Search Results (9,153)

This study investigates the adoption and utilisation of hidden roof construction as an innovative alternative to traditional roofing systems in Ghana’s urban housing. Although hidden roofs offer advantages in climate adaptability, aesthetics, and cost efficiency, their adoption remains limited. Using a survey-based partial least squares structural equation modelling approach, this study identifies the factors influencing their acceptance and use. Quantitative data were collected through field surveys from residents and construction professionals within the Kumasi Metropolitan Area. A structured questionnaire was administered using purposive and convenience sampling, yielding 175 valid responses from a total of 220 distributed questionnaires (79.5% response rate). Findings indicate that hidden roof systems are valued for their climatic suitability, particularly their resistance to water leakage and reduced heat absorption, alongside their efficient drainage design. Aesthetic appeal, cultural relevance, and ease of maintenance also emerged as key determinants of positive perception and adoption. Structural analysis confirmed significant positive relationships between design concept, aesthetic and social values, sustainability, functionality, and overall acceptance. The study provides practical guidance for architects, engineers, developers, and policymakers seeking to promote sustainable, user-centred roof design in tropical urban contexts. Findings are, however, limited to Kumasi and may not fully generalise to other Ghanaian cities. Full article

Previous research identified three reasons for valuing nature (i.e., the basis for seeing nature as valuable and important): (1) valuing nature for what it gives to humans (instrumental), (2) valuing nature for its own sake (intrinsic), and (3) valuing nature because of the relationship between people and nature (relational). Of these, relational value-bases have been less studied, especially in non-Western cultures. Using a large sample (n = 2618), with participants from five distinct cultural regions (Japan, Taiwan, Italy, France, USA), the present research tests whether a three-factor framework of environmental value-bases generalizes to other cultures. Our findings demonstrate the configural and metric invariance of the recently validated Environmental Value-Bases Scale, indicating that the latent constructs generalize across sub-samples of the five regions and that the measure can be used to test associations between the value-bases and outcomes across cultures. However, we only found partial scalar invariance, suggesting (a) that caution is needed when comparing scale means between cultures and (b) that such tests are most appropriately performed using latent means. This research further contributes to the growing value-basis literature by comparing the latent means for each value-basis between and within each of the five regions and by demonstrating their associations with place attachment. Full article

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success. Full article

In the context of urban cultural heritage tourism, this study examines how visitors’ expectations and perceptions contribute to satisfaction and loyalty. We develop and validate an integrative model using structural equation modeling (SEM) on data collected from a large-scale visitor survey of Lingnan classical gardens in China, supplemented by quantitative simulation analysis. The results reveal that Cultural Expectation (CE) and Spatial Expectation (SE) serve as key antecedents to Perceived Cultural Immersion (PCI) and Perceived Spatial Aesthetics (PSA), respectively. PCI and PSA both positively influence visitors’ Perceived Value (PV), which in turn drives overall Satisfaction (SAT) and ultimately enhances Loyalty (LOY). Notably, PCI and PSA act as mediators in the model, channeling the influence of initial expectations into value perception and satisfaction. By highlighting the roles of cultural immersion and spatial aesthetics, this research extends the perceived value–satisfaction–loyalty paradigm in cultural heritage tourism. Theoretically, it bridges urban cultural heritage and environmental psychology with place-attachment theories. Practically, the findings offer guidance for cultural landscape management and visitor experience enhancement, suggesting that narrative storytelling, interactive cultural engagement, and authentic spatial design can elevate perceived value, satisfaction, and loyalty. This article will provide valuable reference material for urban planners. Full article

Background/Objectives: Human trafficking is a serious violation of human rights, with migrant women being among the most affected groups. This study aimed to explore the experiences of health, legal, and social professionals involved in the care of migrant women victims of trafficking and sexual violence in southern Spain. Methods: A qualitative design was applied, using semi-structured interviews with 47 professionals from hospitals, NGOs, and legal institutions. Results: The analysis identified common challenges such as language barriers, limited resources, and the absence of standardized protocols. Health professionals highlighted the need for continuous training and culturally sensitive care; legal professionals emphasized flexibility in procedures and the importance of confidential interviews for early detection; and social workers stressed the value of coordinated action across sectors. Conclusions: The findings underline the need for an integrated approach that combines health, social, and legal responses in order to improve protection and support for migrant women victims of trafficking. Full article

Oral squamous cell carcinoma (OSCC) is an aggressive epithelial malignancy with high local invasiveness and a tendency for early cervical lymph node metastasis. Conventional prognostic markers often lack precision. This study evaluated the expression of putative cancer stem cell markers—CD44, CD133, and CD166—in OSCC tissues and explored their associations with clinical parameters, including salivary flow rates. Twelve patients with histologically confirmed OSCC (9 males, 3 females; mean age: 65 years) were included. Clinical TNM staging and tumor dimensions were recorded. Depth of invasion was measured histologically. Tumor tissues were enzymatically dissociated to establish primary cell cultures, and flow cytometry was used to quantify putative cancer stem cell markers expression. Unstimulated salivary flow rates were measured using sialometry. CD44 expression was uniformly high (median: 96.4%) and CD166 showed moderate to high expression (median: 85.5%), while CD133 was low (median: 1.5%). Co-expression levels were the highest for CD44+/CD166+ (median: 86.6%). Triple-marker co-expression had a median of 2.0%. Depth of invasion was positively correlated with CD133+ and its co-expression with CD44+ and CD166+ (p ≤ 0.05). Salivary flow rates were negatively correlated with CD166+ and CD44+/CD166+ expression (p ≤ 0.01). These findings suggest putative cancer stem cell markers, particularly CD133, may have prognostic value in OSCC and warrant further investigation. Full article

This study examined residents’ perceptions, preferences, and experiences of urban green spaces in four regional units of the Region of Attica—West Athens, Central Athens, South Athens, and Piraeus—demonstrating how demographic diversity, urban morphology, and external stressors—such as extreme heat and the COVID-19 pandemic—shape green space use. The results show that, while green spaces are essential for health, well-being, and social cohesion, their distribution is uneven, which limits their availability (27.3%) and access (21.8%) to residents. Main concerns expressed by residents when visiting green spaces and open green spaces are poor maintenance (50.7%), lack of security (36.7%), and socially irresponsible behaviour (e.g., littering, vandalism) (32.8%). Extreme heat emerged as a major constraint on outdoor activities, particularly affecting women and the elderly. Household-associated outdoor areas (balconies, courtyards, and verandas) were highly valued (59.8%), highlighting the role of private green spaces in dense urban environments. Major metropolitan parks were the most visited and valued by residents for providing contact with nature (23.0%) and benefiting from stress relief (54.0%) while practicing their favourite activity, though their use was limited during heatwaves (30.3% of the residents do not visit). Most activities during and after the COVID-19 pandemic were reported unchanged, though reported increases in walking (34.3%) and park visits (28.3%) demonstrate the importance of green spaces in fostering urban resilience. However, the reported lack of engagement in gardening (48.0%), indoor plant care (41.2%) and bird/wildlife watching (58.3%) suggest missed opportunities for ecological and cultural enrichment. Overall, the study underscores the urgent need for integrated planning strategies to improve accessibility, maintenance, and equity in green space provision. By aligning with the sustainable development goals, the four regional units of the Region of Attica can transform its green infrastructure into an inclusive, resilient system that supports public health, social inclusion, and climate adaptation. Full article

Earthen heritage in desert oases reflects local identity, craftsmanship and traditional knowledge but is facing increasing threat of disappearance from material vulnerabilities, social abandonment and unsuitable interventions. This study develops and validates a novel decision-making tool to guide stakeholders in selecting the most suitable building technology for the adaptive reuse of earthen heritage complexes to ensure their long-term sustainability while maintaining their cultural and social values. The proposed methodology combines the Integrated Value Model for Sustainability Assessment (MIVES) and Delphi technique to evaluate the cultural, economic, environmental and social aspects. Quantitative and qualitative indicators were defined through literature review and weighted by experts in two rounds of Delphi to obtain comparable sustainability index for each building technology. The evaluation of economic and environmental aspects was based on literature data, while cultural and social aspects were assessed through a third round of Delphi with local participants. The tool was applied to the Adrere Amellal Ecolodge in Siwa Oasis, Egypt, comparing three building technologies: Karshif traditional earthen technique, commonly used red bricks and innovative 3D-printed saltblocks. Karshif achieved the highest sustainability index (0.77) due to its cultural values, social acceptance and environmental performance. The findings demonstrate the potential of traditional earthen techniques to ensure sustainable adaptive reuse, providing a replicable method for sustainable adaptive reuse of earthen heritage in desert oases in Egypt and worldwide. Full article

Acid-base analysis is a high-load diagnostic skill that many medical students struggle to master when taught using traditional text-based flowcharts. This multi-institution mixed-methods study evaluated a novel visual mnemonic algorithm that integrated Medimon characters, symbolic imagery, and pop-culture references into the standard acid-base diagnostic framework. First-year medical students (n = 273) at six distributed WWAMI campuses attended an identical lecture on acid-base physiology. Students at five control campuses received the original text-based algorithm, while students at one experimental campus received the Medimon algorithm in addition. Achievement was measured with a unit exam (nine focal items, day 7) and a final exam (four focal items, day 11). A Differences-in-Differences approach compared performance on focal items versus baseline items across sites. Students at the experimental campus showed no significant advantage on the unit exam (DiD = +1.2%, g = 0.12) but demonstrated a larger, but still non-significant, medium-to-large effect on the final exam (DiD = +11.0%, g = 0.85). At the experimental site, 39 students completed the Situational Interest Survey for Multimedia (SIS-M), revealing significantly higher triggered, maintained-feeling, maintained-value, and overall situational interest scores for the Medimon algorithm (all p < 0.001). Thematic analysis of open-ended responses identified four themes: enhanced clarity, improved memorability, increased engagement, and barriers to interpretation. Collectively, the findings suggest that embedding visual mnemonics and serious-game characters into diagnostic algorithms can enhance learner interest and may improve long-term retention in preclinical medical education. Full article

Within the framework of sustainability, the parallel valorization of two challenging industrial (crude glycerol) and agricultural (olive mill wastewaters—OMWs) residues by the yeast Yarrowia lipolytica was examined. The rationale of this study was to evaluate the potential of the Y. lipolytica strain ACA-YC 5031 to produce valuable metabolites under a wide range of pH values and increasing NaCl concentrations in agro-industrial blends. OMWs were used as both microbial substrate and process water, and despite high levels of phenolic compounds in the medium and the simultaneously high initial concentrations of NaCl, appreciable quantities of dry cell weight (DCW) and metabolites were synthesized. Moreover, the growth of the strain under non-aseptic conditions was examined. The simultaneous effect of low pH (3.0) and the presence of OMWs (~2.0 g/L) notably increased the extracellular production of erythritol and the accumulation of cellular lipids (reaching Ery_max = 18.3 g/L and DCW = 38.6% w/w, respectively). In media with low pH (3.0) and high NaCl concentration (5.0% w/v), a metabolic shift towards erythritol secretion was observed (Ery_max = 27.2 g/L, with Y_Ery/Glol = 0.46 g/g). Oleic acid accumulation was enhanced by OMW presence in the medium. Full article

Food, specifically those with heritage attributes, stands as one of the distinctive forms of Intangible Cultural Heritage (ICH). To promote and preserve such heritage, brands have increasingly focused on incorporating heritage elements into the packaging. This research employs three studies conducted in China to explore how different representation styles of heritage elements (verbal vs. non-verbal) shape consumer brand preferences in food packaging. Study 1 confirmed that food packaging featuring heritage elements effectively enhances consumer brand preference. Moreover, consumers exhibit stronger preference for the verbal elements over the non-verbal ones for heritage food due to construal level theory. Study 1 also demonstrated the mediating role of perceived value. Study 2 validated that such an effect remained significant within a tourism shopping context. In addition, Study 3 revealed the moderating effect of purchase motivation. When purchasing food as a gift, consumers tend to adopt a more abstract processing level (e.g., symbolic meaning, cultural connotation), which enhances the effect of verbal heritage elements on brand preference, whereas for self-use purchases, consumers shift to a concrete processing level (e.g., taste or price), thus enhancing the effect of non-verbal representation style. This research enriches the research on heritage element application in food marketing, and offers suggestions for packaging design for heritage food. Full article

The main objective of this paper is to investigate how the interest in the value of performing arts and the awareness of the value of performing arts among local youth in Dhofar can influence their inclinations towards performing arts. Moreover, we have incorporated the perceived brand equity of the Dhofar region as a moderator in the proposed model. A structured questionnaire was administered to a sample of young residents in the Dhofar region (N = 415). The measurement instrument was developed based on the established literature concerning youth behavior, territorial branding, and the perceived value of performing arts. All items were measured using five-point Likert scales. The main theoretical constructs were operationalized as arithmetic means (composite scores) of their corresponding items: VPA (Value of Performing Arts, 9 items), APA (Awareness of Performing Arts, 10 items), YI (Youth Inclination, 11 items), and DBE (destination brand equity). Data analysis proceeded in several stages using Stata 17. The paper concludes that there is a positive and statistically significant effect of VPA on YI. Furthermore, our results confirmed that there is a positive relationship between the awareness of performing arts and youth inclination towards performing arts. Moreover, the results indicated that destination brand equity is not a significant moderator in the relationship, which means that there is no moderating effect of DBE that was confirmed on either path. This study underscores the need of preserving intangible cultural heritage by stimulating interests and developing suitable practices to make the Dhofarian youth inclined towards performing traditional arts. The findings of this study offer some policy implications to policymakers to sustain creating an interest in valuing traditional arts performance and increasing the awareness of these types of events, which are influential factors in shaping youth inclination towards performing traditional arts. The study suggests that generating awareness is vital in creating the intention among local youth to perform traditional arts. These findings suggest that policymakers provide support for traditional art performances by devising an institutional policy that provides structural support to increase interest and awareness. The paper is an original contribution as it has provided insights into how the extent of the interest in the value of performing arts and the awareness of the value of performing arts could influence the inclination of local youth to perform art activities in the Dhofar region. Secondly, this study explores whether perceived brand equity moderates this relationship. Full article

Promoting pro-environmental behavior among university students is a critical component of advancing sustainability in higher education. This study investigated how sustainability education influences students’ environmental behavior through internal psychological mechanisms and the enabling role of institutional support. Drawing on the Theory of Planned Behavior and integrating the concept of psychological commitment, by constructing a moderated mediation model, this research reveals how educational and psychological factors, supported by external incentives, collectively shape students’ environmental intentions and actions. Using structural equation modeling, the results confirm that sustainability education significantly improves pro-environmental intentions and behaviors, mediated by students’ psychological commitment to environmental values. The findings underscore the importance of embedding sustainability education into academic curricula, fostering a culture of environmental responsibility and reinforcing behavioral intentions through supportive institutional environments. Practical recommendations are proposed for universities seeking to design more effective environmental education strategies and build greener campus communities. Full article

Objective: Previous reports showed that periodontopathic bacteria induce epithelial–mesenchymal transition (EMT) in oral squamous cell carcinoma (OSCC). Fisetin, a foodborne flavonoid, is reportedly associated with anticancer potential in various carcinogenic processes. This study aimed to elucidate the effects of fisetin on Fusobacterium nucleatum- and Porphyromonas gingivalis-induced EMT in OSCC cells. Methods: OSCC cells were co-cultured with live and heat-killed forms of F. nucleatum and P. gingivalis. The concentration of fisetin was set at 10 μM. Morphological changes in the OSCC cells were observed under a light microscope. Cell viability was measured using the Cell Counting Kit-8 assay, whereas migration was examined via wound healing. The mRNA expression of EMT-related markers was quantified using quantitative real-time polymerase chain reaction (PCR), and the expression of EMT-related markers and Wnt pathway-associated proteins was examined via Western blotting. Results: At a multiplicity of infection (MOI) of 300:1 for F. nucleatum and 100:1 for P. gingivalis, OSCC cell viability remained unchanged; however, wound closure rates increased significantly relative to the control. Likewise, treatment with fisetin (10 µM) did not materially alter viability; nevertheless, it attenuated promigratory effects induced by heat-killed periodontal pathogens at 3 h and 6 h. The OSCC cells exhibited EMT-like morphological changes after 6 h of co-culture with heat-killed pathogens. Consistently, reverse-transcriptase quantitative PCR and Western blot analyses showed increased expression of TWIST, ZEB1, and N-cadherin, accompanied by decreased E-cadherin expression, which was more pronounced in F. nucleatum than in P. gingivalis. However, fisetin reversed these trends. Moreover, co-culture with heat-killed pathogens markedly elevated β-catenin protein levels. In line with modulation of canonical Wnt/β-catenin signaling, fisetin and a Wnt inhibitor reduced β-catenin expression, whereas co-treatment with a Wnt agonist restored β-catenin levels in the presence of fisetin. Conclusions: Heat-killed F. nucleatum and P. gingivalis induced EMT in OSCC cells, with F. nucleatum exerting the strongest effect. Fisetin suppressed pathogen-driven EMT, at least partly via canonical Wnt/β-catenin signaling, highlighting its potential therapeutic value and warranting further investigation. Full article

While numerous researchers and practitioners view overtime as uniformly detrimental, growing evidence reveals complexity and overlooked benefits, particularly for social inclusion. This study focuses specifically on the impact of overtime work on social inclusion within the framework of Chinese culture and institutions, as well as the moderating effect of environmental factors. Drawing on extended-self theory, we propose that as overtime hours increase, the association between work hours and social inclusion becomes U-shaped. By contrast, this association may be moderated by environmental factors, such as work value. As expected, by conducting hierarchical regression analysis following Janssen’s three-step procedure, a sample (n = 529) of Chinese employees from the China Labor-Force Dynamics Survey (CLD) supported that the U-shaped relationship between overtime work and employees’ social inclusion. In addition, the curvilinear association between overtime work and social inclusion is significantly moderated by employees’ work values. The findings align with sustainability agendas that emphasize decent work, inclusion, and long-term employee well-being. Theoretical and practical implications are discussed. Full article