Search Results (16,096)

Background: Studies indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients. Aim: The aim of this study was to investigate the effect of practice on fatigue, respiratory closure, depression and cognition in patients diagnosed with MS and whether the benefit of Hatha Yoga training is affected by personality structure. Methods: The study included 25 participants between the ages of 18 and 70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous cerebrovascular disease, hypertension (HTN), diabetes mellitus (DM), thyroid dysfunction, or vitamin B12 deficiency was determined as an exclusion criterion. In the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. The MOCA (Montreal Cognitive Assessment) and Beck Depression Scale, personality analysis test, pulmonary function test, and Fatigue Impact Scale were applied to all patients fulfilling the inclusion criteria at the beginning and after the completion of Yoga practice. Results: According to the results obtained, a statistically significant decrease in Beck Depression Inventory scores (p = 0.020) and a significant increase in MOCA Cognitive Test scores (p < 0.001) were detected following the yoga intervention. Although an increase was observed in respiratory capacity (FVC), this change did not reach statistical significance (p = 0.082). These findings demonstrate that yoga practice significantly improves depression levels and cognitive functions. The relationship between the benefits derived from yoga training and personality traits was evaluated using the participants’ Temperament and Character Inventory (TCI) profiles. Following the yoga intervention, a statistically significant increase was observed in novelty seeking (p < 0.001) and persistence (p < 0.001). Conversely, participants exhibited a significant decrease in harm avoidance post-yoga (p < 0.001). However, no statistically significant changes were found in reward dependence (p = 0.766) or cooperation (p = 0.181) scores after the intervention. Full article

Background: Autism Spectrum Disorder (ASD) can be conceptualized not as a static condition but as a dynamic disorder of developmental regulation, in which neuroplastic potential is translated into functional gains only through structured, experience-dependent therapeutic input. Neuropsychomotor Therapy of Early Development (TNPEE) and Therapy in Aquatic Motor Activities (TAMA) have shown differential efficacy in children with ASD, but whether chronological age moderates the magnitude of therapeutic response—or whether the characteristics of the intervention itself are the stronger determinant of outcome—has not been systematically examined. Methods: This was a non-randomized, exploratory secondary stratified analysis of a multicenter 18-month longitudinal cohort (N = 77 children with ASD, age 4–12 years) allocated to three groups: TAMA only, TNPEE combined with TAMA (TAMA+TNPEE), or TNPEE only. Participants were stratified into a younger (≤6 years, n = 16; TAMA n = 8, TAMA+TNPEE n = 3, TNPEE n = 5) and an older (>6 years, n = 61; TAMA n = 18, TAMA+TNPEE n = 22, TNPEE n = 21) subgroup. Adaptive functioning was assessed with the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline and 18 months. Between-stratum comparisons used the Mann–Whitney U test; Spearman rank correlations and ANCOVA models with Age × Treatment interaction terms were used to test age moderation within a neuroplasticity-recruitment framework. Results: In the TAMA-only group, younger children showed significantly smaller adaptive gains than older children across the Composite (2.22 ± 1.14 vs. 3.53 ± 0.76, p = 0.012), Communication (p = 0.041), and Socialization (p = 0.016) subscales, with significant positive Spearman correlations between age and adaptive gains (r = 0.397–0.437). Simple slope analysis confirmed a significant age effect within the TAMA group (b = 0.231, SE = 0.083, p = 0.010) but not in the TNPEE (b = 0.133, p = 0.157) or TAMA+TNPEE (b = 0.135, p = 0.198) groups. The formal Age × Treatment interaction term in the ANCOVA did not reach statistical significance (all p > 0.18). As this interaction test is the formal statistical test of differential age moderation, the simple-slope pattern above should be regarded as exploratory rather than confirmatory. Treatment group accounted for the large majority of variance in adaptive gains (partial η² = 0.78–0.95), whereas age explained only a small proportion of outcome variability. ASD severity level transitions were comparable across age strata in TNPEE-based groups. Conclusions: In this exploratory secondary analysis, TNPEE-based interventions were associated with adaptive gains that did not differ significantly by age across the 4–12 year age range, whereas aquatic therapy alone showed an age-dependent pattern favoring older children. These findings are hypothesis-generating and consistent with a neuroplasticity-recruitment model in which therapeutic architecture—rather than chronological age alone— may be associated with how effectively latent plastic potential is translated into developmental gains, although the non-significant Age × Treatment interaction and the small, imbalanced subgroups (including n = 3 in the youngest TAMA+TNPEE stratum) mean these findings require confirmation in adequately powered, prospectively designed studies, with implications for clinical decision-making regarding therapy timing and design. Full article

To alleviate renewable energy curtailment and the high operating costs arising from the temporal and spatial mismatch of distributed generation, this paper develops a cross-park dispatch optimization approach for power systems under the joint participation of carbon trading and green certificate trading (GCT). The proposed approach aims to improve system flexibility and economic performance in coordinated multi-park operation. Specifically, adjustable resources in different parks are dispatched in a coordinated manner, and the total comprehensive operating cost is taken as the optimization objective. In addition, the Alternating Direction Method of Multipliers (ADMM) is adopted to determine inter-park electricity trading prices and exchanged power in a distributed framework. Furthermore, an asymmetric bargaining model is introduced to distribute the cooperative benefits, ensuring a balance between fairness and incentive compatibility. Simulation results demonstrate that inter-park electricity interaction reduces generation costs by 5.29%. The integration of carbon and green certificate trading further reduces costs by 7.4%. After asymmetric bargaining-based benefit allocation, the operating costs of parks with higher contributions decrease by up to 10.34%. The results conclude that the proposed strategy effectively leverages the complementary advantages of multi-park resources and optimizes the synergy between carbon markets, green certificate markets, and physical dispatch. Full article

Students in higher education often face challenges related to motivation, self-regulation, and engagement. This article presents TIRIA, a user-centered learning analytics dashboard designed for Moodle and adaptable to other Learning Management Systems (LMSs), and reports a formative evaluation of its high-fidelity prototype. The design followed a Design Thinking methodology informed by a targeted literature review, interviews with 10 instructors and 9 students, and iterative prototyping. TIRIA integrates visual analytics, personalized feedback, and a gamification layer (points, badges, goal-setting, and a virtual assistant), aligned with Self-Regulated Learning (SRL) theory and interpreted through Self-Determination Theory (SDT). Because the evaluation used a Figma prototype populated with mock data rather than a deployed integration, the study reports perceptions rather than learning outcomes. Six undergraduate students completed think-aloud sessions, a semi-structured interview, and a survey combining the System Usability Scale (SUS), a Technology Acceptance Model (TAM) measure, and two five-item measures adapted from learning analytics quality indicators and from gamification research. Participants rated usability highly (SUS = 93.75, PEOU = 4.75) and consistently valued organizational features, while responses to the gamification layer were markedly polarized (individual means ranging from 1.2 to 5.0). The article contributes a documented design case mapping features to SRL phases and SDT constructs, formative evidence supporting an opt-in approach to gamification, and implementation considerations covering privacy and Moodle integration. Findings are exploratory and require confirmation through deployment in an authentic learning environment. Full article

This article investigates how secondary teachers in two Australian independent schools engaged with generative AI (GenAI) tools to support teaching and learning. Using a qualitative case study methodology and the Technology Acceptance Model (TAM) as a sensitising framework, the study examines teachers’ perceptions of usefulness, ease of use, and the challenges they encountered. Over three months, teachers participated in professional learning groups supported by university-led workshops and peer collaboration. The findings show that teachers’ adoption of GenAI was not simply determined by tool availability or perceived efficiency. Rather, teachers’ perceptions of usefulness and ease of use developed through cycles of experimentation, prompt refinement, peer sharing, and ethical reflection. The study contributes a contextually grounded interpretation of TAM by showing how collaborative professional learning shaped teachers’ movement from initial experimentation towards more purposeful pedagogical integration. The findings suggest the value of considering how perceptions of usefulness and ease of use may develop over time through sustained engagement with GenAI. Full article

Background and Objectives: Despite extensive research on the management of chronic low back pain, evidence regarding the additional benefits of incorporating lumbar extension-specific exercises into conventional core stabilization programs remains limited. Therefore, the primary objective of this pilot study was to evaluate the feasibility of three 8-week exercise interventions in men in their 30s with chronic low back pain, including recruitment feasibility, retention rate, adherence to exercise sessions, intervention acceptability, and safety. The secondary and exploratory objective was to determine preliminary intervention effects and variability parameters for lumbar extensor strength, activities of daily living, and pain intensity. These findings may help in designing, selecting the outcome, and calculating sample size of a future definitive randomized controlled trial with adequate statistical power. Methods: The study included 30 male participants aged 30–39 years with low back pain persisting for more than 12 weeks. They were randomly divided into a MedX Exercise Program Group, a Deadlift Exercise Program Group, and a Core Exercise Program Group. The intervention consisted of exercise sessions conducted twice weekly for eight weeks. The intervention was evaluated by measuring lumbar extensor strength, the ability to perform activities of daily living, and pain intensity before and after the intervention. The collected data were tested for normality using the Shapiro–Wilk test, and homogeneity was tested using one-way analysis of variance. Group differences between time periods were tested using two-way analysis of variance with repeated measures. For outcome variables showing significant between-group differences at baseline, additional analyses of covariance were conducted with the corresponding baseline values included as covariates. Effect sizes and 95% confidence intervals were calculated and reported for all outcome variables. As this pilot study was not designed to provide confirmatory efficacy testing, analyses of secondary outcomes were considered exploratory in nature, and no adjustments for multiple comparisons were applied. Results: All 30 participants who underwent eligibility screening were randomized, and all participants completed the 8-week intervention and follow-up assessments, resulting in a 100% retention rate. Intervention adherence was also 100%, with all 480 scheduled sessions completed (480/480). No intervention-related adverse events were reported, and complete data were available for all outcome variables. For lumbar extensor strength, a significant main effect of time was observed across all seven lumbar extension angles (all p < 0.001), indicating significant improvements within all three groups. A significant time × group interaction was observed only at 0° (p = 0.048); however, subsequent pairwise comparisons revealed no significant differences between any groups at follow-up. Activities of daily living significantly improved in all three groups, and no significant between-group differences were observed in the baseline-adjusted analysis of variance (p = 0.226). Pain intensity significantly decreased in all groups, with the largest reduction observed in the core stabilization exercise group (−78.05%). Post-hoc analyses demonstrated that the reduction in pain intensity was significantly greater in the core stabilization exercise group than in both the MedX lumbar extension exercise group (p = 0.022) and the deadlift exercise group (p = 0.042). Conclusions: All three 8-week exercise interventions were feasible, achieving complete participant retention and adherence, with no reported adverse events. Although lumbar extensor strength, activities of daily living, and pain intensity significantly improved across all groups, no additional benefits were noted from incorporating MedX lumbar extension exercises or deadlift exercises into a common core stabilization exercise program. Notably, the greatest reduction in pain intensity was observed in the core stabilization exercise-only group. Given the exploratory nature and pilot design of this study, these findings should be interpreted cautiously and require confirmation in future adequately powered randomized controlled trials. Full article

Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants associated with higher serum lipids, although primarily in cross-sectional studies, limiting causal inference. We aim to determine whether there is a causal relationship between PFAS and serum lipid levels by emulating a target trial of a hypothetical PFAS-reduction intervention using observational data. The target trial would enroll adults aged ≥20 years without prior cardiovascular, kidney, or liver disease, diabetes, or use of related medications. Participants would be randomly assigned to either PFAS-reduction counseling or no counseling, with adherence evaluated after 10 years, and then followed up after 10 years to assess effects on serum lipids. To emulate the target trial, we will use data from the Copenhagen City Heart Study on three successive clinical visits: baseline, follow-up, and outcome assessment visit, 10 years apart. Eligible participants meet the target trial criteria, have available blood samples for PFAS quantification at follow-up, and information on serum lipids at the outcome assessment. Intervention strategies will be evaluated based on observed reductions in PFAS concentrations between baseline and follow-up visit. Serum lipids are assessed at the outcome assessment visit. The emulation assumes exchangeability by adjusting for baseline and time-varying confounders using G-computation. This protocol explores applying the target trial emulation framework to improve causal inference in environmental epidemiology. Full article

Background: Tibial bone stress injury (TBSI) with associated bone marrow edema (BME) is a common and clinically challenging condition in athletes, often requiring prolonged load restriction and delayed return to sport. Evidence for adjunctive interventions that improve both symptoms and MRI-derived recovery remains limited. The aim of this study was to investigate whether adding Functional Magnetic Stimulation (FMS) to standardized rehabilitation improves pain, function, and MRI-derived outcomes over 16 weeks in athletes with MRI-confirmed TBSI. Materials and Methods: Forty athletes with Fredericson grade 2–3 TBSI were randomized to FMS plus rehabilitation (n = 20) or rehabilitation alone (n = 20). Both groups completed a 4-week load-based rehabilitation program, while the FMS group additionally received eight 30 min FMS sessions at 40 Hz. Outcomes were assessed at baseline, 4 weeks, and 16 weeks. The primary outcome was activity-related pain (NPRS), while secondary outcomes included lower-limb function (LEFS-GR), BME extent, and Fredericson grade. Continuous outcomes were analyzed using two-way mixed ANOVA, whereas Fredericson grade was analyzed using an ordinal generalized estimating equation model. The level of statistical significance was set at p < 0.05. Results: Groups were comparable at baseline. Significant group × time interactions favored FMS for NPRS, F(2, 76) = 12.46, p < 0.001, η²p = 0.247; LEFS-GR, F(1.08, 41.09) = 81.56, p < 0.001, η²p = 0.682; and BME extent, F(1.44, 54.85) = 49.33, p < 0.001, η²p = 0.565. At 16 weeks, the FMS group showed lower NPRS scores, higher LEFS-GR scores, and lower BME extent than controls. Fredericson grade also showed a significant group × time effect, Wald χ²(2) = 20.38, p < 0.001. The FMS group had significantly lower cumulative odds of classification in a higher Fredericson grade at 4 weeks (OR = 0.045, 95% CI: 0.012–0.163, p < 0.001), whereas the corresponding difference at 16 weeks remained directionally favorable but did not reach statistical significance (OR = 0.033, 95% CI: 0.001–1.029, p = 0.052). Conclusions: The addition of FMS to load-based rehabilitation was associated with greater clinical and functional improvements, greater reductions in BME extent, and a more favorable longitudinal trajectory in MRI severity classification than rehabilitation alone in athletes with TBSI. However, because the study did not include a sham-FMS condition and participants could not be blinded, the self-reported pain and functional outcomes should be interpreted cautiously. FMS may represent a useful adjunct to structured rehabilitation, although sham-controlled and longer-term studies should determine its effects on return-to-sport progression and recurrence risk. Full article

Background and Objectives: Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor associated with atherosclerosis, vascular inflammation, and endothelial dysfunction. However, data regarding its relationship with hypertension-mediated organ damage and circadian blood pressure abnormalities remain limited. We aimed to investigate the association of elevated Lp(a) levels with carotid atherosclerosis and nocturnal blood pressure dipping patterns in patients with hypertension. Materials and Methods: This retrospective cross-sectional study included 80 nondiabetic patients with essential hypertension. Patients were categorized according to serum Lp(a) levels into elevated Lp(a) (≥50 mg/dL, n = 20) and lower Lp(a) (<50 mg/dL, n = 60) groups. All participants underwent carotid ultrasonography, transthoracic echocardiography, ambulatory blood pressure monitoring, and ophthalmologic evaluation. Multivariable logistic and linear regression analyses were performed to determine independent associations between Lp(a), carotid plaque presence, and nocturnal dipping percentage. Results: Patients with elevated Lp(a) levels had a significantly higher prevalence of carotid plaque (55.0% vs. 23.3%, p = 0.008) and non-dipper hypertension (75.0% vs. 46.7%, p = 0.028) compared with patients with lower Lp(a) levels. Serum Lp(a) concentrations were inversely correlated with nocturnal dipping percentage (r = −0.362, p = 0.001). In multivariable logistic regression analysis adjusted for age, sex, LDL cholesterol, and active smoking, elevated Lp(a) remained independently associated with carotid plaque presence (OR 3.24, 95% CI 1.06–9.80, p = 0.039). In multiple linear regression analysis adjusted for age, sex, LDL cholesterol, and office systolic blood pressure, higher Lp(a) levels remained independently associated with lower nocturnal dipping percentage (β = −0.294, p = 0.008). No significant associations were observed between Lp(a) and carotid intima–media thickness, left ventricular hypertrophy, hypertensive retinopathy, or renal functional parameters. Conclusions: Elevated Lp(a) levels were independently associated with carotid plaque presence and impaired nocturnal blood pressure decline in hypertensive patients. These findings suggest that Lp(a) may be more closely linked to focal macrovascular atherosclerosis and abnormal circadian blood pressure regulation rather than diffuse hypertensive structural remodeling. Full article

In increasingly digital and AI-mediated educational environments, adult learners are required to navigate complex information landscapes shaped by artificial intelligence, digital platforms, and algorithmically generated content. In such contexts, digital literacy can no longer be understood solely as the acquisition of technical competencies. Rather, contemporary digital literacy requires the evaluative and reflective capacities traditionally associated with critical literacy, including the ability to question assumptions, critically evaluate information, engage dialogically with knowledge, and recognise the technological and ideological systems that shape contemporary communication and knowledge production. Consequently, critical literacy has become particularly important within adult and lifelong learning as learners seek to participate meaningfully and ethically within digitally mediated societies. Drawing on Freirean pedagogy and transformative learning theory, this paper revisits critical literacy as a reflective, emancipatory, and socially situated practice grounded in critical consciousness and perspective transformation. It explores how digital technologies can support the development of critical literacy when embedded within learner-centred pedagogies. It further examines the pedagogical potential of digital tools including digital badges, Turnitin Clarity, and Gather to foster reflection, dialogue, writing development, communicative learning, and evaluative judgement. Rather than positioning technology as inherently transformative, this paper argues that it is the pedagogical framing of digital tools that determines their capacity to support critical engagement and learner agency, preserving human criticality within AI-mediated educational systems. This paper highlights the continuing relevance of transformative learning theory in contemporary digital contexts and argues that critical reflection and dialogic learning remain central to adult education in an era shaped by artificial intelligence and digital communication. It concludes that critically informed digital pedagogies can create meaningful opportunities for learners to develop the reflective and evaluative capacities necessary for informed participation in contemporary digital society. Full article

The increasing penetration of renewable energy has created an urgent need for economically competitive large-scale energy storage technologies. Conventional economic evaluations mainly focus on lifecycle costs while neglecting market participation, revenue diversification, and investment uncertainty. This study proposes an integrated lifecycle economic assessment framework combining discounted cash flow (DCF) theory, lifecycle cost analysis, multi-market revenue modeling, and uncertainty analysis. A revenue-adjusted indicator, termed Net Levelized Cost of Storage (Net LCOS), is introduced to quantify the actual economic competitiveness of energy storage technologies by incorporating revenues from energy arbitrage, ancillary services, and capacity remuneration. The proposed framework is applied to three representative large-scale energy storage technologies: pumped hydro storage (PHS), compressed air energy storage (CAES), and battery energy storage (BES). The results show that PHS exhibits the lowest levelized cost of energy (LCOE) (0.519 RMB/kWh) and the strongest economic robustness owing to its long service life and superior capital amortization capability. Incorporating multi-market revenues substantially improves the economic performance of all storage technologies. BES exhibits the largest reduction in Net LCOS, whereas PHS maintains the lowest Net LCOS and the strongest overall economic competitiveness. Sensitivity analysis identifies conversion efficiency, capital investment, capacity remuneration, and operational utilization as the dominant determinants of storage economics. The proposed framework extends a comprehensive approach for comparing large-scale energy storage technologies by integrating lifecycle costs, market revenues, and uncertainties, supporting investment decisions and electricity market design. Full article

Background/Objectives: Binge eating (BE)—eating an objectively large amount of food with a subjective loss of control—occurs broadly beyond formal eating disorder diagnoses. However, its real-time occurrence in the general population remains poorly understood due to reliance on retrospective, clinic-based self-reporting. Ecological momentary assessment (EMA) captures repeated, real-time reports of BE and may overcome these limitations. This scoping review mapped EMA studies of BE in non-clinical, general population samples, paying attention to population characteristics, methodological approaches, and key findings. Methods: This review followed PRISMA-ScR guidelines. PubMed and Scopus were searched for studies published between January 2016 and January 2026, with eligibility independently assessed by two reviewers. Results: Twenty-three studies met the inclusion criteria. Twenty studies (87%) comprised predominantly female samples, and most participants were in their twenties; men, middle-aged adults, and racially diverse populations were underrepresented. Regarding EMA methodology, BE was assessed either by measuring overeating and loss of control of eating separately (15 studies) or through direct, instructed self-report (8 studies); most studies used signal-contingent designs, with response rates generally being between 60% and 85%. Across studies, BE was most consistently linked to negative affect, weight stigma, and body dissatisfaction, while dietary restraint and food insecurity—a more recently emerging focus—were each examined in only one or two studies. Conclusions: This review maps the range of EMA methodologies used to assess BE, offering a methodological reference point for future studies. However, the existing evidence remains concentrated in young, female, and predominantly White samples, and further research in underrepresented populations is needed to clarify the broader determinants of BE in everyday life. Full article

Women’s concerns about personal safety significantly affect their use of public spaces, particularly semi-enclosed micro-public environments such as public toilets. Existing studies have not fully clarified how different spatial elements influence women’s perceived safety or how perceived-safety-oriented design priorities should be determined. This study develops and preliminarily examines an evaluation framework for women’s perceived safety in public toilets, which are treated as a highly private type of micro-public space. Grounded in Crime Prevention Through Environmental Design theory, the framework integrates visual scenario simulation, the Kano model, and the Best–Worst Method. A total of 257 female participants evaluated simulated spatial scenarios, and 10 experts assessed the relative importance of key indicators. The Kano results show that Facility condition is a must-be requirement; Lighting, Degree of enclosure, Material transparency, Signage clarity, Entrance buffer zone, Surveillance cameras, Hygiene conditions, and Graffiti and advertisements are one-dimensional requirements; and Women’s care area, Auditory conditions, Olfactory conditions, Loitering detection, and Emergency support are attractive requirements. The weighting results identify Degree of enclosure, Facility condition, and Hygiene conditions as the most important indicators. Based on these findings, the study proposes an integrated framework of “evaluation dimensions–demand attributes–relative weights–design priorities” and a design path of “basic guarantee–priority improvement–support enhancement.” The findings provide design guidance for public toilets and a methodological reference for other micro-public spaces, although the specific Kano classifications and weights require contextual recalibration. Full article

Cardiovascular diseases remain the leading cause of mortality worldwide, and endoplasmic reticulum (ER) stress has emerged as an important molecular mechanism underlying myocardial injury and heart failure. This study investigated the expression of the ER stress-related genes GRP78, PERK, and CHOP in peripheral whole blood obtained from patients with acute cardiovascular diseases. A total of 300 participants were enrolled, including 200 patients with ST-segment elevation myocardial infarction (STEMI, n = 55), non-ST-segment elevation myocardial infarction (NSTEMI, n = 88), decompensated heart failure (DHF, n = 40), or unstable angina pectoris (USAP, n = 17), and 100 healthy controls. Relative mRNA expression levels were quantified using quantitative real-time PCR. Intergroup comparisons were performed using the Kruskal–Wallis test followed by Dunn’s post hoc test with Bonferroni adjustment. Significant differences in GRP78, PERK, and CHOP expression were observed among the study groups (all p < 0.001). GRP78 and PERK expression levels were highest in the STEMI and DHF groups, whereas CHOP expression was highest in the STEMI group. Significant positive correlations were identified between troponin and CHOP (r = 0.48), GRP78 (r = 0.42), and PERK (r = 0.39) (all p < 0.001), while weaker but significant associations were observed between inflammatory markers (CRP and NLR) and ER stress-related gene expression. Exploratory receiver operating characteristic (ROC) analysis showed that CHOP demonstrated the highest discriminatory performance for distinguishing patients with acute cardiovascular disease from healthy controls. These findings indicate that peripheral whole-blood ER stress-related gene expression is associated with acute cardiovascular disease and correlates with established biomarkers of myocardial injury and inflammation. Further prospective studies are required to determine the clinical significance of these findings. Full article

The upcoming proliferation of Automated Vehicles (AVs) above Level 3 fundamentally disrupts established communicative conventions between road users and vehicles, and external Human–Machine Interface (eHMI) emerges as the primary channel for conveying vehicle intent to pedestrians, cyclists, and other drivers. Despite the standardisation of the marker lamp of AVs and the growing research activity since 2016, no internationally harmonized eHMI standard has been established as of early 2026. This Systematic Literature Review (SLR), following the PRISMA 2020 protocol, synthesizes empirical and technical findings from 149 peer-reviewed English journal articles spanning the decade from 2016 to 2026, from Web of Science, Scopus, IEEE Xplore, and Google Scholar. The review covers scenario design, test methodologies, participant demographics, eHMI modalities, and performance evaluation measures by mapping, coding, and presenting in a structured framework the reviewed papers. The key findings are as follows: (1) 13 use cases (50%, out of 26) still need to be further studied; (2) vehicle kinematics remain a primary determinant of crossing decisions, with eHMI signals serving as confirmatory rather than primary cues in many scenarios; and (3) cross-cultural and demographic diversity in empirical studies remains critically insufficient for global regulatory purposes. We synthesize these findings into a structured framework of evidence-based recommendations for international eHMI standardisation organizations and identify critical research gaps requiring resolution before comprehensive standards can be enacted. Full article