Synergy of higher education resources and digital infrastructure construction in China: Regional differences, dynamic evolution and trend forecasting.

The deep integration of higher education with digital technology represents an inevitable trend, and evaluating the interplay between higher education resources (HER) and digital infrastructure construction (DIC) holds significant value for advancing the development of digital higher education and mitigating regional disparities in China. This study establishes two comprehensive evaluation frameworks for HER and DIC. Panel data from 31 provinces, spanning the period from 2011 to 2020, are utilized for analysis. The coupling coordination degree (CCD) model is employed in this work to evaluate the synergy between HER and DIC in China. Furthermore, we analyze the regional differences, spatial distribution, and trend evolution of this synergy. The study results revealed that there is an initial decrease followed by an increase in the synergy between HER and DIC, and the overall CCD is at a moderate coordination, with the mean CCD of the eastern region being significantly higher than that of the other three regions, and the inter-regional difference is the main source of regional disparity in this synergy. The current state of synergistic development reveals a slight inclination towards multi-polarization, although the disparity in regional development was decreasing. Additionally, there is an observed convergence in the coordinated development of HER and DIC, with spatial factors playing a significant role. These findings offer empirical support for efforts to enhance the integration of HER and DIC, reduce regional disparities in higher education, and foster sustainable development in China's higher education sector.

Do digital technologies reduce racially biased reporting? Evidence from NYPD administrative data.

Recent work has emphasized the disproportionate bias faced by minorities when interacting with law enforcement. However, research on the topic has been hampered by biased sampling in administrative data, namely that records of police interactions with citizens only reflect information on the civilians that police elect to investigate, and not civilians that police observe but do not investigate. In this work, we address a related bias in administrative police data which has received less empirical attention, namely reporting biases around investigations that have taken place. Further, we investigate whether digital monitoring tools help mitigate this reporting bias. To do so, we examine changes in reports of interactions between law enforcement and citizens in the wake of the New York City Police Department's replacement of analog memo books with mobile smartphones. Results from a staggered difference in differences estimation indicate a significant increase in reports of citizen stops once the new smartphones are deployed. Importantly, we observe that the rise is driven by increased reports of "unproductive" stops, stops involving non-White citizens, and stops occurring in areas characterized by a greater concentration of crime and non-White residents. These results reinforce the recent observation that prior work has likely underestimated the extent of racial bias in policing. Further, they highlight that the implementation of digital monitoring tools can mitigate the issue to some extent.

"Let's put it this way: you can't really live without it" - digital technologies in routine palliative care delivery: an explorative qualitative study with patients and their family caregivers in Germany.

BACKGROUND: Despite ongoing efforts to integrate palliative care into the German healthcare system, challenges persist, particularly in areas where infrastructure does not fully support digital technologies (DT). The increasing importance of digital technology (DT) in palliative care delivery presents both opportunities and challenges. OBJECTIVE: This study aimed to explore the perspectives and preferences of palliative care patients and their family caregivers regarding the use of DT in care delivery. METHODS: An exploratory qualitative study was conducted using semi-structured interviews with palliative care patients and their family caregivers across various settings. Participants were selected through gatekeeper-supported purposive sampling. Interviews were analysed using structured qualitative content analysis. RESULTS: Nineteen interviews were conducted.Three themes emerged: (1) Application of DTs in palliative care; (2) Potential of DTs; (3) Barriers to the use of DTs. Key findings highlighted the preference for real-time communication using DTs that participants are familiar with. Participants reported limited perceived value for digital transformation in the presence of in-person care. The study identified requirements for DT development and use in palliative care, including the need for direct and immediate functionality, efficiency in healthcare professional (HCP) work, and continuous access to services. CONCLUSION: The findings highlight a demonstrate the importance of familiarity with DTs and real-time access for patients and their families. While DT can enhance palliative care efficiency and accessibility, its integration must complement, not replace, in-person interaction in palliative care. As DTs continue to grow in scope and use in palliative care, maintaining continued user engagement is essential to optimise their adoption and ensure they benefit patients and their caregivers.

Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review.

BACKGROUND: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis. METHODS: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots. DISCUSSION: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF. TRIAL REGISTRATION: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542.

Do political connections facilitate or inhibit firms' digital transformation? Evidence from China's A-share private listed companies.

Given the advent of the digital era, digital transformation has become necessary for enterprise development. Political connections are the most important resources for enterprise development in most countries. However, the impact of political connections on corporate digital transformation has yet to be verified. This study uses ERNIE, a large language model, to construct a measurement of corporate digital transformation from the perspective of digital technology application through a textual analysis of the annual reports of A-share privately listed companies from 2008 to 2020 and analyzes the impact of political connections on corporate digital transformation and its mechanism of action. The findings demonstrate that political connections have a significant inhibitory effect on corporate digital transformation. This conclusion still holds after a series of robustness and endogeneity tests. The mechanism analyses demonstrate that political connections primarily affect corporate digital transformation through three mechanisms: weakening risk, inhibiting innovation, and enhancing resource crowding. We theoretically expand the understanding of the economic impact of political connections and provide new ideas for accelerating enterprise digital transformation from the perspective of policy makers.

The influence of digital platform on the implementation of corporate social responsibility: from the perspective of environmental science development to explore its potential role in public health.

Introduction: This paper aims to explore the intersection of corporate social responsibility (CSR) and public health within the context of digital platforms. Specifically, the paper explores the impact of digital platforms on the sustainable development practices of enterprises, seeking to comprehend how these platforms influence the implementation of environmental protection policies, resource management, and social responsibility initiatives. Methods: To assess the impact of digital platforms on corporate environmental behavior, we conducted a questionnaire survey targeting employees in private enterprises. This survey aimed to evaluate the relationship between the adoption of digital platforms and the implementation of environmental protection policies and practices. Results: Analysis of the survey responses revealed a significant positive correlation between the use of digital platforms and the environmental protection behavior of enterprises (r=0.523;p<0.001), Moreover, the presence of innovative environmental protection technologies on these platforms was found to positively influence the enforcement of environmental policies, with a calculated impact ratio of (a∗b/c=55.31%). An intermediary analysis highlighted that environmental innovation technology plays a mediating role in this process. Additionally, adjustment analysis showed that enterprises of various sizes and industries respond differently to digital platforms, indicating the need for tailored environmental policies. Discussion: These findings underscore the pivotal role of digital platforms in enhancing CSR efforts and public health by fostering improved environmental practices among corporations. The mediating effect of environmental innovation technologies suggests that digital platforms not only facilitate direct environmental actions but also enhance the efficiency and effectiveness of such initiatives through technological advances. The variability in response by different enterprises points to the importance of customizable strategies in policy formulation. By offering empirical evidence of digital platforms' potential to advance CSR and public health through environmental initiatives, this paper contributes to the ongoing dialogue on sustainable development goals. It provides practical insights for enterprises and policy implications for governments striving to craft more effective environmental policies and strategies.

The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift.

In the face of rapid technological advancement, the pharmacy sector is undergoing a significant digital transformation. This review explores the transformative impact of digitalization in the global pharmacy sector. We illustrated how advancements in technologies like artificial intelligence, blockchain, and online platforms are reshaping pharmacy services and education. The paper provides a comprehensive overview of the growth of online pharmacy platforms and the pivotal role of telepharmacy and telehealth during the COVID-19 pandemic. Additionally, it discusses the burgeoning cosmeceutical market within online pharmacies, the regulatory challenges faced globally, and the private sector's influence on healthcare technology. Conclusively, the paper highlights future trends and technological innovations, underscoring the dynamic evolution of the pharmacy landscape in response to digital transformation.

A qualitative investigation of gender-based violence prevention and response using digital technologies in low resource settings and refugee populations.

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020-2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.

Digitalization occurs when products and services are converted to digital forms; violence prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries were no exception to the rapid trend of digitalization during the COVID-19 crisis.Using key informant interviews with service providers working in violence prevention and response sectors in Brazil, Guatemala, Iraq, and in Italy regarding forcibly displaced women/girls, we investigated the rapid digitalization of gender-based violence prevention/response during the COVID-19 crisis.The effectiveness, safety, and equitability of digitalized violence prevention/response services depends on how well they are balanced vis-a-vis the gender digital divide and risk of digital GBV.

HCI-modelling for improving the clinical usability of digital health technologies.

INTRODUCTION: Digital Health Technologies (DHTs) have been shown to have variable usability as measured by efficiency, effectiveness and user satisfaction despite large-scale government projects to regulate and standardise user interface (UI) design. We hypothesised that Human-Computer Interaction (HCI) modelling could improve the methodology for DHT design and regulation, and support the creation of future evidence-based UI standards and guidelines for DHTs. METHODOLOGY: Using a Design Science Research (DSR) framework, we developed novel UI components that adhered to existing standards and guidelines (combining the NHS Common User Interface (CUI) standard and the NHS Design System). We firstly evaluated the Patient Banner UI component for compliance with the two guidelines and then used HCI-modelling to evaluate the "Add New Patient" workflow to measure time to task completion and cognitive load. RESULTS: Combining the two guidelines to produce new UI elements is technically feasible for the Patient Banner and the Patient Name Input components. There are some inconsistencies between the NHS Design System and the NHS CUI when implementing the Patient Banner. HCI-modelling successfully quantified challenges adhering to the NHS CUI and the NHS Design system for the "Add New Patient" workflow. DISCUSSION: We successfully developed new design artefacts combing two major design guidelines for DHTs. By quantifying usability issues using HCI-modelling, we have demonstrated the feasibility of a methodology that combines HCI-modelling into a human-centred design (HCD) process could enable the development of standardised UI elements for DHTs that is more scientifically robust than HCD alone. CONCLUSION: Combining HCI-modelling and Human-Centred Design could improve scientific progress towards developing safer and more user-friendly DHTs.

Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review.

BACKGROUND: Poor-quality care is linked to higher rates of neonatal mortality in low-income and middle-income countries (LMICs). Limited educational and upskilling opportunities for healthcare professionals, particularly those who work in remote areas, are key barriers to providing quality neonatal care. Novel digital technologies, including mobile applications and virtual reality, can help bridge this gap. This scoping review aims to identify, analyse and compare available digital technologies for staff education and training to improve newborn care. METHODS: We conducted a structured search of seven databases (MEDLINE (Ovid), EMBASE (Ovid), EMCARE (Ovid), Global Health (CABI), CINAHL (EBSCO), Global Index Medicus (WHO) and Cochrane Central Register of Controlled Trials on 1 June 2023. Eligible studies were those that aimed to improve healthcare providers' competency in newborn resuscitation and management of sepsis or respiratory distress during the early postnatal period. Studies published in English from 1 January 2000 onwards were included. Data were extracted using a predefined data extraction format. RESULTS: The review identified 93 eligible studies, of which 35 were conducted in LMICs. E-learning platforms and mobile applications were common technologies used in LMICs for neonatal resuscitation training. Digital technologies were generally well accepted by trainees. Few studies reported on the long-term effects of these tools on healthcare providers' education or on neonatal health outcomes. Limited studies reported on costs and other necessary resources to maintain the educational intervention. CONCLUSIONS: Lower-cost digital methods such as mobile applications, simulation games and/or mobile mentoring that engage healthcare providers in continuous skills practice are feasible methods for improving neonatal resuscitation skills in LMICs. To further consider the use of these digital technologies in resource-limited settings, assessments of the resources to sustain the intervention and the effectiveness of the digital technologies on long-term health provider performance and neonatal health outcomes are required.

Professional regulation in the digital era: A qualitative case study of three professions in Ontario, Canada.

Technology is transforming service delivery and practice in many regulated professions, altering required skills, scopes of practice, and the organization of professional work. Professional regulators face considerable pressure to facilitate technology-enabled work while adapting to digital changes in their practices and procedures. However, our understanding of how regulators are responding to technology-driven risks and the impact of technology on regulatory policy is limited. To examine the impact of technology and digitalization on regulation, we conducted an exploratory case study of the regulatory bodies for nursing, law, and social work in Ontario, Canada. Data were collected over two phases. First, we collected documents from the regulators' websites and regulatory consortiums. Second, we conducted key informant interviews with two representatives from each regulator. Data were thematically analyzed to explore the impact of technological change on regulatory activities and policies and to compare how regulatory structure and field shape this impact. Five themes were identified in our analysis: balancing efficiency potential with risks of certain technological advances; the potential for improving regulation through data analytics; considering how to regulate a technologically competent workforce; recalibrating pandemic emergency measures involving technology; and contemplating the future of technology on regulatory policy and practice. Regulators face ongoing challenges with providing equity-based approaches to regulating virtual practice, ensuring practitioners are technologically competent, and leveraging regulatory data to inform decision-making. Policymakers and regulators across Canada and internationally should prioritize risk-balanced policies, guidelines, and practice standards to support professional practice in the digital era.

Therapies go digital. What drives physicians' acceptance?

National healthcare systems face multiple challenges, including the increasing demand for care and decreasing availability of healthcare professionals. Digital health technologies represent opportunities that offer improved efficiency, accessibility, and patient care. In this scenario, Digital Therapeutics are technological advancements to treat or alleviate a disease and deliver a medical intervention with evidence-based therapeutic impacts and regulatory approval. Digital Therapeutics are a paradigm shift for physicians, who exercise caution in terms of trust and wide usage. Digital Therapeutics represents an opportunity and a challenge in healthcare system integration. The research investigates the factors explaining physicians' acceptance of Digital Therapeutics. A research model that combines organizational mechanisms derived from Institutional Theory and rational factors derived from the Technology Acceptance model was developed. The model was tested through 107 responses from a survey distributed to the members of the leading Italian scientific society in Diabetology. Literature-based hypotheses were empirically tested through Structural Equation Modelling. The analysis confirmed the influence of Perceived Ease of Use on Perceived Usefulness and Perceived Usefulness on the Intention To Use Digital Therapeutics. Rules and norms impact Perceived Usefulness when considering the influence of the scientific society. Culture and mindset towards innovation within the hospital positively affect Perceived Ease of Use. The readiness of hospital facilities enhances the extent to which physicians perceive the ease of employing Digital Therapeutics in their daily practice. Instead, esteemed colleagues' opinions and guidelines from the scientific society reveal to physicians the value of Digital Therapeutics in patients' care pathways. Institutions should prioritize cultural, normative, and regulative aspects to accelerate physicians' endorsement of Digital Therapeutics. Findings advance the theoretical knowledge around clinicians' adoption of innovative digital health technologies, unveiling the interaction between rational and institutional factors. The results highlight practical implications for healthcare institutions and Digital Therapeutics manufacturers willing to promote their adoption.

Online dissemination of Cochrane reviews on digital health technologies: a cross-sectional study.

BACKGROUND: This cross-sectional study investigated the online dissemination of Cochrane reviews on digital health technologies. METHODS: We searched the Cochrane Database of Systematic Reviews from inception up to May 2023. Cochrane reviews with any population (P), intervention or concept supported by any digital technology (I), any or no comparison (C), and any health outcome (O) were included. Data on review characteristics (bibliographic information, PICO, and evidence quality) and dissemination strategies were extracted and processed. Dissemination was assessed using review information on the Cochrane website and Altmetric data that trace the mentions of academic publications in nonacademic online channels. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS: Out of 170 records identified in the search, 100 Cochrane reviews, published between 2005 and 2023, were included. The reviews focused on consumers (e.g. patients, n = 86), people of any age (n = 44), and clinical populations (n = 68). All reviews addressed interventions or concepts supported by digital technologies with any devices (n = 73), mobile devices (n = 17), or computers (n = 10). The outcomes focused on disease treatment (n = 56), health promotion and disease prevention (n = 27), or management of care delivery (n = 17). All reviews included 1-132 studies, and half included 1-10 studies. Meta-analysis was performed in 69 reviews, and certainty of evidence was rated as high or moderate for at least one outcome in 46 reviews. In agreement with the Cochrane guidelines, all reviews had a plain language summary (PLS) that was available in 3-14 languages. The reviews were disseminated (i.e. mentioned online) predominantly via X/Twitter (n = 99) and Facebook (n = 69). Overall, 51 reviews were mentioned in up to 25% and 49 reviews in 5% of all research outputs traced by Altmetric data. Dissemination (i.e. higher Altmetric scores) was associated with bibliographic review characteristics (i.e. earlier publication year and PLS available in more languages), but not with evidence quality (i.e. certainty of evidence rating, number of studies, or meta-analysis performed in review). CONCLUSIONS: Online attention towards Cochrane reviews on digital health technologies is high. Dissemination is higher for older reviews and reviews with more PLS translations. Measures are required to improve dissemination of Cochrane reviews based on evidence quality. SYSTEMATIC REVIEW REGISTRATION: The study was prospectively registered at the Open Science Framework ( https://osf.io/mpw8u/ ).

A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study.

Background: Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s): Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design: Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods: Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants: A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions: Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results: Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations: Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions: WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work: The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration: This study is registered as ISRCTN14470430. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense but, often, no one asks them for input or feedback at the time. We worked with service users and staff to develop new technology to make it easy for patients to tell staff about changes in the ward atmosphere. We put everyone's ideas together and some technical developers then built a digital safety tool to use on a tablet computer. Patients put in anonymous information about the ward atmosphere and staff can read it straight away. We tested it on six adult acute mental health wards for 10 weeks. We asked patients and staff what they thought about the tool and we looked at how it was being used. Patients and staff liked the look of the tool on the tablet computer. Some staff said they did not need it because they could tell how patients were feeling, but patients told us that staff did not talk with them much and did not always know when patients were feeling tense. Coronavirus disease 2019 made life difficult on the wards. Most ward managers said the tool could be helpful, but they had not had time to get used to it on the wards. Occasionally, the tablet computers were out of action. Many staff tried hard to use the tool. Most patient information was gathered when it was calm, perhaps because staff were not too busy to help them. We found that this tool could help staff know about tensions on the ward, but they need to get used to it and bring it into ward routines.

Digital technology integration in business model innovation for carbon neutrality: An evolutionary process model for SMEs.

This study delves into the strategies employed by small and medium-sized enterprises (SMEs) to embed digital technology into their business models, aiming to reach carbon neutrality. We offer a comprehensive analysis of five high technology SMEs, unveiling an evolutionary process model that highlights their journey toward integrating technology. The integration process is delineated into three progressive stages. Initially, digital technology is seen as an 'enabler' that promotes the birth of an innovative business model, essentially transforming the mechanisms of value creation, delivery, and capture. As SMEs evolve to an intermediate stage, digital technology becomes a 'disruptor', reshaping and reinventing the business model in terms of how value is created, delivered, and captured. Entering the maturity stage, digital technology is elevated to the role of 'expertise', leading to a sophisticated business model that refines and optimizes these aspects of value. The influence of these business model innovations on carbon neutrality is complex and varies distinctly with each stage, reflecting the dynamic interplay between digital technology and business model evolution.

Stakeholder perspectives on contributors to delayed and inaccurate diagnosis of cardiovascular disease and their implications for digital health technologies: a UK-based qualitative study.

OBJECTIVE: The aim of this study is to understand stakeholder experiences of diagnosis of cardiovascular disease (CVD) to support the development of technological solutions that meet current needs. Specifically, we aimed to identify challenges in the process of diagnosing CVD, to identify discrepancies between patient and clinician experiences of CVD diagnosis, and to identify the requirements of future health technology solutions intended to improve CVD diagnosis. DESIGN: Semistructured focus groups and one-to-one interviews to generate qualitative data that were subjected to thematic analysis. PARTICIPANTS: UK-based individuals (N=32) with lived experience of diagnosis of CVD (n=23) and clinicians with experience in diagnosing CVD (n=9). RESULTS: We identified four key themes related to delayed or inaccurate diagnosis of CVD: symptom interpretation, patient characteristics, patient-clinician interactions and systemic challenges. Subthemes from each are discussed in depth. Challenges related to time and communication were greatest for both stakeholder groups; however, there were differences in other areas, for example, patient experiences highlighted difficulties with the psychological aspects of diagnosis and interpreting ambiguous symptoms, while clinicians emphasised the role of individual patient differences and the lack of rapport in contributing to delays or inaccurate diagnosis. CONCLUSIONS: Our findings highlight key considerations when developing digital technologies that seek to improve the efficiency and accuracy of diagnosis of CVD.

Digital Technology in Clinical Medicine: Correspondence.

We found the article on "The Digital Technology in Clinical Medicine: From Calculators to ChatGPT" interesting.1 According to Kulkarni et al., humanity has witnesses four important social system changes, starting with the primitive huntersgatherers and progressing to horticultural, agricultural, industrial, and the current fifth, which is based on digital information technology and has altered the way we present, recognize, and utilize different factors of production. In clinical medicine, digital technology has advanced significantly since the days of computations. According to Kulkarni et al., we have to benefit from these advancements as we all improve the lives of our patients while being cautious not to overturn the doctor-patient relationship. If technology, clinical expertise, and humanistic values are properly balanced, Kulkarni et al. concluded that the future is quite glorious.1 Regulatory organizations are pushing for improvements through clinical trials as a result of recognition of the expanding influence of digital technology in healthcare delivery. The "World Health Organizations Guidelines for Digital Interventions" and the "Food and Drug Administration's Digital Health Center of Excellence" are only two of the projects that are currently being highlighted in the study as efforts to analyze and implement digital health services.