Search Results (1,534)

Background: Large language models and other generative artificial intelligence (AI) tools are increasingly being embedded in digital healthcare services, including mobile health applications, telerehabilitation, remote monitoring, and hybrid care pathways. In this review, digital healthcare refers to technology-mediated healthcare services in which digital platforms, mobile applications, wearables, remote communication, and AI-enabled interfaces support health assessment, self-management, rehabilitation, clinical decision support, or service delivery. When AI-generated exercise guidance moves from general education to individualized recommendations about dose, progression, contraindications, or rehabilitation, it may become directly actionable and safety-relevant. Objectives: This review aimed to clarify when AI-generated exercise guidance in digital healthcare may warrant safety-relevant governance attention and to outline implementation considerations for explainability, human oversight, and service-level governance. It addresses a gap in the literature: general AI-governance and exercise-prescription discussions rarely specify how point-of-use explanations, review thresholds, and escalation safeguards can be organized for directly actionable AI exercise guidance. Methods: We conducted a governance-oriented narrative review of peer-reviewed literature and representative regulatory or guidance documents. This review was not designed as a systematic review, scoping review, or exhaustive evidence map; transparent source mapping was used to support conceptual synthesis. Searches and source mapping focused on generative AI, large language models, explainable AI, clinical decision support, digital health, mobile health, exercise prescription, rehabilitation, trust, automation bias, and human oversight. Sources were included when they informed the safety, explainability, governance, or real-world implementation of patient-facing AI-generated exercise guidance. Extracted material was grouped by evidentiary role and synthesized through framework synthesis and governance mapping to distinguish literature-supported observations, author interpretation, and proposed implementation tools. Results: The included sources were first organized into five thematic groups: digital exercise delivery and exercise-prescription evidence; explainability, trust, and automation bias literature; professional responsibility, ethics, and patient disclosure literature; regulatory and policy documents; and digital literacy, patient/clinician attitudes, and equity literature. The synthesis then proceeded from safety relevance to explanation needs, human oversight and escalation needs, and selected regulatory and policy signals before translating these strands into conceptual and implementation-oriented outputs rather than empirically validated instruments. AI-generated exercise guidance was most safety-relevant in scenarios involving individualized dose, progression, contraindication-sensitive action, or rehabilitation strategy. Across the included sources, generic transparency alone was not sufficient to support reviewable use; relevant explanation elements included evidence sources, risk warnings, reasoning paths, and reasonable alternatives. Oversight considerations varied with embodied risk, clinical ambiguity, user vulnerability, and likelihood of direct enactment. Implementation considerations linked interface design, clinical review, escalation, auditability, and post-deployment monitoring. Conclusions: AI-generated exercise guidance in digital healthcare may warrant governance attention as a patient-safety and accountability issue when it influences actionable exercise decisions. The proposed framework offers a conceptual basis for designing more reviewable and accountable mobile and remote exercise-support services. Future work can validate these outputs in patient-facing services, clinician review workflows, usability studies, implementation pilots, and safety evaluations. Full article

Person–Environment Fit Theory explains organizational match in beliefs and values influences employee satisfaction and motivation in the workplace. Automated systems [e.g., artificial intelligence (AI)] and advanced technology have been integrated into business operations to compete in the digital era. However, how employee technology orientation and individual differences influence workplace preferences is underexplored. This study advances how organizations can strategically attract talent aligned with their technological infrastructure and work design. Parallel mediation path analysis was conducted on a surveyed U.S. convenience sample (SPSS PROCESS Model 4; N = 912). Technology adaptability was positively associated with preference for a job role highlighting working with automated systems relative to emphasizing supportive coworkers. Technology adaptability related to a greater need to belong and job satisfaction (as parallel mediators) and thereby less preference for a role working with automated systems (i.e., preference for a supportive coworkers job ad). The findings reveal that job ads promoting automated systems do not unilaterally attract tech-adaptive employees. Belonging needs and job satisfaction can function as psychological factors that redirect tech-savvy workers towards socially enriched roles. Proactively advertising social belonging and job satisfaction cues alongside advanced technology use could more comprehensively appeal to tech-adaptive job seekers. This can signal a better value congruence between an organization and these job seekers. Full article

The maritime and logistics sector is undergoing digital transformation, positioning digital logistics platforms (DLPs) as important tools for improving operational coordination, information visibility, and organizational performance (OP). However, prior studies have mainly examined platform adoption, digital capabilities, or macro-level performance outcomes, while paying insufficient attention to the micro-level cognitive and experiential mechanisms through which DLP innovation diffusion is translated into OP, particularly in the Chinese maritime logistics context. Grounded in an integrated framework combining the Stimulus–Organism–Response (SOR) paradigm, Diffusion of Innovations Theory (IDT), and the Extended Technology Acceptance Model (ETAM), this study investigates how DLP innovation diffusion affects OP through perceived usefulness (PU), perceived ease of use (PEOU), and flow experience (FE). Using survey data from 400 professionals in Chinese maritime and logistics enterprises and second-order structural equation modeling (SEM), the results show that DLPs’ innovation diffusion significantly enhances PU, PEOU, and FE. PU has the strongest standardized effect among the paths from DLPs’ innovation diffusion to the mediators (β = 0.779), whereas FE has the strongest direct effect on OP (β = 0.279) and the largest mediating effect. These findings clarify the cognitive–experiential pathway linking DLPs’ innovation diffusion to OP and inform DLPs’ implementation in maritime logistics. Full article

Mitochondrial reactive oxygen species (mtROS) are central regulators of cellular function, yet their biological roles are often reduced to an oxidative-stress/antioxidant dichotomy. This review reframes mtROS through the concept of mitohormesis, in which outcomes are neither inherently harmful nor beneficial but are determined by a defined set of contextual variables. We present a mechanistic framework in which mtROS effects depend on chemical species identity, sub-mitochondrial site of production, temporal dynamics, redox-buffering capacity, and metabolic state; together, these variables determine whether mtROS promote adaptive eustress or pathological distress. We then show that, across polyphenols, isothiocyanates, terpenoids, alkaloids, and quinones, the biologically relevant effects of natural redox-modulating compounds are mediated less by direct radical scavenging than by pro-hormetic mechanisms, including mild electron transport chain perturbation, nuclear factor erythroid 2-related factor 2/Kelch-like ECH-associated protein 1 (NRF2/KEAP1) activation, modulation of mitochondrial membrane potential, mitochondrial quality control, and NAD⁺/NADPH regulation. Applying this framework to disease reveals strong tissue and state dependence: neurodegeneration favors buffering expansion and mitophagy; metabolic disease may benefit from exercise-mimetic and NRF2-activating strategies; cardiovascular disease illustrates mitohormesis through ischemic preconditioning and CoQ10 supplementation; and cancer requires distinction between prevention and therapy because redox buffering can either protect normal tissue or support tumor survival. Finally, we argue that the failure of non-specific antioxidant supplementation is mechanistically predictable and propose context-aware, biomarker-guided, temporally optimized, and compartment-targeted redox interventions as a more rational translational path. Full article

Drawing on dynamic capability theory and upper echelons theory, this study develops a moderated mediation framework that treats green dynamic capabilities as a mediator and top management team (TMT) behavioral integration as a moderator. Empirical tests based on sample data reveal that the application of generative artificial intelligence is positively associated with corporate green innovation. This relationship is partially mediated by green dynamic capabilities. Moreover, TMT behavioral integration not only positively moderates the direct effect of generative AI on green innovation but also strengthens both stages of the indirect path, thereby reinforcing the overall mediated mechanism. The study uncovers a “capability transformation” process and “governance boundary” conditions through which generative AI may facilitate green innovation in agricultural enterprises, extends theoretical research at the nexus of digital technology and green innovation, and offers practical guidance for agri-businesses seeking coordinated digital and green development. Full article

With the continuous deepening of green building concepts and the sustained advancement of research on health-oriented design, increasing attention has been paid to the impact of architectural space on users’ psychological perception and behavioral outcomes. In China, the rapid development of urban cultural facilities and the growing emphasis on high-quality public cultural spaces have made concert halls an important context for examining how architectural environments shape user experience. In recent years, relevant studies have gradually expanded from energy conservation, function, and technical performance evaluation to discussion of the subjective experience of the architectural environment and its psychological effects. As a typical type of cultural building, the concert hall is an important place for music communication and artistic experience, and its spatial environment may also influence users’ state of immersion and emotional resonance. However, existing studies mostly focus on the acoustic quality, visual characteristics, and functional organization of concert halls, and still lack a systematic empirical explanation of how restorative design influences user satisfaction through psychological mechanisms. Using survey data from 972 users of six representative concert halls in six Chinese cities, this study constructs a theoretical model with perceived restorative design as the independent variable, flow experience and musical resonance as mediating variables, and user satisfaction as the dependent variable, aiming to broaden the understanding of the internal mechanism through which restorative design affects user satisfaction. The results show that: (1) perceived restorative design is positively associated with user satisfaction; (2) flow experience and musical resonance respectively play mediating roles between perceived restorative design and user satisfaction; and (3) flow experience and musical resonance respectively play a chain mediating role between perceived restorative design and user satisfaction. This study enriches the applied research on restorative design in the field of cultural architecture, reveals the psychological path through which restorative design in concert halls affects user satisfaction, and expands the theoretical boundaries of research on architectural environment experience. The conclusions provide a theoretical basis for optimizing the design of concert hall buildings and improving user experience, and also offer practical insights for the human-centered and high-quality development of cultural buildings in the context of green building. Full article

Social anxiety, peer victimisation, and social support are key issues during mid-childhood that provide important influence in the later adolescent years. While extensive research has evaluated these constructs in isolation and during adolescence, almost no longitudinal studies have evaluated relationships between them during mid-childhood. The current study obtained self-report measures of social anxiety, peer victimisation, and social support from a close friend, from 7846 students from grades three and four (M age = 9.01 yr), on three occasions over two years. Path analyses examined mediating and moderating relationships, as well as moderation by binary gender. There was minimal moderation by gender on any of the relationships between variables. Over time, there was a stronger positive prediction from social anxiety to later victimisation (β’s = 0.09–0.12) than from victimisation to later social anxiety (β’s = 0.04–0.07). Social anxiety negatively predicted later social support (β’s = −0.05 to −0.09), but social support did not consistently predict later social anxiety (β’s = −0.01 to −0.02). Interestingly, the results did not support a buffering effect of social support on peer victimisation; however, these longitudinal data did support several indirect paths. The results highlight the cyclical relationship between social anxiety and peer victimisation but point to social anxiety as a unidirectional predictor of social support from a close friend during the middle to late childhood years. Early intervention for social anxiety may produce positive downstream effects on both peer victimisation and social support. Full article

(1) Background: Student burnout, widely regarded as a form of “hidden dropout” among adolescents, is associated with lower educational quality and mental health. Grounded in the Study Demands–Resources (SD–R) and Conservation of Resources (COR) theories, this study investigates the relationship between school-based resources, family dynamics, and personal resources by examining how teacher emotional support is associated with burnout through family cohesion and meaning in life; (2) Methods: a moderated mediation model was tested using a sample of 1224 adolescents (Mage = 14.27, SD = 1.72; 48% female); (3) Results: Analysis revealed that: 1. Teacher emotional support significantly and negatively predicted student burnout (β = −0.28, p < 0.001). 2. Family cohesion partially mediated this relationship, accounting for 36% of the total effect. 3. Meaning in life significantly moderated both the direct path and the second half of the mediation pathway (family cohesion → burnout). Notably, meaning in life was associated with a stronger negative association between teacher emotional support and student burnout, but a weaker negative association between family cohesion and student burnout, a pattern consistent with differential resource utilization; (4) Conclusions: These findings suggest a differentiated pattern of resource interplay: school-based emotional resources may connect to family-based relational resources, and the protective role of each external resource may be further moderated by adolescents’ internal meaning systems. These findings highlight the agentic role of adolescents in resource management and point to the value of multi-system interventions. Full article

Digital transformation is reshaping technical and vocational education and training (TVET), yet the behavioral processes through which students’ digital learning competence is associated with learning performance remain underexplored. Drawing on Biggs’ presage–process–product (3P) model, this cross-sectional study examined a dual-path moderated mediation model in which active and rule-based learning participation served as differentiated process pathways, while teacher–student interaction and curriculum practicality were specified as contextual moderators. Survey data were collected from 3693 students in Chinese higher vocational colleges. Hierarchical regression and bootstrapped moderated mediation analyses indicated that digital learning competence was positively associated with learning performance. Active learning participation mediated this association, whereas rule-based learning participation did not function as a stable positive mediator. At higher levels of teacher–student interaction and curriculum practicality, digital learning competence showed stronger associations with active learning participation and stronger indirect associations with learning performance. The rule-based pathway appeared more conditional and reflected an externally regulated, prescribed-task-oriented form of behavioral participation, rather than a stable process pathway associated with deep learning. These findings extend the 3P model to digital learning in higher vocational education, differentiate behavioral forms of participation, and highlight the importance of interactive and practice-oriented instructional contexts. Full article

Leadership competency is critical for sustainable organizational performance, yet the mechanisms driving this relationship in high power distance (HPD) emerging markets remain underexplored. Western-centric models predominantly emphasize employee engagement, often overlooking contextual institutional and cultural pathways. This study tests a dual-pathway model wherein leadership competency influences sustainable performance via psychological activation (employee engagement) and institutional embedding (organizational culture). Three-wave, multi-source data were collected from 215 leadership units in Ethiopia’s commercial banking sector and analyzed using structural equation modeling (5000 bootstrap resamples) and dominance analysis. Results reveal statistically significant but modest indirect effects. Among the two mediators, the institutional pathway (organizational culture) transmits approximately twice the relative influence of the psychological pathway (employee engagement): 24.8% versus 11.1% of total effect (β = 0.058, 95% CI [0.014, 0.109] versus β = 0.026, 95% CI [0.010, 0.046]). Dominance analysis, computed over the two mediators only, indicates culture’s greater relative explanatory weight (68.2% versus 31.8%, p = 0.003). However, leadership competency retains a substantial direct effect (64.1% of total effect), meaning the dual pathways collectively account for only 35.9% of leadership’s total influence. A robustness test using archival performance data alone yields a smaller but directionally consistent institutional indirect effect (β = 0.041, 95% CI [0.009, 0.078]), while the psychological pathway becomes non-significant, suggesting that the institutional route is robust but modest once perceptual common-source variance is removed. These findings contextualize engagement-dominant Western models by demonstrating that cultural embedding operates as a relatively stronger mediator in HPD settings. The modest absolute mediation effects and persistent direct path highlight the need for context-sensitive leadership development and suggest that additional institutional or capability-driven mechanisms warrant future investigation. Full article

The transition to a circular economy (CE) represents a complex socio-technical evolution, requiring synchronized policy frameworks and strategic capital reallocation. Adopting a systems-thinking lens, this study combines bibliometric network mapping with exploratory econometric modelling, to examine the associations between five core policy instruments and tangible circular investments (INV_CE) across the EU-27. Bibliometric analysis identifies the “firm” and “supply chain” as central functional hubs within the CE knowledge system, acting as primary mediators for capital flows. Econometric results indicate that Tradable Permits (TPOs) and an integrated Policy Integration Index (PII), comprising subsidies and energy-based taxes, show the strongest statistical association with circular investment patterns (p ≤ 0.001). However, patterns of structural disparity emerge between OECD and non-OECD Member States (p = 0.014), where the latter often exhibit a more rigid, tax-centric approach. Spearman correlations point toward institutional maturity, specifically government effectiveness (r_s = 0.48) and eco-innovation capacity, as a potential systemic gateway for investment absorption. Furthermore, a structural decoupling appears between voluntary approaches (VAs) and governance capacity in emerging systems, suggesting that such instruments may be less effective without “institutional readiness.” The findings suggest that circular transition is path-dependent and congruent with the co-evolution of policy and institutional regimes. To bridge the investment gap, the study highlights the need for systemic interventions that move beyond “one-size-fits-all” regulations toward targeted strategies that strengthen the institutional and data reporting infrastructures of circular systems. Full article

Technology-driven content is increasingly reshaping how tourists perceive and evaluate destinations, yet the underlying content evaluative processes remain insufficiently investigated. This study, therefore, integrates the Stimulus–Organism–Response (S–O–R) framework with Anthropomorphism Theory to examine how destination anthropomorphic content (DAC) relates to destination image (DI) and destination visitation intention (DVI) in digitally mediated environments. Using a cross-sectional survey design and multi-group Structural Equation Modeling, the study compares relationships across two information sources: AI- and social media influencer-generated content. The results show that DAC is positively associated with both DI and DVI across groups. Permutation-based multi-group analysis indicates that the differences in structural paths between AI and influencer groups are not statistically significant. This finding provides the basis for interpreting group comparisons, suggesting that the observed relationships do not differ meaningfully across content sources. While bootstrapping and effect size (f²) results indicate relatively stronger coefficients in the influencer group, these results are interpreted as descriptive tendencies rather than statistically confirmed differences. These findings suggest that tourists may respond positively to both human and technologically mediated agents’ content when human-like social cues are perceived. This study contributes to the growing discourse on AI and digital content in tourism by unveiling the critical concern of whether the content source matters in anthropomorphic perception. The study further extends the application of S–O–R in AI-mediated marketing contexts. The findings offer practical insights for destination marketers seeking to leverage both AI and influencer-based strategies in shaping tourist perceptions and intentions. Full article

In the digital economy, small and medium-sized enterprises (SMEs) face growing pressure to align digital transformation with sustainability-oriented value creation. Yet, it remains unclear how and through which mechanisms digital leadership is associated with sustainable digital innovation in resource-constrained and turbulent contexts. This study investigates whether digital leadership is associated with sustainable digital innovation directly and indirectly through digital capabilities and digital orientation, and whether strategic agility strengthens these relationships. Drawing on the Resource-Based View (RBV) and Dynamic Capability Theory (DCT), the study develops an integrated framework that explains sustainable digital innovation as a strategically managed outcome of digital economy transformation rather than a simple result of technology adoption. Using survey data from 423 employees in Lebanese SMEs, the hypotheses were tested through partial least squares structural equation modeling (PLS-SEM). The findings show that digital leadership is positively associated with sustainable digital innovation both directly and indirectly, with digital orientation emerging as the stronger mediating pathway compared to digital capabilities. In addition, strategic agility strengthens the association between digital orientation and sustainable digital innovation, while its moderating role on the digital capabilities path is not significant. These findings contribute to the literature by identifying dual transformation mechanisms and revealing an asymmetric boundary role of agility in sustainability-oriented digital transformation. The study also offers practical implications for SME leaders seeking to align digital strategy with long-term environmental, social, and economic value creation. Full article

The rapid expansion of housing financialization (REF) has profoundly reshaped China’s subnational fiscal landscape, yet the dynamic nature of this relationship remains under-explored. This study investigates how the impact of REF on fiscal deficits (DB) evolves over time and identifies the specific transmission channels mediating this influence. First, we construct a multidimensional REF index by integrating enterprise, household, market, financial, and industry indicators via the fuzzy-TOPSIS method. A Markov Regime Switching model identifies three distinct volatility regimes, revealing that REF dynamics are highly sensitive to policy shifts and exhibit significant path dependency. Second, using a Time-Varying Parameter Vector Autoregression model, we find that REF initially functioned as a fiscal stabilizer providing short-term revenue relief; however, as financialization deepened, REF transformed into a procyclical driver of deficit expansion. Third, we further decompose this mechanism, demonstrating that land finance (LAND) and local government debt (UID) amplify systemic fiscal fragility as dynamic mediating channels. Finally, due to the unsustainability of the current “real estate-land-debt” model, we propose policy interventions including the institutionalization of fiscal-debt firewalls, the formation of counter-cyclical fiscal risk reserve funds, and an accelerated transition toward a stable, tax-oriented revenue structure to mitigate systemic risks. Full article

Chronic kidney disease (CKD) is a rising public health concern in low- and middle-income countries (LMICs), with urban populations disproportionately affected. In Bangladesh, particularly in Dhaka, dialysis services have become essential for CKD management. This study investigates the determinants of revisit intention among adult attendants of dialysis patients in Dhaka, using partial least squares structural equation modeling. A cross-sectional survey was conducted across four major dialysis centers totaling 399 valid responses. A purposive sampling technique was employed to ensure the inclusion of respondents with relevant experience and engagement in dialysis service utilization. Among respondents, over half were male, 43% had primary to higher secondary education, and one-third reported household incomes between BDT 40,001 and 60,000. The largest age group was 45–49 years (32.3%), and nearly 60% selected the facility due to nearness. Reliability and validity metrics met recommended thresholds, and multivariate normality was not assumed (Mardia’s test, p < 0.05). The structural model revealed significant direct effects of cost (β = 0.167, p = 0.003), Perceived trust in healthcare providers (β = 0.252, p < 0.001), and Perceived patient satisfaction (β = 0.422, p < 0.001) on Perceived revisit intention. Dialysis Delivery Service and word of mouth influenced revisit behavior indirectly through Perceived patient satisfaction. All mediation paths were statistically significant and classified as complementary. To improve patient retention, the policymaker should prioritize affordability, perceived trust in healthcare providers, and overall service quality, which together enhance perceived patients’ satisfaction and revisit intention. Full article