Core Skill Set Research Articles

Essential core competencies for health policy graduates: a multi-method consensus type study

BackgroundIn light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.MethodsThe study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel’s findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.ResultsIn the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.ConclusionsIt is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

From education to practice—2024 update: An opinion paper of the Drug Information Practice and Research Network of the American College of Clinical Pharmacy

AbstractDrug information specialists (DIS) bring unique, specialized expertise and provide services in diverse settings including health systems, academia, pharmaceutical industry, compendia, medical writing, and other areas. With widespread access to drug information (DI) resources through user‐friendly, online platforms, the role of DIS has shifted. Core skill sets once confined to DIS are now distributed across various non‐DIS clinical specialties. DIS have transformed the application of their specialized skill set and adapted it to a variety of traditional and nontraditional areas, providing and applying advanced expertise to solve a variety of contemporary challenges. The training of students and residents has evolved to include evidence‐based practical contemporary methods that promote critical thinking and reasoning. Effective DI evaluation and communication necessitates customizing content for stakeholders to ensure understanding and contribute to optimal patient care, all while addressing misinformation and disinformation. The future of DI as a specialty is bright, with ever‐increasing recognition of the importance of DI skills in non‐DIS practitioners. DIS will likely continue to guide best practices in the education/training of new practitioners and continue to provide advanced services and formulary analytics. This update to our 2009 DI PRN Opinion paper will focus on: (1) DI education and training needed for all students, residents, and pharmacists; (2) career opportunities, roles, and responsibilities specifically tailored for DIS in health systems, managed care organizations, academia, pharmaceutical/biotechnology industry, and medical writing services; and (3) the future direction of DI, including the potential impact of artificial intelligence.

Preliminary content and construct validity of a new model to differentiate research skills from evidence-based practice skills: Core, Evidence Application, Research (CEAR) Model.

Research is the scientific basis for the profession of dietetics, as it must be located and applied in evidence-based practice (EBP). EBP is often presented as a foundational skill for research. CEAR - Core, Evidence Application, Research - is a newly proposed model that separates Research and Evidence Application skills into distinct domains, jointly supported by a set of Core skills, thus acknowledging that education and advancement in one domain neither requires nor precipitates education and advancement in the other. The goal was to investigate the content and construct validity of the new CEAR Model. A cross-sectional online survey of randomly selected dietitians in the United States was used to collect CEAR domain scores, validated measures of research or EBP skills and self-reported characteristics. Exploratory factor analysis, Cronbach's α and Pearson correlation between various tools and CEAR domains were used to assess validity and reliability. Analysis of variance (ANOVA) and multiple linear regression between CEAR domains and participant characteristics were used to assess convergent and divergent validity. One hundred and fifty-four responses with a valid CEAR score were received and led to a three-factor solution, supporting the theorised differentiation of research from evidence application skills (content validity). Internal reliability for the CEAR Model overall and for each domain was high. The hypothesised correlations between existing research or EBP measurement tools and the relevant CEAR domains were found (construct validity). Known groups analysis demonstrated the expected differences in CEAR domain scores based on participant characteristics. The CEAR Model demonstrates preliminary validity and internal reliability. It adds to the current literature by acknowledging the separateness of evidence application skills from research skills.

Beyond the Four Walls: The American College of Emergency Physicians 2022 New Practice Models Task Force Report

Emergency physicians are highly trained to deliver acute unscheduled care. The emergency physician core skillset gained during emergency medicine residency can be applied to many other roles that benefit patients and extend and diversify emergency physician careers. In 2022, the American College of Emergency Physicians (ACEP) convened the New Practice Models Task Force to describe new care models and emergency physician opportunities outside the 4 walls of the emergency department. The Task Force consisted of 21 emergency physicians with broad experience and 2 ACEP staff. Fifty-nine emergency physician roles were identified (21 established clinical roles, 16 emerging clinical roles, 9 established nonclinical roles, and 13 emerging nonclinical roles). A strength-weakness-opportunity-threat (SWOT) analysis was performed for each role. Using the analysis, the Task Force made recommendations for guiding ACEP internal actions, advocacy, education, and research opportunities. Emphasis was placed on urgent care, rural medicine, telehealth/virtual care, mobile integrated health care, home-based services, emergency psychiatry, pain medicine, addiction medicine, and palliative care as roles with high or rising demand that draw on the emergency physician skillset. Advocacy recommendations focused on removing state and federal regulatory and legislative barriers to the expansion of new and emerging roles. Educational recommendations focused on aggregating available resources, developing a centralized resource for career guidance, and new educational content for emerging roles. The Task Force also recommended promoting research on potential advantages (eg, improved outcomes, lower cost) of emergency physicians in certain roles and new care models (eg, emergency physician remote supervision in rural settings).

Development of a person-centred digital platform for the long-term support of people living with an adult-onset genetic disease predisposition: a mixed-methods study protocol

IntroductionIndividuals at an inherited high-risk of developing adult-onset disease, such as breast cancer, are rare in the population. These individuals require lifelong clinical, psychological and reproductive assistance. After a positive...

The Principal Leadership in Indonesian Islamic School: The Strategy in Shaping the Academic Professionalism

An overview of the current situation of Indonesian Islamic schools may be viewed by examining the areas of management and educational assessment, as well as the schools' amenities and facilities, content, and procedure, as well as the competency of its graduates, teachers, and other educational staff. It has recently come to light that not all Islamic schools in Indonesia can adhere to these standards. This study aims to highlight how principals of Indonesian Islamic Schools promote the academic professionalism of teachers and other educational staff members. In the context of the study of Islamic leadership, it incorporates the idea that the essential leadership talent is instructional leadership. It is associated with the core skillsets of assessment, unity of purpose, diversity, reflection, professional development, curriculum and instruction, instructional leadership, visionary leadership, learning community, organizational management, collaboration, and professionalism. This qualitative research uses a descriptive case study approach to provide a detailed description of the phenomenon under study. Using a purposive sampling technique, data collection involved representatives from public and private Madrasah Aliyah (MA) institutions in Parepare, Indonesia. Our study found the core understanding of academic professionalism emphasizes professional development, social service, competence, and responsibility, requiring the support of a proper institutional outcome plan. It provides evidence that the leadership style of principals influences the academic professionalism of teachers and educational staff, directly contributing to school quality. The excellence of the program and alumni reflects the effectiveness of the leadership of the madrasah principal.

Carbon capture and storage – a safe and reliable monitoring and verification plan developed using oil and gas industry core skill sets

Carbon capture and storage (CCS) is a necessary technology essential for meeting global emissions targets and limiting the impact of climate change – all identified pathways to global net-zero 2050 emissions targets require significant scale-up and deployment of CCS. The Moomba CCS project is an example of the type of projects that will reduce emissions and enable decarbonisation technology such as Direct Air Capture (DAC). The first phase of the project will utilise depleted hydrocarbon fields in the Cooper Basin, South Australia, to safely capture and permanently store 1.7 Mtpa CO2 that is currently vented. This paper will highlight the oil and gas industry’s unique skill sets that make it ideally placed to measure, monitor and verify the permanent storage of CO2 in geological formations. A monitoring and verification plan (M&V plan) has been developed based on SEO and ISO standards that encompasses four key elements: injection telemetry, reservoir surveillance, well integrity and environmental assurance. The plan was developed using a methodical approach to identify key risks, evaluate consequences, take preventative actions and put mitigating controls in place. Core oil and gas industry skill sets were utilised for the evaluation such as geomechanical and geochemical analysis, seal analysis, fault interpretation and reservoir modelling of CO2 migration. A program of surveillance activities will be undertaken to monitor and verify CO2 containment within the storage complex on an ongoing basis for the life of the project, and the M&V plan sets out a response plan and actions that will be taken in the case of deviation from expected performance.

Exploring self-harm risk vulnerabilities in autism using the ‘thinking patterns profiling model’

BackgroundAutism has been linked to higher rates of self-harm. Research is yet to establish the reason for the association between autism and self-harm as a distress response.MethodsUsing the ‘thinking patterns profiling model’, this study explored characteristics associated with self-harm risk in 100 autistic young people. Secondary analysis of routinely collected clinical data was conducted using odds ratios and t-tests.ResultsWe found the prevalence of reported self-harm risk was 48%. Young people with reported self-harm risks had significantly lower regulation skills (p ≤ 0.01) and lower social flexibility skills (p ≤ 0.01) compared to those without reported self-harm risk. For those described as impulsive, mean scores on the following skills were significantly lower: perspective-taking skills (p ≤ 0.01), flexible thinking for creative problem-solving (p ≤ 0.05) and sensory tolerating (p ≤ 0.05). There was no relationship between reported self-harm risk and adverse childhood experiences.ConclusionsThese findings suggest that profiling tools such as ‘Thinking Patterns Profiling Model’ can be used to explore unique patterns of vulnerability and resilience related to self-harm risk in autism. The findings suggest that autistic thinking patterns might interplay with other factors (e.g. impulsivity). Patterns are based on each person’s profile across four core skill-sets: regulation, flexible thinking, sensory coherence, and social perspective-taking. These findings motivate a person-centred and profile-informed approach to planning support and adjustments. Further studies are needed to confirm the ways in which mechanisms typically involved in self-harm risk, may interact with core cognitive and affective differences found in autism.

The effects of educational intervention on perceived barriers toward medical student research involvement: A pilot study

Background: Competency in research as a medical student is a core skill set in training to be a physician and also supports effective continuing education as a physician. Although it is highlighted as an expected competency for educating medical students, there are no specific requirements on the type or depth of educational content that should be offered in the area of research skills for medical students. This observation led us to explore the potential benefits of informative lectures on research fundamentals and their impact on medical students’ perceptions on conducting research in school. Methods: In this study, students were surveyed before (n=71) and after (n=33) formal lectures on research principles to exam changes in perceived barriers to participating in research related activities. Barriers were categorized into three categories: Personal; Competency; and Value. Results: The results of this study demonstrated significantly decreased perception of several barriers within the personal and competency categories after the lecture series on research principles was completed. Although statistically insignificant, a separate and possibly interesting observation is that respondents appeared to have a decreased interest in research and decreased perception that participating in research would add value to their profile as a residency applicant or impact their care of patients as a future physician. Conclusions: Our pilot study suggests that offering formal lectures on research principles may lead to decreased perceived barriers of medical students in becoming involved in research related activities during medical school.

A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia module; (b) 10 daily meditation mini-modules; (c) emphasis on a core skill set called the BOAT (Breathe, Observe, Accept, Take a Moment); and (d) brief phone coaching for both technical and motivational support. In this open trial, we aimed to evaluate (1) acceptability and feasibility; (2) intervention skill use and its association with state mindfulness in daily life; and (3) pre-to-post changes in target mechanisms and outcomes. Eighteen individuals with past-year AN or past-year atypical AN completed Mindful Courage-Beta over 2 weeks. Participants completed measures of acceptability, trait mindfulness, emotion regulation, eating disorder symptoms, and body dissatisfaction. Participants also completed ecological momentary assessment of skill use and state mindfulness. Acceptability ratings were good (ease-of-use: 8.2/10, helpfulness: 7.6/10). Adherence was excellent (100% completion for foundational module and 96% for mini-modules). Use of the BOAT in daily life was high (1.8 times/day) and was significantly associated with higher state mindfulness at the within-person level. We also found significant, large improvements in the target mechanisms of trait mindfulness (d = .96) and emotion regulation (d = .76), as well as significant, small-medium to medium-large reductions in eating disorder symptoms (ds = .36–.67) and body dissatisfaction (d = .60). Changes in trait mindfulness and emotion regulation had medium-large size correlations with changes in global ED symptoms and body dissatisfaction (rs = .43 – .56). Mindful Courage-Beta appears to be promising and further research on a longer, refined version is warranted.

Implementation of a novel team-based model of care using expert intensive care unit physiotherapists to supplement critical care surge demand

Within Victoria, Australia, the emergence of the Delta variant resulted in a significant and rapid increase in case numbers and high demand for intensive care beds statewide. While prior pandemic planning had been undertaken at a state level, the Delta variant necessitated a need for further rapid expansion of intensive care unit (ICU) beds. Our hospital subsequently implemented a Department of Health–designed team-based model of care to support this rapid ICU expansion—where tasks were allocated according to skill and not discipline. Here we report our local experiences as critical care physiotherapists participating in this novel model of care for physiotherapists to support the functioning of the ICU under peak pandemic surge conditions. Our core skill set as ICU-trained physiotherapists, including depth knowledge of the assessment and treatment of critical care patients, and ICU functioning, enabled us to play a contributing role in team-based care. We discuss our reflections and lessons learnt including future directions for clinicians, educators, managers, policymakers, and researchers to refine implementation of this novel model of care and how these lessons could be leveraged in future scenarios where healthcare systems might be significantly strained by future pandemics.

Role of Tele-ultrasound for Teaching Ultrasound-guided Nerve Blocks in the Emergency Department: A Case Series from Peru.

IntroductionUltrasound-guided nerve blocks (UGNB) represent a procedural skill set that can be used to treat acute pain by physicians in the emergency department (ED). However, limited access to education and training represents a barrier to widespread adoption of this core skill set. The implementation of UGNBs within the ED can aid in resource allocation, particularly in limited-resource settings.Case SeriesIn this case series we discuss our experience using tele-ultrasound to train emergency physicians on the use of UGNBs within our international point-of-care ultrasound fellowship in Peru. We highlight the potential role UGNBs serve in management of acute pain when working in resource-limited, public safety-net hospitals in Peru.ConclusionTele-ultrasound may represent a strategy for teaching procedures such as UGNBs via remote guidance and supervision.

A critical analysis of international organizations’ and global management consulting firms’ consensus around twenty-first century skills

A growing number of academic studies and policy reports have identified a set of core skills considered crucial in the twenty-first century economy. This article critically examines the evidence base underpinning that ideational consensus among international organizations (IOs) and global management consulting firms (GMCFs). We collected 234 skills reports produced over the past decade by major IOs (European Commission, ILO, OECD, UNESCO, and World Bank) and GMCFs (BCG, Deloitte, Ernest and Young, KPMG, McKinsey, and PWC). We then extracted bibliographic references from each report and used the analytic technique of citation analysis to examine how the consensus around these core skills was generated in order to uncover the authoritative sources of knowledge and the pattern of ideational policy diffusion observed. Our analysis reveals substantial gaps in the evidence base used. Evidence drew largely on a few academic economists, along with strong use of grey literature, and high rates of self-citation. Given these characteristics, the consensus around twenty-first century skills appears less epistemic in nature and more like an ideational echo chamber, which raises concerns about the extent to which policymakers should rely on this evidence.

Palliative Care and Shared Decision Making in the Neurocritical Care Unit.

This article reviews the evidence on integrating palliative care into the care of patients with various types of serious neurologic illness, emphasizes the importance of palliative care in the neurocritical care unit, and suggests tools for clinicians to improve their communication skills and decision making. Palliative care is a holistic approach to medical care that aims to relieve physical, psychological, social, and spiritual suffering. It is both a medical specialty as young as neurocritical care itself and an approach to patient care by all clinicians who manage patients with serious illness. Patients presenting to the neurocritical care unit and their families have unique palliative care needs that challenge communication and shared decision making. Palliative care, effective communication, and shared decision making require a set of core skills that all neurology clinicians should master.

Pharmacist-Led Education for Final Year Medical Students: A Pilot Study.

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills.Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills.Method: Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention.Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions.Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001).Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula.

Virtual Procedural Supervision During the COVID-19 Pandemic: A Novel Pilot for Supervising Invasive Bedside Procedures in the ICU.

The ability to perform invasive bedside procedures (IBPs) safely and efficiently is a core skill set within critical care medicine. Fellowship training provides a pivotal time for learners to attain baseline proficiency in such procedures to decrease patient complications. The coronavirus disease 2019 pandemic has posed distinct challenges to the traditional model of teaching and supervising IBPs in the intensive care unit, including stewardship of personal protective equipment and limiting health care worker exposure to persons with coronavirus disease 2019. To address these challenges, we piloted a novel method of IBP supervision and teaching using a virtual monitoring system. In this virtual procedural supervision model, the supervising teacher is located outside the patient room, limiting personal protective equipment use and health care worker exposure. An audiovisual monitoring system allowed communication between the teacher and the learner as well as supervisor visualization of the procedural encounter. Virtual supervision was used for central line placement and bronchoscopy in the medical intensive care unit with no complications or instances of the supervisor needing to enter the patient room. Success was felt to depend on camera positioning and preprocedure planning and to be best for advanced learners who would not require tactile feedback. Upper level learners appreciated autonomy granted by this process. Virtual IBP supervision is felt to be a useful tool in specific situations. As with any tool, there are notable strengths and limitations. Success is felt to be optimized when attention is paid to procedural teaching best practices, learner selection, and technological logistics.

Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact

BackgroundEvidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods).MethodsMixed-method data collection was conducted after individual registrars’ completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016–2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews.ResultsThe data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen’s d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences.ConclusionsThis study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor’s role on GP registrars’ ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.

Advocacy, Collaboration, and Conflict Management: Teaching Core Skill Sets in Mental Health Nursing.

Caring for individuals with mental illness requires a core set of skills: knowledge of various disorders; therapeutic communication; collaboration with the multidisciplinary team; proficiency as an advocate whether for individuals, families, groups, or populations; and conflict management. In the current study, students completed toolkits with standardized patient experiences (SPEs) to practice core skill sets. Growth occurred in students' therapeutic communication and their ability to care for standardized or simulated patients with complex mental health issues. Proficiency in interprofessional collaboration, advocacy, and conflict management was also noted. Providing students with opportunities to apply leadership skills to care for individuals with complex mental illness may not always be possible in "real world" settings. Use of SPEs and toolkit activities can bridge the gap between classroom/clinical and real world settings and were highly effective in helping students meet core skill sets in mental health settings. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 26-29.].

Towards Need based Teacher Development Programme

English Language has been taught as a second language in a multilingual situation in India where a three language formula is in practice as language policy of the country. The other two languages are the regional language and Hindi the assumed national language. English language teaching begins at different levels in the different states of India. In states like Andhra Pradesh it begins from class1. To develop proficient users of this language has been the ultimate objective of teaching it at the school and collegiate levels. To develop the same, the need of the hour as it has been is the development of a cadre of facilitators of language learning whose abilities need to be of a high order and are equipped with a set of core and soft skills and with craft knowledge required for an effective transaction of the prescribed content and thus realize the desired curricular objectives. Besides, the teacher of English in the changing scenario has to be a willing co participant in the language learning process. In this background this paper attempts to identify those skills required of the practicing teacher and the need for having an alternative need based curriculum at the teacher training programme levels with special reference to in service teacher training programmes.

Assistance or Resistance? Evaluating the Intersection of Automated Journalism and Journalistic Role Conceptions

Newsrooms are a social context in which numerous relationships exist and influence news work—be it with other journalists, the audience, and technology. As some of these relations change due to technological innovations, new hybrid contexts—technologies that are interwoven with newsroom values, routines, and socio-cultural experiences—can emerge. One key question is how journalists conceptualise and interact with such technologies, and to what degree they retain (creative) agency in the process. Therefore, this study evaluates the intersection of automated journalism and journalistic role conceptions. Using Hanitzsch’s and Vos’s circular model of journalistic roles (2017) and Deuze’s understanding of journalism as an ideology (2005) as a theoretical framework, this study examines some of the discursive aspects of automated journalism by asking: To what extent are journalistic roles (a) challenged or (b) advanced as a result of automated journalism? Our findings more closely align with the latter, pointing to a strong sense of discursive maintenance of journalists’ roles and their core skillset and thus suggesting a high degree of ideological continuity in the face of industrial disruption. It concludes with an agenda for future research and stresses that at times when journalism and automation intersect, the field would benefit from incorporating emerging conceptual frameworks such as human–machine communication.