Search Results (197)

Background/Objectives: Paramedics frequently encounter potentially traumatic events and workplace violence, increasing their risk of burnout. Resilience may attenuate these effects. We examined the pathways through which post-traumatic stress (PTS) and workplace violence influence burnout and clarified the role of resilience among Korean paramedics. Methods: We studied duty-related trauma and violence experienced by 208 Busan Fire Department paramedics using standardized measures of PTS, workplace violence, resilience, and burnout. Using structural equation modeling, we tested the direct and indirect effects; covariates included sex, nursing license, and intention to stay. Results: PTS was most strongly associated with burnout, whereas workplace violence was indirectly associated with burnout through PTS. Resilience reduced PTS, yielding an indirect protective effect on burnout; however, it had no direct effect on burnout. Holding a nursing license and lack of intention to stay were significantly associated with burnout, and female sex and lack of intention to stay were indirectly associated with burnout via PTS. Conclusions: Burnout is primarily driven by PTS, and workplace violence amplifies PTS and indirectly exacerbates burnout. Strengthening violence prevention/response systems, early PTS screening/treatment, and resilience-building programs is warranted, with targeted support for vulnerable subgroups. Full article

Background/Objectives: Virtual reality (VR) has been shown to reduce pain and anxiety in several specialties, but has not been investigated in the setting of steroid injections in rheumatology. We aimed to assess the impact of using a VR headset on pain and anxiety during epidural steroid injection via the sacral hiatus for lumbar radiculopathy. Methods: Patients received two injections via the sacral hiatus and were randomized into one of two groups: group 1 used the VR headset during the first injection and not during the second injection, while group 2 used the VR headset during the second injection but not the first. The primary endpoint was pain evaluated on a numeric rating scale. Secondary objectives were anxiety, measured using the STAI (State Trait Anxiety Inventory), and safety. These analyses were performed using the Mann–Whitney U test. Results: We included 116 patients over 18 years of age who were hospitalized in the Rheumatology department of the University Hospital of Reims and scheduled to receive at least two epidural steroid injections. We observed a significantly lower pain score during the first injection procedure (median 3 (IQ 1; 6) in group 1 vs. 5 (IQ 3; 7) in group 2, p = 0.045). The analysis for the second injection could not be performed by intention-to-treat due to the presence of a sequence effect. There was also a significant reduction in anxiety (p = 0.004 and p = 0.002 by per-protocol analysis). Conclusions: VR can significantly reduce pain and anxiety during epidural steroid injection via the sacral hiatus. Full article

In contemporary tourism, gastronomic offerings increasingly go beyond the boundaries of mere taste enjoyment, becoming an important element of the sustainable development of destinations. At the same time, food safety is gaining importance as a key aspect of the tourist experience and trust in a destination. The research was conducted in Serbia, focusing specifically on agritourism farm stays known for their local food production and sustainable hospitality practices. This study highlights the crucial link between local agricultural practices and tourists’ perceptions of food safety, positioning food safety as a key dimension of both sustainable gastronomy and rural development. The research was conducted on a sample of 650 tourists in farm stays, using a structured survey questionnaire, with data analysed through descriptive statistics, factor analysis, Pearson correlation, ANOVA, and multiple regression analysis. The results indicate that tourists highly value food safety, particularly in the context of local and traditional gastronomy, and that there is a significant correlation between the perception of food safety and the intention to revisit or recommend a destination. This study suggests that the integration of food safety standards into sustainable gastronomic practices is essential for enhancing competitiveness and building long-term trust among individuals of various sociodemographic profiles. Full article

Background/Objectives: Social Media Use has become an integral part of contemporary motherhood, with potential effects on maternal mental health and breastfeeding behaviors. This study aimed to examine the relationship between problematic social media use, anxiety levels, infant feeding attitudes, and feeding intentions among social media-native mothers. Methods: A mixed-methods design was used with 222 mothers. Quantitative data were collected using the Trait Anxiety Inventory (STAI-T), Social Media Disorders Scale (SMDS-9), Iowa Infant Feeding Attitude Scale (IOWA), and Newborn Feeding Intention Scale (IFI). Qualitative data were obtained through semi-structured interviews. Quantitative analyses explored associations between problematic social media use, anxiety, and feeding-related outcomes, while qualitative data were analyzed thematically. Results: SMDS-9 scores were generally low; only 2.7% of participants reported low feeding intention. No significant association was found between problematic social media use and breastfeeding intention or attitudes. Mothers with strong breastfeeding intentions demonstrated significantly more positive attitudes toward nursing than those with lower intentions. Higher problematic social media use was observed among high school graduates and those from high-income groups. Qualitative analysis identified two main themes of Negative Impacts and Positive Impacts, as well as five sub-themes of comparison and inadequacy, information overload, breastfeeding mistakes, anxiety, and social support. Conclusions: Problematic social media use did not directly affect breastfeeding intentions or attitudes; however, high school-educated and high-income mothers were more likely to report higher usage. Incorporating social media literacy into prenatal education and adapting tools for assessing postpartum anxiety to include indicators for problematic social media use, particularly for these at-risk groups, may support early detection, reduce stress, and promote positive breastfeeding practices. Full article

Objectives: We sought to document interim methodologic improvements and preliminary results for pulmonary suffusion. Methods: A Phase I/II trial of thoracoscopic lung suffusion for resectable sarcoma and colorectal carcinoma metastases followed a pilot study on oligometastatic lung malignancy at a comprehensive cancer center. Primary-specific chemotherapy doses (cisplatin, oxaliplatin, doxorubicin, or gemcitabine) suffused unilaterally for 30 min were escalated to amplify regional deliveries three-fold. Drug delivery was measured with tissue, blood samples, and ⁹⁹Tc; pulmonary function tests and clinical adverse events (AEs) assessed safety and tolerance. Results: From 2008–2025, 31 ECOG 0–2 patients (10 male) aged 33–75 years had unilateral lung suffusion (16 right, 14 left, 1 aborted, and 8 sides selected randomly). Vascular occlusion intolerance was immediate or delayed (25 min) in two cases. Two catheter-positioning grade 3 AEs occurred: hypotension with troponin leak (1) and atrial fibrillation (1). Patients averaged 1.3 ± 1.2 metastasectomies (17 sub-lobar, 8 lobar resections, and 2 intentional open cytoreductive metastasectomies). Hospitalizations were brief (1–4 days) except for 6–7 day stays in the only two open cases and one doxorubicin (grade 4 hypoxic respiratory failure) case. Ninety-day survival was 100%, and the Phase I delivery goal of 12.75 mg/m² 65 (15% systemic) was achieved for oxaliplatin. Lung function was preserved according to ⁹⁹Tc differentials within 6.1 ± 7.1% of the predicted reductions at 30 days. Sampling delays, tracer discordances, and atypical pharmacokinetics reduced tissue drug detections. Recent pulmonary artery snaring cases (two) demonstrated in-flow control more stable than that of balloon occlusions. Conclusions: Suffusion for metastatic malignancies appears safe and warrants further investigation. Full article

This study investigates urban life satisfaction and residents’ settlement intention as emergent outcomes of interconnected urban systems and examines the moderating role of urban regeneration budget execution as a systemic policy input. Drawing on the bottom-up spillover perspective and policy feedback theory, this study posits that satisfaction with core aspects of urban living—such as housing, transportation, and public safety—reflects the functioning of multiple interrelated urban subsystems, which accumulate into a global sense of well-being that influences settlement intention. Furthermore, when urban regeneration budgets are visibly and fully executed, they operate as institutional feedback mechanisms, leading residents to attribute their life satisfaction to effective system performance and reinforcing their desire to stay. Using survey data from Incheon Metropolitan City and Gyeonggi Province in South Korea, the study employs stereotype logistic regression to test the proposed model. The findings reveal that urban life satisfaction significantly predicts stronger settlement intention, and this effect is amplified in municipalities with higher levels of budget execution. These results contribute to theoretical understanding by linking subjective well-being with institutional performance and offer practical guidance for South Korean local governments seeking to strengthen community resilience through transparent and outcome-driven urban policy delivery. Full article

This study explores the migration intentions of university students—representing the potential creative class—in Erzurum, a medium-sized city in eastern Turkey experiencing shrinkage. Within the theoretical framework of shrinking cities, it investigates how economic, social, physical, and personal factors influence students’ post-graduation stay or leave decisions. Survey data from 742 Architecture and Fine Arts students at Atatürk University were analyzed using factor analysis, logistic regression, and correlation to identify key migration drivers. Findings reveal that, in addition to economic concerns such as limited job opportunities and low income, personal development opportunities and social engagement also play a decisive role. In particular, the perception of limited chances for skill enhancement and the belief that Erzurum is not a good place to meet people emerged as the strongest predictors of migration intentions. These results suggest that members of the creative class are influenced not only by economic incentives but also by broader urban experiences related to self-growth and social connectivity. This study highlights spatial inequalities in access to cultural, educational, and social infrastructure, raising important questions about spatial justice in shrinking urban contexts. This paper contributes to the literature on shrinking cities by highlighting creative youth in mid-sized Global South cities. It suggests smart shrinkage strategies focused on creative sector development, improved quality of life, and inclusive planning to retain young talent and support sustainable urban revitalization. Full article

We studied Galápagos barn owls on Santa Cruz Island in the Galápagos Archipelago. We collected and analyzed pellets to determine diet composition. Barn-owl diet consisted—in terms of biomass—of ~89% rodents and ~10% insects. Bird remains occurred in 1% of the pellets. Foraging was studied with data loggers, a method not previously applied to the study of Galápagos barn owls. Owls rested during the day in natural and human-built roosts such as lava holes, trees, or huts. Night-time foraging was characterized by periods during which the bird moved and periods during which the bird stayed within one place, with the latter amounting to ~56% of the time away from the day roost. Birds began foraging shortly after sunset and returned to their day roost before sunrise. The duration of foraging was approximately 11 h per night. Foraging areas were small (median value: 0.28 km²). Although our data demonstrate a continued presence of the subspecies, we regard the situation for this subspecies as labile, as multiple threats, such as road kills, poisoning, and intentional killing by farmers, have increased recently, and suggest the development of a management plan to improve its conservation. Full article

Understanding the factors that drive green buying intentions has become critical, as environmental issues continue to rise globally. The study investigates the influence of environmental commitment and green motivation on environmental identity and green purchasing intentions. Additionally, it assesses the mediating role of environmental identity in the relationships between environmental commitment, green motivation, and green purchasing intentions. Moreover, it examines the moderating effect of eco-conscious behaviour on the relationships between environmental commitment, green motivation, green identity, and green purchasing intentions. A total of 440 participants, who stayed in high-rate hotels in Sharm el-Sheikh, were asked to fill out the survey distributed. (PLS-SEM) was used to analyze data. The study outcomes confirmed that environmental commitment and green motivation significantly affect green identity and purchasing behavior. Besides, the results showed the essential mediator contribution of the environmental identity between environmental commitment and green motivation. In addition, it explains eco-conscious behavior as a moderator between the previously mentioned variables. The study contributes to the existing tourism literature by demonstrating the impact of green commitment and environmental motivation on making choices to buy eco-friendly products. Moreover, the results hold significant implications for researchers, policymakers, and tourism stakeholders. Full article

This study examines how memorable tourism experiences (MTEs) influence tourists’ intention to recommend coastal tourism destinations. Using a quantitative approach of PLS-SEM analysis and a disjoint two-stage approach, this study examines MTE as a higher-order construct (HOC) with its seven dimensions and the moderating role of coastal destination competitiveness (CDC) in structural relationships. Data were collected through purposive sampling from 339 tourists who had visited Likupang, one of the priority tourism destinations in Indonesia. The results show that MTE plays a crucial role in increasing perceived economic value (PEV) and place attachment (PLA), and it is directly related to the intention to recommend the destination (ITRD). In addition to the prominent mediation role of PEV, these findings reveal that the CDC can strengthen or weaken the influence of these factors on tourists’ intention to provide recommendations. Specifically, the CDC can strengthen PLA influence towards intention to recommend, whereas, in contrast, it weakens the PEV in driving these intentions. The findings of this study expand the horizon of managing coastal tourism with an understanding of tourist behavior, particularly through a focus on improving MTE from the dynamics of its seven dimensions in encouraging promotion through tourist recommendations while optimizing the natural competitiveness elements of Likupang. Full article

This study aimed to analyze the association of leadership with turnover intentions and whether this relationship is mediated by employee well-being. The sample consists of approximately 306 individuals working in organizations based in Portugal. The results indicate that transformational leadership has a positive and significant association with turnover intentions, while the relationship between transactional leadership and turnover intentions is negative and significant. Both transformational leadership and transactional leadership have a positive and significant association with well-being. Well-being has a negative and significant association with turnover intentions. Well-being only has a mediating effect on the relationship between transactional leadership and turnover intentions. This study contributes to the advancement of academic research and knowledge about the mechanisms through which transformational and transactional leadership styles can influence employees’ turnover intentions, as well as providing empirical evidence on the mediating role of psychological well-being. In addition, practical insights are offered to organizational leaders and managers on adopting practices that foster psychological well-being in the workplace, thereby reducing employee turnover intentions. Full article

Workplace bullying is a widespread yet rarely recognized stressor that impairs employee productivity and organizational harmony. It requires attention in the hospitality industry, where a high volume of interpersonal interactions occurs. It is essential to address employees’ overall outlook and attitudes toward hardships resulting from stressful work environments. This study examined workplace bullying by highlighting the role of psychological capital in employees’ responses to hostile work environments. The relationships among employee voice, perceived organizational support, organizational commitment, and intention to stay were further elaborated based on a conceptual model. An online survey was distributed to hotel employees, and the results were analyzed using structural equation modeling. The indirect effects of psychological capital on perceived organizational support and organizational commitment were stronger than those of workplace bullying. The results demonstrate that employees with higher psychological capital have more proactive response tendencies to workplace bullying. Full article

Background: PIPAC is an innovative treatment that delivers low-dose aerosolized chemotherapy into the abdominal cavity of patients with peritoneal surface malignancies (PSMs). However, its role in the multimodal management of PSMs is unclear. Methods: We retrospectively analyzed data from 64 patients who underwent PIPAC for PSMs of a primary or secondary origin between June 2020 and December 2024 (median age of 64 years). Primary tumor sites included gastric (42.2%), colorectal (23.4%), ovarian cancer (21.9%), and others (12.5%). The median PCI was 15 (IQR 9–25), with ascites present in 60.9% of cases and a positive cytology in 48.4%. Results: A total of 82 PIPAC sessions were performed in 64 patients. The mean operation time was 96 min. Severe adverse events, defined as the Common Terminology Criteria for Adverse Events (CTCAE) of a grade ≥ 2, occurred in four patients (6.2%). The median hospital stay was 3 days, and systemic chemotherapy was resumed within 14 days after the procedure in 27 patients. Among the entire cohort, 37.5% received bidirectional therapy and 62.5% received palliative treatment, with a lower peritoneal cancer index (PCI) in the bidirectional group (9.5 vs. 23). The median overall survival (OS) was 32 months from diagnosis. Sixteen patients (25%) underwent two or more PIPAC sessions and showed an advantage in survival compared to patients who underwent only one procedure (3-year OS: 63.2% vs. 38.4%, p 0.030). Conversion surgery was achieved in 34.4%. Patients treated with a bidirectional intent demonstrated a longer OS (3-year: 66.0% vs. 33.9%, p 0.011). Colorectal and ovarian tumors exhibited better long-term outcomes compared to gastric cancer. Conclusions: PIPAC is a promising treatment for PSMs, with a low morbidity rate. Its favorable safety and short interval to systemic therapy resumption support its use as part of a bidirectional strategy. Full article

Background/Objectives: Robotic surgery has emerged as a promising alternative to traditional approaches, offering enhanced precision and ergonomics. However, its application to pancreaticoduodenectomy (PD) remains controversial due to technical complexity and a steep learning curve. This study aims to evaluate the perioperative outcomes of robotic versus open PD at a single high-volume center, using inverse probability of treatment weighting (IPTW) to control for confounding variables. Methods: A retrospective, single-center analysis was conducted on patients who underwent PD between January 2020 and December 2024. Perioperative and oncological outcomes were compared using IPTW, aiming to balance potential confounding variables. The primary endpoint was 90-day postoperative mortality; secondary endpoints included operative time, estimated blood loss, major postoperative complications (Clavien-Dindo grade ≥ IIIa), and length of hospital stay. Results: Seventy-four patients were included in the intention-to-treat analysis (open: n = 31; robotic: n = 43). After IPTW adjustment, baseline characteristics were balanced across the groups. Operative time was significantly longer in the robotic group (median 540 vs. 479 min, p = 0.009). No significant differences were observed in 90-day mortality (4.9% both groups, p = 0.998), postoperative complications ≥ IIIa, or histopathological outcomes, including R0 resection and lymph node yield. Trends toward reduced estimated blood loss and shorter hospital stay in the robotic group did not reach statistical significance. Conclusions: Robotic pancreaticoduodenectomy demonstrates comparable safety and oncological efficacy to the open approach, with longer operative times but potential perioperative advantages. These findings support the continued integration of robotic techniques even in medium-volume centers with appropriate expertise. Full article

This study explores the factors influencing Arab tourists’ intention to revisit Turkish destinations, contributing to the theoretical discourse on tourist behavior, destination loyalty, and sustainable tourism development. Over the past decade, Türkiye (Turkey) has experienced a steady increase in tourists, with Arab visitors forming a significant segment. This growing market segment presents unique opportunities and challenges that remain understudied in academic literature. Despite their prominence, limited research exists on Arab tourists’ behavior, needs, and experiences in Türkiye. This study employs a mixed-method approach, combining surveys and interviews conducted between July and December 2024. Data from 713 surveys and 14 interviews were analyzed, revealing that 72% of Arab tourists were satisfied with their current visit, 49% with previous visits, 57% indicated a strong intention to revisit, and 81% recommended Turkish destinations to others. The study identifies seven key dimensions of revisit intention through Exploratory Factor Analysis that collectively explain 79.841% of the variance in revisit intention. The regression analysis demonstrates how different factors contribute to revisit decisions, with overall satisfaction (β = 0.622), loyalty (β = 0.521), financial status (β = 0.507), behavior of staff and locals (β = 0.484), cultural and social appeal (β = 0.478), overall experiences (β = 0.329), educational level (β = 0.333), accessibility and convenience (β = 0.288), service quality (β = 0.216), and length of stay (β = 0.128) emerging as significant predictors. These findings underscore the complexity of the decision-making process, suggesting that no single theory can fully explain tourists’ behavior and the sustainability of their visits. The study recommends further exploration of the proposed model and investments in tourism staff training, particularly in foreign languages, to enhance service quality and encourage repeat visits. Addressing issues such as unprofessional behavior and language barriers can improve overall satisfaction and loyalty, increasing the likelihood of Arab tourists revisiting Türkiye. This research highlights the importance of sustainable tourism practices in fostering long-term economic and social benefits for Turkish destinations. Full article