifies the causal sequence through which perceived climate pressure affects livelihood states and induces behavioral responses. The results show that climate risk perception significantly promotes energy-saving behavior. Physical, human, and social capital exert positive effects, whereas natural and financial capital exert negative effects. Moreover, natural, financial, and social capital significantly mediate the link between climate risk perception and energy-saving behavior. Multi-group analysis shows that physical capital matters more for agriculture-dominated households than non-farm households. The ANN results identify social and human capital as the strongest predictors, and the fsQCA results show that high levels of energy-saving behavior arise not from any single condition but from multiple capital configurations, in which social capital is consistently central. Energy conservation under climate risk is therefore best understood as a multidimensional, nonlinear adaptation process embedded in household livelihood structures rather than a response to any single factor. These findings extend rural energy-saving research by linking climate pressure, livelihood conditions, and configurational decision logic in a plateau socio-ecological context. Policy interventions should combine energy-efficient infrastructure, targeted financial incentives, community-based diffusion, and livelihood-sensitive support for rural households. Full article

Understanding the drivers and barriers of wine consumption is of substantial importance for both market development and sensory science research, and this is particularly salient in rapidly changing non-Western markets. Young, highly educated Chinese consumers represent one of the fastest-growing segments in the global wine market, yet large-scale studies of their consumption preferences and rejection patterns remain limited. This study aimed to characterize the conditional dependence structure of wine-consumption behavior in this population and to examine the associations between common consumption barriers and sociodemographic variables. A nationwide cross-sectional online survey collected 4823 valid responses. Non-parametric tests were used to compare sociodemographic groups, and a regularized Gaussian graphical model (GGM) was estimated to characterize the conditional associations among 15 consumption-behavior variables. The sample was dominated by young respondents (18–24 years) and individuals with higher education. The three most frequently endorsed barriers were taste aversion (51.1%), price sensitivity (38.7%), and lack of knowledge (19.6%). Age and education were the most central sociodemographic variables in the network. The knowledge barrier showed a moderate negative conditional association with education (partial r ≈ −0.171), whereas taste aversion—although the most frequently endorsed barrier—did not show clear conditional associations with sociodemographic variables in the network. Gender was not conditionally associated with any other variable in the network. These observations suggest that the three consumption barriers may operate through different network pathways and may therefore have different implications for intervention design, a possibility that warrants further confirmatory and longitudinal research. Full article

Climate change is intensifying flood risks globally, yet preparedness behaviors vary dramatically across governance contexts. While past disaster research suggests that institutional trust enables individual preparedness, this relationship remains unexplored in high-capacity governance systems where citizens hold exceptionally strong confidence in government response. We examined this dynamic in the United Arab Emirates, where several surveys have found extremely high levels of public confidence in the local government institutions. In our survey of 900 respondents in the emirates of Dubai and Sharjah we also found that 97% of the respondents had confidence in local government institutions. However, interestingly we also found that while 77% of residents reported past experience with floods, household flood preparedness was markedly low. Using covariance-based structural equation modeling, we tested whether government trust mediates relationships between flood experience, risk perception, and household preparedness. The results revealed that government trust exhibited a strong negative association with flood preparedness, suggesting that institutional confidence may suppress rather than enable household protective action. Notably, flood experience was associated with reduced government trust, likely reflecting the impact of disappointment with service restoration times that exceeded individual expectations. This erosion of trust created positive mediation, indicating that flood experience was associated with increased preparedness. Conversely, higher risk perception was associated with increased trust, which was associated with reduced preparedness through negative mediation. Direct relationships between flood experience and preparedness were statistically non-significant, indicating complete mediation through the trust pathway. Socioeconomic status was positively associated with flood preparedness, with wealthier residents displaying higher protective behaviors. While these findings seem to challenge conventional disaster preparedness theory, the results align with the moral hazard and dependency arguments. Our results show that state-led disaster management in high-capacity governance systems may inadvertently create dependency that increases systemic vulnerability crowding out endogenous adaptive behavior. Building resilience in such contexts requires reframing institutional trust to emphasize shared responsibility rather than externalized protection. Full article

Background: Population ageing increases the burden of chronic diseases, multimorbidity, and functional limitations, making nutrition and lifestyle important modifiable determinants of healthy ageing. Universities of the Third Age (U3A) provide an educational and social environment for older adults, but multidimensional relationships between nutrition knowledge, diet quality, lifestyle, and health status in this population remain insufficiently characterized. This study aimed to assess these associations among older adults attending U3A in Poland. Methodology: A cross-sectional online survey was conducted between January and April 2026 among community-dwelling older adults participating in U3A programs. Of 700 distributed invitations and 520 returned questionnaires, 450 complete and eligible responses were included. The questionnaire was based on the KomPAN^® framework and expanded with items on health, lifestyle, psychosocial resources, barriers to healthy eating, and sources of health information. Diet quality was assessed using the pro-Healthy Diet Index, non-Healthy Diet Index, and overall Diet Quality Index (DQI). Nutrition knowledge was measured using a 24-item scale. Analyses included distributional diagnostics, non-parametric group comparisons, FDR-corrected Spearman correlations, psychometric assessment, principal component analysis, multivariable regression with model diagnostics, and profile segmentation. Results: The mean age was 73.63 ± 5.73 years, and most participants were women. The median DQI was 15.59 [3.93–24.86], with a predominance of neutral diet quality. Nutrition knowledge was moderate, with a median score of 12.00 [9.00–15.00], and the scale showed very good internal consistency. PCA identified three dietary patterns: convenience/ultra-processed, prudent/health-promoting, and traditional meat-and-fat. Higher DQI was associated with better nutrition knowledge, greater physical activity, a more favorable sleep profile, regular meal timing, and lower disease burden. Participants with multimorbidity had significantly lower DQI. Segmentation distinguished a health-engaged/higher-resource profile and a lower-resource/nutritionally vulnerable profile. Conclusions: U3A participants in Poland are educationally and socially active but nutritionally heterogeneous. The predominance of neutral diet quality, moderate nutrition knowledge, and identifiable knowledge gaps indicates the need for targeted, practical, and behavior-oriented nutrition education supporting healthy ageing. Full article

Background: Seasonal influenza prevention in young adults is influenced by access, trust, and vaccine information exposure, but local evidence linking vaccination uptake with illness and economic burden is limited. Methods: We conducted a non-probability, cross-sectional electronic survey of adults aged 18–49 years who lived, worked, or studied in the San Francisco Bay Area during the 2025 to 2026 influenza season. Measures included vaccination uptake, influenza-like illness, recovery, functional and economic burden, vaccination sites, and vaccine information exposure. Multivariable logistic regression examined factors associated with vaccination uptake; Kaplan–Meier and Cox models examined time to recovery. Results: Of 554 responses, 463 were included. Vaccination uptake was 86.2% (n = 399; 95% confidence interval [CI], 82.7–89.2%), likely reflecting a health-engaged convenience sample. Influenza-like illness was reported by 38.4%; median recovery time was 5 days, median missed work or school was 2 days, and median direct out-of-pocket cost was US$20. Prior season vaccination (adjusted odds ratio [aOR], 2.24; 95% CI, 1.15–4.34) and greater trust in Centers for Disease Control and Prevention (CDC) or public health agencies (aOR, 1.46; 95% CI, 1.05–2.02) were associated with vaccination. Pharmacies were the second most common vaccination site and preferred future site. Conclusions: Influenza prevention for young adults may benefit from pharmacy-inclusive, multichannel access paired with trusted communication. Findings should be interpreted in light of non-probability recruitment and likely overrepresentation of health-engaged respondents. Full article

The concept of technological singularity is discussed here in the context of architecture (of buildings, not software). This is the point at which non-human intelligence is conjectured to surpass ordinary human cognitive limits. Empirically constrained AI may already offer a useful corrective to mainstream architectural culture in one crucial aspect—its capacity to evaluate design that adapts to human emotional health. Postwar building architecture as an institutional power system rewards abstraction and stylistic conformity through media prestige while not always accounting for embodied human experience. By narrowing judgment criteria, architectural studio pedagogy trains tacitly for imitation, not seeking evidence that conflicts with dominant formal ideologies. Yet findings from environmental psychology, health-related design research, neuroscience, and recent AI-based studies show that built form measurably affects empathic response and user well-being. This paper examines what effects dominant architectural culture could impose on the public by producing informationally impoverished, stressful environments. We argue that built environment design may suffer from an epistemic closure because (i) architectural education does not foster curiosity in how design affects users—the core mechanism for intelligence development—and (ii) architectural media may legitimate non-adaptive form languages by habituating populations to ignore distress signals from geometries associated with elevated stress markers. However, empirically constrained AI can now be directed to apply that relevant knowledge base to improve the built environment. The most suggestive evidence in the paper is that LLM emotional scores, LLM geometric scores, human eye-tracking, and large public surveys converge on the same designs. In this sense, the AI singularity can be framed as a domain-specific, testable hypothesis in architecture. This paper does not report new generated results derived from Empirically Constrained Scaffolding (ECS), which appear in prior applications, but reproduces the original prompts as an illustration of the method. Full article

Regarding the reliability that explains a construct formed by a weighted sum of multiple variables, this study employs a nonmodel-based approach independent of factor models. Specifically, we generalize the conventional Cronbach’s alpha and define an estimation method that applies design weights and nonresponse adjustment weights to the reliability coefficient when using sample data from a complex sample design, and then investigate the asymptotic unbiasedness of the estimator. To support the theory, in the simulation study, we generate multivariate data to perform sampling and calculate the expectations and MSEs of the reliability coefficient estimators computed by various methods according to the combinations of weights among variables and response probabilities. Ultimately, we empirically demonstrate the population-level utility of the reliability coefficient based on variable-specific weights, as well as the unbiasedness and efficiency of its estimator using sample survey weights. In addition, two empirical examples are demonstrated to investigate the application of the reliability coefficients discussed in this paper. Full article

Background: Human exposure to environmental endocrine-disrupting chemicals (EDCs) rarely occurs in isolation, yet most epidemiological research has assessed chemicals individually. PFASs, toxic metals, phthalates, and VOCs are ubiquitous contaminants with well-documented reproductive toxicity. Objective: The aim of this study was to investigate the joint and individual effects of 28 EDCs spanning four chemical classes on six reproductive hormone biomarkers in a nationally representative U.S. population—using an innovative approach that simultaneously characterizes nonlinear mixture effects and chemical interactions across multiple exposure domains. Methods: This cross-sectional study used NHANES 2017–2018 data (n = 9254). Multivariable linear regression and Bayesian Kernel Machine Regression (BKMR) characterized individual and mixture associations, respectively. Missing data were handled using multiple imputations by chained equations. Survey design weights were applied in linear regression models. Results: Linear regression revealed heterogeneous associations across chemical classes and hormones. PFOA was positively associated with SHBG (β = 12.35; 95% CI: 8.33, 16.38) and LH (β = 6.91; 95% CI: 1.44, 12.38), while mercury was inversely associated with estradiol (β = −3.38; 95% CI: −5.12, −1.65). BKMR analyses identified pronounced non-monotonic dose–response relationships and emergent mixture effects not predictable from single-chemical analyses for all six hormones. Posterior inclusion probabilities identified cadmium, PFOA, MEHP, and MBzP as the most influential predictors across hormone endpoints. Conclusions: Concurrent real-world exposure to PFASs, toxic metals, phthalates, and VOCs is associated with measurable, nonlinear alterations in reproductive hormone profiles. Chemical mixture effects cannot be reliably predicted from single-pollutant analyses, underscoring the necessity of mixture-based methodologies in environmental reproductive epidemiology. Prospective studies are needed to establish causal temporality and identify critical windows of susceptibility. Full article

Artificial intelligence (AI) is increasingly embedded in marketing work, yet employees who use AI tools may not always disclose AI’s role in producing their outputs. This study examines AI disclosure silence, defined as employees’ intentional withholding of information about the use, role, or contribution of AI tools in work-related outputs after AI has already been used. Unlike AI avoidance or resistance, this construct concerns post-adoption concealment; unlike general employee silence, it focuses on the hidden technological contribution behind visible work. Drawing on Conservation of Resources Theory and Psychological Safety Theory, the study investigates how threat-based conditions, safety and governance conditions, and AI-related capability are associated with AI disclosure silence. Data were collected through a two-wave survey of 635 marketing employees who actively used AI tools at work. The analysis combined measurement validation, Necessary Condition Analysis (NCA), fuzzy-set Qualitative Comparative Analysis (fsQCA), and explainable machine learning. The findings show that no single condition operated as a strong necessary bottleneck. Instead, AI disclosure silence appeared through multiple pathways involving AI anxiety, fear of negative evaluation, perceived creativity threat, perceived job insecurity, low trust in management, weak psychological safety, and unclear AI policy. SHapley Additive exPlanations (SHAP)-based interpretation further indicated that fear of negative evaluation, AI anxiety, perceived creativity threat, and trust in management had the strongest model-based predictive relevance. The study contributes to workplace AI and employee silence research by positioning AI disclosure silence as an emerging post-adoption disclosure construct. It also highlights the need for clear AI disclosure norms, non-punitive managerial responses, AI-assisted authorship guidelines, and psychologically safe AI-governance practices. The findings should be interpreted as configurational and predictive evidence rather than causal effects, and further scale validation across sectors and cultures is encouraged. Full article

The classic tripartite life-course model (education, work, and retirement) is under increasing pressure from rising longevity and structural labour-market change. This study examines how Millennials and Generation Z in Portugal conceptualise retirement and the life course, asking whether these cohorts adhere to a standardised, sequential logic or aspire to more fluid, multi-stage trajectories, and whether observed differences reflect generation or socioeconomic position. A cross-sectional survey of 234 participants aged 18–43 assessed perceptions of retirement, openness to non-linear life cycles, future concerns, preparation strategies, and orientations towards lifelong learning. Responses were analysed using non-parametric tests (Mann–Whitney U, Kruskal–Wallis) and multivariate linear regression, with outcomes stratified by income, education, and occupational status. Participants showed a widespread preference for greater flexibility around the tripartite sequence rather than its abandonment, the statutory retirement age persisting as a reference point. Trust in the public pension system was low and cross-cutting, with over 70% doubting its capacity to ensure an adequate retirement, while Generation Z reported significantly greater concern about losing professional purpose. Socioeconomic position was a more consistent stratifier than generation for financial preparation, which rose with income and education; distrust, by contrast, was predicted by neither socioeconomic position nor generation in multivariate models. These findings indicate that biographical deinstitutionalisation may already be underway among younger Portuguese cohorts, with structural risks increasingly individualised, carrying implications for the redesign of life-course policies and social protection systems in an era of longevity. Full article

Artificial intelligence is reshaping warehouse work through algorithmic task allocation, scanner-based monitoring, KPI feedback, dynamic scheduling, and real-time performance control. Although these systems can improve coordination and operational visibility, they also create governance risks related to fairness, transparency, autonomy, privacy, workload pressure, trust, and employee resistance. This study develops a human-centered decision framework for prioritizing algorithmic management governance packages in third-party logistics (3PL) warehousing. The main contribution is to translate employee-level governance concerns into a scenario-sensitive decision model that helps managers select appropriate governance packages under different operational pressures. The study uses survey data from 380 warehouse employees to examine key psychological and behavioral mechanisms, including procedural fairness, transparency, system/information quality, autonomy, privacy concern, workload, trust, acceptance, and resistance/disengagement. These survey-supported constructs are then converted into six governance criteria: procedural fairness, transparency and contestability clarity, system and information quality, autonomy support, privacy boundary governance, and workload protection. A seven-expert panel evaluates five governance packages under three scenarios: peak season surge, labor shortage/high turnover, and audit pressure/compliance scrutiny. Methodologically, the framework combines Dynamic Multi-Facet Fuzzy Sets to capture membership, non-membership, hesitancy, engagement, and resistance; Bayesian Network weighting to reflect dependencies among governance criteria; and PCA-based ranking optimization to generate scenario-specific and robust rankings. Comparative validation with SAW and TOPSIS is also used to assess ranking consistency. The findings show that effective algorithmic management governance is not a fixed compliance solution. Transparency, workload protection, autonomy support, privacy boundary governance, and procedural fairness become more or less important depending on the operational scenario. A2, which combines transparency, workload protection, and autonomy support, emerges as the strongest robust package. A1 performs best under labor shortage/high turnover, while A3 performs best under audit pressure/compliance scrutiny. These results suggest that 3PL warehouses should adopt adaptive governance routines that combine explainability, contestability, workload safeguards, privacy boundaries, and employee voice mechanisms. The study contributes to the literature on AI in socio-technical systems by showing how human, organizational, and ethical concerns can be embedded into an interpretable decision framework for responsible algorithmic management in logistics work environments. Full article

Innovation proficiency is widely recognized as essential to organizational competitiveness; yet, how product managers and their teams develop these proficiencies across organizational contexts remains understudied. This study examines six innovation proficiencies—Customer Empathy, Insight Generation, Idea Generation, Idea Selection, Experimentation and Learning, and Mobilizing and Executing—using a longitudinal dataset of 15,842 survey responses collected across 1066 organizations over nine years (2016–2024). Responses were analyzed using descriptive statistics, nonparametric group comparisons, correlation analysis, reliability testing, longitudinal analysis, and systematic qualitative theme extraction from nearly 50,000 responses. Insight Generation is consistently the lowest-rated proficiency despite being ranked high in importance. Organization-weighted analysis finds significant, but modest, improvement in just one of the six proficiencies (Idea Selection) over the study period and positive but non-significant trends in the others. Qualitative analysis identifies customer centricity, lack of formalized processes and data-based decision making as persistent challenges over time. These findings suggest that improvement of innovation practices depends not only on Product Managers and their teams, but on organization-wide infrastructure changes to facilitate and support their innovation work. Full article