Search Results (59)

Background and Objectives: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD), yet its clinical significance and association with comorbid conditions remain poorly understood. This study aimed to examine the prevalence of TW in a large Italian cohort of children with ASD and to explore its association with ASD severity, sleep disturbances, feeding behaviors, and gastrointestinal symptoms. Materials and Methods: A total of 289 children with ASD and 289 typically developing controls (TDC), matched for age and sex, were evaluated in a multicentric observational study. TW was assessed during neurodevelopmental evaluations. Sleep quality was assessed using the Sleep Disturbance Scale for Children (SDSC), feeding behaviors via the Brief Autism Mealtime Behavior Inventory (BAMBI), and gastrointestinal symptoms through clinical reporting. Statistical analyses included Chi-square tests, Mann–Whitney U tests, Spearman correlations, and logistic regressions. Results: TW was significantly more prevalent in the ASD group (27.3%) than in TDC (5.5%, p < 0.0001). Within the ASD group, TW occurred in 50.5% of children with Level 3 severity but was absent in Levels 1 and 2 (p < 0.0001). Males exhibited TW more frequently than females. Children with TW had higher SDSC scores (ρ = 0.33, p < 0.0001), though no subscale independently predicted TW. Constipation was reported in 100% of children with Level 3 ASD and was strongly correlated with SDSC total scores (ρ = 0.58, p < 0.0001). The Disorders of Arousal (DA) subscale emerged as an independent predictor of constipation (β = 0.184, p = 0.019). Conclusions: TW in ASD appears to be a marker of greater neurodevelopmental severity and is associated with sleep disturbances and gastrointestinal dysfunction. These findings support the hypothesis that TW may reflect broader dysfunctions involving the gut–brain axis, sensory processing, and motor control. The routine clinical assessment of TW should include the evaluation of sleep and somatic symptoms to better understand the multisystemic nature of ASD phenotypes. Full article

Advanced technologies, such as robotic process automation, blockchain, and machine learning, increase audit efficiency. Nonetheless, some Supreme Audit Institutions (SAIs) have not undergone digital transformation. This research aimed to develop a comprehensive framework for supreme audit institutions to adopt and integrate emerging technologies into their auditing processes using a hybrid theoretical approach based on the TAM (Technology Acceptance Model) and TOE (Technology–Organisation–Environment) models. The framework was informed by insights from nineteen highly experienced experts in the field from eight countries. Through a two-round Delphi questionnaire, the experts provided valuable input on the key factors, challenges, and strategies for successful technology adoption by public sector audit organisations. The findings of this research reveal that technology adoption in SAIs starts with solid management support led by the chief technology officer. They must evaluate the IT infrastructure and readiness for advanced technologies, considering the budget and funding. Integrating solutions like the SAI of Ghana’s Audit Management Information System can significantly enhance audit efficiency. Continuous staff training is essential to build a positive attitude toward new technologies, covering areas like data algorithm auditing and big data analysis. Assessing the complexity and compatibility of new technologies ensures ease of use and cost-effectiveness. Continuous support from technology providers and monitoring advancements will keep SAIs aligned with technological developments, enhancing their auditing capabilities. Full article

Background and Objectives: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA₂DS₂-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with Google Forms 2024 (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test p = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (p = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (p = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (p = 0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA₂DS₂-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population. Full article

Growing concern over food safety and adulteration has thrust milk traceability technologies to the forefront of agrifood supply chains. This qualitative study explores the technological, organisational, and environmental (TOE) determinants of traceability technology adoption in Saudi Arabia’s dairy sector. In-depth semi-structured interviews with nine senior managers from small-, medium-, and large-scale dairy farms were analysed thematically in NVivo. Thematic analysis revealed that technological cost and compatibility played crucial role, while contrary to the prior literature, respondents downplayed technological complexity, arguing that training could offset it. Organisational culture and employee resistance were the primary inhibitors within dairy firms. Saudi Vision 2030, post COVID-19 consumer pressure and competitor pressure emerged as the dominant environmental factors. The findings offer insights for managers and policymakers on how to improve supply chain transparency, operational efficiency, product quality, and consumer trust while advancing several UN SDGs. Full article

Despite the transformative potential of artificial intelligence (AI), small and medium-sized enterprises (SMEs) continue to face significant challenges in its effective adoption. While prior studies have emphasized strategic benefits and readiness models, there remains a lack of operational guidance tailored to SME realities—particularly regarding implementation barriers, resource constraints, and emerging demands for responsible AI use. This study presents an analysis of AI adoption in SMEs by integrating the technology–organization–environment (TOE) framework with selected attributes from the diffusion of innovations (DOI) theory to examine adoption dynamics through a dual structural and perceptual lens. Empirical insights from sectoral and regional contexts are also incorporated. Ten critical challenges are identified and analyzed across the TOE dimensions, ranging from data access and skill shortages to cultural resistance, infrastructure limitations, and weak governance practices. Notably, the framework is expanded to incorporate responsible AI governance and democratized access to generative AI—particularly open-weight large language models (LLMs) such as LLaMA, DeepSeek-R1, Mistral, and FALCON—as emerging technological and ethical imperatives. Each challenge is paired with actionable, context-sensitive solutions. The paper is a structured, literature-based conceptual analysis enriched by empirical case study insights. As a key contribution, it introduces a structured, six-phase roadmap methodology to guide SMEs through AI adoption—offering step-by-step recommendations aligned with technological, organizational, and strategic readiness. While this roadmap is conceptual and has yet to be validated through field data, it sets a foundation for future diagnostic tools and practical assessments. The resulting study bridges theoretical insight and implementation strategy—empowering inclusive, responsible, and scalable AI transformation in SMEs. By offering both analytical clarity and practical relevance, this study contributes to a more grounded understanding of AI integration and calls for policies, ecosystems, and leadership models that support SMEs in adopting AI not merely as a tool, but as a strategic enabler of sustainable and inclusive innovation. Full article

This study explores the factors influencing the adoption of Metaverse technology in the Indonesian tourism sector through the lens of the Technological–Organizational–Environmental (TOE) framework. Data collected from 303 respondents representing academia, government, and industry were analyzed using Structural Equation Modeling (SEM) with SmartPLS 4. The findings reveal that relative advantage, compatibility, top management support, government policy and regulation, and competitive pressure significantly influence the intention to adopt Metaverse technology, while complexity does not. Notably, competitive pressure emerged as the most critical factor, especially among university and government respondents. The study provides theoretical insights into technology adoption and practical recommendations for fostering Metaverse integration in tourism. Despite its contributions, limitations such as sample composition and excluded TOE variables suggest avenues for future research. This work underscores the importance of strategic collaboration among academia, government, and industry to enhance Metaverse adoption in the tourism industry, paving the way for innovation and competitive advantage. Full article

This study investigates how Industry 4.0 technologies can optimize transportation efficiency and contribute to global sustainability goals by reducing CO₂ emissions. In response to the pressing climate emergency, the research examines the role of the Internet of Things (IoT), Artificial Intelligence (AI), and predictive analytics in enhancing operational performance and aligning transportation systems with Sustainable Development Goals (SDGs), particularly Goal 13 (climate action) and Goal 9 (industry, innovation, and infrastructure). Using a qualitative research approach, semi-structured interviews and focus groups were conducted with industry experts, and the data were analyzed using thematic analysis and qualitative network mapping in NVivo software. The findings reveal that IoT enhances real-time monitoring, AI enables dynamic route optimization, and predictive analytics supports proactive maintenance, collectively achieving an average emission reductions of 30%. However, adoption is hindered by infrastructure gaps, high implementation costs, skill shortages, and fragmented regulatory frameworks. This study integrates the Technology–Organization–Environment (TOE) framework and Sustainable Corporate Theory to provide a structured analysis of digital transformation in transportation. The findings offer strategic insights for policymakers and industry stakeholders, highlighting the need for stronger regulatory support, targeted incentives, and digital infrastructure investments. Full article

This study aims to explore the impact of key drivers on the integration of blockchain technology implementation and green innovation practices within green supply chains. This study combines the TOE and TAM frameworks to identify six key driving factors that in the proposed model. A survey was conducted with Vietnamese enterprises, resulting in 328 valid responses from senior managers across various sectors. The PLS-SEM approach was conducted to analyze the relationships between the variables and to gain deeper insights into their interactions. The research findings highlight the significant potential of adopting blockchain and green innovation programs to enhance organizational performance. Six essential factors act as key drivers for implementing these initiatives, exerting a positive influence. Among them, Perceived Usefulness, Organizational Readiness, and Partnerships emerge as the three most influential variables within this research framework. Our research offers several valuable implications, both theoretical and practical. The structural framework model provides empirical evidence demonstrating the feasibility of achieving expected benefits for green supply chains, particularly in emerging economies such as Vietnam. Thus, these results serve as valuable references for senior managers and policy makers. Full article

The optimization of independent automotive suspension systems, which is one of the main pillars of the vehicle performance and comfort, is currently going through a revolutionary change due to the development of artificial intelligence and quantum computing. This paper aims to review the multi-objective optimization of suspension parameters including camber, caster, and toe to discuss the complex design issues that arise from geometric and dynamic considerations. Some of the most common computational methodologies, which are Genetic Algorithms, Particle Swarm Optimization, and Gradient Descent, are discussed in this paper along with the new quantum computing techniques such as Gate-Based quantum computing and Quantum Annealing (QA). In addition, this review incorporates information from the practice of automotive manufacturers who have incorporated the use of artificial intelligence and quantum computing in their suspension systems. However, there are still some issues remaining, such as the computational cost, real-time flexibility, and the applicability of theoretical concepts to actual engineering structures. Some potential future research directions are introduced in this paper, such as hybrid optimization approaches, quantum techniques, and adaptive materials, which are considered as potential directions for future development. This systematic review presents a conceptual framework for researchers and engineers to follow, stressing the importance of interdisciplinarity in the development of intelligent suspension systems with performance objectives that are capable of adjusting to various road conditions. The findings of this work underscore the growing importance of complex computational techniques in modern automotive industry and highlight their potential to shape future developments based on emerging trends and industry practices. Full article

Open innovation serves as a critical pathway for aligning Sustainable Business Models (SBMs) with the dual imperatives of sustainability and the digital economy. This editorial review synthesizes insights from theoretical frameworks, particularly the Resource-Based View (RBV) and Transaction Cost Theory (TCT), integrated with the Technology-Organization-Environment (TOE) framework to explore the mechanisms driving open innovation. Our editorial review highlights the key dimensions influencing open innovation: technology (digital platforms, emerging technologies like AI, IoT, and blockchain), organization (stakeholder collaboration, governance mechanisms), and environment (regulatory frameworks, market dynamics, and industrial spillovers). This unified framework offers actionable insights for policymakers to foster enabling ecosystems and for business leaders to adopt open innovation strategies for resource optimization and governance improvement. The review concludes that the RBV-TCT-TOE framework provides a generalizable and robust tool for understanding and advancing open innovation across industries and regions, bridging theoretical and practical dimensions to address the challenges of sustainability and digital transformation. Full article

Digitalisation has significantly increased cybersecurity risks in organisations, notably for small to medium-sized enterprises (SMEs), in which IT departments often have relatively small teams and limited resources. Cyber insurance enables SMEs to navigate cybersecurity risks more economically, providing an essential risk transfer alternative to costly reduction strategies. This article examines the antecedents, emergence, and application of cyber insurance as a solution to cybersecurity concerns against the backdrop of increasing digitalisation. The research adopts a quantitative deductive approach, with an analysis of relevant literature providing the basis for the development of 12 hypotheses, which are then tested via a survey of 168 SMEs in Turkey. Using the Technology–Organisation–Environment–Individual (TOE-I) model as a top-line conceptual framework, the article finds that cyber insurance policy adoption has facilitated a more rapid and secure digitalisation process and that the mitigation of financial risk associated with cyberattacks has allowed companies to invest more widely in information technologies and systems. The article clearly has its limitations, in that it is based on primary research in one European country, but the authors believe that it nevertheless provides some new insights into the potential benefits of cyber insurance, and the key issues SMEs must consider when considering adopting a cyber insurance policy. The findings will be of practical relevance to SMEs and other organisations reviewing their cybersecurity strategy and are also of relevance to the wider debate around the costs and benefits of digitalisation. Full article

This manuscript presents the development and testing of a novel model designed to help organizations, particularly small and medium-sized enterprises (SMEs), address the challenges of integrating new technologies within the frameworks of Industry 4.0 and 5.0. The proposed model is a metamodel that evaluates organizational and contextual vulnerabilities concerning both existing technologies and potential external technologies under consideration for adoption. It synthesizes three foundational frameworks: the Viable System Model (VSM), the principles of viable and sustainable systems, and the Technology, Organization, and Environment (TOE) Model. The findings demonstrate the practical applicability of this model in an SME context, showcasing its ability to facilitate the gradual and sustainable adoption of new technologies. By aligning business needs with technological solutions and leveraging insights from computer science and organizational cybernetics, the model adapts to varying levels of technological adoption, integrating organizational dynamics and business evolution to support the implementation of emerging technologies. Full article

The formation and development of new quality productivity of agriculture can effectively promote agricultural sustainability and modernization. In order to explore the multiple paths of the formation of new quality productivity of agriculture, using the panel data of 30 provincial levels in China from 2012 to 2021, based on the “technology-organization-environment” framework and dynamic QCA method, this paper explores how seven factors such as agricultural technology innovation, digital infrastructure, innovation policy support, the formation of e-commerce industry, marketization level, green finance, and rural culture modernization interact to promote the formation of new quality productivity of agriculture. The findings reveal that none of the above seven factors can promote the formation of new quality productivity of agriculture, and agricultural technological innovation and digital infrastructure are becoming more and more important to the formation of new quality productivity of agriculture over time. The high new quality productivity of agriculture formation models can be categorized into four types: TOE empowers new business model development-driven, government–market–culture triple-driven, market-oriented efficient transformation of technological achievements-driven, and deep integration of agricultural technological innovation and emerging agricultural business models-driven. The configurational results exhibit significant regional effects, with diverse pathways for the formation of new quality productivity of agriculture across different provinces. Full article

Various industries see digital transformation (DT) as the pillar to coping with intensified competition, energy crises, and climate change. As a critical sector for DT, the construction industry’s project-oriented paradigm and immature industrialized production method limit the research on emerging digital technology and ignore the theoretical mechanism. Through the lens of system adaptability, this study proposes a multifaceted model to examine the DT effectiveness and unveil the driving mechanism. (1) An extensive literature review, action research, and the nominal group technique identified 21 determinants, which were categorized into a technological–organizational–environmental (TOE) framework to analyze the construction industry’s DT determinants from multiple dimensions. (2) This research utilizes data from 272 respondents collected through field research, with a survey designed to measure the relationships among variables. (3) Structural equation modeling (SEM) through Analysis of Moment Structures (AMOSs) has been used to analyze the hypotheses and analyze the impact of determinants from various dimensions on DT and examine their influence pathways. The results indicate that determinants in the technological, organizational, and environmental dimensions positively affect DT’s success in the construction industry. The influence of the technological dimension is the strongest, and the organizational dimension is the weakest. The research findings offer valuable recommendations and insights for stakeholders in the construction industry, highlighting the importance of considering these three dimensions to enhance the overall effectiveness of DT when driving industry transformation and upgrading. Additionally, this study uses the TOE framework to reveal determinants from multiple dimensions. It combines SEM to explore the pathways of their effects, offering key theoretical insights for the body of knowledge. Full article

In the face of escalating environmental challenges, the imperative to reduce pollution and carbon emissions has never been more critical. Synergistic effects aimed at mitigating these pressing issues constitute the central concern of contemporary environmental governance and sustainable development in the global context. This paper adopts the Technology–Organization–Environment (TOE) framework and a configurational perspective to identify three driving pathways for achieving synergistic reduction in pollution and carbon emission (SRPCE), using a fuzzy-set qualitative comparative analysis (fsQCA) approach: the Dual-Wheel Type, the Well-Regulated Type, and the Effective Pull Type. The Dual-Wheel Type illustrates how combining these two strategies can lead to enhanced SRPCE. The Well-Regulated Type is driven by push factors while the Effective Pull Type is driven by pull factors. This study clarifies the interplay between front-end prevention and end-of-pipe treatment in environmental protection investments. It also broadens the understanding of environmental regulation’s impact on corporate environmental governance by highlighting the nuanced ways regulations shape organizational behavior. Finally, it advances research on synergistic effects by focusing on micro-enterprises. This research thus presents a comprehensive perspective on synergistic environmental effects and yields actionable insights, suggesting that the government can adopt synergistic policies while enterprises, through self-regulation and proactive management, can implement sustainable practices to achieve effective pollution reduction and carbon mitigation. Full article