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전체arXiv Math12,367arXiv CS.AI8,535arXiv Physics4,150arXiv Stat1,858PLOS ONE871arXiv Econ593arXiv Q-Bio496eLife165PLOS Global Public Health131PLOS Biology67PLOS Medicine46
PLOS ONE

Characterization of a novel lncRNA RP3-340N1.2 and its association with a miR-4650-5p/SHC1-related regulatory network in lung adenocarcinoma

by Fang Chen, Yan Yan, Wenting Yang, Zhilin Li, Daying Wang, Jianqiao Huang, Chaozhou Wan, Tingting An, Li Tong, Maoxia Ran, Yaqiong Dong, Yunfen Chen Long noncoding RNAs (lncRNAs) are increasingly recognized as regulators of cancer-related biological processes. However, the functional significance of many lncRNAs in lung adenocarcinoma (LUAD) remains incompletely understood. In this study, we identified RP3-340N1.2 as an upregulated lncRNA in LUAD through analyses of public transcriptomic datasets, which was further confirmed by quantitative real-time PCR in LUAD cell lines. Functional assays demonstrated that knockdown of RP3-340N1.2 was associated with reduced proliferation, migration, invasion, and clonogenic growth of LUAD cells in vitro. In addition, suppression of RP3-340N1.2 attenuated tumor growth in a xenograft model. Bioinformatic analysis using the LncBase Experimental v3 database identified hsa-miR-4650-5p as a potential interacting microRNA of RP3-340N1.2. This interaction was further examined by dual-luciferase reporter and RNA immunoprecipitation assays. Functional experiments additionally showed that miR-4650-5p overexpression was associated with reduced proliferative and migratory capacities in LUAD cells. Among the predicted downstream targets of miR-4650-5p, SHC1 was selected for further investigation. Alterations in RP3-340N1.2 or miR-4650-5p expression were accompanied by corresponding changes in SHC1 expression and ERK1/2 phosphorylation. Furthermore, rescue experiments demonstrated that SHC1 knockdown largely reversed RP3-340N1.2-associated cellular phenotypes, supporting the functional involvement of SHC1 within this regulatory framework. Collectively, these findings indicate that RP3-340N1.2 is aberrantly expressed in LUAD and may participate in tumor-associated cellular behaviors through a miR-4650-5p/SHC1-related regulatory mechanism. This study provides preliminary evidence supporting the potential relevance of RP3-340N1.2 in LUAD and offers additional insight into lncRNA-associated regulatory networks in this disease.

PLOS ONE

A pilot study on the impact mechanism of internal and external leading variables on consumers’ purchase intention and healthy dietary behavior of plant-rich foods

by Limin Fang, Shahriman Zainal Abidin, Lesi Zhou, Juncheng Mu, Honglei Lu This study integrates the TPB with Information Processing Theory and Sensory Marketing Theory to investigate the influence mechanisms of Plant-Rich Foods(PRF) attributes and their packaging on consumer purchase intention and healthy eating behaviors. Through the construction of a structural equation model, empirical analysis was conducted on seven core variables and their interrelationships: consumer attitude(CA), socio-cultural environment(SE), consumer individual requirements(CIR), packaging environmental considerations(ECP), perceived experiential value(PEV), food information factors(FIF), and packaging functional attributes(FPP), thereby validating the proposed hypotheses. The results indicate that all seven variables significantly and positively influence purchase intention, albeit with varying strengths. Packaging functional attributes demonstrated the strongest driving force, followed by individual consumer needs and food information factors. Perceived experiential value, consumer attitude, and packaging environmental considerations exhibited moderate influence, while the socio-cultural environment exerted the weakest impact. The overall influence of “externally oriented” product variables on purchase intention surpassed that of “internally oriented” consumer variables. The impact on healthy eating behaviors presented a dual logic of “direct drive and indirect transmission.” consumer individual requirements exhibited a weaker direct influence on healthy eating behaviors compared to their influence on purchase intention, forming a chained transmission pathway from individual needs to purchase intention to healthy behaviors. Theoretically, this research extends the application of the Theory of Planned Behavior, elucidates the transmission mechanisms of variables, and constructs a multidimensional relational framework. Practically, it offers direction for plant-based food enterprises in optimizing packaging and marketing communication strategies, and provides a reference basis for policymakers.

PLOS ONE

Covid-19 related excess mortality: An analysis by age for selected countries

by David Madden Background Measures of excess mortality are generally regarded as providing the best metric for countries’ experience during the Covid pandemic of 2020–2022. Such measures, however, need to be adjusted to take account of the different age structures of different countries as Covid-related mortality can differ substantially by age. Methods This paper analyses excess mortality data for a selection of countries using the Short Term Mortality Fluctuations dataset. A standardised age distribution is applied to the data to obtain age-adjusted excess mortality and this is compared to crude excess mortality data. The metric of years of life lost (YLL) is also calculated for the same dataset and cluster analysis is applied to investigate relationships between the mortality metrics and GDP per capita and inequality. Results The age adjustment makes a significant difference for some countries but the overall ranking of countries in terms of excess mortality changes very little, with rank correlation coefficients in excess of 0.95 for the metrics of crude mortality, age adjusted mortality and YLL Age adjusted excess mortality has a rank correlation of −0.69 with GDP per capita but the rank correlation with the Gini coefficient of 0.11 is not statistically significant. Conclusions Rankings of countries by excess mortality during the Covid period are robust to age adjustment and choice of mortality metric. Cluster analysis suggests distinct clusterings of countries with similar outcomes, particularly the former planned economies of central and eastern Europe.

PLOS ONE

Aptamer-functionalized stiff hydrogel for enhanced BMSC enrichment and osteogenesis

by Jifeng Jing, Fengyu Li, Yu Wang, Shuo Cheng, Lei Guo To address the need to both enrich stem cells and direct their osteogenic fate in bone tissue engineering and bone regeneration, we developed a stiffness-gradient hydrogel (~4.5–33 kPa) functionalized with a cell-enriching aptamer (Apt19s). This design forms a combined “enrich-and-differentiate” system: Apt19s actively enriches endogenous bone marrow-derived mesenchymal stem cells (BMSCs) at the scaffold site, while the osteoinductive high-stiffness niche (~33 kPa) directs their differentiation. Crucially, the combined cues produced an enhanced osteogenic outcome—evidenced by significantly greater alkaline phosphatase (ALP) activity (>2-fold increase), upregulated RUNX2/osteocalcin (OCN) gene expression (186.5% relative to control), and enhanced mineralization—that surpassed the additive effects of either cue presented independently. This integrated platform provides a practical strategy for developing cell-free osteogenic materials that actively tackle the dual challenges of endogenous cell sourcing and lineage-specific induction.

PLOS ONE

Respiratory pattern change in female and male runners by respiratory tract restriction using a respirator

by Petr Bahenský, Tomáš Mrkvička, David Marko, Renata Malátová, Miroslav Krajcigr, Eric Harbour Respiratory protective equipment, particularly filtering facepiece respirators (FFRs), are increasingly used during physical activity, yet their influence on breathing mechanics remains unclear. This randomized, crossover trial investigated the impact of N95 FFRs on thoracoabdominal breathing patterns during graded treadmill exercise. Twenty competitive runners (10 male, 10 female; 18.9 ± 2.3 years) performed Bruce protocol tests with and without FFRs, while optoelectronic plethysmography quantified the contributions of pulmonary ribcage (RCp), abdominal ribcage (RCa), and abdomen (Ab) to tidal volume. Global ventilatory parameters (tidal volume, breathing frequency, minute ventilation) were unaffected by FFR use. However, compartmental analysis revealed significant alterations in breathing patterns at higher intensities. At 12 and 15 minutes, FFRs reduced RCp contribution (−7.85 ± 2.49%, P = 0.002; −8.41 ± 3.35%, P = 0.012) and increased Ab contribution (+5.97 ± 2.08%, P = 0.004; + 6.51 ± 2.80%, P = 0.020). Across all phases, females demonstrated moderate, but variable RCp dominance (P = 0.052). These findings indicate that while FFRs do not impair overall ventilation in trained runners, they substantially modify the biomechanics of breathing under load, reflecting compensatory adjustments that likely help preserve ventilatory efficiency. The results suggest that well-trained athletes may tolerate acute respiratory stress more effectively than the general population, which has implications for athletic training, rehabilitation, and occupational health where respirator use is required. Trial registration ClinicalTrials.gov NCT07032740

PLOS ONE

Development and validation of the AI literacy, risk perception, and academic confidence questionnaire for Chinese pre-service teachers

by Zeyu Zhang, Xiaomei Lu, Guochao Xiao, Xinde Wang Artificial intelligence (AI) is becoming increasingly relevant to teacher education, yet evidence remains limited on how pre-service teachers’ AI literacy, risk perception, and academic confidence can be assessed within a coherent but multidimensional framework. This study examined the psychometric properties of the AI Literacy, Risk Perception, and Academic Confidence Questionnaire (AIRPAC-Q) among Chinese pre-service teachers. A cross-sectional survey was conducted with 528 participants recruited from teacher education programmes in China. The sample was randomly divided into an exploratory factor analysis (EFA) subsample (n = 258) and a confirmatory factor analysis (CFA) subsample (n = 270). Psychometric evaluation included expert-based content validation, pilot refinement, EFA, CFA, reliability testing, convergent and discriminant validity, concurrent validity, and known-group validity analyses. The final questionnaire retained 14 items across three complementary dimensions: AI literacy, risk perception, and academic confidence. Expert ratings showed acceptable content validity (I-CVI = 0.83–1.00; S-CVI/Ave = 0.94). The hypothesized three-factor model showed an acceptable fit to the data (χ² = 146.32, df = 74, χ²/df = 1.98, CFI = 0.952, TLI = 0.941, RMSEA = 0.060, SRMR = 0.047) and outperformed two-factor and one-factor alternatives. Cronbach’s α values ranged from 0.82 to 0.88, composite reliability values ranged from 0.83 to 0.89, and average variance extracted values ranged from 0.56 to 0.59. Participants with prior AI use experience scored higher on AI literacy and academic confidence but slightly lower on risk perception than those without such experience. These findings support the AIRPAC-Q as a context-specific multidimensional tool for assessing competence, caution, and confidence in AI-supported teacher education.

PLOS ONE

Study on electrochemical corrosion behavior of gray cast iron processed via laser cavitation peening

by Chunhui Luo, Jiayang Gu, Jiahao Yang, Yanfen Sun, Yuwen Ding, Aihua Xu, Xiaohu Sang Laser cavitation peening (LCP) is a novel material surface treatment method. In this study, we investigated the electrochemical corrosion performance of LCP-treated HT250 gray cast iron, with and without a coverage layer, under various laser energies, defocusing amounts, and immersion times. In the LCP process, a 0.04 mm aluminum coverage layer was employed. The influence of the coverage layer on LCP processing was analyzed. The results show that the presence of a coverage layer during the LCP treatment improves the specimen’s anti-corrosion ability, with this alignment corresponding with an increase in laser energy. In comparison with laser energy, the effect of a coverage layer on corrosion resistance at various defocusing amounts is not very significant, and at a smaller defocusing amount, the treated specimen presents higher corrosion resistance. The corrosion resistance of gray cast iron in the case with a coverage layer first increases with the increase in laser energy and then decreases. The presence of a coverage layer helps to avoid laser ablation and cavitation erosion.

PLOS ONE

Synchronous brain activity in newborn infants and their mothers during parent-led multimodal pain alleviation with skin-to-skin contact, breastfeeding and lullaby singing: Study protocol for a fNIRS hyperscanning study

by Mats Eriksson, Majja Lund, Mussie Msghina, Maria Reingardt, Alexandra Ullsten Protecting infants’ vulnerable brain during repeated painful procedures like blood-sampling and immunizations in early life is a top priority in neonatal health care. Use of parent-delivered pain management may safeguard the infant brain but at the brain level, it is still unclear what drives the analgesic effect of parent-led interventions such as skin-to-skin contact, breastfeeding, and the parent’s live singing. The objective of this study is to advance our understanding of the neural mechanisms behind parent-led pain management in newborn pain care. Twenty mother-infant dyads will be studied during a planned blood sampling venepuncture, with skin-to-skin contact, breastfeeding, and the mother’s live singing. The potential interbrain synchronous cerebral activation in cortical regions of interest will be registered using functional Near-Infrared Spectroscopy (fNIRS) hyperscanning. Secondly, registration of skin conductance, heart rate variability, and the mother’s gaze will be registered. Social and musical interactions will be studied using microanalysis, as will pain using the Behavioral Indicators of Infant Pain (BIIP). The Swedish Research Ethical Review Authority has approved the study (Dnr 2025-02283-01).

PLOS ONE

Bangla validation of the smartphone addiction scale and the academic underachievement scale: The associative role of classroom mindful attention in the relationship between smartphone addiction and underachievement among adolescents and young adults

by Shakira Khatun, Md. Mehedi Hassan Ridoy, Abu Hanif Noman, Md. Muazzem Hosen Sharon, Md. Rahim Mia, Jahedul Islam, Sajedul Hasan Himel, Mohd. Ashik Shahrier This study aimed to validate the Smartphone Addiction Scale–Short Version (SAS-SV) and the Perceived Academic Underachievement Scale (PAUS) for Bangladeshi adolescents and young adults. In addition, the study investigated whether classroom mindful attention has an indirect association with the relationship between smartphone addiction and academic underachievement in the target population. A cross-sectional survey using convenience sampling was conducted with 712 participants recruited from different educational institutions in Bangladesh. Bangla versions of SAS-SV, Classroom Mindful Attention Regulation Scale, and PAUS were administered in collecting data. Factor structure, reliability, and validity of the measures were assessed, and statistical mediation to determine the indirect association was conducted to achieve the study aims. Both SAS-SV and PAUS showed excellent internal consistency (Cronbach’s α = 0.95 and 0.91, respectively) and confirmed the predefined factor structures with good model fits (CFI = 0.99, TLI = 0.99, RMSEA = 0.05, SRMR = 0.03; PAUS: CFI = 0.99, TLI = 0.99, RMSEA = 0.04, SRMR = 0.03). While determining the convergent validity of the measures, both smartphone addiction and perceived academic underachievement were associated with lower GPAs and reduced classroom mindful attention. Moreover, the SAS-SV and PAUS were found to be invariably applicable across age, gender, and data collection mode. Mediation analyses indicate that the self-awareness component of classroom mindful attention had an indirect association with the relationship between smartphone addiction and perceived academic underachievement in young adults (B = 0.014, 95% CI [0.001, 0.028], p = .033) and the combined sample (B = 0.020, 95% CI [0.005, 0.036], p = .009), whereas no significant indirect association was observed among adolescents. These findings highlight the associative role of classroom self-awareness in the relationship between smartphone addiction and perceived academic underachievement and underscore the potential role of mindfulness-based interventions in educational settings.

PLOS ONE

Quality improvement intervention for school-based support teams for adolescents’ mental health in selected secondary schools in Gauteng: A study protocol

by Xolelwa Dyani, Olanrewaju Oladimeji, Moreoagae Bertha Randa The prevalence of mental health disorders among adolescents poses a significant global health challenge, with approximately one in seven individuals aged 10–19 affected. The limited access to effective mental health services worsens this issue, particularly within schools, which are critical settings for early intervention. The study aims to develop and implement a school-based support team improvement intervention to enhance the mental health of adolescent learners in secondary schools. This study will employ a sequential explanatory mixed-methods approach design. The research will be conducted at selected secondary schools, and the participants for the study will be adolescents aged 13–19 and members of the school-based support team (SBST). Questionnaires will be administered to learners to determine the prevalence of common mental health challenges among adolescents and to determine the factors associated with mental health challenges among adolescents. A scoping review will also be conducted to examine existing interventions aimed at supporting learners with mental health challenges. Following the quantitative phase, interviews will be conducted with SBST members to explore the challenges and successes in supporting learners with mental health problems. The second phase will involve the development and implementation of the SBST quality-improvement intervention to support adolescents experiencing mental health challenges in secondary schools. The researcher will use Statistical Package for the Social Sciences (SPSS, 30.0.0) for quantitative data analysis and statistical interpretation. In addition, ANOVA will be employed to compare, identify, and understand specific factors that significantly impact adolescents’ mental health. The qualitative data will be analysed using Colaizzi’s seven-step framework and will be facilitated with NVIVO 15.

PLOS ONE

Sex and the clock: Exploring sex differences in chronotype and circadian behavior among healthy older adults

by Natalie S. Pandher, Leslie Yack, Esther Li, Quentin Coppola, Kaitlin B. Cassaletto, Lea T. Grinberg, Thomas C. Neylan, Joel H. Kramer, Christine M. Walsh This study aimed to compare subjective and objective circadian measures with a focus on sex differences and cognition in healthy older adults. A total of 126 participants (aged 65–90 years) completed the Horne & Ostberg Morning-Eveningness Questionnaire (MEQ) and the Circadian Type Inventory (CTI) to assess their morning-evening preference and four circadian traits: rigidity vs flexibility (CTI-FR) and languidity vs vigor (CTI-LV). These self-report measures were compared to actigraphy data from a sub-cohort of 63 individuals who wore wrist actigraphs for 24 hours a day over a 7-day period. Results showed that cognitively healthy older adults tend towards rigidity and vigor (on the CTI) and morningness (on the MEQ). Overall, the languid vs vigorous types and flexible vs rigid types displayed differences in MEQ scores. Sex moderated the association between the CTI-LV and MEQ with a steeper association in males than females (p = 0.012). Actigraphy data showed that males had less stable (interdaily stability, IS, p = 0.03) and more fragmented (interdaily variability, IV, p = 0.001) circadian rhythms than older females. Subjective MEQ scores were strongly predictive of acrophase time (p = 0.009) in males but not females. Using information processing speed (IPS) as a marker of cognitive function, we found that greater circadian rhythm fragmentation (IV) was linked to slower verbal IPS (p = 0.004) in males. Morning preference on the MEQ predicted faster spatial IPS in the overall sample (p < 0.001). These findings provide preliminary evidence of the relationship between subjective sleep preferences and objective circadian data in cognitively healthy older adults with notable sex differences in these relationships.

PLOS ONE

Temperament, personality and decision-making accuracy in handball referees

by Jacek Świdwa, Magdalena Król-Zielińska, Adam Kantanista Accurate decision-making is essential for effective handball officiating, yet little is known about how stable psychological traits relate to referees’ decision-making accuracy. This study examined whether temperament and personality characteristics are associated with decision-making accuracy in handball referees. Forty-one officials from three competition levels (Second League, First League, Superleague) completed the FCB-TI and NEO-FFI inventories. Decision-making accuracy was assessed using a video-based test of game situations scored against expert judgments. Sensory Sensitivity showed a positive bivariate correlation with decision-making accuracy (r = 0.32, p R2 = 0.24, p = 0.001). Adding Sensory Sensitivity increased the explained variance to 30%, although its unique contribution did not reach statistical significance. Activity, as a temperament trait, showed different associations with decision-making accuracy across competition levels. No significant relationships were observed between Big Five personality traits and decision-making accuracy. These findings suggest that, among the variables examined, competitive level was the main factor associated with decision-making accuracy, while selected temperament traits, particularly Sensory Sensitivity and, to a lesser extent, Activity, may also be relevant to this outcome.

PLOS ONE

The endurance effort on a mechanical treadmill does not activate the complement system among trained young women

by Robert Nowak, Patrizia Proia, Dorota Kostrzewa-Nowak The complement system (CS) plays a crucial role not only in pathogen-related immune responses but also in immunomodulatory effects associated with increased levels of damage-associated molecular patterns and tissue regeneration. The involvement of CS in response to physical exertion remains unclear. In the present study, the impact of an endurance effort on a mechanical treadmill on CS activation was investigated in healthy young premenopausal women. Twenty-eight well-trained women aged 21–26 years, playing handball or soccer, respectively, performed a progressive test on a mechanical treadmill until exhaustion. The CS component (C1q, C2, C3, C3b/iC3b, C4, C4b, C5, C5a, Factors I, H, B, adipsin, and mannose-binding lectin) concentration in blood was analyzed before, after the test, and 24 hours after the physical test using Luminex xMAP (Multi Analyte Profiling) technology. Progressive effort did not significantly affect the analyzed CS compounds. The lack of CS activation observed in the studied groups of young women suggests that the endurance effort on a mechanical treadmill did not activate an innate immunity. From this perspective, it does not appear to be an inflammatory factor. Considering the small number of participants, this hypothesis needs further exploration.

PLOS ONE

Editorial Note: Multi-objective optimization using improved NSGA-II for integrated process planning and scheduling problems in a machining job shop for large-size valve

by The PLOS One Editors

PLOS ONE

Analysis of vapor cloud explosion behavior in LPG spherical tanks using multi-energy modeling and machine-learning-based factor assessment

by Keyvan Sarebanzadeh, Mahboubeh Es’haghi Vapor cloud explosions (VCEs) associated with liquefied petroleum gas (LPG) storage systems represent a significant hazard in refinery operations. Accurate estimation of explosion distance is essential for safety setback design and quantitative risk assessment. This study developed an integrated framework that combines physics-based and data-driven techniques to study VCE behavior resulting from LPG releases from a 20,000-barrel pressurized spherical tank under realistic refinery conditions. A total of 336 leakage scenarios were simulated using DNV PHAST 2022 and the Multi-Energy method. Seven influencing parameters were considered, including leak diameter, LPG composition (propane–butane ratio), leak location, atmospheric category, seasonal period, day/night conditions, and three overpressure thresholds (0.02, 0.14, and 0.21 bar). The results revealed a wide dispersion in explosion distance across scenarios, with maximum distances exceeding 2,100 m for catastrophic full-bore ruptures. Feature-importance analysis using a Random Forest regression model showed that leak diameter was the dominant controlling parameter, accounting for approximately 74% of the predictive importance, while LPG composition contributed an additional 24–25%. Operational and atmospheric parameters had comparatively minor effects. The three investigated overpressure thresholds produced nearly identical explosion distances across the evaluated scenarios, indicating that within the low-pressure range, explosion extent is primarily governed by the released fuel mass and flammable cloud geometry rather than the threshold value. A classical power-law correlation was used to describe the geometric scaling between leak diameter and explosion distance; however, its predictive capability was limited (RMSE ≈ 337 m) due to its single-variable formulation. In contrast, the Random Forest model captured multi-factor interactions within the PHAST-generated dataset with very high predictive accuracy (R² ≈ 0.9997, RMSE ≈ 9 m). This hybrid framework provides a transparent approach for analyzing LPG vapor cloud explosions and offers practical insights for safety-distance determination, refinery layout optimization, and risk-based inspection planning.

PLOS ONE

Editorial Note: <i>In Vitro</i> and <i>In Vivo</i> Antitumor Activity of [Pt(<i>O,O′</i>-acac)(γ-acac)(DMS)] in Malignant Pleural Mesothelioma

by The PLOS One Editors

PLOS ONE

Expression of Concern: Multiobjective intuitionistic fuzzy programming under pessimistic and optimistic applications in multivariate stratified sample allocation problems

by The PLOS One Editors

PLOS ONE

Retraction: Automated brain tumor diagnostics: Empowering neuro-oncology with deep learning-based MRI image analysis

by The PLOS One Editors

PLOS ONE

Rumination and subjective well-being: The chain mediating role of emotion regulation difficulties and problematic social media use

by Huan Song, Yueyu Shu, Ping Ren Objectives Based on the Compensatory Internet Use Model and the I-PACE framework, the present study develops a serial mediation model grounded in a cognition-emotion-behavior pathway. Specifically, this study examined whether difficulties in emotion regulation and problematic social media use were associated with the relationship between rumination and subjective well-being among a sample of vocational college students within the context of increasingly digitalized everyday life. Methods A survey was conducted among 402 vocational college students using the Ruminative Responses Scale, the Brief the Version of the Difficulties in Emotion Regulation Scale, the Problematic Social Media Use Questionnaire, the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Results Rumination was positively associated with difficulties in emotion regulation and problematic social media use, whereas subjective well-being was negatively associated with all three variables. Difficulties in emotion regulation were also positively correlated with problematic social media use. Mediation analyses identified three significant indirect pathways: the mediating role of difficulties in emotion regulation, accounting for 35.49% of the total effect; the mediating role of problematic social media use, accounting for 22.35%; and the serial mediating role of difficulties in emotion regulation and problematic social media use, accounting for 12.16%. Conclusions The findings suggest that difficulties in emotion regulation and problematic social media use are associated with the relationship between rumination and subjective well-being among the sampled vocational college students. These findings may provide preliminary implications for interventions targeting emotion regulation and problematic social media use among vocational college students.

PLOS ONE

Real-world implementation and cost impact analysis of Oncotype DX testing in early-stage breast cancer

by Niina Mäenpää, Leena Tiainen, Janne Martikainen, Minna Tanner, Arja Jukkola, Maarit Bärlund Background The decision on appropriate adjuvant treatment for patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2 -negative (HER2-) early breast cancer (eBC) is sometimes challenging. Genomic assays have improved individualized treatment decisions by providing information on the genomic risk of tumors. The Oncotype DX assay (ODX) is both prognostic and predictive of chemotherapy benefit. This study aimed to evaluate the implementation process of the ODX into clinical practice, the impact of ODX on adjuvant chemotherapy treatment decisions and conduct a cost impact analysis. Patients and methods A retrospective study at Tampere University Hospital included 129 patients with HR + , HER2- eBC tested with ODX between September 2021 and September 2023. Treatment decisions as well as adjuvant chemotherapy (CT) costs, associated health provider costs, and societal costs were projected. Results ODX testing significantly altered CT recommendations by reducing unnecessary CT for 73% of the study patients. With ODX testing, the cost impact analysis revealed partial cost savings for the health care provider due to reduced CT administration. From a societal perspective, the use of ODX resulted in substantial savings largely attributed to the maintenance of work productivity among working-aged and employed patients. Conclusion This study highlights the importance of streamlined testing processes and the need for clinician training in interpreting test results in a real-world setting. In addition, the findings underscore the role of ODX in enhancing personalized treatment in HR + , HER2- eBC while reducing overtreatment. The cost analysis indicates substantial cost savings with ODX testing.

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