Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study

BACKGROUND

Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development.

OBJECTIVE

This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups.

METHODS

This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups.

RESULTS

In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring.

CONCLUSIONS

This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.

Catalysts for Stone Age innovations: What might have triggered two short-lived bursts of technological and behavioral innovation in southern Africa during the Middle Stone Age?

Fossil and genetic evidence suggests the emergence of anatomically modern humans (Homo sapiens) in sub-Saharan Africa some time between 200 and 100 thousand years (ka) ago. But the first traces of symbolic behavior-a trait unique to our species-are not found until many tens of millennia later, and include items such as engraved ochres and eggshells, tools made from bone, and personal ornaments made of shell beads. These behavioral indicators appear in concert with two innovative phases of Middle Stone Age technology, known as the Still Bay (SB) and Howieson's Poort (HP) industries, across a range of climatic and ecological zones in southern Africa. The SB and HP have recently been dated to about 72-71 ka and 65-60 ka, respectively, at sufficiently high resolution to investigate the possible causes and effects. A remarkable feature of these two industries is the spatial synchroneity of their start and end dates at archaeological sites spread across a region of two million square kilometers. What were the catalysts for the SB and HP, and what were the consequences? Both industries flourished at a time when tropical Africa had just entered a period of wetter and more stable conditions, and populations of hunter-gatherers were expanding rapidly throughout sub-Saharan Africa before contracting into geographically and genetically isolated communities. The SB and HP also immediately preceded the likely exit time of modern humans from Africa into southern Asia and across to Australia, which marked the beginning of the worldwide dispersal of our species. In this paper, we argue that environmental factors alone are insufficient to explain these two bursts of technological and behavioral innovation. Instead, we propose that the formation of social networks across southern Africa during periods of population expansion, and the disintegration of these networks during periods of population contraction, can explain the abrupt appearance and disappearance of the SB and HP, as well as the hiatus between them. But it will take improved chronologies for the key demographic events to determine if the emergence of innovative technology and symbolic behavior provided the stimulus for the expansion of hunter-gatherer populations (and their subsequent global dispersal), or if these Middle Stone Age innovations came into existence only after populations had expanded and geographically extensive social networks had developed.

Re-thinking Innovation in Organizations in the Industry 4.0 Scenario: New Challenges in a Primary Prevention Perspective

In organizations, innovation is considered a relevant aspect of success and long-term survival. Organizations recognize that innovation contributes to creating competitive advantages in a more competitive, challenging and changing labor market. The present contribution addresses innovation in organizations in the scenario of Industry 4.0, including technological innovation and psychological innovation. Innovation is a core concept in this framework to face the challenge of globalized and fluid labor market in the 21st century. Reviewing the definition of innovation, the article focuses on innovative work behaviors and the relative measures. This perspective article also suggests new directions in a primary prevention perspective for future research and intervention relative to innovation and innovative work behaviors in the organizational context.

Wearable monitors for patients following discharge from an intensive care unit: practical lessons learnt from an observational study

AIMS

To identify the practical challenges encountered when using wearable monitors for patients discharged from the intensive care unit.

BACKGROUND

Patients discharged from intensive care units are a high-risk group that might benefit from continuing observation using 'wearable' monitors to enable faster identification of physiological deterioration and facilitate timely clinical action. This area of technological innovation is of key interest to nurses who manage this group of patients.

DESIGN

A prospective observational study.

METHODS

An observational study conducted in 2013-2014 used wearable monitors to record continuous observations for patients discharged from an intensive care unit to develop a predictive model of patients likely to deteriorate. Screening data for study eligibility and case report form data to assess monitor tolerance and comfort were collected daily and analysed using Microsoft Access.

RESULTS/FINDINGS

Patients (n = 2704) were discharged from an intensive care unit during the study, 208 consented to wearing the monitor. Of the 192 included in analysis, 130 (67·7%) removed the monitor before the trial finished. Reasons cited for removal included 'discomfort and irritation' 61 (31·8%) and 'feeling too unwell' 8 (4·2%). Five hundred seventeen patients were screened following adaption of the wearable monitor. Despite design changes, 56 (10·8%) patients were unable to wear monitors for reasons related to their anatomy or condition. Of 124 patients, 65 patients (52·4%) who were approached refused participation.

CONCLUSION

Work is needed to understand wireless monitor comfort and design for acutely unwell patients. Product design needs to develop further, so patients are catered for in flexibility of monitor placement and improved comfort for long-term wear.

Trends for nanotechnology development in China, Russia, and India

China, Russia, and India are playing an increasingly important role in global nanotechnology research and development (R&D). This paper comparatively inspects the paper and patent publications by these three countries in the Thomson Science Citation Index Expanded (SCI) database and United States Patent and Trademark Office (USPTO) database (1976-2007). Bibliographic, content map, and citation network analyses are used to evaluate country productivity, dominant research topics, and knowledge diffusion patterns. Significant and consistent growth in nanotechnology papers are noted in the three countries. Between 2000 and 2007, the average annual growth rate was 31.43% in China, 11.88% in Russia, and 33.51% in India. During the same time, the growth patterns were less consistent in patent publications: the corresponding average rates are 31.13, 10.41, and 5.96%. The three countries' paper impact measured by the average number of citations has been lower than the world average. However, from 2000 to 2007, it experienced rapid increases of about 12.8 times in China, 8 times in India, and 1.6 times in Russia. The Chinese Academy of Sciences (CAS), the Russian Academy of Sciences (RAS), and the Indian Institutes of Technology (IIT) were the most productive institutions in paper publication, with 12,334, 6,773, and 1,831 papers, respectively. The three countries emphasized some common research topics such as "Quantum dots," "Carbon nanotubes," "Atomic force microscopy," and "Scanning electron microscopy," while Russia and India reported more research on nano-devices as compared with China. CAS, RAS, and IIT played key roles in the respective domestic knowledge diffusion.

Environmental Regulation, Technological Innovation, and Export Competitiveness: An Empirical Study Based on China's Manufacturing Industry

A current and universal challenge, particularly in developing nations, is the establishment of effective environmental regulation policies that protect the ecological environment without adversely affecting the international competitiveness of the domestic manufacturing industry. To deal with this dilemma, this study investigates the export competitiveness of China’s manufacturing industry from the viewpoint of export value added. The Porter hypothesis is applied for an empirical investigation of the effect of environmental regulation on export competitiveness and to determine the presence of intra-industry heterogeneity. Furthermore, this study seeks to understand the mechanisms through which environmental regulation affects export competitiveness by exploring the two main approaches to technological innovation. The findings reveal that environmental regulation has a promotion effect of approximately 2% on the export competitiveness of China’s manufacturing industry; however, this effect is non-linear and displays a “U-shaped” tendency, indicating that certain prerequisites must be fulfilled to validate the Porter hypothesis. In addition, the effect of environmental regulation displays significant intra-industry heterogeneity, which is evident primarily in heavily polluting sub-industries and to a lesser extent in moderately polluting sub-industries but insignificant in lightly polluting sub-industries. Environmental regulation also differs significantly in the mechanisms through which it affects different approaches to technological innovation. Independent research and development is affected by environmental regulation through the compliance cost effect, which limits export competitiveness, while technology introduction is affected by the innovation offset effect, which favors export competitiveness. These findings offer political implications for the sustainable development of the ecological environment and foreign trade.

A Roadmap toward Achieving Sustainable Environment: Evaluating the Impact of Technological Innovation and Globalization on Load Capacity Factor

Technological innovations have been a matter of contention, and their environmental consequences remain unresolved. Moreover, studies have extensively evaluated environmental challenges using metrics such as nitrogen oxide emissions, sulfur dioxide, carbon emissions, and ecological footprint. The environment has the supply and demand aspect, which is not a component of any of these indicators. By measuring biocapacity and ecological footprint, the load capacity factor follows a certain ecological threshold, allowing for a thorough study on environmental deterioration. With the reduction in load capacity factor, the environmental deterioration increases. In the context of the environment, the interaction between technological innovation and load capacity covers the demand and supply side of the environment. In light of this, employing the dataset ranging from 1980 to 2017 for the case of South Africa, the bound cointegration test in conjunction with the critical value of Kripfganz and Schneider showed cointegration in the model. The study also employed the ARDL, whose outcome revealed that nonrenewable energy usage and economic growth contribute to environmental deterioration, whereas technological innovation and globalization improve the quality of the environment. This study validated the hypothesis of the environmental Kuznets curve for South Africa, as the short-term coefficient value was lower than the long-term elasticity. Furthermore, using the frequency-domain causality test revealed that globalization and economic growth predict load capacity in the long term, and nonrenewable energy predicts load capacity factors in the long and medium term. In addition, technological innovation predicts load capacity factors in the short and long term. Based on the findings, we propose that policymakers should focus their efforts on increasing funding for the research and development of green technologies.

How Does CEO's Environmental Awareness Affect Technological Innovation?

In this paper, we conduct an empirical study on the impact of CEOs' environmental awareness on technological innovation. To this end, we obtain a large sample with 7615 observations from Chinese A-share listed firms between the years of 2003 and 2014. Our empirical results show that a CEO's environmental awareness has a significant positive impact on technological innovation of his/her enterprise. Environmentally conscious CEOs will invest more in R&D and obtain more patents. This will help their enterprises achieve higher efficiency of technological innovation. Furthermore, the environmental awareness of a CEO has a more significant impact on technological innovation if his/her enterprise is subject to a higher level of monitoring. We also conduct robustness check of our findings and provide managerial insights and proactive government policies to raise the environmental awareness of CEOs and improve the innovation vitality of enterprises.

Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy

Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.

Medicare, ethics, and reflexive longevity: governing time and treatment in an aging society

The clinical activities that constitute longevity making in the United States are perhaps the quintessential example of a dynamic modern temporality, characterized by the quest for risk reduction, the powerful progress narratives of science and medicine, and the personal responsibility of calculating the worth of more time in relation to medical options and age. This article explores how medicine materializes and problematizes time through a discussion of ethicality-in this case, the form of governance in which scientific evidence, Medicare policy and clinical knowledge and practice organize first, what becomes "thinkable" as the best medicine, and second, how that kind of understanding shapes a telos of living. Using liver disease and liver transplantation in the United States as my example, I explore the influence of Medicare coverage decisions on treatments, clinical standards, and ethical necessity. Reflexive longevity-a relentless future-thinking about life itself-is one feature of this ethicality.

Structural and Technological Characterization of Tropical Smallholder Farms of Dual-Purpose Cattle in Mexico

Simply Summary

Dual-purpose cattle smallholder farms (DP) in the tropics suffer from sustainability and viability problems. Grouping small producers according to their structure and characterizing them technologically makes it possible to identify the problems aimed to guide development policies. A sample of 1475 farms located in the tropical area of Mexico was selected. Five groups of smallholders were identified applying multiple correspondence analysis (MCA). Results show that to achieve a sustainable improvement of the DP, a deep understanding of the system, the rational use of the endogenous resources, and implementation of low-cost technologies is necessary. Very small farms (Group 3) showed orientation to subsistence. They need to improve all the technological areas. Groups 1 and 2, covered a 46.5% of the farms; these ones presented a small-scale productive model and the improvements were mainly associated to the area of reproduction and genetics. Groups 4 and 5 (29.4% of the sample) were the biggest and more specialized farms. The improvements were linked to technological areas of reproduction, feeding, management, and animal health.

Abstract

Dual-purpose cattle smallholder farms (DP) exhibit a critical economic situation. The objective of this research was building a typology for DP in tropical conditions and characterizing them technologically. This will help developing more effective public policies in DP farms located in tropical conditions. A sample of 1.475 farms located in the tropical area of Mexico was selected. The typology was built using multiple correspondence analysis (MCA). Subsequently, five groups were identified by a hierarchical cluster analysis with Ward’s method. Groups 1 and 2, covered a 46.5% of the farms; these ones presented a small-scale productive model with low levels of technological adoption, improvements were mainly associated to the area of reproduction and genetics. Very small farms (Group 3) showed orientation to subsistence. They need to improve all the technological areas. Groups 4 and 5 (29.4% of the sample) were the biggest and more specialized farms. Group four farms were located in dry tropics and showed the highest levels of technological adoption in the areas of reproduction, management, and feeding. These farms require improvement in the areas of reproduction, animal health, and feeding. Group 5 farms were located in the wet tropics and showed specialization in reproduction, genetics, and animal health areas. In this last group, it is necessary to improve management and feeding areas.

Hackathons as Stepping Stones in Health Care Innovation: Case Study With Systematic Recommendations

Background

Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users’ unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation.

Objective

This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care.

Methods

A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included.

Results

In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step.

Conclusions

This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons.

Does Technological Innovation Promote Green Development? A Case Study of the Yangtze River Economic Belt in China

The role of technological innovation (TI) in green development is controversial. Based on 2003-2017 panel data of 108 cities in the Yangtze River Economic Belt (YREB), this study constructed an index system to evaluate urban green development and analyzed the role of TI on urban green development with the help of a panel econometric model. The results show that: (1) From 2003 to 2017, the levels of TI and green development of cities in the YREB have gradually improved, but the core-periphery structure is obvious, and the levels of TI and green development in the lower reaches are significantly higher than those in the middle and upper reaches. (2) TI has a significant positive role in promoting green development, showing a U-shaped nonlinear relationship, and this relationship varies from region to region. (3) TI has a significant impact on green development with direct and indirect effects. In the economic and social dimensions, TI has a positive impact on green development, while in the ecological dimension, the direct effect and indirect effect have opposite relationships. (4) TI has a significant threshold effect on green development, and there are differences in threshold characteristics between the three dimensions. These findings provide a scientific basis for policymaking about innovation-driven regional green development, and it can enrich the related theories of environmental economic geography.

Technological Innovations in Disease Management: Text Mining US Patent Data From 1995 to 2017

BACKGROUND

Patents are important intellectual property protecting technological innovations that inspire efficient research and development in biomedicine. The number of awarded patents serves as an important indicator of economic growth and technological innovation. Researchers have mined patents to characterize the focuses and trends of technological innovations in many fields.

OBJECTIVE

To expand patent mining to biomedicine and facilitate future resource allocation in biomedical research for the United States, we analyzed US patent documents to determine the focuses and trends of protected technological innovations across the entire disease landscape.

METHODS

We analyzed more than 5 million US patent documents between 1995 and 2017, using summary statistics and dynamic topic modeling. More specifically, we investigated the disease coverage and latent topics in patent documents over time. We also incorporated the patent data into the calculation of our recently developed Research Opportunity Index (ROI) and Public Health Index (PHI), to recalibrate the resource allocation in biomedical research.

RESULTS

Our analysis showed that protected technological innovations have been primarily focused on socioeconomically critical diseases such as "other cancers" (malignant neoplasm of head, face, neck, abdomen, pelvis, or limb; disseminated malignant neoplasm; Merkel cell carcinoma; and malignant neoplasm, malignant carcinoid tumors, neuroendocrine tumor, and carcinoma in situ of an unspecified site), diabetes mellitus, and obesity. The United States has significantly improved resource allocation to biomedical research and development over the past 17 years, as illustrated by the decreasing PHI. Diseases with positive ROI, such as ankle and foot fracture, indicate potential research opportunities for the future. Development of novel chemical or biological drugs and electrical devices for diagnosis and disease management is the dominating topic in patented inventions.

CONCLUSIONS

This multifaceted analysis of patent documents provides a deep understanding of the focuses and trends of technological innovations in disease management in patents. Our findings offer insights into future research and innovation opportunities and provide actionable information to facilitate policy makers, payers, and investors to make better evidence-based decisions regarding resource allocation in biomedicine.

Stimulating Patient Engagement in Medical Device Development in Kidney Disease: A Report of a Kidney Health Initiative Workshop

New technologies challenge current dialysis treatment paradigms as devices become smaller, more portable, and increasingly used outside the dialysis clinic. It is unclear how patients will view this care transition, and it will be important to consider patient and care partner perspectives during all aspects of development for novel dialysis therapies, from design and clinical trials to regulatory approval. To gain insight into this area, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and nearly 80 member organizations and companies dedicated to enhancing patient safety and fostering innovation in kidney disease, convened a workshop of patients, care partners, and other kidney community stakeholders. The workshop included background presentations followed by focused small group discussions in 3 areas (device design, clinical trials, and regulatory approval). Participants explored how to involve patients throughout the life cycle of a medical device, including discussions of how patients can influence device design, assist in the planning and implementation of clinical trials, and provide input to affect regulatory decisions. Patients were engaged in the workshop discussion and interested in sharing their perspectives, but they recommended additional efforts around education, communication, and outreach in these areas.

The Path to Innovation: The Antecedent Perspective of Intellectual Capital and Organizational Character

Purpose: The high-speed growth of China's large-scale new economy indicates that innovation has become the most important economic growth pole. The study aims to explore the structure of the path to innovation, in which we focus on the mediating effect of organizational character. Design/methodology/approach: Considering the indigenous context of China's new economy, the study divides innovation into two types: technological innovation and business model innovation. Then, we build a path model to achieve the innovation by taking intellectual capital and organizational character as antecedents. Finally, a structural equation model is built to measure the path on the basis of sample data collected via a questionnaire survey. Findings: The results indicate that intellectual capital has a significant positive direct effect on technological innovation, but its direct effect on business model innovation is not significant. Organizational character not only mediates the relationship between the intellectual capital and technological innovation, but also plays a mediating role in the effect path from the intellectual capital to business model innovation. In addition, technological innovation has a positive impact on the business model innovation, and mediates the relationship between the intellectual capital and business model innovation. Originality/value: The study takes intellectual capital and organizational character as the common antecedents of innovation and breaks down the content of innovation research into technological innovation and business model innovation. Thus, it establishes a new theoretical analysis framework for dual innovation research and enriches the related theories. The framework would have stronger explanatory power for revealing the innovation strategy and behavior carried out by a large number of corporate organizations in China and the boom of new economy. Furthermore, it would lead enterprises to organize innovation activities more effectively and improve their innovation performances.

The Dynamic Impact of Natural Resource Rents, Financial Development, and Technological Innovations on Environmental Quality: Empirical Evidence from BRI Economies

Until recently, many countries’ policies were motivated by economic growth; however, few strategies were developed to prevent environmental deterioration including reducing the ecological footprint. In this context, the purpose of this study was to analyze the role of natural resource rents, technological innovation, and financial development on the ecological footprint in 90 Belt and Road Initiative (BRI) economies. This research divided the BRI economies into high income, middle-income, and low-income levels to capture income differences. This research used the second-generation panel unit root, cointegration, and augmented mean group estimators to calculate the robust and reliable outcomes. Based on the annual data from 1991 to 2018, the findings show that natural resource rents drastically damage the quality of the environment, whereas technological innovations are helpful in reducing ecological footprint. Moreover, the outcome of the interaction term (natural resource rents and technological innovations) negatively impacts the ecological footprint. Interestingly, these findings were similar in the three income groups. In addition, financial development improved environmental quality in the middle-income BRI economies, but reduced it in high-income, low-income, and full sample countries. Furthermore, the Environmental Kuznets Curve (EKC) concept has been validated across all BRI economies. Policymakers in BRI countries should move resources away from resource-rich sectors of industries/manufacturing sectors to enhance/promote economic growth and use these NRRs efficiently for a progressive, sustainable environment. Based on these findings, several efficient policy suggestions are proposed.

Modeling the Dynamic Linkage between Tourism Development, Technological Innovation, Urbanization and Environmental Quality: Provincial Data Analysis of China

This study investigates the linkage between tourism development, technological innovation, urbanization and environmental degradation across 30 provinces of China. Based on data from 2001 to 2018, the study used an advanced economic methodology for the long-run estimate, the Augmented Mean Group (AMG) estimator, which accounts for heterogeneity in slope parameters and dependencies across countries. The empirical results show that tourism development degrades environmental quality, while technological innovation mitigates carbon emissions. Further, findings show that urbanization increases carbon emissions, while an inverted U-shaped relationship exists between economic growth and environmental degradation, implying the existence of EKC in China. Further, the Dumitrescu-Hurlin panel causality test shows that any policy aimed at tourism development or technological innovation would substantially contribute to environmental degradation, but not the other way round.

The reimbursement of new medical technologies in German inpatient care: What factors explain which hospitals receive innovation payments?

Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.

Asymmetric impact of renewable energy consumption and technological innovation on environmental degradation: designing an SDG framework for developed economy

Many European nations, including Spain, are having difficulties achieving their Sustainable Development Goals (SDGs) objectives. Resultantly, the current research discusses the development of an SDG framework for Spain, which can be utilized as a model for other EU nations. This research examines whether GDP growth, technological innovation, and energy sources (renewable and non-renewable) have any effect on CO₂ emissions utilizing data from 1980 to 2018. The study applied the non-linear ARDL (NARDL) to investigate these interrelations. The outcomes from the NARDL revealed that positive (negative) shocks in renewable energy improve environmental quality in Spain. Furthermore, positive (negative) shocks in technological innovation lead to a decrease (increase) in CO₂. Lastly, positive (negative) shocks in energy consumption lead to an increase (decrease) in CO_2. The results reveal that Spain is on the right path towards decarburization. This research has important policy ramifications for the policymakers and government of Spain as well as neighbouring countries.

Perspectives of Australian policy-makers on the potential benefits and risks of technologically enhanced communicable disease surveillance - a modified Delphi survey

Background

Event-based social media monitoring and pathogen whole genome sequencing (WGS) will enhance communicable disease surveillance research and systems. If linked electronically and scanned systematically, the information provided by these technologies could be mined to uncover new epidemiological patterns and associations much faster than traditional public health approaches. The benefits of earlier outbreak detection are significant, but implementation could be opposed in the absence of a social licence or if ethical and legal concerns are not addressed.

Methods

A three-phase mixed-method Delphi survey with Australian policy-makers, health practitioners and lawyers (n = 44) was conducted to explore areas of consensus and disagreement over (1) key policy and practical issues raised by the introduction of novel communicable disease surveillance programmes; and (2) the most significant and likely risks from using social media content and WGS technologies in epidemiological research and outbreak investigations.

Results

Panellists agreed that the integration of social media monitoring and WGS technologies into communicable disease surveillance systems raised significant issues, including impacts on personal privacy, medicolegal risks and the potential for unintended consequences. Notably, their concerns focused on how these technologies should be used, rather than how the data was collected. Panellists held that social media users should expect their posts to be monitored in the interests of public health, but using those platforms to contact identified individuals was controversial. The conditions of appropriate use of pathogen WGS in epidemiological research and investigations was also contentious. Key differences amongst participants included the necessity for consent before testing and data-linkage, thresholds for action, and the legal and ethical importance of harms to individuals and commercial entities. The erosion of public trust was seen as the most significant risk from the systematic use of these technologies.

Conclusions

Enhancing communicable disease surveillance with social-media monitoring and pathogen WGS may cause controversy. The challenge is to determine and then codify how these technologies should be used such that the balance between individual risk and community benefit is widely accepted. Participants agreed that clear guidelines for appropriate use that address legal and ethical concerns need to be developed in consultation with relevant experts and the broader Australian public.

Electronic supplementary material

The online version of this article (10.1186/s12961-019-0440-3) contains supplementary material, which is available to authorized users.

Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study

Background

Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU.

Objective

This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU.

Methods

This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework.

Results

This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU.

Conclusions

Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care.

Trial Registration

ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

Study of the Impact of Industrial Restructuring on the Spatial and Temporal Evolution of Carbon Emission Intensity in Chinese Provinces-Analysis of Mediating Effects Based on Technological Innovation

Global warming caused by greenhouse gas emissions seriously threatens a region's sustainable environmental and socioeconomic development. Promoting industrial restructuring and strengthening technological innovation have become an important path to achieving pollution and carbon reduction as well as the green transformation of economic structure. This paper explored the mechanism of the mediating effect of technological innovation on industrial restructuring and carbon reduction while accounting for the direct effect of industrial restructuring on carbon emissions. Then, based on China's provincial panel data from 2001 to 2019, we estimated the carbon emission intensity using the Intergovernmental Panel on Climate Change (IPCC)'s methods and analyzed its spatiotemporal evolution characteristics. Finally, we constructed a fixed-effect model and a mediating effect model to empirically analyze how industrial restructuring and technological innovation affect carbon emission intensity. The results are as follows: (1) From 2001 to 2019, China's carbon emission intensity showed a continuous downward trend, with a pronounced convergence trend; there were obvious differences in carbon emission intensity between eastern, central, and western regions (western region > central region > eastern region) due to the unbalanced industrial structure. (2) In terms of direct effects, industrial restructuring can significantly reduce carbon emission intensity. The intensity of the effect is inversely proportional to the level of industrial restructuring, and the results of sub-regional tests are similar. Nevertheless, there is an obvious regional difference in the size of the carbon emission reduction effect of industrial restructuring in the east, central, and western regions. (3) In terms of indirect effects, industrial restructuring can reduce carbon emission intensity by enhancing technological innovation, and it acts as a mediating variable in the process of industrial restructuring to reduce carbon emission. Finally, we put forward recommendations for promoting industrial restructuring, strengthening green technological innovation, and properly formulating carbon reduction measures to provide a reference for countries and regions to achieve the goals of carbon neutrality, carbon peaking, and high-quality economic development.

Technological innovation and its effect on public health in the United States

Background

Good public health ensures an efficient work force. Organizations can ensure a prominent position on the global stage by staying on the leading edge of technological development. Public health and technological innovation are vital elements of prosperous economies. It is important to understand how these elements affect each other. This research study explored and described the relationship between these two critical elements/constructs.

Methods

Indicators representing technological innovation and public health were identified. Indicator data from 2000 to 2009 were collected from various US federal government sources, for the four US Census regions. The four US Census regions were then compared in terms of these indicators. Canonical correlation equations were formulated to identify combinations of the indicators that are strongly related to each other. Additionally, the cause–effect relationship between public health and technological innovation was described using the structural equation modeling technique.

Results

The four US Census regions ranked differently in terms of both type of indicators in a statistically significant manner. The canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, with a magnitude > 0.65 at the 95% confidence interval, for all census regions. Structural equation modeling analysis provided β < −0.69 and Student’s t statistic > 12.98, for all census regions. The threshold Student’s t statistic was 1.98. Hence, it was found that the β values were significant at the 95% confidence interval, for all census regions.

Discussion

The results of the study showed that better technological innovation indicator scores were associated with better public health indicator scores. Furthermore, the study provided preliminary evidence that technological innovation shares causal relation with public health.