Search Results (469)

Background and Objectives: Dual bronchodilation in chronic obstructive pulmonary disease (COPD) has demonstrated beneficial effects on health-related quality of life (HRQoL) and exercise-related outcomes. Real-world evidence in treatment-naïve COPD remains limited. Materials and Methods: Forty-six COPD patients and 23 age-, gender-, BMI-, and cardiovascular comorbidity–matched controls underwent spirometry, plethysmography, symptom-limited incremental cardiopulmonary exercise testing (CPET), and the 36-item Short-Form Health Survey (SF-36). Following baseline assessment, COPD patients received tiotropium/olodaterol as part of routine practice. Thirty-two patients underwent repeated examinations at 12 weeks. Baseline differences between the COPD and control groups were assessed, and longitudinal changes in pulmonary function, CPET, and SF-36 were evaluated in COPD patients. Results: Compared with controls, COPD patients had lower peak oxygen uptake (VO₂; 17.4 ± 4.4 vs. 22.8 ± 4.5 mL/kg/min, p < 0.001) and oxygen pulse (11.5 ± 3.5 vs. 14.0 ± 2.4 mL/beat, p = 0.003), failed to reach 80% of predicted values, and exhibited worse ventilatory efficiency (p < 0.001). SF-36 scores in the COPD group were lower across all domains. After 12 weeks of tiotropium/olodaterol, pulmonary function improved significantly. CPET was performed at comparable efforts at both visits. Peak VO₂ increased from 70 ± 15 to 75 ± 16% predicted (p = 0.044), and peak oxygen pulse from 74 ± 16 to 79 ± 16% predicted (p = 0.015). VE/MVV decreased from 0.77 ± 0.23 to 0.69 ± 0.15 (p = 0.03). Higher baseline VE/MVV predicted a larger improvement after treatment (B = 0.71, p < 0.001), while beta-blocker use had no effect on the change of VE/MVV. SF-36 physical functioning and health change scores improved (both p < 0.01). Conclusions: At diagnosis, COPD was associated with impaired exercise physiology and reduced HRQoL. Dual bronchodilation improved exercise responses and perceived physical functioning. Beta-blocker use was not associated with changes in breathing reserve, supporting the use of cardioselective agents when indicated. Full article

Background/Objectives: Cervical pain is defined as pain in the neck that may or may not radiate to one or both upper extremities and lasts at least one day. Headaches are within the spectrum of neck pain, defined as any painful sensation perceived in the head that can extend to the neck. They are classified as primary (migraines and tension headaches) or secondary (cervicogenic headaches) depending on their clinical presentation and associated symptoms. The objective of this review is to compare the effects of dry needling with and without spinal manipulative techniques versus the application of other physical therapy modalities. Methods: A systematic review was conducted searching articles compatible with the objectives of this study in PubMed, ScienceDirect, and Scopus databases using the search terms spinal manipulation, cervical manipulation, dry needling, headache, headaches, and migraine over the last five years and combined with the Boolean operators AND and OR. After screening, all studies underwent methodological quality assessments using the PEDro scale and qualitative synthesis for study design, patients’ characteristics, interventions, comparators, outcomes assessed and main results data. Results: Thirteen randomized clinical trials were selected. The quality of the studies is varied, with PEDro scale values ranging from six to eight. Dry needling and cervical manipulations have proven to be effective tools, compared to other interventions, in reducing pain and improving functionality in patients with headaches. Conclusions: Dry needling techniques and manipulations have shown significant effects on parameters related to pain, sensitivity, functionality, and general health in patients with headaches. However, future studies are necessary to more deeply analyze the long-term effects of both techniques. Full article

In the context of smart manufacturing, with the widespread deployment of Industrial Internet of Things (IoT) devices, a large number of computation tasks that are highly sensitive to latency and have strict deadlines have emerged, requiring real-time processing. Effectively offloading tasks to address the issues of increased latency and task dropouts caused by dynamic changes in edge node load has become a key challenge in the cloud–edge–end collaborative environment of smart manufacturing. To tackle the complex issues of unknown edge node loads and dynamic system state changes, this paper proposes a distributed algorithm based on deep reinforcement learning, utilizing convolutional neural networks (CNN) and the Informer architecture. The proposed algorithm leverages CNN to extract local features of edge node loads while utilizing Informer’s self-attention mechanism to capture long-term load variation trends, thereby effectively handling the uncertainty and dynamics inherent in node loads. Furthermore, by integrating the Dueling Deep Q-Network (DQN) and Double DQN techniques, the algorithm achieves a precise approximation of the state–action value function, further enhancing its capability to perceive system temporal characteristics and adapt to heterogeneous tasks. Each mobile device can independently make task offloading decisions and scheduling strategies based on its observations, enabling dynamic task allocation and optimization of execution order. Simulation results show that, compared to various existing algorithms, the proposed method reduces task dropout rates by 82.3–94% and average latency by 28–39.2%. Experimental results validate the significant advantages of this method in intelligent manufacturing scenarios with high load and latency-sensitive tasks. Full article

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered by primary healthcare, local government, and lived-experience recovery organisations in the North East of England, UK. Methods: Pragmatic mixed-methods process evaluation with data sources including a patient survey, overt observations, qualitative interviews, and routine patient data. Qualitative data were analysed using inductive and deductive thematic analysis; quantitative data were analysed descriptively. RE-AIM framework dimensions were applied to inform interpretation. Results: N = 164 patients accessed the bus between 1 April and 31 October 2025, with survey data indicating that most patients were PWUS (n = 96, 84%), with experience of homelessness (n = 67, 61%) and/or lived in the most deprived neighbourhoods, with complex physical and mental health needs (Reach). Patients expressed satisfaction with the service, valuing the compassionate and comprehensive support provided. There was qualitative evidence of further re-engagement with statutory healthcare following attendance on the bus (Effectiveness). Local organisations were mostly keen to be involved in the pilot, with participation benefiting from existing local relationships and infrastructure (Adoption). The flexible yet consistent approach of those involved in service delivery was viewed as positive. There was some uncertainty around the functions of the bus and the role of some delivery staff (Implementation). Limited funding was perceived as a barrier to sustaining the bus, alongside lack of capacity within local organisations (Maintenance). Conclusions: The study highlighted the positive impact that an MHC can have on this marginalised population and provides further evidence for the need for clinical care that provides relational support and attends to the social determinants of health. The study indicates the potential for interdisciplinary working to improve access to healthcare for PWUS, and underlines that delivering healthcare at a neighbourhood level is reliant on strong community networks. Wider system change is still needed to further support the population. Full article

Cultural heritage can strengthen urban resilience when mobilized as educational infrastructure that builds stewardship, place attachment, and civic agency. This study examines whether the Art Nouveau Path, an outdoor mobile augmented reality heritage game in Aveiro, Portugal, can function as a curriculum-aligned pathway for sustainability competences and resilience-relevant meaning-making in formal education. A curriculum translation matrix mapped eight points of interest and 36 tasks to Portuguese curriculum anchors, Education for Sustainability themes, GreenComp sustainability competences, and the Sustainable Development Goals, framing the matrix as an adoption-oriented design artefact. Empirical evidence comprised accompanying teachers’ in-field observations (T2-OBS; N = 24 across 18 sessions) and students’ post-activity survey data (S2-POST; N = 439), with open-ended reflections coded through a directed resilience-mechanism codebook (Krippendorff’s alpha = 0.91). Teachers reported high perceived value and feasibility and frequently noted enacted stewardship and placed responsibility during sessions. Students’ reflections most often linked resilience to sustainable conservation under pressure and to nature-city interconnections, whereas hazard-memory mechanisms appeared less often. Adoption-related evidence is limited to teacher feasibility reports and institutional legibility from curriculum translation, rather than confirmed institutional uptake indicators. Scaling is likely to require explicit supports for differentiation, assessment scaffolds, and routine delivery in public spaces. Full article

The interaction between humans and birds plays an important role in shaping the sustainability of tropical rainforest ecosystems, particularly through bird vocalizations that function as bioacoustic indicators of ecological conditions while simultaneously embedding socio-cultural meanings within local communities. This study aims to (1) classify types and categories of bird sounds as perceived by rural communities, and (2) assess the role of bird vocalizations as cultural symbols supporting community-based conservation practices. The study was conducted across six islands and eight villages in North Maluku, Eastern Indonesia, using a qualitative approach based on semi-structured interviews and community workshops. A total of 435 respondents, all of whom were farmers residing along forest margins, participated in the study. The results documented 51 bird species belonging to 26 families, whose vocalizations were interpreted and classified by local communities into three acoustic categories: 21 species with loud calls (41.18%), 12 species with melodious calls (23.53%), and 18 species with sad calls (35.29%). Melodious vocalizations were commonly associated with values of beauty, calmness, and social harmony, whereas loud calls were predominantly interpreted as warnings, signals of alertness, or indicators of environmental change. These findings demonstrate that bird sounds serve not merely as ecological cues, but as culturally embedded symbols that guide daily activities, moral values, and conservation ethics within rural communities. By documenting the cultural significance of bird vocalizations across a clearly defined geographic context, this study provides an empirical basis for culturally informed conservation strategies aimed at protecting bird species subject to high levels of cultural use and ecological pressure. Full article

Emerging digital technologies are increasingly embedded in consumer-facing financial services, reshaping how users experience, evaluate, and engage with AI-mediated interactions. This paper investigates how the perceived sociality of AI Digital Human Advisors influences user experience in digital financial services. Sociality—defined as the extent to which users perceive an AI Digital Human Advisor as a socially capable actor (e.g., responsive, relational, and role-embedded) rather than a purely functional tool—was experimentally manipulated across four controlled behavioral experiments simulating interactions on financial platforms. The results from four controlled experimental simulations consistently demonstrate that, under controlled interaction conditions, high-sociality AI advisors significantly enhance both utilitarian and hedonic value. Social presence was found to partially mediate these effects, revealing the psychological mechanism through which social cues embedded in emerging AI technologies are transformed into experiential value. Furthermore, two boundary conditions were identified: communication style and usage context. Communication framed around task completion amplified the influence of sociality on utilitarian value, whereas interaction styles emphasizing social connection strengthened its effect on hedonic value. Likewise, purchase-related scenarios heightened functional perceptions, while browsing situations elicited stronger emotional responses. By situating AI Digital Human Advisors within the broader context of emerging digital technologies, these findings extend Social Response Theory into AI-mediated financial environments and provide insights into how technologically enabled social cues shape consumer experience and behavior in digital finance. Full article

Early adolescent sport dropout is commonly explained through individual psychological factors such as declining motivation, burnout, or identity conflict. While valuable, these accounts often assume parental logistical and financial support as a stable background condition. This conceptual article introduces the Utilitarian Shift as a novel, family-level structural mechanism that helps explain why sport dropout peaks during early adolescence. Drawing on Social Exchange Theory, sociological perspectives on family investment, and developmental psychology, the framework conceptualizes dropout as emerging from a developmentally timed recalibration of parental investment. During childhood, parental support is largely sustained by custodial and broad developmental incentives; however, as adolescents gain functional independence and perceived developmental returns decline, continued investment becomes conditional rather than assumed. At the same time, sport system demands intensify through specialization pressures, rising costs, and selection mechanisms such as the Relative Age Effect. The convergence of declining perceived returns and escalating costs prompts rational parental withdrawal of logistical and financial support, thereby dismantling the material infrastructure required for sustained participation. Importantly, this withdrawal precedes and reshapes adolescents’ capacity to enact motivation, agency, and resilience, rather than merely responding to disengagement. The article situates early adolescent sport dropout as a relational and structurally mediated process, shifting analytic attention away from athlete-centered deficit models toward dynamic parental decision-making within marketized youth sport systems. Practically, the framework highlights the need for sport organizations and governing bodies to redesign participation pathways and value propositions that sustain parental engagement during early adolescence, even in the absence of elite performance trajectories. Full article

This study examines how consumers’ perceptions of corporate environmental, social, and governance (ESG) performance are statistically associated with sustainable relational outcomes within a structured cognitive and relational framework. Drawing on signaling theory and perceived value theory, we propose and empirically test a sequential mediation model in which perceived ESG performance is positively associated with perceived sustainability awareness (PSA), PSA subsequently is associated with dual-path value perceptions (cognitive and socio-emotional value), and these value perceptions are positively related to long-term trust (LTT) and value co-creation (VCC). In addition, the moderating role of signal credibility on the ESG–PSA relationship is examined. Using survey data from 278 South Korean consumers and structural equation modeling, the results indicate that perceived ESG performance is significantly positively associated with PSA, which in turn is positively associated with both cognitive and socio-emotional value. These value dimensions independently and positively relate to long-term trust, which is in turn associated with value co-creation. Contrary to expectations derived from signaling theory, signal credibility does not significantly moderate the ESG–PSA relationship, suggesting that ESG signals may function as baseline legitimacy cues within the South Korean institutional context, where sustainability norms are relatively institutionalized. Overall, the findings suggest that ESG effectiveness does not operate through direct persuasion but is consistent with a multi-stage cognitive and relational framework. By distinguishing sustainability awareness from ESG perception and decomposing value perceptions into dual paths, this study advances theoretical understanding of how ESG signals may be internalized and statistically linked to sustainable firm–consumer relationships. From a managerial perspective, the results highlight the strategic importance of designing ESG initiatives and communications that enhance sustainability awareness and support long-term trust as foundations for engagement and co-creation. Given the cross-sectional design, the proposed sequential structure should be interpreted as associative rather than definitive causal evidence. Full article

Eating disorders are multifactorial mental health conditions that predominantly affect adolescent girls and young women and constitute a major public health concern due to their severe and often chronic impact on physical, psychological, and psychosocial functioning. Although existing research suggests that gender-related constructs and traditional gender roles may be associated with the development and expression of eating disorders, empirical evidence using validated measures remains limited. Accordingly, the present study examines health-related variables from a gender-sensitive perspective in a clinical sample of women diagnosed with an eating disorder. Forty women aged 14 to 50 years completed an assessment protocol including measures of gender norms, eating disorder symptoms, mental health, and self-perceived overall health. Results indicated that poorer mental health and self-perceived overall health were significantly associated with higher levels of eating disorder symptomatology. In an exploratory hierarchical regression analysis, overall conformity to traditional feminine gender norms was associated with eating disorder symptomatology after accounting for health-related variables. Exploratory analyses of individual gender norm dimensions indicated that only a small number of associations remained statistically significant after applying a false discovery rate correction. In sum, within the limitations of a modest and heterogeneous clinical sample, the findings suggest that conformity to traditional feminine gender norms is associated with less favorable health indicators and greater eating disorder symptomatology among women with EDs. These results underscore the potential value of incorporating gender-informed perspectives into future research and clinical reflection, while highlighting the need for replication in larger and longitudinally designed studies. Full article

Older adults with disabilities face compounded vulnerabilities due to both functional limitations and socioeconomic disadvantage. In South Korea, where public welfare systems remain fragmented and cultural values emphasize independence and productivity, understanding the mechanisms linking socioeconomic status (SES) to health outcomes is critical. This study investigates whether reserve capacity mediates the relationship between SES and self-rated health (SRH) in older adults with disabilities. Data were drawn from the supplementary survey on people with disabilities in the 18th wave (2023) of the Korea Welfare Panel Study (KWePS). The analytic sample included older adults aged 65 and above with registered disabilities. A multiple mediation analysis was conducted using Model 4 of the PROCESS macro in SPSS to examine whether three dimensions of reserve capacity—intrapsychic resources (self-esteem), interpersonal resources (social support satisfaction), and tangible resources (use of public disability services)—mediated the relationship between SES and SRH. Demographic and health-related covariates were statistically controlled. The results are as follows: The direct effect of SES on SRH was not significant; however, significant indirect effects were found through all three mediators. Higher SES was positively associated with intrapsychic and interpersonal resources and negatively associated with tangible resource use. Among the mediators, interpersonal resources had the strongest positive effect on SRH, while tangible resources showed a negative association—possibly due to compensatory activation or increased disease awareness among service users. The findings highlight the importance of psychosocial and relational resources in shaping perceived health among disabled older adults in Korea. Policy interventions should move beyond material assistance and focus on strengthening social networks and psychological resilience to reduce health disparities in this population. Full article

This study examines how sustainability orientation shapes sustainability behavior among entrepreneurial small and medium-sized enterprises (SMEs) in Turkey. Grounded in self-determination theory (SDT) and the theory of planned behavior (TPB), this study develops and empirically tests a conditional process model in which perceived social support functions as a mediating mechanism and sustainable entrepreneurship operates as a boundary condition. Data were collected from 519 senior managers of ISO 14001-certified SMEs using a two-wave survey design to mitigate common method variance (CMV). Using Hayes’ PROCESS macro, the results indicate that sustainability orientation is positively associated with sustainability behavior and that perceived social support partially mediates this relationship by facilitating the translation of sustainability values into action. Furthermore, sustainable entrepreneurship strengthens both the direct association between sustainability orientation and sustainability behavior and the indirect pathway operating through perceived social support. SMEs with higher sustainable entrepreneurship capabilities are better positioned to leverage internal values and external social reinforcement to enact proactive sustainability practices. Overall, the findings highlight the joint role of motivational orientations, social reinforcement, and entrepreneurial capability in shaping sustainability outcomes. The study contributes to sustainability and entrepreneurship research by clarifying how value-based orientations are converted into sustainable behavior and offers practical implications for policymakers and SME leaders seeking to accelerate sustainability transitions in emerging economies. Full article

This study examines how artificial intelligence (AI) contributes to contemporary processes of authenticity evaluation by functioning as a multimodal diagnostic cue in consumer decision-making. Drawing on survey data collected from 468 visitors at Terra Madre Salone del Gusto in Turin, Italy, the study tests a structural model comprising five latent constructs: Authenticity Trust, Perceived AI Usefulness and Diagnosticity, Multimodal Value, User Engagement, and Behavioural Intentions. The findings indicate that heritage-based and institutional authenticity cues remain foundational in consumers’ evaluations, but are increasingly associated with interaction with AI-supported information perceived as credible and diagnostically informative. Multimodal inputs—particularly the integration of textual, visual, and auditory narratives—are positively associated with perceived multimodal value and user engagement within AI-supported evaluation. Experiential enjoyment during interaction with the AI system is positively associated with behavioural intentions to adopt AI-supported evaluation tools, while behavioural intentions encompass both adoption readiness and a stated willingness to pay a premium for products perceived as authentic. Although the use of a convenience sample limits generalisability, the results highlight the broader potential of multimodal AI systems to enhance perceived diagnostic clarity and evaluative confidence in complex cultural and consumer environments. Conceptually, the study advances the notion of augmented authenticity, defined as a hybrid evaluative process in which tradition-based trust mechanisms are interpreted in relation to perceived AI diagnosticity and multimodal coherence. By situating AI within culturally embedded processes of meaning-making rather than purely instrumental evaluation, the findings contribute to interdisciplinary debates on technology-supported trust processes, consumer judgement, and the societal implications of AI-supported decision-making. Full article

Drawing upon social presence and perceived value theories, this study examines how time-limited (TL) and quantity-limited (QL) promotions influence consumers’ purchase intention in live-streaming shopping. Through two controlled experiments (using countdown prompts for TL and inventory visualization for QL), the findings reveal distinct mechanisms: TL promotions elevate functional value by fostering a perception of collective synchronicity, whereas QL promotions boost social value identification through the perception of interactive control. Notably, this latter pathway is moderated by social cue sensitivity. Theoretically, this work unveils a “dual social presence–perceived value” framework that overcomes the limitations of single-mediation models and integrates evidence from eye-tracking and neurobehavioral analysis. Practically, it proposes a strategic promotion-matching criterion (recommending TL for high-circulation goods and QL for scarce items) to optimize live-streaming marketing effectiveness. Full article

The successful integration of autonomous vehicle (AV) technologies into future mobility systems depends not only on technological maturity but also on user acceptance and perceived value. While existing research has identified several demographic determinants of AV acceptance, the role of educational background—particularly differences between humanities and STEM graduates—has received limited attention within the context of user-centred mobility research. This study examines how educational background and gender influence attitudes toward autonomous vehicle technologies using a large-scale survey conducted in Hungary (N = 8663). The analysis combines non-parametric statistical tests with effect size measures, exploratory factor analysis, and structural equation modelling (SEM) to capture both group differences and underlying attitudinal mechanisms. The results indicate no meaningful differences between humanities and STEM graduates in overall acceptance of autonomous vehicles or trust in the technology. Statistically significant differences are observed only in two dimensions: willingness to spend on autonomous driving features and expectations regarding improved travel speed. However, effect size analyses reveal that these differences are negligible in practical terms, indicating substantial overlap in user attitudes. SEM results show that educational background does not directly determine acceptance of autonomous vehicle technologies. Instead, its influence is mediated through three latent attitude dimensions relevant for electric and autonomous mobility adoption: willingness to invest, functional expectations (e.g., time savings and convenience), and safety orientation. Humanities graduates—especially men—exhibit slightly higher financial openness toward autonomous features, whereas STEM graduates place greater emphasis on functional performance. Safety-related attitudes play a central mediating role, with gender-specific patterns. By integrating large-sample effect size interpretation with SEM-based modelling, this study provides a nuanced understanding of user acceptance of autonomous vehicle technologies. The findings suggest that differences between educational groups reflect variations in attitudinal emphasis rather than fundamental divides, offering relevant insights for user-centred AV development, mobility policy design, and communication strategies in the transition toward automated and electric mobility systems. Full article