Search Results (5,126)

Drawing on signaling theory and a relational perspective, this study examines how perceived influencer credibility is associated with e-loyalty intentions in influencer-mediated social commerce. Rather than claiming that each individual path is theoretically unexpected, this study positions its contribution in specifying a conditional signal-to-relationship process. Specifically, perceived influencer credibility is conceptualized as a credibility-based digital promotional signal, brand trust and customer engagement are examined as sequential relational mechanisms, and perceived brand authenticity is positioned as an identity-consistency boundary condition in the customer engagement–e-loyalty intention relationship. Using survey data from 372 consumers with influencer-mediated social commerce experience, the data were analyzed using partial least squares structural equation modeling (PLS-SEM). The results show that perceived influencer credibility is positively associated with brand trust, brand trust is positively associated with customer engagement, and customer engagement is positively associated with e-loyalty intentions. The bootstrapped serial indirect association through brand trust and customer engagement is significant, indicating a trust–engagement pathway linking influencer-mediated promotional credibility to e-loyalty intentions. Perceived brand authenticity also positively moderates the customer engagement–e-loyalty intention relationship. Descriptive conditional indirect estimates further suggest that the indirect association through brand trust and customer engagement is stronger at higher levels of perceived brand authenticity; however, this conditional indirect pattern is interpreted conservatively because bootstrapped confidence intervals for the low and high conditional estimates were not directly available. These findings extend influencer marketing research by shifting attention from isolated credibility effects to a theory-driven process explaining how influencer credibility is associated with e-loyalty intentions through trust, engagement, and authenticity-based boundary conditions. Full article

Background: The vestibular system has traditionally been interpreted within a reflex-based framework, mainly centered on gaze stabilization, vestibulo-ocular reflex pathways, and peripheral vestibular deficits. This model remains essential, but it is insufficient to explain the full spectrum of postural, perceptual, visual-motion, and self-motion complaints observed in contemporary clinical otoneurology. Objective: This conceptual narrative review examines selected representative works by Kathleen E. Cullen as landmarks in a broader transition from reflex physiology to predictive, multimodal, context-dependent, body-centered self-motion control. Methods: This is not a systematic or bibliometric review. Papers were selected because they mark distinct conceptual steps in Cullen’s work: neural encoding of self-motion, peripheral and central coding strategies, multimodal integration, active versus passive self-motion, reafference suppression, body-centered encoding, proprioceptive prediction, vestibular cerebellar internal models, sensory reweighting, and clinical translation. Synthesis: Angelaki and Cullen’s 2008 synthesis and Cullen’s subsequent work demonstrate that vestibular processing is inherently multimodal from the earliest central stages and that neural representations of self-motion depend on behavioral context. Vestibular nuclei, visual-vestibular networks, and vestibular cerebellar circuits integrate labyrinthine signals with optic flow, proprioceptive, oculomotor, motor, cerebellar, cortical, and contextual information. This architecture enables the brain to distinguish expected from unexpected motion, suppress predictable vestibular reafference during voluntary action, compute internal estimates of body motion, adapt to altered sensory reliability, and reweight sensory inputs according to task demands. Conclusions: The clinical relevance of this trajectory is substantial. Patients may show preserved high-acceleration vestibulo-ocular reflex responses while experiencing persistent instability, visually induced dizziness, defective self-motion perception, or abnormal sustained vestibular processing. Such dissociations are not paradoxical when the vestibular system is understood as a predictive, distributed, body-centered control system. Cullen’s long lesson offers a neurophysiological foundation for a modern vestibular grammar in which clinical findings are interpreted across the reflexive, perceptual, postural, visual-vestibular, sustained, and predictive domains. Full article

Background/Objectives: Despite the growing popularity of the topic of wellness in society, children with chronic illnesses are rarely introduced to the concept. Wellness may be an unexpected and complex topic for a medical visit, especially for those living with chronic medical conditions. Our goal is to intentionally design an individualized referral process to wellness services for children with chronic illnesses. Methods: Human-Centered Design (HCD) methods were utilized to understand patient, caregiver and provider needs and challenges when making wellness service referrals. Stakeholders participated in workshops and interviews, which informed the design of a referral prototype. The referral prototype was evaluated through simulations and was pilot-tested in a new Center. Results: Optimal referrals to wellness services are best delivered through conversations that are compassionate, relational, respectful and motivating. We developed operational, contextual and experiential Design Requirements that informed a personalized “Wellness Conversation” to create an experience that was distinct from a medical visit. The conversation follows a four-step framework: trust and rapport building, assessment of current state of wellness, prioritization of wellness areas, and establishment of goals in wellness planning. Conclusions: HCD allowed us to produce a referral prototype with high perceived acceptability, feasibility and fidelity. These findings indicate that approaching referrals to wellness services as a conversation may help create a more positive, supportive, and hope-inspiring experience for children and families. Full article

Importance: Most couples who turn to assisted reproductive technology (ART) treatment do so, usually, after giving up emotionally on the chances of conceiving naturally. Others undergo ovulation induction with intrauterine insemination (IUI) and turn to ART after the latter has failed. Spontaneous conception after having experienced the exhausting process of ART, whether it was successful or not, could be very surprising and confusing for many couples. Objective: Review all the scenarios within which an unexpected spontaneous conception can occur and the likelihood of its occurrence. These are four such scenarios: (1) after being referred to ART but before the actual initiation of ART; (2) between ART cycles; (3) after a successful ART pregnancy; (4) after giving up on treatment. We have found only a systematic review on #3, but not the other three. Evidence Review: We collected all PubMed citations for the terms “spontaneous conception” and ART or IVF. Thereafter, we realized that no AI tool can filter only the relevant literature. Hence, we exhausted all possible cross-references by manual search to ensure the completeness of the search. Findings: In each of the four scenarios, spontaneous conceptions occur. Before treatment, a critical element is the length of the waiting time, as is the gap between treatments when already treated, with the cost of treatment being a critical determinant. After the conclusion of treatment, whether successful or failed, the main determinants of the chance for spontaneous conception are age, length of infertility, and the leading etiology for infertility. Overall, the chances range from as little as 2% and up to 25%, with severe male factor and a woman’s age being the most notable for low rates. Conclusion and Relevance: Each couple entering ART treatment should be informed of the chances for spontaneous conception, whether as an aid to the decision to enter or the decision to leave after a failure, and on the more cheerful side, to be aware of the chances for unplanned pregnancy after a successful treatment. Full article

Pantothenic acid (PA; vitamin B5) is an essential component of many key metabolic processes. Vitamin B5 deficiency causes dysfunction in various systems and organs. Humans do not produce vitamin B5, so it must be constantly replenished through diet or supplementation. Pantothenic acid is synthesized by plants, fungi, and bacteria, so a well-balanced diet is a good source of pantothenic acid. Pantothenates have beneficial effects on the skin (regenerative, healing, and anti-inflammatory effects). They are readily absorbed through the skin, making them a common active ingredient in cosmetics and medications with soothing, healing, regenerative, moisturizing, and protective properties for damaged, sensitive, or atopic skin, including topical products labeled hypoallergenic or specifically intended for people with sensitive skin. Although PA is considered non-allergenic and safe, paradoxically, frequent exposure, especially to damaged skin, appears to lead to hypersensitivity to this substance. The pathogenetic mechanisms of pantothenate hypersensitivity have not been clearly defined. The main sensitization pathway is likely a delayed cellular mechanism (type IV, contact). However, other types of hypersensitivity, including immediate (type I) and mixed mechanisms, cannot be ruled out. PA allergy is considered rare and therefore difficult to diagnose. This is due to the unexpected sensitizing factor and the lack of standard diagnostic tests. Due to the likely contact nature of the allergy, patch testing (PT) with a cosmetic (drug) provided by the patient (“as is”) and PA (5% in petrolatum; 5% PET) appears to be the best approach. It is also suggested that PA (5% PET>) be included in the standard series of allergens (haptens) used in routine PT diagnostics. It appears that PA allergy is more common than currently believed, particularly in people with atopic skin and polysensitized individuals, who are the primary users of products containing pantothenate. It is possible that in these individuals, pantothenic acid may be more harmful than beneficial. Full article

Early fault diagnosis of ball bearings is essential for maintaining the reliability of rotating machinery and preventing unexpected downtime. This study proposes a fault diagnosis framework that combines non-contact ultrasonic visualization with a lightweight convolutional neural network (Light CNN). Seven bearing conditions, including ferrous particle contamination and grease starvation, were investigated using ultrasonic, vibration, and acoustic emission (AE) sensors under identical experimental conditions. Sa-liency-map extraction and two-dimensional histogram analysis were applied to ultrasonic RGB images to generate compact feature representations, which were compressed into 20 × 20 feature maps and used as inputs to a three-layer Light CNN. The proposed method achieved an average classification accuracy of 99.98% and an F1-score of 99.98%. In addition, an average inference throughput of 11.47 IPS was obtained, representing approximately ten times higher computational efficiency than vibration- and AE-based approach-es. Stable diagnostic performance was also maintained under a low-speed operating condition of 500 rpm. These results demonstrate the effectiveness of combining ultrasonic visualization and a lightweight CNN for accurate and computationally efficient bearing fault diagnosis. Full article

Background/Objectives: Implant-associated infections are challenging conditions in orthopedic surgery. This experimental study aimed to evaluate phage localization within infected tissues following different routes of administration. Methods: An implant-related infection model was created using methicillin-resistant Staphylococcus aureus (MRSA) in twenty-four rats. Subjects were randomly divided into four groups depending on the bacteriophage administration route. Three rats were designated as the control group. Phage suspension was applied intraperitoneally, intravenously, orally and locally at 0.1 mL/day of 1 × 10⁸ PFU/mL suspension for three consecutive days. In the control group, intravenous, intraperitoneal and oral phage suspensions were administered separately at the same dose for 3 days. After completion of the experiment, tibia samples were taken in the experimental group. Additionally, liver, kidney, stomach, brain, heart muscle and striated muscle tissue samples were taken from the three subjects in the control group. Results: In the control group, unconfirmed phage-like structures were incidentally observed in some mitochondria of renal proximal tubular epithelial cells on transmission electron microscopy. In the experimental group, there was a strong positive linear relationship between the total number of bacteria and the number of bacteriophage clusters, independent of the groups. Conclusions: Bacteriophage clusters were detected in infected tibial tissues after all administration routes, suggesting phage localization at the infection site. Unexpected phage-like clusters were observed within mitochondria of proximal tubular epithelial cells in the control animals. This finding should be regarded as an unconfirmed incidental finding requiring further validation. Full article

Voltage-gated ion channels (VGICs) are traditionally associated with electrically excitable cells; however, increasing evidence indicates that they are also expressed in non-excitable cells, including vascular endothelial cells. This review aims to summarize the current knowledge on the expression, regulation, and functional role of VGICs in the vascular endothelium, and to highlight their potential contribution to endothelial signaling. We examined the molecular structure, biophysical properties, and functional roles of voltage-gated Na⁺ (Na_V), Ca²⁺ (Ca_V), and K⁺ (K_V) channels in vascular endothelial cells. Particular attention was given to studies investigating VGIC activity in native endothelium and to emerging mechanisms regulating their activation. Endothelial cells express multiple VGIC subtypes at low densities, which are insufficient to generate action potentials but can modulate membrane potential (V_M) and Ca²⁺-dependent signaling. The dynamic regulation of the endothelial V_M, through the interplay between hyperpolarizing and depolarizing conductances, emerges as a key determinant of VGIC availability and activation. VGICs contribute to essential endothelial functions, including angiogenesis, vasomotor responses, blood–brain barrier permeability, and inflammation. Dysregulated VGIC expression and/or activity may be implicated in several pathological conditions, such as atherosclerosis, calcific aortic stenosis, and tumor vascularization. VGICs represent an unexpected but functionally relevant component of endothelial signaling. Elucidating their role in native vascular beds and disease contexts may uncover novel mechanisms of endothelial regulation and identify new therapeutic targets in cardiovascular and cancer biology. Full article

Unexpected cut-in events may elicit driver anger even when braking is partly supported by driver-assistance systems. This preliminary simulator study examined whether SAE Level 1 longitudinal braking assistance alters affective responses to dangerous cut-in events. Ten young male licensed drivers completed three within-subject scenarios: manual driving without a cut-in, manual driving with a dangerous cut-in, and SAE Level 1 braking assistance with a dangerous cut-in. STAXI State Anger and salivary amylase were measured before and after each scenario. STAXI State Anger showed an overall scenario effect (p = 0.0045), but Holm-corrected post hoc comparisons were not statistically significant. In particular, the data did not indicate an anger-reducing effect of braking assistance compared with manual driving during the same cut-in event. Salivary amylase showed no significant scenario effect (p = 0.273). These preliminary findings suggest that physical braking assistance alone may be insufficient to mitigate anger-related responses to sudden cut-in events, and they motivate future controlled studies of cognitive support and system intent communication in ADAS contexts. Full article

Background and Clinical Significance: The Coronary Sinus Reducer (CSR) is a percutaneous therapeutic option for patients with refractory angina who are unsuitable for further myocardial revascularization. The procedure has a generally favorable safety profile, with a low rate of reported procedural complications. To our knowledge, major atrioventricular (AV) conduction disturbances during CSR implantation have not been previously described. This case highlights a rare but clinically relevant intraprocedural complication; Case Presentation: A 71-year-old man with multivessel coronary artery disease and previous coronary artery bypass grafting was referred for CSR implantation because of refractory angina despite optimal medical therapy and lack of further revascularization options. The procedure was performed via a right jugular venous approach. Baseline electrocardiography showed right bundle branch block and findings consistent with previous inferior myocardial infarction, without definite criteria for left anterior fascicular block. During coronary sinus cannulation, the patient developed transient complete AV block, resulting in an approximately 8–10-second ventricular pause without a stable ventricular escape rhythm. The conduction disturbance resolved after catheter withdrawal and repositioning. Given the severity of the event, a temporary transvenous pacemaker was inserted via the right femoral vein, allowing safe completion of CSR implantation. At three-month follow-up, angina had improved from Canadian Cardiovascular Society class III to class I, and no recurrent advanced AV block was documented; Conclusions: Transient complete AV block may occur during CSR implantation, particularly during coronary sinus manipulation and possibly in patients with pre-existing conduction disease. Careful catheter handling, prompt recognition of conduction disturbances, and immediate availability of temporary pacing support should be considered in selected high-risk patients undergoing CSR implantation. Full article

Background: Hemodynamic depression, characterized by bradycardia and hypotension, is a common complication of carotid artery stenting (CAS) and is primarily attributed to carotid sinus baroreceptor stimulation. While prophylactic atropine is often used in high-risk patients, predictors of unexpected hemodynamic depression among patients initially deemed low-risk remain incompletely defined. Objective: To identify clinical, anatomical, and procedural predictors of hemodynamic depression in patients undergoing CAS without prophylactic atropine. Methods: We performed a retrospective, single-center observational study of consecutive patients undergoing CAS between January 2015 and May 2024. Patients who received prophylactic atropine for low baseline heart rate (HR) were excluded. Hemodynamic depression was defined as a >20% reduction in HR from baseline. Absolute bradycardia (HR <50 bpm) and hypotension (>40% reduction in systolic blood pressure) were recorded descriptively. Results: A total of 158 patients underwent CAS, of whom 33 (20.9%) were excluded due to prophylactic atropine administration for low pre-procedural heart rates (<60 bpm). Among 125 included patients, 62 (49.6%) experienced significant HR reduction during CAS. In multivariable analysis, a shorter distance between the stenotic lesion and the carotid bifurcation was independently associated with hemodynamic depression (OR 0.90 per mm increase; 95% CI 0.82–0.99; p = 0.023). Greater intraprocedural reductions in systolic and mean arterial pressure were also associated with HR depression. Traditional clinical risk factors, including age, sex, comorbidities, degree of stenosis, calcification severity, anesthesia type, and procedure urgency, were not independently predictive. Conclusions: Hemodynamic depression remains frequent during CAS even among patients classified as low risk. Lesion proximity to the carotid bifurcation is a key anatomical predictor of autonomic instability, highlighting the limitations of standard risk stratification and supporting a lesion-specific approach to periprocedural hemodynamic management. Full article

Background: Calonysterone (CAL) is a natural derivative of 20-hydroxyecdysone (20E) with enhanced bioactivity on skeletal muscle cells in vitro, but its in vivo physiological actions remain less well characterized. This study aimed to compare the effects of 20E and CAL on metabolic, muscular, and endocrine parameters in normal and obese male rats, with a particular focus on androgen balance. Methods: Male rats were treated with 20E or CAL under normal (ND) or high-fat, high-sugar dietary (HFHSD) conditions for 12 weeks. Body weight, food intake, skeletal and androgen-sensitive muscle mass, and testicular weight were measured. Testicular expression of androgen receptor (Ar) and aromatase (Cyp19a1) mRNA was assessed by RT-PCR. ELISA was used to determine the plasma corticosterone, testosterone and ERβ level in testes. Results: 20E and CAL prevented HFHSD-induced weight gain and skeletal muscle atrophy. CAL uniquely preserved testicular and levator ani muscle mass in obese rats. CAL increased the expression of Cyp19a1 and ERβ in testicles. Decreased Ar mRNA expression was regulated in 20E- and CAL-treated obese animals. While 20E treatment significantly reduced plasma testosterone levels in the normal diet group compared to controls, both 20E and CAL interventions elicited significant reductions in the obese group relative to both the ND and HFHSD groups. HFHSD-induced increase in plasma corticosterone levels was normalized by 20E or CAL treatment. Conclusions: 20E and CAL exhibit beneficial metabolic and anabolic effects by preventing HFHSD-induced obesity and consequential muscle atrophy. CAL counteracts obesity-induced testicular atrophy in terms of tissue mass. Based on our results, we hypothesized that CAL enhances testicular aromatase levels, which may lead to increased compensatory androgen receptor mRNA expression and increased ERβ levels. These complex, not yet fully understood results underscore the need for caution in the use of phytoecdysteroids as dietary supplements. Full article

In the fabric warehouse, order picking operations face high labor intensity and rising operational costs, requiring urgent optimization. This study investigates the order scheduling and task assignment problem within an elastic staffing framework, where temporary labor recruitment and real-time task allocation need to be adjusted dynamically in response to fluctuations in order volumes. Nevertheless, conventional approaches often suffer from severe computational bottlenecks under such highly dynamic conditions, and struggle to maintain optimal solutions when demand undergoes large and frequent fluctuations. To address these challenges, this study proposes a Graph Transformer Policy Network with Proximal Policy Optimization (GTP-PPO), which combines graph structure features with a global attention mechanism. First, the return picking strategy and the S-shaped picking strategy are compared and analyzed in the fabric warehouse scenario. The results reveal that the return strategy is more suitable for the studied warehouse layout. Subsequently, a mixed-integer programming (MIP) model and a GTP-PPO model are established for optimizing order dispatching and scheduling. Finally, an empirical analysis is carried out based on the peak order day of the year in the fabric warehouse. The results demonstrate that the proposed GTP-PPO model not only achieves near-global optimal solutions (gap < 4%) comparable to the MIP model, but also exhibits robust real-time decision-making capabilities under dynamically increasing order volumes and unexpected disruptions. Compared to the MIP model, the GTP-PPO approach reduces unskilled labor hours by 84.80% and decreases operational volatility by 27.60%, with only a 3.52% increase in operational costs. Full article

The study investigates the state-dependent dynamics of overconfidence in the Bangladesh equity market by exploring the relationship between market returns and trading volume within a nonlinear information-theoretic framework. Building up on the traditional return–volume literature, the study differentiates between total market returns and unexpected returns, with the latter representing unexpected information shocks obtained using the Market Index Model. Transfer Entropy with bootstrap inference estimates the directional and asymmetric information flows across five different market states, namely: bullish, bearish, crisis, extended crisis, and COVID-19. The evidence suggests that the overconfidence biases in aggregate market returns are small and intermittent and are reflected in poor and unstable information flow between market returns and trading volume. In comparison, unexpected market returns have a directionally significant impact on trading behavior, which supports the behavior of state-dependent overconfidence. The findings also reveal that overconfidence is higher in normal and bullish market situations but drops significantly in crisis-based situations. The asymmetric analysis indicates increased trading responses to negative returns shocks, as it is more evident that investors are more sensitive to losses and recovery expectations. The research adds to behavioral finance literature on frontier markets through an unexpected return decomposition with nonlinear causality model. The results have serious implications on market surveillance, assessment of investor behavior and design of regulatory policies. Full article

Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake County, a large (~1 million inhabitants), diverse county in North Carolina. We screened and adjudicated victims of sudden, unexpected, out-of-hospital deaths in adults aged 18–64 years reported by emergency medical services between 2013 and 2015. We randomly selected sex- and age-matched control patients from a university health system from the same county and time period. Characteristics of sudden death victims and controls were ascertained via standardized chart reviews. Unhealthy alcohol use was identified via chart review and was defined as any evidence of excessive alcohol use, such as it being stated in the social history or medical history, alcohol abuse being listed as a possible contributor to death, or alcohol-related diagnoses. We used logistic regression to estimate odds ratios (ORs) for the association of unhealthy alcohol use and sudden death, adjusting for age, sex, race, and other psychiatric diagnoses, including depression, anxiety, schizophrenia, bipolar disorder, and substance use disorders other than tobacco and alcohol. We also calculated the E-value to estimate the impact of any unmeasured confounders. Results: We identified 399 sudden death victims, of whom 374 (94%) had alcohol use data available. Among these 374 included victims, 256 (68%) were male, and 239 (62%) were White, with a median age at death of 55 years (IQR 48, 60). The demographic characteristics of the 1114 matched controls were similar to those of sudden death victims. Unhealthy alcohol use was present in 115 (31%) sudden death victims and 27 (2%) controls. In analyses adjusted for demographics only, unhealthy alcohol use was associated with a higher incidence of sudden death, with an OR of 17.5 (95% CI 11.4, 27.8). When further adjusted for other psychiatric diagnoses, the OR was 11.2 (95% CI 7.1, 18.0). The calculated E-value was 21.8, meaning an unmeasured confounder would need to be associated with both unhealthy alcohol use and sudden death by 21.8-fold to explain away the observed OR. Conclusions: Unhealthy alcohol use was strongly associated with higher sudden death risk in working-age adults. Our calculated E-value indicates it is unlikely that any unmeasured confounders alone would account for the observed association. Our findings suggest that interventions to reduce unhealthy alcohol use may be an effective strategy to prevent sudden death in working-age adults. Full article