Objective: To explore the risk factors for severe Chlamydia pneumoniae pneumonia (SCPP) in children and construct a predictive model. Methods: The retrospective cohort study included 179 children with Chlamydia pneumoniae pneumonia admitted to the Children's Hospital Affiliated to Zhengzhou University between January 2024 and June 2025. Their general information, clinical symptoms, and main laboratory indicators were collected. The included patients were randomly divided into a training cohort and an internal validation cohort at a ratio of 7:3, and were further categorized into SCPP and non-SCPP groups according to disease severity. In the training cohort, univariate analysis, Lasso regression and multivariate Logistic regression were used to screen the risk factors for SCPP in children, and a nomogram model was constructed. Model performance was validated in both the training and internal validation cohorts using receiver operating characteristic curve, calibration curve, Hosmer-Lemeshow test, decision curve analysis and clinical impact curve. Results: Of the 179 children with Chlamydia pneumoniae pneumonia, there were 106 males and 73 females, including 125 cases in the training cohort and 54 cases in the internal validation cohort. In the training cohort, there were 60 cases in the SCPP group (37 males and 23 females) and 65 cases in the non-SCPP group (39 males and 26 females). In the internal validation cohort, there were 25 cases in the SCPP group and 29 cases in the non-SCPP group. Multivariate Logistic regression analysis showed that co-infection (OR=2.66, 95%CI 1.04-6.79), fever duration (OR=1.94, 95%CI 1.07-3.54), erythrocyte sedimentation rate (OR=2.38, 95%CI 1.30-4.38), interleukin-8 (OR=2.04, 95%CI 1.17-3.55), lactate dehydrogenase (OR=1.84, 95%CI 1.06-3.19) were independent risk factors for SCPP in children (all P<0.05). The areas under the receiver operating characteristic curve were 0.88 (95%CI 0.82-0.94) and 0.83 (95%CI 0.73-0.94) in the training cohort and internal validation cohort, respectively. Calibration curve and Hosmer-Lemeshow test showed high consistency between model predictions and the actual situation (training cohort P=0.787; internal validation cohort P=0.680). Decision curve analysis revealed that the model yielded positive net benefit within the threshold probability range of 8%-90%. Clinical impact curve analysis confirmed that the model could accurately screen intervention subjects. Conclusions: Co-infection, fever duration, erythrocyte sedimentation rate, interleukin-8, and lactate dehydrogenase were identified as independent risk factors for SCPP in children. The constructed SCPP nomogram model for children based on the above risk factors has good predictive accuracy and provides support for clinicians to identify children with SCPP at an early stage.

This study investigates the relationship between customers' intention to purchase health insurance in Northern India and perceived behavioral control (PBC), which is based on the decomposed theory of planned behavior (DTPB). Three core dimensions of PBC are identified: social influence, perceived ease of access and financial affordability, discovered through the use of exploratory factor analysis (EFA). The study further investigates how gender and marital status moderate these relationships to inform targeted marketing strategies. Convenience sampling was used to gather primary data through an online poll with 400 participants. The three PBC dimensions were extracted and validated using EFA, and their direct impacts on purchase intention were then tested using partial least squares structural equation modeling (PLS-SEM). Moderation effects by marital status and gender were investigated using multi-group analysis (MGA), which produced strong t-statistics and p-values. PLS-SEM reveals perceived ease of access is the best predictor of purchase intention (t=6.070, p<0.001), followed by social influence (t=4.400, p<0.001) and financial affordability (t=5.486, p<0.001). Financial affordability and social influence have a greater impact on women, whereas perceived ease of access had a greater impact on males, according to MGA, which shows significant gender-based moderation. These associations are also moderated by marital status; married people react more strongly to accessibility, whereas single people are more impacted by affordability and social influence. These results offer practical applications for lawmakers and insurance companies undertaking business in developing nations. The study makes recommendations for future longitudinal and cross-cultural research while acknowledging the drawbacks of convenience sampling and a cross-sectional approach. This study examines the dimensional structure of PBC in relation to health insurance purchase intention in a developing-nation situation by integrating PLS-SEM and EFA in a novel way inside the TPB framework. It fills a major vacuum in culturally nuanced consumer Behavior research in emerging nations and provides actionable data for insurers looking to segment their marketing strategies by revealing innovative moderations based on gender and marital status.

Objective: To explore the efficacy of the implementation of quality control (QC) program for children with fulminant myocarditis (FM) on improving the survival rate, reducing mortality and complication rates, and to evaluate the feasibility of the QC protocol. Methods: A retrospective cohort study was conducted. A Clinical Medical Quality Control Scoring Scale for Pediatric Fulminant Myocarditis (the QC Scale) was implemented since January 2021. Clinical data and the QC Scale data of 187 children with FM admitted to 8 tertiary hospitals capable of pediatric extracorporeal membrane oxygenation (ECMO) treatment over 6 years were collected, including the pre-QC group (January 2018 to December 2020) and the post-QC group (January 2021 to December 2023). Independent-samples t-test, Mann-Whitney U test, Chi-square test or Fisher's exact test were used for intergroup comparisons; and multivariate Logistic regression was performed for risk factor analysis. The clinical characteristics of pediatric FM and the feasibility and clinical efficacy of the QC protocol were evaluated. Results: A total of 187 children with FM were enrolled, including 82 cases in the pre-QC period and 105 cases in the post-QC period. The age was (8±4) years, and the weight was (28±14) kg. There were 104 female cases (55.5%) and 83 male cases (44.5%). A total of 156 children survived and 31 died, with an overall in-hospital mortality rate of 16.6% (31/187). The completion rates of electrocardiogram or cardiac monitoring and echocardiography or non-invasive hemodynamic monitoring within 30 min after admission were 98.7% (81/82) and 92.6% (72/82) in the pre-QC group, compared with 96.2% (101/105) and 90.5% (95/105) in the post-QC group. The post-QC group showed significantly higher completion rates of blood lactate measurement and Glasgow Coma Scale assessment within 60 min of admission than the pre-QC group (86.5% (71/82) vs. 98.1% (103/105), 62.2% (51/82) vs. 81.9% (86/105), χ²=9.43, 8.72; P=0.002, 0.003). The pre-QC completion rates of reaching blood lactate ≤5 mmol/L, central venous oxygen saturation ≥65%, and urine output≥1 ml/(kg·h) at 12 h after treatment were 82.1%(46/56), 72.1%(31/43) and 72.7%(48/66), respectively, compared with 81.1%(77/95), 69.1%(47/68) and 80.9%(76/94) in the post-QC group. The time from admission to ECMO initiation was shorter in the post-QC group than in the pre-QC group ((11±17) vs. (7±10) h, t=2.09, P=0.037). The mortality rates were 22.0% (18/82) in the pre-QC group and 12.4% (13/105) in the post-QC group. Compared with the pre-QC group, the post-QC group presented decreased rates of pre-ECMO cardiopulmonary resuscitation, cerebral injury and severe renal injury (51.2% (42/82) vs. 28.6% (30/105), 19.5% (16/82) vs. 8.6% (9/105), 19.5% (16/82) vs. 8.6% (9/105); χ²=9.97, 4.76, 4.76, all P<0.05). Conclusions: The implementation of the QC protocol for pediatric FM improves the ability of organ injury identification and standardized treatment, facilitates timely ECMO initiation, reduces the occurrence of cardiac arrest and major complications, and is of great significance for improving long-term quality of life. The pilot hospitals achieves high completion rates of QC indicators, indicating good feasibility of the protocol.

The issue of employee absenteeism presents a continual obstacle to the effectiveness of organizations, especially within sectors that rely heavily on labor. This research introduces an innovative probabilistic framework that employs Bayesian Belief Networks (BBNs) to forecast the risk of absenteeism as well as the absenteeism rate, tackling the intricate and uncertain relationships among various contributing factors. By employing thorough factor analysis and drawing on expert insights, we systematically identify and organize essential variables spanning personal, organizational, familial, health-related, and external domains. The model integrates the insights of experts and addresses the challenge of limited data by employing a functional interpolation technique to develop conditional probability tables. Two models based on Bayesian Belief Networks have been developed: one assesses the probability of an employee being absent on a specific day, while the other predicts absenteeism rates on a monthly basis. The Monte Carlo simulation serves as a valuable tool for addressing the uncertainty inherent in essential input variables. The validation process, which includes scenario, sensitivity, and diagnostic analyses, highlights the strength and relevance of the models. This study presents a practical and scalable resource for decision-makers to evaluate and address absenteeism, particularly in contexts where data may be limited. • Develops two models to predict absenteeism risk and absenteeism rate. •Applies Bayesian Belief Networks to model uncertainty. •Introduces a structured expert elicitation approach. •Enables customization using factor analysis. •Validated through real-world manufacturing case study.

This study aimed to develop and validate the Community Development Competency Scale (ComDe-Scale) for public health nurses (PHNs) working in Community General Support Centers (CGSCs) in Japan. A nationwide cross-sectional survey was conducted with all 5495 CGSCs, yielding 1562 valid responses (28.4%). Item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed to examine the factor structure, internal consistency, and construct validity. Hypothesis testing included correlations with the Network Establishment Practices Scale (NEPS) and subgroup comparisons by CGSC experience and managerial status. Convergent and discriminant validity were assessed using average variance extracted (AVE), composite reliability (CR), and the Fornell-Larcker criterion. Measurement invariance across management types (direct vs. outsourced) was evaluated through multigroup CFA. The ComDe-Scale demonstrated a three-factor, 20-item structure: (1) Strategic Management for Driving Community Health, (2) Empowerment for Interprofessional and Organizational Collaboration, and (3) Community-Rooted Outreach for Building Networks. Model fit indices indicated a good fit (CFI = 0.955, RMSEA = 0.060). Internal consistency was high (Cronbach's α = 0.845-0.946). All hypotheses for construct validity were supported (p < .001). Convergent validity (AVE = 0.569-0.589, CR = 0.842-0.941) and discriminant validity (√AVE > inter-factor correlations) were confirmed. Partial measurement invariance was observed across management types. The ComDe-Scale demonstrated satisfactory reliability and validity and can serve as a practical tool for evaluating and strengthening the competencies of PHNs engaged in community development at CGSCs.

Validity and reliability of the Turkish version of the hand scleroDerma lived experience scale.

This study investigated the relationships of language aptitude (LA) with working memory (WM) and their predictive roles in explaining third language (L3) comprehension. A sample of L1 Turkish-speaking English language teaching majors (N = 109) completed the LLAMA version 3 (Meara & Rogers, 2019), forward digit span, rotation, symmetry, and operation span tasks (Foster et al., 2015). L3 listening and reading comprehension measures were also administered to a subgroup of participants with L3 learning experience (N = 33). A factor analysis indicated verbal/phonological memory (digit span, operation span, and partially LLAMA D), visuospatial WM (symmetry and rotation span), and LLAMA (LLAMA B, E, F, partially D) factors. The L3 experience was not significantly correlated with any of the cognitive factors. The cognitive factors did not significantly contribute beyond L3 experience in explaining variance in L3 reading and listening comprehension. Findings were discussed regarding the verbal abilities shared by LA and WM and the potential sources of variation within L3 experience in young adult populations.

Psychometric evaluation of the SPEED questionnaire: Factor structure and measurement invariance across contact lens wearers and non-wearers, sex and age.

Reliable and valid assessment tools are critical for evaluating and improving primary school students' hand hygiene behaviors, yet corresponding adaptable assessment methods are currently limited. We aimed to develop and validate a Hand Hygiene Behavior Questionnaire for Primary School Students (HHBQ-PSS). Cluster sampling recruited 376 Grade 4-5 students from two central primary schools. The 15-item HHBQ-PSS encompasses three dimensions (capability, opportunity, motivation) of hand hygiene, using a 5-point Likert scale. HHBQ-PSS was evaluated through internal consistency reliability, split-half reliability, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The Cronbach's α coefficient of HHBQ-PSS was 0.844, and all Cronbach's α coefficients remained above 0.750 after corresponding dimensions were deleted. The Spearman-Brown coefficient was 0.784. EFA extracted four common factors (cumulative variance contribution rate = 58.67%). CFA confirmed adequate model fit (χ2/df = 2.832, CFI = 0.905, GFI = 0.927, AGFI = 0.893, and RMSEA = 0.070). The reliable and valid HHBQ-PSS may inform the implementation of targeted health interventions and the improvement of hand hygiene levels among primary school students. HHBQ-PSS demonstrates good reliability and validity to assess hand hygiene behaviors in Chinese primary school students.

GmSOD from Glycine max fine-tunes H2O2 homeostasis to coordinate antioxidant defense and citrate exudation under aluminum stress in Nicotiana benthamiana.

BackgroundWith the rise in cancers, palliative care (PC) is increasingly important for improving the quality of life for patients and families. Systematically assessing PC needs is crucial for providing appropriate services.ObjectiveTo develop and validate an instrument (Palliative-care-Need Assessment-Tool [P-NAT]) to identify PC needs of cancer patients.MethodsMixed-method sequential exploratory design was used. The P-NAT development and validation was done in 3 phases: item generation & reduction, scale development, and scale evaluation. Items were generated in English based on literature and key informant interviews followed by item reduction with expert opinion. Forward and backward translation done (Sinhala/English). Translated Sinhala version was assessed for face and content validity. Exploratory Factor Analysis (EFA) was done with 302 subjects. Construct validity was assessed through Confirmatory Factor Analysis (CFA) on another 309 participants, followed by convergent validity in a subsample of 201. Test-retest reliability and internal consistency were assessed using Spearman r and Cronbach α, respectively.ResultsAfter reduction, 53 items were selected for the scale. The EFA identified 12 factors with 45 items. The CFA confirmed an 8-factor model as the best fit (root mean square of approximation = 0.068, CFI = 0.96, PNFI = 0.85). The overall scale had Cronbach α 0.919, Spearman r 0.986 (P < .01). Spearman r coefficient between P-NAT and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire was 0.668.Conclusions and recommendationsThe P-NAT is a valid, reliable tool to assess PC needs among cancer patients. The P-NAT is recommended for rapid comprehensive assessment at hospital and community settings.

Pelvic floor dysfunctions (PFDs) are common but frequently underdiagnosed. While the initial measurement of patient-reported pelvic floor complaints tool (IMPACT) standardizes PFD symptom assessment across specialties, a validated Arabic short form for bowel function has not been available. This cross-sectional study recruited Arabic-speaking adults with clinically diagnosed PFD from colorectal, gynecology, and urology clinics (November 2024 to July 2025). Translation followed international guidelines with expert review and pilot testing. Validity was assessed through face/content evaluation, Pearson correlation, and factor analysis; reliability was assessed using Cronbach's alpha. Associations with demographic and clinical variables were examined using t -tests and ANOVA. A total of 205 participants were included, with a mean age of 33.5 ± 9.4 years; 86.3% were female and 66.3% married. Face and content validity were confirmed, and two items were removed after item analysis. Final item-total correlations were significant. Factor analysis revealed 11 factors, accounting for 80.05% of the variance. Internal consistency was excellent (Cronbach's alpha = 0.922). Higher IMPACT scores were associated with asthma (77.7 ± 41.1, P = 0.002), neurological disorders (68.7 ± 27.8, P = 0.030), and chronic disease (59.2 ± 26.5 vs. 51.1 ± 22.9, P = 0.034). Marital status also influenced scores, with widowed/divorced individuals reporting the highest burden (64.4 ± 45.8, P = 0.019). Bristol Stool Type 1 was strongly correlated with symptom severity (60.2 ± 23.3, P = 0.011). The Arabic IMPACT bowel function short form is a valid and reliable instrument. Its adoption may enhance culturally appropriate care, and facilitate standardized evaluation of bowel-related PFD symptoms among Arabic-speaking populations.

Development and psychometric validation of the Adolescent Self-Harm Risk Assessment (ASRA) Scale: A multi-dimensional approach.

Mental health literacy (MHL) is a key determinant of help-seeking behavior and the utilization of mental health services. Currently, no validated instrument is available in Bangladesh to assess MHL. This study aimed to culturally adapt and evaluate the psychometric properties of the Bangla version of the Mental Health Literacy Scale (MHLS-Bangla). Three tertiary care hospitals were purposively selected, and nursing students were randomly recruited. Data were collected through face-to-face administration in classroom settings (N = 224). The MHLS was adapted using a standardized process including translation, synthesis, back-translation, expert review, and pretesting. The MHLS-Bangla comprises 35 items reflecting key domains of MHL: mental illness and treatment, mental health promotion, help-seeking, stigma and attitude. Exploratory factor analysis using Principal Axis Factoring supported a four-factor structure with acceptable sampling adequacy (KMO = 0.67; Bartlett's test p < 0.001), explaining 19.1% of the total variance. Most items loaded ≥ 0.30 on a single factor, with a small number showing weaker or cross-loadings. Internal consistency for the total scale was acceptable (α = 0.75; ω = 0.75). The confirmatory factor analysis (CFA) was not conducted due to sample size limitations. The mean MHL score was 19.78 (SD = 4.82) out of 35. The MHLS-Bangla provides a culturally adapted instrument with preliminary evidence of reliability and construct validity for assessing MHL in Bangladesh. Further validation in larger and more diverse populations is recommended to strengthen its psychometric robustness and broader applicability.

Teacher education and the European education area: A scale development study.

This study aimed to develop and validate the Parental Mental Health Literacy (PMHL) Scale for caregivers of children aged 0-6 years. Initial items were developed based on established mental health literacy and health literacy frameworks and were piloted among 1074 caregivers of children aged 0-6 years in Shanghai, China. Exploratory factor analysis using principal axis factoring with oblique rotation identified a four-factor structure. Confirmatory factor analysis was subsequently conducted to examine the dimensionality of the scale and to compare alternative models, including one-factor, higher-order, and bifactor models. The bifactor model demonstrated the best fit to the data (RMSEA=.088, CFI=.931, TLI=.917). The final version consisted of 28 items across four dimensions: recognition, help-seeking, awareness of parenting and parent-child interaction. Criterion validity was examined using the Strengths and Difficulties Questionnaire (SDQ) and the Early Warning Signs Checklist (WSC). PMHL scores showed modest negative correlations with children's emotional and behavioral difficulties. Internal consistency was high (Cronbach's α=.98; ωh=.89). These findings suggest that the PMHL may serve as a useful instrument for assessing parental mental health literacy in early childhood, although further validation in more diverse samples is warranted.

The Color-Blind Racial Attitudes Scale (CoBRAS; Neville et al., 2000) is a widely used measure of color-blind racial ideology, a belief system that minimizes the significance of race and race-based systemic inequities. Despite its widespread use and promise, questions remain regarding the CoBRAS's dimensionality and the validity of its scores across race and gender. This preregistered study evaluated the CoBRAS's psychometric properties using full-information factor analysis within an item response theory framework. Measurement invariance across race and gender was evaluated at both the scale and item level using multiple-group confirmatory factor analysis and differential item functioning tests. Data were drawn from four cross-sectional samples (Ntotal = 4,010). Participants who identified as Asian, Black, or White and cisgender were included in the main analyses to optimize sample size for comparisons. Factor analytic results supported a bifactor structure comprising a general dimension of color-blind racial attitudes with three specific dimensions. A reduced 18-item set excluding two misfitting items performed comparably to the full-scale overall, with modest fit gains in race-group models. Configural invariance was supported across race and gender. However, metric and scalar invariance were not supported across racial groups, suggesting that individuals from different racial backgrounds may interpret and respond to CoBRAS items differently. Across gender, the 20-item scale demonstrated configural and metric invariance but not scalar invariance, whereas the reduced item set demonstrated full configural, metric, and scalar invariance. The findings highlight the value of advanced psychometric methods in enhancing the precision of measures of sociocultural phenomena across diverse populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Development and validation of the individual and social music listening scale (ISMUS-LI)

Combined effects of warming and hypoxia on aquatic ectotherms: A multilevel meta-analysis of physiological and fitness responses.

This paper presents a computational framework for predicting the heat transfer from a burning battery energy storage system (BESS) to adjacent enclosures using computational fluid dynamics (CFD) modeling representative of a large-scale fire test (LSFT) configuration. Simulations were conducted using representative input parameters informed by literature and experimental data. The predicted heat fluxes were in agreement under quiescent conditions with three empirical models. A full factorial sensitivity analysis examined the influence of heat release rate, wind speed and direction, ventilation configuration, radiative fraction, and atmospheric absorption parameters. The results demonstrate that predicted peak heat flux and total heat transfer to neighboring enclosures are sensitive to the flame geometry resulting from the interaction of the heat release rate, enclosure ventilation, and ambient winds. The radiative fraction also impacted the predicted exposure, although atmospheric absorption had less impact in the near field. This work highlights the need to evaluate a range of scenarios when conducting a hazard assessment in BESS installations. CFD models provide a critical role in filling the gap from variability in real-world installations and statistical power of individual full-scale tests. Recommendations are provided for additional measurements in LSFTs to improve model validation and reduce uncertainty in separation distance evaluations. • Explores the impact of different potential test configurations on the heat transfer. • Presents systematic analysis of physical inputs affecting heat transfer from BESS. • Discusses the model sensitivity to combustion reaction and atmospheric attenuation. • Provides a detailed sensitivity analysis of the computational domain. • Recommends measurements to collect in LSFT to maximize value for future modeling.