The introduction of digital systems in healthcare has been under discussion for over two decades. While implementation within individual facilities is well advanced, there is still considerable room for improvement in cross-facility data exchange. To describe the current state of digital connectivity and organizational frameworks in Germany and Austria. Analysis and description of the legal framework and the various initiatives in both countries. In Germany, the comprehensive introduction of an electronic health records in 2026 marks asignificant step toward increasing digitalization. While the current focus is primarily on documents and electronic medication, this structure could also prove useful for image data exchange in the future. Austria, on the other hand, created structures several years ago with the introduction of ELGA (electronic health records) that allow for more comprehensive digital communication. Consequently, more has already been achieved in terms of implementing Europe-wide EU recommendations. The status of national infrastructure implementation differs between the two countries. Overall, increasing acceptance has been observed in recent years. The European initiative for aEuropean Health Data Space (EHDS) could lead to further intensification of the integration of digital services and interoperability.

Industrial Internet of Things (IIoT)-based technologies are becoming increasingly popular in water-distribution cyber-physical systems (CPS) for automated, real-time control and information-based decision-making. Nevertheless, this increased digital connectivity has also expanded the attack surface, allowing adversaries to interfere with sensor data and control logic, and to cause harmful hydraulic disturbances. To overcome them, this paper proposes a comprehensive secure IIoT architecture that integrates blockchain-based data integrity with a sophisticated anomaly-detection framework tailored to a water-distribution CPS. The architecture uses a permissioned blockchain to provide tamper-resistant recording of sensor telemetry, device identity validation via smart contracts, and verifiable provenance for the operator and forensic analysis. To supplement the trust layer, a hybrid anomaly-detection model based on LSTM autoencoders with cyber-physical feature fusion can provide real-time detection of both sudden and covert attacks. Three popular benchmark datasets, BATADAL, WADI, and SWaT, are used to evaluate the proposed system, simulated hydraulic networks, and full-scale industrial testbeds. The results of the experiments show that the proposed framework is more accurate, has higher recall, and achieves a higher AUC than classical machine-learning and modern deep-learning baselines. The cross-dataset analysis demonstrates the framework's ability to be transferred into a cross-dataset and heterogeneous water and industrial CPS environment, where performance depends on the density of sensors, complexity of processes, and distribution of attacks. The result shows the strength of the proposed model and the potential necessity of further domain adaptation-based methods in the case of highly heterogeneous deployments.

Blood pressure-related deaths from cardiovascular disease are higher in rural than in urban areas in the Unites States, especially in southeastern states. However, the barriers and potential solutions to hypertension care are inadequately understood. We interviewed 62 local community and health systems key informants in 2 rural (Pamlico and Robeson) counties in North Carolina. Probes based on the Consolidated Framework for Implementation Research were used to identify contextual barriers and facilitators affecting existing resources and services for improving hypertension care. Data were analyzed using hybrid deductive and inductive approaches, and organized into themes and subthemes with illustrative quotations. The prominent barriers of hypertension care emerged across outer setting (economic constraints, insufficient health insurance, food insecurity, wide accessibility of processed food, lack of transportation, digital connectivity gap, limited awareness of partnership and resources, and mistrust), inner setting (provider shortage, weak communication, rural food culture, and mistrust of health systems), and individual level (low health literacy, chronic stress, and a sense of hopelessness). The most cited facilitators were codesigning task-sharing approaches to hypertension care with community outreach that are tailored for rural settings, targeted subsidies for healthy food and health care, and trust building with the community, preferably led by faith-based leaders. Our findings based on consultations with diverse community and health systems partners show key challenges and highlight potential solutions to improve blood pressure control and cardiovascular health in rural communities in the United States. Concerted efforts to codesign hypertension care programs that are multisectoral, build on local resources, and include community outreach and trust building efforts are likely to be acceptable, effective, and sustainable.

ABSTRACT Paraguay’s National System for the Evaluation of Educational Process (SNEPE) conducted census-based Grade-3 mathematics tests in 2015 and 2018, revealing a sharp overall drop in scores. We used these open datasets (n = 182,016) to investigate the source of this decline. We estimated two-level random-intercept models with standardised predictors, first separately for each cohort and then pooled across years with a random slope for year. In both cohorts, teacher attendance—a proxy for opportunity to learn—and socio-economic status (SES) were the strongest predictors of students’ performance, while teacher attendance was the strongest predictor of schools’ performance. By 2018, additional factors—digital connectivity, a safe climate, and engaged leadership—had become salient. Schools that improved teacher attendance and teacher–parent relations experienced a noticeably smaller decline in scores, yet the SES gradient steepened and the between-school variance rose, signalling emerging equity risks. Policy options centre on attendance monitoring, purposeful family engagement, and violence-prevention measures.

ABSTRACT Purpose Access to agricultural extension and crop advisory services is critical, yet, in conflict-affected settings, their delivery and use are poorly understood. This paper has three objectives: first, to assess the distribution and types of agricultural extension services used by farmers in Myanmar; second, to examine changes in service use before and during conflict, focusing on the rise of digital agricultural services; and third, to analyze patterns of inclusion in accessing these services, comparing digital and in-person options. Design/methodology/approach We use a mixed-method approach for analysis. We rely on primary data from unique, large-scale, and repeated farm surveys conducted in Myanmar. This is complemented by a descriptive analysis of major digital extension platforms and contextual interviews with digital extension providers. Findings Since the onset of conflict, the use of in-person extension services has declined, while digital services have risen, with over 50 percent of farmers accessing them. Nonetheless, access remains uneven, with better-educated, wealthier, less remote, and more secure farmers benefiting disproportionately from both in-person and digital extension services. Practical implications Digital extension services have potential in conflict-affected settings but require targeted interventions to bridge access gaps. Policymakers must address digital literacy, connectivity, and affordability barriers. Theoretical implications Our research contributes to the literature by assessing the structure of digital extension services, focusing on their use in fragile settings, and advancing knowledge on the inclusiveness of agricultural extension in conflict-affected contexts. Originality/value This study provides timely evidence on digital agricultural advisory services in conflict settings, offering lessons for similar fragile environments globally.

This study examined the predictive roles of digital connectivity and access to online resources on global competence among pre-service teachers in Oyo State. A correlational survey research design was adopted for the study. The population comprised all pre-service teachers in public Colleges of Education in Oyo State, with a sample of 310 year-three pre-service teachers selected using a simple random sampling technique. Data were collected using three self-designed instruments: the Pre-service Teachers’ Digital Connectivity Scale (PTDCS), the Pre-service Teachers’ Access to Online Resources Scale (PTAORS), and the Pre-service Teachers’ Global Competence Scale (PTGCS). The reliability of these instruments was established through a pilot study, yielding Cronbach’s alpha coefficients of 0.82, 0.79, and 0.85, respectively, indicating high internal consistency. Data were analysed using Pearson Product-Moment Correlation and Multiple Regression Analysis at a 0.05 level of significance. The findings revealed a significant positive relationship between digital connectivity and global competence (r = 0.436, p < 0.05). Additionally, the joint effect of digital connectivity and access to online resources significantly predicted global competence (R² = 0.62, F = 45.23, p < 0.01). Digital connectivity was found to have a stronger influence (β = 0.56, p < 0.01) compared to access to online resources (β = 0.42, p < 0.01). The study concludes that enhancing digital connectivity and access to online resources can significantly improve pre-service teachers' global competence. It recommends that policymakers and institutions invest in digital infrastructure and ensure equitable access to online learning resources to foster global competence among pre-service teachers

IntroductionAccess to falls prevention programs, addressing an important public health concern, is often limited for Francophone and Acadian minority communities. Technology has been used to deliver falls prevention programs, but health equity factors linked to improving its access for all are still poorly understood. This study aimed to document health equity factors influencing access from the perspective of older francophone adults in various communities across Canada.MethodsGuided by the digital health equity framework, we used a sequential explanatory mixed method, including a descriptive sociodemographic questionnaire and semi-structured interviews, to document perspectives on access of persons who had completed different versions of a telehealth falls prevention program.ResultsSixty-one participants from five provinces completed the sociodemographic questionnaire, of which most participants (n = 45) represented perspectives from francophone communities living in a minority situation. Results revealed that 91% of participants had access to a computer or tablet with adequate audio-visual components for telehealth. Twenty of these participants, from four provinces, shared their perspectives. The majority of them reported that falls prevention programs should be offered in their preferred language and with different delivery options that consider the social and safety preferences of participants. Eight recommendations informing policy and implementation emerged.DiscussionAdvocacy around digital connectivity is essential to ensure that all Canadians have equitable access to high-speed internet connections and proper infrastructure. Participants also raised the importance of adapting services to their linguistic realities, geographic location, safety, and basic needs to optimize the impact of the health services provided to them.

Digital health services are expanding, yet community readiness for digital care varies widely. Without a validated, granular measure of readiness, health systems and policymakers cannot reliably enable targeted support or monitor equitable deployment. To develop and validate a reproducible census tract-level index of community digital health readiness integrating socioeconomic conditions, access to care, and digital connectivity. This cross-sectional index development and validation study analyzed public data from 2018 to 2022. The Digital Health Index (DHI) was constructed from 21 indicators with equal weighting representing 3 domains: socioeconomic, health access, and connectivity. Content validity was assessed using a 2-round Delphi panel including 37 experts. Structural validity was assessed with exploratory and confirmatory factor analyses. Convergent validity was assessed against the Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Digital Divide Index (DDI). External validity was assessed using health care spending. Robustness was assessed using leave-one-out, weight-perturbation, and group-based cross-validation analysis. Data were analyzed between June 2023 and April 2026. Primary outcomes were validation metrics, including factor structure fit indices, correlations with established indices, association with health care spending per capita, and Delphi consensus rates for each indicator. Robustness outcomes included stability of tract rankings under indicator removal or weight changes. The DHI was computed for 85 396 US census tracts across all 50 states. DHI scores correlated with SVI, ADI, and DDI scores (Spearman ρ = 0.61-0.84) but prioritized different low-readiness communities, with only 33% to 44% overlap between tracts in the highest DHI decile and those in the highest SVI, ADI, or DDI deciles. Health care spending showed similar inverse associations across indices. DHI rankings remained stable in sensitivity analyses. All 21 indicators met Delphi consensus criteria after 1 or 2 rounds. In this cross-sectional index development and validation study, a reproducible measure of community digital health readiness was constructed at the census tract level, integrating socioeconomic, access, and connectivity factors. The DHI may help health systems, public agencies, and researchers identify communities requiring support and track readiness over time as digital health and artificial intelligence initiatives expand.

Survivorship after critical illness is often characterised by fragmented recovery and lingering cognitive, psychological, and physical impairments collectively described as post-intensive care syndrome. Current recovery frameworks and follow-up models remain inconsistently delivered, poorly standardised, and rarely address survivors' and families' need to make sense of the intensive care unit (ICU) experience in a transparent, inclusive, and sensitive way. The Critical Illness Survivorship Programme is proposed to humanise post-intensive care by integrating generative artificial intelligence technologies with co-designed, person-centred recovery strategies. This discussion paper provides the theoretical foundation for the proposed Critical Illness Survivorship Programme, which intends to humanise post-intensive care recovery through ethically governed, artificial intelligence-enabled narrative approaches. The Critical Illness Survivorship Programme redefines recovery as both a biological and narrative process. Drawing from interpretive nursing inquiry, narrative medicine, cognitive rehabilitation, and responsible artificial intelligence design, the Critical Illness Survivorship Programme is designed to generate personalised intensive care unit journey summaries that translate complex health-record data into accessible, emotionally attuned stories, visualisations, and audio outputs. These narratives aim to support sense-making, memory integration, and emotional recovery while promoting transparency, inclusivity, and cultural sensitivity. The proposed Critical Illness Survivorship Programme will offer a conceptual pathway for developing ethically governed, artificial intelligence-enabled tools that bridge digital innovation and human connection in survivorship care. It emphasises interdisciplinary collaboration, trauma-informed communication, and co-design as essential safeguards for compassionate technology integration. Future research should examine the feasibility, ethical oversight, and educational implications of the Critical Illness Survivorship Programme within clinical pathways. By reframing technology as a partner in empathy and understanding, the Critical Illness Survivorship Programme proposes a potential model of recovery - one that restores coherence, dignity, and meaning in life after critical illness.

Capturing spatial interaction remains a challenge in GIScience and spatial epidemiology, yet many studies rely on a single neighborhood definition. We proposed a multi-network spatial error workflow that treats spatial weight matrices as theory-guided synthetic connectivity channels and estimates channel-specific dependence parameters within one likelihood. Using county-level U.S. gonorrhea, chlamydia, and HIV outcomes (2018–2019), we controlled for established sexually transmitted infection (STI) covariates and evaluated candidate spatial error models based on queen contiguity ( W Q ), Twitter-derived mobility connectivity ( W P ), and Facebook-derived socio-spatial connectivity ( W S ). Model choice used a two-stage procedure that screened candidates in-sample and then evaluated shortlisted models out-of-sample via leave-one-state-out prediction and held-out residual autocorrelation diagnostics. The selected dependence structures were pathogen-specific: HIV supported a joint adjacency-plus-mobility specification ( W Q + W P ), chlamydia was dominated by mobility ( W P ), and gonorrhea was dominated by socio-spatial connectivity ( W S ). These channel choices were associated with systematic re-ordering of fitted risk rankings, but the resulting shifts remained model-derived rather than externally validated indicators of real-world transmission importance. This study supports a reproducible workflow for comparing and selecting adjacency-, mobility-, and socio-spatially defined neighborhood structures in large-scale spatial modeling, with applications beyond STIs.

The rapid expansion of hybrid work has transformed organizational communication, increasing dependence on platforms such as Zoom, Microsoft Teams, Slack, email, and asynchronous collaboration systems. Although these technologies improve flexibility and operational continuity, they have also intensified “always-on” communication cultures characterized by persistent connectivity, rapid responsiveness expectations, and communication hyper connectivity. This evolving work environment has heightened concerns regarding communication fatigue as an emerging organizational risk associated with cognitive overload, technostress, burnout, emotional exhaustion, and declining workplace wellbeing. This critical narrative review examines how perpetual digital connectivity contributes to communication fatigue and workplace stress within hybrid organizations while evaluating implications for organizational sustainability and future workplace governance. Relevant literature published between 2015 and 2026 was identified through searches conducted in Scopus, Web of Science, PubMed, and Google Scholar. The review employed thematic synthesis and comparative critical analysis to integrate findings across organizational communication, occupational health, and management research. The findings indicate that communication fatigue is a multidimensional organizational phenomenon driven by excessive message volume, meeting overload, notification saturation, digital multitasking, productivity monitoring, and responsiveness cultures reinforcing perpetual availability. Communication overload contributes to burnout, disengagement, work-life conflict, reduced concentration, and declining organizational trust and productivity. In response, this review proposes a Sustainable Digital Communication Framework centered on communication boundary management, asynchronous-first communication, digital wellbeing leadership, AI-supported communication filtering, and organizational communication ethics. The review highlights the urgent need for sustainable digital communication governance capable of supporting healthier, more resilient, and human-centered hybrid workplaces.

The article examines methods of migration administration in the People's Republic of China, the Republicof Belarus, and the Russian Federation amid the digitalisation of public administration and increasinglycomplex migration flows. The triad of permissions, prohibitions, and positive duties is specified across thecontours of pre-entry screening, border inspection, domestic registration and record-keeping, and proceduralresponse. It is shown that the Chinese model relies on deep integration of registries, biometric procedures,and address registration; the Belarusian model is evolving as a service-and-oversight architecture withinthe Ministry of Internal Affairs with precise standardisation of procedures and an expansion of electronicservices while retaining in-person administration where necessary; the Russian model is characterised byan extensive system of registration and detailed regulations of the Ministry of Internal Affairs. The articlesubstantiates the autonomous role of international cooperation methods (readmission, joint operations,interoperability of registry systems) and of registration as legal “data logistics” that reduces administrativeerrors and uneven practices. It proposes strengthening digital inter-agency connectivity and fine-tuninginternational cooperation without creating new structures, with priority given to legality, proportionality, anda service-oriented approach.

ObjectiveTo examine virtual health service (VHS) device usage patterns and identify factors associated with VHS engagement among Indigenous Australian adults with chronic conditions.DesignCross-sectional survey.SettingAn Aboriginal Community Controlled Health Organisation providing primary healthcare services across rural and remote Queensland, Australia.Participants74 consenting Indigenous Australian adults with at least one chronic condition who were registered VHS users.MethodsParticipants completed surveys assessing their use of four Bluetooth-enabled monitoring devices (pulse oximeter, blood glucose monitor, blood pressure monitor, weight scale) over a 2-week recall period. The primary outcome was VHS device usage status, categorised as active versus inactive users. Active users were defined as participants who reported any frequency of device use, while those reporting no use were classified as inactive users. All participants had access to Indigenous health coach support as part of the VHS model. Binary logistic regression was used to identify sociodemographic and geographical factors associated with VHS engagement.ResultsSixty-four per cent (n=47) were active users, with 73% of these using all four devices concurrently. Among active users, blood pressure monitors showed the highest utilisation (98%), followed by weight scales (91%), blood glucose monitors (89%) and pulse oximeters (86%). Three factors were significantly associated with VHS usage using binary logistic regression: residing in medium rural towns (adjusted OR 4.71, 95% CI 1.23 to 17.94, p=0.02), age 18–65 years (adjusted OR 3.59, 95% CI 1.05 to 12.22, p=0.04) and having multiple chronic conditions (adjusted OR 10.95, 95% CI 1.25 to 95.87, p=0.03) compared with those in more remote areas, aged ≥66 years and with single condition, respectively.ConclusionIndigenous-led VHS achieve substantial engagement through culturally grounded health coach support. However, addressing digital connectivity in remote areas, age-appropriate support for older adults and Indigenous workforce development is essential to ensure equitable access and sustained engagement

In the networked era, digital platforms have redefined how intimacy is expressed, sustained, and dissolved. This paper explores the role of WhatsApp in mediating romantic relationships among young Indians, focusing on how its affordances both nurture and destabilize emotional bonds. Drawing on 25 semi-structured email interviews with unmarried participants who experienced being blocked by partners, the study reveals that constant digital connectivity through messaging, voice notes and “last seen” monitoring creates a sense of “connected presence,” echoing Giddens’ notion of the “pure relationship.” Yet, this same connectivity renders intimacy fragile, reflecting Bauman’s “liquid love,” where affection is sustained through technological mediation but easily ruptured through blocking, ghosting and digital withdrawal. Participants described emotional distress, obsessive surveillance and self-doubt following digital disconnection, alongside instances of deceptive love that culminated in coercion, sexual exploitation and bodily objectification demonstrating the persistence of patriarchal control in virtual spaces. Coping mechanisms included reliance on friends, family, spirituality and creative engagement, with gender shaping both emotional vulnerability and resilience. The study situates these experiences within broader structures of social exclusion and gendered inequality, showing that digital intimacy is inseparable from offline hierarchies. By integrating the frameworks of Giddens, Bauman and feminist phenomenology, the paper advances a sociological understanding of how WhatsApp mediates both connection and rupture in contemporary romance, revealing the emotional precarity of love in a digitized world.

ABSTRACT This study conceptualizes children’s digital (dis)connection as a relational and moral practice embedded in the intertwined structures of family, school, and peers. Using a 360° interview approach, this study situates children, parents, and teachers within relational clusters to examine how digital (dis)connectionis negotiated across overlapping social contexts. Drawing on Giddens’ Structuration Theory the analysis demonstrates that children’s decisions about when and how to disconnect are not simply the product of adult regulation or individual self-control but recursive processes through which social structures are both reproduced and transformed. Across contexts, shared moral frameworks of attentiveness, respect, balance, and responsibility shape how disconnection is practiced, interpreted, and justified. Children actively reinterpret these frameworks through their own reasoning and emotional engagement, turning externally imposed rules into reflexive acts of self-governance. By examining how children navigate, comply with, and contest moral expectations surrounding digital (dis)connection, this study advances an understanding of digital agency as relationally constituted and morally grounded. The findings invite a shift from protectionist or developmental framings of children’s digital lives toward relational and dialogical approaches that recognize children as active moral agents in co-creating thesocial norms that organize everyday (dis)connection.

With the rapid advancement of Smart City development, its impact on per capita household consumption in households with older adults remains insufficiently understood. This study aims to examine the causal effects of Smart City pilot policies on household consumption and consumption structure among older households in China. This study uses panel data from the China Health and Retirement Longitudinal Study from 2011 to 2020. A difference-in-differences approach is employed to identify the causal impact of Smart City pilot policies on per capita household consumption. Mechanism analysis is conducted to explore potential pathways, and heterogeneity analysis is performed across age, education, and income groups. The findings show that Smart City policies significantly increase per capita household consumption in households with older adults. This effect is primarily driven by improvements in digital connectivity, healthcare accessibility, and financial inclusion. The positive impact is more pronounced among households with older, less educated, and low- to middle-income members, while no statistically significant effects are observed among younger, higher-educated, or higher-income groups. In terms of consumption structure, Smart City development significantly increases subsistence-oriented expenditure but has limited effects on development- and leisure-oriented consumption. Additionally, the results suggest that these policies contribute to reducing disparities in household consumption. Smart City development plays a significant role in promoting household consumption and reducing consumption inequality among older households. The findings provide micro-level evidence on the distributional effects of urban digital policies and offer important implications for designing inclusive and equitable Smart City strategies.

ABSTRACT This paper examines how, during the COVID-19 pandemic, international students used the resources embedded within the transnational spaces they occupied to secure the affective support they needed. Based on 33 interviews and 23 follow-up interviews with international master’s degree students in Finland, this paper shows how digital connectivity became fundamental to the ways in which international students navigated the COVID-19 pandemic, how they made sense of their transnationality and how it acquired greater significance for them as they sought emotional support from their friends and family at home through the use of various communication technologies and social media. Their familial bonds were thus strengthened and led them to reimagine how they were positioned in the world. The major contribution of this analysis shows that it challenges the common understanding of how transnationalism is constituted by various empirical modalities. Instead, the paper shows how transnationalism involves dynamic processes of the ways in which human agents make sense of the shifting material conditions pertaining to cross-border connectivities.

ABSTRACT Digital nomadism has emerged as a distinct form of location-independent work characterized by temporary mobility, digital connectivity, and transnational labor participation. This paper examines its local economic, social, and regulatory implications, with particular attention to housing markets, labor dynamics, public services, and social inequality. Digital nomads typically high-skilled, mobile professionals generate new patterns of consumption, place-based engagement, and urban demand, while simultaneously straining housing affordability, local infrastructure, and service provision in host destinations. The phenomenon also reshapes labor markets by increasing demand for flexible, service-oriented work while reinforcing global disparities in access to digital infrastructure and skills. Regulatory responses vary widely, ranging from promotional visa schemes and city branding strategies to restrictive residency and taxation policies. However, these governance frameworks remain fragmented and often fail to address equity concerns or long-term urban sustainability. Overall, digital nomadism is shown to intensify existing socio-spatial inequalities while creating new opportunities for urban innovation and economic diversification, requiring integrated and equity-oriented policy responses. Keywords: Digital nomadism; Remote work mobility; Urban housing markets; Migration policy; and Socio-spatial inequality.

• Hybrid digital twins secure IIoT while preserving data privacy • Continual learning adapts models to new threats with low data needs • Hardware-in-the-loop validates detection under realistic conditions • Achieves 97% accuracy with 20 × less training data than full retraining • Scalable framework for resilient anomaly detection in Industry 4.0 The Industrial Internet of Things (IIoT) is increasingly exposed to cyber threats due to its tight integration of operational technology and digital connectivity. Traditional intrusion detection systems (IDSs) often struggle with adaptability, false positives, and operational scalability in dynamic, non-stationary environments. This paper proposes a cyber threat detection framework that integrates hybrid digital twins (DTs) with continual learning to enable reliable and adaptive intrusion detection in realistic IIoT settings. The hybrid DTs act as local mirrors of IIoT devices, preserving sensitive data close to the source while supporting controlled validation of firmware updates and configuration changes. The continual learning mechanism enables the detection model to incrementally adapt to evolving traffic patterns and emerging attacks, mitigating catastrophic forgetting without requiring repeated offline retraining. Experimental validation on benchmark datasets and real IIoT traffic shows that the proposed DT-enabled framework supports stable detection performance over time under bounded memory and incremental update constraints, reflecting realistic deployment conditions. The proposed architecture highlights a practical trade-off between offline optimality and online adaptability, offering a robust, scalable solution for securing IIoT infrastructure that balances continuous operation, reliability, and controlled adaptation.

Digital professionalism and the evolving identity of nursing students in the social media era.