Technology Adoption Research Articles

Bank market power and its determinants: evidence from listed conventional commercial banks from Indonesia

PurposeOver the past three decades, financial deregulation and various reforms have significantly transformed the competitive environment for banks in Indonesia. These changes have introduced new challenges for banks to retain their market power and ensure their survival. In light of this, the article aims to assess the current levels of market power held by Indonesian banks and explore the factors that influence it.Design/methodology/approachThe paper measured the degree of market power and identified its impacting factors for 22 listed commercial banks using the Adjusted Lerner Index (ALI) and appropriate regression technique over a period of 2011–2023.FindingsThe empirical findings reveal that banks in Indonesia enjoy high market power, and factors such as capitalization, diversification, operational inefficiency, asset quality and GDP growth rate significantly impact banks’ market power. Additionally, the findings contradict the structure-conduct-performance paradigm, which advocates that a concentrated banking system impairs competition.Research limitations/implicationsThe study suggests that regulatory authorities should closely monitor the market power levels and promote strategies to enhance competition within the banking sector. Additionally, banks should prioritize implementing measures to reduce operational costs and improve the quality of assets.Originality/valueThis research represents one of the early attempts to gauge the market power of publicly listed conventional commercial banks in Indonesia by employing the Adjusted Lerner Index. Additionally, it introduces “technology adoption” as a novel variable to the analysis alongside other established variables.

Breeding distrust during artificial intelligence (AI) era: how technological advancements, job insecurity and job stress fuel organizational cynicism?

PurposeThis study examines how technological advancements and psychological capital contribute to job stress. Furthermore, the paper examines how job insecurity, job stress and job involvement influence the cynicism of recently laid-off employees. Despite various research studies, there is a lack of understanding of employees’ views on their work future and its probable influence on their job behaviors in this era of technology.Design/methodology/approachA quantitative method was used to collect a sample of 403 recently laid-off employees. The research tool of this study was a questionnaire, and the sampling technique was stratified random sampling. IBM SPSS and AMOS software were utilized to ensure the trustworthiness and accuracy of constructs via factor analysis. The proposed hypotheses were tested using structural equation modeling.FindingsThe analysis showed that technological advancements, specifically in job-related stress, job involvement and job insecurity, significantly affect organizational cynicism. Job involvement is negatively associated with employee’s cynicism.Practical implicationsThe current study adds to the comprehension of shifts in the perceived behavior of employees toward their organizations due to factors like the adoption of new technology in the organization, job stress, job insecurity and job involvement. Accordingly, there will be a need to form a favorable working atmosphere so that employees can perform their jobs with positive psychology and without any insecurity or stress.Originality/valueThe study is thought to contribute to the literature in terms of measuring organizational cynicism while layoffs continue due to AI advancements.

Artificial intelligence in hospitality services: examining consumers’ receptivity to unmanned smart hotels

PurposeWith recent advances in artificial intelligence, the hospitality industry has introduced the concept of unmanned smart hotels staffed by service robots instead of human employees. Research is needed to understand consumers’ receptivity to such an innovation. This paper examines factors associated with consumers’ potential resistance to using automated service hotels via two sequential studies. Given that younger generations of consumers are typically early adopters of advanced technology and innovative services, our sampling approach focused on this consumer group.Design/methodology/approachTwo studies were conducted. Study 1 proposed and empirically tested a theoretical model. Results revealed that attitude, subjective norms and perceived behavioral control each positively influenced individuals’ intentions to use unmanned smart hotels. In Study 2, we further investigated aspects informing perceived security, a key variable in the use of unmanned smart hotels.FindingsFindings showed how people’s beliefs about unmanned smart hotels and security control assurances led to perceived security. These perceptions were shaped by perceived physical risks, privacy concerns, website design and hotel reputation. Overall, this research provides theoretical and practical implications for various stakeholders associated with unmanned smart hotels.Practical implicationsFindings of this study suggested that managers of unmanned smart hotels should design user-friendly, secure processes and offer comprehensive support resources to enhance customer experience and usage.Originality/valueThe findings provide a holistic understanding of consumers’ receptivity to unmanned smart hotels.

Exploring the impact of digital knowledge, integration and performance on sustainable accounting, reporting and assurance

Purpose The purpose of this study is to perform bibliometric analysis to systematically and comprehensively examine the current landscape of digital knowledge, integration and performance in the transformation of sustainability accounting, reporting and assurance. Design/methodology/approach This research uses a systematic literature review, following the Scientific Procedures and Rationales for Systematic Literature Review protocol and uses various bibliometric and performance analytical methods. These include annual scientific production analysis, journal analysis, keyword cooccurrence analysis, keyword clustering, knowledge gap analysis and future research direction identification to evaluate the existing literature thoroughly. Findings The analysis reveals significant insights into the transformative impact of digital technologies on sustainability practices. Annual scientific production and journal analyses highlight key contributors to the adoption of digital technologies in sustainability accounting, reporting and assurance. Keyword cooccurrence analyses have identified key themes in sustainability accounting, reporting and assurance, highlighting the transformative role of digital technologies such as artificial intelligence (AI), blockchain, Internet of Things (IoT) and big data. These technologies enhance corporate accountability, transparency and sustainability by automating processes and improving data accuracy. The integration of these technologies supports environmental, social and governance (ESG) reporting, circular economy initiatives and strategic decision-making, fostering economic, social and environmental sustainability. Cluster-by-coupling analyses delve into nine broader revealing that IoT improves ESG report accuracy, eXtensible Business Reporting Language structures ESG data and AI enhances life cycle assessments and reporting authenticity. In addition, digital transformation impacts environmental performance, big data optimizes resource use and edge computing improves eco-efficiency. Furthermore, this study identifies avenues for future research to advance the understanding and implementation of digital technology in sustainability accounting, reporting and assurance practices. Research limitations/implications Academically, this research enriches the understanding of how digital technologies shape sustainability practices and identifies gaps in digital knowledge and integration. Practically, it provides actionable insights for organizations to improve sustainability reporting and performance by effectively leveraging these technologies. Policy-wise, the findings advocate for frameworks supporting the effective implementation of these technologies, ensuring alignment with global sustainability goals. Originality/value This study offers a detailed analysis of the performance and intellectual framework of research on implementing digital technology in sustainability accounting, reporting and assurance. It highlights the evolving research landscape and emphasizes the need for further investigation into how emerging technologies can be leveraged to achieve sustainability goals.

Digitalization and Dynamic Criticality Analysis for Railway Asset Management

The primary aim of this paper is to support the optimization of asset management in railway infrastructure through digitalization and criticality analysis. It addresses the current challenges in railway infrastructure management, where data-driven decision making and automation are key for effective resource allocation. The paper presents a methodology that emphasizes the development of a robust data model for criticality analysis, along with the advantages of integrating advanced digital tools. A master table is designed to rank assets and automatically calculate criticality through a novel asset attribute characterization (AAC) process. Digitalization facilitates dynamic, on-demand criticality assessments, which are essential in managing complex networks. The study also underscores the importance of combining digital technology adoption with organizational change management. The data process and structure proposed can be viewed as an ontological framework adaptable to various contexts, enabling more informed and efficient asset ranking decisions. This methodology is derived from its application to a metropolitan railway network, where thousands of assets were evaluated, providing a practical approach for conducting criticality assessments in a digitized environment.

Decarbonization Strategies in the U.S. Maritime Industry with a Focus on Overcoming Regulatory and Operational Challenges in Implementing Zero-Emission Vessel Technologies.

The U.S. maritime industry plays a significant role in global trade and is a substantial contributor to carbon emissions, with the sector facing increasing pressure to decarbonize in line with global climate goals. This paper discusses the challenges and strategies for decarbonizing the U.S. maritime industry, laying emphasis on the adoption of zero-emission vessel (ZEV) technologies, such as battery-electric ships, hydrogen fuel cells, wind-assisted propulsion, and alternative fuels like bio-LNG and ammonia. Despite the availability of these technologies, the transition to ZEVs faces several barriers, including high capital costs, regulatory inconsistencies, and insufficient infrastructure. Existing regulatory frameworks, including the International Maritime Organization’s (IMO) emissions targets, the U.S. Clean Air Act, and the U.S. Coast Guard requirements, offer some guidance but are often fragmented and insufficiently aligned to foster widespread adoption of decarbonization technologies. Upcoming mandates, such as the IMO's 2050 target, further brings to view the urgency of this transition. However, gaps in regulations and the lack of incentives hinder technological innovation and fleet modernization. The paper also discusses the need for enhanced governmental involvement, with organizations like the Environmental Protection Agency (EPA), the Maritime Administration (MARAD), and the U.S. Coast Guard playing a critical role in streamlining policies and supporting the adoption of zero-emission technologies. It also emphasizes the importance of addressing infrastructure gaps related to fueling, charging, and port readiness for ZEVs. Furthermore, it highlights operational challenges such as range, performance, and energy density concerns that must be overcome for ZEVs to become commercially viable. The paper advocates for stronger policy frameworks, including subsidies, tax incentives, carbon pricing, and investment in research and development, to drive the transition. Public-private partnerships and industry collaboration are essential to overcoming financial barriers and creating a sustainable, decarbonized maritime sector. By implementing these strategies, the U.S. maritime industry can significantly reduce its emissions, contribute to global climate goals, and set a precedent for sustainable maritime practices worldwide.

The impact of clean technology adoption on carbon emissions: A global perspective

The impact of clean technology adoption on carbon emissions: A global perspective

Use of Artificial Intelligence in the Banking Industry: A Case Study of Pakistan

This study investigates the adoption and impact of Artificial Intelligence (AI) in Pakistan’s banking sector, with a focus on Habib Bank Limited (HBL), Faysal Bank, and Bank Alfalah. The objective is to understand the extent to which AI technologies have transformed core activities within customer service, operations, fraud detection, and risk management in these banks. Data were collected from semi-structured interviews with ten respondents, selected based on their experience with AI implementation. This qualitative methodology allows for in-depth insights into the functionality and challenges associated with AI in banking. Results reveal that AI has notably improved operational efficiency by streamlining risk management and enabling real-time fraud detection. Additionally, AI-driven chatbots and virtual assistants have enhanced customer experiences by offering faster and more personalized services. Despite these benefits, the study identifies significant challenges, particularly regarding data privacy and regulatory compliance, as well as the need for human resources to adapt to AI-enabled tools. Key pressures in the industry include building capabilities to work alongside AI while addressing concerns over automation. To maximize the advantages of AI, the study emphasizes the need for comprehensive policies that balance technological adoption with ethical considerations, data security, and staff training. Strategic planning in Pakistan’s banking sector will be crucial to harnessing AI’s potential while managing its risks.

Exploring the Influence Factors of Digital Entrepreneurship in Improving the Digitization of Small and Medium Enterprises in Yemen

This research provides valuable insights into the impact of digital entrepreneurship on the digitalization of small and medium-sized enterprises (SMEs) in Yemen. By integrating the Technology Acceptance Model (TAM) and the Technology-Organization-Environment (TOE) framework, the research examines the role of various factors-technological, organizational, environmental, and individual, affecting technology adoption and utilization in SMEs. The study primarily explores the direct and indirect influences of these factors on actual system use, with a particular focus on the mediating roles of perceived usefulness and perceived ease of use in shaping attitudes toward technology adoption. Data were collected through a survey of 392 respondents, and the results were analyzed using partial least squares structural equation modelling (PLS-SEM). The measurement model was validated for reliability and accuracy, followed by an evaluation of the structural model to test the proposed hypotheses. The findings highlight the critical role of information and communication technology (ICT) adoption in enhancing both perceived ease of use and perceived usefulness. Additionally, the knowledge of IT entrepreneurs and government support were found to uniquely influence perceived ease of use and perceived usefulness, respectively. Both of these perceptions, in turn, positively impacted attitudes toward and the actual use of digital tools within SMEs. To address the challenges faced by Yemeni SMEs, it is recommended to enhance digitalization through ICT adoption and promote a pro-technology culture. Policymakers should create a supportive environment via targeted policies, subsidies, and public-private partnerships to foster sustainable growth and competitiveness.

A systematic review of strategies for enhancing pharmaceutical supply chain resilience in the U.S

This review aims to explore strategies for enhancing pharmaceutical supply chain resilience in the United States by addressing vulnerabilities exposed by recent global events, including the COVID-19 pandemic. The study identifies and analyzes eight key strategies: supplier diversification, increased inventory and safety stock, adoption of advanced technologies, improved forecasting and demand planning, vertical integration, reshoring and nearshoring, contingency planning and risk management, and collaboration and information sharing. Drawing on these strategies in the context of the United States, the review examines the advantages and potential challenges associated with them. The implementation of strategies such as supplier diversification and the adoption of advanced technologies shows positive effects, but these approaches require significant resources and face policy restrictions. This paper also analyzes the policy and industry implications of these strategies, emphasizing the need for collaboration between the government and industry. Various policy implications include the need to encourage supplier diversification, support for strategic stocking, and funding for technology implementation. For the industry, there is a need for operational adjustments such as redesigning supply chain networks with emphasis on enhancing risk management practices. Although implementing these strategies presents certain complexities, they hold great promise for improving the overall resilience of the US pharmaceutical supply systems and should be further explored in the future. Keywords: Supply Chain, Risk Management, Industry Disruption, Inventory Management, Blockchain Technology

Pandemic-Era Trends in US Automatic Payment Adoption: A 2022 Behavioral Analysis

Introduction: This study analyses the adoption trends of automated payment methods among different racial groups in the United States during the COVID-19 pandemic in 2022. It investigates the correlations among financial literacy, risk attitudes, customer sentiment, and the adoption of automated payment mechanisms for bill settlements. Method: An analysis of responses from a diverse demographic is conducted using logistic regression on data from the 2022 Survey of Consumer Finance. This analysis investigates the trends associated with subjective and objective financial literacy, consumer sentiment as evaluated by economic perceptions, and risk attitudes among several generations, taking into account race as well. Results: Initial results suggest disparities in the degrees to which financial literacy, risk attitudes, and consumer sentiment are connected with adoption rates among various racial groups. The statistical analysis highlights disparities in the adoption of automated payments among different racial and ethnic groups. Discussion: The findings underscore the complex interplay among socio-economic status, behavioral variables, and technology adoption in the period after the pandemic. This methodology aligns with current scholarly works on behavioral finance, which emphasize the need to consider both individual psychological aspects and wider social impacts in the process of making financial decisions. By incorporating racial diversity into the research, the study provides a valuable understanding of how cultural and demographic factors interact with behavioral aspects in the particular setting of financial technology adoption during a time of substantial economic transformation.

Driving Digital Transformation: The Impact of SME Digitalization on Technology Acceptance and Usage in Small and Medium Enterprises of Yemen

This research investigates the relationships between digitalization, perceived usefulness, attitudes toward using technology, and actual system use of technologies within the context of small and medium-sized enterprises (SMEs) in Yemen. Using a two-step structural equation modelling approach, the research investigates both direct and mediating effects. Data were gathered from 392 SMEs in Yemen by employing a survey research design. The measurement model was estimated to evaluate the constructs' accuracy, while the structural model was analyzed to investigate the proposed relationships. Findings reveal that SME digitalization significantly enhances perceived usefulness, which positively influences users' attitudes toward technology adoption and subsequently drives actual system use. Specifically, the analysis shows that improvements in digitalization practices lead to heightened perceptions of usefulness and favorable attitudes, ultimately resulting in increased actual system use. Moreover, the results indicate that perceived usefulness and attitudes serve as significant mediators between digitalization and system use. This research contributes to understanding how enhancing perceived usefulness and fostering positive attitudes can facilitate technology adoption in SMEs, providing important implications for practitioners, policymakers, and researchers focused on digital transformation. Overall, the findings emphasize the importance of strategic digitalization efforts to improve operational efficiency and promote successful technology acceptance in small and medium enterprises.

High-temperature carbon dioxide capture in a porous material with terminal zinc hydride sites.

Carbon capture can mitigate point-source carbon dioxide (CO2) emissions, but hurdles remain that impede the widespread adoption of amine-based technologies. Capturing CO2 at temperatures closer to those of many industrial exhaust streams (>200°C) is of interest, although metal oxide absorbents that operate at these temperatures typically exhibit sluggish CO2 absorption kinetics and instability to cycling. Here, we report a porous metal-organic framework featuring terminal zinc hydride sites that reversibly bind CO2 at temperatures above 200°C-conditions that are unprecedented for intrinsically porous materials. Gas adsorption, structural, spectroscopic, and computational analyses elucidate the rapid, reversible nature of this transformation. Extended cycling and breakthrough analyses reveal that the material is capable of deep carbon capture at low CO2 concentrations and high temperatures relevant to postcombustion capture.

Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review.

Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86%) sDHTs were wearable tools while the remaining 23 (14%) sDHTs were ambient tools. The majority of studies (55/83, 66%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99%) captured data from targeted end users, but only 18 (22%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83% (136/164) and 91% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7%), 4 (2%), and 2 (1%) out of 164 sDHTs, respectively. A total of 14 (9%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25% of all studies and 17/55, 31% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17% of studies). Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use.

Addressing the challenges towards the adoption of digital technologies in construction supply chain management

Addressing the challenges towards the adoption of digital technologies in construction supply chain management

Integrative Review-Based Conceptual Modeling: An Agent-Based Modeling Synthesis of Dynamic Energy Tariff Research and Models

Adoption of dynamic energy tariffs by households is crucial for the transition to carbon-neutral energy systems. Influencing the adoption patterns of these tariffs necessitates an examination of the drivers, decision components, and contextual factors influencing household decisions. Few computational models address this comprehensively, often omitting non-financial decision variables. Moreover, methodologically robust integrative reviews on this topic are scarce. To address this gap, this paper develops a concept-centered integrative review methodology aimed at deriving computer models for socio-techno-economic simulations of household adoption of sustainable technologies. The methodology encompasses five sequential phases: Setup, Literature Search, Analysis, Synthesis and Conceptual Model, and Discussion. To illustrate the methodology, it is applied to the case of household adoption of dynamic energy tariffs, resulting in an abstract conceptual model adaptable to local contexts. The review reveals a lack of consensus on modeled tariffs but highlights the significance of tariff complexity, relative advantage, household heterogeneity, and various agent properties. It also identifies potential improvements in model fundamentals, particularly spatial modeling. The developed process model focuses on the stages ‘knowledge’, ‘decision’, and ‘reevaluation’. The article contributes by presenting a comprehensive review scheme and delivering a concept-centered integrative review along with an explicit conceptual model derived from it.

Analyzing the Relationship between Risk Management Strategies and Supply Chain

Purpose: The purpose of this article examined how different risk management strategies affect supply chain resilience in Malaysia. It aims to identify effective strategies, such as supplier diversification and digitalization, that help Malaysian companies mitigate disruptions. The findings offer insights to enhance operational continuity and adaptability within Malaysia's unique risk environment. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that effective risk management strategies, like supplier diversification and real-time monitoring, significantly enhance supply chain resilience in Malaysia. Companies adopting these strategies experienced fewer disruptions and quicker recovery times. However, challenges such as high costs and limited technology access still hinder broader adoption among smaller firms. Unique Contribution to Theory, Practice and Policy: Resource-based view (RBV), contingency theory & high reliability theory (HRT) may be used to anchor future studies on the relationship between risk management strategies and supply chain resilience in Malaysia. Practically, companies should implement risk management strategies that are tailored to their specific supply chain contexts and risks. At the policy level, governments and industry bodies should support the adoption of resilience-enhancing technologies by offering financial incentives or subsidies, particularly for small- and medium-sized enterprises.

Predicting THE Determinants of Mobile TV Adoption in an Emerging Market: Moderating Effect of Gender and Age

This article focuses on the impact of consumer-centric factors on the adoption of mobile TV in an emerging market, considering the widespread use of mobile technologies worldwide. It aims to explore the motivations behind users’ utilization of mobile TV and over-the-top platforms in the era of digitalization. The study identifies eight independent factors affecting mobile TV adoption intention, grouped using a three-dimensional THE (technology, human, and environment) framework. Data was collected from 324 smartphone users to test the hypothesized relationships using covariance based structural equation modeling (CB-SEM) analysis. Further, moderating effect of gender and age was studied on the proposed relationships. The findings revealed that factors such as cost, content, perceived enjoyment, individual viewing experience, social influence, and convenience play a significant role in the successful adoption of mobile TV. On the other hand, app switching and technology readiness were found to be statistically insignificant. The results offer valuable insights to industry players regarding consumers’ adoption behaviour of mobile TV, helping them minimize business risks and focus their efforts, resources, and investments on profitable innovations. The study is first of its kind in India and adds two relatively new factors, that is individual viewing experience and app-switching, to the existing literature on technology adoption theories.

Exploring the scope and depth of digitalisation in times of crisis: Implications for SME resilience

This article investigates the role of digitalisation in bolstering small- and medium-sized enterprises (SMEs) during crises. Drawing on data from 245 North American SMEs, we examine the impact of digital technology adoption on firm resilience. The findings reveal nuanced relationships: both the depth (Digital Depth) and scope (Digital Scope) of digitalisation exhibit curvilinear associations with resilience (Profit Outlook), suggesting optimal levels for maximum benefits. Moreover, digital depth moderates the relationship between digital scope and resilience, highlighting their interactive role in enhancing adaptive capacities. This research employs a quantitative approach to explore how SMEs can leverage digital tools for resilience. Notably, it highlights the importance of strategic digital investments tailored to industry dynamics for resilience enhancement illustrating the study underscores the practical significance of digital integration for SMEs, indicating its potential to not only restore pre-crisis performance but also foster sustainable growth in the aftermath of disruption.

Regulatory mechanisms of steroid hormone receptors on gene transcription through chromatin interaction and enhancer reprogramming.

Regulation of steroid hormone receptors (SHRs) on transcriptional reprogramming is crucial for breast cancer progression. SHRs, including estrogen receptor (ER), androgen receptor (AR), progesterone receptor (PR), and glucocorticoid receptor (GR) play key roles in remodeling the transcriptome of breast cancer cells. However, the molecular mechanisms by which SHRs regulate chromatin landscape in enhancer regions and transcription factor interactions remain largely unknown. In this review, we summarized the regulatory effects of 3 types of SHRs (AR, PR, and GR) on gene transcription through chromatin interactions and enhancer reprogramming. Specifically, AR and PR exhibit bi-directional regulatory effects (both inhibitory and promoting) on ER-mediated gene transcription, while GR modulates the transcription of pro-proliferation genes in ER-positive breast cancer cells. In addition, we have presented four enhancer reprogramming mechanisms (transcription factor cooperation, pioneer factor binding, dynamic assisted loading, and tethering) and the multiple enhancer-promoter contact models. Based on these mechanisms and models, this review proposes that the combination of multiple therapy strategies such as agonists/antagonists of SHRs plus endocrine therapy and the adoption of the latest sequencing technologies are expected to improve the efficacy of ER positive breast cancer treatment.