Browse publications by year: 2023

  1. Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, et al.
    J Cachexia Sarcopenia Muscle, 2023 Oct;14(5):1949-1958.
    PMID: 37667992 DOI: 10.1002/jcsm.13323
    Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
  2. Tuygunov N, Zakaria MN, Yahya NA, Abdul Aziz A, Cahyanto A
    J Mech Behav Biomed Mater, 2023 Oct;146:106099.
    PMID: 37660446 DOI: 10.1016/j.jmbbm.2023.106099
    Bone regeneration is a rapidly growing field that seeks to develop new biomaterials to regenerate bone defects. Conventional bone graft materials have limitations, such as limited availability, complication, and rejection. Glass ionomer cement (GIC) is a biomaterial with the potential for bone regeneration due to its bone-contact biocompatibility, ease of use, and cost-effectiveness. GIC is a two-component material that adheres to the bone and releases ions that promote bone growth and mineralization. A systematic literature search was conducted using PubMed-MEDLINE, Scopus, and Web of Science databases and registered in the PROSPERO database to determine the evidence regarding the efficacy and bone-contact biocompatibility of GIC as bone cement. Out of 3715 initial results, thirteen studies were included in the qualitative synthesis. Two tools were employed in evaluating the Risk of Bias (RoB): the QUIN tool for assessing in vitro studies and SYRCLE for in vivo. The results indicate that GIC has demonstrated the ability to adhere to bone and promote bone growth. Establishing a chemical bond occurs at the interface between the GIC and the mineral phase of bone. This interaction allows the GIC to exhibit osteoconductive properties and promote the growth of bone tissue. GIC's bone-contact biocompatibility, ease of preparation, and cost-effectiveness make it a promising alternative to conventional bone grafts. However, further research is required to fully evaluate the potential application of GIC in bone regeneration. The findings hold implications for advancing material development in identifying the optimal composition and fabrication of GIC as a bone repair material.
    MeSH terms: Biocompatible Materials/pharmacology; Bone and Bones*; Bone Cements; Bone Regeneration; Glass Ionomer Cements*
  3. Xu S, Deo RC, Soar J, Barua PD, Faust O, Homaira N, et al.
    Comput Methods Programs Biomed, 2023 Nov;241:107746.
    PMID: 37660550 DOI: 10.1016/j.cmpb.2023.107746
    BACKGROUND AND OBJECTIVE: Obstructive airway diseases, including asthma and Chronic Obstructive Pulmonary Disease (COPD), are two of the most common chronic respiratory health problems. Both of these conditions require health professional expertise in making a diagnosis. Hence, this process is time intensive for healthcare providers and the diagnostic quality is subject to intra- and inter- operator variability. In this study we investigate the role of automated detection of obstructive airway diseases to reduce cost and improve diagnostic quality.

    METHODS: We investigated the existing body of evidence and applied Preferred Reporting Items for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search records in IEEE, Google scholar, and PubMed databases. We identified 65 papers that were published from 2013 to 2022 and these papers cover 67 different studies. The review process was structured according to the medical data that was used for disease detection. We identified six main categories, namely air flow, genetic, imaging, signals, and miscellaneous. For each of these categories, we report both disease detection methods and their performance.

    RESULTS: We found that medical imaging was used in 14 of the reviewed studies as data for automated obstructive airway disease detection. Genetics and physiological signals were used in 13 studies. Medical records and air flow were used in 9 and 7 studies, respectively. Most papers were published in 2020 and we found three times more work on Machine Learning (ML) when compared to Deep Learning (DL). Statistical analysis shows that DL techniques achieve higher Accuracy (ACC) when compared to ML. Convolutional Neural Network (CNN) is the most common DL classifier and Support Vector Machine (SVM) is the most widely used ML classifier. During our review, we discovered only two publicly available asthma and COPD datasets. Most studies used private clinical datasets, so data size and data composition are inconsistent.

    CONCLUSIONS: Our review results indicate that Artificial Intelligence (AI) can improve both decision quality and efficiency of health professionals during COPD and asthma diagnosis. However, we found several limitations in this review, such as a lack of dataset consistency, a limited dataset and remote monitoring was not sufficiently explored. We appeal to society to accept and trust computer aided airflow obstructive diseases diagnosis and we encourage health professionals to work closely with AI scientists to promote automated detection in clinical practice and hospital settings.

    MeSH terms: Artificial Intelligence; Humans; Respiratory Physiological Phenomena; Databases, Factual
  4. Tay ST, Merican AM, Abdul Jabar K, Velayuthan RD, Ayob KA, Lee JL, et al.
    Int J Infect Dis, 2023 Nov;136:77-80.
    PMID: 37660726 DOI: 10.1016/j.ijid.2023.08.025
    We report the isolation of a rare Gram-positive coccobacillary bacterium from synovial fluids of a patient with periprosthetic joint infection on three occasions over an 8-month period. As routine microbiological methods were not able to identify the isolate definitely, sequence analyses of the bacterial 16S ribosomal RNA gene and whole genome were performed. Analysis of the bacterial 16S ribosomal RNA gene showed the highest similarity (98.1%) with that of Falsarthrobacter (previously known as Arthrobacter) nasiphocae, which was first isolated from the nasal cavities of common seals (Phoca vitulina). The genome size of the strain (designated as UM1) is 2.4 Mb. With a high G+C content (70.4 mol%), strain UM1 is phylogenetically most closely related to F. nasiphocae based on whole genome analysis. Strain UM1 was susceptible to vancomycin, linezolid, trimethoprim-sulfamethoxazole, doxycycline, and intermediate to penicillin and ciprofloxacin. Ceftriaxone resistance was noted. The patient who was also on hemodialysis for his end stage kidney disease died approximately 3 weeks following implant removal and fusion with an external fixator. This study describes the first isolation of F. nasiphocae from human clinical samples. The use of emerging technologies has supported more definitive etiological diagnosis associated with rarely encountered organisms in periprosthetic joint infection.
    MeSH terms: Bacteria; Gram-Positive Bacteria; Humans; Micrococcaceae*
  5. Hai T, El-Shafay AS, Goyal V, Alshahri AH, Almujibah HR
    Chemosphere, 2023 Sep 01.
    PMID: 37660791 DOI: 10.1016/j.chemosphere.2023.139782
    Considering the persistent human need for electricity and fresh water, cogeneration systems based on the production of these two products have attracted the attention of researchers. This study investigates a cogeneration system of electricity and fresh water based on gas turbine (GT) as the prime mover. The wasted energy of the GT exhaust gases is absorbed by a heat recovery steam generator (HRSG) and supplies the superheat steam required by the steam turbine (ST). In order to produce fresh water, a multi-effect desalination (MED) system is applied. The motive steam required is provided by extracting steam from the ST. In order to reduce the environmental pollution of this cogeneration system, the steam injection method is proposed in the GT's combustion chamber (CC). This system is optimized by a multi-objective optimization tool based on the Genetic Algorithm (GA). The design variables include pressure ratio of compressor (CPR), inlet temperature of gas turbine (TIT), steam injection mass flow rate in the CC, HRSG operating pressure, HRSG evaporator pinch point temperature difference (PPTD), steam pressure of the MED ejector, ejector motive steam flow rate, number of MED effects, and return effect. The goals are to minimize the total cost rate (TCR), which includes the cost of initial investment and maintenance of the system, the cost of consumed fuel, and the cost of disposing of CO and NO pollutants, as well as maximizing the exergy efficiency. In the end, it is observed that the steam injection in the CC leads to the reduction of the mentioned pollutant index, and it is proposed as a suitable solution to reduce the pollution of the proposed cogeneration system.
  6. Zhao Y, Sazlina SG, Rokhani FZ, Su J, Chew BH
    Asian Nurs Res (Korean Soc Nurs Sci), 2023 Oct;17(4):208-218.
    PMID: 37661084 DOI: 10.1016/j.anr.2023.08.002
    PURPOSE: This study aims to explore the expectations and acceptability of a smart nursing home model among Chinese older adults and their family members based on a scoping review that defines the concept of smart nursing homes.

    METHODS: A qualitative case study was employed for this research. Semi-structured, in-depth interviews and focus group discussions were conducted on WeChat. Participants were purposively sampled through snowball sampling in Hainan and Dalian, China. A total of 28 older adults aged 60-75 and six adult children were interviewed until data saturation was achieved, followed by a thematic analysis.

    RESULTS: The expectations of smart nursing homes include: 1) quality of care supported by governments and societies; 2) smart technology applications; 3) the presence of a skilled healthcare professional team; 4) access to and scope of basic medical services; and 5) integration of medical services. The acceptability of smart nursing homes included factors such as stakeholders' perceived efficaciousness, usability, and collateral damages of using smart technologies, and the coping process of adoption was influenced by factors such as age, economic status, health status, education, and openness to smart technologies among older adults.

    CONCLUSIONS: Chinese older adults and their family members have a positive perception of the smart nursing home model. The qualitative evidence regarding their expectations and acceptability of smart nursing homes contributes valuable insights for a wide range of stakeholders involved in the planning and implementation of smart nursing homes.

  7. Mat Amin NA, Nor Mohamed I, Lai YS
    Transfus Apher Sci, 2023 Oct;62(5):103798.
    PMID: 37661487 DOI: 10.1016/j.transci.2023.103798
  8. Anuar MA, Lee JX, Musa H, Abd Hadi D, Majawit E, Anandakrishnan P, et al.
    Brain Dev, 2023 Nov;45(10):547-553.
    PMID: 37661525 DOI: 10.1016/j.braindev.2023.06.004
    INTRODUCTION: Since the emergence of COVID-19, we have experienced potent variants and sub-variants of the virus with non-specific neurological manifestations. We observed a surge of the Omicron variant of COVID-19 patients with neurological manifestations where less cases of multisystem inflammatory syndrome in children (MIS-C) were reported. This article describes our experience of children with severe and rare neurological manifestations following COVID-19 infection.

    METHODS: This is a retrospective observational case series of patients under 18 years old who fulfilled the WHO COVID-19 case definition and were referred to our paediatric neurology unit at Hospital Tunku Azizah Kuala Lumpur. Their demographic data, neurological symptoms, laboratory and supporting investigations, neuroimaging, treatment and outcomes were collected and analysed.

    RESULTS: There were eleven patients with neurological manifestations who fulfilled the WHO COVID-19 case definition. Nine patients presented with seizures and/or encephalopathy, one patient with eye opsoclonus and another patient with persistent limbs myokymia. Based on the history, clinical, electrophysiological and radiological findings, two of them had febrile infection-related epilepsy syndrome, two had acute disseminated encephalomyelitis, two had acute necrotising encephalopathy of childhood, one each had hemiconvulsion-hemiplegia-epilepsy syndrome, acute encephalopathy with bilateral striatal necrosis, hemi-acute encephalopathy with biphasic seizures and reduced diffusion, infection-associated opsoclonus and myokymia.

    CONCLUSIONS: This case series highlighted a wide spectrum of neurological manifestations of COVID-19 infection. Early recognition and prompt investigations are important to provide appropriate interventions. It is essential that these investigations should take place in a timely fashion and COVID-19 quarantine period should not hinder the confirmation of various presenting clinical syndromes.

    MeSH terms: Brain Diseases*; Child; Humans; Seizures/etiology; Seizures/therapy; Ocular Motility Disorders*; Myokymia*
  9. McEllistrem B, Owens M, Whitford DL
    Int J Med Educ, 2023 Aug 31;14:117-122.
    PMID: 37661729 DOI: 10.5116/ijme.64e3.740e
    OBJECTIVES: This study explores a method of transferring a post graduate medical education curriculum internationally and contextualising it to the local environment. This paper also explores the experiences of those local medical educationalists involved in the process.

    METHODS: Several methods were implemented. Firstly, a modified Delphi process for the contextualisation of learning outcomes was implemented with a purposefully sampled expert group of Malaysian Family Medicine Specialists. Secondly a small group review for supporting materials was undertaken. Finally, qualitative data in relation to the family medicine specialists' experiences of the processes was collected via online questionnaire and analysed via template analysis. Descriptive statistics were used.

    RESULTS: Learning outcomes were reviewed over three rounds; 95.9% (1691/1763) of the learning outcomes were accepted without modification, with the remainder requiring additions, modifications, or deletions. Supporting materials were extensively altered by the expert group. Template analysis showed that Family Medicine Specialists related positively to their involvement in the process, commenting on the amount of similarity in the medical curriculum whilst recognising differences in disease profiles and cultural approaches.

    CONCLUSIONS: Learning outcomes and associated material were transferable between "home" and "host" institution. Where differences were discovered this novel approach places "host" practitioners' experiences and knowledge central to the adaptation process, thereby rendering a fit for purpose curriculum. Host satisfaction with the outcome of the processes, as well as ancillary benefits were clearly identified.

    MeSH terms: Curriculum*; Education, Medical, Graduate; Family Practice*; Health Facilities; Humans; Learning
  10. Sundaram T, Rajendran S, Gnanasekaran L, Rachmadona N, Jiang JJ, Khoo KS, et al.
    Bioengineered, 2023 Dec;14(1):2252228.
    PMID: 37661811 DOI: 10.1080/21655979.2023.2252228
    Algae-based biofuel developed over the past decade has become a viable substitute for petroleum-based energy sources. Due to their high lipid accumulation rates and low carbon dioxide emissions, microalgal species are considered highly valuable feedstock for biofuel generation. This review article presented the importance of biofuel and the flaws that need to be overcome to ensure algae-based biofuels are effective for future-ready bioenergy sources. Besides, several issues related to the optimization and engineering strategies to be implemented for microalgae-based biofuel derivatives and their production were evaluated. In addition, the fundamental studies on the microalgae technology, experimental cultivation, and engineering processes involved in the development are all measures that are commendably used in the pre-treatment processes. The review article also provides a comprehensive overview of the latest findings about various algae species cultivation and biomass production. It concludes with the most recent data on environmental consequences, their relevance to global efforts to create microalgae-based biomass as effective biofuels, and the most significant threats and future possibilities.
    MeSH terms: Biomedical Engineering; Biomass; Biofuels*; Bioengineering; Microalgae*
  11. Bustam A, Poh K, Shuin Soo S, Naseem FS, Md Yusuf MH, Hishamudin NU, et al.
    Digit Health, 2023;9:20552076231197961.
    PMID: 37662675 DOI: 10.1177/20552076231197961
    OBJECTIVE: Direct urine color assessment has been shown to correlate with hydration status. However, this method is subject to inter- and intra-observer variability. Digital image colorimetry provides a more objective method. This study evaluated the diagnostic accuracy of urine photo colorimetry using different smartphones under different lighting conditions, and determined the optimal cut-off value to predict clinical dehydration.

    METHODS: The urine samples were photographed in a customized photo box, under five simulated lighting conditions, using five smartphones. The images were analyzed using Adobe Photoshop to obtain Red, Green, and Blue (RGB) values. The correlation between RGB values and urine laboratory parameters were determined. The optimal cut-off value to predict dehydration was determined using area under the receiver operating characteristic curve.

    RESULTS: A total of 56 patients were included in the data analysis. Images captured using five different smartphones under five lighting conditions produced a dataset of 1400 images. The study found a statistically significant correlation between Blue and Green values with urine osmolality, sodium, urine specific gravity, protein, and ketones. The diagnostic accuracy of the Blue value for predicting dehydration were "good" to "excellent" across all phones under all lighting conditions with sensitivity >90% at cut-off Blue value of 170.

    CONCLUSIONS: Smartphone-based urine colorimetry is a highly sensitive tool in predicting dehydration.

  12. Arai T, Taha H, Alidon N, Jumat J, Azmey S, Zan ND, et al.
    Heliyon, 2023 Sep;9(9):e19348.
    PMID: 37662727 DOI: 10.1016/j.heliyon.2023.e19348
    The yellowfin snapper, Lutjanus xanthopinnis, was recorded as a newly described species in the Indo-Pacific region in 2015. However, the knowledge of its biology, biogeography and ecology is scarcely understood, and, hence, its current conservation status is categorized as Data Deficient. The mitochondrial cytochrome c oxidase subunit I (COI) gene was examined to confirm species identification. We also examined the COI gene haplotypes of L. xanthopinnis in Brunei Darussalam and Malaysia together with other waters, i.e., Bangladesh, Indonesia, Japan, Singapore, Sri Lanka and Taiwan. Our molecular analyses found that Brunei Darussalam and eastern Peninsular Malaysia samples were genetically similar. However, the former showed higher genetic diversity than the latter. The samples from these two sites also showed signatures of population expansion. Furthermore, identical haplotypes could be found in different locations, suggesting the absence of spatial genetic structure. On the other hand, Lutjanus lutjanus showed a population structure associated with geographical locations, i.e., western Pacific Ocean, Indian Ocean and Maluku in Indonesia.
  13. Hazrin NA, Chong KL, Huang YF, Ahmed AN, Ng JL, Koo CH, et al.
    Heliyon, 2023 Sep;9(9):e19426.
    PMID: 37662729 DOI: 10.1016/j.heliyon.2023.e19426
    In consideration of the distinct behavior of machine learning (ML) algorithms, six well-defined ML used were carried out in this study for predicting sea level on a day-to-day basis. Data compiled from 1985 to 2018 was utilized for training and testing the developed models. An assessment of the multiple statistics-driven regression algorithms resulted such that each tested location was associated with a particular preferred model. The following were the developed best models for their respective study areas: In Peninsular Malaysia, the interactions linear regression model was the best at Pulau Langkawi (RMSE = 19.066), the Matern 5/2 gaussian process regression model at Geting (RMSE = 49.891), and the trilayered artificial neural network at Pulau Pinang (RMSE = 20.026), while the linear regression model was the best at Sandakan in Sabah, East Malaysia (RMSE = 14.054). Other metrics, such as MAE and R-square, were also at their best values, each providing its best values, further substantiating the RMSE respectively, at each of the study areas. These empirical statistics (or metrics) also revealed that despite employing sea level as the sole parameter, results obtained were exceptional better when utilizing a 7-day lag, regardless of the model used. Notably, lag variables with less than a 7-day lag could degrade the model's accuracy in representing ground reality. The study emphasizes the importance of thorough training and testing of ML to aid decision-makers in developing mitigation actions for the climate change phenomena of sea level rise through reliable ML.
  14. Ren D, Jiang H, Cheng J, Peng C, Zou Y
    Heliyon, 2023 Sep;9(9):e19200.
    PMID: 37662732 DOI: 10.1016/j.heliyon.2023.e19200
    Building on the upper echelons theory and demographic faultline theory, this paper investigates the role of the top management team (TMT) faultline as a mediator and explores the moderating effect of CEO power as an important contextual factor. We utilize a sample of A-share listed companies on the Shanghai and Shenzhen Stock Exchanges from 2009 to 2020. Our findings show that outside CEO successors are significantly and positively related to corporate strategic change. TMT faultline mediates the effect of CEO successor origins on corporate strategic change, while CEO power reinforces the relationship between the two. Heterogeneity tests reveal that the effect of outside CEO successors on strategic change is insignificant in state-owned enterprises (SOEs) but has a significant impact on firms at their growth and maturity stages. Furthermore, our findings suggest that outside CEO successors inhibit the positive role of strategic change in promoting firm value.
  15. Zhang H, Gopinath SCB, Hu Y
    Heliyon, 2023 Sep;9(9):e19304.
    PMID: 37662784 DOI: 10.1016/j.heliyon.2023.e19304
    A spinal cord injury is damage to the nerves and cells that receive and provide a signal from the brain to the rest of the body. Spinal injury causes changes in movement, sensation, and strength, affect the body functions near the injury site, and may lead to paralysis. S100β was found as a suitable biomarker for identifying spinal cord injury and its causing problem. Herein, S100β immunoassay was developed on interdigitated electrode sensor to diagnose spinal cord injury. For effective anti-S100β antibody immobilization, the antibody was premixed with 3-Aminopropyl)triethoxsilane and then attached to the hydroxylated interdigitated electrode surface. This method of antibody immobilization enhanced the antibody attachment two-times than the method without premix. Antibody-attached surfaces increased current responses as S100 concentrations increased, and the limit of detection was seen to be 1 pg/mL on the linearity until 3000 pg/mL at an R2 value of 0.9907 [y = 7x - 6.4667]. Further, biofouling experiments with glial fibrillary acidic protein and γ-aminobutyric acid failed to enhance the current response, indicating the specific detection of S100β. This immunoassay identifies S100β at its lower level and helps to diagnose spinal cord injury and its related problem.
  16. Jabbar AAJ, Alamri ZZ, Abdulla MA, Salehen NA, Salim Amur Al Sinawi Z, Alfaifi SM
    Heliyon, 2023 Sep;9(9):e19418.
    PMID: 37662795 DOI: 10.1016/j.heliyon.2023.e19418
    Gynura procumbens is an edible flowering plant that has been utilized as traditional therapy for numerous diseases. The current experiment investigates the hepatoprotective potentials of the ethanol extract of Gynura procumbens leaf (EEGPL) against thioacetamide (TAA)-induced liver cirrhosis in rats. Thirty Sprague Dawley rats were randomly divided into 5 clusters: A, rats received orally 10% Tween 80 and intraperitoneal (i.p) inoculation of sterile distal water; B, rats received orally10% Tween 80; C, rats received orally daily 50 mg/kg of silymarin, while groups; D and E, rats received orally daily doses of 200 and 400 mg/kg of EEGPL, respectively. Furthermore, B-E clusters received 200 mg/kg thioacetamide (i.p) three times a week for 60 days. The liver gross morphology of rats that received only TAA (B) revealed irregular rough surface layers compared to smoother livers of rats that received EEGPL. Histopathology of group B revealed clear hepatic necrosis and fibrous connective tissue, which were significantly reduced in C-E groups. EEGPL treatment caused a significant down-regulation of PCNA and α-SMA protein expressions. Antioxidant (SOD and CAT) enzymes in hepatic homogeneity were meaningfully lower, and MDA levels were significantly higher in TAA controls compared to those of C-E groups. Moreover, EEGPL treatment caused a reduction of TNF-α and IL-6 and increased expression of IL-10 cytokines. Therefore, the hepatoprotective potentials of EEGPL might be contributed to its modulation of detoxification enzymes, anti-inflammatory, and antioxidant activities.
  17. Yao P, Osman S, Sabri MF, Zainudin N, Li Y
    Heliyon, 2023 Sep;9(9):e19131.
    PMID: 37662809 DOI: 10.1016/j.heliyon.2023.e19131
    Online-to-offline food delivery (O2OFD) services have become popular worldwide, and consumers' O2OFD usage and sedentary behavior have increased during the COVID-19 pandemic. However, whether consumers will continue to use O2OFD in the post-pandemic era is uncertain, and the relationship between sedentary lifestyle and O2OFD usage is poorly understood to date. Therefore, this study aims to investigate consumers' continued intention to use O2OFD in the post-pandemic era and their subsequent use behavior, as well as to explore the roles of sedentary lifestyle. A research model based on the unified theory of acceptance and use of technology 2 (UTAUT2), integrating network externalities and including sedentary lifestyle, was proposed. A two-stage online survey was conducted in China, with 409 eligible responses used in the data analysis. The results indicate that habit, perceived network size, and perceived complementarity were the main predictors of continued intention, whereas habit and continued intention were the primary determinants of use behavior. Sedentary lifestyle was positively related to O2OFD use behavior and moderated the effects of habit and continued intention on use behavior. In addition to its theoretical contributions, this study has implications for public policies, marketing strategies, and consumer well-being.
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