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Abstract Background Legitimate androgen use, such as testosterone replacement therapy, requires a legal prescription. Off-label use for reasons like wellness and aesthetics continues to grow. Recent regulatory changes in Australia aim to curb non-prescribed androgen use, potentially intensifying stigma, however seeking prescriptions through legal channels persists. This study aimed to explore community pharmacists’ knowledge, attitudes, and practices regarding individuals who use androgens. Methods We conducted semi-structured interviews with 15 community pharmacists, to explore knowledge and experiences related to the dispensing of androgens. The data analysis followed an iterative process, developing a codebook for thematic analysis and aligning findings with relevant literature. Results Pharmacists face challenges when meeting the needs of individuals using androgens. They often made judgments based on appearance, leading to stigmatisation and potential refusal of prescription supply. However, this is tempered by the complex environment that pharmacists work in with respect to professional and legal requirements. Limited knowledge about androgens and varying exposure to people who use androgens were evident, prompting a unanimous desire for tailored training, especially in communication skills and interaction strategies. Conclusions Facilitating androgen use within regulated healthcare settings, under professional medical supervision, is crucial to mitigating health risks. Varied pharmacist knowledge underscores the urgent need for targeted training, emphasising education initiatives to address structural stigma and inform healthcare policies globally.

Between 2020 and 2021, the COVID-19 pandemic forced governments, around the globe, to implement innovative initiatives to avoid a complete collapse of significant sectors. Emergency remote teaching (ERT) operational frameworks were developed through the Council for Higher Education (CHE) to guide higher education (HE) institutions' operational procedures. Considering that students at Universities of Technology (UoTs) are used to face-to-face teaching, ERT may have been aversely experienced. Thus, for this study, the review of Tourism Management students' learning preferences during ERT across three South African UoTs were ascertained. Through means of a sequential-explanatory research design, students were asked to complete a survey and, afterwards, those students who showed interest were interviewed in focus groups. Tourism Management UoT students did not see ERT in a positive light as access to HE was a major challenge for them during lockdown periods, indicating a lack of sufficient resources to properly participate in learning activities, and crucially, a lack of access to support mechanisms during ERT. Contribution: This study offers student perspectives of remote learning experiences. This data could assist in offering a balance between ERT initiatives and learner-guided frameworks for HE. This knowledge could be critical in limiting the gap in access and success for hybrid or blended tourism programmes post-COVID-19.

This paper reports on a study carried out by tutors and students on Early Childhood Studies degree courses at a University in England. The research explored perspectives of three to six-year-old children's outdoor play in Danish forest kindergartens with the aim of troubling and informing approaches to outdoor pedagogy. Inspired by Somerville and Powell's 'deep hanging out' ([Somerville, M., and J. Powell. 2018. "Thinking Posthuman with Mud: And Children of the Anthropocene." "Educational Philosophy and Theory" 51 (8): 829--840. https://doi.org/10.1080/00131857.2018.1516138, 1) with data, researchers visited the kindergartens for a full day at a time during annual week-long field visits. This provided opportunities to notice the children's journeys and possibilities over time. Findings showed that, given time and space to play in the forest, children were able to pursue their interests, engage in extended periods of concentration and thinking while working together as they played and explored with each other, with the educators and with the materiality of their surroundings. Implications for practitioners highlight the need to provide uninterrupted time for children to develop their curiosities and enjoyment of the outdoor environment.

Background Artificial intelligence (AI) has the potential to revolutionise healthcare. If the implementation is successful it has the potential to improve healthcare outcomes for patients and organisations. Little is known about the perceptions of allied health professionals (AHPs) towards AI in healthcare. Objective This study investigated barriers and enablers to AI implementation in the delivery of healthcare from the AHPs perspective. Methods Qualitative methodology informed by behaviour change theory using focus groups with AHPs at a health service in Queensland, Australia. Results Twenty-four barriers and 24 enablers were identified by 25 participants across four focus groups. Barriers included: lack of AI knowledge, explainability challenges, risk to professional practice, negative impact on professional practice, and role replacement. Enablers include AI training and education, regulation, reputation, understanding the healthcare benefits of AI and engaging clinical champions. Conclusions AHPs have concerns about the impact and trustworthiness of AI and the readiness of organisations to support its use. Organisations must take a proactive approach and adopt targeted and multifaceted strategies to address barriers. This may include workforce upskilling, clear communication of the benefits of AI use of local champions and ongoing research.

BackgroundArtificial intelligence (AI) has the potential to address growing logistical and economic pressures on the health care system by reducing risk, increasing productivity, and improving patient safety; however, implementing digital health technologies can be disruptive. Workforce perception is a powerful indicator of technology use and acceptance, however, there is little research available on the perceptions of allied health professionals (AHPs) toward AI in health care. ObjectiveThis study aimed to explore AHP perceptions of AI and the opportunities and challenges for its use in health care delivery. MethodsA cross-sectional survey was conducted at a health service in, Queensland, Australia, using the Shinners Artificial Intelligence Perception tool. ResultsA total of 231 (22.1%) participants from 11 AHPs responded to the survey. Participants were mostly younger than 40 years (157/231, 67.9%), female (189/231, 81.8%), working in a clinical role (196/231, 84.8%) with a median of 10 years’ experience in their profession. Most participants had not used AI (185/231, 80.1%), had little to no knowledge about AI (201/231, 87%), and reported workforce knowledge and skill as the greatest challenges to incorporating AI in health care (178/231, 77.1%). Age (P=.01), profession (P=.009), and AI knowledge (P=.02) were strong predictors of the perceived professional impact of AI. AHPs generally felt unprepared for the implementation of AI in health care, with concerns about a lack of workforce knowledge on AI and losing valued tasks to AI. Prior use of AI (P=.02) and years of experience as a health care professional (P=.02) were significant predictors of perceived preparedness for AI. Most participants had not received education on AI (190/231, 82.3%) and desired training (170/231, 73.6%) and believed AI would improve health care. Ideas and opportunities suggested for the use of AI within the allied health setting were predominantly nonclinical, administrative, and to support patient assessment tasks, with a view to improving efficiencies and increasing clinical time for direct patient care. ConclusionsEducation and experience with AI are needed in health care to support its implementation across allied health, the second largest workforce in health. Industry and academic partnerships with clinicians should not be limited to AHPs with high AI literacy as clinicians across all knowledge levels can identify many opportunities for AI in health care.

Background Intravenous unfractionated heparin (IVUFH) and low molecular weight heparins (LMWH) are first line anticoagulants for the management of acutely unwell patients. The decision to prescribe either IVUFH or an LMWH is complex with minimal direction from clinical guidelines. The aim of this study was to explore individual prescribers’ perceptions on prescribing IVUFH or LMWH in patients’ acute management.Methods Semi-structured interviews were conducted with purposively selected senior medical officers who were from specialities including cardiology, cardiothoracic surgery, respiratory, emergency, vascular surgery, nephrology, neurology and general medicine, identified as those that routinely prescribe IVUFH or LMWH. An interview tool with seven questions and four hypothetical case scenarios guided interview discussions. Interviews were audio recorded, transcribed and inductively coded for thematic analysis.Results Twelve doctors participated in interviews between February and October 2022. Mean interview duration was 24 min; data saturation was achieved. Most were senior doctors: one was a registrar and others were staff specialists. Three key themes emerged: (1) rationale for the choice of heparinoid, (2) patient safety considerations and (3) resources required. The themes and subthemes identified the complexity of issues to consider when choosing between IVUFH and LMWH. Multiple factors were considered by participants which were based on previous experiences and institutional capabilities rather than evidence-based medicine.Conclusion Future interventions should focus on highlighting LMWH as the preferred heparinoid in most clinical scenarios. The use of IVUFH should be reserved for specific patient cohorts where the benefit of IVUFH outweighs the additional risks.

As Earth's climate has varied strongly through geological time, studying the impacts of past climate change on biodiversity helps to understand the risks from future climate change. However, it remains unclear how paleoclimate shapes spatial variation in biodiversity. Here, we assessed the influence of Quaternary climate change on spatial dissimilarity in taxonomic, phylogenetic, and functional composition among neighboring 200-kilometer cells (beta-diversity) for angiosperm trees worldwide. We found that larger glacial-interglacial temperature change was strongly associated with lower spatial turnover (species replacements) and higher nestedness (richness changes) components of beta-diversity across all three biodiversity facets. Moreover, phylogenetic and functional turnover was lower and nestedness higher than random expectations based on taxonomic beta-diversity in regions that experienced large temperature change, reflecting phylogenetically and functionally selective processes in species replacement, extinction, and colonization during glacial-interglacial oscillations. Our results suggest that future human-driven climate change could cause local homogenization and reduction in taxonomic, phylogenetic, and functional diversity of angiosperm trees worldwide.

Introduction: This study aimed to explore the views and perceptions of Advanced Life Support (ALS) practitioners in two South African provinces on initiating, withholding, and terminating resuscitation in OHCA. Methodology: Semi-structured one-on-one interviews were conducted with operational ALS practitioners working within the prehospital setting in the Western Cape and Free State provinces. Recorded interviews were transcribed and subjected to inductive-dominant, manifest content analysis. After familiarisation with the data, meaning units were condensed, codes were applied and collated into categories that were then assessed, reviewed, and refined repeatedly. Results: A total of 18 ALS providers were interviewed. Five main categories were developed from the data analysis: 1) assessment of prognosis, 2) internal factors affecting decision-making, 3) external factors affecting decision-making, 4) system challenges, and 5) ideas for improvement. Factors influencing the assessment of prognosis were history, clinical presentation, and response to resuscitation. Internal factors affecting decision-making were driven by emotion and contemplation. External factors affecting decision-making included family, safety, and disposition. System challenges relating to bystander response and resources were identified. Ideas for improvement in training and support were brought forward. Conclusion: Many factors influence OHCA decision-making in the Western Cape and Free State provinces, and numerous system challenges have been identified. The findings of this study can be used as a frame of reference for prehospital emergency care personnel and contribute to the development of context-specific guidelines.

Here we provide the 'Global Spectrum of Plant Form and Function Dataset', containing species mean values for six vascular plant traits. Together, these traits -plant height, stem specific density, leaf area, leaf mass per area, leaf nitrogen content per dry mass, and diaspore (seed or spore) mass - define the primary axes of variation in plant form and function. The dataset is based on ca. 1 million trait records received via the TRY database (representing ca. 2,500 original publications) and additional unpublished data. It provides 92,159 species mean values for the six traits, covering 46,047 species. The data are complemented by higher-level taxonomic classification and six categorical traits (woodiness, growth form, succulence, adaptation to terrestrial or aquatic habitats, nutrition type and leaf type). Data quality management is based on a probabilistic approach combined with comprehensive validation against expert knowledge and external information. Intense data acquisition and thorough quality control produced the largest and, to our knowledge, most accurate compilation of empirically observed vascular plant species mean traits to date.

A comprehensive review of sodium-based flue gas desulphurisation is presented in this article. The paper provides a comparison of various sodium-based technologies with regards to sulphur removal efficiency, sorbent cost, by-product valorisation and overall process economics. More emphasis was placed on dry sorbent injection (furnace sorbent injection, economizer sorbent injection, duct sorbent injection) and semi-dry flue gas desulphurisation. Particular effort was devoted in identifying state-of-the-art technologies and potential research gaps in a summarized way. In water-scarce countries, where sodium-based technologies are more economically feasible, and duct sorbent injection processes are favourable, it is recommended to use sodium-based absorbents since they will have higher sorbent utilization and improved electrical resistivity (compared to their calcium-based and/or magnesium-based sorbent equivalents). However, the check-and-balance of the associated advantages and disadvantages are a pivotal determinant of the sorbent choice. Apart from sulphur dioxide abatement, the additional advantages of sodium-based absorbents include its high sulphur trioxide removal efficiency as well as its hydrogen fluoride and hydrogen chloride removal capability. A scarcity in literature, especially as it relates to application in the South African coal-fired power generation industry, necessitates the need for further research with particular focus on local sodium-based absorbent markets, the physiochemical properties and sulphur dioxide reduction potential of locally acquired sodium-based absorbents, modelling of sulphation reaction kinetics in semi-dry and dry application, as well as the techno-economic feasibility of sorbent based technologies for the South African power industry.

When "quality being everyone’s business" coincides with the reality of a disruptive work environment, critical self-evaluation becomes an essential tool to ensure accountability. Academics who design curricula and their tuition offering have a certain degree of freedom in what and how they teach. However, academics need to be consciously discerning, yet inclusive, about the voices that should speak into curriculum design. This study operates from the principle of co-creation in curriculum design and acknowledges the multiplicity of relevant voices that speak into curriculum design. These voices are influenced by the past, present, and possibilities of the potential future. To remain relevant in the imagined future, this research identified the co-creators and curriculum design partners for the multidisciplinary field of knowledge management. The curricula of three related academic departments were analysed to determine knowledge management tuition linkages. These curricula were then compared with the Skills Framework for the Information Age (SFIA) level descriptors. Following on from this desktop analysis, Sensemaker®, a distributed digital ethnographic methodology was piloted that will be used to collect micronarratives from emergent curriculum co-creators. This article identifies gaps in current curricula, expresses expectations for future possibilities and highlights potential niche opportunities for knowledge management curriculum design.

This qualitative study investigated the long-lasting effects of an average tour to the Holy Land on travellers of the same faith. Data were collected using written interviews, diary entries, observations and communications at least one year after Protestant travellers returned from their planned trip. Thematic analysis was used to analyse the data through the three phases of noting, encoding and then interpreting important aspects. The findings show these faith travellers invested themselves into the trip before, during and after, as part of their committed faith formation. Any faith-based reader would be interested in the results that evidence long-lasting effects for the participants through their actions and behaviours. All participants stated that this trip was a highlight, enhancing their personal connection with God and increasing their involvement in various faith events and activities. Since their return from the trip participants have initiated or contributed to multiple activities such as personal Bible study, storytelling, giving a particular book to others, starting Bible study groups and other personal faith formation behaviours within their work, home and community contexts.

No abstract available.

Safeguarding Earth's tree diversity is a conservation priority due to the importance of trees for biodiversity and ecosystem functions and services such as carbon sequestration. Here, we improve the foundation for effective conservation of global tree diversity by analyzing a recently developed database of tree species covering 46,752 species. We quantify range protection and anthropogenic pressures for each species and develop conservation priorities across taxonomic, phylogenetic, and functional diversity dimensions. We also assess the effectiveness of several influential proposed conservation prioritization frameworks to protect the top 17% and top 50% of tree priority areas. We find that an average of 50.2% of a tree species' range occurs in 110-km grid cells without any protected areas (PAs), with 6,377 small-range tree species fully unprotected, and that 83% of tree species experience nonnegligible human pressure across their range on average. Protecting high-priority areas for the top 17% and 50% priority thresholds would increase the average protected proportion of each tree species' range to 65.5% and 82.6%, respectively, leaving many fewer species (2,151 and 2,010) completely unprotected. The priority areas identified for trees match well to the Global 200 Ecoregions framework, revealing that priority areas for trees would in large part also optimize protection for terrestrial biodiversity overall. Based on range estimates for >46,000 tree species, our findings show that a large proportion of tree species receive limited protection by current PAs and are under substantial human pressure. Improved protection of biodiversity overall would also strongly benefit global tree diversity.

Lean Engineering can be used in the higher education sector to improve administrative processes. This study focused on the unit that delivers part-time programmes. Staff from this unit and from the faculty registries were interviewed to identify which processes were being used. A workshop used five Lean tools to establish which were most useful. Interviews were used to confirm the analysis of the outcomes of the workshop, leading to a proposed model for the application of these tools. This resulted in a model that uses the Kipling Analysis with process flow mapping to understand the current state with an overarching approach that draws on DMAIC. This study aims to use Lean in a context where its methods and processes are not commonly known or used, and can be used in several pilot studies to increase awareness of the value of Lean within the institution, leading to its more holistic implementation.

In the last few decades, the expansion of online learning and online assessment has attracted both negative and positive attention, some of which has celebrated the flexibility and individualised affordances of online learning contexts, while also lamenting the overuse of one-size-fits-all teaching approaches. Virtual learning contexts have been criticised for their lack of human presence and, while continual developments in learning technologies have supported advances in flexible education and remote learning, assessment and feedback processes have not always improved accordingly. This systematic literature review focuses on the assessment process from the design phase through to the post-feedback phase with particular emphasis on the way in which individual choices and personalised features of assessment can enhance student learning. Twenty-nine articles that met the inclusion criteria developed for this study were analysed. Results show that personalised online assessment is mostly researched using qualitative methods that focus on students. Furthermore, these results reveal that it is pivotal for the lecturer to focus on the process of personalising online assessments, acknowledging the significance of the assessment design. An additional outcome from this study was the clarification of the terms: humanised, personalised and individualised, previously used interchangeably.

Plant functional traits can predict community assembly and ecosystem functioning and are thus widely used in global models of vegetation dynamics and land-climate feedbacks. Still, we lack a global understanding of how land and climate affect plant traits. A previous global analysis of six traits observed two main axes of variation: (1) size variation at the organ and plant level and (2) leaf economics balancing leaf persistence against plant growth potential. The orthogonality of these two axes suggests they are differently influenced by environmental drivers. We find that these axes persist in a global dataset of 17 traits across more than 20,000 species. We find a dominant joint effect of climate and soil on trait variation. Additional independent climate effects are also observed across most traits, whereas independent soil effects are almost exclusively observed for economics traits. Variation in size traits correlates well with a latitudinal gradient related to water or energy limitation. In contrast, variation in economics traits is better explained by interactions of climate with soil fertility. These findings have the potential to improve our understanding of biodiversity patterns and our predictions of climate change impacts on biogeochemical cycles.

The convenience sample used in the study reported on here consisted of 91 students enrolled in the primary and middle school Postgraduate Certificate in Education course for 2 consecutive years at a South African university. We used the Student Understanding of Science and Science Inquiry instrument to answer questions about these students' knowledge of the nature of science and scientific inquiry compared to that published for pre-service primary and middle school teachers from China, Turkey, and the United States of America (USA), whether the changes proposed for the instrument enhanced its reliability, and whether any correlation could be found to these students' age and educational factors. The findings show that these South African student teachers shared similar levels of knowledge of the nature of science and scientific inquiry to their counterparts from Turkey and the USA, all of which were less sophisticated than that of the Chinese students. The test was found to have a high degree of reliability in the South African context, with the proposed changes to the instrument doing little to enhance this. The older students and those who did not study any tertiary science or mathematics courses scored statistically significantly higher. We suggest that the confirmatory nature of tertiary practical science work and exposure to the complexity of science in postgraduate work or employment in industry could explain these findings.

Purpose – This study analyses the motives of visitors to two food and wine events in the Western Cape, South Africa. Its purpose is to enhance the ongoing success, sustainability, and distinctiveness of these culinary events in comparison to alternative leisure and entertainment activities. Methodology/Design/Approach – A spatial systematic approach was used to survey 680 event visitors. Visitors self-completed the structured questionnaires with mostly closed-ended questions. Findings –Preliminary results suggest that visitors to food and wine events come for largely the same reasons. More detailed analyses revealed that food and wine event visitors place more importance on certain factors, suggesting that the visitors will have different leisure behaviours and needs in terms of event product requirements. Originality of the research – The findings help identify visitors to food and wine events in the Western Cape, allowing for targeted marketing and tailored event offerings. This increases the precision and effectiveness of marketing and supports the successful development of future events. The study provides valuable insights into the motivations for attending South African food and wine events, adding to the existing literature, which can also help to ensure the continued success, competitiveness and sustainability of these events in the region.

This systematic review and meta-analysis was conducted to determine the clinical relevance of echocardiographically measured left atrial (LA) size to predict the recurrence of atrial fibrillation (AF) after direct current cardioversion (DCCV). A search was performed on Medline (Ovid), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL) in Cochrane Library, Wiley and Web of Science (Clarivate) to identify relevant studies. Amongst the initial 4066 citations identified, 31 fulfilled the criteria for inclusion in the data analysis incorporating 2725 patients with a mean follow-up period of 6.5 months. The weighted mean left atrial volume index (LAVI) was 40.56 ml/m2 (95 %CI:37.24–43.88) in the sinus rhythm (SR) maintenance group versus 48.69 ml/m2 (95 % CI: 44.42–52.97) in the AF recurrence group with P value of