Vespa velutina has spread across Europe and Asia from its native range in SE Asia in recent years. A common control method is the removal and destruction of its nests on citizens’ request to call centers. In this paper we have explored the knowledge and main factors that influence the perceptions of the citizens on the species in an invaded municipality in NW Spain, as well as the management practices of the municipal emergency unit responsible for nest removal activities. Our analysis brings out multiple drivers of management practices that derive both from the citizens’ and practitioners’ knowledge, and highlights several points of conflict between both stakeholder groups connected to (1) the degree of service provided to the local population, (2) the risk of allergic reactions as a motive to urge removals, or (3) the quality of information provided by mass media. Our results support the crucial importance of environmental education programs that seek to increase the knowledge of the general public about the threats of invasive species. Such programs might be incorporated to implement and optimize management plans of V. velutina by enhancing communication between experts and local population.Implementing management practices for the control of invasive species can be a complex task with multiple dimensions, where the identification of stakeholders and drivers of those practices is of paramount importance. The invasive hornet  Within the realm of biology, debates around invasive alien species (IAS) go from foundational definitions to the availability of evidence of their impact Davis . DiscussVespa velutina invasion control is paradigmatic of the need of defining best management practices in community engagement activities in IAS management programs. The invasive Asian hornet V. velutina has spread across Europe from its native range in SE Asia in recent years. It was accidentally introduced in France before 2004, and the species is nowadays present in most of Western Europe, where eradication is considered to be no longer possible  may have about management strategies or priorities. This often leads to misunderstandings, inefficiency, and even conflict  and removing nests, as well as an overview of the main responsibilities of regional departments. It included also a call center number for nest removal requests that could be used by any citizen, which might be considered a passive surveillance system sensu Hester and Cacho  implemented by a municipality in Galicia (NW Spain), one of the European areas where the species is already well established. The removal of nests of V. velutina might be considered a partially faulty community-based or participatory management .Describe and analyze the nest removal plan and practices in the municipality of Oleiros, where the personnel of the Emergency and Civil Protection Unit (ECP-Oleiros) are responsible for all the management practices concerning Assess community engagement with the control of the species and identify drivers of citizens’ actions, including beliefs, risk perception and attitudes.Analyze the interaction between the ECP-Oleiros personnel and the civilians by studying the problems and/or conflicts between them, the origin of those problems and potential solutions. This analysis includes a fine-scale estimation of nest removal costs as a potential factor of pressure on the ECP-Oleiros unit.In particular, we:V. velutina, could facilitate the detection of possible barriers in the establishment of effective management plans, as well as the integration of the community within them. This could make it easier to reduce conflict, improve stakeholder participation and engagement and gather support for the measures envisaged in the management plans  Fig. . It cove2  and a population density that ranges from 240 to 3390 persons per km2  as the ratio of removed nests to requested nests , where large values (close to 100%) mean high efficiency , date of removal, staff that participated in the action and further observations such as the size of the nest (embryonic/mature nest), materials and techniques used, success in removal and any other information of interest.V. velutina control as well as time invested in those activities from 2016 to 2019.Besides the nest removal database, ECP-Oleiros keeps a general detailed record of all the annual activities, time invested in each, material used, etc. that is published online .V. velutina.Whether they felt well informed or not on Their opinion on the activities carried out by the local administration, which may indicate the degree of communication between both stakeholder groups.A total of 173 surveys were conducted in November 2019, and interviewees were asked on the following topics (Online resource 1):The questions were mostly multiple-choice or open-ended, so choices selected for a question may exceed the number of respondents, causing percentages to add up to more than 100%.V. velutina, as well as changes in practices they have been introducing during these years. The interview included sections on: (1) ECP-Oleiros decisions and practices for nest removal; (2) economic aspects; (3) design and details of the nest removal database; (4) citizens’ calls or inquiries to ECP-Oleiros on V. velutina and (5) other control activities.By conducting individual interviews with ECP-Oleiros staff in November 2019 (Online resource 2), we tried to detect the most common challenges and obstacles for the control of Interviews were semi-structured and the interviewer was able to add questions that were not on the original list. Questions about nest data management were answered by the employee in charge of this task, while questions on economic aspects were answered by the coordinator of the unit.Following ECP-Oleiros unit answers, a decision-making diagram on nest removal was created Fig. .Fig. 2DeThese interviews were used also to assess the interaction and transmission of information between the ECP-Oleiros personnel and the local population by comparing responses on the same topic.p < 0.05. All statistical analyses were performed using the R statistical software package  in our discourse analysis to identify and group the main issues of concern with our informants and to describe the interaction between practitioners and local civilians.We conducted descriptive analyses of the responses obtained from the survey to the Honey Festival participants, as well as sociological discourse analysis (Feindt and Oels p = 0.0037), with significant differences between 2016–2017 (p = 0.047), 2017–2019 (p = 0.047) and 2018–2019 (p = 0.047)   doubled the total number of nest removal requests recorded in 2016, while this ratio descended notably in 2018 and 2019 , the area  and the population density   do not actively participate in control activities because they consider they do not have the opportunity or the know-how (unconcern or fear are less frequent reasons) Table . Trappin.4% do noIn general, interviewees are skeptical on the ability of administrations to manage the invasion and do not have a good opinion of their management activities. They ask for organizational improvements in the management program (40.6%) and more resources (14.5%), as well as more research and information by the administrations (23.9%). An important percentage did not answer this question (21%), indicating that they are not aware of the activities carried out by the administration.Service to citizens. Any call on the species was answered, even in doubtful cases (misidentifications were common in early years). Visits to places and claimants were considered to be important in order to calm the citizens, and they did so even in cases of nests already considered inaccessible in previous visits. The staff admitted notable improvements over the years in their knowledge of the species and their ability to communicate with citizens.Protocols. The initial training of the unit on removal methods was provided by beekeepers through informal collaborations. The staff participated in formal courses, though they considered these courses to be scheduled late, and they missed clear guidelines and methodological protocols. They considered that field experience was their main way to improve their labor, and used scattered web resources and social media for solving doubts. Interestingly, they found press news to be rarely informative and to increase the feeling of danger of the species.Efficiency. One of their main aims was to reduce traveling, as this was time-consuming and restricted the availability of personnel, material and vehicles for other activities and emergencies. Thus, it was crucial to improve the quality of the information obtained from direct calls to the ECP-Oleiros headquarters concerning correct identification of the species, location, nest characteristics, material that might be needed, etc. Another objective was to reduce the removal of nests already abandoned and damaged during winter, so they improved the information given to people by explaining that nests are not reused.Equitability. The activities were very frequent at certain periods of the year and required a notable effort, as most nests were removed during the night. Consequently, they implemented an internal organization system to make work equitable and avoid conflicts in relation to responsibilities to remove problematic nests , responsibilities to organize material, update databases, etc.Budget. Purchase of personal protective equipment and adequate materials was an important problem at the beginning of the invasion, as a wide array of products were offered to the unit by sales representatives without adequate testing evidence or guidance support. This resulted in some superfluous purchases and required an extra effort of investigation by the coordinator of the unit in order to find adequate material at a fair price. The correct use of equipment and materials, including chemical products such as pesticides, required the implementation of internal protocols.ECP-Oleiros annual reports and their database provided valuable information on management practices, that was summed up in Fig. Since nest removal is free of charge for citizens, we tried to estimate a realistic value of the costs of this activity to the Council by taking into account: distance from the ECP-Oleiros headquarters to place of removal, total time invested in removing a nest depending on its size (embryonic or mature nests) and costs of personnel and material . Estimates were computed by the coordinator of the unit by referring to a public document of the council on costs of emergency material and personnel  indicated that they would call emergencies for the presence of a nest or even hornets, which coincides with the experience of the ECP-Oleiros unit. However, while few of them declared to be allergic and they indicated no major fear or feeling of danger to the species, ECP-Oleiros staff highlighted that the most common arguments for nest removal requests were allergies or other health-risk conditions. As for information about the species, the participants of the Honey Festival taking part in the survey considered themselves to be well informed. However, ECP-Oleiros staff indicated that they frequently had to answer questions on identification, nest construction behavior, aggressiveness of the species, or the use of traps. Indeed, the staff recommended citizens to use traps for reducing the presence of hornets in their gardens, but never recommended unprofessional nest removal.An interesting remark made by the ECP-Oleiros unit staff was that they felt that even if concern for the species seems to be decreasing in recent years, citizens requesting nest removal use the motives of fear and danger related to allergies to urge the staff, which obliges them to attend both the content and relational dimensions in communication to avoid conflicts.V. velutina , the search for optimal internal functioning  and cost-effective responsibility as a municipal department (efficient use of time and resources). These attributes make practitioners’ activities adequate for the correct collection of citizens’ data in the passive surveillance of V. velutina climate suitable areas based on costs of ten French administrations that subsidize this activity, and they expect expenses to increase as the species invades new areas. As for Spain, V. velutina has been already included in the list of the ten IAS that generate the greatest expense in management .The implementation of a closer dialog among stakeholders might help to get to an agreement on whether resources to emergencies should be invested primarily to control an already established invader, as in the present case, or if such resources should be directed to make an efficient reduction of their socioeconomic, health and ecological impact. This requires a clear exposition of methods and results by managers, practitioners and/or facilitators to the public, including the economic and organizational aspects. In the particular case of V. velutina, might be framed into an adaptive management strategy, and our results might be incorporated to optimize management plans in an iterative process. This is of great importance at the present state of the invasion in some European areas where V. velutina is a recent IAS or where models predict a potential future invasion, but also for areas where management has not been evaluated and discussed in depth.The information gained from the present diagnosis, together with the analysis of practices and social aspects related to the management of The data provided in this paper support the crucial importance of environmental education programs that seek to increase the knowledge of the general public about the economic and health threats of IAS, as they could reduce the pressure on practitioners so that they can be more efficient. This would require enhancing communication and promoting social learning between experts and local population, either through targeted actions such as information points or meetings with affected communities or through non-targeted actions such as information campaigns in media and social media. This will contribute to control misinformation, irrational beliefs and fake news or sensationalist and misleading headlines, and to ease the relation between administration and local people.Online Resource 1Online Resource 2


Digital health technologies are emerging as promising technologies to advance clinical care. This study aimed to assess providers’ perceptions and acceptability of digital health interventions (DHIs) in the clinical care and treatment of tuberculosis (TB) and HIV in Addis Ababa, Ethiopia.This was a multi-center, facility-based, mixed-method, cross-sectional study that included 14 government health-care facilities. The participants were health-care providers (HCPs) who provide TB and HIV clinical care. Using a tool framed by the unified theory of acceptance and use of technology model, data were collected. A linear regression model was used to assess the relationship between dependent and independent variables.t = 3.784, P = 0.006), age , work experience . The strongest facilitator of their acceptance and the use of the digital adherence technology were perceptions of positive performance expectancy.There were 76 HCPs actively engaged in HIV/TB clinical care services in the selected 14 study sites, of whom 60 met the inclusion criteria and participated in this study. The major factors that influence HCPs’ willingness to use different technologies were educational level (β = 0.097, Many public healthcare facilities in Addis Ababa have already begun the process of implementing various DHIs and the level of acceptability of these technologies by HCPs was found to be high. As a result, a wide range of DHIs has been proposed, although the impact and extent of these technologies in real-world precision medicine are ambiguous.–7 The implementation of DHIs is made possible by several factors, including trained and qualified staff, good perception of healthcare providers (HCPs) and their willingness to use the system, and adequate infrastructure.–12Digital health interventions (DHIs) such as electronic health , mobile health digital devices, and wireless devices are emerging as promising technologies to advance clinical care and treatment of diseases. and HIV by 2030 as these are diseases of high public health concerns. According to the WHO Global TB report 2020, TB remains a worldwide threatening and one of the top 10 causes of death, with an estimated 10 million people fell ill with TB annually, and with drug-resistant TB (DR-TB) continuing to be a major global health issue. For HIV, according to the UNAIDS 2020 Global HIV/AIDS Report, 690 000 people died of AIDS-related illnesses in 2019 and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment. Studies evaluating the effectiveness of DHIs in low-and middle-income countries are desperately needed.–19As part of the Sustainable Development Goals, WHO, UNAIDS (The Joint United Nations Programme on HIV/AIDS) and their partners have a strategy to end tuberculosis (TB) by 2035 However, the Ethiopian government has been taking key measures to fight these two diseases, and as a result, Ethiopia is among the seven high-burden countries that reached the first milestone of the End TB Strategy: a 20% reduction of TB incidence between 2015 and 2020.Ethiopia is one of the 14 triple burden countries – TB, HIV-associated TB, and multi DR-TB – and one of the 30 high-burden countries, with TB remaining one of the major causes of morbidity and mortality in the country. As of the 30 April 2021 report, there were 54.7 million total telecommunication subscribers in the country. Mobile voice subscribers reached 52.8 million, data and internet users 25 million, fixed broadband subscribers 349,000, and fixed service subscribers 923,000. The telecom population and geographic coverage reached 95% and 85.4%, respectively, and the density reached 50%. The Ethiopian Health Sector Transformation Plan recognizes the need for improving digital health infrastructure to facilitate equitable access to quality healthcare for all Ethiopians.Understanding how theoretically promised new digital technologies to work within a specific local context is vital to understand context-sensitive implementation requirements and scale up in a wide range. Although Ethiopia’s health system has been one of the poor technologically supported sectors, new initiatives are rapidly emerging. The Ethiopian Ministry of Health recently, on 06 August 2020, launched a Digital Health Innovation and Learning Center, the first of its kind, where experts can design and validate digital health tools, synthesize and promote best practices, and scale-up innovations.–26 The objective and purpose of such new DHIs should be clear enough to all stockholders, including HCPs, for effective implementation and premier outcomes. The perceptions and acceptance of the HCPs to adopt DHIs technologies may be influenced by the overall digital health ecosystem of the country or prior experience of the HCPs using such technologies. The theoretical basis of this study is that HCPs’ perspectives are critical in determining the extent and success of implementing DHIs.Several factors contribute to the success of TB/HIV programs and the perception, acceptability, and competency of the HCPs regarding the individual program is the uppermost.Thus, this study aimed to assess providers’ perceptions and acceptability of DHIs in the clinical care and treatment of TB and HIV in Addis Ababa, Ethiopia.–29 It comprises multiple constructs from prior literature on technology acceptance into a single framework (acceptability of DHIs). Three of these constructs-effort expectancies, performance expectancy, and social influences are essential to comprehend the behavioral intention of individuals to utilize technology [The unified theory of acceptance and use of technology (UTAUT) was developed to assess user acceptability of new innovative technology.chnology . PerformData from a range of other studies show that performance expectancy often has the most substantial influence on behavioral purpose to utilize technology. On the other hand, facilitating situations, the fourth construct in the UTAUT, directly influence individuals’ actual utilization of a novel technology. Facilitating circumstances include the underlying infrastructure such as human resources, power supply, Internet connection, and others to enable the use of new technology.For HCPs, we interpreted this to hold factors such as the quality of the institutional infrastructure to assist individuals in utilizing such technology. This includes the quality of training they earned before placement of the technology and infrastructure given by the health organization to certify the proper functionality of the technologies and if any higher-level support related to the technology was offered at the time of the deployment procedure.A central element to the acceptance of DHIs is the conservation of care providers’ time and improvement of health-care service, including improving system speed and quality of documentation .The study was conducted in Addis Ababa, the capital city of Ethiopia. The statistics show that the population number increases from time to time and Addis Ababa is much crowded than ever. Therefore, the people of the city are highly vulnerable to TB transmission during transportation and other social activities that put them at high risk. Studies also indicated that Addis Ababa is one of the Ethiopian cities with a large number of patients with HIV.There are a total of 94 health centers found in 10 sub-cities of the capital city. Of these, 10 public health centers with high TB/HIV patient flow from each sub-city were selected as indicated in Under the administration of Addis Ababa Health Bureau, there are 6 governmental hospitals of which 4 of them were identified as being having high TB/HIV patient flow. Accordingly, for the study purpose, we took these hospitals, i.e., Dagmawi Menelik Referral Hospital, Zewditu Memorial Hospital, Ras Desta Damtew Memorial Hospital, and Yekatit 12 Hospital.A facility-based mixed-method cross-sectional study was conducted in both public health centers and governmental hospitals in Addis Ababa to investigate the capacity and readiness of these facilities to incorporate various DHIs. The study was combined semi-structured interviews and a self-administered questionnaire in a mixed-methods study design. The study was conducted between January and March 2021 in Addis Ababa, Ethiopia.Source population: TB/HIV care providers from all healthcare facilities of Addis Ababa were the source population for the studyStudy Population: all TB/HIV care providers working in the selected health-care facilities were considered as the study population.Health-care professionals were who had willing to provide informed consentProfessionals working in selected TB and HIV clinics at the time of data collection.Working experience on TB/HIV care for less than 6 months.Healthcare workers were interviewed and requested to fill out self-administrated questionnaires based on purposive sampling. In the purposive sampling technique, predefined criteria were used to determine the selection of participants based on the requirements of the study objectives. Using purposive sampling, participants were selected for both questionnaires and interviews within the study cities of 10 public health centers and 4 hospitals. Accordingly, fourteen sites were sampled as part of a larger evaluation with a high TB/HIV patient load. This was incorporating all health workers meeting inclusion criteria at each site for the interview and to fill the prepared questionnaires.As the information obtained, in health centers on average there were 8 HCPs working on TB/HIV clinics in health centers and an average of 13 HCPs in hospitals. Total HCPs who were assigned in 10 health centers and 4 hospitals were found to be 76 in number. Of these, 60 HCPs met the inclusion criteria and became the sample of this study which covered 80% of the total health-care workers as respondents from the selected healthcare facilities.Data were gathered from healthcare workers using adopted questionnaires as well as semi-structured interview questions based on the adapted UTAUT model. Interview questions were used to investigate the relative advantages and simplicity of DHIs, social acceptance, and enabling factors to utilize technologies using the model. The acceptability of technology was asked only for those HCPs who held solid prior experiences of using DHIs in their health-care delivery or if they were involved in any technology utilization-related research or study.Current technology utilization, personal perception, and acceptability of the technology in selected health facilities were investigated using interview questions and interview-based questionnaires that were replied to by the respondents.Health workers usually work in very busy clinics, therefore; to ensure their privacy and to manage their time; the researchers used available empty office spaces. The interview was lasted for about 20 to 30 minutes and was conducted in Amharic or English depending on the interests of the respondents or the participants. The audio recording was later transcribed and translated to produce de-identified English-language transcripts.The epistemological approach is supposed that people construct their own understanding of fact from their varied personal experiences. According to this thought during interviews, participants were needed to draw meaning with respect to how the introduction of the new technology changed their practice and impacted the lives of their patients.To ensure the confidentiality of participants’ data, any physical records  were safeguarded in a locked personal cabinet, and interview recordings and transcripts were also be stored on a coded password-protected computer. To verify translation accuracy, one-quarter of English language transcripts were randomly chosen and were assessed against the original audio recordings for the correctness and completeness of the gathered data.The questionnaires and checklist were treated quantitatively, but most interview questions were analyzed qualitatively using a thematic approach. Quantitative data were analyzed using SPSS computer software, version 20 .Categorical data were expressed as frequencies and percentages. After the interviews were conducted, the responses of the respondents were written down and documented. Then, two investigators manually coded qualitative data, and a thematic approach to analyze the data was utilized. The transcription procedure was followed by coding the transcripts. Consequently, the descriptive codes were documented, and analytic codes were established. Afterward, key themes were identified and recognized. A codebook comprised both descriptive and analytical codes that related themes were utilized to guide the study’s progress. Discussion and conclusion were forwarded.Regarding statistical analysis, we used multiple regression to assess age, sex, work experience, educational level, and department, either TB or HIV clinic influence on their inclination toward technology utilization.The researchers reviewed transcripts of respondents to endorse the content captured whether they used accurate quotes in reporting to confirm the reliability. Moreover, this study was carried out in light of the COREQ guidelines for writing qualitative data.Data quality assurance includes the validity and reliability of data. Validity is the accuracy of measurement to which data truthfully represent a concept. Researchers use a validity test to ensure both dependent and independent variables have been measured accurately. Accordingly, for this particular research, the validity of the data was verified by using critical statistical tools.A pre-test of the study questionnaires was conducted at selected health facilities on 10% of the estimated sample size to check clarity and make essential amendments to the questionnaire before its actual use. The training was provided to the data collectors to avoid hypothetical bias and confirm appropriate categorization and coding of questionnaires. The study Supervisor and the Principal Investigator verified the collected data thoroughly for completeness each day.The following procedures were taken to ensure ethical issues in line with the purpose of the study. Approval was attained from the Scientific and Ethics Review Committee of the Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University on December 11/2021 with reference number CDT/1463/20. Another approval has been attained from the Ethics Committee of Addis Ababa Health bureau. An official letter was also sent to each health facility to get permission to undertake the study accordingly. Any participants, who had not willing to be included in the study, were not be forced to be part of the study.At the individual level, after a clear explanation of the purpose and importance of the study, written informed consent was obtained from all participants before they participated in the study. During the consenting process, the participants were informed that personal identifiers were omitted to ensure their privacy and confidentiality. The study units’ culture, language, beliefs, and values were considerably respected, and participants were asked permission for digital recording of the interview sessions. The study participants were informed that the study process had no intention to harm them, and there was the possibility to withdraw from the study at any time.As indicated in Technology utilization by HCPs was assessed. The research was conducted in 14 healthcare facilities under Addis Ababa health offices. Based on the responses of the respondents and also revealed in According to the data obtained from the respective respondents, the TB care providers in selected hospitals were found to be less familiar with technology utilization as compared with the rest of 10 selected health centers in which TB care providers likely became one part of a pilot study using Digital Adherence Technology (DAT). For such a study, they had been using the internet (Wi-Fi) and computers to follow the drug adherence of their patients. In using this new technology, the HCPs of those health facilities had been provided pertinent training.Among the respondents, 43.3% of them confirmed that they had a favorable working environment to utilize the new technologies in their respective facilities. In addition to this, the majority of the respondents, 81.7% endorsed as being there were a lot of opportunities in the health facilities to properly implement DHIs in both health centers and public hospitals under the study.To assess the technology acceptability and perception of HCPs about using DHIs, an interview-based questionnaire and open-ended interview guiding questions were used. Based on the framework used, assessment has been made on the extent of technology acceptability and perceptions of HIV care providers who had solid experiences in using the smart care; which is used as a digital recording of patients’ data including card number, CD4 count, viral load and other essential information. It was observed that among the selected hospitals, unfortunately at the time of data collection only one hospital of TB clinic tried to implement a new system which helped them to record patient’s data and connected digitally with different departments such as laboratory technicians and pharmacists. Likewise, the other three hospitals had also planned to implement such technologies but were not executed yet. It was evidenced that a pilot study had been conducted in selected 10 health centers to use a digital adherence technology. The HCPs working in TB clinics were also assessed their perception and acceptability towards the digital adherence technology. Similarly, the perception and acceptability of HIV caregivers toward smart care were assessed accordingly.The strongest facilitator of their acceptance and the use of the digital adherence technology were perceptions of positive performance expectancy . In particular, most HCPs felt that remote monitoring of medication adherence had some benefits for both patients and HCPs. During the pilot implementation of the technology, TB patients were generally dispensed 15 days of medications in the device. Patients who visited the clinic to pick up medications, which were previously required daily were likely reduced substantially. It was evidenced that the assumption of remote monitoring of adherence minimized the need for more frequent in-person monitoring. Most HCPs felt that patients benefited considerably from this reduction in required clinic visits. HCPs in the HIV clinic also described how smart care facilitated their works since they could easily retrieve patients’ data from the record so that patients’ follow-up was become easier in turn this situation likely enhanced their job satisfaction as well. R2 for the overall model was 54% with an adjusted R2 of 51%, a large size effect is reported by the model .P = 0.03 as shown by ANOVA The overall model was significant to predict care providers’ willingness to use various technologies in their facility: F  = 15.536), This study was conducted to determine if various factors can influence HCPs’ willingness to use different technologies. It was hypothesized that their sex, educational level, their department either TB or HIV clinic, age, work experience will predict their willingness toward the use of technologies. To test this hypothesis, multiple regression analysis was used. Results show that 51% of the variance can be accounted for by the five predictors, collectively, F  = 15.536), P = 0.03. Looking at the unique individual contribution of the predictors, the result shows that educational level , age , Work Experience  . Further,32 According to the respondents, the Internet access of the healthcare facilities was found to be 100%. However, this data had some discrepancies regarding Internet access among healthcare workers. Thus, HIV care providers had more access to use the Internet relative to HCPs working in TB clinics. On the other hand, few Participants in this study confirmed that they used the Internet for regular medical/professional updates. A possible reason mentioned was that the poor computer hardware and very slow Internet connection at the selected health-care facilities.In this study, we assessed the current technology utilization by HCPs, the level of acceptance and perception toward the technology and the overall readiness of the sampled healthcare facilities to adopt and implement different new technologies. Among the respondents, 80% of them have ever used different technologies in their respective healthcare facilities to support health-care delivery. This finding is similar to other studies conducted elsewhere in comparable settings. Besides, our study found that HCPs with access to computers believed that they would personally benefit from the implementation of a digital health system. As a result, they would gain the necessary skills for the implementation of such a system of technology in more innovative ways.The majority of HCPs included in the study had better access to computers at their respective healthcare facilities. This finding is important since, better access to such technology among HCPs working in health-care facilities, advance their healthcare service. In fact lack of access to technology mainly to computers is assumed as a major barrier to the adoption of ICTs in their respective workplaces which is similar to other results of studies. Another study conducted in London showed that the current ICT utilization among HCPs acts as a facilitator for the acceptance and use of eHealth technologies. Those HCPs, who used the computer at the center daily, believed that they had the necessary skills for the implementation of such a system as compared to those who never used the computers at the center. This corroborates or verifies with the findings from another study conducted in a primary healthcare center setting.A previous study conducted among HCPs in some primary care practices found that providers that used computers often were more eager regarding the technology and that providers who already have been using computers believed that they had the skills for adapting to newly implemented technologies. This is actually reported in the same fashion by the current study in that health professionals who had ever trained for the DHIs were more likely to be willing to use the DHIs than their counterparts as supported by previous studies. This is also actually in line with the existing fact that training can change the knowledge, attitude, and skills of health professionals on computer systems and as a result increase commitment to use the DHIs in particular and the other technologies in general. Thus, before the actual launching of such kind of program, it is mandatory to assess the existing level of knowledge, acceptance, and utilization habits of those HCPs in the facilities.Some studies found that the deficit of basic and refreshment training on computers and eHealth among health professionals is the possible hindrance factor for the utilization of DHIs in health-care facilities that might lead to undesirable patient health outcomes.Drawing from the UTAUT model, we found that a digital adherence monitoring intervention by TB care providers and smart care is largely acceptable for supporting TB and HIV care delivery in the selected health-care facilities. Overall, the key factor for acceptability appeared to be perceived usefulness; for TB caregivers, although the electronic adherence monitor was only initially intended to monitor adherence, it was also beneficial in creating a sense of being “cared for” and a sense of fear of “being caught” not adhering, both of which inspired participants to take medications to maintain their ongoing relationships with the study staffs. SMS text messages not only reminded patients to take the medication in time but also enabled social supporters to provide medication-taking-related support. This might be explained by the fact that when managerial support is in place, more resources including working manuals would be allocated to the implementation, undoubtedly health professionals become motivated and eager to use the technology.For HIV care providers the key factor for acceptability also appeared to be perceived usefulness; care providers were able to retrieve any patient-related data including patients’ cards, date of appointment, CD4 count, viral load, and other pertinent information. Reliable and timely health information is the foundation of health systems action where information and communication technology initiatives such as Smart Care helps electronically keep documents and enhance the decision-making process. However, it is sometimes not available when required because of poor managerial priority, budget allocation, and support. This was truly explained by the current study by the fact that managerial support, guidelines, and access to strong signal internet were independent determinants for acceptability and utilization of the system. This result is similar to that of the study conducted in Ethiopia.Many public healthcare facilities in Addis Ababa have already begun the process of implementing various DHIs and e-Health systems for TB/HIV services and the level of acceptability of these technologies by HCPs was found to be high. However, most of the available digital health technologies in the facilities were utilized without reliable DHIs/eHealth regulatory policy in place. Thus, there is a critical need for reliable DHIs/e-Health regulatory policies and some improvement is needed in DHIs/e-Health strategic planning (core readiness). There should be a prior need assessment and proper training given to HCPs to properly adopt and implement new DHIs in healthcare facilities.This study was undergone with selected subjects with the limited number of participants and selected governmental health-care facilities in Addis Ababa. Therefore, a replication or transfer of the result of this study to other parts of Ethiopia, particularly for the rural areas and the private health-care environment, should consider the potential differences resulting from varying cultural, socioeconomic, infrastructural, and political backgrounds healthcare is a much-institutionalized industry. The same carefulness must be executed when applying this study’s result in other developing countries and worldwide.


Zika virus (ZIKV) was first isolated in 1947 and, in 1952, antibodies against it were identified in humans. It is a flavivirus that causes a dengue-like syndrome, including fever, headache, malaise, arthralgia, myalgia, maculopapular rashes, and conjunctivitis. After a long period of sporadic reports of human infections, two major outbreaks occurred in 2007, in Micronesia, and in 2013•2014, in French Polynesia, from where it has spread to other countries, including Brazil, particularly in the northeast,A newborn from a twin pregnancy was delivered by caesarian section during the 37th week of gestation. On physical examination the only apparent anomalies were microcephaly  and bilateral clubfoot. The other twin was normal. His mother, who lived in the state of Pernambuco, in northeastern Brazil, reported a rash and fever on about the 28th day of pregnancy.Transient otoacoustic emissions were absent. The auditory brainstem response (ABR) to clicks was then measured and repeated one month later. On both occasions, no response was obtained from the left ear. In the right ear, there was a response to clicks at 99 dB . FrequenHerpes simplex in serum were negative; PCR tests for cytomegalovirus in cerebrospinal fluid, serum and urine were also negative; toxoplasmosis IgM was negative and IgG positive in the mother's blood, and IgM negative and IgG positive in the newborn's blood but at lower levels than in the mother. Other causes of microcephaly, such as alcoholism or genetic disorders, were also excluded.Computerized tomography revealed diffuse bilateral reduction of cerebral parenchyma, ventriculomegaly, malformation of cortical development, with simplified gyral pattern and multiple cerebral calcifications predominantly in the basal ganglia and cortical-subcortical regions . CaptureOn ophthalmologic evaluation, cornea and lens were found normal. There was high level of myopia, the fundus presented bilateral macular coloboma; there was a large area of exposed sclera at right and optic nerve hypoplasia at left. Glaucoma was noted bilaterally. The twin brother was completely normal both on clinical examination and blood and CSF tests.At two months the child presented with major irritability. An electroencephalogram showed focal activity. Unstable cervical control, poor interaction, no evidence of visual contact and global retardation of development were noted. He was operated during the third month to correct the clubfeet, and on the fourth month for glaucoma. A neuromotor stimulation program was initiated.In 2015, the Brazilian Ministry of Health recorded a 15-fold increase in the number of cases of microcephaly in the state of Pernambuco, and in November 28th 2015 it confirmed a correlation between gestational Zika infection and microcephaly in newborn infants.We believe that this is the first report of hearing loss associated with gestational Zika infection in the world literature. We must stress that all the other infectious causes of congenital hearing loss were excluded by serologic tests, that the rash and fever suffered by the mother occurred during an outbreak of ZIKV on that same region, and that IgM for ZIKV was detected in CSF. It is also of note that his twin brother did not have signs of ZIKV infection and was absolutely healthy. This highlights the potential for this viral disease to cause disastrous consequences for the fetus when acquired during pregnancy. The pathological mechanisms involved in causing this functional damage is far from being elucidated, but it is probable that they follow the routes common to other congenital viral disorders such as cytomegalovirus or rubella.Microcephaly has a variety of causes which include congenital infections such as cytomegalovirus, herpes simplex type II, human immunodeficiency virus, rubella and varicella zoster virus.These central lesions can be the origin of the auditory impairment of this child, but the absence of otoacoustic emissions indicates that a peripheral (cochlear) damage is more likely to be the cause. Patients with rubella and cytomegalovirus can also present with microcephaly, but it is well established that in these cases the auditory malfunction is secondary to a peripheral problemIt is still uncertain if the tissue damages caused by the intrauterine ZIKV infection are an expression of a direct effect of the virus itself or of an immune reaction from the host. Further histologic studies are necessary to determine the exact pathogenesis of the disease.This case indicates that the occurrence of ZIKV must be carefully monitored for during prenatal visits in affected regions and must be considered as a possible cause of congenital deafness when a history of a rash and fever occurs during the gestational period, especially during the first trimester. In hearing assessment protocols for neonates, mother's infection by ZIKV should be included among the risk factors for hearing loss.The authors declare no conflicts of interest.


Work organization is a strong predictor of occupational stress and of mental and physical health among hospital employees.In complex systems such as hospitals, work organization can influence the level of occupational stress and, consequently, the physical and mental health of workers. Hospital healthcare workers were asked to complete a questionnaire during their regular occupational health examination, in order to assess the perceived level of organizational justice, and to verify whether it was associated with occupational stress, mental health, and absenteeism. The questionnaire included the Colquitt Organizational Justice (OJ) Scale, the Karasek/Theorell demand-control-support (DCS) questionnaire for occupational stress, and the General Health Questionnaire (GHQ12) for mental health. Workers were also required to indicate whether they had been absent because of back pain in the past year. Organizational justice was a significant predictor of occupational stress. Stress was a mediator in the relationship between justice and mental health. Occupational stress was more closely related to perceptions of lack of distributive justice than to perceptions of procedural, informational, and interpersonal justice. Physicians perceived significantly less distributive justice than other workers. In adjusted univariate logistic regression models, the perceptions of organizational justice were associated with a significant reduction in the risk of sick leave for back pain (OR 0.96; CI95% 0.94–0.99;  Organizational justice is a construct that defines the quality of social interaction in the workplace . OrganizIn complex systems, especially in work domains that are essential to our society, organizational structure may lack coherence and transparency, leading to perceived injustice . The hosThe perception of organizational injustice could be associated with increased occupational stress and physical and psychological symptoms in workers. In fact, organizational justice is one of the models that expresses the relationship between stressful factors present in the workplace and illnesses in workers ,13,14,15We aimed to test this hypothesis by asking healthcare workers (HCWs) in a public hospital to report their perceptions of organizational justice during the regular medical examination they undergo in application of the European guidelines for health and safety at work. Our aim was to assess the perceived level of organizational justice and to verify whether it was the same in the different categories of workers. We also wanted to investigate the relationship between organizational justice and occupational stress, workers’ mental health, and absenteeism due to low back pain.In the first half of 2020, all workers in a hospital in Lazio, Italy, were sequentially asked to complete an anonymous questionnaire on organizational justice, occupational stress, and mental health, as part of the regular medical surveillance examination to which workers exposed to occupational risks are subjected.The questionnaire included measures of organizational justice, stress, and mental health. Colquitt’s Organizational Justice Measure (OJM) , the ItaThe demand/control/support questionnaire (DCS) is a derivative of Karasek’s work content questionnaire , modifieThe General Health Questionnaire (GHQ12)  is a meaWorkers were also asked whether they had been absent from work in the past year because of back pain. The study is in accordance with the principles of the Declaration of Helsinki . The stuThe distribution of the scores obtained from the questionnaires was initially studied using mean, median, and standard deviation We then compared the levels of perceived organizational justice and its components in the different categories of workers, in the two sexes, and in the different age groups. Comparisons were tested by one-way analysis of variance (One-way ANOVA) and, in case of significance, with multiple post-hoc comparisons using the Bonferroni correction for multiple comparisons.To evaluate the relationship between justice, occupational stress, and mental health, we first studied the correlation between these continuous variables using the Pearson correlation coefficient. Once we verified the existence of a significant correlation between these three variables, we evaluated their relationship by hypothesizing that the perception of justice may act as a predictor, stress may be the mediator, and mental health (as measured by the GHQ12) as the response variable. In the mediation analysis, the level of confidence for all confidence intervals in output was set at 95%; the number of bootstrap samples for percentile bootstrap confidence intervals at 5000. We adjusted the mediation analysis by considering sex and age as covariates.Logistic regression analysis was used to evaluate the association between justice or strain and having made absences for back pain in the year preceding the visit. The estimated effect was presented in terms of odds ratio (OR) and 95% confidence intervals. Each of the variables was initially posited as an independent variable in univariate models, in which the absence for back pain was the dependent variable.The statistical analyses were carried out with the SPSS 26.0 program  integrated by PROCESS vers. 4.1 .Two-hundred and eighteen of two-hundred and forty-five health care workers submitted a complete questionnaire and were, thus, eligible for the survey. The participation rate was 89%. The refusal to participate was mainly motivated by the lack of time to complete the questionnaire. Almost two thirds of the workers were female. Most of them were over 40 years of age. Nurses were the largest group . These cThe distribution of perceptions of organizational justice among the different professional categories , among genders, and among age groups is shown in Organizational justice, occupational stress, and mental health were significantly correlated . Lower lMediation analysis revealed that both the direct and indirect (via job strain) associations between perceived justice with psychological disturbance were statistically significant, after adjustment for gender and age . Figure Logistic regression was used to examine the extent to which the perceptions of organizational justice were related to absenteeism due to back pain. In univariate models considering each variable separately, both organizational justice and social support were significantly associated with a lower risk of back pain, whereas job strain was associated with a significant increase in risk . Next, aOur study has shown how, in a complex structure such as a hospital, organizational justice can be perceived very differently by workers. The findings indicated that the perceptions of organizational justice are closely related to occupational stress, and these two variables are directly and independently associated with psychological disorders. Organizational justice is also indirectly related to mental health through the mediation of job strain. Both justice and social support are important protective factors against back pain, whereas job strain is associated with a significantly increased risk of back pain.Our findings are consistent with previous studies. A systematic review of longitudinal studies showed that procedural justice and relational justice were associated with mental health; these associations remained significant after controlling for occupational stress measured by both the DCS and other stress models . These wAs we have shown, the perceptions of equity vary across different groups in the hospital population. Physicians tend to complain about less distributive justice than other workers. Older workers perceive less informational justice. The latter aspect may be related to the fact that older people have greater difficulty using computer resources and digital media. Women who complain of less interpersonal justice than men indicate a gender gap. Gender gaps are not uncommon in the health professions, and often manifest in an unequal distribution of resources, information, and material rewards rather than explicit relational inequity , as repoOur investigation, therefore, confirmed the existence of some problems in the hospital organization that have been known and discussed for a long time, and for which various, but apparently ineffective, measures have been proposed. Greater transparency and fairness in the allocation of medical appointments, increasing electronic literacy and bridging the digital divide, and enforcing gender equity appear to be pervasive and achievable goals that can help improve the perceptions of organizational justice among health care workers.Healthcare managers should have a vested interest in enhancing employees’ perceptions of equity as it relates to both health and productivity.To our knowledge, this is the first study to show an association between organizational justice and absenteeism due to back pain. Many other negative effects of poor organizational justice have been reported in the recent literature. A prospective cohort study with an observation period of one year found that low interpersonal justice was associated with both the occurrence and duration of insomnia . A JapanWork-related musculoskeletal disorders are one of the most common causes of occupational sick leave, accounting for 21% to 28% of work absenteeism days in 2017/2018 in some European countries . In 2019This intriguing topic, therefore, requires well-conducted longitudinal studies, which also consider psychosocial factors. Our study deserves to be continued, observing in a prospective way the onset of back pain episodes and the relative absenteeism trend in relation to the different levels of perceived justice and occupational stress. Furthermore, monitoring the level of organizational justice perceived by workers can allow the occupational doctor to study and prevent phenomena such as job dissatisfaction, burnout, and turnover. What is more, it makes it possible to orient occupational health and safety services in a salutogenic sense, enhancing work engagement, job satisfaction, and the physical and mental well-being of workers.Organizational justice may have a direct relationship with the quality of care. The lack of correctness in the organizational procedures  or in the transmission of the information necessary for the work  could interfere with the diagnostic and therapeutic procedures that take place in the hospital. A future study could be designed to evaluate this hypothesis. The lack of interpersonal justice and distributive justice could also affect the motivations of health professionals, and, thus, indirectly harm patients. A longitudinal study could verify whether the justice perceived by hospital workers is associated with variations in the quality of care.The results of this study should be considered in the light of some limitations. It was conducted with a cross-sectional design, which prevents causal inferences. A causal relationship between justice, occupational stress, and mental health could only be demonstrated by longitudinal studies. We hope that the continued health surveillance of these workers will allow such studies to be conducted in the future. Another limitation concerns the fact that the study was conducted in only one hospital, which limits the generalizability of the results. However, comparison with the literature suggests that the conditions in the public hospital where we conducted the study are similar to those in other hospitals.In conclusion, our study has shown that hospital organization creates a sense of diminished distributive, interpersonal, and informational justice among a portion of the workforce. These organizational justice biases are associated with increased stress levels and poorer mental health, both directly and indirectly through job strain. In addition, perceived low justice is associated with absenteeism due to back pain. Hospital organization should be improved to increase workers’ health and the quality of care that depends on it.The great complexity of the hospital structure and the conflicting organizational needs must not weigh on the health of workers, because it is obvious that, to guarantee the quality of care, the health and safety of health workers must first be guaranteed . The comOur study reinforces the view that the organization of the hospital must be based on criteria of justice, rather than on mechanisms aimed at maximizing production. To achieve this, a culture of respectful communication, justice in policies, and a proper procedure for allocating resources, workload, and rewards systems is a must.


This study explores the influence of the power of family business successors on firm innovation under the theory of social embeddedness. Based on the 2000–2019 unbalanced panel data of listed Chinese family enterprises, this study empirically examines the differences in the influence of the implicit and explicit power of successors on incremental and radical innovation respectively. Our findings show that explicit power has a more positive impact on incremental innovation, while implicit power is more conducive to promoting radical innovation. In addition, the study finds that the reason why the explicit power of succession does not have a significant impact on radical innovation, that is, the reason why board dissent is not related to radical innovation, is that some of the major innovation decisions in the enterprise are not all made at formal meetings. The research conclusions not only extend the theoretical application of social embeddedness in family enterprises, but also provide certain practical guidance for promoting enterprise innovation. In the next five to ten years, about 3 million Chinese family business companies is projected to face successionchange of leadership which means that China will enter an intensive period of family business inheritance . Under tFirst is the lack of dual causal exploration. Individual power can come from the legal granting of formal authority from higher authorities, i.e., explicit power, or from some non-institutional arrangement, i.e. implicit power . Since tSecondly, there is a lack of exploration of the mechanism of this effect. Social embeddedness theory has shown that human beings do not act in isolation outside their social context, but instead, human actions are closely embedded in social relations and within a social structure . In thisBased on the Corporate Governance Theory, it is necessary to pay attention to the interaction between actors in order to deeply understand the decision-making behavior of enterprises. The introduction of existing managers’ constraint effect on successors can make a more comprehensive exploration of the influence of successors’ power perspective on family business innovation. In addition, board membership is an important consideration,, as board members have the right to challenge the innovation decisions of their successors . Some scBased on the above questions, this study explores the impact of the authority of the successor of a family business on corporate innovation. Compared with previous studies, this study contributes to empirically examine the influence of implicit power and explicit power on dual innovation respectively. Secondly, it takes into account process factors and explores the mediating effect of board dissent between managerial power and corporate innovation. To this end, this study determines the kinship relationship between the parent entrepreneur and the successor of the family enterprise according to the public information such as the annual report of listed companies, the Baidu search engine and the news report, and selects the A-share listed family enterprise from 2001 to 2019 for empirical testing.Managers have a crucial role in supporting innovative behaviors and their impetus to innovation is often the driving force to organizational evolution. Research has found that managers with greater power tend to have more resources and influence and, therefore, they are more capable of playing an influential role in the development of new products or services . The curExplicit power mainly comes from the organizational structure and assignment of the power based on the role in the hierarchical structure. It is the formal, legal and institutional basis of power in an organization. It emphasizes that subordinates should obey their superiors based on their different role in the hierarchy. The implicit power on the other hand comes from informal factors, such as the influence formed by the individual’s ability, knowledge and morality in the group, and it can influence decision-making and implementation.Incremental innovation mainly emphasizes the expansion of the current market share and product market portfolio through simple adjustments and minor changes, as well as the introduction of new products and services, and the expansion of company scale to meet new market target needs . IncremeAccording to the social embeddedness theory, power implies the control of scarce resources . From thH1: Compared with implicit power, explicit power has a stronger positive influence on incremental innovation.Radical innovation is an innovation that is more groundbreaking . To meetAccording to social embeddedness theory, if power is not linked to the possession of scarce resources, it means that whoever has the right to speak determines the direction of public opinion . From thH2: Compared with explicit power, implicit power has a stronger positive impact on radical innovation.Board meetings are the most important place for directors to collect information, supervise management, and implement decisions  where thIn addition to the formal interaction such as the board meeting, the informal interaction formed by trustand rules among directors also plays an important role in the performance of functions of the board of directors . Informal innovation. On the contrary, when the successor has explicit power, senior executive members may become rebels of radical innovation out of personal interests, thus leading to the objection of radical innovation. Therefore, there is no direct relationship between board dissent and radical innovation.Incremental innovation often occurs in the day-to-day decisions of formal meetings, and it can occur at every stage of the business’s operational process. Regardless of whether the successor has implicit or explicit power, board dissent has impact on incremental innovation. Compared with incremental innovation, radical innovation is characterized by both high returns and high risks, and this type of innovation usually happens with the major projects of enterprises . The finH3a: Board’s dissent plays an mediating role in the relationship between implicit power and incremental innovation.H3b: Board’s dissent plays a mediating role in the relationship between implicit power and radical innovation.H3c: Board’s dissent plays a mediating role in the relationship between explicit power and incremental innovation.In summary, the research framework is shown in This study takes the Chinese family-listed companies from 2011 to 2019 as a research sample. In terms of the definition of family business, this paper refers to the research of Ellul et al. (2010)  and Wu eThe research samples were excluded as follows: (1) St, *ST, S*ST and delisted samples were excluded; (2) Exclude the sample of incomplete succession, that is, the next generation of members of the parent entrepreneur  are not serving as the chairman or general manager of the listed company; (3) Eliminate missing data and abnormal samples; (4) Exclude samples listed after the succession of family business successors; To eliminate the effect of outliers, continuous variables are Winsorized at 1% above and below. Through the above process, we finally obtained 310 observed values of 85 A-share family enterprises of family enterprises with the period from 2011 to 2019.Dual innovation includes incremental innovation and radical innovation. Drawing on the research of Bi et al. (2017) , the perThis study draws on the studies of La Porta et al. (1999)  calculataij∈(0.1), where “i” stands for control chain i and t stands for layer t on the control chain.In existing studies, the main indicators for measuring explicit power are experience, education, and gender. Obviously, a single indicator cannot accurately measure the implicit power (Dom) of successors, and too many indicators are prone to multicollinearity. Based on the practice of Quan et al. (2010) , this stAccording to Shanghai and Shenzhen Stock Exchange regulations, board members with voting rights need to vote on relevant proposals which include approval, opposition, and abstention in the decision-making process of the board of directors of listed companies. According to Ma & Khanna (2016), voting opinions other than “agree” are regarded as dissenting opinions . In thisn and the year when the company is listed. Cash flow is measured by net cash flow generated from operating activities, growth is measured by TobinQ, yield is measured by return on net assets, and institutional investment is measured by institutional investment. Shareholders’ equity is measured by year-end shareholders’ equity. In addition, in order to eliminate the influence of industry and year differences on the company’s dual innovation, we added industry and annual dummy variables into the model. All variables are showin in With reference to existing research , this reBased on the hypothesis of this study, the following regression model is set to test hypotheses H1 and H2.In order to test the hypothesis H3, this study introduces board’s dissent in the regression model to test the mediating effect. The measurement model is as follows:2 are better than implicit power. This shows that explicit power has a stronger positive impact on incremental innovation than implicit power, which means hypothesis H1 is supported. At the same time, the results of Model 1—Model 6 show that board’s dissent plays a partial mediating role in the implicit power, explicit power and incremental innovation of successors.When discussing the relationship between power and corporate innovation , some scTo make the research more convincing, this research re-evaluates the implicit and explicit power of successors. The implicit power of the successor is measured by the political connection of the successor (1 for holding a position at a government authority and 0 for not), and the implicit power of the successor is measured by ownership. In this paper, the hypothesis is tested again according to this variable, and the regression results are consistent with the previous research which are shown in This study uses dual innovation to measure the degree to which directors are willing to take risks with their successors. Some studies show that higher risk projects undertaken by enterprises will lead to greater fluctuations in future earnings and greater uncertainty in cash inflows. Therefore, the volatility of corporate earnings, namely the standard deviation of ROA, is adopted to measure the risk-taking situation . At presi, n represents the Earnings Before Interest, Tax, Depreciation and Amortization of the current year, Asseti,n represents the total assets at the end of the current year, and X represents the total number of enterprises in the industry in which Enterprise i is engaged.In this formula, This study uses A-share listed Chinese family companies from 2011 to 2019 as a sample to conduct empirical tests on the proposed hypotheses, and draws the following main conclusions: (i) Compared with implicit power, explicit power of successors has a stronger positive effect on incremental innovation which is an innovation with less risk. Directors who are calculating their own benefits will cooperate with their successors to carry out incremental innovation activities. On one hand, since explicit power allows successors to control more enterprise resources, it can directly cooperate with successors to sign documents to promote incremental innovation. On the other hand, Implicit power requires a series of tedious evaluations to increase incremental innovation. Therefore, compared with implicit power, explicit power of successors has a stronger positive impact on incremental innovation. Therefore, compared with implicit power, explicit power of successors has a stronger positive impact on incremental innovation. (ii) Compared with explicit power, implicit power has a stronger positive impact on radical innovation. Radical innovation is a risky transformative activity, which means directors will reduce radical innovation activities in order to avoid risks and safeguard their own interests. The implicit power of successors can induce the voluntary risk-taking behavior of directors, while the explicit power weaken the following behavior of risk-taking. Therefore, compared with implicit power, explicit power of successors has a stronger positive impact on incremental innovation. (iii) Board dissent has a mediating effect on the relationship between explicit power and incremental innovation, explicit power and incremental innovation, and implicit power and radical innovation, but there is no mediating effect between explicit power and radical innovation. Since corporate decisions need to be voted on by the board of directors, the more powerful the successor is, the less opposition there will be from the board. Because incremental innovation is conventional innovation with less risk, such decisions are ultimately allowed to be made at a formal meeting (a board meeting). Thus, there is a significant correlation between board dissent and incremental innovation. Radical innovation, however, is an unconventional innovation with high risk, which means the final decision often needs to be made by successors and senior executives in informal meetings or in private. Therefore, radical innovation is not vetoed only when the successor has implicit power, that is, board dissent is significantly associated with incremental innovation. On the contrary, radical innovation is easy to be vetoed when the successor has explicit power, so that there is no significant relationship between board dissent and radical innovation.Based on the research conclusions and existing literature research results, we construct a "relationship quality-venture capital situational matching" model in the context of social embeddedness between successors and executive members . In future studies, the discussion of trust and norms can be added to obtain more applicable research conclusions.


Background: During the outbreak of COVID-19, online public opinion related to the epidemic was rapidly generated and developed rapidly. If some online public opinions cannot be effectively responded to and guided, it will bring risks to social order. The government should understand how to use information on social media to grasp public demands, provide useful information in a timely manner and take countermeasures. Studying the formation mechanism of online public opinion during the outbreak can help the government make scientific decisions and improve risk management capabilities. Methods: The research selects the public opinion information of online platforms represented by WeChat, online communities, Sina Weibo and search engines, involving 75 relevant texts (1 January to 31 March 2022). According to the grounded theory method, using the QSR NVivo12 qualitative research software, the collected network texts were successively researched using open coding, axial coding and theoretical coding. Results: The structure of online public opinion during the COVID-19 epidemic was obtained. The operation mechanism of the online public opinion system about COVID-19 was mainly affected by the interaction of online public opinion objects, online public opinion subjects, online public opinion intermediaries and government forces. It was based on social facts and citizens’ appeals as the starting point, subject behaviors and prevention and control measures as the focus, government’s governance as macro-control and citizens’ evaluation as the guide. Conclusions: Scientific analysis of online public opinion is an important tool to identify and manage risks and improve the quality of government activities. Online public opinion has the function of assisting government decision-making, and the government can identify the important information reflected in it, especially the mainstream public opinion, as a reference for decision-making. By taking effective measures and properly responding to citizens’ reasonable demands, the government can prevent social risks and avoid new negative public opinions. Contributions: According to the characteristics of the basic model of online public opinion, this study provides risk mitigation suggestions for Chinese public sectors to use online public opinion, optimize epidemic prevention policies and formulate strategic measures. It has been more than two years since the outbreak of COVID-19 in 2019. At present, the epidemic prevention and control has entered a new stage—the normalization stage [According to the China Internet Network Information Center (CNNIC), as of June 2022, the number of internet users in China was 1.051 billion, and the internet penetration rate was 74.4%, of which 99.6% use mobile phones to access the internet .Faced with the current situation in China, this study attempts to answer the following questions. What important factors can be identified in the process of generating online public opinion related to the COVID-19? How do we effectively avoid these risks from online public opinion?In recent years, various online social media platforms have been widely used, and people have released a large amount of information to the internet, forming a huge online public opinion database over time. During the epidemic, these data covered all aspects of social life, involving vaccination, isolation measures, food security, urban management, medical assistance and other issues, covering social hotspots and difficult issues in a certain period of time, just like a “Microcosm” of social reality .ThereforIn recent years, some scholars have studied the factors that affect the generation and change of online public opinion . ResearcSome scholars believe that the influencing factors can be divided into objective factors and subjective factors . Among tSome scholars believe that the change of online public opinion has a periodic law, and each stage presents different characteristics . It is pIn recent years, China has been in a period of social transition, with various hidden social contradictions, and the existence of multiple interest groups has the potential to bring about divergent interests and conflicting opinions, which will cause various public incidents and affect state security and social stability ,15. The Researchers mainly focus on the impact of online public opinion on such aspects as public decision-making, political democracy and social stability. In terms of the impact on public policy, there are both positive and negative impacts. Relevant departments can make decisions based on online public opinion on the basis of data collection and information research and judgment to create a favorable environment for public decision-making and implementation. False or disorderly development of online public opinion will affect the public decision-making and implementation of the government ,18,19. IThrough the literature review on the influencing factors and propagation rules of online public opinion, it was found that the research on the influencing factors of new coronavirus online public opinion is mostly concentrated in computer science and other fields. These studies usually analyze online public opinions from the perspective of data modeling ,26,27. AGrounded theory is inductive in its nature and “facilitates the process of discovery” or “theory generation” . The thehttps://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home, accessed on 22 March 2022). This study focuses on important online public opinion events in China under the background of normalization of epidemic prevention and control, uses grounded theory methods to study the key risk factors and change rules in online public opinion events and constructs a theoretical model of online public opinion transmission. Furthermore, the research focuses on primary data, generating concepts from massive raw data. Connections are made by comparing concepts in detail, ultimately building theoretical models based on coding. This paper mainly adopts open coding, axial coding and theoretical coding to complete the qualitative research on the online public opinion text data of COVID-19  of People’s Daily Online publishes the top ten pieces of online public opinion information among the four information sources every week.The PODC releases the ranking information to specific paying users and does not allow users to disclose relevant information. The ranking information is obtained through certain data analysis. The information ranking list of Wechat is a comprehensive ranking based on the search of Wechat hot words. The information ranking list of online communities is a comprehensive ranking based on factors such as the number of hits, replies and social attention of Chinese knowledge communities such as the Zhihu community, Hongwang community and the Huasheng forum. The Weibo information ranking list is a comprehensive ranking based on popular topics on microblogs. The information ranking list of the search engine is a comprehensive ranking of the latest data collected by heat filtering and directional crawling through the public opinion channel of the People’s Daily Online, the monitoring system of Chinese newspapers and periodicals of the People’s Daily Online, Baidu, China Search and Google Advanced Search. The object data come from national and regional important news websites, online communities and blogs.This study selected the information related to the COVID-19 from the four information sources published by PODC from 1 January to 31 March 2022, involving 75 relevant texts, with a total of 74,360 words  was removed from the meaningless information and then re-encoded with three-level coding. The resulting concepts were included in six categories, which was consistent with the theoretical model. The overall test results show that the theoretical model of the public opinion system is saturated.Based on the above research results, especially the basic model of online public opinion, it was found that the operation mechanism of the online public opinion system under the COVID-19 epidemic was mainly affected by the interaction of online public opinion objects, online public opinion subjects, online public opinion intermediaries and government forces.The objects of online public opinion are the stimulus that triggers public opinion, which directly leads to the occurrence and spread of online public opinion. During the outbreak of COVID-19, some events related to the epidemic are likely to become “social facts” that trigger public opinion. The online public opinion objects can attract the attention of the public opinion subjects in the evolution of public opinion, and have close interests with the subjects. COVID-19 has posed a major threat to the lives and health of the masses, is a major challenge to economic and social development, and has formed “social facts” that netizens are most concerned about. As the online public opinion has a certain influence, it will have an impact on the online public opinion objects, and may also derive a series of secondary public opinion events. For example, the public is concerned about the low vaccination rate of the elderly (over 60 years old). In order to actively carry out vaccination for the elderly, the government has accelerated the pace of vaccination. However, whether some elderly people with basic diseases should be vaccinated has become a new public opinion focus. Primary public opinion events and secondary public opinion events together constitute the objects of online public opinion.The subjects of online public opinion play a leading role in practice: especially, the evaluation results of netizens will affect the development of events. Online public opinion subjects include not only netizens, but also ordinary citizens, medical workers, government officials, etc. related to public opinion events. Netizens are the most important part of internet public opinion subjects. The netizens’ concerns, attitudes and emotions will play a leading role in the evolution of the entire public opinion system. As a non-negligible part of the public opinion subject, opinion leaders have played an increasingly important role. Some opinion leaders’ misconduct has directly played a negative role in guiding the development of the whole public opinion event. In the study, it was found that the subject of online public opinion is an unstable but instructive part among all parties involved in online public opinion.An online public opinion intermediary is the carrier on which online public opinion comes into being and changes. The online public opinion intermediary mainly refers to information technology and major network information platforms. In this study, we found that most of the online public opinion events of COVID-19 rely on the spread of public information platforms such as microblogs, WeChat, Tik Tok and the online community, which together constitute the backbone in the dynamic evolution of online public opinion. The online public opinion intermediary is not only a platform for netizens to express their opinions through We Media, but also a platform for official mainstream media to release news and express their attitudes. It is crucial to make good use of online public opinion intermediaries for the trend of online public opinion.Government power plays an important role in the evolution of online public opinion. From holding a government press conference to taking administrative measures, every move of the government affects the fluctuation of online public opinion events. In the context of the COVID-19, netizens are looking forward to seeing a government that is active and responsive. In the theoretical model, the arrangement of government prevention and control measures will directly affect the development of original public opinion events, and the government’s direct or indirect publicity and education will have a direct impact on the values and behaviors of online public opinion subjects. For example, the government urgently allocates living materials to ensure the basic life of residents. These actions have received positive comments from netizens and can create a good atmosphere of online public opinion.The development and change of online public opinion is a complex process, and online social media has greatly released the people’s right to speak. Anyone can express their demands through Weibo, WeChat, online communities and other platforms, and the people’s demands are continuously amplified through the influence of the internet. Only by recognizing, grasping and making good use of online public opinion and finding the mainstream public opinion, can the government interact with the public in a targeted manner. This will also help the government to control social risks and better achieve the effect of concerted efforts to fight the epidemic.The government should actively take measures to prevent negative online public opinion and actively prevent and resolve social risks. Through the analysis of online public opinion data in the first quarter of 2022, we find that as a “barometer” of social sentiment, online public opinion can directly reflect the “explicit demand” of society, which is generally manifested as new claims caused by interest damage and attempts to seek relief. Online public opinion is caused by social events, so the government must take countermeasures against events that may cause online public opinion.The government should identify and prevent the upcoming events that may cause negative online public opinion. This is conducive to taking effective measures from the source to prevent and resolve potential social conflicts in a timely manner. On the one hand, before taking epidemic prevention and control measures, the government should assess the possible impact of the measures on people and take preventive measures in advance to minimize the adverse impact. On the other hand, the government should establish a public opinion monitoring mechanism, collect information through multiple channels, grasp social risks and hidden dangers and timely identify events that may lead to negative public opinion. Intervention shall be made in advance to prevent the risk from expanding.For the events that have occurred, the government should actively pay attention to the evolution of the events and take positive actions to avoid causing more negative online public opinion. For some events that cause negative online public opinion, it is necessary to analyze the causes of the events in a timely manner, evaluate the hazards and impacts and find the parties involved. In short, the government should quickly meet the expectations of the masses and actively respond to their concerns.Although online public opinion is not equal to public opinion, it is necessary to identify mainstream public opinion by identifying online public opinion. Accurately identifying online public opinion is of great significance, and is the key to improving the government’s risk management capabilities. In the above, we have explored and analyzed the model of online public opinion, and we can approach the mainstream public opinion by analyzing “citizens’ appeals“ and “citizen evaluation”.First, identify vague online public opinion. Online public opinion is often ambiguous. For example, for some epidemic prevention and control measures, netizens expressed their complaints and dissatisfaction through the network platform, but did not further clarify their demands . This woSecond, identify impulsive online public opinion. The conflict of online public opinion refers to differences in opinions among different groups, holding different views and positions on the same event. The netizen group itself is complex and diverse. Different netizens have different information, and everyone’s interests are also different. When expressing opinions on an event, different netizens have different opinions. For example, some people think that dancing for nucleic acid testing staff to express their gratitude is very warm, but some people—especially those who are carrying out nucleic acid testing—will think that doing so will affect the normal order of nucleic acid testing . This reThird, accurate identification of public opinion also needs to be combined with the basic theoretical model of online public opinion of COVID-19. Before judging the public opinion on the internet, we need to first analyze the social facts, mainly focusing on the development and changes of the epidemic, such as the scope of the spread of the epidemic, the new number of infected people, the status of social order , and so on. This is the premise of obtaining real public opinion. When we have a basic grasp of social facts, we should pay attention to the demands of citizens, which are also the needs of citizens in the process of the development and change of the epidemic. The needs here are more manifested in the fact that they cannot be achieved by relying on their own strength. For example, due to the rapid development of the epidemic, people began to panic, so some rushed to supermarkets to buy supplies, resulting in a temporary shortage of supplies. Many citizens urgently need to buy vegetables, rice, flour and other necessities of life. When confirming the needs of citizens, we must also eliminate some unreasonable needs. For example, some netizens proposed on the internet that they need to purchase materials with reserves exceeding their actual needs. This unreasonable demand is a false demand and cannot be used as a reference factor.How to respond to the reasonable demands of citizens is the key to the problem. On the one hand, citizens will meet their various demands during the epidemic through their own behavior, on the other hand, they also hope that the government will provide corresponding support and protection. In the case of no epidemic or no serious epidemic, the operation of the government is stable, and the conventional prevention and control measures taken will not cause major social unrest. However, when the epidemic changes, people’s demands will be stronger and their behaviors will be more intense. Meanwhile, if the government still adopts the usual practices, it will easily lead to social instability. We found that some public opinions are generated in the process of the government’s nucleic acid testing of all employees, and there will be new demands of citizens here, such as the need for home testing of the disabled and the desire to provide sunshades for those who test outdoors. These problems will not occur when citizens voluntarily go to the testing institutions when they have their own needs. In these abnormal circumstances, the government must take emergency measures, preferably in advance. According to important information such as social facts and citizens’ demands, the government needs to formulate and improve epidemic prevention and control policies at the macro level, and take appropriate measures in the implementation of specific policies. The effectiveness of the measures taken by the government is directly reflected in the evaluation of citizens. Therefore, in the process of taking measures, we need to pay attention to the evaluation of citizens in time and make flexible adjustments to policies.The government should make good use of online public opinion intermediaries, keep information open and transparent, and maintain information communication with internet users. During the outbreak of COVID-19, people were eager to obtain some important information. The information released by the media with a government background has the characteristics of strong authority, high reliability and great influence. It can play a positive role in guiding the online public opinion by being a timely voice throughout the epidemic. If the government fails to release the information in time, it is likely to cause panic or misunderstanding among the people. There is also the possibility that online public opinion may be misled. Opinion leaders on the internet have an important impact on the development of online public opinion. Their anomie words and deeds will directly play a negative guiding role in the development of the whole public opinion event . For exaThis brief report does not cover the government’s management of online information. The amount of public opinion in the study may not represent the actual number of public opinion events in the first quarter, which may be because some negative online public opinion has been effectively controlled and can no longer be queried.The scientific analysis of online public opinion is an important tool to identify and manage risks and improve the quality of government activities. From the perspective of the modernization of national governance, online public opinion should not be regarded as a threat to risk management, but as a valuable information resource. The establishment of bottom-up information feedback channels is an important mechanism to feedback risks in the social governance system . Online Through the coding analysis of online public opinion samples, we obtained a basic model of online public opinion. This model is based on summarizing node information from many online public opinion events and abstracting the ontology structure of online public opinion. This study makes it possible to analyze and manage online public opinion, and provides a new tool for online public opinion research. The model is simple and easy to understand. On this basis, we can further explore the analysis tools of complex online public opinion. Combined with the logical relationship among the elements, we propose a method to analyze online public opinion by using this model, which provides suggestions for the government for properly handling online public opinion, and provides a new scheme for the public sector to optimize epidemic prevention policies and take measures.