Fatigue is a pervasive feature of multiple sclerosis (MS) and its interaction with other MS symptoms is complex. These interactions were explored over time in a large cohort of adults with MS, using a measure reflecting a patient-based definition of MS fatigue. Participants were recruited across the UK to complete a questionnaire pack, measuring fatigue and associated demographic, clinical and symptom factors, repeated serially over up to 54months. Following conversion to interval-level estimates, data were analysed by regression, structural equation and trajectory modelling, and Classification and Regression Tree Analysis. In 6356 people with MS, the prevalence of moderate/severe fatigue was 565.4/1000 (95% CI: 553.0-577.8), with no difference between sexes but significantly higher in progressive subtypes. Peak prevalence was from age 50-64. Spasticity-related pain, physical/cognitive function, anxiety, visual problems and non-restorative sleep were associated with increased fatigue. Self-efficacy had strong influences to reduce fatigue. Use of disease modifying treatment was associated with worse fatigue. Trajectory analysis showed four groups, 28.9% have ongoing severe fatigue, 66.3% fall into two worsening fatigue groups with different inception points. Only 4.9% had low, stable fatigue. These four groups varied significantly by MS subtype, EDSS, symptoms, comorbidity, and employment. The risk of fatigue worsening to moderate/severe over the ensuing 27months could be predicted by sex, EDSS, vision and self-efficacy. The factors interacting with MS fatigue need consideration when managing this prevalent symptom. In addition, their effect should be accounted for in any MS trial where fatigue is an outcome.

Objective and subjective socioeconomic status affect subjective well-being through psychosomatic symptoms: A structural equation modeling analysis.

From altruistic values to sustainable entrepreneurial intention: A multiple mediation analysis using the value-attitude-behavior framework in Latin America.

Identification of major odor-causing compounds and algal causes in the Huangpu River.

Integrating optimized irrigation with soybean-wheat system for sustainable winter wheat production and environmental sustainability

This study examines the effects of perceived managerial care from head nurses and individual resilience on nurse-to-nurse lateral violence among newly graduated registered nurses and determines whether individual resilience mediates the effect of perceived managerial care from head nurses and nurse-to-nurse lateral violence. Previous studies have examined how managerial care contributes to lateral violence among nurses. However, few studies have examined how individual resilience contributes to reducing lateral violence among newly graduated registered nurses. This cross-sectional survey study used a three-stage, stratified convenient sampling method, which involved 425 newly graduated registered nurses. Participants completed the Chinese version of the Management Caring Assessment Scale, the Connor-Davidson Resilience Scale, and the Nurse-to-Nurse Negative Behaviour Scale. Structural equation modelling and mediation effect analysis were used to explore the relationships among perceived managerial care from head nurses, individual resilience, and nurse-to-nurse lateral violence. New nurses experienced moderate levels of lateral violence. The final model accounted for 76.4% of the total variance of lateral violence. Managerial care and individual resilience both had a direct effect on lateral violence. Individual resilience mediated the correlations between managerial care and lateral violence. Newly registered nurses, especially from rural areas with low levels of education and an inability to perform night shifts independently, are a special group that requires higher attention from nursing management. Head nurses' managerial care plays an important role in ensuring that new nurses adapt well to their new role and promoting the formation of psychological resilience among nurses. Nursing managers should increase the level of concern they display for new nurses, especially those from rural areas, those with low levels of education, and those who are unable to perform night shifts independently. Patients contributed to data collection through completing questionnaire surveys.

Optimizing drip irrigation and organic fertilizer management across diverse environments: Global patterns of nitrogen-driven production efficiency

The association between cyberchondria and eating disorder risk among adolescents: The mediating role of body image.

Technology or innovation alone is not enough: A SEM-fsQCA based study on intelligent automation driven supply chain resilience

Inflammatory and metabolic pathways underlying the association between PM2.5 exposure and dementia.

Squaring the circle: Is triangulation of child abuse reports helpful?

The association between positive childhood experiences and executive function among Chinese adolescents.

Short-video engagement, health-related behaviors, and mental well-being: Evidence from a longitudinal study of Chinese youth.

This study examines the role of organizational culture in mediating the influence of critical thinking and digital leadership on employee performance at the University of Muhammadiyah Aceh. Digital transformation demands that organizations have adaptive and innovative human resources, where critical thinking and digital leadership are key competencies expected to improve performance directly or through strengthening organizational culture. This study used a quantitative approach with a survey design and Structural Equation Modeling (SEM) analysis of 205 respondents who were all permanent employees of the university. The variables tested included critical thinking and digital leadership as independent variables, organizational culture as a mediating variable, and employee performance as a dependent variable. The results showed that critical thinking and digital leadership did not have a significant direct effect on employee performance, but both had a significant positive effect on organizational culture, which in turn had a significant effect on performance. Organizational culture was proven to partially mediate the relationship between critical thinking and digital leadership with employee performance. This finding emphasizes the importance of strengthening an adaptive and innovative organizational culture as a key pillar of performance improvement in the digital era. Practically, the research recommends the development of critical thinking training programs, improving digital leadership competencies, and strengthening a work culture that aligns with the university's vision and mission, as well as providing theoretical contributions to digital-based human resource management in higher education.

In the context of the strong development of sustainable eating trends, different forms of vegetarian food were born, including vegetarian buffet meals (VBM), becoming an option for youth consumers. However, the factors driving this trend have not been clarified in the current research literature. Therefore, to fill this research gap, the aim of the current study is to explore the factors that influence the intention of young people in Ho Chi Minh City (HCMC) to continue choosing VBM. Specifically, the study focuses on the role of consumer perceived values and ethical concerns (animal welfare concerns) in the formation of attitudes and intentions. The study collected data from 250 participants aged 18–37 who had eaten VBM recently through direct surveys at vegetarian places in HCMC. Analysis of Partial Least Squares Structural Equation Modelling shows that consumer perceived values are important predictors of positive attitudes towards VBM, which in turn influences the intention to continue choosing VBM. In addition, animal welfare concerns influence both attitude and intention. This study provides important implications for managers to develop VBM services in line with ethical consumption trends and attract young consumers interested in the values of vegetarian nutrition.

ABSTRACT Most prior studies on the impacts of parental beliefs and harsh parenting on victimization in school and psychological well-being have focused on younger children, with few examining whether these associations are relevant to adolescents and differ by sex and age group. This study aims to examine how parental attitudes toward punishment impact adolescent victimization in school and psychological distress through harsh parenting and whether these associations vary by sex and age group. Data were collected from middle and high school students, along with their parents/guardians, in Taiwan. Multistage cluster random sampling was conducted to select children and their guardians as participants. The final sample consisted of 898 parent–child dyads. Data were collected from parents and children using self-administered surveys before the semester and three months thereafter, respectively. A multiple-group structural equation modeling analysis was conducted to identify whether the theoretical model and path coefficients differed significantly by sex and age group. Victimization by students, maltreatment by teachers, and psychological distress were not directly associated with parental attitudes toward corporal punishment. However, they were indirectly associated with parental attitudes toward corporal punishment through harsh parenting behaviors. Certain paths within the model differed by sex and age group. The findings highlight the critical role of harsh parenting as a mediator between parental attitudes and adolescent outcomes, underscoring the need for parenting programs that encourage positive disciplinary strategies while also considering adolescents’ developmental stages and gender-specific vulnerabilities to ensure more effective intervention outcomes.

Phosphorus (P) limitation is prevalent in terrestrial ecosystems. Plants can improve soil P availability through the exudation of organic acids and symbiotic interactions with microorganisms. However, associations between different plant functional groups and phosphorus cycling in P limited karst ecosystems remain poorly understood. To investigate this, the exudation rates of oxalic, citric and acetic acids from fine roots, the contents of carbon, nitrogen, and P in leaves and fine roots, and the contents of oxalic, citric and acetic acids, total P, available P (AP), and microbial biomass P in rhizosphere soils were measured across different plant functional groups in a karst ecosystem in southwestern China. Additionally, the activities of acid and alkaline phosphatases were also analyzed, as well as the relative abundance, community structure, diversity, and co-occurrence network patterns of arbuscular mycorrhizal fungi (AMF) and alkaline phosphatase-encoding (phoD) gene-harboring bacteria. The results showed that both the exudation rates and the contents of organic acids and AP were highest in the tree group, followed by the shrub and grass groups. The AP content of the legume group was significantly higher than that of the non-legume group. The exudation rates of oxalic acid were significantly greater than those of citric and acetic acids. AMF diversities were highest in the shrub and legume groups. The diversities of phoD-harboring bacteria decreased from the tree group to the shrub group and then to the grass group, yet there were no significant differences between the legume and non-legume groups. The communities of both AMF and phoD-harboring bacteria exhibited significant differences among these plant functional groups. The prevalent genera of phoD-harboring bacteria across all groups were Pseudomonas and Halomonas, with Halomonas being particularly prevalent in the legume group. The AMF community was dominated by Glomus, which attained its highest relative abundance in the tree and legume groups. Furthermore, the increased exudation rate and content of oxalic acid were associated with higher relative abundances of Glomus in AMF and Pseudomonas and Bacillus among phoD-harboring bacteria. Structural Equation Model (SEM) analysis demonstrated that plant-exuded organic acids, especially oxalic acid, were positively associated with P availability indirectly through their linkages with the diversity and abundance of AMF and phoD-harboring bacteria. The crucial role of oxalic acid was particularly prominent in the tree and legume groups. Our findings suggest that screening AMF and phoD-harboring bacteria with highly efficient P transformation activity and inoculating them into the rhizosphere of plants with high oxalic acid exudation could help improve plant resilience to P limitation and support sustainable restoration in karst ecosystems.

The aim of this study was to examine the relationships between perceived stress during pregnancy, ruminative responses, self-efficacy regarding vaginal birth and to test whether perceived stress during pregnancy mediates the relationship between self-efficacy regarding vaginal birth and ruminative responses. In this cross-sectional and correlational study, 351 pregnant women were reached. Associations were confirmed using structural equation modeling and linear regression analysis. The study's findings provide a deeper understanding of the psychological mechanisms that influence women's childbirth preferences. Self-efficacy perception regarding vaginal birth has a significant indirect effect on ruminative responses through perceived stress during pregnancy (β = -0.147, p = 0.014). These results highlight the potential role of perceived stress as a psychological mechanism linking self-efficacy and ruminative thinking. Clinically, interventions aimed at reducing stress and supporting self-efficacy such as tailored antenatal care and psychological support may help enhance women's confidence in vaginal birth and support their childbirth preferences. Future longitudinal studies are recommended to further examine these relationships.

ABSTRACT In this paper, we aim to explore the factors influencing college students’ water-saving behavioral intention and behaviors. Using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), we construct a theoretical model based on a survey of 240 Chinese college students. Structural Equation Modeling (SEM) and moderation analysis are employed. The results indicate that performance expectancy, effort expectancy, social influence, facilitating conditions, and habit influence college students’ water-saving behavioral intention, while facilitating conditions and water-saving behavioral intention positively influence water-saving behaviors. However, habit does not exhibit a positive influence on water-saving behaviors. Additionally, place of origin significantly moderates the effects of performance expectancy, facilitating conditions, and habit on water-saving behavioral intention. In contrast, gender, educational level, and professional background show no significant moderation effects. These findings provide a decision-making basis for college administrators to better implement water-saving management.

Purpose This study aims to investigate smart tourism technologies (STTs) attributes (accessibility, informativeness, interactivity and personalization) from the perspectives of both macro, generally used via smartphones and micro, those embedded in smart applications (Apps). Design/methodology/approach This study adopted a mixed-method approach combining partial least squares structural equation modeling and conjoint analysis. In Study 1, partial least squares structural equation modeling was used to examine the effects of the four attributes on tourists’ experiential value, satisfaction and revisit intentions. Study 2 involved conjoint analysis, using a scenario-based online survey, to determine the relative importance of the four attributes. Findings The results of this study indicate that while tourists emphasize all four attributes to varying degrees, their effectiveness in enhancing tourists’ experiential evaluations and revisit intentions differs. Originality/value This study enriches the existing Stimulus–Organism–Response (S-O-R) theory by determining the experiential evaluation factors (experiential value and satisfaction) as parallel mediators at the organism stage. As the first attempt, the use of conjoint analysis to identify users’ preferences regarding STT attributes embedded on smartphone apps suggests a feasible mixed-method approach to studying tourists’ attitudes toward STT usage.