Five-step Process Research Articles

A rare cause of chronic musculoskeletal pain in children: complex regional pain syndrome

The Journal of the Postgraduate Institute of Medicine (JPGIM) is an open access, peer-reviewed, biannual journal published by the Postgraduate Institute of Medicine (PGIM) of the University of Colombo (UOC), Sri Lanka. The JPGIM aims to publish articles relevant to clinicians, policymakers, and researchers on topics relating to the practice of medicine, medical education, professionalism, integrity, and ethics of the research enterprise. The JPGIM has been in publication since 2014 and publishes accepted manuscripts online immediately after copy-editing, enabling rapid dissemination of scientific knowledge. The published articles are compiled into two issues in June and December.The Journal practices a double-blind peer review policy. The JPIGM does not charge any article processing or publication fee.We recommend that you review the About the Journal page for the journal's section policies, as well as the Submission Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

Novel polar AhR-active chemicals detected in sediments of an industrial area using effect-directed analysis based on in vitro bioassays with full-scan high resolution mass spectrometric screening.

Studies investigating aryl hydrocarbon receptor (AhR)-active compounds in the environment typically focus on non- and mid-polar substances, such as PAHs; while, information on polar AhR agonists remains limited. Here, we identified polar AhR agonists in sediments collected from the inland creeks of an industrialized area (Lake Sihwa, Korea) using effect-directed analysis combined with full-scan screening analysis (FSA; using LC-QTOFMS). Strong AhR-mediated potencies were observed for the polar and latter fractions of RP-HPLC (F3.5-F3.8) from sediment organic extracts in the H4IIE-luc in vitro bioassays. FSA was performed on the corresponding fractions. Twenty-eight tentative AhR agonists were chosen using a five-step process. Toxicological confirmation using bioassay revealed that canrenone, rutaecarpine, ciprofloxacin, mepanipyrim, genistein, protopine, hydrocortisone, and medroxyprogesterone were significantly active. The relative potencies of these AhR-active compounds compared to that of benzo[a]pyrene ranged from 0.00002 to 2.0. Potency balance analysis showed that polar AhR agonists explained, on average, ~6% of total AhR-mediated potencies in samples. Some novel polar AhR agonists also exhibited endocrine-disrupting potentials capable of binding to estrogen and glucocorticoid receptors, as identified by QSAR modeling. In conclusion, the focused studies on distributions, sources, fate, and ecotoxicological effects of novel polar AhR agonists in the environment are necessary.

Urban heat island (UHI) intensity and magnitude estimations: A systematic literature review.

The severity of urban heat islands (UHIs) is increasing due to global and urban climate change. The damage caused by UHIs is also increasing. To establish a plan to improve the deteriorating thermal environment in cities due to UHIs and to minimize the damage, further research is needed to accurately estimate and analyze the intensity and magnitude of UHIs. This systematic literature review (SLR) is an in-depth review of 51 studies obtained through a five-step filtering process focusing on their analysis of the spatial extent of UHIs, the UHI concept that was used for UHI estimation, and the UHI estimation and analysis methods. This SLR confirmed the need for accurate UHI intensity and magnitude estimation and analysis to reset the existing UHI classification based on the variety of vertical and horizontal ranges where UHIs occur. The results also indicated that the existing UHI energy concepts for estimating UHIs need to be modified and developed to reflect the three-dimensional physical form of the city. Finally, this SLR clarifies the need to develop an optimized analysis method for UHI research. The review results of this SLR will inform future studies and be the cornerstone for establishing policies and plans that can accurately predict and respond to the damage caused by UHIs.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

BackgroundPeople with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers.MethodsThis pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers’ self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI.DiscussionWhile we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery.Trial registrationClinicalTrials.gov, NCT04696653. Registered on January 6, 2021

Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework.

Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners' perceived barriers and enablers to the implementation of evidence-based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi-structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five-step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence-based practice included high levels of self-reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self-reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.

46920 Engagement and co-creation in a DNA integrity cohort study

ABSTRACT IMPACT: Our work is demonstrative of the value embedded in community engagement as a vehicle to facilitate and expand the focus of translational research. OBJECTIVES/GOALS: To develop a community-informed recruitment process for a population-based DNA integrity longitudinal study aiming to document the average amount of DNA damage as well as DNA repair capacity in a cohort of community-dwelling individuals. METHODS/STUDY POPULATION: The three-member Community Engagement team (CE Team) partnered with a ten-person Community Advisory Board (CAB) to develop recruitment procedures and materials. Through an iterative process taking place over 13 meetings, CAB members answered questions about community context, appropriate recruitment approaches, and tone of communication with potential study participants. They also collaborated in the creation of outreach materials, informational booklets, and the informed consent document. The CAB’s input was recorded in meeting notes that informed successive versions of the materials. The CE Team held post-meeting debriefs to develop consensus on lessons learned and next steps. RESULTS/ANTICIPATED RESULTS: CAB input generated a five-step recruitment process. It informed approaches to communications with potential participants and resulted in a set of printed recruitment materials. Furthermore, the CAB pushed the CE Team and laboratory scientists to think beyond study participation to a comprehensive view of respectful engagement including notification of elected officials and other community institutions. By sharing personal anecdotes and asking how this study would reflect their lived experiences and/or contribute to their communities, CAB members inspired the university team to recognize the environmental context that may underlie DNA damage in residents of an underserved community. DISCUSSION/SIGNIFICANCE OF FINDINGS: The CAB was very effective in generating tools for recruitment. Moreover, CAB members provided insights beyond those originally sought by the CE Team, regarding broader engagement and a focus of future research relevant to the needs of both the community and the university researchers.

How well do audit textbooks currently integrate data analytics

The auditing profession is undergoing a transformation, becoming heavily reliant on computerized systems to produce data analytic reports. As a result, the demand for accounting graduates with knowledge in data analytics (DA) has increased. Because textbooks remain the primary educational resource in a college classroom, we sought to determine the extent to which textbooks include DA content and provide a summary of our findings to assist auditing educators in locating this content. Our primary analysis includes the examination of the six most commonly used audit textbooks and one book on DA for accountants. For each text, we evaluated (1) the degree to which textbooks have integrated current and emerging technologies into the written chapter content; (2) the degree to which auditing textbooks have students perform specific DA activities, using DA software; and (3) the degree to which these problems follow the AICPA’s five-step process for planning and performing audit DA. We also provide a Detailed Analysis section for each text in which we summarize both in-chapter and end-of-chapter DA exercises. Recognizing the large amount of DA resources available online such as case studies and datasets, we also provide a review and summary of this content, thereby providing auditing educators a wide variety of options for including DA in their classroom. Finally, based on our review of these resources, we provide recommendations for educators, textbook authors, and publishers to consider when developing DA educational materials. Our purpose is to contribute to the discussion on auditing curriculum and whether trends in practice are reflected in the course resources.

The Review of the Government’s Response to COVID-19 - Focusing on the Intellegence Process -

2020년 COVID-19에 대한 한국 정부의 대응 과정을 정보 프로세스를 통해 점검하고, 문제점을 식별하고, 이에 대한 해결책을 제시하는 것이 이 연구의 목적이다. 이 연구에서는 5단계 정보 프로세스를 통해 COVID-19에 대한 한국 정부의 초기 대응과 현재 진행 중인 위기 관리 프로세스를 점검하였다. 5단계 정보프로세스는 (1) COVID-19에 대한 정보를 수집하는 과정을 살피고. (2) 수집된 정보 분석과정을 통해 살피고. (3) 대응 조직간의 정보 공유 상황을 확인하고, (4) 감염병 정보가 얼마나 투명하고 정확하며 시기적절하게 공개되는지 조사하였다. (5) 정부가 지속적으로 정보를 최신화 및 관리조치를 살폈다. 결과적으로 정부는 해외 감염병 발생 시, 더 신속한 정보 수집 노력, 전문인력 및 분석체계 구축, 정부 주도의 적극적인 정보 공유 노력, 신중하고 원칙 있는 정보 공개 시스템 구축, 인력이 아닌 체계 구축을 통한 정보 관리를 위한 투자와 연구에 지속적인 노력이 필요할 것으로 보인다.The purpose of this study is to check the Korean government s response to COVID-19 in 2020 through an information process, identify problems, and suggest solutions. This study examined the Korean government s initial response to COVID-19 and the ongoing crisis management process through a 5-step information process. The five-step information process looks at (1) the process of gathering information about COVID-19. (2) Look through the process of analyzing the collected information. (3) The status of information sharing among the responding organizations was checked, and (4) Infectious disease information was investigated how transparent, accurate, and timely information was disclosed. (5) The government continuously updated information and looked for management measures. As a result, in the event of an overseas infectious disease, the government strives to collect information more quickly, establish a professional manpower and analysis system, share information led by the government, establish a discreet and principled information disclosure system, and manage information through a system, continuous efforts for investment and research.

Maintaining a global health partnership during the COVID-19 pandemic: a road map from the Toronto Addis Ababa Academic Collaboration in Emergency Medicine.

The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.

Coupled Effect of Electronic Medical Record Modifications and Lean Six Sigma Methodology on Rheumatoid Arthritis Disease Activity Measurement and Treat‐to‐Target Outcomes

ObjectiveRheumatoid arthritis (RA) disease activity assessment is critical for treatment decisions and treat to target (T2T) outcomes. Utilization of the electronic medical record (EMR) and techniques to improve the routine capture of disease activity measures in clinical practice are not well described. We leveraged a Lean Six Sigma (LSS) approach, a data‐driven five‐step process improvement and problem‐solving methodology, coupled with EMR modifications to evaluate improvement in disease activity documentation and patient outcomes.MethodsA RA registry was established, and structured fields for Routine Assessment of Patient Index Data (RAPID3) and Clinical Disease Activity Index (CDAI) were built in the EMR, along with a dashboard to display provider performance rates. An initial rapid‐cycle improvement intervention was launched, and subsequent LSS improvement cycles helped in standardization of clinic workflow, modifying provider behaviors, and motivating better documentation practices. Trends related to CDAI score categories were compared over time using run charts.ResultsOur project included 1322 patients with RA and 10 241 encounters between April 2016 and December 2019. Initially, RAPID3 completion rates increased from 16% to 50%, and CDAI from 15% to 44% from the RCI intervention. Post LSS intervention, the RAPID3 rate increased to more than 90% (sustained at 85%), and CDAI rate increased to more than 80% (sustained at 72%). The patients in the low disease/remission category increased from 54% to 66% (p < 0.001), and those in the high disease category decreased from 15% to 7% (p < 0.001), demonstrating improved T2T outcomes.ConclusionCombining EMR modifications with systems redesign utilizing LSS approach led to impressive and sustained improvement in disease activity documentation and T2T outcomes.

A natural experimental study of improvements along an urban canal: impact on canal usage, physical activity and other wellbeing behaviours

BackgroundThere are few robust natural experimental studies of improving urban green spaces on physical activity and wellbeing. The aim of this controlled natural experimental study was to examine the impact of green space improvements along an urban canal on canal usage, physical activity and two other wellbeing behaviours (social interactions and taking notice of the environment) among adults in Greater Manchester, UK. The intervention included resurfaced footpaths, removal of encroaching vegetation, improved entrances, new benches and signage.MethodsTwo comparison sites were matched to the intervention site using a systematic five-step process, based on eight correlates of physical activity at the neighbourhood (e.g. population density) and site (e.g. lighting) levels. Outcomes were assessed using systematic observations at baseline, and 7, 12 and 24 months post-baseline. The primary outcome was the change in the number of people using the canal path from baseline to 12 months. Other outcomes were changes in physical activity levels (Sedentary, Walking, Vigorous), Connect and Take Notice behaviours. Data were analysed using multilevel mixed-effects negative binomial regression models, comparing outcomes in the intervention group with the matched comparison group, controlling for day, time of day and precipitation. A process evaluation assessed potential displacement of activity from a separate existing canal path using intercept surveys and observations.ResultsThe total number of people observed using the canal path at the intervention site increased more than the comparison group at 12 months post-baseline (IRR 2.10, 95% CI 1.79–2.48); there were similar observed increases at 7 and 24 months post-baseline. There was some evidence that the intervention brought about increases in walking and vigorous physical activity, social interactions, and people taking notice of the environment. The process evaluation suggested that there was some displacement of activity, but the intervention also encouraged existing users to use the canal more often.ConclusionsUrban canals are promising settings for interventions to encourage green space usage and potentially increase physical activity and other wellbeing behaviours. Interventions that improve access to green corridors along canals and provide separate routes for different types of physical activities may be particularly effective and warrant further research.Study protocolStudy protocol published in Open Science Framework in July 2018 before the first follow-up data collection finished (https://osf.io/zcm7v). Date of registration: 28 June 2018.

Replicating natural topography on marine artificial structures – A novel approach to eco-engineering

Ocean sprawl is a growing threat to marine and coastal ecosystems globally, with wide-ranging consequences for natural habitats and species. Artificial structures built in the marine environment often support less diverse communities than natural rocky marine habitats because of low topographic complexity. Some structures can be eco-engineered to increase their complexity and promote biodiversity. Tried-and-tested eco-engineering approaches include building-in habitat designs to mimic features of natural reef topography that are important for biodiversity. Most designs mimic discrete microhabitat features like crevices or holes and are geometrically-simplified. Here we propose that directly replicating the full fingerprint of natural reef topography in habitat designs makes a novel addition to the growing toolkit of eco-engineering options. We developed a five-step process for designing natural topography-based eco-engineering interventions for marine artificial structures. Given that topography is highly spatially variable in rocky reef habitats, our targeted approach seeks to identify and replicate the ‘best’ types of reef topography to satisfy specific eco-engineering objectives. We demonstrate and evaluate the process by designing three natural topography-based habitat units for intertidal structures, each targeting one of three hypothetical eco-engineering objectives. The process described can be adapted and applied according to user-specific priorities. Expanding the toolkit for eco-engineering marine structures is crucial to enable ecologically-informed designs that maximise biodiversity benefits from burgeoning ocean sprawl.

Magnetic resonance imaging as a diagnostic method

AdmissionIn human medicine, magnetic resonance imaging (MRI) is one of the leading and most popular diagnostic methods. In veterinary medicine, initially, MRI was treated mainly as a research tool, but with the development of veterinary specializations, an increase in the number of specialists, reference clinics, but also an increase in awareness and expectations of animal owners, MRI began to play a key role in the clinical practice of small animals - dogs and cats , exotic animals and horses.Aim The aim of the study is the analysis of magnetic resonance as a diagnostic method.Material and method Review of the available literature on the subject.ResultsMagnetic resonance imaging is based on the phenomenon of nuclear magnetic resonance, characteristic of the nuclei of elements with an odd number of protons or neutrons, and therefore having a momentum (spin) and a magnetic moment. The most commonly used element is the hydrogen atom, thanks to its richness in living organisms. The general scheme of how MRI works is a five-step process involving the following phenomena:—Placing the patient in a constant homogeneous electromagnetic field—Radio frequency (RF) signal emission—Interruption in RF signal emission—RF feedback by the body—Processing of the emitted signal and image reconstruction.Currently, the most popular areas of research are the central nervous system (brain and spine) and the musculoskeletal system. The test allows you to diagnose intracranial diseases such as: birth defects, inflammatory changes in the brain tissue, demyelinating diseases or cancer. Conclusions The versatility of magnetic resonance imaging, both in terms of species diversity (small animals, horses, exotic animals) and imaging areas (central and peripheral nervous system, bones with their joints, muscle tissue) has made MRI a very important method diagnostic used in clinical veterinary medicine. The other advantages of magnetic resonance imaging include imaging in three planes, enabling subsequent three-dimensional reconstruction, no harmful X-rays and the possibility of using contrast agents.

English language in African higher education: A systematic review

One of the features of the internationalisation of higher education is the increasing use of the English language as a medium of instruction and research in higher education. This growing use of English spurs this article’s attempt at systematically reviewing literature focusing on African higher education systems. The analysis of the selected literature focuses on assessing the main themes, theoretical assumptions and core findings. As a result, 30 articles accessed through continental and international research databases were included in the final analysis after a five-step selection process using relevant keywords related to the topic and the context of the study. The findings indicate that research on the English language in higher education in African contexts overwhelmingly focuses on the language as a medium of teaching and learning. The other aspects, such as the role that the language plays as a medium of research and archiving knowledge, seem to be overlooked. The findings of the majority of both empirical and review papers seem to present critical and, at times, unfavourable views on the role English plays in the specific contexts studied. In light of these findings, the recommendation is that the role of the English language as a medium of instruction should be expanded to cover issues related to research, publication and archiving knowledge. This indicates that the continent’s higher education systems need more research on English language, which suggests that robust and pragmatic theoretical approaches might also be needed in future studies. A further observation is that the findings from the reviewed studies might be the result of using theories that are underpinned in traditions that are already critical of the use of the English language. Thus, more research attention could be given to strengthening the efficacy of using multiple theoretical perspectives to render the African contexts studied more intelligible.

The TPOCS-self-reported Therapist Intervention Fidelity for Youth (TPOCS-SeRTIFY): A case study of pragmatic measure development.

Developing pragmatic assessment tools to measure clinician use of evidence-based practices is critical to advancing implementation of evidence-based practices in mental health. This case study details our community-partnered process of developing the Therapy Process Observation Coding Scale-Self-Reported Therapist Intervention Fidelity for Youth (TPOCS-SeRTIFY), a pragmatic, clinician-report instrument to measure cognitive behavioral therapy (CBT) delivery. We describe a five-step community-partnered development process. Initial goals were to create a self-report instrument that paralleled an existing direct observation measure of clinician delivery of CBT use to facilitate later assessment of measure performance. Cognitive interviews with community clinicians (n = 6) and consultation with CBT experts (n = 6) were used to enhance interpretability and usability as part of an iterative refinement process. The instrument was administered to 247 community clinicians along with an established self-reported measure of clinician delivery of CBT and other treatments to assess preliminary psychometric performance. Preliminary psychometrics were promising. Our community-partnered development process showed promising success and can guide future development of pragmatic implementation measures both to facilitate measurement of ongoing implementation efforts and future research aimed at building learning mental health systems. Developing brief, user-friendly, and accurate tools to measure how therapists deliver cognitive behavioral therapy (CBT) in routine practice is important for advancing the reach of CBT into community settings. To date, developing such "pragmatic" measures has been difficult. There is little known about how researchers can best develop these types of assessment tools so that they (1) are easy for clinicians in practice to use and (2) provide valid and useful information about implementation outcomes. As a result, there are few well-validated measures in existence that measure therapist use of CBT that are feasible for use in community practice. This paper contributes to the literature by describing our community-partnered process for developing a measure of therapist use of CBT (Therapy Process Observation Coding Scale -Self-Reported Therapist Intervention Fidelity for Youth; TPOCS-SeRTIFY). This descriptive case study outlines the community-partnered approach we took to develop this measure. This case study will contribute to future research by serving as a guide to others aiming to develop pragmatic implementation measures. In addition, the TPOCS-SeRTIFY is a pragmatic measure of clinician use of CBT that holds promise for its use by both researchers and clinicians to measure the success of CBT implementation efforts.

How Elite Configurations Explain Shifts from Democracy to Authoritarian or Totalitarian Regimes: Turkey as a Case Study

Attempting to predicting the formation of particular types of governance structures has been one of the central tasks of sociologists and political scientists. John Higley and Michael Burton argued that the configuration of elite groups in a society is an important predictor of the governance structure that develops in that society. The Higley-Burton theory outlines several ways in which the configuration of elites can predict the transformation of governance structures, from authoritarian regimes to liberal democracies. In the current research, this previous theoretical work is extended by articulating a route by which societies can go the other way—from democracy to an authoritarian regime. Turkey is being used as a contemporary case study to show how shifts elite configurations in a democracy can lead to authoritarian regime. A five-step process for this transformation is outlined. The steps in this model for one route of moving from an unstable democracy towards autocracy or dictatorship can be summarized as follows: 1) Political success by one group or faction. 2) Establishment of an inner circle and consolidation of power. 3) Replacement of the inner circle with weaker members who can be controlled. 4) Self-isolation of the leader. 5) Government control of opposition and suppression of dissent.

Enduring life in between a sense of renewal and loss of courage: lifeworld perspectives one year after hip fracture

ABSTRACT Purpose: To explore everyday life experiences of being active in aged adults´ with walking impairment one year after hip fracture (HF). Methods: A phenomenological-hermeneutic study design is based on Heidegger´s and Gadamer´s thinking focusing on aged adults being-in-the-world one year after HF. Individual semi-structured interviews were conducted from May to July 2017 in the homes of nine participants, who were part of a longitudinal qualitative study with four interview-rounds for a period of 18 months after the HF event. The analysis was interpretative and secured that the authors´ pre-understanding was put at stake through a five-step process of meaning condensation. Results: One theme, “Enduring life in between a sense of renewal and loss of courage”, described aged adults´ experiences of being active in three sub-themes: “Facing loss and losing courage”, “Taking up the challenge and maintaining courage “, and “Renewing the energy to be active”. Living with being under change and increased vulnerability created a challenge in maintaining courage and reaching for possibilities to unfold their own being in life. Conclusion: This study contributes knowledge on how the aged adults´ experiences of the balance between courage and loss in being active one year after HF are profoundly connected with experiences of well-being.

Australians' Experience of the COVID-19 Pandemic: Advantages and Challenges of Scaling Up Qualitative Research Using Large-Scale Rapid Analysis and Building Research Capacity Across Rural Australia.

Australia responded to the emergence of the COVID-19 global pandemic in 2020 by initiating a border and bio-security zone lockdown and policies emphasising social distancing and hand hygiene. To understand the public response to this, Southern Queensland Rural Health commenced a two-phase research project exploring attitudes and practices towards the COVID-19 pandemic in Australia. An initial online survey foreshadowed 90 qualitative interviews with respondents to explore what the pandemic meant for everyday life. This paper details use of a qualitative approach by a national collaborative of investigators from 9 rural university departments in Australia who came together to research the qualitative phase of the project. Our methodological approach aligned with extant literature describing the management of large-scale interviewing and coding in the context of unfolding and dynamic contexts. The ‘RITA’ model (Rapid Identification of Themes from Audio recordings) entails a five-step process designed to progress from identifying research foci, through deductive and iterative coding to identify key concepts. We used a combination of coding templates, organisation and tagging of field notes and real-time sharing through a secure cloud drive to create a data set for immersive analysis and generation of ideas. Use of this method has added to the collective knowledge about successful rapid research investigations, recognising the inherent tension between speed and rigour. This is not a binary but a dialectic; trustworthiness is integral to qualitative research. However, use of fresh approaches is accommodated by new technologies and can preserve adequate rigour while enabling collaboration, research capacity building and increasing the pace of data collection and analysis. This project has presented methodological challenges and highlights some strengths of such an approach. It is hoped that reporting our approach and experiences is useful for the broader health and research community considering large-scale qualitative research.

Essential service delivery in reproductive, maternal and child health services during the pandemic

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the ‘Start Submission’ link and follow the five-step article submission process which is a simple and self-guided process.

Quality of care in the management of asthmatic children with regard to compliance with the guidelines in in-ward setting in a district of Sri Lanka: a descriptive study

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the ‘Start Submission’ link and follow the five-step article submission process which is a simple and self-guided process.