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BACKGROUND: Outcome measures are crucial to support a treat-to-target approach to rheumatoid arthritis (RA) care, yet their integration into clinical practice remains inconsistent. We developed an Electronic Heath Record-integrated, patient-facing side-car application to display RA outcomes (disease activity, functional status, pain scores), medications, and lab results during clinical visits (RA PRO Dashboard). The study aimed to evaluate patient perceptions and attitudes towards the implementation of a novel patient-facing dashboard during clinical visits using a mixed-methods approach. METHODS: RA patients whose clinicians used the dashboard at least once during their clinical visit were invited to complete a survey regarding its usefulness in care. We also conducted semi-structured interviews with a subset of patients to assess their perceptions of the dashboard. The interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. Emerging themes and subthemes were organized into four domains of the Ecological Model of Health. RESULTS: Out of 173 survey respondents, 79% were interested in seeing the dashboard again at a future visit, 71% felt it improved their understanding of their disease, and 65% believed it helped with decision-making about their RA care. Many patients reported that the dashboard helped them discuss their RA symptoms (76%) and medications (72%) with their clinician. Interviews with 29 RA patients revealed 10 key themes: the dashboard was perceived as a valuable visual tool that improved patients understanding of RA outcome measures, enhanced their involvement in care, and increased their trust in clinicians and the clinic. Common reported limitations included concerns about reliability of RA outcome questionnaires for some RA patients and inconsistent collection and explanation of these measures by clinicians. CONCLUSIONS: In both the quantitative and qualitative components of the study, patients reported that the dashboard improved their understanding of their RA, enhanced patient-clinician communication, supported shared decision-making, and increased patient engagement in care. These findings support the use of dashboards or similar data visualization tools in RA care and can be used in future interventions to address challenges in data collection and patient education.

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 WILDs longitudinal sustainability and impact for women trainees.

Purpose: This research analyzes the effects of a Service-learning program on the development of civic attitudes and skills on preservice teachers (n = 98). They provided a direct service of motor sessions aimed at children with functional diversity. Method: The topic was approached using a mixed methodological approach. A pre- and posttest quantitative analysis was performed on the results obtained after applying the Civic Attitudes and Skills Questionnaire, and a qualitative analysis was performed on the content of follow-up journals. Results: The quantitative results indicated a significant positive posttest, and qualitative analysis explained the civic skills and attitudes that the preservice teachers acquired. Discussion/Conclusion: Service-learning is a useful method for promoting the civic attitudes and skills of preservice teachers. The acquired learning specifically affected the different dimensions involved in achieving meaningful learning, an improvement in the skills and attitudes that are essential characteristics of an inclusive teacher. [ABSTRACT FROM AUTHOR]

BACKGROUND: Information on salt consumption patterns is needed to inform the need for and design of salt reduction strategies. OBJECTIVES: In northern Ghana, this study aimed to estimate household consumption of salt, including salt from bouillon, and compare (estimated) women and childrens salt intake to global recommendations; to estimate the proportion of salt consumed from bouillon; and to identify factors, including knowledge, attitudes, and practices, associated with household salt consumption. METHODS: Employing mixed-methods methodology, we conducted a pilot survey (n = 369 households enrolled) and focus group discussions (FGDs; n = 20) in Tolon and Kumbungu districts (14 urban, 14 rural clusters) (clinicaltrials.gov registry: NCT04632771). Households reported purchases of discretionary salt (DS, table salt) and bouillon cubes. DS and total salt (TS; DS+salt from bouillon) consumption for women (15-49 y) and children (2-5 y) were estimated using the Adult Male Equivalent method and compared with global recommendations (

BackgroundDespite being disproportionately impacted by COVID-19 due to a lack of structural support, marginalized communities have been largely ignored in the politically polarized debate over school masking. In response to this, we sought to explore masking attitudes by centering the voices of parents and children at historically marginalized, predominantly Hispanic schools in southern California.MethodsWe conducted a mixed-methods study with parents and children attending 26 low-income predominantly Hispanic-serving elementary schools. A random sample of parents was asked to provide a freelist of words they associate with masking. A subset of parents with children aged 4-6 was recruited from these surveys to participate in parent-child interviews (PCI). We calculated Smith's salience index for all unique items, stratifying by language (English/Spanish). Item salience guided PCI thematic analysis for additional context and meaning.Results648 participants provided 1118 unique freelist items in English and Spanish. 19 parent-child pairs were interviewed, 11 in Spanish and 8 in English. The most salient words were "safety"(0.37), "protection"(0.12), "prevention"(0.05), "health"(0.04), "good"(0.03), "can't breathe"(0.03), "necessary"(0.02), "care"(0.02), "precaution"(0.02), and "unnecessary"(0.02). Spanish speakers had a more favorable view of masking than English speakers, particularly regarding "protection" (0.20 vs 0.08) and "prevention" (0.10 vs 0.02).DiscussionMasking is an affordable individual-level risk mitigation that protects the communities that have inequitably shouldered the burdens of the COVID-19 pandemic. We recommend that policymakers prioritize the views of those most impacted when deciding on risk mitigation policies like school masking.

BACKGROUND: Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize womens health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS: This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION: Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and womens outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

Objective: This study aimed to evaluate the feasibility of a workplace-delivered outpatient multidisciplinary service (ReCOV) for staff experiencing post COVID-19 condition ('Long COVID'). Methods: A mixed-methods study of staff at a large, tertiary hospital with Long COVID who attended the service was conducted. Participants completed questionnaires to determine baseline symptoms and were offered allied health appointments for up to 12 weeks each based on clinical indication. Acceptability, implementation, practicality and limited efficacy were evaluated via one-on-one semi-structured interviews and analysed using inductive thematic analysis. Limited efficacy was evaluated via pre- and post-questionnaires and demand via multidisciplinary utilisation. Results: Twenty-three (median age 37 [interquartile range 30–45] years, 52% female) participants were included. Participants had appointments with a median of 4 [3–5] different professions; most commonly exercise physiology (n = 19, 83%), occupational therapy (n = 17, 74%) and neuropsychology (n = 15, 65%). Median time spent on the ReCOV service was 15 [9–19] weeks. Thirteen semi-structured interviews were completed and analysed. Participants valued ReCOV for being a COVID-19 specific, convenient, flexible and multidisciplinary service at their workplace. Participants preferred the service to have been available for longer than 12 weeks to achieve further benefits as many participants perceived little change in physical health. Conclusions: Attending a multidisciplinary service located at their workplace was feasible for staff to manage post COVID-19 symptoms. Further research is required to confirm the efficacy on patient outcomes. What is known about the topic? Self-management strategies and multidisciplinary rehabilitation with self-monitoring are considered best practice for treatment of Long COVID. What does this paper add? A workplace delivered outpatient multidisciplinary service was feasible in terms of demand, acceptability and practicality and provided valued support for hospital staff experiencing Long COVID. What are the implications for practitioners? A flexible, workplace delivered multidisciplinary service was acceptable and convenient to hospital staff with Long COVID. Further research is required to confirm the effectiveness of such a service on patient outcomes. [ABSTRACT FROM AUTHOR]

The AI-enabled intelligent learning system (AEILS) is able to provide personalised and intelligent tutoring and is more capable of meeting individuals' need. Nevertheless, limited studies focused on the effect of AI-specific factors on user behaviour. To fill this research gap, we identified the AEILS-specific affordances (i.e. interactivity, personalisation, competition, convenience) and explored their effect on user engagement and foreign language speaking anxiety (FLSA). In this paper, we integrate quantitative and qualitative studies to explore user behaviour in AEILS. Survey data was collected from 457 respondents and analysed using structural equation modelling with the smart-PLS software. The results showed that AEILS-specific affordances significantly affect flow experience and self-expansion, thus facilitating user engagement and alleviating FLSA. Semi-structured interviews were conducted to corroborate the findings of the quantitative study. These findings highlighted the importance of technology affordance in AEILS. This study contributed to the literature on IS and education by incorporating context-specific factors into account. [ABSTRACT FROM AUTHOR]

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively assess changes in recovery of people recovering from COVID-19 treated by a primary care allied health professional, and to qualitatively describe how they dealt with persistent complaints. Materials and methods: This mixed-methods study is part of a Dutch prospective cohort study, from which thirty participants were selected through purposive sampling. Quantitative data on recovery were collected at start of treatment and 6 months. Additionally, by use of semi-structured interviews participants were asked on how persistent complaints influenced their lives, and how they experienced received primary care allied health treatment. Results: Despite reported improvements, most participants still experienced limitations at 6 months. Hospital participants reported a higher severity of complaints, but home participants reported more diverse complaints and a longer recovery. Most participants were satisfied with the primary care allied healthcare. Tender loving care and a listening ear, learning to manage limits, and support and acceptance of building up in small steps were perceived as contributing most to participants' recovery. Conclusion: Although improvements were reported on almost all outcomes, most participants suffered from persistent complaints. Despite these persistent complaints, many participants reported being better able to cope with persistent complaints because they had decreased substantially in their intensity. Trial registration: Clinicaltrials.gov registry (NCT04735744). IMPLICATIONS FOR REHABILITATION: Participants recovering from COVID-19 receiving treatment from primary care allied health professionals reported improvements after 6 months, but still experienced persistent complaints. Home participants reported more persistent complaints and a longer recovery from COVID-19 than hospital participants. Personal attention for patients recovering from COVID-19 is necessary. Next to implementing a treatment plan (e.g. physical exercise), primary care allied health professionals should also pay attention to listening to the patient's story and offering support. Interprofessional collaboration between primary care allied health professionals, with a unified message to patients, is essential. [ABSTRACT FROM AUTHOR]

Aim: To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse–patient communication and supporting data input. Design: A cross‐sectional study with quantitative and qualitative mixed methods. Methods: We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Results: Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record‐keeping but noted a learning curve for less tech‐savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse–patient interactions are crucial considerations. Conclusion: Electronic whiteboards have usability and acceptability as a tool to improve nurse–patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Implications for the Profession and/or Patient Care: Nurses perceive electronic whiteboards as user‐friendly and as facilitating data input. Reporting Method: TREND (Nonrandomised evaluations of behavioural and public health interventions). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness with a 10–15% mortality rate. Even with timely treatment, survivors may experience acute and long-term health complications. While meningococcal vaccines are recommended for adolescents and young adults in the USA, vaccination coverage remains uneven across serotypes. This study investigated the physical, social, psychological, and economic burden of IMD on survivors and their caregivers in the USA during the acute phase (Part 1, presented in this manuscript) and the long-term phase (Part 2, presented in a separate manuscript) of IMD. Methods: This study implemented a non-interventional, mixed-methods approach using a bespoke survey and qualitative interviews (designed on the basis of a preliminary conceptual model of IMD) with US survivors and their caregivers. Results: A total of 11 survivors (1 adolescent, 10 adults) and 3 caregivers participated in the study. Survivors contracted IMD during infancy (n = 2), childhood (n = 3), or adulthood (n = 6), and often described leading healthy lives pre-IMD. At IMD onset, interactions with the healthcare system impacted participants' experiences; confusion and care delays were common, and procedures were often invasive (e.g., amputations). Survivors commonly experienced symptoms including skin rash (7/11), fever (6/11), and unconsciousness (6/11), consistent with caregivers' reports. Survivors able to report on the short-term impacts of IMD (n = 9) described functional limitations (9/9), emotional impacts (6/9) such as fear and trauma, and school (6/9), work (4/9), and financial (5/9) challenges. Caregivers also experienced emotional impacts (3/3) and family (2/3), work (3/3), and financial (3/3) impacts during the acute phase. Conclusions: IMD places a significant humanistic burden on survivors and their caregivers during the acute phase. Results from Part 1 of this study indicate a need for increased disease awareness and healthcare provider education, expeditious diagnosis, and improved access to prevention methods such as available meningococcal vaccines. A video abstract is available with this article. 7CedpUhoy_P6EE5C2Mz6-e Video abstract (MP4 1,24,432 kb) Plain Language Summary: Invasive meningococcal disease (IMD) is an uncommon but serious infection. Even with treatment, IMD is deadly for up to 10–15% of people who get sick, and survivors may experience short-term and long-term health problems. While IMD can be prevented through vaccination, many people are not vaccinated. We asked 11 survivors and 3 of their caregivers in the USA about their experiences with IMD during the time of their infection and initial recovery (the "short term"). We were particularly interested in the symptoms that survivors experienced, their diagnosis and treatment experiences, and the impact on survivors' and caregivers' quality of life. Most survivors described leading healthy lives before getting sick. Severe skin rash, fever, and unconsciousness were common symptoms when survivors got the infection. Most participants were admitted to the hospital when symptoms started (many through the emergency room). However, not everyone was diagnosed quickly or accurately, and many experienced delays in receiving care. Treatments could be drastic, such as immediate surgery to remove arms or legs. Survivors and caregivers described feeling scared and traumatized, and many experienced challenges with day-to-day activities. Healthcare-related expenses and the inability to attend school or work led to financial challenges for some. The burden of IMD infection and initial recovery is significant. There is a need for increased public disease awareness, targeted education for healthcare providers, and improved access to prevention measures such as vaccination. The long-term effects of IMD infection were also explored in this study, and are presented in another paper [1]. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness that is preventable via vaccination. Even with treatment, up to 10–15% of cases are fatal, and many survivors may experience severe long-term sequelae. Building upon the acute-phase findings presented in the Part 1 manuscript for this study, we describe the long-term physical, social, psychological, and economic burden of IMD on US survivors and their caregivers in this Part 2 manuscript. Methods: This was a novel, non-interventional, mixed-methods study among US survivors and their caregivers using a bespoke survey and qualitative interviews. Results: Ten adult survivors, one adolescent survivor, and three caregivers participated in this study. Survivors described extensive physical, neurological, and systemic sequelae, including difficulty walking (11/11), repeat secondary infections (9/11), and numbness (6/11), among others, which were echoed by caregivers. Survivors shared that IMD had negatively impacted their long-term quality of life, citing long-term impacts including emotional impacts (11/11), social impacts (10/11), memory (7/11) and attention (5/11) problems, and difficulty with functional (10/11), self-care (7/11), and physical (6/11) activities. Caregivers were also impacted, describing emotional trauma (3/3), sleep problems (2/3), and day-to-day challenges (2/3). Long-term financial challenges related to healthcare resource utilization were substantial, with specialized care and rehabilitation therapy expenses (11/11), insurance challenges (8/11), and high out-of-pocket costs (6/11) for survivors. Productivity losses were also commonly described by survivors (9/11); sequelae hindered ability to attend school (9/11) or work full time (8/11). Caregivers (2/3) described taking leave from their employment, affecting family income. Conclusions: The humanistic burden of IMD on survivors and their caregivers is substantial and persistent. A comprehensive approach, including preventative measures (e.g., vaccination) and long-term medical, psychological, and financial support for those affected, is needed to mitigate the burden of IMD. A video abstract is available with this article. -99uXpJYNLEniKmRRZ2d4e Video abstract (MP4 1,17,430 kb) Plain Language Summary: Invasive meningococcal disease (IMD) is an uncommon but life-threatening disease that can lead to serious long-term health problems and impacts on quality of life. We conducted this study to understand the experiences of survivors of IMD and their caregivers in the USA. In a previous paper, we described the experiences of 11 survivors and 3 caregivers during the time of IMD infection and initial recovery (the "short-term") [1]. Here, we continue to follow the journeys of those survivors and caregivers, and explore the health complications and impacts of IMD that persist long after initial recovery. Survivors experienced long-term physical, neurological, and systemic health problems due to IMD, such as difficulty walking, repeat infections, and numbness. Many shared that their quality of life had been negatively affected by IMD, describing memory and attention problems, social challenges, emotional trauma, and difficulty with daily activities. Caregivers were also impacted, experiencing sleep problems, distress, and day-to-day challenges. Even with insurance, specialized medical care and therapies were expensive and led to long-term financial challenges. Many survivors also found it difficult to attend school or work full-time because of their health limitations. Caregivers' ability to work was also limited because of caregiving needs, affecting ability to earn income. IMD places a heavy, long-term burden on survivors and their caregivers, and understanding the lived experiences of those affected is crucial. In addition to prevention (such as through vaccination), comprehensive, long-term medical, psychological, and financial support is needed to reduce the burden of this disease. [ABSTRACT FROM AUTHOR]

Despite advances in inclusion and access to the general curriculum for students with disabilities at large, students with extensive support needs (ESN) continue to receive instruction that is disconnected from the general curriculum and general education peers. One area of the general curriculum that students with ESN have historically lacked access to is science. However, ongoing research in this area has identified several evidence-based and promising practices that support the science learning of students with ESN. This project used a convergent mixed-methods single-case research design, specifically a single case adapted alternating treatments design paired with qualitative methods, to explore how an intervention to support comprehension of science content supported student learning and engagement for four middle school students with ESN. Implications of the study findings, as well as the value added from the mixed-methods approach, will be discussed. [ABSTRACT FROM AUTHOR]

Aim: To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. Design: Mixed‐methods explanatory sequential. Methods: In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web‐based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper‐and‐pencil questionnaire. Twenty semi‐structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. Results: Participants spent approximately one‐quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision‐making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. Conclusion: Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. Impact: This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. Reporting Methods: MMR checklist. Patient/Public Contribution: None. [ABSTRACT FROM AUTHOR]

Recent reports show that low-income students make up a significant share of those participating in higher education, and their well-being constitutes a key factor that influences their college success. This mixed-methods study examined first-year, low-income students' time use and its relationship to well-being framed by an equity-oriented lens that recognizes the time constraints low-income students navigate. Our mixed methods findings identified the link between time use and well-being and—critically—empirical explanations for these links. First, leveraging a unique experience sampling survey design and multilevel analyses, we found that attending class, studying or doing homework, and working for pay were consistently and adversely related to low-income students' well-being. Low-income students who were also first-generation in college fared worse than continuing-generation students when engaging in these experiences. On the other hand, socializing was positively related to low-income students' well-being. Second, an exploration of longitudinal data from hundreds of student interviews illuminated two primary factors that shaped the relationship between low-income students' time use and well-being: (a) structuring time and developing a routine, and (b) the power of reflection and meaning-making. These findings provide important novel insights about low-income students' college experiences and the relationship between their time use and well-being, and offer crucial guidance for educators on how to support low-income students' well-being as they navigate college. [ABSTRACT FROM AUTHOR]

The surge of emojis in computer-mediated communication (CMC) since 2011 presents a significant analytical challenge across various disciplines, such as linguistics, neurophysiology, psychology, computer science, and marketing. Departing from earlier works that exclusively utilized Natural Language Processing (NLP) techniques or engaged in the analysis of experimental or selectively curated social media texts, this study embraces a broader linguistic scope. By integrating NLP extraction and linguistic analysis of emojis within a specific language, in a one-to-one CMC corpus, this paper delivers an extensive examination of emoji usage in Mexican Spanish WhatsApp messages, uncovering underlying cultural nuances, gender differences, and a variety of pragmatic functions. The corpus contains 1,487,503 messages from a gender-balanced group of male and female participants finding that females used emojis in 17% of messages, whereas males used them in 11%. Comparing emoji usage trends revealed that while most commonly used emojis usually reflect global patterns, some culture-specific deviations exist. Out of 1049 distinct emojis, 34 were deemed significant in predicting gender-based usage, taking into account a minimum occurrence (0.8% of messages). Variables like message length, emoji positioning, and sentiment were also analyzed. This study also examines emoji Mexicanisms and employs a semiotic approach to emojis under the framework of Peirce's theory. Additionally, a structured codebook that categorizing emoji functions is provided. Employing a mixed-methods approach, this study elucidated gender-based variations in emoji usage patterns across various functions, including discourse management, substitution, and reiteration. [ABSTRACT FROM AUTHOR]

"Ariadne's thread" is a psycho-educational intervention designed by the Breast Unit and the Clinical Psychology Unit of an Italian Comprehensive Cancer Center and aims to promote empowerment in patients with metastatic breast cancer. It consists of 8 online meetings led by a psycho-oncologist in which informative sessions by patients' referring physicians alternate with moments of stress management techniques. This study aims to investigate (1) the feasibility of the "Ariadne's thread" pilot intervention and (2) the satisfaction and perceived benefits of the pilot intervention. We used a mixed method approach in which (1) it was detected: the number of acceptance to the single session of the intervention by both patients and professionals, the number of help requests by patients, and the number of change of date requests by professionals; (2) semi-structured interviews were conducted with the professionals who participated in the intervention; (3) 2 focus groups were conducted with patients, and (4) a questionnaire was submitted to each of them. The intervention is sustainable from the perspective of the organization, professionals, and patients. In particular, the patients declared perceiving benefits in many aspects: improved relationships with doctors, acceptance of their illness, learning of a relaxation technique, possibility to look at the world with trust and hope, etc. The questionnaires show an improvement in empowerment and satisfaction as a result of the intervention. "Ariadne's thread" is a psycho-educational intervention that effectively addresses the needs of patients with MBC. It can be applied to other contexts (1) if it has been confirmed that similar needs exist or (2) if it can be modified to accommodate other needs. [ABSTRACT FROM AUTHOR]

Background: In the UK, over 7,000 people are on the waiting list for an organ transplant and there are inequalities in need, access and waiting time for organs, with notable differences between minority ethnic groups. In May 2020, England changed the law and introduced a 'soft' opt-out system of consent to organ donation with a view to increase consent rates. We aimed to learn more about the impact of the law change on attitudes and views likely to be relevant to consent to deceased organ donation between different population subgroups. Methods: Mixed-methods design involving latent class analysis of data from twelve repeated cross-sectional surveys undertaken from 2015 to 2021 (n = 19,011); analysis of the law change survey dataset collected quarterly from 2018 to 2022 (n = 45,439); and interviews with purposively selected members of the public (n = 30) with a focus on minority perspectives. Results: Support for the principle of deceased organ donation remained high and stable in the general population (80%) but was 20% lower among ethnic minorities. From 2018 to 2022, an average of 58% of the general population was aware of the law change; this was lower among minority ethnic groups (31%). We identified four population subgroups (supportive donors (24% of the population); unengaged donors (22%); uncommitted donors (46%); and unsupportive donors (9%)). Interview themes included the challenges of discussing organ donation decisions, balancing autonomy with respecting family relationships, targeted misinformation, frustrations at the lack of consensus between community leaders, limited understanding of what happens during the end-of-life care leading to organ donation, and how this aligns with cultural values and preferences. Conclusion: Implementation of the law change has not been associated to date with any change in public attitudes and preferences likely to influence consent overall or in minority ethnic groups in England. Uncommitted donors may benefit from encouragement to express their organ donation decision, and unengaged donors from attempts to address mis/information, confusion, and uncertainty. Interventions to raise the consent rate need to take account of the significant role of the family as well as wider community influences on attitudes, preferences and decision-making, particularly among certain minority (ethnic) groups. [ABSTRACT FROM AUTHOR]

Street‐level bureaucrats rely on credibility judgments when navigating interactions with citizen‐clients who are mostly strangers. These credibility judgments are inherently susceptible to prejudice against marginalized social groups, especially among majority bureaucrats who do not represent the marginalized groups in question. This argument was examined through a sequential mixed‐methods design, focusing on the case of police investigations of women's sexual assault accusations. In a mock investigatory case presented through vignettes, results revealed that male investigators were less inclined than their female counterparts to find the accusations credible. Interviewed investigators admitted to often relying on stereotyping cues when assessing the accusations' credibility, and elaborated on how increasing female representation in the workforce could help mitigate this problem. Our study highlights that client credibility judgments act as an inequitable gatekeeper in street‐level implementation. The implications extend beyond policing to other policy domains where program integrity is a salient issue, such as welfare. [ABSTRACT FROM AUTHOR]

This research is designed to identify distinct profiles of well-being among hospitality employees and their relationships with motivation. Results from a latent profile analysis reveal four well-being profiles: lack of pursuit, task-focused, overall well-being, and flourishing groups. Then, these four well-being profiles were further supported and explained with the qualitative results through a content analysis. Lastly, results of multinomial logistic regression analysis suggest that integrated regulation and amotivation significantly predict hospitality employees’ well-being. This work contributes to well-being studies by extending the scope of well-being theory and self-determination theory. It offers practical insights for developing managerial strategies to improve hospitality employees’ well-being and increase their motivation. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Our understanding of the impact of eating disorders (ED) treatment in Autistic people remains elusive. Research has begun to explore ED treatment outcomes and experiences in this population, however current understandings are poorly integrated. The current review therefore sought to explore the impact of ED treatment on Autistic people and those with higher Autistic traits.A convergent, segregated approach was used, independently evaluating quantitative then qualitative studies before integrating findings into a coherent narrative synthesis.Autistic people and people with higher Autistic traits report poorer experiences of treatment and may be at increased risk of inpatient admission and prolonged inpatient treatment, possibly explained by difficulties with treatment timeframes and a lack of autism‐informed support. Both groups reported similar improvements in ED symptoms and BMI. Higher rates of psychosocial difficulties pre‐and post‐treatment were reported in those with higher Autistic traits, and emotion‐focused interventions were felt to be particularly relevant to Autistic presentations of EDs. Concerns were reported as to how well aligned group‐based programs and cognitive‐based interventions are for Autistic individuals and those reporting higher Autistic traits.Future research in diagnosed autism samples is urgently needed to develop a more robust understanding of Autistic outcomes and experiences. Review findings demonstrate the need for increased understanding of ED presentations and the possible need for treatment adaptations, for Autistic people or those with higher Autistic traits. [ABSTRACT FROM AUTHOR]

Background: Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods: This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results: Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident... there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug...but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions: These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10‐year period and understand their reasons by interviewing obstetricians and midwives.Mixed‐methods study.A tertiary university public maternity hospital, Paris, France.All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician‐gynaecologists and midwives.Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi‐structured interview with 20 obstetricians and midwives, with an interview guide.Obstetric anal sphincter injuries.The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10‐year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals. [ABSTRACT FROM AUTHOR]

Introduction: This 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. Methods: A 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. Results: The 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. Discussion: The 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. [ABSTRACT FROM AUTHOR]

Background: The efficacy of lung cancer screening (LCS) to reduce lung cancer specific mortality is heavily dependent on adherence to recommended screening guidelines, with real-world adherence rates reported to be drastically lower than rates described in clinical trials. There is a dearth in the literature on reminder processes and clinical workflows used to address adherence and robust data is needed to fully understand which clinical set-ups, processes, and context enhance and increase continued LCS participation. This paper describes a protocol for an environmental scan of adherence and reminder processes that are currently used in LCS programs across the United States. Methods: This study will triangulate data using a 3-step explanatory sequential mixed methods design to describe mechanisms of current adherence and reminder systems within academic and community LCS programs to pinpoint clinic or system barrier and facilitator combinations that contribute to increased adherence. In step 1, surveys from a nationally representative sample of LCS programs will yield quantitative data about program structure, volume, and tracking/reminder processes and messages. After completion of the survey, interested LCS program personnel will be invited to participate in an in-depth interview (step 2) to explore current processes and interventions used for adherence at the participant and program level. Finally, in step 3, triangulation of quantitative and qualitative data will be completed through qualitative comparative analysis to identify combinations of components that affect higher or lower adherence. Discussion: This research advances the state of the science by filling a gap in knowledge about LCS program characteristics and processes associated with better adherence which can inform the development and implementation of interventions that are scalable and sustainable across a wide variety of clinical practice settings. [ABSTRACT FROM AUTHOR]

Do authoritarian regimes adopt similar or equal policies? Despite the large literature on policy convergence in democracies, we know little about whether and to what extent authoritarian regimes follow analogous paths. This article argues that similar policy legacy, political and institutional context, and international influences lead to policy convergence among nondemocratic regimes. Analyzing welfare state trajectories in Kazakhstan, the Kyrgyz Republic, and Tajikistan, the empirical analysis finds that the welfare state in the three post‐Soviet countries has converged at the level of social spending and the source of welfare financing, while divergence persists in disaggregated levels of social spending; configuration of key welfare programs, particularly in old‐age pensions and unemployment; and the extent of welfare state reforms. Overall, the findings provide important insights into the determinants of policy convergence in nondemocratic regimes and yield critical implications for future research on the welfare state's trajectory in former Soviet countries. [ABSTRACT FROM AUTHOR]

Despite their many benefits, longitudinal studies are much less common than one-time data collection or pre-post intervention designs. One reason for their scarcity is that longitudinal studies introduce requirements and challenges that non-longitudinal studies do not. One of the biggest challenges is participant attrition. In order to help researchers plan and conduct longitudinal studies and mitigate some of these challenges, this article presents methodological findings from five years of mixed-methods data collection with the same 16 participants. Findings consist of participants' reasons for continued participation, which spanned a range of personal and professional reasons, and my reflections on methodological lessons I have learned over these years. Understanding why participants have continued to participate and lessons I have learned can support the successful design and completion of future longitudinal research, which in turn will advance understandings of social processes, changes over time, pathways, and emergences. [ABSTRACT FROM AUTHOR]

Purpose: Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility. Methods: A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Results: This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion. Conclusion: This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being. IMPLICATIONS FOR REHABILITATION: Individuals with disabilities who actively engage in adaptive sports report higher quality of life (QoL) scores compared with those who were inactive or did not participate. The relationship between the duration of regular participation in adaptive sports and QoL scores exhibits inconsistent results. A multi-component adaptive sports program may further improve QoL scores. Qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion. [ABSTRACT FROM AUTHOR]

Clinical supervision plays a pivotal role in training the next generation of health service psychologists. Given the dyadic nature and multiple priorities of supervision, dilemmas are common; however, few data exist on the frequency and types of dilemmas, and more importantly, how they are navigated. Of the limited data that are available on this topic, few encompass the perspectives of both supervisors and supervisees. This study aims to address these gaps by surveying supervisor (N = 29) and supervisee (N = 65) responses to eight vignettes of supervision dilemmas. We use a mixed-methods approach to investigate quantitative ratings of perceived dilemma frequency and harmfulness, and content analysis to identify themes in qualitative responses assessing how participants navigate dilemmas. A supervisor failing to provide adequate critical feedback to a supervisee was perceived by participants as the most frequent and harmful dilemma. Strong consistency in frequency and harmfulness ratings of vignettes was found among supervisors and supervisees. Content analysis revealed four main themes among reported strategies: relational, reflective, direct, and indirect. The majority of strategies reported were direct, involving confrontation and problem solving. However, there were situational and temporal nuances in how participants described they would use strategies. Supervisees reported greater use of indirect strategies involving passivity and avoidance. Overall, our study underscores the potential for a decision-making framework that could help standardize supervision guidelines and recommends that such a framework incorporate an assessment of the severity, frequency, and temporal aspects of each dilemma. Public Significance Statement: Supervision is a core clinical competency, yet how supervision dilemmas are navigated is not well understood. This study suggests that supervisors and supervisees report that they would mainly use direct confrontative and problem-solving strategies to address dilemmas and occasionally use relational, reflective, and indirect strategies. Results could inform a framework that standardizes supervision guidelines surrounding common supervision dilemmas. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to establish the feasibility of delivering a structured post‐diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. Design: A two‐phase explanatory mixed‐method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five‐part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self‐efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. Methods: Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post‐programme and 3‐month follow‐up. Post‐programme semi‐structured interviews were conducted with dyads and programme facilitators. Results: Twenty‐nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. Conclusion: Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow‐up time to 6 months. Impact: This study established the feasibility of registered nurses delivering a post‐diagnosis information and support programme for people living with early‐stage dementia or mild cognitive impairment and their informal carers in primary care settings.The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time.Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance.Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. Reporting Method: The authors have adhered to the EQUATOR STROBE Statement. Patient or Public Contribution: A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation. [ABSTRACT FROM AUTHOR]

Introduction: As research on cognitive training methods for older adults with mild cognitive impairment (MCI) progresses, fully immersive virtual reality cognitive training (fi-VRCT) has shown promise in enhancing cognitive function. However, its effectiveness in improving instrumental activities of daily living (IADL) and fostering independence is still unclear. This study aims to address these uncertainties by developing and validating a fi-VRCT program focused on IADL, with the goal of enhancing both cognitive function and IADL performance in older adults with MCI. Methods and Analysis: This mixed methods program evaluation study consists of three phases: feasibility, intervention, and extension. In the feasibility phase, we will implement fi-VRCT in real-world community settings and invite 20 older adults with MCI to participate in a single training session. Participants will provide feedback through questionnaires and individual interviews. The intervention phase will involve a double-blind, cluster-randomized controlled trial with 52 older adults with MCI, who will be randomly assigned to either the fi-VRCT or control groups. Both groups will complete 16 sessions over eight weeks, with cognitive and functional performance assessed at various intervals. During the extension phase, feedback will be gathered from 26 participants who underwent fi-VRCT through focus group interviews and ongoing questionnaires. Quantitative and qualitative findings will be synthesized to refine the fi-VRCT program and elucidate training outcomes. Ultimately, fi-VRCT has the potential to enhance cognitive and functional abilities in older adults with MCI in community settings. Ethics and Dissemination: Ethical approval has been obtained from the Research Ethics Committee at National Taiwan Normal University (202312EM009). The research findings will be disseminated through reputable, peer-reviewed journals and professional international conferences to engage and inform academic and clinical audiences. Trial Registration: NCT06392412. [ABSTRACT FROM AUTHOR]

This study explores the relationship between language competence and intercultural communicative competence (ICC) among English as a Foreign Language (EFL) learners through a mixed-methods approach. A sample of 196 Chinese EFL learners was divided into three proficiency groups (low, intermediate, and high), with data collected through Likert-scale questionnaires and semi-structured interviews involving 16 participants. Quantitative analysis revealed that higher language proficiency is linked to improved overall ICC scores and its specific dimensions. The Kruskal-Wallis H test confirmed significant differences in overall ICC, attitude, and skill across proficiency levels, with attitude showing the strongest effect. Spearman's correlation analysis demonstrated small but significant positive correlations between English proficiency and overall ICC, attitude, and skill. Qualitative findings further enriched the quantitative results, emphasizing the foundational and catalytic role of language competence in enhancing ICC and its dimensions. However, participants acknowledged that language competence alone is insufficient for fully successful intercultural interactions. This study expands Byram's model by offering detailed insights into the intricate relationship between language competence and various ICC dimensions. The study recommends that to fully cultivate ICC, it is essential to integrate the development of language competence into instructional practices. [ABSTRACT FROM AUTHOR]

Context: Agriculture relies on irrigation in many parts of the world, and the need for irrigation is increasing due to rising demands for agricultural products and climate change-induced alterations in rainfall patterns. However, irrigated agriculture has been found to damage ecosystems and threaten landscape sustainability. Objectives: Against this background, there has been a recent development towards large-scale irrigation in Spain. The aim of this study is to understand this development at the landscape level and its impact in the context of landscape sustainability. Methods: We focused on two study sites in Castilla y León using a mixed-methods approach. We studied driving forces, landscape changes, and sustainability outcomes through document analysis, interviews, and aerial photograph analysis. Results: The development of a landscape-level underground pipe network took place at one study site and is planned for the second study site. Interviewees perceived institutional and social driving forces as particularly influential and technological driving forces as less influential. Political and economic driving forces were often interlinked. The irrigation development tied to land consolidation led to landscape changes, such as the removal of trees and increases in field size. Thus, in terms of environmental sustainability, trade-offs were found, while social sustainability outcomes were mainly positive. The impact on farmers’ economic security varied. Conclusions: For further landscape-level irrigation developments, we recommend integrating preserving seminatural habitats and the structural diversity of the agricultural landscape in planning processes. We also recommend a shift towards more water efficient crops, evapotranspiration management, and a new funding scheme for farmers to offset rising electricity costs. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.Massachusetts, USA.We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all. [ABSTRACT FROM AUTHOR]

Background: Learning assistants (LAs) are undergraduate students who serve as instructional assistants in STEM classrooms. In addition to engaging in active practice, they take a pedagogy seminar and regularly meet with a content instructor. While aspects of LAs' pedagogical beliefs and actions have been investigated, there remains a gap in understanding how LAs make sense of their new instructional roles and how they negotiate between their experiences as students and their responsibilities as instructors. This study uses a sequential, exploratory mixed-methods approach, which includes constant comparative open-coding, thematic analysis, and epistemic network analysis, to analyze 178 reflections written by 89 LAs across five terms at two institutions. Here, we identify each LA's expressed goals and intended actions at the start and the end of their first term as an LA. Using a community of practice framework, we seek to explicate the shifts in these LAs' values as they become more central members of the LA community. Results: LAs' expressed roles shift from being cognitive coaches, where they focus on student thinking, sense-making, and understanding of disciplinary concepts, to being social architects, where their focus shifts to attending to the aspects of the environment that can support productive interactions for learning. A social architect prioritizes goals related to mutual trust, respect, & approachability, understanding and learning about students, and creating a sense of belonging. Similarly, their intended actions emphasize compassion, understanding, and facilitating group discussion. While all LAs studied exhibited this shift, it manifested in different ways and to different extents, as illustrated in detail by four selected cases. These cases illustrate how the shifts coupled to a change in language around teaching, becoming more specific and contextual. Conclusions: LAs express a shift in their valued practices over their first term as LAs related to their instructional role. The goal of student-centered instructional practice is often framed as becoming a better cognitive coach; however, this orientation does not foreground ideas around teaching practice that aim to foster engagement, belonging, and student agency. Implications for both the LA model and, more generally, for postsecondary STEM instructors are discussed. [ABSTRACT FROM AUTHOR]

Background: Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding. Methods: A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results. Results: The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=–0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=–0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data. Conclusion: Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Results Conclusion Psychosis is associated with significant health and societal costs. Early intervention in psychosis services (EIP) are highly effective in promoting recovery, yet substantial proportions of young people disengage. The current study aimed to develop and evaluate a novel engagement intervention in EIP services.A qualitative investigation of facilitators and barriers to engagement in 68 first episode psychosis patients, family members and young people, and a Delphi consultation with 27 regional and national youth and psychosis service leads informed the development of the intervention.A mixed‐methods feasibility‐pilot study then compared engagement outcomes in 298 EIP service users in two cohorts: standard EIP versus standard EIP plus the novel early youth‐engagement (EYE) intervention. A qualitative study explored intervention experiences in 22 randomly selected service users, carers and clinicians. A process evaluation explored delivery.Disengagement was 24% in the standard EIP cohort compared to 14.5% in the standard EIP plus EYE intervention cohort. A 95% Bayesian credibility interval revealed a 95% probability that the true reduction in disengagement lay somewhere between 0% and 18%. The number needed to treat was 11, 95% CI [5, 242]. Use of the EYE resources was associated with engagement. Qualitiative feedback supported effects on communication, social network engagement, service user goals, mental health and well‐being outcomes.The EYE intervention was designed from a service user, young person and carer perspective. Both qualitative and quantitative data support impacts on engagement. We now need to evaluate effectiveness, cost‐effectiveness and implementation in a multi‐site randomised controlled trial. [ABSTRACT FROM AUTHOR]

Background: Research is needed to better understand the specific challenges for autistic learners in informal STEM learning settings. This study aimed to increase inclusion in STEM museums, with a larger goal of increasing the impact (i.e., learning and application of knowledge during and after visits) of informal STEM learning settings for autistic youth. We conducted an online parent attitudes survey with 93 parents of autistic adolescents and 53 parents of adolescents in the general population to better understand the experiences of autistic adolescents when visiting STEM-related museums. Parent responses informed professional development training for museum staff at four partner museums, which taught strategies to better support autistic learners. Then, autistic adolescents (n = 20) and their parents were randomly assigned to visit one partner and one control museum. They were asked to report their experiences through an online survey and semi-structured interviews. Results: Participants who completed the parent attitudes survey indicated significantly lower inclusion, engagement, and general impact of STEM museum visits among autistic adolescents compared to the general population comparison group. Parents of adolescents who visited partner and control museums reported higher STEM impact during visits to partner museums; however, parent-reported inclusion, engagement, and general impact did not differ significantly between partner and control museums. Qualitative analysis identified four themes (Spectrum of Museum Impact; Adolescent-Environment Fit; Barriers to Engagement, and Barrier Breakers), providing context for quantitative findings. Conclusions: Findings underscore the need for increased inclusion for autistic individuals in informal STEM learning environments like museums. This project demonstrated feasibility of professional development training of forward-facing staff and identified several themes that should inform future efforts to improve inclusion in informal STEM learning settings. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsMedical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students’ aspirations for this learning with the realities of employed work as HCAs.This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis.The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses’ work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience.HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner. [ABSTRACT FROM AUTHOR]

Lifelong learning is emerging as a key priority for promoting equity and sustainability in societies. Self-regulated learning (SRL) is a fundamental requirement for achieving successful lifelong learning, and digitization is increasingly influential in this regard. This mixed-methods study explores the degree to which adaptive learning technology (ALT) can assist university students in their SRL with timely and personalized support. Additionally, the study examines how students perceive this feedback and incorporate it into their learning behavior. Using hierarchical linear modeling, we investigated the development of SRL over a 9-week period. Semi-structured interviews were conducted with purposively selected learners, based on stimulated recalls. The quantitative results demonstrate positive development in certain components of SRL. Furthermore, the results indicate that metacognitive activity can be partially predicted by motivational and emotional states. The qualitative findings reveal that learners have varying perceptions of feedback received from ALT and integrate it into their learning behaviors based on their individual benefits. The results support the assumption that feedback provided through educational technology must be precisely tailored to the needs of learners, taking into account the dynamics of their individual learning processes. The study contributes to the ongoing discussion on the design of educational technology. [ABSTRACT FROM AUTHOR]

AbstractThis study explored the types of constraints that inhibit women’s participation in community basketball. It investigated whether the perception of these constraints changes at different ages to understand how this impacts one’s intention to leave the sport of basketball. A mixed-methods approach was used. In phase 1, Concept Mapping examined the types of constraints faced by Australian women community basketball players. In phase 2, quantitative survey data were analyzed to understand how age and the constraints identified from phase 1 impacted on women’s intention to leave basketball. Results demonstrated that key types of constraints are a lack of playing opportunities and gender discrimination. Younger women were more likely to intend to leave basketball when they reported higher incidences of these constraints, indicating that they are more difficult to negotiate. Sport organizations must increase playing opportunities for young women and eradicate nuanced gender discrimination to improve the retention of younger women. [ABSTRACT FROM AUTHOR]

This mixed-methods study examines the marketing of, and toxic ingredients found in, common personal care products (PCPs) such as shampoos or deodorants that are sold in the United States. Through qualitative analyses of the messaging presented by PCP packaging and quantitative analyses of the prevalence of toxic ingredients by product and target consumer, we reveal what we term “toxic personal care”: the usage of products sold to consumers as minimally necessary, and perhaps even beneficial, to their personal well-being through gendered messaging, yet introduce consumers to chemical toxicity. Supporting research on postfeminist sensibilities, we find that products marketed to women are no more likely to contain toxic ingredients than those marketed to men, nor do lower-priced products contain more toxic ingredients. Instead, product descriptions perpetuate a “cult(ure) of confidence” that not only encourages the usage of PCPs equally across women and men through drawing from traditional gendered stereotypes, but also masks the similarities in ingredients and toxins. These findings have implications for understanding consumption, well-being practices, gendered marketing, and constructions of confidence in the United States, including monetary and possible health costs to consumers. [ABSTRACT FROM AUTHOR]

Introduction: Treatment with chimeric antigen receptor T (CAR-T) cells involves a large number of interdisciplinary stakeholders and is associated with complex processes ranging from patient-specific production to follow-up care. Due to the complexity, maximum process optimization is required in order to avoid efficiency losses. This study aimed at systematically determining the preconditions for a frictionless flow of the CAR-T process by surveying the stakeholders involved. Methods: A Group Concept Mapping (GCM) analysis, a mixed-methods participatory research, was conducted. CAR-T experts from different professional backgrounds went through three steps: 1) Brainstorming relevant aspects (statements) for a frictionless process, 2) Sorting the collected statements based on their similarity, and 3) Rating the importance and feasibility of each statement. A cluster map reflecting the overarching topics was derived, and mean ratings per statement and cluster were calculated. Results: Overall, 20 CAR-T experts participated. A total of 80 statements were collected, resulting in a map of the following 10 clusters (mean importance/feasibility): Information for patients and physicians (4.16/3.77), Supportive network (4.03/3.53), Eligibility of patients (4.41/3.63), Evidence, transparency and communication (4.01/3.33), Paperwork (4.1/2.52), Interface with pharmaceutical manufacturer (4.03/2.85), Reimbursement (4.29/2.31), Quality Management (4.17/3.18), Infrastructure of CAR-T clinics (4.1/2.93), and Patientoriented processes (4.46/3.32). Discussion: The 80 statements underlined the complex and manifold nature of the CAR-T treatment process. Our results reflect the first step in overcoming hurdles: identifying potential hurdles and required preconditions. Decisionmakers and stakeholders can use the results to derive strategies and measures to further promote a frictionless process. [ABSTRACT FROM AUTHOR]

Background/Objective: The Alternative Model for Personality Disorders (AMPD) within the DSM‐5 includes separable components representing general personality dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Some critique Criterion A for accounting for little incremental variance in PD beyond Criterion B. However, Morey et al. (2020) hypothesized that personality dysfunction is a key mechanism through which normal‐range traits account for the maladaptive component of personality traits, justifying its inclusion. We sought to replicate and extend this work in a psychiatric sample with mixed methods. Method: In total, 152 participants recruited from mental health clinics completed multiple measures of personality dysfunction and normal‐range and maladaptive traits. Results: Replication was only partially achieved. The degree of incremental prediction of maladaptive traits and the extent to which personality dysfunction explained the relations between normal‐range and maladaptive traits varied significantly across traits, and those effects that reached significance were small in magnitude. Removing variance due to personality dysfunction reduced intercorrelations among maladaptive traits by only a small amount. Conclusion: Counter to Morey et al. (2020), our results failed to support maladaptive traits as composites of normal‐range traits and personality dysfunction, suggesting that other methods of distinguishing personality pathology severity and style are needed. [ABSTRACT FROM AUTHOR]

Unlike in most Western countries where singleness has been relatively considered as an individual's choice, singleness is often regarded as a social problem in Indonesia. This causes challenges for never married individuals to meet their belonging needs and to maintain their well-being. The current study aimed to explore the roles of social support, religiosity, and religious coping in assisting never-married Indonesian adults to maintain their well-being, as indicated by their levels of life satisfaction and loneliness. An online survey administered to 350 never-married adults (Mage = 29.79; SD = 4.50), followed by in-depth interviews to 40 participants (Mage = 33.14; SD = 4.04) demonstrated that, unlike in many Western countries where the religion seems to be losing its role, In Indonesia, engaging in a nurturing spiritual relationship may assist unmarried individuals, especially those wishing to get married, to cope with societal and personal challenges of being single. [ABSTRACT FROM AUTHOR]