Purpose: This study investigated the effects of customer perceptions of service quality on eWOM (electronic word of mouth) and switching intentions through cognitive and emotional responses, specifically in the context of the Kingdom of Saudi Arabia's (KAS) telecom industry.Design/ methodology/ approach: We have developed a theoretical framework based on behavioural theories to analyse the environmental aspects of relationships that affect customer behavioural intentions. We adapted quantitative methodology along with the positivist philosophical approach to investigate our hypotheses within the theoretical framework. We applied a protracted stimuli-organism-response (SOR) model to highlight the peripheral reliability, responsiveness, tangibility, empathy, assurance, and the impact of the customer's feelings while simultaneously linking the elements to each other. In addition, we apply theory of reason action (TRA) to reflect the marginal elements of subjective norms, attitude, and customers' behavioral intentions. A survey with 601 responses has been used in this study. Findings:In the setting of KSA's mobile telecom industry, we confirm that there is a positive effect of customer perceptions of service quality on their eWOM and switching intentions through their cognitive and emotional responses. Originality and value:The framework of this study enhances our understanding of the role of service quality as an environmental influence on an individual's intentions to switch and eWOM. This conceptual framework is essential in evaluating the mediating roles of attitude and emotions in relation to eWOM and intention to switch.

Figure 1. (A) ERCP with cholangiogram showing a low-grade distal biliary stricture without significant upstream dilation. (B) Liver biopsy with H&E stain, 500 mm magnification showing small portal tracts with no bile ducts (red circle); note marked cholestasis (arrows) in dilated canaliculi and lack of ductular reaction. Also visible at this magnification is the ballooning degeneration of hepatocytes. (C) Liver biopsy with cytokeratin 7 immunostain, 500 mm magnification. Small portal tracts with no terminal/small bile ducts. Early signs of ductular reaction seen by hepatocytes taking up CK7 stain (arrows).

Extragenital manifestations of Chlamydia trachomatis infection can be challenging to diagnose. A previously healthy 33-year-old man presented with pericarditis recurring despite anti-inflammatory therapy and progressing to cardiac tamponade. Pericardiocentesis yielded bloody-appearing fluid with increased neutrophils and negative standard cultures. The patient reported recent unprotected sexual exposure, and urine nucleic acid amplification test detected C. trachomatis. He had no urogenital, ocular, or joint symptoms. The result of an extensive workup for other causes of pericarditis was negative, including HLA-B27 testing. He was treated with an extended course of doxycycline with full resolution of symptoms. We found 4 previously reported cases of chlamydial myopericardial disease, all of which shared key features with ours. Differentiating disseminated C. trachomatis from reactive phenomena is currently difficult owing to the limited availability of molecular tests and lack of their validation for clinical use. The diagnosis remains one of the clinical suspicions and circumstantial pieces of evidence, and further diagnostic developments are needed.

A 74-year-old man with chronic obstructive pulmonary disease on home oxygen and coronary artery disease was transferred from an outside facility to obtain an inguinal lymph node biopsy to rule out malignancy. He underwent an uncomplicated procedure and was discharged the same day. While waiting for transportation, he had sudden-onset dyspnea and collapsed. After resuscitation, patient had return of spontaneous circulation and was admitted but was provided comfort care and soon expired. Autopsy showed metastatic squamous cell carcinoma with multiple bilateral tumor emboli. Pulmonary tumor embolism is a rare cause of dyspnea in cancer population. Most of the cases are diagnosed with autopsy after sudden death; however, few cases have been reported antemortem. Tumor embolism is rare and difficult to diagnose without an autopsy with a poor outcome.

Behavioral financing is an emerging science and a relatively new area for academic research, leveraging investors' irrational behavior. To a certain degree, most investment decisions are affected by investors' biases and expectations, which do not follow rationality requirements. This study rigorously investigated a group of behavioral financial factors-optimism, pessimism, overconfidence, herd behavior, and loyalty-and firm characteristics, and then it examined whether and to what extent behavioral financial factors drive investors' behaviors about the largest initial public offerings (IPOs). This study employed structural equation modelling and used a representative survey of 353 investors during the IPO of Saudi Aramco. The study found that the factors that stimulated investors in the Saudi market, especially during the Aramco IPO behavior decision, included behavioral finance factors, such as optimism, overconfidence, loyalty, and herd behavior, while firm characteristics failed to shape investors' decisions during Aramco's IPO.