ABSTRACT Few things are more dangerous than extreme altitude climbing (EAC). While the objective risks are well known, less is known about climbers’ motivation to pursue EAC. This study explores the motivations of mountaineers who climb 7,000- and 8,000-metre peaks in the Himalayas. Through the theoretical lens of Self-Determination Theory, we examine how the climbers´ basic psychological needs are met under extreme conditions and connected to their self-determined motivation. Using a deductive approach, interviews were coded and sorted into themes of autonomy, relatedness, competence and autonomous motivation. Findings show that the climbers generally have their psychological needs met and that needs are connected to issues of risk and safety. Competence is developed through mastery of increasingly more difficult and risky climbs. Relatedness is dependent upon friendship and building trust in each other’s competence. Autonomy is about finding the right balance between being involved in decision-making processes in the climbing team and making safe overall decisions. The satisfaction of basic needs fosters intrinsic- and autonomous motivation, with less emphasis on controlled motivation. However, there are examples of amotivation when basic needs are frustrated. Overall, the research highlights the complex interplay of psychological needs and quality of motivation in EAC.

A structured, behavioural science approach was adopted to develop antimicrobial stewardship interventions in UK first-opinion companion animal veterinary practice. The objectives were to identify behavioural targets for intervention and to understand how practice contexts influence these behaviours. Behavioural targets were selected by expert collaborators from a longlist prepared by the lead author. Five veterinary practices were recruited through opportunistic sampling. The lead author shadowed 17 consulting veterinarians, recording observations and informal interviews. Common themes were identified through a combined deductive and inductive approach to describe barriers to and enablers of the behavioural targets. The behavioural targets were that veterinarians should: (1) document why they prescribed the highest-priority antimicrobials, (2) perform cytology, (3) prescribe alternative pharmaceutical interventions, and (4) provide advice and reassurance. Important barriers were that veterinarians were unfamiliar with less critically important antimicrobials for cats and non-prescription topical chlorhexidine products. A single researcher was responsible for constructing the longlist of behavioural targets, visiting practices, collecting data, and coding observations and quotations. The behavioural targets were complex and data saturation was unlikely to have been achieved. Choosing and exploring behavioural targets in a structured manner identified clear and specific targets for intervention.

Academic vitality, a dynamic and positive aspect of university life, is crucial for fostering student motivation, academic success, and learning quality, especially in challenging disciplines like nursing. This study, therefore, aimed to design and validate a specific instrument for assessing academic vitality among nursing students. The present study was a methodological investigation focused on instrument design and psychometric evaluation, conducted from March to July 2025 at Kermanshah University of Medical Sciences. Instrument development followed both inductive (qualitative interviews with students) and deductive (literature review of existing sources) approaches, leading to the creation of an item pool. To ascertain face and content validity, qualitative and quantitative evaluations were performed with the participation of faculty members and students. Exploratory Factor Analysis (EFA) was conducted using SPSS software to determine the instrument's factorial structure. Additionally, internal consistency coefficients, including Cronbach's Alpha, McDonald's Omega, and Average Inter-item Correlation (AIC), were meticulously evaluated. The instrument's reliability was also assessed using the test-retest method (ICC). Statistical analyses revealed that the final instrument comprises 20 items categorized into two dimensions: "Clinical Vitality," and "Research Vitality,". These two dimensions collectively accounted for approximately 82.43% of the total variance in the data. Furthermore, the instrument demonstrated excellent and acceptable internal consistency coefficients (Cronbach's Alpha = 0.991, McDonald's Omega = 0.991, and AIC = 0.765) and test-retest reliability (ICC = 0.997). The developed instrument exhibits desirable psychometric properties in terms of validity and reliability, rendering it a robust tool for assessing academic vitality in nursing students. Utilizing this instrument can significantly contribute to identifying factors influencing academic vitality and formulating effective educational and clinical interventions to enhance it.

Despite the well-established need to increase access to HIV testing and prevention services among people with serious mental illness, little is known about the determinants of implementation of these services in behavioral health organizations. This multi-method study was conducted in King County, Washington, an EHE priority jurisdiction. A quantitative survey of 16 county behavioral health organizations explored the HIV testing and prevention services currently offered. Three organizations that viewed HIV testing and prevention services as very important or essential for their clients participated in in-depth qualitative interviews; 21 staff, providers, and leaders were interviewed about barriers and facilitators to on-site HIV testing and prescription or referral for Pre-exposure prophylaxis (PrEP). We used a rapid deductive qualitative analysis approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Commonly identified facilitators were organizational culture and a non-judgmental approach to care, frequent contact and long-standing relationships with clients, and a mission to provide holistic care. Commonly identified barriers were lack of resources and trained staff, infrastructure challenges (inability to bill services, weak referral pathways), higher priorities for services (including testing for Hepatitis C and sexually transmitted infections), and lack of knowledge and information. Lack of trained staff and the complexity of the service were more often perceived as barriers to providing PrEP on-site than HIV testing. Opportunities to build capacity were also identified, and included training, implementing universal testing, and expanding partnerships with other organizations to provide HIV testing and prevention services on-site at the behavioral health organization.

Adolescents and young adults (AYAs) worldwide display poor dietary behaviors, including high consumption of sugar-sweetened beverages and insufficient intake of fruits and vegetables. These issues are more pronounced in Sub-Saharan Africa, such as rural Eastern Uganda, where 45.3% of adolescents eat low-diversity diets high in refined grains and fats. Such diets raise the risk of malnutrition and diet-related non-communicable diseases (NCDs). However, there is limited contextual evidence on the multi-level factors influencing AYAs' dietary behaviors in rural Uganda. This study examined socio-ecological factors shaping dietary behaviors among AYAs in this setting. A qualitative study guided by the socio-ecological model (SEM) was conducted in Mayuge District, Eastern Uganda. Focus group discussions (FGDs) were held with AYAs, including male and female, aged 10-14, 15-19, and 20-24 years. To have a nuanced understanding of how AYAs' dietary behaviours are shaped, additional FGDs were conducted with parents or guardians and teachers, and key informant interviews with the district education officer, nutrition focal person, civil society staff, and food vendors. Data were analyzed in ATLAS.ti using both inductive and deductive thematic approaches: data-driven sub-themes were first identified inductively, then deductively mapped onto pre-determined themes of the SEM. Dietary behaviors were shaped by satiety, energy needs, sensory appeal, and nutrition knowledge at the individual level. Peer influence, parental control, and food's perceived link to attractiveness acted interpersonally, while community factors included gendered cultural taboos, norms, and health worker advice. At the societal level, cultural identity, ancestral restrictions, and media exposure strongly influenced choices. This study contributes novel rural-specific evidence from rural Uganda, where AYAs' diets are uniquely constrained by satiety demands, parental dominance, cultural taboos, and seasonal scarcity; contrasting with urban contexts where convenience, autonomy, and wider food environments prevail. Multi-level interventions integrating nutrition education, family and peer engagement, cultural dialogue, and household food security support are essential for promoting healthier diets in resource-limited rural settings.

IntroductionAdolescents and young adults (AYAs) worldwide display poor dietary behaviors, including high consumption of sugar-sweetened beverages and insufficient intake of fruits and vegetables. These issues are more pronounced in Sub-Saharan Africa, such as rural Eastern Uganda, where 45.3% of adolescents eat low-diversity diets high in refined grains and fats. Such diets raise the risk of malnutrition and diet-related non-communicable diseases (NCDs). However, there is limited contextual evidence on the multi-level factors influencing AYAs’ dietary behaviors in rural Uganda. This study examined socio-ecological factors shaping dietary behaviors among AYAs in this setting.MethodsA qualitative study guided by the socio-ecological model (SEM) was conducted in Mayuge District, Eastern Uganda. Focus group discussions (FGDs) were held with AYAs, including male and female, aged 10–14, 15–19, and 20–24 years. To have a nuanced understanding of how AYAs’ dietary behaviours are shaped, additional FGDs were conducted with parents or guardians and teachers, and key informant interviews with the district education officer, nutrition focal person, civil society staff, and food vendors. Data were analyzed in ATLAS.ti using both inductive and deductive thematic approaches: data-driven sub-themes were first identified inductively, then deductively mapped onto pre-determined themes of the SEM.ResultsDietary behaviors were shaped by satiety, energy needs, sensory appeal, and nutrition knowledge at the individual level. Peer influence, parental control, and food’s perceived link to attractiveness acted interpersonally, while community factors included gendered cultural taboos, norms, and health worker advice. At the societal level, cultural identity, ancestral restrictions, and media exposure strongly influenced choices.ConclusionsThis study contributes novel rural-specific evidence from rural Uganda, where AYAs’ diets are uniquely constrained by satiety demands, parental dominance, cultural taboos, and seasonal scarcity; contrasting with urban contexts where convenience, autonomy, and wider food environments prevail. Multi-level interventions integrating nutrition education, family and peer engagement, cultural dialogue, and household food security support are essential for promoting healthier diets in resource-limited rural settings.

Adolescent girls and young women (AGYW) aged 15-24 years still remain a very important target population for sexual and reproductive health services as their pattern of conduct is more significantly associated with sexual affection . Modern birth control services use among AGYW in Sub-Saharan Africa is still low despite having a high prevalence of unintended pregnancy. Modernbirth controlservices are crucial for sexually active Adolescent Girls and Young Women (AGYW) to prevent unintended pregnancies. This study aimed to explore the barriers to the utilization of modern birth controlservices (including short term methods, long term methods and permanent methods) among AGYW (15-24 years) in Oyam District, Northern Uganda. We conducted a qualitative study involving eight focus group discussions (FGDs) each with ten respondents, who were AGYW, aged 15-24 years residing in Oyam district Northern Uganda. The FGDs lasted 60-90 minutes and they were audio-recorded. Audio recordings were transcribed verbatim and Open Code software was used to evaluate the data using both an inductive and deductive thematic approach. Three main themes emerged as barriers to modern birth control services use. First, opposition to modern birth control including; religious, male and cultural opposition. Secondly, health concerns related to modern birth control methods use such as side effects, rumors and misconceptions. Thirdly, health systems factors such as availability of modern birth control methods and waiting time at the health facilities. The main barriers to the utilization of modern birth control services among AGYW (15 - 24 Years) in Oyam District, Northern Uganda were opposition to modern birth control, health concerns, health systems factors and rumors and misconceptions. Family and community rumors were important decision-influencing factors when it came to using modern family planning services, implying that modern birth control campaigns should target more than just the individual.

Background:Although medical risk prediction tools are widely developed, few achieve sustained clinical adoption. In cirrhosis patients, surgical risk calculators have achieved broad utilization. We sought to identify key design and implementation factors that influence provider uptake of such tools, using the VOCAL-Penn score (VPS) as a case example.Methods:We conducted a qualitative study of 22 diverse clinicians who care for patients with cirrhosis. Semi-structured interviews were guided by the Consolidated Framework for Implementation Research to explore factors influencing the adoption of risk prediction tools. Interviews were transcribed and analyzed using a combined grounded theory and deductive approach. Emergent themes were synthesized into a conceptual framework.Results:Five recurrent themes emerged as central: efficiency, accessibility, transparency, accuracy, and generalizability. Clinicians emphasized the need for tools that are intuitive, require minimal inputs, and integrate seamlessly into existing workflows. Ensuring input variables were clinically meaningful and readily available was cited as critical to encouraging use. Transparency in model development was essential to building trust. Participants stressed the importance of comparative performance data relative to existing clinical standards, as well as published external validations, to support the tool’s credibility. Finally, generalizability was key to equitable application across diverse patient populations.Conclusions:Using the VPS as a grounding example, our findings identify 5 domains—efficiency, accessibility, transparency, accuracy, and generalizability—that inform the development and dissemination of future tools. By aligning tool design with real-world clinical needs, this framework may support broader adoption and more equitable implementation of medical risk prediction tools.

Purpose This study builds on the natural resource-based view of dynamic capability to explore whether, how and when green dynamic capabilities (GDCs) contribute to green competitive advantage (GCA). Specifically, it investigates the role of marketing innovation capability (MIC) as a mediator and the effect of environmental attitudes (EA) as a moderator in this relationship. Design/methodology/approach A quantitative design and deductive approach were employed using a three-wave time-lagged dataset collected from 218 managers and their subordinates to examine hypothesized relationships using IBM SPSS 28.0 and the PROCESS macro. Findings The empirical findings revealed that MIC mediates the positive relationship between GDCs and GCA. Furthermore, the results indicate that the mediating effect was stronger when EA was high than when it was low. Originality/value This study makes valuable contributions to the literature by providing empirical evidence of the interplay between GDCs, MIC and EA in shaping a firm’s GCA. These findings have significant implications for practitioners and policymakers in the hospitality and tourism industry, emphasizing the importance of developing GDCs and fostering EA to achieve superior performance through sustainable practices.

Experiences and Perspectives of the American Public Health Association Chiropractic Health Care Section Leaders: A Qualitative Analysis.

Creating an adolescent intensive health behavior and lifestyle treatment for type 1 diabetes: Feedback from the target population.

Post-Hospitalization Telerehabilitation is Acceptable and Feasible for Veterans With Dementia: A Secondary Qualitative Study.

Decisional needs of intensive care unit survivors with alcohol use disorder considering alcohol treatment: A qualitative study.

Abstract EP2.3, e-Poster Terminal 2, September 4, 2025, 10:05 - 10:30 According to the World Health Organization, at least 50 percent of the world’s population still lacks access to essential healthcare services. The United Nations human rights committee on Economic, Social, and Cultural rights in their General Recommendation 14, explains the four components of human rights based approach to health -availability, accessibility, acceptability, and quality (AAAQ) which are crucial to the enjoyment of the right to health by all and to address global health inequalities. This study aimed to understand the knowledge, attitudes, and perceptions of healthcare providers on AAAQ of health service delivery in Kakuma and Kalobeyei refugee camps in Kenya. The study also examined the extent of application and nature of AAAQ integrated into service delivery in humanitarian settings. The research study employed qualitative methodologies, including four focused group discussions (n = 28), and four health facility assessments. Homogenous sampling was used to recruit healthcare workers. All interactions were audio recorded upon consent. The study used principles of community-based participatory research. Partner organizations contributed to the research process at all stages. The data was collected in February 2024 and stakeholder consultation workshops were conducted in July/August 2024. Data analysis is being conducted on MaxQDA. A codebook with preliminary themes and categories has been designed using a deductive and analytic inductive approach. The results are currently being analyzed and a complete analysis of the data collected is expected to be completed by May 2025. We hope the insights from our findings could lead to improvements in reproductive health service delivery that integrates a human rights approach to health to achieve the realization of the right to health. The study also aims to inform policymakers, researchers, practitioners, and donors to invest in robust, rights-based solutions for reproductive health in crisis settings.

Garage sales as more-than-human affinity spaces: Reimagining social participation in later life.

In an era marked by escalating living standards, the allure of lottery as an alternative revenue stream has surged globally, exemplified by Sri Lanka's long-standing lottery systems. However, the ethical dimensions of lottery sales practices remain critically under-explored. This study delves into the ethical implications of predatory sales tactics, misinformation, neglect of customer needs, and the erosion of trust on lottery agent motivation within the Galle District, Sri Lanka. Employing a positivism philosophical standpoint along with deductive approach and has applied, mono-quantitative choice to surveyed 135 agents, utilizing simple random sampling and statistical analysis conducted, including Spearman correlation, and Chi-square tests. Our findings reveal a significant positive relationship between unethical sales behaviors and agent motivation. Despite the potential for short-term gains, these practices jeopardize long-term trust and customer loyalty. This research bridges a critical gap by highlighting the necessity for ethical sales practices in the lottery sector, a domain often overlooked. We advocate enhanced ethical training, transparent communication, and incentive restructuring to foster sustainable sales practices. By integrating Self-Determination Theory principles, organizations can cultivate an environment that prioritizes agent well-being and customer trust. This study underscores the importance of ethical integrity in lottery sales, offering actionable insights for regulatory bodies and lottery boards to safeguard both agents and consumers. Ultimately, this research contributes to a more responsible and sustainable lottery sales ecosystem in Sri Lanka and beyond, emphasizing that ethical conduct is not merely a moral imperative but a strategic necessity for long-term success. Keywords: Ethical Implications, Commission-Based Incentives, Lottery Agents, Motivation, Sales Practices

The masjid should be an inclusive and welcoming space for all, including children as integral members of the jam?‘ah (congregation). In Malaysia, while acceptance of children in masjids has improved, many parents still face challenges related to design inadequacies, management gaps, and social attitudes. This study aims to explore parental experiences and identify the key design and management challenges in creating child-friendly masjids. Semi-structured interviews were conducted with twelve parents who regularly bring their children to the masjid. The interviews were transcribed, translated, and analysed using NVivo 12 through a deductive thematic approach to categorise emerging challenges. Findings indicate that parents’ struggles cluster into three interconnected domains: physical – inadequate spatial layout, lack of child zones, and poor safety features; social – negative perceptions and intolerance among some congregants; and management – inconsistent policies, weak supervision, and insufficient facilities. Despite these obstacles, parents remain dedicated to introducing their children to religious life, underscoring a strong commitment to nurturing faith and communal belonging. The study concludes that effective masjid design must integrate child-friendly features such as designated yet visually connected zones, safe circulation, and acoustic treatments, complemented by responsive management and community engagement. These strategies can enhance the masjid’s function as a nurturing space for families, reinforcing its role as both a spiritual and social hub. These findings contribute to developing inclusive design and management guidelines that promote holistic community participation.

Research Aims: The educational landscape has undergone profound transformations driven by technological advancements, global events, and societal shifts. In this context, the study aims to examine the comparative knowledge gains in online versus face-to-face learning, focusing on the role of students' interaction and engagement. Design/methodology/approach: Utilising Social Learning Theory and the Theory of Education, this paper adopted a deductive reasoning approach. Additionally, the study has incorporated cross-sectional, descriptive, causal, and relational research design. A structured questionnaire was successfully administered to 110 students at Quality Assurance and Accreditation (QAA)-certified colleges in the Kathmandu Valley, and the data were analysed using mean, median, standard deviation, variance, kurtosis, skewness, correlation, and regression. Research Findings: Results indicate a slightly higher knowledge gain in online learning, with a grand weighted mean of 2.85. The study identifies student engagement as a partial mediator in the relationship between learners' interaction and knowledge gain. Both student interaction and engagement have a significant positive impact on knowledge gain, with the relationship being statistically significant at the 0.01 level. Theoretical Contribution/Originality: The study findings suggest that implementing online learning strategies can improve educational outcomes, providing valuable insights for educational institutions and policymakers. The study results underscore the significance of integrating digital learning approaches to enhance student achievement.

ObjectiveThis study explores the reasons and methods by which medical students use Medical Educational Commercial Off-the-Shelf (MedED-COTS) learning platforms for exam preparation. It also compares student use of these platforms with institutional resources and identifies their benefits and limitations.MethodsA qualitative cross-sectional study was conducted at the University of Birmingham, UK, involving semi-structured focus groups with 5 medical students and 6 clinical teaching fellows (early career clinical instructors). Transcripts were analysed thematically using a deductive approach, with supplementary inductive coding to capture emerging themes.ResultsStudents reported that MedED-COTS were integral for exam preparation, often perceived as essential for success. Platforms were valued for accessibility, gamified features, and continuity with familiar strategies, such as working through past papers. Peer influence strongly shaped platform selection and use. Students highlighted the benefits of identifying knowledge gaps and flexible, self-directed learning opportunities. However, concerns were raised about subscription costs, equity of access, and the need to purchase multiple platforms. Clinical teaching fellows acknowledged the appeal of MedED-COTS but cautioned that oversimplification of complex topics risked undermining the development of deeper clinical reasoning skills.ConclusionMedED-COTS play a prominent role in student learning but require careful integration with institutional resources to ensure balance between exam preparation and clinical reasoning development. Medical schools should provide guidance on appropriate use, address barriers of cost and equity, and consider how validated elements of these platforms could be incorporated into curricula. Given the small, exploratory sample from a single institution, findings should be interpreted as preliminary but highlight important directions for future, larger-scale research on the role of commercial learning platforms in medical education.

Background The emergence of AI technologies has revolutionised dentistry, with intraoral imaging being a key area for innovation. Despite advances and growing interest in applying AI algorithms to intraoral x-rays, the methodological quality, diagnostic validity, and clinical applicability of existing studies remain unclear. Aim To synthesise and critically appraise the current evidence on AI integrated with intraoral digital radiographic imaging for detecting dental caries in adults, focusing on diagnostic accuracy compared with gold-standard methods and examining methodological quality, clinical applicability, and implementation challenges. Methods Following the JBI scoping review framework and PRISMA-ScR reporting guidelines, a comprehensive literature search was conducted across the PubMed, Scopus, and IEEE Xplore databases from January 2015 to May 2025. Studies that met the predefined eligibility criteria were included. Thematic analysis, combining inductive and deductive approaches following Braun and Clarke’s framework, identified five themes. The CASP quality appraisal was performed to ensure methodological rigour. Results Ten peer-reviewed studies were included in the final data analysis. AI systems detected a greater number of carious lesions than human clinicians, particularly in early-stage caries, with representative metrics including 88% sensitivity, 91% specificity, and 89% accuracy. Other models reported F1-scores up to 89% and AUC ≈95%. Methodological diversity was notable, with histology-validated designs providing the strongest evidence. Implementation challenges included limited external and real-world validation, clinician oversight, ethical/regulatory considerations, and inadequate model interpretability. Conclusion AI exhibits strong potential to enhance early caries detection on intraoral radiographs and support clinical decision-making in adults. Fully realising AI’s clinical potential requires overcoming implementation and methodological challenges. Standardised validation methods across diverse populations and settings are crucial to ensure AI diagnostic reliability and generalisability. Current AI applications in dentistry are primarily designed to assist clinicians in detecting caries; however, their greatest potential lies in a future where they can independently guide treatment planning decisions.