Substantial Direct Effect Research Articles

The impact of government support and organizational culture on sustainable performance: Unveiling the mediating role of circular economy and eco-innovation

Attaining a sustainable competitive edge and exceptional performance stands as the foremost objective for business organizations. Manufacturing industries frequently encounter challenges that hinder their success, primarily due to well recognized factors such as insufficient resources, limited financial capabilities, and a deficiency in managerial skills. Consequently, they frequently seek out sources that are less risky and more convenient to maintain their competitive edge in the market, ultimately leading to limited growth and innovation. Numerous factors have been examined in relation to improving sustainable performance (SP); however, the influence of government support (GS) and organizational culture (OC) in this context has garnered limited focus. This study explores the impact of GS and OC on the SP of manufacturing industries, with the mediating roles of eco-innovation (EI) and the circular economy (CE). Hypotheses were examined through structural equation modeling utilizing Smart PLS4 software, applied to a dataset comprising 200 manufacturing industries in Pakistan. The findings suggest that while GS does not exert a substantial direct effect on SP, its impact is mediated by EI and CE practices. The OC plays a crucial role in improving SP, impacting it in both direct and indirect ways. It is recommended that governmental entities extend both financial and non-financial assistance to the manufacturing sector, which can subsequently enhance economic growth and sustainability. It is recommended that the government implement mechanisms to evaluate adherence to policies and regulations, ensuring that incentives are effectively promoting sustainable practices to enhance organizational sustainable performance. To enhance sustainability results, organizations ought to prioritize developing a culture that encourages innovation and circular practices.

INSTRUCTIONAL LEADERSHIP AND TEACHER SELF-EFFICACY ON JOB SATISFACTION: THE MEDIATING EFFECT OF SCHOOL CLIMATE IN INDONESIAN ISLAMIC SENIOR HIGH SCHOOLS

This study explores the impact of instructional leadership and teacher self-efficacy on job satisfaction among teachers in Indonesian Islamic Senior High Schools (Madrasah Aliyah), focusing on the mediating role of school climate. Instructional leadership plays a crucial role in shaping a positive school environment, which can enhance teacher job satisfaction by providing necessary guidance, resources, and support. A mixed-method approach was employed, with data collected from 219 teachers using validated survey instruments. The Content Validity Index (CVI) was used to ensure instrument reliability. Data analysis was conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM) to assess relationships between variables and the mediating effect of school climate. The results show that instructional leadership significantly impacts both school climate and teacher job satisfaction, with path coefficient values of .463 and .818, respectively. However, school climate did not significantly mediate the relationship between instructional leadership and job satisfaction. Teacher self-efficacy, while positively influencing school climate (p < .05), did not have a substantial direct effect on job satisfaction (ß = -0.058). This research provides fresh insights into the nuanced interplay between leadership, teacher self-efficacy, and job satisfaction in the context of Islamic schools. The findings highlight school climate's indirect yet pivotal role in educational leadership dynamics. By integrating these variables, the study offers practical recommendations for improving leadership strategies and enhancing teacher well-being in faith-based educational settings.

New Analytical Paradigm to Determine Concentration of Brown Carbon and Its Sample-by-Sample Mass Absorption Efficiency.

Brown carbon (BrC) has a substantial direct radiative effect, but current estimates of its impact on radiative balance are highly uncertain due to a lack of measurements of its light-absorbing properties, such as mass absorption efficiency (MAE). Here, we present a new analytical paradigm based on a Bayesian inference (BI) model that takes multiwavelength aethalometer measurements and total carbon data to resolve the concentrations of black carbon and BrC, and MAEs of BrC on a sample-by-sample basis. Hourly MAEs, unattainable in previous studies, can now be calculated, enabling the first-time observation of the darkening-bleaching dynamics of BrC in response to photochemical transformation. We demonstrate the application of this BI model to analyze measurements collected over one year (2021-2022) in Hong Kong. Diel variations in MAE370nm of BrC reveal a darkening-to-bleaching transition occurring between 8 and 10 O'clock when the solar irradiance ranges from 30 to 400 W m-2. Furthermore, we consistently observe an increase in MAE370nm of BrC with nitrogen oxide concentrations, suggesting the enhanced formation of nitrogenous organics. This BI model-based data analysis would bring forth a breakthrough in amassing observation data of BrC and its MAEs in diverse ambient environments and with high time resolution.

The Role of Purchase Behavior in Consumers' Intent to Revisit and Recommend Coffee Shops in Manila: A Mediation Analysis

The study investigates the influence of purchase behaviour on customers' intentions to revisit and recommend coffee shops in Manila, utilizing a mediation analysis. In light of coffee shops' growing significance as social and recreational venues, this study attempts to comprehend the all-encompassing experience that fosters patron loyalty. The study specifically examines how characteristics such as product, service, price, and physical environment quality influence consumer satisfaction and buying behaviour. These factors then influence consumers' inclination to recommend and return. We employed a causal quantitative research methodology to gather data from 235 customers of coffee shops located in Metro Manila through a structured survey. We used a structural equation modelling technique known as partial least squares (PLS-SEM) to examine the correlations between the variables. The results indicate that the quality of the product and the pricing significantly influence customer satisfaction and purchasing behaviour, two major factors that determine intents to return and recommend. However, there was no substantial direct effect of either physical environment or service quality on purchasing behaviour, indicating the possibility of other factors at play. The study emphasizes how crucial it is to uphold fair pricing policies and excellent standards for products in order to increase client loyalty. It also emphasizes how intricate client experiences may be and how important it is for coffee shops to concentrate on the whole experience rather than just their product lines. For coffee shop owners and managers looking to improve consumer advocacy and retention in a cutthroat industry, the findings offer insightful information.

Fate and drivers of mariculture-derived microplastics from ponds to mangrove forests

Due to the combined influences of marine and terrestrial disturbances, the sources of microplastics (MPs) in mangrove ecosystems are complex and diverse. Previous studies have inferred the possible involvement of mariculture activities as a potential source of mangrove MPs based on the characteristics of MPs. However, the direct contributions of mariculture-derived MPs to mangrove MPs remain largely unknown. In this study, we systematically investigated the fate of MPs in the discharge of mariculture wastewater by quantifying the source contributions of mariculture-derived MPs to rivers and mangroves. The majority of detected MPs were transparent fibers, with their composition primarily comprising materials commonly used in mariculture activities such as polyvinylpyrrolidone (PVP), polyethylene terephthalate (PET), and nylon. The partial least squares path model elucidated the relationships among the composition of MPs in ponds, rivers, and mangroves, indicating that ponds exert a substantial direct effect on mangroves, particularly significant in the sediments (63.68%). Water turbidity, sediment carbon content, and sediment particle size are key ecological factors influencing the abundance of mariculture-derived MPs. This study provides compelling evidence regarding the sources of mangrove MPs and novel insights into mitigating the dissemination of MPs.

Closed Management System Relationship to Students’ Performance: Basis for a Sustainable Classroom Management Program

Learning styles vary for effective classroom management depending on the appropriate contexts, activities, proper structure, and student empowerment. In China, leadership in schools and universities manifested the closed management requirement during the pandemic, which affected students’ academic performance. This policy causes various effects due to the volume of tasks, mixed feelings, and unstable social interaction. The purpose of the study is to explore the factors of a closed management system and how they affect students’ academic performance towards effective learning and teaching.
 This study employed a descriptive research design with a quantitative approach using PLS-SEM. There are 341 students’ participants chosen purposefully at Qingdao Vocational College of Aviation Technology. The findings indicate that well-being significantly affects students’ performance. Factors like, fear of being delayed, student participation, family support, and instructor support do not have a substantial direct effect on academic performance. It can be improved by enhancing and facilitating learners’ environmental conditions and promoting well-being.
 Today, there are limited studies on the impact of the closed management system on students ‘academic performance. Existing studies concentrate on the political and cultural variables that influence the educational system rather than focusing on a particular mechanism. This aspect requires a systematic plan to create a learning environment that prioritizes students’ emotional and academic performance; thus, recommending programs for sustainable classroom management is encouraged.

Effects and Influential Factors on the Performance of State Elementary School Principals in North Sumatra

Many factors are projected to affect the success of elementary school principals. The basis of this research is the impact and factors that influence the central performance of the State Elementary School Principals in North Sumatra Labuhan Batu Regency, especially the variables of organizational culture, interpersonal communication, innovative behavior, work motivation, and performance of the elementary school principal. This research is quantitative research with ex post facto research. The variables analyzed were not controlled and modified by the researcher, but the facts were revealed based on measuring the symptoms that have been owned or testing what will happen. The path analysis technique was used to investigate the pattern of relationships between variables to know the direct and indirect effects between endogenous and exogenous factors. Research results indicated that the exogenous component that had more substantial direct effect on the principal’s work motivation was the innovative behavior of the principle, interpersonal communication abilities, and the relatively less influential variable was the school’s organizational culture. Meanwhile, exogenous characteristics that had more substantial direct effect on the success of school principals are the school’s organizational culture, the principal’s work drive, innovative conduct and the lowest interpersonal communication abilities.

Factors Affecting English Foreign Language (EFL) Learners’ Acceptance of Content-Based Language Application for Language Learning

In recent years, investigating factors affecting learners’ acceptance has gained prominence. However, little is known about the effect of behavioural intention, and interactivity and engagement as mediating variables, particularly in the use of technology-based content application for language learning. This study explored the relationships among variables on learners’ acceptance of Content-Based Language Application (CBLA). The Unified Theory of Acceptance and Use of Technology (UTAUT) construct reveals a strong correlation with both self-efficacy and attitude. Performance expectancy demonstrates a positive correlation with attitudes, indicating that learners’ beliefs about favourable outcomes and performance in language learning influence their attitudes positively. Social influence exhibits a critical correlation with behavioural intention, highlighting the role of social factors in shaping learners’ intentions to engage in language learning activities. Effort expectancy shows a positive direct correlation with self-efficacy and attitude. Social influence significantly affects self-efficacy and attitude, and these effects are mediated by behavioural intention, as well as interactivity and engagement. These findings underscore the important role of social factors in shaping learners’ self-efficacy beliefs and attitudes, which in turn influence their behavioural intentions. Facilitating conditions have a substantial direct effect on behaviour, while interactivity and engagement act as mediators in the relationship between facilitating conditions and self-efficacy and attitude, highlighting their significance in shaping users’ attitudes and intentions to adopt and use content-based language application. Future research can investigate the suitability of the suggested model in other linguistic settings for broader applicability of the results. In light of the ever-evolving nature of technology and language learning, longitudinal studies could offer valuable insights into the lasting effects and stability of the observed relationships over an extended period.

Lipid accumulation product, poverty income ratio, and bone mineral density in U.S. adults: a mediation analysis based on NHANES (2009-2020).

This study aims to investigate the relationship between the lipid accumulation product (LAP) index and total femur bone mineral density (BMD), while also examining the mediating role of the poverty-income ratio (PIR). Using the most recent data from the National Health and Nutrition Examination Survey (NHANES) spanning 2009 to 2020, multivariate logistic regression models were employed in this study to investigate the relationship between the LAP index and total femur BMD. Saturation effects and potential non-linear associations were examined using a smooth curve-fitting approach to determine saturation levels. Interaction tests and subgroup analyses were also performed. Additionally, a mediation analysis was conducted to explore the mediating role of PIR. Three thousand two hundred and twenty three participants aged 20 years or older were recruited for this study. Multivariate regression analysis demonstrated a greater total femur BMD in individuals with a high LAP index. Additionally, analysis of the saturation effect and smooth curve fitting identified a clear saturation effect between the LAP index and total femur BMD. A saturation value of 16.05 was determined when investigating the relationship between the LAP index and total femur BMD. Subgroup analysis revealed no significant interaction effects after adjusting for covariates. Moreover, mediation analysis indicated that the LAP index had a substantial direct effect on total femur BMD (p < 0.0001), with PIR partially mediating this relationship (1.115%, p = 0.0280). The results of this investigation demonstrated a saturation effect between the LAP index and total femur BMD, which may have been mediated by PIR.

Effect of empathy competence on moral sensitivity in Chinese student nurses: the mediating role of emotional intelligence

BackgroundEthical issues may pose challenges to nursing students entering clinical practice. Moral sensitivity can assist them in recognising existing moral situations and then taking adequate action. Identifying the variables associated with moral sensitivity may be useful in preparing to improve nursing students' moral sensitivity.ObjectivesThis study investigated empathy, emotional intelligence, and moral sensitivity in Chinese student nurses to explore the association among these three factors and to verify the mediating function of emotional intelligence in determining the connection between empathy and moral sensitivity.DesignThis study used a cross-sectional correlational design.Setting and participantsThrough convenience sampling, 239 fourth-year nursing undergraduates at a university in Western China were enrolled in this study.MethodsNursing students who volunteered to participate in the study completed self-reported scales on empathy, emotional intelligence, and moral sensitivity between September and October 2022. The potential mediating effect was explored using the Process Macro and bootstrap method.ResultsThe nursing students' average scores were 39.62 ± 5.27 on moral sensitivity, 108.21 ± 15.49 on empathy, and 124.41 ± 13.66 on EI. Moral sensitivity was positively correlated with emotional intelligence (r = 0.454, p < 0.001) and empathy (r = 0.545, p < 0.001). Furthermore, empathy exerted a substantial direct effect on nursing students' moral sensitivity (B = 0.1424, p < 0.001). Emotional intelligence could mediate the indirect path from empathy to moral sensitivity. (B = 0.0372, p < 0.001).ConclusionEmotional intelligence mediated the association between empathy and moral sensitivity. Thus, educational activities and programmes placing an emphasis on empathy and emotional intelligence may offer an alternative way to promote moral sensitivity in Chinese student nurses.ImplicationsNursing educators can organise programmes to improve nursing students' emotional competence and professional values. Early exposure to clinical practice benefits nursing students a lot in terms of building interactions with patients and increasing emotional resonance. In addition, nursing educators should develop situational teaching in nursing ethics courses to help students cope with ethical issues.

Potentiality of Sustainable Maize Production under Rainfed Conditions in the Tropics by Triggering Agro-Physio-Biochemical Traits Ascertained from a Greenhouse.

A major portion of maize is produced under rainfed conditions in the tropics with relatively poor yield because of the unpredictable and irregular distribution of seasonal rainfall, as well as a decline in pre-rainy season rainfall due to climate change, so identification of sustainable production options is utmost needed. Thus, the present studies were conducted in a greenhouse (GH) to ascertain the water stress-tolerant traits of maize and at the field level in the tropical environment of Thailand to see the stimulating possibility of the ascertained traits in a locally popular cultivar using ethephon. Depending on tolerance level, three maize genotypes (Suwan 2301 > Suwan 4452 > S 7328) were tested under different water conditions-well-watered, short-term, and long-term water stress-in the GH. At the field level, the locally popular maize cultivar Suwan 5819 was examined with six ethephon levels (doses in g a.i. ha-1 of ethephon, i.e., T1, 281 at V6 stage; T2, 281 at V6 + 281 at V10 stage; T3, 281 at V10 stage; T4, 562 at V6 stage; T5, 562 at V6 + 562 at V10 stage; T6, 562 at V10 stage) against no ethephon application (T0) under rainfed conditions. Maize suffered from the scarcity of sufficient rainfall during 26-39 days after planting (DAP) and 43-63 DAP in the field. The yield index (YI) was identified from biplot analysis as one of the suitable standards for drought tolerance checks for maize at GH as well as at field level in the tropics. The YI value of observed agro-physio-biochemical traits of maize in GH showed that relative water content (RWC, 1.23), stem base diameter (SBD, 1.21), total soluble sugar (TSS, 1.15), proline (Pr, 1.13), aboveground plant biomass (APB, 1.13), root weight (RW, 1.13), relative growth rate (RGR, 1.15), specific leaf weight (SLW, 1.12), and net assimilation rate (NAR, 1.08) were the most desirable. Efforts were made to stimulate these traits under water stress at the field level. Ethephon application as T1 helped to gain higher kernel yield (KY) (5.26 t ha-1) with the support of higher RWC (90.38%), proline (24.79 µmol g-1 FW), TSS (1629 mg g-1 FW), SBD (24.49 mm), APB (271.34 g plant-1), SLW (51.71 g m-2), RGR (25.26 mg plant-1 day-1), and NAR (0.91 mg cm-2 day-1) compared to others, especially no ethephon application. Furthermore, the attributes SLW, SBD, Pr, heat utilization efficiency (HUE), 100-kernel weight, TSS, electrolyte leakage, and lodging percentage showed a substantial direct effect and significant correlation with KY. Aside from higher KY, ethephon application as T1 tactics resulted in higher values of energy efficiency (1.66), HUE (2.99 kg ha-1 °C days-1), gross margin (682.02 USD ha-1), MBCR (3.32), and C absorption (6.19 t C ha-1), indicating that this practice may be a good option for maize sustainable production under rainfed conditions.

Islamic-Based Relationship Marketing: Measuring the Purchasing Intention of Islamic Branded FMCG

The purpose of this study is to look at the relationship between religiosity and the intention to buy religiously labeled products among Muslim customers in Indonesia. In Indonesia, a total of 241 questionnaires were delivered to respondents. PLS-SEM (Partial Least Squares Structural Equation Modeling) is a statistical tool for analyzing complex correlations between observable and latent variables. According to the results of this study, intrinsic-extrinsic religiosity has a substantial direct effect on Muslim perceived value and Muslim relationships, but not on purchase intention. However, the indirect impacts of intrinsic-extrinsic religiosity on purchase intention are strong via Muslim perceived value and Muslim relationships. In particular, intrinsic-extrinsic religion has a greater indirect effect on purchase intention via Muslim perceived value than via Muslim relationships. These findings imply that Muslim perceived value and Muslim friendship serve as a bridge between intrinsic-extrinsic religiosity and purchase intention. This conclusion adds to the research contribution to an issue that is still rarely mentioned in investigating the relationship between religious relationships and Indonesian Muslim consumers' inclination to purchase Islamic-labelled FMCG products. This report will help to stress the significance of the issue and its ramifications for business decisions. Keywords: intrinsic religious, extrinsic religious, Muslim relationship, Muslim perceived value, purchase intention

The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis

Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.

Examining the effect of consumption values on mobile banking adoption in Bangladesh: the moderating role of perceived security

PurposeThe objective of this study is to investigate the effect of consumption values (functional, social, epistemic, and emotional value) on mobile banking (m-banking) usage intention and intention to recommend m-banking services in the context of the Bangladeshi banking sector. Furthermore, this study examines how perceived security moderates the effects of consumption values on m-banking usage intention and recommendation intention.Design/methodology/approachA self-structured questionnaire had been used to obtain survey data from a sample of 237 m-banking users in Bangladesh using a convenience sampling method. Data were analyzed by structural equation modeling based on AMOS 23.0.FindingsThe findings show that all the dimensions of consumption values (functional, epistemic, and emotional value) except social value have a significant impact on mobile banking usage intention. In turn, mobile banking usage intention has a substantial direct effect on users' recommendation intention. Furthermore, the results also demonstrate that perceived security moderates the effects of functional values on m-banking usage intention as well as m-banking usage intention on recommendation intention.Practical implicationsThese research findings offer insightful guidelines to bank marketers to increase m-banking usage intention and recommendation intention by emphasizing the functional, epistemic, and emotional value of m-banking services as well as safeguarding consumers' perceived security in m-banking transactions.Originality/valueThis study contributes to the body of knowledge by measuring the effects of consumption values dimensions on the m-banking usage intention and recommendation intention which were hardly investigated particularly in the m-banking context. To date, this study is the first attempt to examine how perceived security moderates the effects of consumption values dimensions on the m-banking usage intention as well as m-banking usage intention on recommendation intention. The findings contribute to a theoretical understanding of the importance of consumption values in consumer decision-making, particularly in the rarely studied domain of mobile banking.

Soil moisture and pH differentially drive arbuscular mycorrhizal fungal composition in the riparian zone along an alpine river of Nam Co watershed.

The riparian zone is an important ecological corridor connecting the upstream and downstream rivers. Its highly complex biological and physical environments significantly affect the biogeographical pattern of species and various ecosystem functions. However, in alpine riparian ecosystems, the distribution patterns and drivers of arbuscular mycorrhizal (AM) fungi, a group of functionally important root-associated microorganisms, remain poorly understood. In this study, we investigated the AM fungal diversity and community composition in near-bank (wetland) and far-bank (alpine meadows) soils along the Niaqu River in the Nam Co watershed, and assessed the relative importance of abiotic and biotic filtering in shaping these distributions. Overall, 184 OTUs were identified in the riparian ecosystem, predominantly belonging to the genus Glomus, especially in the downstream soils, and Claroideoglomus in near-bank soils. AM fungal colonization, spore density, and α diversity showed an overall increasing trend along the river, while the extraradical hyphae declined dramatically from the middle of the river. AM fungal communities significantly varied between the wetland and alpine meadows in the riparian zone, mainly driven by the geographic distance, soil water content, soil pH, and plant communities. Specifically, soil pH was the principal predictor of AM fungal community in near-bank wetland soils, while soil water content had a most substantial direct effect in alpine meadows. These findings indicate that abiotic factors are the most important divers in shaping AM fungal communities at the watershed scale, which could be helpful in alpine riparian biodiversity conservation and management.

Examining Relation among Entrepreneurial Leadership, Innovative Work Behavior, &amp; Innovation Support

Due to the increased competition in today’s business world and industrial revolution 4.0, many small and medium enterprises (SMEs) undergo swift and vigorous changes. For this reason, SMEs were expected to pay their attention to innovative work behaviors (IWB) to ensure survival in the competitive world. This research evaluates the effect of entrepreneurial leadership (EL) dimensions (including communicative, motivational, strategic, and personal) on innovative work behavior (IWB) of people employed in SMEs of Oman. Moreover, mediating role of innovation support (IS) is examined on the relationship of entrepreneurial leadership (EL) and innovative work behavior (IWB). Data were collected through personally administered survey questionnaires from the population of SME sector employees and managers in Oman. A total of 211 usable responses were collected and then further analyzed through SmartPLS 3.3.3 (PLS-SEM) software while a two-stage reflective-formative analysis of higher-order and lower-order constructs was conducted. The results exhibit that entrepreneurial leadership and innovation support have a significant positive impact on innovative work behavior (IWB). Additionally, a mediating role of innovation support was also confirmed on the relationship between EL and IWB. All four dimensions of entrepreneurial leadership (EL) were reported with a substantial direct and indicted effect on innovative work behavior (IWB) of people employed in SME sector in Oman. This is a pioneer study in Oman that examined the influence of entrepreneurial leadership (EL) dimensions on innovative work behavior (IWB) and mediating role of innovation support using a reflective-formative higher order analysis. Finally, practical and theoretical implications along with future research directions were suggested at the end of this research.

The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis.

To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. A cross-sectional descriptive study. In total, 208stroke survivors (70.25±9.08years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.

Guest benefits of hedonic value and perceived community value drive hotel CSR participation

Successful promotion of guest participation in Corporate Social Responsibility (CSR) activities for the hedonic context of a hotel stay is challenging, especially where the CSR activity requires substantial guest involvement. Moreover, understanding of this issue becomes increasingly important as investment by hotels on CSR engagement strategies that include guests directly participating in such activities grows. While perceived benefits of guest participation are critical to optimizing CSR participation strategies, studies explicitly investigating guests’ evaluation of costs versus benefits are lacking. Using an experimental scenario based on a guest’s return to a hotel recently visited, a self-oriented hedonic benefit, a other-oriented benefit of perceived community value, and perceived time constraint were tested for their effects on guest CSR participation. Data was obtained from respondents in the US and Thailand. Analysis using structural equation modeling (SEM-PLS) demonstrated that a hedonic value benefit had a substantial direct effect on guest CSR participation while the effect from perceived community value was fully mediated by CSR reputation. The effect of perceived constraints on CSR participation was significantly stronger for US respondents. Findings present insights for hotel managers, policy makers, non-government agencies with a mission to promote CSR practices and researchers.

Still proliferating CD44+/Ki67+ tumor cells after neoadjuvant radiochemotherapy identify rectal cancer patients with poor survival

IntroductionDistant recurrence, especially liver metastases, occurs in one-third of rectal cancer patients initially treated with curative therapy and is still an unsolved problem. The identification of patients at risk is crucial for enabling individualized treatment. Material and methodsAll patients undergoing curative resection for histologically confirmed rectal cancer after neoadjuvant radiochemotherapy between January 2001 and December 2015 were included. Sections were stained for Ki67, CD44, apoptosis and CD133. Patients were categorized based on whether they were found to have (CD44+/Ki67+) or not have (CD44+/Ki67+) still proliferating tumor cells. Results218 patients who underwent R0 resection for stage I-III rectal cancer were selected. In 37 (17%) of these patients, CD44+/Ki67+ tumor cells were found. In multivariable Cox regression analysis, patients with CD44+/Ki67+ cells had significantly impaired overall (hazard ratio (HR): 3.84, 95% CI: 1.77–8.31, p = 0.001) and relative survival (HR 3.44, 95% CI: 1.46–8.09). The previous results were confirmed after propensity-score matching. In mediation-analysis, the presence of CD44+/Ki67+ cells was associated with a substantial direct effect on overall (HR 1.92, 95% CI: 1.09–9.28) and relative survival (HR 1.63, 95% CI: 1.31–6.38). ConclusionsThe presence of still proliferating CD44+/Ki67+ tumor cells after neoadjuvant radiochemotherapy was associated with impaired oncological long-term outcomes. Characterization of these cells should be performed.

Predicting Telemedicine Adoption: An Empirical Study on the Moderating Effect of Plasticity in Brazilian Patients

Predicting behaviors around telemedicine acceptance in developing countries is an important developing area of study. This importance has been enhanced since the emergence of the COVID-19 pandemic, especially in Latin America. In this context, this study aims to explore the effect of plasticity on telemedicine acceptance in Brazil. This paper focuses on Brazilian patients and their acceptance of telemedicine through the Theory of Planned Behavior and the concept of Plasticity as a superordinate factor of the patients’ personality traits. An online survey of Brazilian patients was carried out, and structural model modeling was then utilized. Results indicate that the proposed model explains 62.1% of the behavioral intention of the use of telemedicine by the patients. Furthermore, the findings suggest that attitude has the most substantial direct effect on behavioral intention, with plasticity playing a considerable role in the strength of the impact. Government strategies for the spread of telemedicine in Latin America could consider these results for their design.