Contextual Interviews Research Articles

Endocannabinoid concentrations in major depression: effects of childhood maltreatment and relation to hippocampal volume

Evidence from preclinical animal models suggests that the stress-buffering function of the endocannabinoid (eCB) system may help protect against stress-related reductions in hippocampal volume, as is documented in major depressive disorder (MDD). However, stress exposure may also lead to dysregulation of this system. Thus, pathways from marked stress histories, such as childhood maltreatment (CM), to smaller hippocampal volumes and MDD in humans may depend on dysregulated versus intact eCB functioning. We examined whether the relation between MDD and peripheral eCB concentrations would vary as a function of CM history. Further, we examined whether eCBs moderate the relation of CM/MDD and hippocampal volume. Ninety-one adults with MDD and 62 healthy comparison participants (HCs) were recruited for a study from the Canadian Biomarker Integration Network in Depression program (CAN-BIND-04). The eCBs, anandamide (AEA) and 2-arachidonylglycerol (2-AG), were assessed from blood plasma. Severe CM history was assessed retrospectively via contextual interview. MDD was associated with eCBs, though not all associations were moderated by CM or in the direction expected. Specifically, MDD was associated with higher AEA compared to HCs regardless of CM history, a difference that could be attributed to psychotropic medications. MDD was also associated with higher 2-AG, but only for participants with CM. Consistent with hypotheses, we found lower left hippocampal volume in participants with versus without CM, but only for those with lower AEA, and not moderate or high AEA. Our study presents the first evidence in humans implicating eCBs in stress-related mechanisms involving reduced hippocampal volume in MDD.

Inefficient Processes and Associated Factors in Primary Care Nursing: System Configuration Analysis.

Industrywide, primary care nurses' work is increasing in complexity and team orientation. Mobile health information technologies (HITs) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses' work processes, owing to an incomplete or incorrect understanding of the underlying work systems. Despite this need for context, published evidence has focused more on inpatient settings than on primary care. This study aims to characterize nurses' and health technicians' perceptions of process inefficiencies in the primary care setting and identify related work system factors. Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we conducted an exploratory work system analysis with a convenience sample of primary care nurses and health technicians. Semistructured contextual interviews were conducted in 2 sets of primary care clinics in the Midwestern United States, one in an urban tertiary care center and the other in a rural community-based outpatient facility. Using directed qualitative content analysis of transcripts, we identified tasks participants perceived as frequent, redundant, or difficult, related processes, and recommendations for improvement. In addition, we conducted configuration analyses to identify associations between process inefficiencies and work system factors. We interviewed a convenience sample of 20 primary care nurses and 2 health technicians, averaging approximately 12 years of experience in their current role. Across sites, participants perceived 2 processes, managing patient calls and clinic walk-in visits, as inefficient. Among work system factors, participants described organizational and technological factors associated with inefficiencies. For example, new organization policies to decrease patient waiting invoked frequent, repetitive, and difficult tasks, including chart review and check-in using tablet computers. Participants reported that issues with policy implementation and technology usability contributed to process inefficiencies. Organizational and technological factors were also perceived among participants as the most adaptable. Suggested technology changes included new tools for walk-in triage and patient self-reporting of symptoms. In response to changes to organizational policy and technology, without compensative changes elsewhere in their primary care work system, participants reported process adaptations. These adaptations indicate inefficient work processes. Understanding how the implementation of organizational policies affects other factors in the primary care work system may improve the quality of such implementations and, in turn, increase the effectiveness and efficiency of primary care nurse processes. Furthermore, the design and implementation of HIT interventions should consider influential work system factors and their effects on work processes.

Augmented reality for endoscopic transsphenoidal surgery: evaluating design factors with neurosurgeons.

This study investigates the potential utility of augmented reality (AR) in the endoscopic transsphenoidal approach (TSA). While previous research has addressed technical challenges in AR for TSA, this paper explores how design factors can improve AR for neurosurgeons from a human-centred design perspective. Preliminary qualitative research involved observations of TSA procedures ( ) and semi-structured interviews with neurosurgeons ( ). These informed the design of an AR mockup, which was evaluated with neurosurgeons ( ). An interactive low-fidelity prototype-the "AR-assisted Navigation for the TransSphenoidal Approach (ANTSA)"-was then developed in Unity 3D. A user study ( ) evaluated the low-fidelity prototype of ANTSA through contextual interviews, providing feedback on design factors. AR visualisations may be beneficial in streamlining the sellar phase and reducing intraoperative errors such as excessive or inadequate exposure. Key design recommendations include a lean mesh rendering, an intuitive colour palette, and optional structure highlighting. This research presents user-centred design guidelines to improve sensemaking and surgical workflow in the sellar phase of TSA, with the goal of improving clinical outcomes. The specific improvements that AR could bring to the workflow are discussed along with surgeons' reservations and its possible application towards training less experienced physicians.

The impact of the home recording phenomenon on the Czech independent music scene

The paper explores the phenomenon of home recording and the impact of democratization of recording technologies in the Czech independent music scene. The main goal of the paper is to clarify the links between home-recordings and the emergence of new music, describe current trends in the field of home recording, network studios, distribution, and self-education, as well as outline the ethical dilemma of using illegal software in music production. The research approach is based on conducting qualitative contextual interviews with musicians across the entire independent music scene and on the content analysis of a questionnaire survey among musicians and music producers. The results of the research provide an essential characterization of the impact of home recording on the emergence of new music in the Czech environment and chart trends in illegal software downloading.

A Mixed-Methods, Multimedia Pilot Study to Investigate Sleep Irregularity Determinants Among Undergraduate Students.

To pilot a novel approach investigating the interplay of social and institutional determinants influencing university undergraduate student sleep patterns. A two-part, three-phase mixed-methods approach. A mid-size US university conducted in spring and fall 2020. 191 undergraduate students (69 first-years, 43 second-years, 48 third-years, 31 fourth-years). For Part A, participants texted their activities and emotions in real time, producing a data-rich, weeklong diary of comprehensive activity logs, emoticons, multimedia submissions, and juxtapositions of ideal vs real schedules. Semi-structured contextual interviews were also conducted. For Part B, a one-time survey examined Part A insights across all class years. These diverse datasets were triangulated using thematic, comparative, and content analyses through MAXQDA software and visual mapping methods. Three preliminary themes were identified as encouraging an irregular sleep schedule: a prevailing academic ethos emphasizing busyness, time management challenges, and the rhythm of institutional schedules and deadlines. An overarching theme suggests that perceptions of peer sleep habits and academic prioritization above all else could be influential across factors. This pilot study indicates that sleep regularity among undergraduates is potentially shaped by individual choices combined with broader institutional paradigms. While it is limited by its exploratory nature, timing, and small sample size, the results highlight the promise of this methodology for more extensive studies and suggest that future interventions should emphasize systemic changes that prioritize sleep.

The contextual interview: a cross-cutting patient-interviewing approach for social context

ABSTRACT Patient interviewing pedagogy in medical education has not evolved to comprehensively capture the biopsychosocial model of healthcare delivery. While gathering a patient’s social history targets important aspects of social context it does not adequately capture and account for the real-time reassessment required to understand evolving factors that influence exposure to drivers of health inequities, social determinants of health, and access to supports that promote health. The authors offer a patient interviewing approach called the Contextual Interview (CI) that specifically targets dynamic and ever-changing social context information. To substantiate the use of the CI in medical education, the authors conducted a qualitative review of the Accreditation Council for Graduate Medical Education Milestones for primary care specialties (Family Medicine, Internal Medicine, and Pediatrics). Milestones were coded to the extent to which they reflected the learner’s need to acknowledge, assess, synthesize and/or apply patient contextual data in real-time patient encounters. Approximately 1 in 5 milestones met the context-related and patient-facing criteria. This milestone review further highlights the need for more intentional training in eliciting meaningful social context data during patient interviewing. The CI as a cross-cutting, practical, time-conscious, and semi-structured patient interviewing approach that deliberately elicits information to improve the clinician’s sense and understanding of a patient’s social context. The authors reviewed future directions in researching adapted versions of the CI for undergraduate and graduate medical education.

Stressful Life Events and Reward Processing in Adults: Moderation by Depression and Anhedonia

Background. Exposure to acute stress is associated with reduced reward processing in laboratory studies in animals and humans. However, less clear is the association between reward processing and exposure to naturalistic stressful life events. The goal of the current study was to provide a novel investigation of the relation between past 6-month stressful life events and reward processing, and the extent to which this relation was moderated by depression diagnostic status and state symptoms of anhedonia. Methods. The current study included a secondary analysis of data from 107 adults (37 current-depressed, 25 past-depressed, 45 never-depressed; 75% women) drawn from two previous community studies. Past 6-month stressful life events were assessed with a rigorous contextual interview with independent ratings. Response to monetary reward was assessed with a probabilistic reward task. Results. Among current-depressed participants, and among both current- and past-depressed participants with high levels of anhedonia, greater exposure to independent life events outside of individuals’ control was significantly associated with poorer reward learning. In direct contrast, among those with low levels of anhedonia, greater exposure to independent life events was significantly associated with a greater overall bias toward the more frequently rewarded stimulus. Conclusions. Results suggest that depression and anhedonia are uniquely associated with vulnerability to blunted reward learning in the face of uncontrollable stressors. In contrast, in the absence of anhedonia symptoms, heightened reward processing during or following independent stressful life event exposure may represent an adaptive response.

A Smartphone Application Facilitating Sustainable Fashion

This paper aims to present a novel approach to promoting sustainable fashion in India through the development of a smartphone application. The fashion industry has come under intense scrutiny due to its significant environmental and social repercussions, thereby making sustainability a critical concern both on a global scale and in India. According to the United Nations Environment Programme, the fashion industry is a major contributor to carbon emissions, accounting for 8-10% of total carbon emissions. This alarming statistic highlights the fashion industry’s substantial environmental footprint, surpassing the combined carbon emissions from two major global sectors: international flights and maritime shipping. The primary objective of this study is to bridge the gap between sustainable fashion and the Indian public by leveraging the ubiquitous presence of smartphones. This study employs qualitative and quantitative research methods comprising surveys, contextual interviews, and market analysis. The survey received 262 responses, serving as a vital instrument for gauging the level of awareness concerning sustainable fashion. The survey and the contextual interviews highlighted opportunities to address existing barriers and foster greater adoption of eco-friendly fashion practices and products. The variation in awareness levels for sustainable fashion among respondents from different age groups highlighted the need for a solution. Hence, the proposed app aims to educate and engage consumers in sustainable fashion practices while providing easy access. By combining education, accessibility and engagement, the application offers a unique platform to sustainably spark the public’s interest and encourages them to make more eco-conscious choices. In the future, the app can incorporate augmented reality (AR) technology for virtual clothing try-ons and supply chain exploration, elevating the user experience. This immersive approach to sustainable fashion engagement could revolutionise how consumers interact with and make informed choices about eco-conscious clothing, further promoting sustainability in the fashion industry.

Relation of hippocampal volume and SGK1 gene expression to treatment remission in major depression is moderated by childhood maltreatment: A CAN-BIND-1 report

Preclinical research implicates stress-induced upregulation of the enzyme, serum- and glucocorticoid-regulated kinase 1 (SGK1), in reduced hippocampal volume. In the current study, we tested the hypothesis that greater SGK1 mRNA expression in humans would be associated with lower hippocampal volume, but only among those with a history of prolonged stress exposure, operationalized as childhood maltreatment (physical, sexual, and/or emotional abuse). Further, we examined whether baseline levels of SGK1 and hippocampal volume, or changes in these markers over the course of antidepressant treatment, would predict treatment outcomes in adults with major depression [MDD]. We assessed SGK1 mRNA expression from peripheral blood, and left and right hippocampal volume at baseline, as well as change in these markers over the first 8 weeks of a 16-week open-label trial of escitalopram as part of the Canadian Biomarker Integration Network in Depression program (MDD [n = 161] and healthy comparison participants [n = 91]). Childhood maltreatment was assessed via contextual interview with standardized ratings. In the full sample at baseline, greater SGK1 expression was associated with lower hippocampal volume, but only among those with more severe childhood maltreatment. In individuals with MDD, decreases in SGK1 expression predicted lower remission rates at week 16, again only among those with more severe maltreatment. Decreases in hippocampal volume predicted lower week 16 remission for those with low childhood maltreatment. These results suggest that both glucocorticoid-related neurobiological mechanisms of the stress response and history of childhood stress exposure may be critical to understanding differential treatment outcomes in MDD.ClinicalTrials.gov: NCT01655706 Canadian Biomarker Integration Network for Depression Study

Negative feedback-seeking in depression: The moderating roles of rumination and interpersonal life stress.

Swann's self-verification theory proposes that negative feedback seeking (NFS)-the solicitation of negative feedback from others that confirms one's self-views-works in a negative cycle to maintain and exacerbate depression in the face of interpersonal stress. We propose a cognitive-interpersonal integration account of NFS such that this maladaptive behavior prospectively predicts depression only among those with a trait tendency to ruminate on the causes and consequences of depressed mood and stress. Participants included 91 young adults who were over-sampled for a lifetime history of a unipolar depressive disorder (age 17-33; 69% women; 67% lifetime depressive disorder). At baseline, participants completed a structured diagnostic interview and self-report measures of NFS, rumination, and depression symptoms. In addition, participants engaged in an interpersonal rejection task (the Yale Interpersonal Stressor) followed by a behavioral measure of NFS. At a 3-month follow-up, depression symptoms were again assessed by self-report and exposure to stressful interpersonal life events in the intervening period were assessed with a rigorous contextual interview and independent rating system. Controlling for baseline depression severity, greater self-reported, and behaviorally assessed NFS predicted greater follow-up depression severity, but only among those with higher trait tendency to ruminate. For self-reported NFS, this association was further moderated by level of interpersonal, but not noninterpersonal, life events experienced over follow-up. These findings suggest that rumination may represent a modifiable intervention target that could break the vicious interpersonal cycle of depression and, thus, mitigate the depressogenic effects of NFS.

Policy work in educational leadership courses: university teachers’ interpretations, translations and engagements

ABSTRACT This study investigates policy work in educational leadership courses at universities. It analyses the types of engagement present in university teachers’ policy work and in their interpretations and translations of policy intentions into teaching designs and practices. The study illustrates policy work as a phenomenon and draws on the theory of policy work; it examines one case from Norway and one from California. The data has been analysed through discourse analysis. Observational data and materials from teaching practices constituted the supporting data, while contextual interviews with university teachers formed the main data. In both cases, various types of engagement were identified, which reflected academic freedom and different policy contexts. The analysis also revealed that university lecturers use their professional discretion and experience when interpreting and translating policy intentions into teaching designs and practices. This has implications for higher education administration, especially for the achievement of coherence across programmes and courses.

Anxious arousal predicts within-person changes in hippocampal volume in adults with a history of childhood maltreatment: A CAN-BIND4 report.

Childhood maltreatment (CM) is a strong transdiagnostic risk factor for future psychopathology. This risk is theorized to emerge partly because of glucocorticoid-mediated atrophy in the hippocampus, which leaves this area sensitive to further volume loss even through adulthood in the face of future stress and the emergence of psychopathology. This proof-of-principle study examines which specific dimensions of internalizing psychopathology in the context of a CM history are associated with decreases in hippocampal volume over a 6-month period. This study included 80 community-recruited adults (ages 18-66 years, 61.3% women) oversampled for a lifetime history of internalizing psychopathology. At baseline and a naturalistic 6-month follow-up, the symptom dimensions of the tripartite model (anxious arousal, anhedonic depression, and general distress) were assessed by self-report. Hippocampal volume was derived through T1-weighted magnetic resonance imaging scanning segmented via the volBrain HIPS pipeline. CM severity was determined via a semistructured, contextual interview with independent ratings. We found that higher levels of anxious arousal predicted decreases in hippocampal volume over time in those with greater severity of CM but were associated at a trend with increases in hippocampal volume over time in those with lower severity of maltreatment. Findings were specific to anxious arousal and the CA1 subregion of the hippocampus. These novel results suggest that for individuals with a history of CM, transdiagnostic interventions that target and reduce psychological and physiological arousal may result in the preservation of hippocampal structure and, thus, improvements in cognitive and emotional regulation in the face of stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

0678 Consequences of following the herd: Perceptions drive a vicious cycle of poor student sleep habits at an elite university

Abstract Introduction Poor sleep health is widespread among undergraduate university students. This study sought to understand the contributors to poor sleep quality at an elite undergraduate university in the United States. In particular, we were interested in uncovering the social influences on sleep regularity, which is increasingly regarded as a critical determinant of overall sleep quality. Methods An exploratory, mixed-methods study was designed combining a week-long diary study (n=5) and in-depth contextual interviews (n=5) to better understand undergraduate students’ college experience and sleep behaviors, followed by a student survey (n=181) to uncover primary macro trends and factors related to those sleep behaviors. Results A significant irregular sleep schedule emerged as highly common among students. Sleep irregularity was strongly influenced by students’ perceptions about their peers’ sleep and working habits. These perceptions combined with a personal desire to keep pace with their peers and the prioritization of academic work implicitly stated by the university culture influenced when and how students went about their lives, even if those behaviors meant acting against their knowledge and judgment. The convergence of perceptions and behaviors generates a vicious cycle of sleep deprivation and low productivity. The cycle stems from students’ desire to match their peers, which leads to late nights and sleep deprivation. The resulting impaired executive functioning contributes to subsequent inefficient scheduling and lack of concentration. As concentration drops, students multi-tasked more often and incomplete tasks piled up, necessitating further sleep deprivation to get it all done. Conclusion Poor sleep regularity in college is influenced by a set of interconnected factors derived at both the level of the individual student and at the student-body level. Interventions should consider a dual approach to break the vicious cycle, targeting the harmful beliefs among students about the sleep and working habits of their peers, and the prioritization of academic work. Support (if any)

Elements of Food Service Design for Low-Carbon Tourism-Based on Dine-In Tourist Behavior and Attitudes in China

One of the key issues in sustainable tourism research is the gap between tourists’ expressed friendly attitudes towards sustainable behaviors and their actual behaviors. Although many “low-carbon” themed restaurants have emerged during the low-carbon transformation of the Chinese tourism industry, low-carbon food services have not been significantly improved. This study takes food as the entry point to explore tourists’ behavior and attitudes towards low-carbon tourism in relation to food. We conducted two interviews. The first interview was a semi-structured contextual interview with 120 tourists who had experiences in food streets, aiming to identify the core user group: low-carbon attitude-friendly tourists with high-carbon food behaviors. The second interviews was an in-depth interview based on grounded theory with 29 core users, analyzing the four main reasons for their high-carbon food behaviors and their requirements for low-carbon food services in tourism. Based on this, we extracted four design elements for low-carbon tourism food services: low-carbon information show service, low-carbon service product attractiveness improvement, low-carbon food environment atmosphere creation, and service providers’ low-carbon behaviors. Through these four service elements, we constructed a low-carbon tourism food service design framework based on the core users’ needs, discussed the mechanism of service elements, and provided service design suggestions accordingly. The research results can be helpful for tourism providers, low-carbon tourism researchers, and designers.

Mixed Reality–Exploring the Requirements of Realism in the Context of Mass Casualty Incident Training

Introduction:The occurrence of mass casualty incidents is increasing globally. Training is an essential cornerstone in achieving disaster preparedness, yet studies show that medical first responders perceive their level of readiness to face disaster incidents as inadequate. As real-world disaster training exercises can be characterized as resource-intensive in terms of cost and time, virtual training environments have been highlighted as a potential alternative to mass casualty incident training. In order to increase the preparedness of medical first responders, a deeper understanding of their requirements in the context of disaster training exercises is needed.Method:Individual, contextual interviews were conducted with a total of 26 medical first responders from four European emergency service organizations: Hellenic Rescue Team (Greece), Summa 112 (Spain), Sanitätspolizei Bern (Switzerland), and Johanniter Österreich (Austria). The interviews were analyzed using qualitative content analysis.Results:The preliminary results indicate that real-world disaster training exercises have limitations regarding realism. The participants described a need to train in an environment that accurately represents what they might face amidst a real-world incident site. This included the recreation of potential environmental dangers that had to be taken into consideration before approaching the incident site. The participants also highlighted the importance of realistic representations of injuries and reactions from the victims during training. The limited possibilities to provide a realistic training environment that corresponds to the set requirements lead to the participants feeling less prepared to face a real-world mass casualty incident.Conclusion:Medical first responders’ need for increased realism in real-world disaster training exercises deserves attention. Training solutions that could potentially increase the level of preparedness needs to be taken into consideration. How the degree of realism in Virtual or Mixed Reality based training platforms affects the perception of preparedness among medical first responders warrant further research.

A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder

In mental health, oral health is often given little attention. Mental health nurses (MHNs) are professionally the appropriate target group to support maintaining and increasing oral health. We aimed to develop and validate personas that reflect the attitudes and needs of MHNs regarding oral health in patients with a psychotic disorder. We used a human-centered design with contextual interviews (n = 10) to address the key issues of the problems and needs of MHNs working with patients with a psychotic disorder. We analyzed the data thematically and reflected on insights into unique personas, which were then validated by conducting semi-structured interviews (n = 19) and member checking. Four personas were found based on attitudes and perspectives, barriers, needs, suggestions for interventions, and site conditions regarding practicing oral care in this patient group. Our findings were as follows: the attitudes and perspectives differed from not feeling any responsibility to a holistic obligation, including oral health; suggestions for interventions for MHNs ranged from interventions focusing on improving skills and knowledge to using practical tools; most MHNs recognized themselves within a persona that had a holistic obligation that included oral health; in addition, the MHNs indicated that they considered the issue of oral health in this patient group important, but, in practice, took little responsibility for that role. These findings suggest that a toolkit with interventions for MHNs that are tailored to the personas that emerged from our research should be developed by MHNs in co-creation with designers. The differences between the perceived role and MHNs' practice in oral health highlighted the need for role clarification and professional leadership of MHNs regarding oral health, which should be considered when developing interventions.

The Differential Relation of Emotional, Physical, and Sexual Abuse Histories to Antidepressant Treatment Remission and Persistence of Anhedonia in Major Depression: A CAN-BIND-1 Report.

Childhood maltreatment is a potent enviromarker of risk for poor response to antidepressant medication (ADM). However, childhood maltreatment is a heterogeneous construct that includes distinct exposures that have distinct neurobiological and psychological correlates. The purpose of the current study is to examine the differential associations of emotional, physical, and sexual maltreatment to ADM outcome and to examine the unique role of anhedonia in driving poor response in patients with specific maltreatment histories. In a multicentre clinical trial of major depression, 164 individuals were assessed for childhood emotional, physical, and sexual maltreatment with a contextual interview with independent, standardized ratings. All individuals received 8 weeks of escitalopram, with nonresponders subsequently also receiving augmentation with aripiprazole, with outcomes measured with depression rating scales and an anhedonia scale. Greater severity of emotional maltreatment perpetrated by the mother was a significant and direct predictor of lower odds of week 16 remission (odds ratio [OR] = 1.68, P = 0.02). In contrast, the relations of paternal-perpetrated emotional maltreatment and physical maltreatment to week 16 remission were indirect, mediated through greater severity of anhedonia at week 8. We identify emotional maltreatment as a specific early exposure that places patients at the greatest risk for nonremission following pharmacological treatment. Further, we suggest that anhedonia is a key symptom domain driving nonremission in patients with particular maltreatment histories.

A service design thinking approach: What are the barriers and opportunities of using Augmented Reality for primary science education?

It has previously been argued that Augmented Reality (AR) has the potential to provide relevant digital information to support pupils learning in real-time through engaging formats. However, the use of AR in the classroom remains uncommon for mainstream adoption. This study uses a service design methodology to focus on a more holistic approach toward AR as an educational service by investigating the challenges and conditions of integrating AR learning experiences into a primary curriculum. The research paper aims to provide an overview of how primary science (Key stage 2) in the UK is currently being delivered and where both barriers and opportunities occur for adoption to integrate more meaningful AR experiences that add real value to primary science education. An exploration stage (phase one) includes a questionnaire, contextual interviews, classroom observations, and focus groups. A thematic analysis was conducted on gathered data, identifying emerging patterns around teachers’ needs. The discussion section empathises with teachers’ needs and unearths key factors surrounding the implications of using augmented reality for primary science education.

Innovative Leadership-a Missing Puzzle in the Economic Administration of the Judiciary in the Czech Republic

This article dissertation aims to define the role of innovative leadership in the context of other leadership roles in the court’s administration of the Czech Republic and to define its influence on the perception and attitudes of followers. Specifically, these are the roles of accountability, compliance with rules and regulations, political loyalty and network governance. The attitudes of followers are represented by the dimensions of perceived leadership effectiveness, organizational commitment and work engagement. The theoretical model is created verified in the practical part on this basis. Hypotheses are tested using structural modelling. Factor analysis evaluates the data sample; the results are further specified using contextual interviews. The results of data analysis have not supported the hypothesis of a strong influence of the role of accountability on the attitudes of followers in the judicial administration. Unlike other examined leadership roles, the results of data analysis indicate a significant influence of the innovative leadership role on followers’ attitudes and define its function as an essential driver of procedural and organizational changes in the economic section of the Czech courts.

Desired Characteristics of a Clinical Decision Support System for Early Sepsis Recognition: Interview Study Among Hospital-Based Clinicians.

Sepsis is a major burden for health care systems in the United States, with over 750,000 cases annually and a total cost of approximately US $20 billion. The hallmark of sepsis treatment is early and appropriate initiation of antibiotic therapy. Although sepsis clinical decision support (CDS) systems can provide clinicians with early predictions of suspected sepsis or imminent clinical decline, such systems have not reliably demonstrated improvements in clinical outcomes or care processes. Growing evidence suggests that the challenges of integrating sepsis CDS systems into clinical workflows, gaining the trust of clinicians, and making sepsis CDS systems clinically relevant at the bedside are all obstacles to successful deployment. However, there are significant knowledge gaps regarding the achievement of these implementation and deployment goals. We aimed to identify perceptions of predictive information in sepsis CDS systems based on clinicians' past experiences, explore clinicians' perceptions of a hypothetical sepsis CDS system, and identify the characteristics of a CDS system that would be helpful in promoting timely recognition and management of suspected sepsis in a multidisciplinary, team-based clinical setting. We conducted semistructured interviews with practicing bedside nurses, advanced practice providers, and physicians at a large academic medical center between September 2020 and March 2021. We used modified human factor methods (contextual interview and cognitive walkthrough performed over video calls because of the COVID-19 pandemic) and conducted a thematic analysis using an abductive approach for coding to identify important patterns and concepts in the interview transcripts. We interviewed 6 bedside nurses and 9 clinicians responsible for ordering antibiotics (advanced practice providers or physicians) who had a median of 4 (IQR 4-6.5) years of experience working in an inpatient setting. We then synthesized critical content from the thematic analysis of the data into four domains: clinician perceptions of prediction models and alerts; previous experiences of clinician encounters with predictive information and risk scores; desired characteristics of a CDS system build, including predictions, supporting information, and delivery methods for a potential alert; and the clinical relevance and potential utility of a CDS system. These 4 domains were strongly linked to clinicians' perceptions of the likelihood of adoption and the impact on clinical workflows when diagnosing and managing patients with suspected sepsis. Ultimately, clinicians desired a trusted and actionable CDS system to improve sepsis care. Building a trusted and actionable sepsis CDS alert is paramount to achieving acceptability and use among clinicians. These findings can inform the development, implementation, and deployment strategies for CDS systems that support the early detection and treatment of sepsis. This study also highlights several key opportunities when eliciting clinician input before the development and deployment of prediction models.