BACKGROUND: The purpose of this study is to examine the use of electronic cigarettes (e-cigarettes) among college students in Hangzhou, and to analyze the influencing factors of their intention to use e-cigarettes.
METHODS: Using a stratified cluster sampling method, 775 students from two universities in Hangzhou were selected for an on-site questionnaire survey from March to April 2022. Adjusted logistic regression analysis was conducted on the influencing factors of use intention, based on innovation diffusion theory.
RESULTS: Within our sample of college students, 16.5% of students had tried e-cigarettes; 6.32% had used e-cigarettes in the past month, and 8.0% had the intention to use e-cigarettes. There were significant differences in willingness to use e-cigarettes among different genders, economic status, smoking status of close friends around them, and their own use of tobacco and alcohol (p<0.05). The logistic regression model showed that the observability of e-cigarettes (AOR=1.28; p<0.05), personal factors (AOR=1.39; p<0.05), and social systems (AOR=1.63; p<0.05), were all influencing factors of intention to use e-cigarettes.
CONCLUSIONS: College students in Hangzhou have a high intention to use e-cigarettes, and the impacts of the product itself, individual characteristics and the living environment are crucial. It is necessary to strengthen the promotion of tobacco knowledge at the social and family levels to reduce the occurrence of vaping.

Nurses frequently innovate in response to operational failures, regulations, procedures, and/or other workflow barriers that prevent them from delivering high-quality patient care. Unfortunately, most nurse innovations do not diffuse to a broader audience, depriving other nurses from taking advantage of solutions that have already been developed elsewhere. This under-diffusion is problematic from a societal and welfare point of view. The goal of this paper is to understand how diffusion shortage of nurse innovations can be reduced.
We develop a qualitative case study of a medical makerspace at the largest academic hospital in the Netherlands. This medical makerspace reported unusually high rates of nurse innovation diffusion. Our data collection includes on-site observations, archival data, secondary data, and fifteen in-depth interviews with key informants. Qualitative coding procedures and a combination of deductive and inductive reasoning are used to analyze the data.
Our data show that personal, organizational, regulatory, and market barriers prevent nurses from further developing and diffusion their innovations in an anticipatory manner. That is, because nurses expect that transforming an initial solution into an innovation that can be shared with others will be too time consuming and difficult they do not proceed with the further development. The medical makerspace that we investigated adequately addresses this problem by developing an innovation ecosystem that largely takes over the innovation and diffusion process.
We provide a concrete example of how a medical makerspace, and innovation support systems in a broader sense, can be designed to more adequately address the nurse innovation-diffusion gap. The two main elements of the practical solution that we identified are: (1) Support systems should facilitate that others may lead the development and diffusion of innovations and (2) The support system should promote that actors integrate their functional specializations within an innovation ecosystem. We make two theoretical contributions. First, we contribute to understanding barriers in the nurse innovation-diffusion process from a psychological point. Second, we identified that an ecosystem perspective is beneficial to develop innovation support systems in which diffusion occurs more often.

This study investigates the impact of renewable and non-renewable energy sources on carbon emissions in the context of China\'s 14th Five-Year Plan (2021-2025). The plan emphasises a \"Dual-control\" strategy of simultaneously setting energy consumption limits and reducing energy intensity for GDP (gross domestic product) in order to meet the targets of the five-year plan. Using a comprehensive dataset of Chinese energy and macroeconomic information spanning from 1990 to 2022, we conduct a Granger causality analysis to explore the relationship between energy sources and the level of air pollution. Our findings reveal a unidirectional link, wherein renewable energy contributes to a reduction in air pollution, while non-renewable energy sources lead to an increase. Despite the government\'s investment in renewable energy, our results show that China\'s economy remains heavily reliant on traditional energy sources (e.g., fossil fuels). This research is the first systematic examination of the interplay between energy usage and carbon emissions in the Chinese context. Our findings provide valuable insights for policy and market strategies aimed at promoting carbon neutrality and driving technological advancements in both government and industries.

UNASSIGNED: Evidence-based digital health technologies are increasingly important in delivering care to an ageing population with constrained resources. In the United Kingdom, accelerator programmes (APs) have been developed to support the adoption of digital health technologies within the National Health Service. This study aims to explore the perspectives of stakeholders using APs.
UNASSIGNED: Stakeholders representing nine small -and medium-sized enterprises (SMEs) that were engaged with three different APs (n = 9). Semi-structured interviews were conducted with key informants between April and September 2018. Framework analysis of the data was performed to explore their perspectives on APs.
UNASSIGNED: Four key themes were generated. Informants reported the need to generate evidence before and during the programme, appreciating different types of evidence and their importance. Informants identified several key factors that were a catalyst for success, including involvement in the programme and access to individuals and organisations that were crucial for support. However, several barriers were identified at the programme and system levels. Finally, informants identified key supporting processes that enhanced the adoption of their innovations.
UNASSIGNED: SMEs that develop digital health technologies report that, while APs are useful in supporting the adoption of these technologies, some issues remain. These relate to the emphasis on traditional research evidence that remains a challenge for SMEs to generate. Also, several system-level barriers to innovation in healthcare persist. As APs and SMEs continue to create an entrepreneurial ecosystem, there is increased potential for the development of supporting processes and infrastructure to accelerate the efficient and timely adoption of new digital health technologies.

Standardization is gaining importance for digital platform eco-systems as they try to balance both stability and flexibility of their core as well as their boundary resources. Our knowledge on which factors influence standardization processes in business-to-business (B2B) focused digital platform eco-systems remains limited. Using three B2B platform eco-systems from the cargo transportation and seaport eco-system context, we apply a multiple case study to investigate which factors affect the standardization mode and the standard adoption. Based on 19 interviews and a systematic coding procedure, we identified 24 factors and cluster them into four overarching themes. We show the relatedness between standardization and innovation research, identify standard characteristics as the most important theme of factors and show that standardization has to be seen as a dynamic and interconnected process, as some factors are interdependent but the controllability varies between factors. Lastly, implications of these results and future research directions are discussed.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12525-022-00551-1.

Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging.
This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs.
This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women\'s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation.
A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system\'s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs\' business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals.
There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients\' well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow.
This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community.
A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years-between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained.
There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: \"Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge.\" The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date.
This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

BACKGROUND: This study discusses the acceptance of new medical technologies in health care settings and resistance to these technologies from hospitals, doctors\' surgical centers, electronic health (eHealth) centers, and related institutions. We suggest a novel method of identifying factors that influence the acceptance of, and resistance to, new technologies by medical staff and patients.
OBJECTIVE: The objective of this study was to determine and evaluate the factors that influence acceptance and resistance to achieve a successful implementation of new technologies.
METHODS: The target group was patients residing in Brandenburg and major stakeholders in the local health care structure, for instance, medical institutions and medical professionals. The process relies on 3 models: the technology acceptance model, the unified technology acceptance and use of technology model, and the theory of technical innovation diffusion. Qualitative methodology was employed in this study, and an exploratory design was adopted to gain new insights into a poorly understood phenomenon in the German context. This enabled the researcher to take a flexible approach toward exploring a wide range of secondary data and to choose a different approach when unexpected information emerged. Content analysis was used to identify and interpret the data, and the researcher assured that the meaning associated with the information has concurred with that of the original source.
RESULTS: This study confirmed that adoption of new technologies in health care depended on individual opinions of the factors relating to them. Some medical professionals believed that technology would interfere with their ability to make independent diagnoses and their relationships with patients. Doctors also feared that technology was a means of management control. In contrast, other medical staff welcomed technology because it provided them with more opportunities to interact with patients and their carers. Generally, patients were more enthusiastic about technology than medical professionals and health care managers because it allowed them to have greater autonomy in selecting health care options. The need for all groups to be involved in the development of the new health care approach was an important outcome, otherwise resistance to it was likely to be greater. In other words, the strategy for change management was the indicator of success or failure. Therefore, following our analysis, a number of practical precepts emerged that could facilitate user acceptance of digital solutions and innovative medical technologies.
CONCLUSIONS: The acceptance of digital solutions and innovative medical technology by patients and professionals relies on understanding their anxieties and feelings of insecurity. The process will take time because individuals accept change at different rates. Hence, the development of an extensive user community to fully and successfully implement eHealth is less likely in the short term; however, this should not prevent the push for changes in health care technology.