Research on the "multi-agent co-governance" system of unfair competition on internet platforms: Based on the perspective of evolutionary game.

Unfair competition on internet platforms (UCIP) has become a critical issue restricting the platform economy's healthy development. This paper applies evolutionary game theory to study how to utilize multiple subjects' synergy to supervise UCIP effectively. First, the "multi-agent co-governance" mode of UCIP is constructed based on the traditional "unitary supervision" mode. Second, the government and internet platform evolutionary game models are built under two supervision modes. Finally, MATLAB is used to simulate and analyze the evolutionary stage and parameter sensitivity. In addition, we match the model's evolutionary stage with China's supervisory process. The results show that (1) the Chinese government's supervision of UCIP is in the transitional stage from "campaign-style" to "normalization." (2) Moderate government supervision intensity is essential to guide the game system to evolve toward the ideal state. If the supervision intensity is too high, it will inhibit the enthusiasm for supervision. If the supervision intensity is too low, it cannot form an effective deterrent to the internet platforms. (3) When the participation of industry associations and platform users is low, it can only slow down the evolutionary speed of the game system's convergence to the unfavorable state. Nevertheless, it cannot reverse the evolutionary result. (4) Maintaining the participation level of industry associations and platform users above a specific threshold value while increasing punishment intensity will promote the transition of government supervision from the "campaign-style" to the "normalization" stage. This paper provides ideas and references for the Chinese government to design a supervision mechanism for UCIP.

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans.

BACKGROUND: 1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. METHODS: Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. DISCUSSION: The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.

Cash outs during in-play sports betting: Who, why, and what it reveals.

Cashing out is a popular feature of modern 'in-play' sports betting that allows sports bettors to withdraw a bet before the sporting event on which the bet was placed is finalized. Previous studies have shown that use of the cash out feature is positively related to problem gambling symptomatology. However, little is known about demographic and psychological characteristics of in-play sports bettors who use the cash out feature, or their motivations for use. To fill this knowledge gap, we recruited 224 adults (18 + years) from Ontario who engaged in in-play sports betting in the past three months. Participants completed self-report measures of psychological and gambling-related variables. Participants also provided qualitative responses for their motivations for using the cash out feature. Approximately half (51.8 %) of the participants reported using the cash out feature. No statistically significant demographic differences were found between participants who used and did not use the cash out feature. Participants who used the feature (compared to those who did not) reported higher problematic alcohol and cannabis use, feelings of depression, anxiety, and stress, and were motivated to gamble to make money. The primary reasons for cashing out were to access money immediately, to cut losses, and because cashing out felt like a less risky option. The current findings shed light on underlying psychological vulnerabilities associated with individuals who use the cash out feature, which can inform initiatives to reduce the harms associated with this popular feature of sports betting.

[Resolution based on the results of the interdisciplinary expert council "Cognitive health of a comorbid patient"].

On September 29, 2023, a meeting of the interdisciplinary expert council "Cognitive health of a comorbid patient" was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

Female researchers are under-represented in the Colombian science infrastructure.

Worldwide women have increased their participation in STEM, but we are still far from reaching gender parity. Although progress can be seen at the bachelor's and master's level, career advancement of women in research still faces substantial challenges leading to a 'leaky pipeline' phenomenon (i.e., the continuous decrease of women's participation at advanced career stages). Latin America exhibits encouraging rates of women participation in research, but the panorama varies across countries and stages in the academic ladder. This study focuses on women's participation in research in natural sciences in Colombia and investigates career progression, leadership roles, and funding rates by analyzing data on scholarships, grants, rankings, and academic positions. Overall, we found persistent gender imbalances throughout the research ecosystem that were significant using classical statistical analyses. First, although women constitute >50% graduates from bachelors in natural sciences, <40% of researchers in this field are female. Second, women win <30% of research grants, and in turn, their scientific productivity is 2X lower than that of men. Third, because of the less research funding and output women have, their promotion to senior positions in academic and research rankings is slower. In consequence, only ~25% of senior researchers and full professors are women. Fourth, the proportion of women leading research groups and mentoring young scientist in Colombia is <30%. Our study deepens our understanding of gender gaps in STEM research in Colombia, and provides information to design initiatives that effectively target gender disparities by focusing on key areas of intervention, and then gradually building up, rather than tackling structural inequities all at once.

Incentive mechanism of multiple green innovation behaviors of equipment manufacturing enterprises: A managers, green coordination groups and employees perspective.

Employees play a pivotal role in the implementing of green development strategies and the attainment of dual-carbon objectives within manufacturing enterprises. Effective motivation of employees, fostering consensus on environmental protection, increased engagement in environmental initiatives, and the cultivation of employee cohesion are all vital for fostering green development within these enterprises. This paper seeks to elucidate the roles of general managers, green coordination groups (GCG), and employees in actualizing green behaviors. Furthermore, it advocates for a double incentive model to be employed in the implementing of green strategies within manufacturing enterprises. The research reveals that multiple factors, including incentive intensity, green capability, effort cost, risk aversion, and green variance, significantly influence the formulation of incentive contracts for green behaviors. The motivation level of the general manager directly impacts the efforts of the GCG, the organization's green climate, the manager's individual efforts, and indirectly influences the motivation and efforts of employees towards green behaviors. Notably, the influence of the organization's green climate on employees surpasses than on the manager, underscoring the imperative for collaboration efforts between the general manager and GCG to instill green behaviors among employees. Hence, it is imperative for the general manager and GCG to collaborate not only on critical aspects of green strategy implementation but also in fostering green behaviors among employees. This collaboration will facilitate the development of a multi-layer incentive mechanism aimed at promoting and facilitating the adoption of green behaviors among employees, thus contributing to the advancement of theory regarding employees' green behaviors and offering practical guidance for effectively realizing dual-carbon targets and achieving high-quality development within enterprises.

Encirclement of productive capacities and institutions in context of sustainable development.

The question of whether productive capacities and institutional quality facilitate or impede progress towards sustainable development is a significant issue that has not been extensively explored in prior literature. Despite their importance, these variables are often overlooked in the literature on sustainable development, yet they play a crucial role in enabling efforts to achieve sustainable development. In this study, we examined how productive capacities affect sustainable development, with a moderating impact of institutional quality. The sample was comprised of 44 Belt and Road Initiative (BRI) economies, covering the period from 2000 to 2018. Using a two-step system GMM, we found that the relation between productive capacities and sustainable development is dynamic, positive, and significant. Additionally, institutional quality played a moderating role in achieving sustainable development, especially among regionally connected countries. Our findings suggest that sustainable development is strongly linked to a country's productive capacities. Therefore, improving productive capacities and institutional quality may lead to long-term development and sustainability. These results are valuable to academia as they provide new thought regarding the influence of productive capacities and institutional quality on sustainable development, and policymakers may benefit from the suggestions presented regarding productive capacities and institutional quality.

Environmental, social and governance performance and green transformation strategies for enterprises: Improving technical efficiency or expanding technological boundaries.

Under the ongoing implementation of the "dual carbon" goal, research has focused on the impact of Environmental, Social, and Governance (ESG) initiatives on green innovation. However, few studies have analyzed in depth the mechanisms of ESG impact on green total factor productivity (green TFP). Here, we explored the impact of ESG performance on green TFP, green technical efficiency, and green technological progress using A-share listed companies in China's Shanghai and Shenzhen stock markets from 2011 to 2021. The results show that good ESG performance can significantly improve the green TFP of enterprises, and that this effect is more prominent in industries with lower environmental risks and enterprises in the growth and maturity stages. We identified the importance of the psychological account path and propose that the promotional effect of ESG performance on green TFP mainly derives from improving green technical efficiency, rather than from expanding green technological boundaries. These findings have practical implications for guiding companies to implement ESG concepts, strengthening the synergistic role of government regulation and professional supervision, and promoting micro-level implementation of innovation-driven and sustainable development strategies, thereby promoting high-quality development.

Towards a conceptual framework for the prevention of gambling-related harms: Findings from a scoping review.

The global gambling sector has grown significantly over recent years due to liberal deregulation and digital transformation. Likewise, concerns around gambling-related harms-experienced by individuals, their families, their local communities or societies-have also developed, with growing calls that they should be addressed by a public health approach. A public health approach towards gambling-related harms requires a multifaceted strategy, comprising initiatives promoting health protection, harm minimization and health surveillance across different strata of society. However, there is little research exploring how a public health approach to gambling-related harms can learn from similar approaches to other potentially harmful but legal sectors such as the alcohol sector, the tobacco sector, and the high in fat, salt and sugar product sector. Therefore, this paper presents a conceptual framework that was developed following a scoping review of public health approaches towards the above sectors. Specifically, we synthesize strategies from each sector to develop an overarching set of public health goals and strategies which-when interlinked and incorporated with a socio-ecological model-can be deployed by a range of stakeholders, including academics and treatment providers, to minimise gambling-related harms. We demonstrate the significance of the conceptual framework by highlighting its use in mapping initiatives as well as unifying stakeholders towards the minimization of gambling-related harms, and the protection of communities and societies alike.

Investigating barriers & facilitators for the successful implementation of the BP@home initiative in London: Primary care perspectives.

BACKGROUND: The COVID-19 pandemic led to the implementation of a national policy of shielding to safeguard clinically vulnerable patients. To ensure consistent care for high-risk patients with hypertension, NHS England introduced the BP@home initiative to enable patients to self-monitor their blood pressure by providing them with blood pressure monitors. This study aimed to identify barriers and facilitators to the implementation of the initiative based on the experience and perspectives of programme managers and healthcare professionals (HCPs) involved in its implementation in London. METHODS AND FINDINGS: We conducted five semi-structured focus groups and one individual interview with a total of 20 healthcare professionals involved at different levels and stages in the BP@home initiative across four of the five London Integrated Care Systems (ICSs). All focus groups and interviews were audio-recorded, transcribed and analysed thematically following the Framework Method. Respondents reported being challenged by the lack of adequate IT, human and financial resources to support the substantial additional workload associated with the programme. These issues resulted in and reinforced the differential engagement capacities of PCNs, practices and patients, thus raising equity concerns among respondents. However respondents also identified several facilitators, including the integration of the eligibility criteria into the electronic health record (EHR), especially when combined with the adoption of practice-specific, pragmatic and opportunistic approaches to the onboarding of patients. Respondents also recommended the provision of blood pressure monitors (BPMs) on prescription, additional funding and training based on needs assessment, the incorporation of BP@home into daily practice and simplification of IT tools, and finally the adoption of a person-centred care approach. Contextualised using the second iteration of the Consolidated Framework for Implementation Research (CFIR), these findings support key evidence-based recommendations to help streamline the implementation of the BP@home initiative in London's primary care setting. CONCLUSIONS: Programs such as BP@Home are likely to become more common in primary care. To successfully support HCPs' aim to care for their hypertensive patients, their implementation must be accompanied by additional financial, human and training resources, as well as supported task-shifting for capacity building. Future studies should explore the perspectives of HCPs based in other parts of the UK as well as patients' experiences with remote monitoring of blood pressure.

Validation and refinement of the "Airman Comprehensive Assessment": Evaluating competency proficiencies of enlisted members.

Beyond proficiency on occupationally specific tasks, the U.S. Air Force expects members to develop proficiency on institutionally valued "soft skill" competencies (e.g., Teamwork, Communication, and Initiative) throughout their careers. As such, all E1-E6 members are annually evaluated using Behaviorally Anchored Rating Scales (BARS) designed to measure such competencies. Despite mandated use, these Airman Comprehensive Assessment (ACA) scales previously have not been empirically evaluated. To address this gap, we surveyed Air Force supervisors, using a criterion-related sampling methodology to validate the behavioral anchors for each scale. Supervisors identified two subordinates of the same rank/career field who they viewed as having (a) high potential for future success in an Air Force career or, alternately, (b) lower potential for future career success and rated each subordinate on the individual behaviors that comprise the 12 scales. ACA items were intermixed with scale items previously identified as distinguishing top performers in civilian organizations. Results demonstrate scale reliability and generally validate the ACA competency scales as stronger differentiators of supervisor-rated career potential than competency scales developed for civilian organizations. We provide recommendations for re-calibration of scale anchors based on the relative percentage of high vs. low potential members that demonstrate each behavior, and suggest changes to improve correspondence between measured competency proficiency and supervisor-rated career potential.

Place branding: Religion in shaping the three-dimensional essence of a city brand through stakeholder engagement.

This study explores the role of religion in engaging stakeholders in branding a place on social media and unmasks what implications this has for (re)constructing the three-dimensional meanings of a place brand. Using the content analysis method to examine the case of Saudi Arabia, it probes how the key stakeholder groups of the government and the residents structure and interact with the narratives of the cities-Jeddah and Riyadh-on Twitter, Facebook, and Instagram. The results show the Islamic religion serves as a powerful tool for motivating the residents to engage in the government-led city branding initiatives at the individual level. However, the strategy of dwelling on religion to mobilize resident engagement at the individual level towards the social level with the aim of growing resources in support of social development should be reassessed within a dynamic social system. Theoretically, the proposed framework of religion city branding expands the scope of stakeholder engagement in place branding research through the integration with the driver of religion, especially unveiling how religious factors shape the personality traits of a place brand. It contributes to the practical sense that religious elements might be deployed by the key stakeholder groups of the government and residents in city branding initiatives, which potentially contributes to their relationship and the engagement of residents in co-creating a place brand with the government. This Saudi-focused study, therefore, possesses significance for place branding practices in Middle Eastern countries and beyond.

Study protocol: Local labour market programs-institutional structures, organizational forms and lived experiences.

In this programme, we map and examine local labour market programmes (LLMPs) at the municipal level in Sweden. This includes their institutional structure and organisation, as well as the experiences of participants in the programmes, using a longitudinal approach with the aim to improve LLMPs. The long-term goal is to increasing the inclusion of LLMP participants in working life. To answer the programme's questions, data will be collected and analysed within the four work packages. In each work package, a mixed-method approach is applied with a combination of quantitative and qualitative methods. The programme is informed by three overarching general theoretical approached, tying together institutional ethnography, intersectional studies of structural inequalities on different levels, and the role of emotions in everyday work. At the organisational level (WP 1), we will investigate the circumstances under which LLMPs are performed and negotiated by those involved. Here, the internal organisation, activities and methods are the focus. This approach will result in knowledge about the characteristics of these organisations and the factors promoting the inclusion of underrepresented groups in working life. By examining the activities in LLMPs (WP 2), we will be able to determine how their institutional structure differs between regions in Sweden, how the different municipalities work with labour market policy, how they translate national policy into the local context, how they organise their work and which initiatives they choose to adopt. By examining the individual experiences of those who are directly affected by such incentives (WP 3), knowledge and understanding will be obtained of the connections between experiences and labour market policies. This will give important insights into the functioning of local programmes and of the opportunities to create entry into the labour market. Furthermore, in WP4 we will develop and test an effect evaluation of work methods used in LLMPs and their effect on clients' progress over time.

Research delivery secondments: A scoping review.

AIM: To explore and summarise published literature with regards to secondments to clinical research and to identify the gaps in research to inform further work. DESIGN: Systematic scoping review. METHOD: A scoping review was undertaken in accordance with the Patterns, Advances, Gaps, Evidence and Research framework. Databases searched included CINAHL, PubMed, Medline and Embase. Inclusion/exclusion criteria were applied by two independent reviewers. Two reviewers independently retrieved full-text studies for inclusion and applied the framework as a tool for synthesising Patterns, Advances, Gaps, Evidence and Research recommendations. RESULTS: Six papers and one abstract published between 2003 and 2018 were included. All secondees (n = 34) were released from NHS posts, with secondments (where specified) ranging in duration from 0.25 to 2 years and for 40%-100% of their working hours. All seven papers reported benefits for personal and professional development, predominantly in the form of personal reflections. Few described involvement with research delivery teams. CONCLUSION: Published initiatives vary in nature and lack standardised reporting and measurement of impact. Further research is required to identify benefits at a departmental or organisational level, the facilitators for setting up secondments and the application of knowledge gained from secondment opportunities. IMPLICATIONS FOR THE PROFESSION: Undertaking a research secondment is reported to offer professional and personal benefit for clinical staff. Research secondments are one way in which a research culture can practically be embedded within clinical settings. IMPACT: This scoping review identified a lack of published empirical research seeking to understand research secondments as a tool to enhance research and evidence engagement. Although there is a suggestion that secondments could positively impact staff retention, there is limited evidence about the benefit for the organisation or for patient care. These findings have implications for staff, managers and their organisations. REPORTING METHOD: The PRISMA-ScR guidelines were used to guide reporting. NO PATIENT OR PUBLIC CONTRIBUTION: This was not relevant to the research design.

Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study.

AIM: SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. DESIGN: The study used a quasi-experimental pre-test-post-test design. METHOD: The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. RESULTS: There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.

Examining Factors Associated with the Use of Community Food Resources: An Application of the Andersen Model to Inform Future Interventions.

The role of the food environment in shaping nutrition and health has gained substantial attention from policymakers, public health researchers, and advocacy groups. To promote equities in food access and nutrition outcomes, understanding factors linked with the utilization of local community food resources is crucial. Using Andersen's service utilization model, we explained how adults use their neighborhood food resources. In a cross-sectional study design, an online survey was conducted in REDCap Version 13.4.0 via the Amazon Mechanical Turk (MTurk) involving 1830 adults with a mean age of 37.9 ± 12.1 years. Participants answered questions on predisposing, enabling, and need factors that influence their use of different community food resources. The predisposing factors that were statistically significant included age, family size, marital status, race, and ethnicity. The enabling factors included travel time, travel mode, income, and shopping decision motivators (such as being able to use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers, delivery services, great sales, and coupons). Food security and community food resources need for lower food price were the significant need factors. However, these factors vary by the types of food resources. In conclusion, enhancing the utilization of community-based food access initiatives and programs among underserved families requires consideration of family composition, racial and ethnic diversity, and transportation access.

Developing a strategy to scale up place-based arts initiatives that support mental health and wellbeing: A realist evaluation of 'Arts for the Blues'.

Place-based arts initiatives are regarded as rooted in local need and as having capacity to engage local assets. However, many place-based arts initiatives remain poorly funded and short-lived, receiving little attention on how to scale up and sustain their activities. In this study we make a unique contribution to knowledge about scaling up place-based arts initiatives that support mental health and wellbeing through focusing on the example of 'Arts for the Blues', an arts-based psychological group intervention designed to reduce depression and improve wellbeing amongst primary care mental health service users in deprived communities. Methodologically, we used realist evaluation to refine the study's theoretical assumptions about scaling up, drawing on the lived and professional experiences of 225 diverse stakeholders' and frontline staff through a series of focus groups and evaluation questions at two stakeholders' events and four training days. Based on our findings, we recommend that to scale up place-based arts initiatives which support mental health and wellbeing: (i) the initiative needs to be adaptable, clear, collaborative, evidence-based, personalised and transformative; (ii) the organisation has to have a relevant need, have an understanding of the arts, has to have resources, inspiration and commitment from staff members, relevant skillsets and help from outside the organisation; (iii) at a policy level it is important to pay attention to attitude shifts towards the arts, meet rules, guidelines and standards expected from services, highlight gaps in provision, seek out early intervention and treatment options, and consider service delivery changes. The presence of champions at a local level and buy-in from managers, local leaders and policy makers are also needed alongside actively seeking to implement arts initiatives in different settings across geographical spread. Our theoretically-based and experientially-refined study provides the first ever scaling up framework developed for place-based arts initiatives that support the mental health and wellbeing, offering opportunities for spread and adoption of such projects in different organisational contexts, locally, nationally and internationally.

Why Substance Use Screening Frequency Matters in Adult Primary Care.

BACKGROUND: Evidence-based early intervention practices, such as screening, brief intervention, and referral to treatment (SBIRT), are recommended to identify unhealthy use and provide linkages to treatment to prevent substance use disorder. However, there is a lack of screening frequency recommendations. Pennsylvania (PA) SBIRT was a five-year initiative to implement SBIRT in primary care sites. This study evaluated the effects of screening policies in PA SBIRT on changes in substance use risk category over time. METHODS: Quantitative data were obtained from seven primary care sites implementing SBIRT, with patients who were screened twice using the Drug Abuse Screening Test, US Alcohol Use Disorders Identification Test, or the Alcohol, Smoking, and Substance Involvement Screening Test and experienced any risk category change (n = 1,364). Patients were 49% male, 51% female, 81% White, and 14% Black. An intercept-only generalized estimating equation model tested whether category changes between screen one and screen two were statistically significant. RESULTS: The average number of months between screenings for those experiencing a risk category change was 9.01 with a range of 0 to 46 months. There was a statistically significant change between screening one and screening two (P > 0.001), with 44% undergoing a decrease in risk category and 56% undergoing an increase in risk category. Of those undergoing an increase in risk category, 91% moved from a negative/low risk category to a positive/higher risk category. CONCLUSIONS: Results suggest that frequent screening policies may improve identification of substance use risk category changes. The results act as a catalyst to further evaluate recommended screening intervals for detecting unhealthy substance use to increase identification and patient connection.

Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Navigating the doctor-patient-AI relationship - a mixed-methods study of physician attitudes toward artificial intelligence in primary care.

BACKGROUND: Artificial intelligence (AI) is a rapidly advancing field that is beginning to enter the practice of medicine. Primary care is a cornerstone of medicine and deals with challenges such as physician shortage and burnout which impact patient care. AI and its application via digital health is increasingly presented as a possible solution. However, there is a scarcity of research focusing on primary care physician (PCP) attitudes toward AI. This study examines PCP views on AI in primary care. We explore its potential impact on topics pertinent to primary care such as the doctor-patient relationship and clinical workflow. By doing so, we aim to inform primary care stakeholders to encourage successful, equitable uptake of future AI tools. Our study is the first to our knowledge to explore PCP attitudes using specific primary care AI use cases rather than discussing AI in medicine in general terms. METHODS: From June to August 2023, we conducted a survey among 47 primary care physicians affiliated with a large academic health system in Southern California. The survey quantified attitudes toward AI in general as well as concerning two specific AI use cases. Additionally, we conducted interviews with 15 survey respondents. RESULTS: Our findings suggest that PCPs have largely positive views of AI. However, attitudes often hinged on the context of adoption. While some concerns reported by PCPs regarding AI in primary care focused on technology (accuracy, safety, bias), many focused on people-and-process factors (workflow, equity, reimbursement, doctor-patient relationship). CONCLUSION: Our study offers nuanced insights into PCP attitudes towards AI in primary care and highlights the need for primary care stakeholder alignment on key issues raised by PCPs. AI initiatives that fail to address both the technological and people-and-process concerns raised by PCPs may struggle to make an impact.