Business Source Complete Research Articles

Cost-effectiveness analysis of valvular surgery in high- and low- to middle-income countries: A scoping review.

Global disparities in valvular surgery services exist. Cost-effectiveness analysis (CEA) and cost-utility analysis can be used to guide national investment decisions. This scoping review aims to synthesize economic evaluations for valvular surgery by income settings and provide recommendations. A systematic literature review identified primary CEAs or CUAs in English comparing surgical management strategies for valvular heart disease. MEDLINE, Embase, CINAHL, Web of Science, and Business Source Complete were searched using keywords "valvular surgery," "valve disease," "cost-effectiveness," and "cost-benefit analysis". Articles comparing outcomes or costs only were excluded. Search results were uploaded and screened on COVIDENCE. Variables from eligible articles were charted in a spreadsheet. Twenty articles were eligible, six from low- and middle-income countries (LMICs) and 14 from high-income countries (HICs). In HICs, the top conditions were degenerative aortic valve disease (7/14) and mitral valve disease (4/14) compared to congenital (2/6) and rheumatic heart diseases (2/6) in LMICs. HICs evaluated new technologies and techniques, whereas LMICs compared different valve types or surgery versus no intervention. Most articles used published studies (12/20) or databases (7/20) to conduct their CEA and quality-adjusted life years was the most common effectiveness measure (12/20). Comparator interventions were cost-effective in all LMIC articles and in 8/14 for HICs. Economic evaluations are mostly conducted in HICs and for adult conditions. More analyses in LMICs are needed. This can be facilitated by maintaining databases, documenting costs, and implementing quality of life assessments.

Competencies and learning outcomes for healthcare professionals in climate change and sustainability: A protocol for a scoping review

Rationale The planetary crisis is a serious threat to human health. Healthcare professionals need to be trained to adapt to and mitigate against this crisis. Competencies, curricular frameworks and learning outcomes relating to climate change and sustainability (CC&S) have been proposed for healthcare professionals. A synthesis of these competencies, learning outcomes and frameworks is necessary to identify commonalities and differences, understand the process of their development and highlight areas for future development. Objective The objective of this scoping review is to identify and synthesise the evidence on competencies, curricular frameworks and learning outcomes for healthcare professionals in climate change and sustainability. Inclusion criteria Sources relating to healthcare professionals and healthcare students, describing competencies, curricular frameworks and learning outcomes in CC&S, will be included. Sources in all healthcare contexts will be included. Sources in the English language, published from 2014 to June 2024 will be considered for inclusion. Methods The review will be conducted in line with the Joanna Briggs Institute guidance for scoping reviews. The following electronic databases will be searched: PubMed, Embase, CINAHL, PsycINFO, SocINDEX, Academic Search Complete, Business Source Complete, British Education Index, Australian Education Index, Scopus and ERIC. A search of the grey literature will also be conducted. Two reviewers will independently screen the titles and abstracts and full texts for eligibility. Data extraction will be conducted independently by two reviewers. A narrative summary and tables will be presented. Key stakeholders will be consulted throughout the review. Discussion This review will summarise the range of competencies, curricular frameworks and learning outcomes proposed internationally for various healthcare professionals. The findings will be used to inform core competencies for all healthcare professions in CC&S, in addition to highlighting gaps in the literature and areas for future development. The findings will be disseminated at conferences and in a peer-reviewed publication. Registration This protocol was registered on 31st July 2024 on the Open Science Framework (https://osf.io/vnx2g).

The Price of Foods, Beverages, and Diets in Australia: An Updated Systematic Review

Abstract Context The price and affordability of food are priorities for public health and health equity; however, Australia lacks a consistent method to evaluate healthy versus unhealthy diets, creating a gap in routine food price reporting. Objective This review aimed to identify and summarize recent methods used to assess and monitor the price and/or affordability of food and beverages in Australia using a health lens. Data Sources Four academic databases (MEDLINE Complete, Global Health, CINAHL Complete, and Business Source Complete) were searched in English from 2016 to 2022. Relevant gray literature was searched through Google Scholar and government websites. Data Extraction Five reviewers screened titles and abstracts, and full-text screening was conducted by 1 reviewer, with eligibility confirmed by a second reviewer. The quality of studies was assessed using the Joanna Briggs Institute “Checklist for Analytical Cross-Sectional Studies.” Data Analysis Twenty-five eligible studies were identified. Eleven studies used a version of the Healthy Diets Australian Standardized Affordability and Pricing protocol to collect prices for a “healthy” diet modelled on dietary guidelines and an “unhealthy” diet based on a habitual Australian diet. These studies consistently found unhealthy diets to be more expensive than healthy diets. Other identified methods included assessing the price of household diets across healthy baskets (n = 6), store types (n = 5), a planetary health diet (n = 1), packaged foods according to their Health Star Rating (n = 1), a fruit and vegetable basket (n = 1), school canteen foods against a traffic light system (n = 1), and weekly healthy meal plans (n = 1). Healthy diets tended to be less costly than less healthy diets, but both diets were often unaffordable in regional areas, for people on low incomes, and for First Nations peoples. Conclusion Consistent country-wide application of methods for monitoring the price and affordability of foods and diets in Australia is needed—including tailored approaches for priority groups. Systematic Review Registration PROSPERO registration no. CRD42022333531.

Outcomes of Art-Based Leadership Development: A Qualitative Metasummary.

Art-based leadership development, grounded in experiential learning, offers a learner-centered approach to leadership training by integrating relational, aesthetic and embodied dimensions. This systematic review investigates evidence on the outcomes of art-based leadership development, addressing the critical need for empirical validation of its effectiveness. A qualitative metasummary was employed to review 31 empirical studies published between 2008 and 2023. The studies were sourced from databases including Business Source Complete, ERIC, PsycINFO, Scopus, and Web of Science. The Quality Assessment for Diverse Studies (QuADS) tool was used to assess the studies. The analysis revealed that art-based methods significantly enhance reflective and reflexive practices, higher-order cognitive skills, emotional intelligence, and interpersonal competencies. Representing leader development, art-based initiatives facilitate holistic self-discovery and transformative shifts in mindset, offering a valuable complement to conventional skill-based approaches. Despite these promising benefits, the review highlights a need for more rigorous empirical studies, particularly longitudinal and quantitative research, to substantiate the long-term effectiveness of art-based methods.

Work-related smartphone use during off-job hours and work-life conflict: A scoping review.

Over recent decades the use of smartphones for work purposes has burgeoned both within and beyond working hours. The aim of the study was to conduct a scoping review to explore the association between the use of smartphone technology for work purposes in off-job hours with employees' self-reported work-life conflict. Arksey and O'Malley's methodological framework was adopted. Searches were conducted in PsycINFO, International Bibliography of the Social Sciences (IBSS), Academic Search Complete, ProQuest Central, Web of Science, ProQuest Theses, Emerald, Business Source Complete, ScienceDirect, Scopus, Google Scholar. Articles were eligible that reported on a sample of workers, were published in English between 1st January 2012 and 29th November 2023. The review was conducted and reported using a quality assessment checklist and PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Data charting and synthesis was undertaken narratively, using the framework approach and thematic analysis. Twenty-three studies were identified, conducted in nine countries. Nineteen studies (83%) showed a significant association between increased use of smartphone for work purposes in off job-hours and increased work-life conflict, with small-to-moderate effect sizes. This relationship was mediated by psychological detachment from work, and communication about family demands with one's supervisor. Moderators either strengthened or attenuated the relationship between use of smartphone for work purposes in off job-hours and increased work-life conflict. Findings suggest that smartphone use during off-job hours is likely to impact negatively on work-life conflict, which has implications for employee wellbeing. Managers could play a key role in clarifying expectations about after-hours availability, reducing job pressure, advocating psychological detachment from work in off-job hours where it is appropriate, and creating a workplace culture where communication about the interplay between work and home life is encouraged. The protocol is registered on the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/WFZU6).

Assessment of communicative competence in adult patients with minimum response in intensive care units: A scoping review.

Few formal instruments exist to assess the communicative competence of patients hospitalized in intensive care units (ICUs). This can limit interventions by health professionals. To map the categories and instruments for assessing the communicative competence of adult patients with minimal response in ICUs. A scoping review was carried out following the Joanna Briggs Institute protocol between February and March 2022 and using the MEDLINE (PubMed), Scopus, Scielo, Business Source Complete (via EBSCOhost), Academic Search Complete (via EBSCOhost) and Web of Science databases, in Portuguese, English and Spanish. Eight studies met the inclusion criteria. The different communication and pain assessment protocols covered awareness, cognition, sensory capacity, motor capacity, language, speech and literacy. The present review offers a starting point for the construction of a formal assessment instrument to enable clinicians to implement an augmentative or alternative communication system (AACS) for the voluntary, independent and active participation of patients. What is already known on the subject Patients in ICUs are subject to various forms of treatment and continuous and intensive monitoring, compromising their capacity to communicate and actively participate (e.g., sharing symptoms and making decisions). Although there is some awareness of their disadvantage in such a regard, few protocols of assessment of communicative competence have been adapted to patients with a minimum response. What this paper adds to the existing knowledge The present review highlights different protocols for the assessment of communication and pain. They include the following categories: awareness, sensory capacity, auditory and visual acuity, positioning and motor capacity, language, speech, and literacy. The review offers a starting point for the construction of a formal assessment instrument encompassing the aforementioned categories, along with duly validated guidelines for its application. What are the potential or actual clinical implications of this work? Our formal assessment instrument takes into account the need to adapt to different patient profiles. It is hoped that it will provide speech therapists and other health professionals with the information required to implement an AACS in which patients participate actively.

Diversity Dishonesty: Smoke and Mirrors in the Organization

The article aims to discuss the phenomenon known as “diversity dishonesty” (term “smoke and mirrors” was coined by Stacey Morin as a metaphor of diversity dishonesty). Diversity dishonesty is defined as encapsulating a complex scenario wherein organizations outwardly portray a façade of commitment to genuine and quantifiable progress concerning diversity initiatives, while in practice, they manifest insincerity and disingenuousness. In recent years, diversity dishonesty has garnered substantial scholarly attention, particularly within organizational dynamics. This phenomenon is characterized by a superficial and performative engagement with diversity, creating the illusion of progress and dedication while failing to bring about substantive and meaningful transformations in diversity and inclusivity. The article presents the results of systematic literature review of peer-reviewed journals that analyzed diversity dishonesty in the organization, examine diversity dishonesty in organizations, to reveal a complex interplay of psychological, social, and organizational factors. Search engines provided by Marymount University Library and such resources as: ABI/INFORM Collection, Business Source Complete (EBSCO Host), Google Scholar, JSTOR and ProQuest Research Library were used. The research introduces an infinity loop framework that leverages accountability and transparency in conjunction with stakeholder theory. The article examines the following symptoms of diversity dishonesty within an organization: pluralistic ignorance, exclusion, othering, erosion of trust and morale, inconsistency between promotional material and lived experience, limited representation in leadership, microaggression, and tokenism. The article examines the following cascade of consequences of diversity dishonesty within an organization: legal risk, reputational damage, and stifled innovation and creativity. By shedding light on the intricacies of this phenomenon, this article offers valuable insights for organizations aiming to move beyond performative diversity efforts and genuinely foster diverse, equitable, and inclusive environments.

Neighbourhood inequities in the availability of retailers selling tobacco products: a systematic review

ObjectiveTo examine inequities in tobacco retailer availability by neighbourhood-level socioeconomic, racial/ethnic and same-sex couple composition.Data sourcesWe conducted a 10 November 2022 search of PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform,...

What is known about the role of external facilitators during the implementation of complex interventions in healthcare settings? A scoping review

ObjectiveTo synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings.DesignA scoping review was conducted. We reviewed original...

Investigating the use of actor-network theory in healthcare: a protocol for a systematic review

Healthcare systems are confronted with constant challenges and new crisis waves necessitating a transformation of current approaches to healthcare delivery. Transformation calls for integration, partnerships, interprofessional teamwork and collaboration between...

The characteristics of leadership and their effectiveness in quality management in healthcare - A systematic literature review and a content analysis.

Effective quality leadership is identified as a critical factor for organisational success. Leadership style has an important role in the implementation of quality management. This systematic review describes the characteristics of leadership in quality management in healthcare, and analyses their association with successful or unsuccessful quality management by using content analysis. Papers published in peer-reviewed journals between 2011 and June 2023 were selected by exploring the Abi/Inform, Business Source Complete, Cinahl, Pubmed and Web of Science electronic databases. Altogether 3014 records were found. PRISMA-protocol was used for selection of studies. 12 original and three review articles were included. Six leadership characteristics were identified that were linked to successful or unsuccessful implementation of quality management. The six categories were strategic, knowledge-oriented, value-based, supportive, participatory and communicative leadership. Supercategories and subcategories of successful and unsuccessful implementation are described. The results can be used to identify the leadership characteristics that promote successful quality management in healthcare organisations. In education for leaders and managers, attention should be in the characteristics and style of leadership and their impact on the effectiveness of quality management.

The use and application of Lean Management methods to research processes—a scoping review protocol

IntroductionWaste in medical research is a relatively well-known issue. However, only a few initiatives exist to address this issue. Lean Management methods (Lean) were developed in industrial manufacturing and later...

Name Bias: Application Through the 4-Step Process Using Foundations of Critical Theory in Organizational Settings

The phenomenon of name bias in the workplace has received scholarly attention, particularly within organizational dynamics, diversity, equity, and inclusion efforts. The article aims to identify the ramifications of name bias within organizational structures and how to mitigate it using the foundations of critical theory. The article provides a comprehensive overview of name perception within organizational settings, mainly focusing on the potential biases leading to unintentional or deliberate favoring of individuals in hiring decisions or discrimination based solely on their names. This research highlights the detrimental impact of name bias on organizational dynamics, proving that it hinders progress toward a more diverse, inclusive, and equitable workplace culture. The article conducts a literature review of articles in peer-reviewed journals selected from such academic resources as ABI/INFORM Collection, Business Source Complete (EBSCO Host), Google Scholar, JSTOR and ProQuest Research Library using the keywords “critical theory”, “diversity”, “equity”, “inclusivity” and “name bias”. Application of critical theory in the hiring process empowers organizations to deconstruct systemic biases, fostering a fairer, more inclusive environment for all candidates. This approach enables scrutiny of neutrality of hiring practices, exposing how seemingly objective criteria can obscure underlying biases rooted in race. Moreover, it unveils the social and cultural significance embedded in names, often intertwined with stereotypes and power dynamics. Organizations are advised to implement a four-step process: 1) raising awareness among staff involved in the hiring process about unconscious bias, including name bias, and its impact on decision-making, and the historical and social context of bias; 2) anonymous screening which is the blind recruitment practice, particularly in the initial stages of the hiring process, which involves removing personal information such as names from resumes to minimize unconscious name bias; 3) diverse hiring panels that include individuals from various racial backgrounds and give voices to marginalized groups. This can help reduce the impact of individual biases and promote a more inclusive decision-making process; 4) clear and standardized criteria for evaluating candidates to ensure that assessments are based on relevant skills, qualifications, and experience rather than subjective judgements influenced by names. The use of inclusive language in job descriptions and communications is needed to avoid terms that may be associated with certain demographic groups. The research findings can serve as a valuable resource for organizations looking for solutions to mitigate the phenomenon of name bias.

Enhancing capability for continuous organisational improvement and learning in healthcare organisations: a systematic review of the literature 2013–2022

BackgroundHealthcare organisations strive to meet their current and future challenges and need to increase their capacity for continuous organisational improvement and learning (COIL). A key aspect of this capacity is...

Financial Health Literacy and Community-Dwelling Older Adults: A Concept Analysis

Aim. To examine and clarify the concept financial health literacy (FHL) within the context of aging and healthcare. Background. Older adults have a high chronic disease burden and low financial and health literacy levels which often leads to high healthcare costs and poor self-management. Clarification of the concept FHL is necessary to better support nursing care and successful self-management. Design. Concept analysis using literary synthesis. Data Sources. Electronic databases were used to find scientific literature (i.e., PubMed, CINAHL, and Business Source Complete), and online dictionaries were used to find basic definitions. Review Methods. Walker and Avant’s eight-step method was used as a guide to construct a concept analysis of FHL. Clinical, aging, financial, and economic studies were reviewed to determine defining attributes, antecedents, and consequences of FHL on the older adult’s health. Results. FHL is defined as the knowledge, skills, and ability to make decisions that allow an individual to manage finances to optimally meet healthcare-related and household expenses, including resources to self-manage health, and plan for short-term, long-term, and end-of-life healthcare. Personal context, opportunity, and access are antecedents to FHL. There are 3 defining attributes: knowledge about health and financial-related concepts, skills in health and financial planning, and healthcare and financial-related decision-making behaviors. The 4 consequences of FHL include effective healthcare utilization, effective cost management, effective self-management, and positive health outcomes. Conclusions. FHL is a complex, multidimensional concept. A better understanding of this concept has significant nursing implications for research, clinical, practice, education, and policy development. Older adults have unique health and financial needs due to the complexity of retirement, living on a fixed income, and self-management of chronic diseases. Development of a FHL assessment tool and intervention is needed and may be supported based on the results of this concept analysis.

Delivering Patient Education in Healthcare Organizations: An Integrative Review of the Nursing Administrative Actions

Aim. To analyze the literature on nursing administrative actions related to patient education to inform healthcare organizations for the development of patient education and identify the knowledge gaps for future research. Background. Patient education is a patient’s right, yet numerous organizational factors can hinder the effective delivery of patient education. Nursing administrative actions can mediate these factors, but little is known about nursing administration in patient education. Evaluation. A systematic integrative review was conducted in October 2022 on five databases (CINAHL (Ebsco), PubMed, Web of Science, ABI/Inform, and Business Source Complete). No time limitations were set. Empirical research articles reporting nursing administrative actions related to educational actions as a main topic were screened and evaluated. The data analysis was based on a constant comparison method. Key Issues. There were 3,110 studies identified, of which five quantitative and four qualitative studies were included. Three main themes were generated from the data describing nursing administrative actions related to patient education: (1) strengthen the commitment to patient education, (2) ensure the necessary resources for patient education, and (3) enhance patient education policies. Conclusion. This review provides insights into nursing administration in patient education, focusing on commitment, resources, and policies. It not only highlights the critical role of nurse administrators but also calls for further research to assess the impact of these actions. Implications for Nursing Management. The findings of this review will be useful for nurse administrators by providing knowledge about nursing administrative actions in patient education and underlining the need for them to pay more attention to it. The implications for nursing management also include supporting further research in the field.

A scoping review of E-scooter safety: Delightful urban slalom or injury epidemic?

IntroductionE-scooters are a convenient, relatively inexpensive and fun new mode of transportation with rapidly increased use in cities throughout the world. Despite the popularity of e-scooters, increases in rider injuries and fatalities have become a public health concern. Objective. To characterize the types of safety issues associated with e-scooter use. Methods. Scoping review methods focused on any safety issues associated with the use of dockless, stand-up, motorized, electric kick scooters from companies offering short-term rentals or through private ownership, published in English between January 2017 and March 2022. Databases included Academic Search Complete, Business Source Complete, Google Scholar, PsychINFO, PubMed, Scopus, SocINDEX, TRID Database, and Web of Science databases. After abstract screening and full text review, a total of 81 studies were included in the scoping review. Results. Few e-scooter riders wear helmets except where legally required. Alcohol impairment is a primary contributor to e-scooter injuries. Younger males, underage riding, double riding, speeding and rider distraction were also identified as behavioural contributors to e-scooter injury crashes. Environmental contributors included crash locations (e.g., sidewalks, bike paths, roads) parking issues (e.g., tripping hazard), fixed object collisions (e.g., lampposts, parked cars), road surface and slope (e.g., uneven, curbs, downhills) and insufficient nighttime visibility. E-scooter reliability was affected by brake failures and design limitations (e.g., stability over rough terrain). Injury patterns included mechanism of injury (loss of balance and/or control, fall) and moving object collisions (e.g., vehicles, pedestrians, bicyclists). The head, face, upper and lower extremities were the most common anatomical locations injured. Fractures, contusions, concussions, lacerations, and sprains were the most frequent injury types. Discussion. Policies, regulations and interventions that address helmet requirements, alcohol and drug use, rider skill and knowledge acquisition, restrictive speed limits, education and enforcement are discussed with respect to evidence-based safety guidance for transportation policy and decision makers. Conclusion. Behavioural, environmental and device design safety issues associated with e-scooter use require effective interventions to reduce the frequency and severity of rider injuries.

The psychological well-being of schoolteachers in South Africa: A critical review

Teaching is a stressful occupation associated with various challenges that may adversely affect schoolteachers’ psychological well-being (PWB) and the provision of quality basic education. The nature and effects of teacher PWB may depend on their work context. This critical review aimed to synthesise and evaluate the evidence from available scientific literature on schoolteacher PWB within the South African context. We searched the following databases: African Journals, NWU-IR, Academic Search Complete, Africa-Wide Information, APA PsycInfo, OAlster, Directory of Open Access Journals, Library Catalogue, SciELO, SocINDEX with Full Text, MEDLINE, ERIC, CINAHL with Full Text, Springer Nature Journals, Teacher Reference Center, SPORTDiscus with Full Text, and Business Source Complete. For rigour of the search and analysis process, we employed the Search, AppraisaL, Synthesis, and Analysis (SALSA) method. This critical review research study included a final sample of 12 studies. Thematic analysis was used to analyse the data, and the following themes were identified: teaching as a stressful occupation; intrapersonal factors that affect teachers’ PWB; contextual factors that influence teachers’ PWB; differences in levels of teacher PWB; and the consequences of high or low levels of teacher PWB. To work towards the provision of quality basic education, it is vital to first acknowledge the importance of schoolteachers’ PWB in South Africa. With a clear and comprehensive understanding of teacher PWB, it is possible to implement interventions to promote and enhance teachers’ PWB in schools in South Africa.

The use of private regulatory measures to create healthy food retail environments: a scoping review.

Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these. Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework. Food retail. Food retail settings using private regulatory measures to create healthier food retail environments. In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35). We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.

A systematic review of the implementation of healthy food retail interventions in settings with multiple food retail outlets (complex food retail settings).

Complex food retail settings, where multiple food retail outlets operate in close proximity are common. Despite their ubiquity, there remains a significant knowledge gap regarding healthy food retail interventions implemented within these settings. Furthermore, understanding the factors affecting the implementation of interventions in these settings remains limited. This systematic review aimed to (1) identify and describe complex food retail settings where interventions were implemented to promote the healthiness of foods purchased, (2) synthesise the evidence on the effectiveness of the interventions implemented, and (3) identify enablers and barriers to the implementation of the interventions in these settings. Four databases, namely, MEDLINE Complete, Global Health, Embase, and Business Source Complete, were searched until December 2022. The Effective Public Health Practice Project quality assessment tool was used. Six studies reported on the implementation of interventions promoting healthy food purchases across multiple food retail outlets. Three studies each described two complex food retail settings: university and hospital. Interventions including promotion and promotion plus price improved the healthiness of foods purchased. There was limited description of institutional food policies, conceptual frameworks, formative research, or evaluation outcomes to inform the implementation of interventions in these settings. No study analysed enablers and barriers to the implementation of interventions. No study identified their settings as complex food retail settings. There is limited evidence describing complex food retail settings, their impact on intervention effectiveness, and associated enablers or barriers. Investigating factors influencing the effectiveness of interventions implemented within complex food retail settings is critical to support their implementation at scale.