Consumers’ intention to purchase electric vehicles: the moderating role of environmental awareness

Electric vehicles (EVs), having the ability to reduce CO2 emissions, are considered a strategy to mitigate global warming, and thus, the widespread diffusion of EVs attracts much attention. In this study, we investigate the formation of consumers’ EV purchase decisions with a developed theoretical framework that incorporates environmental awareness into the model of goal-directed behavior (MGB). We test the model using structural equation modeling with data collected from 423 participants in China. Results indicate that attitude, subjective norm, positive and anticipated emotions, and frequency of past behavior (FPB) positively influence consumers’ desire to purchase an EV, which in turn influences their purchase intentions. The effect of negative anticipated emotion and perceived behavioral control on desire is not significant. Interestingly, environmental awareness does not significantly influence consumers’ intention to purchase EVs, but it positively moderates the impact of desire on behavioral intention. This study provides important theoretical and managerial implications for the promotion of EVs in China. Limitations and future research opportunities are discussed.</p

How Commonly Is the Diagnosis of Gastric Low Grade Dysplasia Upgraded following Endoscopic Resection? A Meta-Analysis

<div><p>Gastric dysplasia is a well-known precancerous lesion. Though the diagnosis of gastric low grade dysplasia (LGD) is generally made from endoscopic forceps biopsy (EFB), the accuracy is doubtful after numerous EFB-proven gastric LGD were upgraded to gastric high grade dysplasia (HGD) or even carcinoma (CA) by further diagnostic test with the procedure of endoscopic resection (ER). We aimed to evaluate the upgraded diagnosis rate (UDR) and the risk factors by ER in EFB-proven gastric LGD lesions. Two investigators independently searched studies reporting the UDR by ER in EFB-proven gastric LGD lesions from databases and analyzed the overall UDR, HGD-UDR and CA-UDR. The pooled UDR by ER in EFB-proven gastric LGD lesions was 25.0% (95% CI, 20.2%-29.8%), made up of HGD-UDR and CA-UDR by rates of 16.7% (95% CI, 12.8%-20.6%) and 6.9% (95% CI, 4.2%-9.6%) respectively. Lesion size larger than 2 cm, surface with depression and nodularity under endoscopic examinations were the major risk factors associated with UDR. In conclusion, one quarter of EFB-proven gastric LGD lesions will be diagnosed as advanced lesions, including gastric HGD (16.7%) and gastric CA (6.9%) by ER. The diagnosis of those LGD lesions with an endoscopic diameter larger than 2cm, and depressed or nodular surface are more likely to be upgraded after ER.</p></div

Funnel plot comparing type-specific UDR vs. standard error of UDR (Begg’s asymmetry test).

<p>(A) HGD-UDR, (B) CA-UDR. UDR, upgraded diagnosis rate; s.e., standard error; HGD, high grade dysplasia; CA, carcinoma.</p

Quality of studies using QUADAS tool.

<p>QUADAS, Quality Assessment of Diagnostic Accuracy Studies; Y, yes; N, no; U, unclear. Item 1. Was the spectrum of patients representative of the patients who will receive the test in practice? Item 2. Were selection criteria clearly described? Item 3. Is the reference standard likely to correctly classify the target condition? Item 4. Is the time period between reference standard and index test short enough to be reasonably sure that the target condition did not change between the two tests? Item 5. Did the whole sample or a random selection of the sample receive verification by using a reference standard of diagnosis? Item 6. Did patients receive the same reference standard regardless of the index test result? Item 7. Was the reference standard independent of the index test? Item 8. Was the execution of the index test described in sufficient detail to permit replication of the test? Item 9. Was the execution of the reference standard described in sufficient detail to permit its replication? Item 10. Were the index test results interpreted without knowledge of the results of the reference standard? Item 11. Were the reference standard results interpreted without knowledge of the results of the index test? Item 12. Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? Item 13. Were uninterpretable/intermediate test results reported? Item 14. Were withdrawals from the study explained?</p><p>Quality of studies using QUADAS tool.</p

Funnel plot comparing overall UDR vs. standard error (Begg’s asymmetry test).

<p>UDR, upgraded diagnosis rate; s.e., standard error;</p

Flow chart of the process for selecting eligible studies.

<p>LGD, low grade dysplasia; ER, endoscopic resection.</p

Forrest Plot of the overall UDR by ER in EFB-proven gastric LGD lesions.

<p>LGD, low grade dysplasia; EFB, endoscopic forceps biopsy; ER, endoscopic resection; UDR, upgraded diagnosis rate; CI, confidence interval.</p

Characteristics of the eligible studies.

<p>Pro., Prospective; Retro., Retrospective; Consecu., Consecutive; ER, endoscopic resection; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; LGD, low grade dysplasia; EFB, endoscopic forceps biopsy; HGD, high grade dysplasia; ER, endoscopic resection; CA, carcinoma; HC, high grade dysplasia plus carcinoma;</p><p>^†Gender and Age are counted based on number of LGD (EFB) patients</p><p>^‡Gender and Age are counted based on number of LGD (EFB) lesions.</p><p>Characteristics of the eligible studies.</p

Forrest Plot of the type-specific UDR by ER in EFB-proven gastric LGD lesions.

<p>(A) HGD-UDR, (B) CA-UDR. LGD, low grade dysplasia; EFB, endoscopic forceps biopsy; HGD, high grade dysplasia; CA, carcinoma; ER, endoscopic resection; UDR, upgraded diagnosis rate; CI, confidence interval.</p

Supplemental material 1 - Supplemental material for Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy

<p>Supplemental material, Supplemental material 1 for Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy by Jinwei Ying, Honglin Teng, Yunfan Qian, Yingying Hu, Tianyong Wen, Dike Ruan and Minyu Zhu in Acta Radiologica</p