Tea is a popular beverage all around the world. Tea composition, quality monitoring, and tea identification have all been the subject of extensive research due to concerns about the nutritional value and safety of tea intake. In the last 2 decades, research into tea employing electrochemical biosensing technologies has received a lot of interest. Despite the fact that electrochemical biosensing is not yet the most widely utilized approach for tea analysis, it has emerged as a promising technology due to its high sensitivity, speed, and low cost. Through bibliometric analysis, we give a systematic survey of the literature on electrochemical analysis of tea from 1994 to 2021 in this study. Electrochemical analysis in the study of tea can be split into three distinct stages, according to the bibliometric analysis. After chromatographic separation of materials, electrochemical techniques were initially used only as a detection tool. Many key components of tea, including as tea polyphenols, gallic acid, caffeic acid, and others, have electrochemical activity, and their electrochemical behavior is being investigated. High-performance electrochemical sensors have steadily become a hot research issue as materials science, particularly nanomaterials, and has progressed. This review not only highlights these processes, but also analyzes and contrasts the relevant literature. This evaluation also provides future views in this area based on the bibliometric findings. Tea is one of the most popular natural health drinks and is deeply ingrained in people’s lives. Tea trees are grown in around 30 nations throughout the world, yielding roughly 2.5 million tons of tea every year. The introduction of tea trees, on the other hand, can be easily influenced by soil and climate conditions . Furtherelectrochemistry and tea and discovered a total of 865 papers dedicated to the study of tea using electrochemistry from 1994 to 2021, as shown in Tea leaves contain about 700 chemicals that have been extracted and identified. The secondary metabolic components of tea, such as tea polyphenols, amino acids, alkaloids, aromatic chemicals, pigment molecules, and so on, are primarily responsible for its distinctive flavor . They haWe conducted a bibliometric analysis of these 865 studies to see if electrochemical biosensing may replace existing analytical approaches in tea quality control. For the bibliometric analysis and visual presentation, CiteSpace was employed . The anaChanges in electrical signals are the basis for signal production in electrochemical biosensing systems. Changes in current and resistance can be used as signals. Electrochemical oxidation-reduction is present in the bulk of these signal alterations. Under a result, the vast majority of tea research using electrochemical sensing technologies is classified as chemistry, electrochemistry, or analytical chemistry . It’s imDespite the fact that the tea tree is a widely produced plant, tea consumption in various countries has been influenced by cultural factors. As a result, in the scientific study of tea, there is relative independence between countries. Although many nations have actively investigated the development of electrochemical sensing technology in tea, as illustrated in 3+-doped NiO to detect Pb (II) and Cd (II) in black tea.Cluster analysis of the content reveals some of the most important study avenues for this subject. Electrochemical detection, electrophoretic deposition, electrochemical investigation, hierarchical pore structure, caffeic acid, electrochemical analysis, techo-economic analysis, spent tea, carbon paste electrode, oxidative DNA damage, and mixed monolayers structure were among the 11 top themes identified by bibliometric clustering of research on electrochemical sensing for tea . The resThe clustering analysis results included caffeic acid, which is particularly important in tea, in addition to the development of electrochemical techniques and sensors. For the detection of caffeic acid in tea leaves, many of these studies propose an electrochemical sensing device. Chang and colleagues, for example, suggested a ratiometric electrochemical sensor for the detection of caffeic acid . CaffeicTea extracts are frequently utilized to examine the consequences of oxidative DNA damage due to their high antioxidant activity. Yury et al. , for exaTea that has been discarded can be recycled as a valuable biological resource. High-temperature carbonization of wasted tea has been used to make electrodes or electrocatalysts in several investigations . In thesKeyword analysis can also reveal which research hotspots are being followed. The use of citation burst to analyze keywords might reveal how the study topic’s focus has shifted over time. The top 27 keywords with the greatest bursts of electrochemical sensing techniques for tea analysis are shown in Around 2010, due to the development of electrochemical analysis techniques, a lot of work started to focus on the study of electrochemical behavior and antioxidant capacity measurement. It is worth noting that the studies of electrochemical behavior are not primarily an investigation of the electrochemical properties of tea components. According to the specific literature revealed, these works mainly focused on the use of extracts of tea leaves as inhibitors for the corrosion protection of metals. Changes in the electrochemical behavior of metals can be used as a characterization of the degree of corrosion. For example, Rauf et al.  evaluateThe preparation of electrochemical sensors for tea detection has been the hottest topic since 2016. GCE has been chosen as the most commonly used commercial electrode. Different nanomaterials have been synthesized for the modification of GCE. Among them, graphene and its derivatives and gold nanoparticles have been studied the most.According to the results of the preceding two sub-sections’ analyses, the most essential aspect of electrochemical biosensing in the research of tea is the detection of tea components. We used bibliometrics to summarize these specific works. The major characteristics  of various electrochemical sensors for tea composition detection are summarized in From In the design and fabrication of electrochemical biosensors, the electrochemical methodology established by Bard and Faulkner  is the mCluster A has a dense network of pairs, representing work that is largely within a broad theme and is very closely linked. Important papers in this cluster include the work on gallic acid by Abdel-Hamind and Newair , previouBehind the detection of these substances is the passion of scientists for antioxidant substances. The explanation of the principle for antioxidant substances reported by Huang et al.  links clClusters D and E are two relatively independent groups. Cluster D focuses on tea as a source of carbon materials and has been used for energy storage. This cluster was accidentally included in the scope of this review because of the many electrochemical characterizations required in energy storage studies. This is a frequent occurrence in bibliometrics in sample statistics due to the sharing of similar keywords across different research directions. Cluster E is about the kinetic study of the electrochemistry of the tetraethylammonium/water interface. Since the abbreviation for tetraethylammonium is TEA, this literature was also accidentally included in the sample for this review.1) Between 1994 and 2010, electrochemical techniques were often used as a detection step after the separation of samples by chromatographic techniques.2) After the study of tea components gradually came to our attention, the electrochemical behavior of those components that have electrochemical activity began to be investigated.3) Since some important components in tea have very pronounced electrochemical redox behavior, electro-chemical sensors are starting to become a technique to detect the concentration of these components.4) As materials science, especially nanomaterials, has become a hot topic, the use of nanomaterials to improve the performance of electrochemical sensors has become the focus of this field. A large number of papers have been published from 2010 onwards.5) Electrochemical techniques allow not only the detection of specific components in tea but also the evaluation of their antioxidant properties. Therefore, different methodologies based on electrochemical biosensing have been established for measuring the antioxidant properties of tea.This bibliometrics-based review summarizes the progress of electrochemical analysis for tea component sensing. The following conclusions can be drawn based on the focus of research in different time periods:1) The use of novel nanomaterial composites, particularly carbon materials and noble metal nanoparticles, will continue to be popular in the design and fabrication of biosensors.2) Antioxidant property detection biosensors based on DNA ligand technology may become the norm for evaluating tea’s antioxidant properties.in vitro biological experiments.3) Because electrochemical sensors allow for rapid assessment of antioxidant properties, this technique can be applied to a wide range of 4) Miniaturization of electrochemical biosensors is an important step toward applying this technology in the field for food detection and quality control.Based on the bibliometric survey of trends in this area, we believe that future direction is likely to focus on the following areas:


Research has found links between academic failure and criminal offending and suggest that many incarcerated young people have experienced significant behavioral and learning problems in school, which could result in criminal outcomes and poor academic performance. The objective of this study was to analyse writing disorders in impulsive and compulsive prisoners. The sample was composed of 194 male prisoners, of which 81 had been diagnosed with Antisocial Personality Disorder and 113 with Obsessive Compulsive Personality Disorder. Male participants were recruited at the Granada Prison Center. They completed the Demographic, Crime, and Institutional Behavior Interview; the International Personality Disorder Examination (IPDE); The Symptom Checklist (SCL-90-R) and Assessment Battery of Writing Processes (PROESC in its Spanish acronym). We found that prisoners with writing disorders generally have difficulties in the skills necessary to write properly due to impulsive and compulsive behavior. Classic studies in the literature have found links between academic failure and criminal offending  in spite of the long-term negative consequences . Despite the fact that impulsivity and compulsivity are noted for their role in different aspects of response control, there is a high probability that both are mediated by related neural circuits, albeit linked in different ways to motivational and decision-making processes. For example, according to Suhas and Rao , an incrDyslexia may appear due to damage or malfunction in these neural circuits and also in the areas with which they are connected. The complex functions that are linked to these areas could help to explain the possible relationship between compulsivity and oral and written language pathologies. However, to the best of our knowledge, no studies have yet been conducted to demonstrate the relationship between writing disorders and compulsive and criminal behaviors. Thus, the objective of this study is to analyse writing disorders in impulsive and compulsive prisoners.SD = 9.32) and 113 diagnosed with OCPD with a mean age of 38.78 years (SD = 8.47). Male participants were recruited at the Granada Prison Center. Participants were screened using the International Personality Disorder Examination . = 73.962; p < 0.001].To address our study hypotheses, we proceeded to check whether the writing processes evaluated through PROESC differed between the groups. To do this, a Multivariate Analysis of Variance (MANCOVA) was carried out, for a between-group unifactorial design, using educational level as a covariate; group (ASPD and OCPD) as the independent variable, and the variables derived from the Battery for the Evaluation of the Writing Processes in the Dictation mode  as dependent variables. This analysis revealed statistically significant differences between the groups , the scores being higher for the ASPD group than for the OCPD group; for Words with Lexical Spelling  with the ASPD group showing lower scores than the OCPD group; for Words with Rule-based Spelling  with the ASPD group showing higher scores than the OCPD group; for Pseudowords , with the ASPD group showing higher scores than the OCPD group; for Pseudowords with Rules-based Spelling  with the ASPD group showing higher scores than the OCPD group; for Accent Phrases  with the ASPD group showing higher scores than the OCPD group; for Capital Phrases  with the ASPD group showing higher scores than the OCPD group; for phrases with Punctuation Marks  with the ASPD group showing higher scores than the OCPD group . These ANCOVAs revealed statistically significant differences for Syllables [roup see .In the present study we evaluated writing disorders among a sample of impulsive and compulsive prisoners. In particular, we sought to confirm the original observation of an orthographic lexical disorder in OCPD prisoners, which could be similar to dyslexia. First, the OCPD group showed lower scores on Syllable Dictation in comparison with the ASPD group. For example, they have written, in Spanish, the syllable /wi/ instead of /güi/, or /zoo/ instead of /zo/ creating a real word from a syllable. Many OCPD prisoners added accents to the syllables and were doubtful with regard to the use of the /h/ at the beginning of the syllable. Moreover, most of the OCPD prisoners eliminated the last /-s/ or even added it in other cases, whilst they also changed /-l/ to /-r/, or /ch-/ to /x-/. Although these findings have never been described by other authors, Nicolson and Fawcett , Nigro eSecond, the OCPD group showed higher scores on Words with Lexical Spelling in comparison with the ASPD group. This is a novel finding that could be explained by the characteristics of the OCPD profile. According to Nicolson and Fawcett , this kiinjectar for inyectar). These results are extremely novel, given that there are no recent studies that have examined spelling disorders in OCPD prisoners, although Afonso et al. . They also failed to correctly use the Spanish graphemes /y/, /j/ and /g/ . These results are congruent with those of Martínez-García et al. (Fourth, the OCPD group obtained lower scores on Pseudowords and Pseudowords with Rule-based Spelling than the ASPD group. This finding could be explained by the fact that OCPD sufferers are strict and inflexible with orthographic rules or the OCPD group in our study have not acquired them (Cain et al., a et al.  and Suzua et al. , indicatFifth, regarding formal aspects, the OCPD group obtained lower scores on Accent Phrases, Capital Phrases and Phrases with Punctuation Marks than the ASPD group. This could be due to an alteration in certain cognitive elements of written composition such as the implementation of grammatical judgments and syntactic-semantic composition. These striking and novel findings are consistent with the results reported by Gutiérrez-Fresneda and Díez-Mediavilla  who demoIn conclusion, prisoners with writing disorders are generally lacking the skills needed to write as a consequence of compulsive rather than impulsive behavior. OCPD is characterized by pervasive patterns of preoccupation with orderliness, along with perfectionism that is manifest in the preoccupation with details, rules, order, and organization. Moreover, OCPD sufferers show mental and interpersonal control at the expense of flexibility. This perfectionism could explain why people with OCPD perform behaviors or tasks in a recurring and repetitive way. These types of behaviors are also characteristics of dyslexia. Whilst no studies have been conducted to confirm this possibility, dyslexia and compulsivity share common biological bases (D'Mello and Gabrieli, It is important to acknowledge certain limitations of the present study. The first limitation could be due to the selection of men instead of a mixed gender sample, although we have evaluated crimes such as gender abuse, which is understood to mean male to female aggression, and the prison population contains five times more men than women. The second limitation is related to the measures used, which might involve the cognitive processes implied in language such as learning, attention, working memory, and executive functions. The third limitation is associated with the lack of dyslexia and control groups. In order to overcome these limitations, future research studies could include these new groups and could also attempt to evaluate the cognitive processes involved in language. However, the main strength of this study is that it is the first to analyse each part of the PROESC separately.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University of Granada. The patients/participants provided their written informed consent to participate in this study.The main idea of this study and the exhaustive bibliographic search was developed by LM-L, FL-T, and FS. LM-L and FL-T took the samples from the participants. LM-L, FL-T, and FS wrote the manuscript and revised the text in its different versions. All authors participated in the statistical analysis.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


During the last few decades, income inequality in emerging Asian economies has been increased dramatically. It is widely recognized that income inequality has severely impacted population health. This study attempts to estimate the impact of income inequality on health outcomes in emerging Asian economies for a time horizon ranging from 1991 to 2019. Our empirical analysis shows that income inequality has a negative effect on life expectancy in the long run. We also find that positive changes in income inequality decrease life expectancy, but a negative change in income inequality increases life expectancy in the long run in emerging Asian economies. The symmetric and asymmetric results are robust to different measures of econometric methods. Thus, governments should pay more attention to the consequences of their economic policies on income inequality to improve health outcomes. To be healthy is the primary concern of any individual because, without health, a person cannot play an active role in any walk of life. If a person remains unhealthy for a longer time, he cannot take care of himself, his family and become a liability for society. On the other side, a healthy mind and body can contribute to the socioeconomic development of society in many ways; thus, it becomes an asset for society. However, deciding whether a person is healthy or unhealthy is difficult because health is not just the absence of illness but much more. Wolinsky and Arnold  recommenLiterature on health and social science is filled with the growing number of studies with regard to the effects of income, poverty, and social policies on a person's physical and mental well-being , 5. SeveThough several studies in the past have focused on the health status of the people within different countries Mahasneh et al. , howeverAfter the economic crisis of the year 2008, the awareness related to the consequences of income inequality increased in the USA and all across the globe. These concerns were not baseless; instead, based on the fact that during the period 2009–2012, there was a 31.4% rise in income of the richest 1% of people against 0.4% of the bottom 99% people . The conBesides, these people are also not highly educated, which repercussions an individual's health . As the Our main motive is to capture the impact of income inequality on health. To achieve that goal, we have borrowed a model from Bakkeli .Specification (1) is the health function that relies on income inequality (Gini), gross domestic product (GDP), unemployment, and education. We used life expectancy as a proxy of health. To convert this equation into panel ARDL-PMG, we need to, respectively. equation (1) into error correction format as described below:Arrangement (2) has now become panel ARDL-PMG of Pesaran et al.  and Pesa+, whereas Gini represents the negative shocks in the series−. Next, we replace these partial sum variables in the place of original variables in equation (2), and the outcome of this action is shown below:The positive shocks in the series are represented by GiniEquation (4) is known as the panel NARDL-PMG model proposed by Shin and Greenwood , and thiFor robust analysis, this study is used pooled-OLS (P-OLS), dynamic ordinary least squares (DOLS), and fully modified ordinary least squares (FMOLS) estimators in analysis. The DOLS and FMOLS are highly efficient in handling the issue of serial correlations in the error terms and endogeneity among regressors. The FMOLS is considered one of the non-parametric approaches that control autocorrelation and endogeneity problems Pedroni , whereasTo do empirical analysis, we collect cross-sectional data for five Asian emerging countries, namely China, India, Japan, Indonesia, and Turkey. The data set is missing of our focused variables which were observed from 1991 to 2019. The missing data is completed through the extrapolation method. To measure health outcomes, life expectancy at birth, total (years) variables are employed. The elements used in our analysis are the Gini index which measures income inequality, GDP per capita (current US$), unemployment, total , the average year of schooling (education). The data set was constructed from the , 29.First of all, we apply three different panel unit root tests to confirm whether our variables are stationary at level or first difference because the application of NARDL requires that none of the variables in the model should be I . For thaTo investigate the relationship between income inequality and health outcomes, we have decided to apply the linear and non-linear panel ARDL-PMG as our baseline models, reported in From This finding is consistent with Qasim et al. , who infAfter the financial crisis of the year 2008–2009, people started to raise their voices against income inequality and its related problems because during the period 2009–2012, the income of the top 1% richest people in the USA increased drastically while the income of other 99% increased marginally. Such a drastic difference in the income of the two factions of the society raised eyebrows of many. On one side, economic inequality will negatively affect the mental health of the lower-income class due to a sense of deprivation. On the other side, the number of social capital facilities for this class will also be reduced. They also do not have access to better education facilities; hence, the level of awareness among them vis-à-vis their health status is very low. Furthermore, as the economic disparity between the rich and poor class increases, it also increases the difference between their socioeconomic status and related indicators such as education, living standards, health, and the problem is more severe in the emerging economies . Our finAmong the control variables, the estimates of GDP are insignificant in the baseline linear and non-linear models, whereas significant and positive in all the robust models, implying that as the level of affluence in the economy goes up, life expectancy also increases. The estimated coefficient of UNEMPLOYMENT is negatively significant in the linear baseline model, whereas positive but insignificant in the non-linear baseline model. Similarly, UNEMPLOYMENT estimates are negatively significant in the linear and non-linear models with all three estimation techniques in the robust models. These findings suggest that a decline in the level of unemployment will have a positive impact on health outcomes. However, the size of the estimates is too small in the baseline, and the robust models suggest that though the decline in the unemployment rate improves the health status of the people in emerging Asian economies, the magnitude of these effects is not that large. Finally, the EDUCATION variable appeared to be significant and positive in the linear ARDL-PMG model and insignificant in the NARDL-PMG model. On the other hand, in the linear and non-linear robust model, the EDUCATION estimates were positively significant with any estimation techniques. We can deduce that education can make people more cautious about their health status, and consequently the life expectancy increases.xed, to say the least. The detailed results of the causal analysis are provided in The health of the population is a significant economic concern for the world. It plays a central role in the development process. Therefore, this study empirically examined the asymmetric impact of income inequality on health status in Asian emerging economies. We found that income inequality has a statistically negative significant influence on health in the symmetric model in the long run. Similarly, asymmetric findings of income inequity have deviated from the symmetric model in the long run. A positive change in income inequity negatively impacts health, while a negative change in income inequity positively impacts health in the long run in emerging Asian economies. Findings show that income inequity has no impact on health in symmetric and asymmetric models in the short run. The robust regression models of study have obtained similar findings of long-run in FMOLS and DOLS. Regarding control variables, unemployment is negative, and education positively impacts health in the long run. Unemployment has an unfavorable impact on health in the long run. Education is one key determinant of health outcomes, as education has favorable impacts on health in the long run.Regarding implications, the authorities can improve the health of the population via the redistribution of income. Policymakers should also reduce urban-rural inequality for better population health. Government should provide better health facilities to poor people. Asian policymakers should focus on strengthening the basic health care systems in their countries to reduce the adverse effect of income inequality on health. Asian governments give special attention to reducing health inequality. The governments and the international community should pay more attention to the consequences of their economic policies on income and health inequality to improve population health. A well-designed “National Health Insurance Scheme” in emerging Asian economies can significantly alleviate inequalities in health.This research could not found a relationship between income inequality, mental and physical health outcomes. The study could not incorporate the COVID-pandemic in empirical analysis. There is a need for further work to scrutinize the impact of income inequality on mental and physical health at micro-level data. This kind of work will help explain how income inequality impacts health outcomes for different population sectors. Such studies will further improve our implications on health. Finally, future studies on the link between income inequality and mental and physical health might use other measures of income inequality such as Gini coefficient, Palma ratio, Decile ratio, Theil Index, Lorenz curve, and Log Mean Deviation. The upcoming studies assessing the key determinants of income-related health inequalities during the COVID-19 pandemic are significant for redesigning appropriate policies.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.SC: conceptualization, software, data curation, and writing—original draft preparation. BG: methodology, visualization, and investigation. Both authors contributed to the article and approved the submitted version.The paper was supported by the Project of Humanities and Social Sciences of Cultivation Plan for 1,0000 Middleaged and Young Backbone Teachers in Higher Education Institutions in Guangxi (2020QGRW016), the Natural Science Foundation of Guangxi Province of China (AD20159052).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers’ and retailers’ perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context. The Gloht loss” . DespiteSEA countries have experienced an increase in overweight and obesity prevalence, including Indonesia, Malaysia, the Philippines, and Thailand. In Indonesia, the prevalence of overweight and obesity in 2013 was 13.5% and 15.4%, respectively. In the span of five years, the prevalence of overweight increased by 0.1 percentage points, and obesity increased by 6.4 percentage points ,9. In MaModifying the obesogenic environment at the community and policy level to promote healthy food should help to create and reinforce social norms for the consumption of healthier food . As partASEAN (Association of South East Asian Nations) member governments have expressed a high-level commitment to combat all forms of malnutrition, which is believed to be slowing down socio-economic development . HoweverMany questions remain unanswered regarding the retail food environment in SEA. For example, it is unclear to public health policymakers what the retail food landscape looks like, how the average consumer interacts with the retail food environment, what the drivers of food retailer decision-making are, and what public policies are of most relevance to food retail, and why. In addition, the growing disruptions caused by the COVID-19 pandemic continue to present challenges to supply and demand of consumable items. The pandemic has exposed the fragility of the food system, particularly food distribution , which iTo increase access to healthy foods, retail stores can play an important role in driving change by offering consumers a wider choice of culturally acceptable and affordable foods to promote healthy eating. In common with many nations, SEA countries are currently undergoing a food retail transition. For example, Thailand and Malaysia have experienced a rapid growth in large food retail formats, such as supermarkets ,22. MeanIn addition, packaged and processed foods are increasingly available in convenience stores across the SEA region. Use of convenience stores is growing rapidly, with sales in 2020 at least double those in 2015 in the Philippines, Malaysia, and Indonesia . HoweverTo analyze the characteristics of the national food retail landscape in Malaysia, Indonesia, the Philippines, and Thailand.To explore the consumer experience of their retail food environment, and to assess the retail food environment in selected urban poor areas.To analyze retailer decision-making relevant to selling healthier food in urban poor areas.To analyze the policy landscape relevant to the national retail food environment.The aim of the SEAOFE study is to improve understanding of the retail food environment, consumers’ and retailers’ perspectives on factors influencing their food retail-related decisions, as well as the existing national-level policies and actions influencing food retail in SEA. The results of this research should help to inform policy design and implementation across the sectors that govern the food supply. The specific objectives of the research are as follows:The SEAOFE uses a mixed-methods sequential explanatory study design, and the proposed implementation consists of four phases . The resThis study defines the ‘retail food environment’ according to the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) , which cThe SEAOFE study will be conducted in Malaysia, Indonesia, the Philippines, and Thailand. These countries were selected based on similarities and differences in relation to food and nutrition policy, as well as socio-demographic and economic disparities. These countries are all ASEAN member nations with middle-income economies , and varThis study will be conducted in line with appropriate standards of research ethics, and approval of the study protocol has been obtained from the research ethics authority in each of the study countries. Reports of findings will present aggregated anonymous data in all publications. The proposed study will be conducted over four years, with approximately one year planned for each phase. In September 2020, the first Coordination Meeting among the four study countries was convened to discuss the protocol development. resale  of new and used goods, mainly to the general public for personal or household consumption or utilization, by shops, department stores, stalls, mail-order houses, hawkers, peddlers, consumer cooperatives, auction houses, etc. Most retailers take title to the goods they sell, but some act as agents for a principal, and sell either on consignment or on a commission basis” [where food is prepared and intended for individual portion service and includes the site at which the individual portions are provided, whether consumption occurs on or off the premises” [“Retailing,” based on the definition of the International Standard Industrial Classification (ISIC), is the “n basis” . The retn basis” . Sale win basis” . Based on basis” . For theremises” .This study will focus on the following major categories of food retailers, as defined by FAO, 2009 :2 with at least 35% of selling space devoted to non-food items. Sometimes, hypermarkets are also called “super stores,” which are a combination of a supermarket and a department store. Hypermarkets are usually located in suburbs due to the limited space available in city centers, and the need for large parking areas for shoppers. Some hypermarkets are located close to residential areas and can be adjacent to shopping centers that sell consumer electronics, furniture, durable and leisure goods, etc.).Hypermarket: A store with a sales area of over 2500 m2 with at least 70% of its selling space dedicated to food and beverage products.Supermarket: A store with a sales area of typically 400 to 2500 mConvenience stores (C-stores): These outlets sell a wide range of goods, and have extended operating hours. A convenience store is often located alongside a busy road, as part of a gas or railway station, or in a densely-populated urban area. Product selection is limited compared with supermarkets and, in many stores, only one or two choices are available for each type of product. Prices in convenience stores are typically higher than in supermarkets.Traditional retailers” are those who source merchandise from traditional traders  and sell to consumers in wet markets , or modern retailers or those who procure mainly from domestic and multinational food manufacturers and sell through modern supermarket outlets [Modern retailers rely on formal markets, are easily accessible, and have a high level of food promotion strategies . Moreove outlets . This phase will describe and interpret the characteristics of the retail food environment in each study country, and provide the basis for Phase Two selection of an important retail sector for in-depth analysis. Findings from an interdisciplinary review of recent data and relevant literature will be used to define the characteristics of the current retail food environment in each study country. A broad range of databases will be searched. Source materials that are available in either English or local language(s) will be included. Next, the researchers will identify suitable locations and/or categories of retailers for in-depth focus in the subsequent phases. This step will use the analytic hierarchy process (AHP) for prioritization of study sites.The first phase will initially use Google to search for sources of data related to the national food landscape for each country, and limit the search to the first ten screen-pages of results. In addition, the researchers will scan books, reports, working papers, websites of food retailers/government/intergovernmental agencies, market research databases , and other grey literature for contextual information of relevance to the retail food environment. Each country will use the same Microsoft Excel spreadsheet format to map their findings for each indicator from several data sources as identified by the Google search. This phase aims to comprehensively understand the recent dynamics of the retail food environment, especially in the context of the response to the COVID-19. Therefore, data sources will be limited to reports published/completed between 2010 and 2020. Researchers from each country team will carry out the search for their country, and will translate relevant data labels/explanations into English if needed.Similarly, the researchers will collect information about the spread of COVID-19 in each study country to explore the potential implications of the pandemic for food retail. Each research team will use the same keywords to search for relevant news items/articles, which describe the impact of COVID-19 on the retail food environment in their respective country. News text on food retail will be obtained through Internet search, Scopus, and other relevant news outlets. Throughout this phase, the researchers define ‘food retail’ as an outlet that sells fresh and packaged food or food products, excluding food service .For the selection of news source, the research teams will use those most relevant to their country. The search will be limited to the major news outlets in each country. Each country will then collect all the news items/articles that appear in the first five screen-pages of the keyword search. All items will be summarized and coded per theme. At least two coders will confirm each other’s assignment of an item to a particular code.The research teams will determine the timeframe for the search according to each country’s COVID-19 situation. The beginning of the timeframe should start on the week that their respective government enacted any national regulation or measure to contain the spread of COVID-19, and extend through the end of 2020.Data will then be entered into a pre-formatted Excel spreadsheet to allow further analysis within and between countries. All data sources, by year published and the name of the individual who conducted the search, will be documented on the first page of the spreadsheet.To analyze and synthesize the findings from the included literature, this phase will employ a ‘narrative synthesis,’ which is a flexible approach that allows the reviewers to be reflective and critical when reporting on the studies identified in this phase .Two key outputs of this phase will be the provision of comparable data to classify potential ‘types’ or ‘categories’ of retailers that could be considered ‘hotspots’ in the emerging obesogenic food environment of each study country. Each research team will use Phase One data to apply AHP ,41 to naIn the AHP process, the research team in each country will invite three to seven experts in food retail and other relevant stakeholders, who are purposively selected, to rank the type of retailers by importance and relevance. The research teams will then prioritize food retailers based on the AHP method formula. The outcome of the AHP will determine what type/category of food retailer will be the focus of the subsequent phases of this study.This phase will interpret the consumer experience of the retail food environment in selected urban poor areas. This will be conducted in relation to the retailer types identified in Phase One as having relevance to the obesogenic food environment for each study country. This phase uses a cross-sectional design to assess consumer perception of their retail food environment and consumer behaviors in relation to this environment, and the association of these with socio-demographic characteristics  of the study population. The analysis will draw on concepts of food and nutrition environments and consumer behavior ,42,43. CThe association of malnutrition with urban poverty is evident, especially in middle- and lower-income countries ,46,47,48Proportionate stratified sampling will be used to select respondents (aged 18 years or older) who report purchasing a food/beverage from the selected retailer in each study location. The respondent who shops at the selected retail outlet will be systematically intercepted (every nth person to avoid bias and ensure representativeness) based on pedestrian traffic. The minimum sample size for problem identification in marketing research is 500 respondents, while a typical sample size is 1000–2500 respondents . Thus, tThe SEAOFE questionnaire will be completed through an intercept survey using in-person or telephone interviews, or through an online survey platform, depending on the COVID-19 epidemic situation and restrictions in each country. The questionnaire will take approximately 15–30 min to complete, and consists of questions on sociodemographic characteristics, food shopping preference, factors influencing food purchase and the respondent’s perception of the retail food environment, including food availability and adequacy. Questions include what they usually buy at the retail store, how much they spend (on average) on those food items, where else do they usually go to buy food, how has COVID-19 affected how much food they buy at the retail store, reason for shopping at the particular store, the importance of specific factors in influencing food purchase and a question on customer satisfaction on the overall shopping experience at the particular retailer.Prior to data collection the research teams will (i) conduct forward and backward translation of the questionnaire from English into the relevant local language(s), and (ii) pretest the questionnaire with local participants in each study country, to ensure the suitability of wording, terms used, sequencing of questions, interview time, and other issues likely to affect the accuracy and completeness of response. Data collection will be completed at different times of the day  on all seven days of the week. Data will be collected across a range of time periods to accommodate individual shopping patterns . TrainedSPSS version 25  will be used for data analysis. Descriptive statistics will be used to characterize consumer purchasing behavior and perception of the retail food environment. Mean and standard deviation (SD) of each variable will be presented. Both bivariate and multivariate statistics will be used to examine the relationships between sociodemographic factors and the type of food retail and food products purchased by consumers. For bivariate analysis, cross-tabulation along with Fisher’s exact test will be conducted. Results of the multiple regression analysis will be estimated using maximum likelihood estimation.The researchers will expand on the Monitoring Availability, Placement and Promotion—Supermarkets (MAPP-S) audit tool , and adaData will be collected at the selected retail food outlets based on the findings of Phase One. This will involve measurement of the floor length and height/width allocated to particular products, a count of shelves allocated to various products, categorization of the location of various healthy and unhealthy products  and the type of price promotion used in these areas. The healthfulness of products was adapted from the Australian Dietary Guidelines , as all The researchers will review the MAPP-S-validated indicators by study country context, and conduct a pretest of the tool. Written approval will be sought from the retailer  prior to data collection.Descriptive analysis will be used to calculate the mean value of each outcome variable, e.g., in-store availability, placement, and promotion of healthy and unhealthy foods and beverages. The mean values of these outcome variables will then be analyzed across different types of retailers in each study country by pairwise comparison. In addition, several multivariable linear regression models will be used to explore factors, which may have a statistically significant effect on the outcome variables. The analysis should help to explain how in-store availability, placement, and promotion of healthy and unhealthy foods and beverages vary across retailers.The aim of this phase is to understand the factors influencing a food retailer’s decisions relevant to stocking policy, their perception and attitude toward food retail policies, and opportunities that will facilitate the supply and promotion of healthy and unhealthy foods through food retailing in each study country. Food retailers, as marketing firms, operate in bilateral contingencies ,65. TheiThis research will use an embedded mixed-method approach in which the quantitative data play a secondary role to the qualitative data . The quaIn each country, at least 15 candidates for interviews  will be recruited through telephone or email. Eligible respondents should have the authority in making procurement, retail, and product placement decisions, and should have at least one year’s experience in his/her position at the retail food outlet.Open-ended interview questions (with prompts) will be used to explore the food retailer’s business strategies and their relationship with suppliers. The interview guide will probe emergent themes  and their interrelationships. Quantitative data will include retail food store characteristics  and demographic information of the retailers. Before data collection, the interview guide will be pretested to validate the questions.Interviews will be audio-recorded, and interviewees will be assured of anonymity of response. Written or oral informed consent will also be obtained from the interviewees.Audio recordings will be transcribed non-verbatim  into a Microsoft Word file . Member The outputs from Phase Three will identify and provide a better understanding of factors influencing food retailer decisions, and their perception and attitude toward food retail policies and opportunities that could facilitate the supply of healthy food through product retailing in each study country. The outputs from this phase, together with the outputs from Phase Two, will inform the development of an interview guide for use in Phase Four.The aim of this phase is to identify key opportunities for policy to improve the retail food environment, increase the availability of affordable healthier food in each study country, and decrease the availability of unhealthy food.This phase will use a policy space analysis approach ,71 to anThe interview guide will be informed by the points of leverage identified in previous phases, and will be used to examine how policy could incentivize positive  changes in the retail food environment. The final number of key informant interviews will be based on theoretical data saturation, i.e., the point at which no new themes or information emerge, and content becomes redundant. Following established methods for case study research , a likelThe key stakeholders involved in policy implementation will be identified using purposive sampling, implemented in two stages. The first stage will involve a search of policy documents through government websites and documents, NGO publications and websites, and major newspapers in each study country. In addition, the researchers will make direct overtures to representatives of key government ministries and non-government agencies , and issue formal invitations to the heads of agencies to participate in the study. The second stage will involve snowball sampling to identify additional relevant stakeholders.The content of the interview guide will be informed by findings of previous phases, and will focus on the following: (1) perceptions of the ‘problem’ of nutrition and diet-related NCDs; (2) understanding among policy actors of the potential role of retail food in improving diets; (3) political context; (4) stakeholder influence on current policy; (5) gender considerations. Prior to data collection, the interview guide will be pretested to validate the questions. Interviews will be conducted in person and audio-recorded.disincentive’ or ‘barrier’ is used, or (2) there is mention of something that deters the implementation of improvements to the nutrition and food retailing system. This phase will then draw on the interview data to analyze the policy context and stakeholders in order to better understand the political economy of retail food policy. Last, this phase will draw on the findings of previous phases to analyze how policy could address points of leverage for improving the healthiness of the retail food environment, and to provide policy recommendations.In this phase, the researchers will first analyze relevant policies across sectors  with a focus on current and potential incentives and disincentives relevant to healthy retail food, and use deductive thematic analysis based on the study framework. The following two criteria will be used to identify incentives: either (1) the concept of an incentive or facilitator is used, or (2) there is mention of something that may encourage or help to facilitate policymakers and/or government agencies to improve good governance for nutrition and increase healthy food retailing. Similarly, the following two criteria will be used to identify disincentives: either (1) the term ‘After completion of Phase Four, a stakeholder meeting between government and non-government actors will be organized in each study country. The preliminary results from all phases and policy recommendations will be reported to the stakeholders. The meeting will expose a wide range of stakeholders to the results of the research, and solicit their professional opinion and critical assessment of the conclusions and the potential impact on the second opinion directive.Following the in-country analysis, the researchers will examine the similarities and differences of the findings across study countries to identify any regional patterns in retail food policy, and distil any lessons at the regional level.To the best of the authors’ knowledge, this will be the first study to comprehensively analyze the retail food environment, consumer and retailer perspectives regarding the retail food environment, as well as existing policies influencing food retail in Indonesia, Malaysia, the Philippines, Thailand, and in SEA generally. A mixed-method approach to data collection will be applied, including quantitative (surveys) and qualitative (in-depth interviews) methods. Although Malaysia, the Philippines, and Thailand have previously conducted an assessment of their respective food environment as part of the INFORMAS Project, these assessments focused on the particular domain or setting of the food environment. Malaysia and the Philippines conducted their assessment of the food-promotion domain, while Thailand conducted an assessment of the food-retail domain only in the school setting . There iThe proposed research is a collaboration of researchers who are already engaged in nutrition/food environment policy in each study country. The research is also designed so that there is ample opportunity for two-way engagement with policy actors in each study country.This study will strategically engage stakeholders throughout the research to ensure that the design is sensitive to the local context and creates opportunities for policymakers and other stakeholders to be informed of and to apply the research findings. The research teams will convene open public forums for policy stakeholders (government and non-government) at the beginning and end of the study. Stakeholder consultations involving design and policy relevance have been completed. There will be an end-of-project forum to present final results of all four study countries. The researchers will also conduct one-on-one consultations mid-project in order to keep key stakeholders from government, civil society, academia, and the private sector engaged.The researchers will disseminate key findings through policy briefs for every phase of the study, and produce final country reports for stakeholders.The research teams in the four study countries will produce comprehensive case studies, and collect the data in such a way as to permit direct, cross-country comparisons. The structure of the government varies in important ways among the four study countries. This is an advantage, however, since it will allow comparisons of the food retail policy environment across different facets of socio-demographic and economic dimensions.The SEAOFE study will be the first international comparative study that provides comprehensive evidence for policies to facilitate healthier retail food and, thereby, en-courage consumption of healthy food. The study will analyze consumer experience and retailer perception of the food environment, the in-store retail environment, and existing food policy context in a single, integrated, comprehensive design.This study brings together what are usually discrete studies. Conducting them in an interconnected way, brings information on communities, food retail and policy together to collectively strengthen the study findings.The study will also provide a multi-stakeholder engagement platform for policy dialogue to discuss how to collaboratively address the growing burden of malnutrition through improving the retail food environment in the study countries and in SEA generally.The protocol has been designed to allow each study country to adapt the tools and processes to fit the national context, and the protocol can also be applied in other countries with a similar context. In this way, the research has the potential to contribute to the collection of regional and global evidence of the food environment in low- and middle-income countries. That said, the proposed research is limited to the retail-ers around urban poor areas, with detailed data on only selected retail sectors in those areas in each study country. Thus, many forms of informal retail are not included. Other limitations may relate to sampling and recall bias of survey participants. Nonetheless, a broad understanding of the retail food environment in pre-COVID-19 and pandemic eras will be obtained from the literature review.The SEAOFE study will generate evidence on consumer and retailer experience of the food environment, and the existing food policy context (including barriers and opportunities for policy change) in the SEA region.The four study countries differ across economic and socio-demographic contexts. Therefore, the country case examples provide an opportunity to learn from each other’s progress and challenges, and will aid in identifying areas for continued work.In this way, the research has the potential to contribute to the regional and global knowledge base on the food environment in low- and middle-income countries, and to improve understanding of the barriers and facilitators to policy change.Any new evidence of food environment interactions, together with the detailed analysis of policy content and context will be used to identify specific opportunities for policy change that would facilitate consumption of healthy food through improving the external food environment in each of the four study countries and in SEA generally. The research will also inform key decision-makers directly through dissemination of policy briefs and stakeholder engagement.


Assistive technologies including assistive robots (AT/AR) appear to be a promising response to the increasing prevalence of older adults in need of care. An increasing number of long-term care facilities (LTCFs) try to implement AT/AR in order to create a stimulating environment for aging well and to reduce workload for professional care staff. The implementation of new technologies in an organization may lead to noticeable cultural changes in terms of social interactions and care practices associated with positive or negative emotions for the employees. This applies especially for LTCFs with high rates of vulnerable residents affected by increasing care needs and specific ethics in nursing and cultural rules within the setting. Thus, systematic consideration in leadership management of emotions and ethical aspects is essential for stakeholders involved in the implementation process. In this article, we explicitly focus on the emotions of the employees and leaders within LTCFs. We relate to direct consequences for the organizational well-being and culture, which is of course (indirectly) affecting patients and residents. While aspects of technology acceptance such as safety and usefulness are frequently discussed in academic literature, the topic of emotion-management and ethical questions during the organizational implementation process in LTCFs received little attention. Emotional culture entails affective values, ethical norms and perceptions of employees and further investigation is needed to address the importance of transformational leadership during implementation process. For this purpose, we developed a three-staged assessment tool for implementation of AT/AR in long-term care institutions. Acceptance (A), ethical acceptability (A) and emotional consequences (E) are considered as comprehensive assessment, in which emotional consequences comprise management aspects of transformational leadership (T), emotion-management (E) and organizational culture (O). Based on AAE and TEO, this paper presents an integrated framework illustrated with a illustrative example and aims to combine established approaches with ethical insights in order to unfold potentials of AT/AR in LTCSs. Digitalization 4.0 and assistive technology including assistive robotics (AT/AR) evoke certain aspirations in health care with regard to well-being and economic arguments . In Marc“The impact of assistive technology goes far beyond the benefits of health and well-being to individual users and their families. It also has socioeconomic benefits, by reducing direct health and welfare costs , enabling a more productive labor force, and stimulating economic growth” , p. 3.1 n this way nurses are portrayed as multi-skilled emotion managers who both comply with and resist the organizational constraints which exist around them.” Idealized influence” represents the role model function of leaders. A clear orientation of values, which is reflected in the attitude of the leader, provides orientation for employees. Furthermore, the authors emphasize that in this form of leadership, managers put their own interests behind those of the organization as a whole. Such leadership behavior triggers respect, admiration and trust among employees.“(2)Inspirational motivation” is about motivating employees through challenging and attractive goals. The meaning of these goals must be made clear. By pursuing a common goal, team spirit, optimism and commitment can be fostered.“(3)intellectual stimulation” of employees. Creativity and problem-solving skills of employees should be promoted. In the long term, employees should acquire the ability to critically question outdated assumptions, routines and habits and find new approaches to solutions.The approach also emphasizes the role of “(4)individualized consideration,” employees should be individually supported according to their personal strengths, weaknesses and expectations. The leader acts as a kind of coach and promotes the development of the professional perspectives and potentials of the individual to a higher level (ibid.).Within the framework of “Transformational leaders express themselves through aspects such as inspiration, vision or personal role model action and thus deliberately appeal to emotions of their employees in order to support them as well as consecutively raise their acceptance, aspirations, motives and goals . TransfoThe implementation of new technologies in an emotional-sensitive setting like LTCFs require specific leader behavior in respect of the identity and stability of the care personnel. Following the approaches of emotion-management and transformational leadership, the successful implementation and realization of profound change and innovation processes can be decisively supported by shaping an emotional relationship between leaders and those led . In lighacceptance (A), ethical acceptability (A) and emotional consequence (E). Together, they form the acceptability and emotional consequences (AAE) model according to our perspective. In a subsequent step, we apply this model to our illustrative example and use it to arrive at a holistic evaluation of the implementation for the organizational culture.Following the work of When addressing the issue of technology acceptance, it is important to consider the needs and characteristics of potential users. Persons in LTCFs are more frequently confronted with experienced functional losses and decreased coordinative and sensory abilities. These difficulties cause individuals to perceive, use and accept technology differently.One of the most prominent concepts is the “Technology Acceptance Model (TAM)” by The further developed TAM2-Model  considerAll TAM-models in their modification are considered to have been empirically tested many times. However, these models have hardly been applied in relation to persons in need of care or in care homes.In the Almere model, In summary, these prominent and empirical tested models for technology acceptance focused on various aspects of acceptance such as perceived usefulness, ease of use, or voluntary in use. In the prominent triangle of caregivers, care recipients and technology, organizational culture and ethics were, however, mentioned only in passing.For an ethical evaluation acceptance alone is not a sufficient criterion. A humane perspective does not first ask about the usefulness of a technology for solving concrete practical problems or a mere acceptance. It asks about acceptability against the background of the consequences of a technology’s use for the image of humanity and coexistence. First of all, AT/AR in care contexts are undoubtedly something good, if what they help to achieve in turn produces something good in the end.Justice, self-determination, privacy, etc., and the criteria for nursing formulated by We first take a look at already existing instruments of ethical evaluation of AT/AR before we sharpen and propose our position. An ethical evaluation-model popular in the context of Ambient-Assisted-Living (AAL) is the MEESTAR-Model  , 2020. IBeyond procedural ethics, we have to refer to models with a strong concept of acceptability , like foAccording to this view, the use of technology is acceptable if it enables every human being to live up to the responsibility given to her/him (by God or by reason) before herself/himself, before each other (and before God or before reason). The unconditional human dignity as the basis of humanity and thus of ethics is then justified, for example, in the idea of the image of God in man (Christianity), the idea of the substitution of God by man (Islam) or in the necessities of reason (Kant). Autonomy understood in this way is thus always linked to given tasks or duties, which could be justified in Kantian or religious terms . Equal dDrawing on the idea of emotion-management and transformative leadership, organizational changes as AT/AR implementation in LTCFs are emotional challenges, which can trigger uncertainty, mistrust or fear within the setting. The competence of the nurse to establish a safe and healing connection with the person in need of care symbolizes a central ethical and emotional content of the care profession. On the other hand, the effects of technology use could facilitate the daily work routine/process of nurse-skilled employees and promote a pleasant organizational culture.If certain emotions are successfully fostered (not manipulated!) by leaders in the long term, the corporate culture may also change in this direction over time and contribute to individual and organizational well-being. For leaders in the care sector it is a matter of accepting and reflecting on existing emotions within the workforce, but also of creating framework conditions that positively support the change process on an emotional level .As described in section “Acceptance (A),” several models on technology acceptance embrace factors as attitude and behavior shaped by structural and cognitive factors. Purchasing behavior and positive emotions about AT/AR implementation are, however, susceptible to manipulation and misinformation. Concerning the legitimacy and emotional consequences for the image of caregivers as human beings, this means concretely that the use of technology is only legitimate if it does not lead to the isolation or anonymization of human contacts. If technology replaces human interaction and feelings of belonging and agency, the social nature of human beings is misled.Collective emotions are part of the corporate culture and generally to accept. This may mean that in an organization where cautious, protective behavior has reliably led to success in the past, implementation should be undertaken in particularly slow steps, staff should be able to try out the new solution first in test settings, where mistakes do not mean serious consequences and where they have the opportunity to express concerns openly.Furthermore, leaders—as distinct role models—should be aware of their own emotions regarding the change and reflect emotions that new tools and practices trigger in them, even before the actual implementation. However, emotions such as satisfaction or anticipation are naturally more conducive to the implementation process than fear, anger or sadness. Therefore, it is helpful to create framework conditions that promote positive emotions regarding the change of nursing practice. This can be, for example, the possibility of co-determination in the choice of technology or the co-design of the adaptation of work processes, but it can also initially mean giving space for the articulation of negative emotions on their workflow.transformational leadership, emotion-management and organizational culture as diagnosis and iterative assessment instrument of the dimension “emotional consequence.”Since AT/AR is added as a supporting factor, the former dyadic “two-way relationship” between care receiver and care giver becomes a “three-way relationship” see . We callIn To summarize, measures for an AT/AR implementation should address the following key questions:1.status quo before running the change management process within the organization or among employees we have to consider in order to create a corresponding emotional culture?What is the emotional 2.What changes—especially in the caregiving relationship, communicative behavior, and health status—could each result from the use of technology?3.To what extent may these positive/negative effects influence workflow and job satisfaction of the nursing staff as well as the organizational culture and thus promote/impair the implementation?Under this assumption, an intended implementation would necessarily have to take into account the patient-nurse relationship, general ethical-human assessment criteria, and their interactions.Having presented our specific assessment tool of AAE, we now would like to illustrate this model along the illustrative example introduced earlier: A LTCF and the implementation of the “Care Assist Robot” (CAR).According to important models of user acceptance [see section “Acceptance (A)”], this dimension represents the willingness of the employees to include CAR in their daily routines. As the TAM model and its modifications or the Almere model indicate, the acceptance depends for example on the tasks, CAR is designed for—in this context physical assistance in care work—and its perceived usefulness and how easy CAR can be operated. In this case, greater acceptance can be assumed, as CAR is supposed to reduce physical burden for caregivers and therefor performs an important care tasks that doesn’t replace social or emotional interactions between caregiver and care receiver .Nursing staff’s concerns about insufficient functions (like taking too much time for moving a patient) or loss of control could be addressed in terms of specific workshops for introduction and peer-to-peer-education, which relates to specific user characteristics, realistic scenarios and the social context in which the robot is used. The opportunity to try out CAR and its functions in a workshop setting (and not in urgent situations) allows employees a prevention-oriented culture in respect of shortcomings but also as arenas for experienced self-efficacy and confidence. In addition, it is important to consider the voluntariness to use CAR and if resistance  against the robot is acceptable for leaders. Possibilities of participation in the implementation process (as mentioned in this example) and transparent information policy by the leaders are also crucial to avoid negative attitudes and perceptions of replacement.Ethical acceptability in our example is more likely as CAR provides physical tasks to reduce physical impairments and mobile difficulties for the persons in need of care. However, staff members in our example are concerned about the possibility to become removed by CAR in their personal assistance.In respect to ethics in nursing social interactions and non-maleficence of patients are roles, which cannot be compensated by a AT/AR. However, conflicts between patients and care staff in the ethical evaluation of CAR use may arise, for example, where patients prefer the use of technology to a human nursing service, while nurses see this specific service as essential to their job description and identity. Or, vice versa, a nurse may want to get rid of unpleasant care services that the patient prefers to see provided by a human. Such conflicts have consequences for organizational culture when nurses’ issues of conscience affect their motivation, job satisfaction, and identification with their work. The criterion of ethical acceptability of CAR use does not require smoothing out all such conflicts. If the use of technology with all its consequences leads to the fact that thereby the human relationship between them and patients wins, then it is acceptable. The concrete evaluation in individual cases depends on the semantics of the idea of humanity, which can be shaped differently for cultural or ideological reasons.In our example, it is possible that patients in specific care contexts prefer the use of CAR to care by humans, for example out of shame, and therefore regard this arrangement as morally preferable. For the self-image of nursing staff, the use of CAR can then also be seen as a facilitation, because encounters with shame can be avoided. Such a substitution of human care by robotics is acceptable in principle, if it is always clear that an ethical evaluation on the use of CAR does not itself attribute a moral quality to this concrete robotics. The use may be acceptable, but the robotics itself is never morally good or bad. Other positions are conceivable here, for example in animism .Who is CAR in comparison to the nurse and other employees in terms of human image and nursing ethics? How is responsibility in care tasks attributed between staff and CAR? Once such questions have been clarified in the organization , the use of CAR could be ethically supported in principle under these conditions if it actually relieves the workload of the scarce nursing staff and if this robotics is easy to operate.In our illustrative example employees reported various emotions with regard to CAR: anxiety, anger, confusion but also curiosity. While some of them are frustrated and disappointed, because the management is buying robots instead of creating new jobs, others are worried about being replaced by a CAR with the possible loss of their job. Possible unexpected reactions could arise on the part by generating even more negative emotions among the staff, developing a disturbed trust relationship with the management, leading to for example increased sick days or staff turnover.The application of TEO  in its practical feasibility means that leadership is associated with an emotional reaction of the employees and has corresponding emotional effects that have presumably hardly been perceived in leadership management.In the illustrative example of a LTCF, knowing exactly what contributes to a professional workflow and satisfaction of care staff in their job, are significant steps to move together positively in the direction of change management . In the case of the existing negative emotions with regard to CAR, it is important that the manager promotes positive emotions and has a calming effect with less intensity, satisfaction and serenity and that their role model function again exemplifies trust through authentic, honest and beneficial communication processes as well as the emphasis on joint positive performances, so that a change from negative can be converted into positive emotions.emotion-management, timing and emotions must be thought together. The change management process in our example starts a long time before the implementation process of the AT/AR . In workshops  the transformational leadership has to create an emotional vision of CAR implementation. Caregivers want to be informed and active part of the process and transparent, authentic and communicative information policy by the leading management. This means to create emotions around the robot, like trust, joy, peace, harmony etc., were caregivers feel accepted, creative and are able to flourish.With the focus particularly on The application of our three-stage system for the introduction of the Care Assist Robot has shown that acceptance, ethical acceptability and emotions each make criteria for an implementation transparent, which allow a holistic evaluation also in a human perspective. These critical criteria can now be easily merged. They are the compass for the management of LTCF to design a responsible transformational change process in response to AT/AR implementations.In the future, residential care will increasingly face the challenge of successfully implementing digital technologies. This can especially be expected for LTCFs, as multiple assistive technologies and robots promise new possibilities for maintaining the quality of life of vulnerable residents as well as facilitation for professional caregivers in their daily work. Several studies underlined the importance of different acceptance dimensions in the care sector and specific outcomes for different user groups.From our perspective, successful implementation by organizational leaders also has to take into account the existing organizational culture and to support employees in these changes beyond traditional concepts of technology acceptance, especially on an emotional level and in respect of ethical values in nursing. Compared to other industries, the implementation of AT/AR in LTCFs has to consider specific emotional conditions in care settings in terms of vulnerable residents with daily care needs, shortage of professional caregivers and ethical social rules in nursing. In the context of facilitators and barriers contributing to the AT/AR deployment, the stakeholder-entities are decisive too: The aim of AT/AR implementation is frequently to evoke positive emotionality in patients and employees and thus to support the health balance of older or cognitively impaired people. Ideally, these generated effects would have an equally positive effect on professional caregivers and, in a broader sense, the entire organization, including the prevailing work culture.Thus, we argue here for a more ethical and emotion-led leadership and management strategies in care institutions to enable modern organizations to adopt a constructive and reflexive attitude toward technology without, however, being manipulative. We offer a humanistic compass with the evaluation criterion of AAE , which includes the idea of humanity and social coexistence for the solution of concrete individual questions in care practice. In doing so, we avoid a paternalistic narrowing, as local norms and organizational cultures should be considered.To avoid unpredictable/unintended results and resistance, employees should be stimulated by change and involved in a participative way. In this respect, an intentional utilization of factors which foster facilitator-categories is very beneficial for the entire institution. While the concept of “emotion-management” explores human emotions at the workplace and conceptualize a new management approach , “transfOur findings should be interpreted while considering certain limitations. We are aware that our AAE-model is initially a working hypothesis that deserves further development. Thus, a fourth or fifth essential perspective could be added to AAE as other acceptance logics could be applied. The ethical acceptability model could be given a different semantics than ours (humanistic-Christian-Kantian), i.e., utilitarian, anthroposophical, etc. In addition, the specific organizational context  plays an important role for the debate around the priority of robots vs. human care providers. In addition, leadership styles like transformational leadership can be taught to leaders by individual coaching or peer counseling, but it needs to be practiced and internalized, which takes time and support. Another limitation lies in the implementation of the model, which first of all means an additional effort  for the management.In addition, there is still a need for research regarding the question which contextual conditions in the care sector shape a resonant relationship between leading attitudes and behavior by the management and emotions by employees . A deepeAF prepared the general concept and outline of the publication, the introduction, the theoretical part on relevant concepts of technology acceptance as well as discussion and conclusions. EN, A-KP, AZ, and CH prepared the whole theoretical part on emotion-management, change management and role of leadership. All authors made comments, suggestions and corrections to the rest of the article.AZ was employed by the company Youse GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.