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This paper proposes a methodological framework that integrates poststructuralist Discourse Theory (DT), Critical Discourse Studies (CDS) and Corpus Linguistics (CL). While previous research has discussed potential compatibility between combinations of these approaches, there have been few attempts to bring them all together into a cohesive research programme. Fostering dialogue between diverse methodological perspectives can facilitate multi-level analysis to capture the complex dynamics of sociopolitical issues. In this vein, the article presents the methodological tree, an analogy used to illustrate how these traditions may come together to complement one another. This foundation lays the groundwork for practical application in discursive analysis, with a flexible analytical structure proposed and examples provided to illustrate its implementation. It is hoped that the article can stimulate further discussion around how DT, CDS and CL can be brought together to harness their strengths. [ABSTRACT FROM AUTHOR]

The financial crisis of 2007 and 2008 was a wake-up call for the banking sector. Since then, many activities have been taken to improve the stability of the financial industry. Our paper aims to derive a risk-related tone from the top that enables top management to equalise their employees' risk behaviour and align the desired risk behaviour with the bank's risk appetite. Even though individual fragments of measures and requirements to implement a risk-related tone from the top have emerged over the years, a holistic picture is still waiting to be established. Especially the normative management is crucial for implementing a risk-related tone from the top as this channel supports top management in communicating the core values. To gain news insights into the tone from the top and the top managements' communication behaviour, we use a sequential explanatory mixed method approach. Our aim is to unite the positions of research and supervision. Therefore, we start with a comprehensive literature review to identify the relevant research streams. Building on this theoretical fundament, we evaluate practitioners' communication behaviour quantitatively via a questionnaire with a sample size of 197 German regional banks. Qualitatively, we analyse the communication behaviour via eight interviews with CEOs of German regional banks. For the supervisory perspective, we build on the FSB 'Guidance on Supervisory Interaction with Financial Institutions on Risk Culture'. This guidance not only emphasises the importance of the tone from the top, but also provides a first holistic picture of supervisory efforts on the topic. In summary, we consolidate the results from research, supervision and practice to derive a holistic picture for the implementation of a risk-related tone from the top. Finally, our holistic integration reveals future directions for research, supervision and practice. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the experiences of education professionals in their efforts to provide education and support to children with special educational needs and disabilities (SEND) amid the COVID‐19 pandemic, and to gain insights into the perceived repercussions of pandemic‐related restrictions on the educational development and overall wellbeing of these children. Mixed‐methods surveys (N = 100) and semi‐structured qualitative interviews (N = 6) were utilised. Data were analysed using descriptive statistics and thematic analysis. Findings indicate substantial challenges faced by education professionals in delivering appropriate and effective education and well‐being support to children with SEND during periods of school 'closures', resulting in hindered academic progression and adverse impacts on the well‐being of children with SEND, their families and the education professionals themselves. It is vital that effective support strategies and appropriate training are implemented, in addition to further research to establish what would be most beneficial for all teachers, and particularly those supporting children with SEND. [ABSTRACT FROM AUTHOR]

Cross-boundary interactions between second-home owners and local are complex over time – networks form and evolve within second-home owners and between owners and locals, each with its deliberately selective inclusion and exclusion. However, little attention has been paid to this phenomenon in the literature. This study, based on social network analysis alongside qualitative interviews, explores the dynamics of interactions between second-home owners and locals by analysing the networks formed by second-home owners in Qinglinkou, China. The ways in which second-home owners maintain and strengthen pre-existing networks with other owners and forge new links with locals, shape the cross-boundary interactions between the two groups. This study contributes to understanding the dynamics of cross-boundary interactions that are interwoven into the networks that second-home owners establish and maintain over time, and offers additional insights into the fragility of integration and high risk of segregation between the two groups in second-home destinations. [ABSTRACT FROM AUTHOR]

There is a global concern regarding boys' poor engagement in literacy activities. It is suggested that boys enjoy ways of learning that are active and have explicit goals. Readers' theater (RT) provides an active and collaborative means of practicing oral reading fluency, with a clear goal of performing for an audience at the end of training. In the context of an intervention study for struggling readers in grades 3 and 4 (9–10 years old), we investigated whether boys benefit more than girls from the goal to perform in readers' theater in terms of reading fluency development, engagement, and retrospective perception of their learning. We found that girls slightly outperformed boys in expressive reading and showed higher engagement in RT. Girls were also more interested in drama and more likely to participate in the study. However, boys showed a larger reduction in RT-related disaffection over time. In addition, boys in the goal-oriented program reported learning to act and immerse themselves in the text more often than boys in the practice-oriented RT. In contrast, girls reported learning these skills also in the practice-oriented RT. We conclude that the goal to perform in RT may be particularly helpful in engaging boys in RT. [ABSTRACT FROM AUTHOR]

The study assessed the Alternative Learning System (ALS) in Bulacan, focusing on learning delivery, resources, environment, and assessment to propose a professional development plan for teachers. Utilizing a mixed-methods approach, data were collected from 342 ALS implementers and learners through surveys and interviews. Findings revealed a diverse teacher demographic, predominantly female and single, with most having less than five years of experience and no recent seminar attendance. Most teachers held Bachelor's degrees, with some possessing Master's degrees, and a majority had passed the LET exam. Respondents rated ALS implementation as "fully implemented," except for learners who rated the learning delivery and learning resources as "implemented". As for significant differences among the respondents, ALS implementation has no significant differences among the four learning domains. Challenges included limited interaction, ineffective communication, curriculum mismatches, resource constraints, and high workloads. Overall, there was consensus on ALS implementation across respondent groups, highlighting strengths and areas needing improvement to enhance the program's effectiveness and teacher support. To effectively address the challenges the ALS program faces, it is essential to enhance instructional delivery through increased face-to-face interaction between students and teachers, alongside providing targeted training on ALS pedagogy for educators. Developing effective learning materials, ensuring adequate facilities, creating a separate ALS curriculum, and establishing clear assessment policies will help minimize distractions, support student engagement, and improve overall learning outcomes. [ABSTRACT FROM AUTHOR]

This is a mixed-methods case study aiming to understand teachers` self-efficacy beliefs for sustainability education in the context of climate change education. Therefore, we studied teachers` self-efficacy beliefs from their own perspective as well as the connection between self-efficacy and related concepts, perceived content knowledge (pCK) and perceived pedagogical content knowledge (pPCK). Twentytwo teachers from 18 countries participating on a climate change education professional development camp answered to a questionnaire, and 19 of them were interviewed using semi-structured interviews. The results of this study show that, according to the interviews, the studied teachers have willingness to continuous learn and develop their sustainability teaching. They have beliefs not only about sustainability education but also about themselves as sustainability educators, which is something that the future instruments on teachers` beliefs should acknowledge. The questionnaire results however showed that teachers had the lowest self-efficacy beliefs on supporting students` actions for sustainability. Teachers` pCK and their pPCK were shown to correlate with their self-efficacy, especially with items related to action. In conclusion, teacher education could focus on supporting teachers pCK and pPCK to develop teachers` action-related self-efficacy beliefs thus supporting students to act for sustainability. [ABSTRACT FROM AUTHOR]

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The purpose of this study is to examine gender differences in harassment and bullying and their effect on professional satisfaction in a sample of legal practitioners in California (n = 486). Quantitative data indicate that harassment and bullying significantly decrease the odds of professional satisfaction. As compared to men, women experienced greater professional dissatisfaction, and in particular, harassment and bullying had a greater negative impact on their professional satisfaction. Qualitative data provide a deeper understanding of the respondents' experiences. Policy implications derived from this research to address workplace harassment and bullying at the macro and micro levels are discussed. [ABSTRACT FROM AUTHOR]

After the fall of the USSR, Cuba was plunged into an economic crisis with devastating effects on the agricultural system. With few options, the government restructured its agricultural system from an industrial model to a model based on smallholders and agroecology. After several decades, the results of this transition have been far reaching for both landscapes and livelihoods. This research uses mixed-methods, including remote sensing, interviews, and economic and agricultural statistics to present the case study of a smallholder community that has undergone a shift from industrial sugarcane to small-scale agroecology. This work reveals that while agricultural extent has plummeted, production of staple crops has increased dramatically. At the same time, on-farm incomes and food market availability have risen steadily. In the context of strong social, economic, and environmental protections, this represents a process of a sustainable rural transition with several concurrent benefits to people and the environment. [ABSTRACT FROM AUTHOR]

The iSOLVE implementation project established and evaluated integrated processes and pathways, including a decision-making tool and educational interventions for general medical practitioners (GPs) and the upskilling of allied health professionals (AHPs). The study used a mixed-methods (parallel) design comprising surveys, qualitative methodologies, and an embedded cluster randomized controlled trial (RCT). Sampling was conducted within a Primary Health Network (PHN) geographic area in Sydney, Australia. AHP workshops (n = 367 attendees) covered six evidence-based interventions, resulting in increased confidence (p

AbstractDrawing upon dynamic capability theory, this article tested high performance organization (HPO) framework with relation to organizations’ performance and explore causes of tested results in public sector of Pakistan. An explanatory sequential mix method was applied whereby the partial least square structural equation modeling method was used to test the direct effect of the HPO framework on organizations’ performance while qualitative method was used to explore causes of poor factors resulted from HPO framework. The results show that the HPO Framework is valid for PSOs. However, this study found weak predictive relevance and small effect size of HPO framework in public organizations. The overwhelming and compelling causes identified are mechanistic structure, lack of commitment and resources, and lack of ethical and visionary leadership in qualitative strand of the study. This study has several contributions; firstly, it explains whether HPO framework is valid to be applied in public organizations, secondly, this study answer question: how five factors criteria of HPO framework influence public organization performance? Thirdly, this study explains HPO framework application to improve organization status from low performance to high performance through ethical and visionary leadership under the lens of dynamic capability theory. This study provides a clue for public managers of developing countries to produce models of high performance and to generate new ideas and information to realize the power of high performance. High performance factors and models will promote sustainable performance of organizations which will benefit employees, organizations and society overall.

AbstractStudent-athletes in university undergo assessments in both sport and academic domains, which can encompass varying conceptions and outcomes related to assessment. However, questions on whether this ‘doubling up’ of assessments result in similar or different assessment-related outcomes, or whether assessments are conceived the same way across sport and academic contexts, are an omission in achievement research. This study sought to explore the experiences of Canadian student-athletes’ conceptions of assessment, perceptions of control, and emotions in sport and academia through an explanatory mixed-methods design. The study comprised 77 Canadian USports university athletes (Mage = 20.21) for the quantitative data, and 6 athletes partaking in focus group/individual interviews for the qualitative data. The quantitative findings revealed student-athletes reported higher conceptions of assessment as fun and irrelevant in sport compared to university, and greater emotions such as anger, helplessness, and relief in university compared to sport (p < .05). In the qualitative strand, three themes were identified for conceptions of assessment: function, discrete outcomes, broad consequences; three themes for perceptions of control: effort, preparation, and motivation; and three themes for emotions: anticipatory, retrospective, and relational. Mixed insights revealed the importance of assessment consequences, the natural motivation and effort for sport assessment, and the differences in positive and negative emotions between sport and academic domains. Recommendations are discussed for both postsecondary coaches and instructors to help improve sport and academic assessment in ways tailored to the student-athlete experience of assessment.

Objectives: Lack of awareness of Alzheimer's disease (AD) among Black Americans may undermine their ability to identify potential AD risk. We examined Black Americans' perceptions and knowledge of AD, and views of a healthy brain, which may contribute to the development of effective and culturally sensitive strategies to address racial disparities in AD. Methods: We conducted a mixed-methods study, integrating a cross-sectional survey of 258 older (>55 years) Black participants and qualitative interviews with a sub-sample of N = 29. Both data sets were integrated to inform the results. Results: Participants endorsed having little knowledge of AD. While most participants reported practicing a healthy lifestyle to promote a healthy brain, the range of activities listed were limited. Participants made several suggestions to increase AD awareness, which includes using AD educational materials containing information that would benefit the whole family, not only older adults. Outreach approaches that address both individual behaviors and structural factors were also encouraged. Conclusion: Our findings identify ongoing needs to improve AD awareness among traditionally under-represented groups. Innovation: The study utilized novel approaches to examine participants' perspectives of AD that included a diverse sample of research naïve participants, and integrated exploration of participants' views of AD and brain health.

Introduction Person-centered care (PCC) is considered a fundamental approach to address clients’ needs. There is a dearth of data on specific actions that HIV treatment providers identify as priorities to strengthen PCC. Objective This study team developed the Person-Centered Care Assessment Tool (PCC-AT), which measures PCC service delivery within HIV treatment settings. The PCC-AT, including subsequent group action planning, was implemented across 29 facilities in Zambia among 173 HIV treatment providers. Mixed-methods study objectives included: (1) identify types of PCC-strengthening activities prioritized based upon low and high PCC-AT scores; (2) identify common themes in PCC implementation challenges and action plan activities by low and high PCC-AT score; and (3) determine differences in priority actions by facility ART clinic volume or geographic type. Methods The study team conducted thematic analysis of action plan data and cross-tabulation queries to observe patterns across themes, PCC-AT scores, and key study variables. Results The qualitative analysis identified 39 themes across 29 action plans. A higher proportion of rural compared to urban facilities identified actions related to stigma and clients’ rights training; accessibility of educational materials and gender-based violence training. A higher proportion of urban and peri-urban compared to rural facilities identified actions related to community-led monitoring. Discussion Findings provide a basis to understand common PCC weaknesses and activities providers perceive as opportunities to strengthen experiences in care. Conclusion To effectively support clients across the care continuum, systematic assessment of PCC services, action planning, continuous quality improvement interventions and re-measurements may be an important approach.

Many healthcare organisations have extensive documentation detailing the processes behind their various research and innovation projects. Analysing this data can provide valuable insights into why some projects succeed without major issues, others encounter and overcome problems, and some ultimately fail. This study introduces an approach that combines narrative interviews and Natural Language Processing (NLP) to identify patterns associated with innovation project outcomes. We analysed 618 documents from 67 projects provided by ZonMw, a major Dutch healthcare research funder, and conducted 32 narrative interviews across seven cases of healthcare innovation projects. By using narrative interviews to inform and pre-train a text embedding model, we demonstrate the potential to create a proxy for human judgement, allowing for a more natural identification of contextual patterns in project documentation. The findings indicate that successful projects are more likely to adopt a proactive approach to role changes and uncertainty (due to ambiguous laws and regulations) and to allow flexibility, which enhances stakeholder engagement, compared to failed projects. However, while we were able to conduct descriptive analysis to gain these insights, significant interpretation is still required to fully understand the findings. Our study makes two primary contributions: first, it offers a new approach for future research on the factors that determine project success or failure, closely aligning with Structuration Theory. Additionally, it suggests potential efficiency improvements in theory development by enabling multiple pattern configurations within Grounded Theory. Second, it offers practical strategies for organisations to more effectively capture and use contextual information in their project documentation for future success.

BackgroundPrisons are high-risk settings for the transmission of communicable disease. Robust surveillance systems are required to identify and control outbreaks. Wastewater surveillance for SARS-CoV-2 was introduced in four prisons in Wales in March 2022. We investigated its contribution to the COVID-19 surveillance programme.MethodsWe evaluated prison wastewater surveillance against eight system attributes using a mixed-methods approach. Semi-structured interviews were completed with key stakeholders to assess usefulness, flexibility and acceptability. Quantitative analyses were completed to assess data quality, sensitivity, positive-predictive value, representativeness and timeliness. To assess sensitivity of the system to detect changes in incidence we carried out a time-series analysis comparing levels of virus in wastewater with trends in confirmed COVID-19 cases from clinical surveillance.ResultsInterviews with stakeholders indicated that wastewater surveillance is a useful adjunct to existing case-based surveillance. However, it had limited influence on action taken within the prison, often lagging behind existing surveillance and not specific enough to target interventions. The novelty of wastewater surveillance meant stakeholders lacked confidence in interpreting the data. Despite these limitations, wastewater surveillance detected changes in SARS-CoV-2 activity in Welsh prison populations which corroborated trends in case surveillance.ConclusionPrison wastewater surveillance, implemented in Wales for a period during the COVID-19 pandemic, was useful and should be considered as part of a wider surveillance programme in response to future SARS-CoV-2 waves, or in response to future pandemics. It is particularly beneficial in the absence of comprehensive clinical testing. We identified several limitations to address should this surveillance be re-started.

Background Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging. Objectives To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources. Design A mixed-methods, phased design. Setting Six care homes in England caring for older adults. Participants Care home staff (n = 31), residents (n = 17), family members (n = 17), senior health and care leaders (n = 13). Methods A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics. Results The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents’ physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff. Limitations The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either ‘good’ or ‘outstanding’. There was a lack of ethnic diversity in resident and family participants. Conclusions Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information. Plain language summary Older people living in care homes are at risk of poor health and death if they get coronavirus disease 2019 (COVID-19). To protect older people from COVID-19, care homes use different measures, including social distancing and isolation. These measures can be challenging. Our research aimed to explore the challenges and solutions to using social distancing and isolation in care homes. We reviewed existing evidence to examine how care homes have used social distancing and isolation measures to control the spread of COVID-19 and other contagious diseases. We investigated how social distancing and isolation measures have been used in six care homes in England. We spoke with residents, families and staff. We collected care home documents and other data. We held group discussions with senior health and care leaders. The review showed limited research and the limited nature of policy documentation on social distancing and isolation measures. Interviews revealed that social distancing and isolation measures were difficult, and sometimes impossible, for staff to implement. These measures made care homes feel less homely and inhibited touch, for example hugs. Residents and families valued the work of care homes to keep residents safe and the use of technology for keeping connected. Social distancing, isolation and related restrictions negatively affected residents’ physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government to the care home sector was described as chaotic and trauma was inflicted on care home staff, residents, families and friends. These findings have been used to design guidance to help care homes implement social distancing and isolation measures both now and for any future outbreaks. Scientific summary Background Older people living in care homes (CHs) (i.e. homes that provide residential and/or nursing care) often have complex health and care needs and are at high risk of poor health outcomes and mortality, especially if they contract coronavirus disease 2019 (COVID-19). To protect older people from COVID-19, CHs use interventions such as social distancing and isolation, but these measures have been reported as challenging. Research is needed to explore and understand the challenges experienced by CHs endeavouring to implement these interventions while mitigating any negative consequences. Objectives The overall aim of the study was to explore and understand the real-life experiences of social distancing and isolation measures for older people living in CHs in England from the perspective of multiple stakeholders, and to develop a toolkit of evidence-informed guidance and resources for CHs now and for future outbreaks. The study objectives were as follows: (1) to investigate the mechanisms and measures used by CHs currently and previously to socially distance and isolate older people to prevent and control the spread of COVID-19 and other infectious and contagious diseases (2) to examine the experiences of residents and families/friends of social distancing and isolation measures during the COVID-19 pandemic, including how these measures impacted upon their well-being and how they adapted to change (3) to explore how registered nurses and care staff adapted to and managed the delivery of personal, social and psychological care for residents with different needs while maintaining social distancing and isolation measures (4) to identify how CH managers, owners and external stakeholders developed, managed and adapted policies, procedures and protocols to implement social distancing and isolation measures including workforce organisation, training and support, use of communal spaces, visiting, and working with external health and social care professionals (5) to use the findings to develop a toolkit of evidence-informed guidance and resources, including a mosaic film, detailing which interventions and strategies for social distancing and isolation work well and which do not work in specific situations and contexts to support decision-making about health and care delivery in CHs and to facilitate resilience-building for future planning. Methods A mixed-methods, phased design was undertaken to identify the challenges, consequences and solutions to implementing social distancing and isolation measures in CHs for older adults to prevent and control the spread of COVID-19. The study was conducted in three phases: (1) a rapid evidence review of measures used to prevent or control the transmission of COVID-19 and other infectious diseases in CHs for older people, following the guidance for conducting rapid reviews1 (2) in-depth case studies of six purposively sampled CHs in England involving individual interviews with care staff, managers, residents and family/friends, the collection of social distancing and isolation policies/protocols and routinely collected CH data, and focus groups with purposively sampled CH owners and external stakeholders. Reporting guidance for qualitative research was used2 (3) development of a toolkit of evidence-informed guidance and resources, and a mosaic film for CHs. The findings from earlier phases were used in two co-design workshops with external stakeholders to develop the toolkit. Findings from the 103 papers included in the rapid review were synthesised using tables and a narrative summary organised around the review questions. Interview audio-recordings were transcribed verbatim and data analysed using thematic analysis. Descriptive summary statistics described the quantitative data collected. For the CH documents, information was collated around the key themes of social distancing, isolation, cohorting, zoning and other restrictions. Concurrent data collection and analysis informed decision-making about the need for further data and from which source. Patient and public involvement (PPI) was an integral part of this study, informing its design, method, analysis and dissemination. PPI group members also participated in online workshops to contribute to the co-design of the toolkit. Results The rapid review highlighted the following: There is a lack of empirical evidence around how measures to prevent or control COVID-19 and other infectious diseases are implemented in CHs. Most papers were grey literature or policy documents, which were mainly descriptive, or opinion based. Furthermore, these interventions were generally mentioned as part of a wider discussion of COVID-19 strategies and were not the primary focus of the papers. Key interventions for preventing and controlling the transmission of COVID-19 and other infectious diseases in CHs for older people include social distancing; isolation of residents and staff; restrictions for residents, family members and staff; zoning and cohorting; and surveillance. Evaluative research on the use of these interventions in CHs is needed urgently. The six case study sites were geographically spread and all had a Care Quality Commission rating of good (n = 4) or outstanding (n = 2). All were part of organisations (ranging in size from 7 to 114 CHs per organisation, and between 767 and 5875 beds per organisation). Four of the CHs were part of privately run organisations, and two were part of voluntary/not-for-profit organisations. One CH had a ‘dual’ registration, three had a ‘nursing’ registration and two were registered as ‘without nursing’. Most provided some specialist care such as for dementia, learning disabilities, physical and mental health problems. The number of beds offered ranged between 37 and 73. One CH comprised a household of 12 residents within a village complex. Care homes varied on the number of positive COVID-19 cases, for example one reported only one case between March 2020 and February 2021, while another reported 27 cases within the month November 2020 alone – this home had opened a specially allocated ‘COVID-ward’. In one CH no residents had died within 28 days of a positive COVID-19 test, while 10 residents had died from another home. Policies and protocols about social distancing and isolation measures were collected from each CH and compared. Key findings were as follows: There was significant variation between CHs in the content, length and level of detail presented in policy and guidance documents. Capturing the frequent updates in guidance was challenging with documents sometimes being repetitive and unclear. Many documents had further, embedded documents or links to government guidance that provided a great deal of information, which might be unrealistic for CH staff to read. Shorter documents were less comprehensive and may not provide the necessary detail to guide CH staff. None of the documents included guidance on staff training and development. Research at the case study sites included individual interviews with 31 CH staff. Key findings were as follows: The impact that the COVID-19 pandemic had upon CH staff must not be underestimated. Staff reported trauma and emotional distress. For many staff, the difficulties experienced during the pandemic were compounded by the government’s response to CHs. Some staff felt they had been abandoned by the government, while others criticised the ‘blanket approach’ to government guidance and the rapidly changing rules for CHs. Care home managers valued the support of their senior leadership to help them interpret and implement government guidance. Staff talked of the difficulties of ‘policing’ social distancing measures while simultaneously trying to maintain a sense of ‘normality’ for their residents. Although staff and residents were supposed to maintain a social distance from each other, this was often impossible to uphold when providing personal care. Care homes were perceived as a resident’s home rather than an institution, which made some staff question whether social distancing was appropriate. Many staff felt that social distancing measures denied residents (and themselves) of the important need for touch, as hugs were felt to have a vital role in CH life. Understanding fully the impact on residents living with dementia was recognised as a challenge and not always possible to achieve. The design and layout of CHs meant that there was not always the physical space for social distancing to be implemented. Staff felt that new admissions to CHs had the most difficult experience with isolation regulations. For some managers, isolation measures went against the ethos of the CH environment and ruined the family feel of the CH. The requirement for residents to isolate when returning from hospital could lead to a reluctance in residents to attend hospital appointments and a disinclination of staff to refer residents for hospital care. Several different resident restrictions were implemented in CHs, but restrictions around residents leaving the home, changes to food preparation/delivery and visitor restrictions were perceived to have the greatest negative impact. On occasions, staff became a target of anger and frustration from residents and their families, who could not comprehend that they were being prevented from seeing each other. Good support from CH management was considered by staff to make the process of implementing these measures easier. Individual interviews were conducted with 17 residents and 17 family members. Key findings were as follows: The experiences of residents and families were varied, and their impact was influenced by the existing pattern of relationships residents and families maintained within and beyond the CH. Residents and families valued the work of the CHs in keeping residents safe. They accepted the need for restrictions. Residents and families appreciated the support they received in communicating with one another virtually and the importance of this communication for residents’ health and well-being. Measures relating to isolation were particularly difficult for residents, particularly for those unable to communicate with the outside world through technology. Measures to make isolation less difficult for residents included ensuring that they were entertained purposefully with regular socially distanced visits from staff and various resources to occupy their time. Creative approaches to activities for residents not isolating were also evidenced, for example indoor gardening, yoga and quizzes. Social distancing made aspects of CH life and social visiting difficult and sometimes unsatisfactory; residents and families missed physical touch and other non-verbal forms of communication. This was particularly important for residents with cognitive impairment. Residents and families were involved with staff in complex judgements of risk, choice and control, which were complicated by two factors. First, families (and some residents) were aware that those in CHs were in the twilight of their lives and that time was ebbing away. Second, many families and residents were also learning how to manage their relationships in the new living context of a CH. Two focus groups were conducted with a purposive sample of 13 external senior health and care leaders. Key findings were as follows: Isolation of the sector: the sector felt cut off from the National Health Service (NHS) and pre-pandemic sources of service and support. Government guidance for CHs and communication processes: ‘chaos’ described the approach to cascading information to CHs, especially in the first wave of the pandemic. Visiting: regulations evolved throughout the different waves of the pandemic and led to variations in interpreting and implementing visiting guidance. Trauma: as the pandemic wore on and the different waves and variants emerged, there was a need to take account of the broader health and well-being of residents, families, visitors and the workforce. Trauma impacted at several different levels – for staff, residents and family members. Implications for practice and policy For practice Implications of the study findings for practice are captured in our toolkit for supporting CHs with social distancing and isolation measures. These are framed around six areas: caring for residents when they are social distancing; caring for residents when they are isolating; supporting residents, families and friends to communicate when visiting is not permitted; supporting visits from families and friends when visiting is allowed but with restrictions; caring for care staff; and caring for managers. For policy The study findings can inform discussions involving CH providers, managers and external stakeholders to enhance understanding of social distancing and isolation measures for residents – consequences, challenges, solutions and learning. Our findings also have implications about how guidelines are developed and disseminated. They reinforce the need for CHs and social care to be considered as an integral part of integrated care systems, to ensure that actions taken during national emergencies fully account for the impact on all parts of health and social care. Our findings can inform discussions about developing digital technologies to help residents with different needs stay connected with families and friends, and for CHs to communicate effectively with residents’ families and friends. Our findings can contribute to the content of the digital hub for the social care workforce. Recommendations for further research This study has identified that research is needed in several areas including the following: Evaluations of the toolkit. Evaluation of social distancing and isolation measures used in CHs to prepare for future pandemics. Research to develop and evaluate remote social interaction for residents living with dementia and their families. Research to understand what a trauma-informed approach looks like for the CH sector – to care for residents, families, friends and staff in CHs caring for older people. Research to co-design and evaluate an intervention to enable residents with different needs to transition to living well in a CH. The study of an intervention that cares for families and friends. Conclusions The CH sector was ill-prepared and under-resourced for the COVID-19 pandemic. During the pandemic and for any further surges, it is paramount that CH services are safe, effective, caring, responsive to individual needs and well-led. The loss of older people living in CHs due to COVID-19 has been substantial; it is essential to learn from this devastation, to understand the consequences, challenges, solutions and to evaluate these solutions. Evidence to support learning and recovery of the CH sector from the pandemic and to inform policy-making is paramount. Care homes need evidence-informed guidance that sets out what and how social distancing and isolation measures should be operationalised, while meeting residents’ individual needs. Our toolkit is designed to capture such innovative approaches. Our study makes an important contribution to this learning and recovery, as one of the first to study the challenges and solutions to implementing social distancing and isolation measures for older people living in CHs in England. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.

Diese Forschungsarbeit geht der Frage nach, ob kleine Gemeinden die Energie- und Klimastrategien von grossen Gemeinden nachahmen, um die Entstehung von kommunalen Energie- und Klimastrategien besser zu verstehen. Dazu wird ein Mixed-Methods-Ansatz angewendet. Zunächst wurden 472 kommunale Energie- und Klimastrategien von Schweizer Gemeinden hinsichtlich ihrer Ambition analysiert. Als Mass dienten die Bewertungen von akkreditierten Energiestadtberater:innen. Danach folgt eine Diskussion der Resultate mit drei Expert:innen. Entgegen den Erwartungen kann keine Tendenz nachgewiesen werden, dass kleine Gemeinden grosse Gemeinden nachahmen. Dafür ergibt sich aus den Expert:inneninterviews, dass Nachahmungseffekte bei Peer-Gemeinden durchaus eine Rolle spielen. Zudem deuten die quantitativen und qualitativen Ergebnisse darauf hin, dass einwohnerreiche und politisch links-orientierte Gemeinden ambitioniertere Energie- und Klimastrategien formulieren. Für beides gibt es Erklärungsansätze: Erstens verfügen grosse Gemeinden über mehr finanzielle und personelle Ressourcen, um energie- und klimapolitische Massnahmen umzusetzen. Zweitens wäre es denkbar, dass der Stellenwert einer Energie- und Klimastrategie von der politischen Ausrichtung einer Gemeinde abhängt. Die Forschungsarbeit leistet schliesslich einen Beitrag zu einem besseren Verständnis über die Entstehung von kommunalen Energie- und Klimastrategien und kann für Bund sowie Kantone für die Justierung bestehender Unterstützungsprozesse von Nutzen sein.

Given that little is currently known about gambling in the workplace, we conducted a mixed-methods study to describe the characteristics and experiences of people who gamble at work. We administered a Canada-wide online survey (n = 2,000) of adults who 1) gamble, 2) are currently employed full-time, and 3) have internet access at work. A descriptive analysis of quantitative survey data showed that individuals who gamble at work had lower job satisfaction and higher rates of problem gambling compared to those who do not. Among those who gamble at work, we quantitatively described the types of gambling, the consequences experienced, and the motivations for gambling. Qualitative interviews were conducted with 18 individuals who met the criteria for problem gambling and who gamble at work. Data were integrated to provide a richer description of the experiences of those who gamble at work, including their motivations, the role of work–life satisfaction, and the dynamic influence of work as a social context. Motivations for workplace gambling included excitement, social connection, avoidance, and coping with stress or emotions. The results highlight the importance of understanding the varied motivations of individuals who gamble at work, and the role of work experiences in shaping meaning regarding gambling behaviours.

Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions. Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions. Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis. Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors. Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks. Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.

IntroductionThis study examines the influence of teacher job embeddedness, collective efficacy, and work meaningfulness on the psychological well-being of Chinese teachers. The focus is on understanding how these constructs contribute to teacher well-being through a mixed-methods approach.MethodsA two-stage structural equation modeling (SEM) analysis was conducted using quantitative data collected from 406 in-service Chinese teachers. The study also incorporated a qualitative phase involving digital ethnography within online teaching communities to provide deeper insights into teachers’ experiences.ResultsThe quantitative analysis revealed significant positive direct effects of job embeddedness, collective efficacy, and work meaningfulness on psychological well-being, with work meaningfulness showing the strongest effect. The mediating role of work meaningfulness partially explained the relationships between job embeddedness, collective efficacy, and teacher well-being. The qualitative findings supported and expanded upon these results, emphasizing the role of a supportive school community and strong administrative leadership.DiscussionThe results suggest that enhancing job embeddedness, collective efficacy, and work meaningfulness can significantly contribute to teachers’ psychological well-being. These findings provide actionable insights for school leaders and policymakers in the Chinese educational system to foster environments that promote teacher well-being.

BackgroundMass drug administration (MDA) with primaquine (PQ) is being considered for accelerating Plasmodium vivax elimination in remaining active foci. This study aimed to determine the acceptability of MDA with PQ in malaria endemic villages in a malarious setting in the South of Thailand undergoing MDA with PQ.MethodsA cross-sectional mixed-methods approach was conducted in seven malaria endemic villages where MDA with PQ was implemented. The data were collected from community villagers and health workers using structured questionnaires, in-depth interviews, and focus group discussions. Descriptive statistics and logistic regression models were used for quantitative data analysis. Thematic analysis was applied for qualitative data.ResultsAmong a total of 469 participants from the MDA villages, 293 participants were eligible for MDA with PQ and 79.86% (234) completed 14-days of PQ. The logistic regressions indicated that males (adjusted odds ratio: 2.52 [95% confidence interval: 1.33-4.81]) and those who are farmers (2.57 [1.12-5.90]) were most likely to participate in the MDA. Among 293 participants in the post-MDA study, 74.06% had originally agreed to participate in the MDA with PQ while 25.94% had originally reported not wanting to participate in the MDA. Of those who originally reported being willing to participate in the MDA, 71.23% followed through with participation in the first or second round. Conversely, 93.24% of those who originally reported not being willing to participate in the MDA did in fact participate in the MDA. Factors contributing to higher odds of agreeing to participate and following through with participation included being male (1.98 [1.06-3.69]) and correctly responding that malaria is preventable (2.32 [1.01-5.35]) with some differences by village. Five key themes emerged from the qualitative analyses: concern about side effects from taking PQ; disbelief that malaria could be eliminated in this setting; low overall concern about malaria infections; misunderstandings about malaria; and a general need to tailor public health efforts for this unique context.ConclusionWhile the reported likelihood of participating in MDA was high in this setting, actual follow-through was relatively moderate, partially because of eligibility (roughly 71% of those in the follow-up survey who originally agreed to participate actually followed through with participation). One of the largest concerns among study participants was PQ-related side effects-and these concerns likely heavily influenced participant adherence to the MDA. The results of this study can be used to tailor future MDAs, or other public health interventions, in this and potentially other similar settings.

Acknowledging the critical role of English for Specific Purposes (ESP) in shaping professional and academic success across various fields, the research delves into the nuanced interplay between gender and academic discipline in shaping the ESP needs of higher education students. The investigation investigates the impact of gender and academic discipline on Chilean dentistry and business administration students’ perceived lack, want, and need for English for Specific Purposes (ESP). Drawing on sociocultural theory and self-determination theory, a mixed-methods model that involved data collected from 94 dentistry and 121 business administration students was adopted. Findings revealed significant gender differences: males reported greater perceived lack, whereas females exhibited higher want and need for English, suggesting gender influences ESP perception and necessitates customized learning strategies. Contrarily, academic discipline did not significantly affect ESP perceptions, challenging assumptions that ESP needs are strictly discipline-dependent and highlighting a generalized demand for English proficiency across fields. The findings demonstrate the importance of gender-sensitive and flexible ESP programs that cater to diverse learner needs while considering broader educational and individual factors. The study implies that educational practitioners should develop ESP curricula that not only address specific professional terminologies and situations but also reflect an understanding of the roles gender and discipline play in language learning. This approach could foster more effective and inclusive language education tailored to the varied aspirations and requirements of students in different fields.

This research contributes to the literature on journalistic news framing by analyzing the portrayal of telehealth as a particularly relevant topic during the COVID-19 pandemic. Frames before and after the onset of the pandemic were examined across four news regions: Canada, Australia, the U.K., and the U.S.A. A mixed-methods news framing analysis combined computational linguistic analysis with manual coding methods and determined five general frames through which telehealth is discussed in the news. Results show differences in non-pandemic and pandemic news frames, and in national frames.

Abstract Background Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as “complex”. Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. Case presentation A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. Conclusions A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.

Abstract Background Although internet-based stress management programs are proven effective in improving mental health among workers, micro- and small-sized enterprises (MSEs), lacking in occupational healthcare services, face challenges implementing them. To address this gap, this study will develop the program with stakeholders at MSEs to aim for real-world implementation. Objectives This paper describes a study protocol for a pre-post feasibility study of an effectiveness-implementation hybrid type 2 trial of text-based internet-based programs (“WellBe-LINE”) in MSEs with less than 50 employees. This feasibility study primarily aims to evaluate trial methods for future effectiveness-implementation hybrid type 2 trials. Methods For this study protocol, an internet- and text-based self-care intervention program using the LINE app (a popular message tool in Japan) will be prepared according to evidence-based psychoeducational topics. Based on our online survey findings, personalized algorithms will be implemented according to employees’ gender, age, and psychological distress levels. A personalized program using a popular pre-existing text app is expected to reduce employees’ burdens and be attractive to them, resulting in successful implementation outcomes and mental health benefits. A pre-post design feasibility study will be conducted on ten companies to evaluate trial methods (e.g., recruitment and procedures). The primary outcome will involve individual-level penetration, defined as the proportion of the number of employees who register for the program divided by the total number of invited employees at the company. The progression criterion to go next trial specifies that more than 50% of the recruited companies obtain 60% individual penetration, which is set based on the findings of the prior survey of employees at MSEs and of interviews of stakeholders involved in this study, and will be measured by LINE system. Finally, acceptability, appropriateness, and feasibility will be measured using internet-based questionnaires and interviews. Discussion This pre-post feasibility study for future effectiveness-implementation hybrid type 2 trials will provide in-depth knowledge about the successful implementation of text-based, semi-personalized, self-care mental health interventions in real-world settings using both quantitative and qualitative data. Conclusions This feasibility study will help validate the effectiveness of text-based interventions using a widely used social networking service (SNS) tool for employees in MSEs. Trial registration UMIN clinical trial registration, UMIN000046960. Registered on February 21, 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053570

Abstract Background Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees. Aim To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development. Setting University of California, San Francisco. Participants 359 women residents and fellows from 41 specialties. Program description A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review. Program evaluation A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively. Discussion 23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILD’s longitudinal sustainability and impact for women trainees.

Abstract Background Women experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress. Objective This paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data. Methods HOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists’ private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women’s experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned. Discussion The HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth. Trial registration. ClinicalTrials.gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

The rate of alcohol consumption among student-athletes places them at risk for engaging in unsafe behaviors. Although coaches play a key role in regulating alcohol use among athletes, many lack the knowledge and self-confidence to be effective. This study aimed to examine the relationship between alcohol consumption literacy and alcohol confrontation efficacy among National Collegiate Athletic Association head coaches and attempted to identify types of training and education wanted to better manage student-athlete alcohol use. A total of 518 National Collegiate Athletic Association head coaches completed alcohol consumption literacy and alcohol confrontation efficacy measures and two open-ended questions about what kind of alcohol training, information, and skills were needed. When accounting for previous education/training and gender of team coached, alcohol consumption literacy predicted all confrontation efficacy subscales. Content analysis showed coaches wanted training related to alcohol literacy, effective communication, and prevention planning. Findings have implications for designing alcohol prevention and intervention programs aimed at National Collegiate Athletic Association coaches. [ABSTRACT FROM AUTHOR]

In recent years, there has been a growing concern about the health issues young individuals face, and the COVID-19 pandemic has further exacerbated this trend. It is crucial to explore effective methods of delivering mental health services to provide psychosocial support and prevent the onset of severe mental illnesses. The objective of this study was to assess the mental health problems and needs of university students to lay the groundwork for the development of an intervention program. To achieve this, a mixed-method design consisting of two components was employed. First, an online survey was conducted on 634 university students to assess their health symptoms. Second, four focus groups were conducted, with an average of nine participants each. These participants had completed the survey and displayed moderate symptoms of depression and anxiety. The focus groups utilized a semi-structured interview guide. The results of the study revealed that 84.4% of the survey respondents experienced severe levels of depressive symptoms, while 74.6% reported severe levels of anxiety symptoms. Notably, LGBTQ+ individuals and fourth-year students exhibited higher levels of anxiety symptoms compared to other groups. Through data analysis, several themes emerged: (1) balancing outside and inside demands, (2) characteristics of mental health problems, (3) pain-protecting wall, and (4) pain relieving techniques. Overall, our findings highlight that the majority of university students experienced moderate to severe levels of depression and anxiety symptoms, particularly in the aftermath of the COVID-19 pandemic. Based on these findings, researchers will develop interventions aimed at preventing the worsening of anxiety and depressive symptoms among university students. [ABSTRACT FROM AUTHOR]

Many of our transactions and interactions are now exclusively online; however, whilst we live in a world which is becoming ubiquitously digital, digital exclusion remains a complex societal issue. This study aimed to identify the scale and characteristics of ‘digitally excluded’ individuals in one borough in North East England and investigate factors influencing experiences of digital exclusion. A two-phase, sequential explanatory mixed-methods design was used. Phase One utilised a survey which was sent to every household in the borough (N = >98,000). The surveys (N = 9181) were analysed using exploratory univariate analysis, followed by a two-staged regression model. Of those responses, 1130 individuals (12.3%) were identified as digitally excluded. Older adults with disability, no or low-level education, and residing in specific (micro) geographical areas, were at higher risk of digital exclusion. Smaller household sizes and lower income also contributed to digitally exclusion. To further enhance inclusivity, three focus groups were conducted with groups who were identified as being at higher risk of digital exclusion (N = 10). Discussions highlighted the complexities of digital exclusion and digital use across communities and within individual circumstances. Digital exclusion is multi-factored and complex. It requires regional institutions and local communities to collaborate in an integrated governance framework to improve digital inclusion. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between second or foreign language (L2) writing learners' perception of ChatGPT, their usage behavior, and L2 writing proficiency, including complexity, accuracy, and fluency. A mixed-methods design was utilized to collect data from 215 university L2 writing learners through surveys and argumentative writing samples, and four students participated in a focus group discussion. Results indicated that performance expectancy and effort expectancy significantly influenced students' intended behaviors, while the effect of social influence was non-significant. Facilitating conditions significantly predicted actual behaviors. Furthermore, the study found that ChatGPT usage significantly predicted only complexity. During the focus group discussion, students expressed the need for support from teachers. The study highlights the importance of human agency in writing instruction, including clear principles, critical evaluation of ChatGPT feedback, and constant monitoring to reinforce human roles in writing. These findings provide insights into students' perceptions and behaviors toward AI-based writing tools and inform effective writing instruction in the AI era. [ABSTRACT FROM AUTHOR]

Academic career development relies on a combination of teaching and research skills. In Australia, it is common for recent Doctor of Philosophy graduates to have a short-term post-doctoral research experience to build publication track-record and increase grant competitiveness, before securing a combined research and teaching or 'academic' role at a university. Other scientists work as full-time researchers for several years before transitioning to academic roles with expectations they can teach. The aim of this study was to explore the experiences of health and biomedical science researchers transitioning into academic roles using a mixed methods design. Sixty-six participants working in health and biomedical sciences at over 20 Australian Universities who had been in an academic role for 5 years or less completed an online survey. Of 66 participants, 18 (27%) had never been in a research-only role before, while 48 (63%) had held a research-only role for up to 11 years before starting their current academic role. Findings showed most academics were not trained nor equipped to successfully undertake scholarly teaching. They reported a lack of awareness of teaching expectations, practical resources, and direct support provision at the start of their appointment. For former researchers specifically, these experiences led to low confidence and poor enjoyment in their academic role, with the potential to decrease overall teaching quality, student learning and student satisfaction. We postulate that these issues may be mitigated by the implementation of teaching-specific training programs catering for the research-only background of staff entering health and biomedical academic roles in the higher education workforce. [ABSTRACT FROM AUTHOR]

Background Despite antibiotic stewardship programs existing in most acute care hospitals, there continues to be variation in appropriate antibiotic use. While existing research examines individual prescriber behavior, contextual reasons for variation are poorly understood. Methods We conducted an explanatory, sequential mixed-methods study of a purposeful sample of 7 hospitals with varying discharge antibiotic overuse. For each hospital, we conducted surveys, document analysis, and semi-structured interviews with antibiotic stewardship and clinical stakeholders. Data were analyzed separately and mixed during the interpretation phase, where each hospital was examined as a case, with findings organized across cases using a strengths, weaknesses, opportunities, and threats framework to identify factors accounting for differences in antibiotic overuse across hospitals. Results Surveys included 85 respondents. Interviews included 90 respondents (31 hospitalists, 33 clinical pharmacists, 14 stewardship leaders, 12 hospital leaders). On surveys, clinical pharmacists at hospitals with lower antibiotic overuse were more likely to report feeling: respected by hospitalist colleagues (P =.001), considered valuable team members (P =.001), and comfortable recommending antibiotic changes (P =.02). Based on mixed-methods analysis, hospitals with low antibiotic overuse had 4 distinguishing characteristics: (1) robust knowledge of and access to antibiotic stewardship guidance; (2) high-quality clinical pharmacist–physician relationships; (3) tools and infrastructure to support stewardship; and (4) highly engaged infectious diseases physicians who advocated stewardship principles. Conclusions This mixed-methods study demonstrates the importance of organizational context for high performance in stewardship and suggests that improving antimicrobial stewardship requires attention to knowledge, interactions, and relationships between clinical teams and infrastructure that supports stewardship and team interactions. [ABSTRACT FROM AUTHOR]

The advent of the Metaverse, a convergence of virtual and physical realities, presents unprecedented opportunities for promoting cultural tourism along the historic Silk Roads within the Belt and Road Initiative (BRI) framework. However, this emerging technology's potential remains largely unexplored in the context of cultural heritage preservation and its promotion. The aim of this study is to address this gap by empirically examining how the Metaverse can be harnessed to improve tourists' experiences, support sustainable tourism development, and promote cultural exchange along the Silk Roads. In this study, we employed a mixed-methods approach grounded in attribution theory, using both surveys and semi-structured interviews with Silk Road tourists who had been exposed to Metaverse applications. To investigate the relationships between Metaverse features, tourists' attributions, satisfaction, and behavioral intentions, we used structural equation modeling and thematic analysis. The findings revealed that perceived immersion, avatar identification, and cultural authenticity significantly influenced tourists' internal, stable, and controllable attributions. Interviews further highlighted the Metaverse's potential to promote accessibility, interpretation, and engagement with Silk Road heritage, while also raising sociocultural and ethical considerations. This paper also showcases the development of Metaverse digital twin prototypes for several iconic Silk Road cities to demonstrate the potential for participatory virtual environments to promote cultural heritage preservation, accessibility, and sustainable tourism. The study's findings contribute to the theoretical understanding of Metaverse tourism and the application of attribution theory, offering practical insight for the responsible and effective harnessing of this transformative technology. This research provides actionable recommendations for policymakers, destination managers, and technology providers to optimize the Metaverse's potential for cultural tourism along the Silk Roads. This has great potential in promoting the BRI's connectivity and cooperation objectives. This paper lays the foundation for future research and responsible innovation at the intersection of emerging technologies, cultural heritage, and sustainable tourism development. [ABSTRACT FROM AUTHOR]

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017–2018, 2020–2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work—whether because of transportation challenges or pregnancy-related health complications—led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women. [ABSTRACT FROM AUTHOR]