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During the COVID-19 pandemic, the reliance on digital services increased in most developed countries leaving many communities who are digitally excluded cut-off from vital services such as health and social care. Globally, digital exclusion is proposed to be one of the largest issues on discrimination within countries where smart cities and digital-by-default policies have been promoted, preventing certain groups of society from having access to public services. Addressing why people are being digitally excluded is important in improving the access people have to healthcare and other services that improve a person’s quality of life. Through a focused review of literature and publicly available secondary information, this paper examines the impact of Covid-19 on digital exclusion in Europe, Scandinavia, North America and Asia Pacific region and the methods that have been successful in limiting digital exclusion. Results show that while some countries handled the COVID 19 pandemic well, other countries’ attempts widened the gap with more people becoming digitally excluded.

The integration of digital technologies has significantly reshaped marketing campaigns in Kuwait, where digital tools increasingly supplement or replace traditional outreach. In this paper, the authors offer a theoretical exploration of how digital transformation impacts marketing across business, political, and governmental sectors. Using secondary data and existing literature, the authors examine how platforms like social media, artificial intelligence, and analytics systems enhance engagement, personalization, and campaign efficiency. These technologies contribute to business intelligence by supporting real-time interaction and data-driven decision-making. However, challenges such as technological integration, regulatory uncertainty, and cultural factors persist. The study concludes with insights and future research directions focused on intelligence-driven innovation.

This research explores the causes behind increasing defaults among Small and Medium Enterprises (SMEs) in Kuwait by focusing on the impact of the crisis and the role of the Kuwait National Fund for SME Development. The central crisis examined in this study is the COVID-19 pandemic, which acted as a catalyst that intensified pre-existing financial and operational challenges within the SME sector. Other systemic vulnerabilities such as limited financial literacy, weak risk management, and policy gaps are also considered within this broader crisis context. By employing a mixed method approach, the study draws on 15 interviews with owners of defaulted SMEs and a questionnaire involving 64 defaulted SMEs. This dual method framework qualitative (thematic analysis) and quantitative (survey based statistics) provides both depth and generalizability in understanding default risks. Thematic analysis revealed that crises such as COVID-19 related operational delays, changes in customer behaviour, and increased financial obligations were the main contributing factors. The quantitative findings align with these themes, with 89% acknowledging that the pandemic affected their ability to repay loans. This research contributes to existing literature by empirically linking crisis induced pressures to SME loan defaults in a Gulf context, with Kuwait as the focus. Policy implications include strengthening the Kuwait National Fund’s role in flexible financial support, risk management programs, and enhancing SME access to alternative funding channels. The study proposes that the Kuwait National Fund for SME Development could implement sustainability policies and practices such as flexible financial support, capacity building, risk management, and facilitating connections with alternative funding sources to address these issues. These proposed strategies provide SMEs with more resources and skills to handle challenges, which may reduce default rates and contribute to a more resilient SME sector in Kuwait.

Purpose The purpose of this study is to understand the public value of the government of Kuwait using blockchain technology to develop the capabilities of smart cities. Design/methodology/approach Research was conducted in Kuwait, where the increased use of blockchain technology has been evidenced in both the private and public sectors. A total of seven IT managers were interviewed to gauge their responses to blockchain and its use in Kuwait ministries. Findings Blockchain technology offers many benefits for the development of smart cities in Kuwait. This is a statement that received almost mutual agreement amongst all the IT managers interviewed. However, as regards wider acceptance, the majority mentioned that a framework is necessary to better articulate the public value of using blockchain in smart cities in Kuwait. Originality/value This paper develops research hypotheses and a framework for articulating the public value of blockchain technology for smart cities in Kuwait.

PurposeThe research identifies literature on Home-Based Businesses (HBBs) from 2000 to August 2023, focuses on their economic roles, challenges for entrepreneurs and success strategies, reflecting societal and technological changes. This guides future studies and highlights knowledge gaps.Design/methodology/approachA systematic literature review of published, peer-reviewed research between the years 2000 and 2023 is performed to examine how research on HBBs has changed over time, areas needing more study and how research has been done.FindingsA total of 58 articles were analyzed and categorized into five distinct themes. Key insights into the evolution, significance and multifaceted aspects of HBBs are presented, revealing the impact and role of these businesses in a modern economic context.Originality/valueThe synthesis of existing literature enhances our understanding of recent studies on HBBs, focusing on challenges, and identifies promising directions for future research.

Purpose - The aim of this study is to investigate the factors affecting the net benefits and change in user behaviour in a technology push scenario in Smart Cities. Design/methodology/approach -The research was conducted using a quantitative approach. Hence, quantitative data was obtained by devising and distributing a questionnaire adapted from the literature to serve the purpose of this research. Data was analysed by using SmartPLS software, since this tool allowed for the creation of a Structural Equation Modelling (SEM). Contributions -The research is expected to help foster an understanding of the factors affecting citizens' satisfaction with technology-supporting smart cities. The focus of this research was on the scenario where technology was introduced by the government to support the development of smart cities, and where citizens 'do not have a choice' and are 'pushed' to use them. The research contributes a model for assessing the role of satisfaction in enhancing the net benefits of smart city technologies on the lives of citizens, as well as the change in individuals' behaviour towards smart city technologies when they are 'pushed' for use. The findings provided insights to enable policy makers to implement smart cities in developing countries while ensuring the satisfaction of the users. Originality/value - The originality of this research is centred around determining how satisfied citizens are with smart cities and the net benefit of smart cities within a developing country (Kuwait) context. The research is also unique in that it examines the role of citizens' satisfaction in changing their behaviour towards 'push' technology within smart cities. Theoretical Contributions - This study examined the factors that led to acceptance of smart cities in Kuwait. Hence, this study used the theories related to user acceptance of technology and added to its trust in provider. Previous studies have examined trust as a broad concept. Moreover, this study incorporated the push theory and also examined the change in user behavior, which was not examined in earlier studies.

Background Pressure injuries (PIs) remain a critical quality and safety concern in healthcare, often resulting from fragmented care coordination and inconsistent adherence to evidence-based practices. They mainly impact immobile patients, especially the elderly, critically ill, or neurologically impaired individuals with extended stays or poor nutrition. Digital health solutions show promise in standardizing and enhancing interdisciplinary care, but many systems do not accurately reflect real-world workflows or frontline clinical needs. Objective This study describes the first two phases in the development of the Multidisciplinary e-Care Coordination (MDeCC) system, an evidence-based, co-designed digital care component for PI management focusing on protocol development, stakeholder engagement, and initial digital configuration. Methods A qualitative participatory design approach was employed across two phases to co-develop the content and structure of the MDeCC prototype. In Phase 1, three iterative co-design workshops were conducted with clinicians, administrators, and caregivers. These workshops served as qualitative inquiry sessions to explore current workflows, identify challenges, and co-generate design input. A structured PI care protocol was co-created and validated through stakeholder feedback. In Phase 2, the validated protocol was translated into a configurable digital prototype compatible with the hospital’s OASIS system. Results The process yielded a tailored MDeCC prototype grounded in seven evidence-based care domains: assessment, nutrition, mobility, pain management, support surfaces, education, and sustainability of care. Design features emphasized multidisciplinary usability, mobile accessibility, role-specific dashboards, and integration with institutional workflows. Conclusion The MDeCC has the potential to support wound care teams, hospital policymakers, and quality inspectors in advancing more coordinated, accountable, and sustainable pressure injury care practices. Future phases will assess real-world deployment and impact. Clinical trial number Not applicable.

Background Interleukin-10 (IL-10) regulates immune responses in solid tumours, but its role in colorectal cancer (CRC) is unclear due to inconsistent findings. Tumour location is a critical prognostic factor, with proximal tumours often linked to worse outcomes. However, the relationship between IL-10 expression and tumour site is poorly understood. Methods Protein expression of IL-10, its α-receptor (IL10Rα), and intracellular signal transducer (STAT3) was measured by immunohistochemistry in archived paired non-cancerous and cancerous colonic specimens collected from the same patients (n = 120). The data were then stratified according to clinical stages (early-stage I/II vs. late-stage III/IV) and tumour sites (right-sided cancers; RSCs vs. left-sided cancers; LSCs). Functional effects of biologically active IL-10 protein (0.1, 1, and 40 ng/ml), anti-IL10Rα monoclonal antibody (0.1, 1, and 40 ng/ml), and a single concentration of a specific STAT3 inhibitor (2 µM) on cell cycle and apoptosis were assessed in HT29 and SW620 CRC cell lines, along with the expression of key regulatory molecules. Results Overall, protein expression of IL-10, IL10Rα, and STAT3 was significantly higher in malignant tissues compared to non-malignant tissues. Early and late-stage RSCs exhibited markedly increased expression of these proteins relative to LSCs, with the highest levels observed in late-stage RSCs. Elevated protein levels of all molecules correlated with high-grade tumours, mucinous histology, lymph node metastasis, and advanced cancer stage. While IL-10 treatment showed minimal effects, IL-10Rα blockade or STAT3 inhibition led to cell cycle arrest and apoptosis in HT29 and SW620 cells, associated with increased p21, p27, and Caspase-3, and decreased CCND1, CCND3, PCNA, and survivin gene and protein expression. Conclusions IL-10 and its signalling molecules increased in CRC progression, particularly in RSCs, suggesting their potential oncogenic roles and prognostic significance. Furthermore, targeting IL-10 signalling pathways could offer a promising avenue for CRC treatment. However, further studies are required to explore the IL-10 system in relation to tumour consensus molecular subtypes to better elucidate its biological functions and prognostic values in CRC.

(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities––which are often not taken into account while estimating nurse-to-patient care time allocation––that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses’ overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time–motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.

Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade. Data for this analysis is a synthesis of raw and published data from eleven Hajj seasons between 2005 and 214. For seven Hajj seasons the data were obtained from studies involving pilgrims of UK, Saudi Arabia and Australia; and for the remaining four Hajj seasons data were abstracted from published studies involving pilgrims from multiple countries. The data from both sources were synthesised to estimate the relative risk (RR) of acquisition of ILI in vaccinated versus unvaccinated pilgrims. The pooled sample size of the included studies was 33,213 with most pilgrims being in the age band of 40–60 years (range: 0.5 to 95 years) and a male to female ratio of 1.6. The pilgrims originated, in order of frequency, from Iran, Australia, France, UK, Saudi Arabia, Indonesia, India, Algeria, Ivory Coast, Nigeria, Somalia, Turkey, Syria, Sierra Leone and USA. Except for one year (2008), data from individual years did not demonstrate a noticeable change in the rate of ILI against influenza vaccine coverage, however the combined data from all studies suggest that the prevalence of ILI decreased among Hajj pilgrims as the vaccine coverage increased over the last decade (RR 0.2, P<0.01). This analysis suggests that influenza vaccine might be beneficial for Hajj pilgrims. However, controlled trials aided by molecular diagnostic tools could confirm whether such an effect is real or ostensible.