Flexible Options Research Articles

The Industrial Revolution 4.0 (IR 4.0) has shown researchers, scholars, and experts in education that traditional textbook-based language learning is often static and non-participatory. The temporary halting of physical classes during the COVID-19 pandemic increased the shift from classroom textbook-based language learning to online learning. As a result, students and teachers had to adapt to online learning platforms, requiring learners to adapt to more engaging, inclusive, and student-led resources. The LG’s Linguaphiles 4.0 is an English language learning application software designed to make learning English more enjoyable through gamification, interactive content, and mobile-oriented basics. The application covers a broad range of language skills: pronunciation, listening, grammar, and reading, targeting students from A1 to B2 levels of the Common European Framework of Reference for Languages (CEFR). Android Studio and Java were used during development, and Firebase for data management, instant feedback, and scalability in the future. Features critical to "The Mobile Application" include spy-story plot, rewards-based learning, and practice with built-in feedback, text-to-speech, and controlled but limited instructor oversight to promote student autonomy. Designed to boost motivation and sustain interest, the programme fits the current learning culture by supporting autonomous learning and reducing dependence on traditional pedagogic approaches. Beta testing revealed high level of user engagement, and students were satisfied with the functionality and content organisation. The LG’s Linguaphiles 4.0 also showed high commercial value in non-academic and academic contexts. With its user-friendly interface, CEFR-compliant organisation, and adaptive nature, the application software offers a practical and scalable solution for modern English language learning in a fast-changing digitalising world where flexible and accessible learning options are in demand.

Temporary mental health (MH) staffing gaps are common and may compound access challenges due to increasing demand for MH care combined with a shrinking MH workforce. In 2019, the Veterans Health Administration (VA) implemented a system of 18 regionally based Clinical Resource Hubs (CRHs) staffed with remote providers delivering virtual MH care. While the program demonstrated promise during early implementation for effectively addressing some access challenges, its sustainment may depend partly on leaders' perceptions of its ability to meet and adapt to access-related priorities. Our aim was to explore and describe how VA regional MH leadership identified and weighed values of the CRH during early implementation, and how it might have functioned beyond filling temporary staffing gaps. We conducted semi-structured interviews with CRH MH leaders (n = 36) across all 18 VA administrative regions. We analyzed data using a rapid qualitative approach that included templated summaries and matrix analysis. Three key perceived values of the CRH were identified: (1) its potential to offer a more integrated care experience than community (VA-purchased) care in some cases, (2) its ability to provide specialized MH services (e.g., suicide prevention) to rural areas and, (3) its capacity to improve MH provider recruitment and satisfaction. Virtual care delivered through the CRH can be a flexible option for maintaining access to MH services during staffing shortages. MH leaders' perspectives suggest the CRH program is not only a contingency staffing solution to access problems, but provides additional values that could be leveraged to improve MH care services more generally.

Corporate Practice/Dental Service Organization.

How flexible is the German biogas sector? Stakeholder acceptance of flexible feeding options to support better system integration

The traditional agricultural supply chain in India often depends on middlemen who drive up consumer prices while giving farmers little profit. This imbalance leads to financial instability, with some cases resulting in farmer suicides. Consumers also suffer, paying more for produce that often loses freshness and quality before it reaches them. To tackle these issues, this paper introduces AgroGo, an Android-based mobile app built with Kotlin and Firebase Fire store. The app creates a direct digital marketplace between farmers and consumers, reducing the need for middlemen. AgroGo allows farmers to upload product details with images, manage their inventory in real time, and set fair prices. It integrates with the Razor pay API to provide secure and flexible digital payment options. For consumers, AgroGo offers access to fresh, seasonal produce through easy search and filtering features, real-time order tracking, and options for delivery or pickup. AgroGo also includes product listing, orders dashboards, smart inventory management, especially for rural communities. By promoting transparency and supporting digital integration, the platform boosts farmer profits, builds consumer trust, and encourages rural digitization. In summary, AgroGo is more than just a transactional platform. It is a socio-technical innovation that helps transform agriculture into a sustainable, transparent, and fair ecosystem. The system empowers farmers to engage in the digital economy while enhancing food security and efficiency in the agricultural supply chain.

The COVID-19 pandemic accelerated the adoption of hybrid flexible (HyFlex) learning models in education, providing students with flexible learning options. While research highlights benefit for students, understanding teachers’ experiences is essential for successful implementation, particularly in physical education, a subject traditionally taught in-person. This phenomenological study explored the lived experiences of 33 Filipino physical education teachers implementing HyFlex across 15 schools in Cebu, Philippines. The objective was to examine their experiences navigating HyFlex in physical education classrooms. Data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step method. The findings revealed HyFlex’s potential to enhance accessibility and inclusivity, promote active learning and student agency, improve teacher-student interaction, and increase flexibility and efficiency. Teachers reported improved access for students with health or geographical constraints, increased student motivation through choice, and enhanced communication via online tools. HyFlex also facilitated seamless transitions during disruptions and optimized resource use. However, challenges included increased teacher workload, unequal access to technology, difficulties maintaining online student engagement, assessment complexities, and impacts on physical education’s social dynamics. Pedagogical considerations emphasize engaging students in both in-person and online environments, fostering flexibility and student choice, building community, providing effective feedback, and ensuring inclusivity. The study offers implications for professional development, addressing equity, fostering community, and ongoing evaluation. It contributes to the limited research on HyFlex in physical education, particularly in the Philippine context, and underscores the need for further exploration of its long-term effects and optimization strategies.

BackgroundAs medical education evolves, current teaching practices often remain misaligned with how today’s digitally native students prefer to learn. While the use of digital tools is widespread, there is limited clarity on students’ learning behaviors, particularly their preferences for self-paced, assessment-driven, and technology-supported strategies. This study explores these patterns using a mixed-methods approach to inform more responsive medical curricula.MethodsA mixed-methods, cross-sectional study was conducted among undergraduate medical students (n = 432) from three universities in the UAE and Jordan. A 23-item questionnaire, developed through literature review and expert validation, included both quantitative and qualitative components. Exploratory and confirmatory factor analyses (EFA and CFA) were used to establish construct validity. Free-text responses were analyzed using thematic analysis to complement and contextualize the quantitative findings.ResultsCFA supported a five-factor, 17-item structure with good model fit (χ² = 180.02, df = 102, χ²/df = 1.77, CFI = 0.97, RMSEA = 0.04, SRMR = 0.053). The identified dimensions were: self-paced learning, exam-oriented learning, partnership in learning, collaborative learning, and AI-enhanced learning. Thematic analysis of 218 qualitative responses revealed eight key themes: flexible learning options, enhanced formative assessment, active teaching, study skills development, collaborative learning, use of technology, clinically focused learning, and resource accessibility. These qualitative themes reinforced and expanded upon the quantitative constructs.ConclusionsMedical students in the AI era adopt a complex, multidimensional approach to learning that is personalized, flexible, and technology driven. The convergence of quantitative and qualitative data underscores the urgent need to align curricula with students’ preferences by promoting self-regulated, interactive, and AI-enhanced learning environments. These findings have critical implications for faculty development, curriculum reform, teaching, student assessment, and the future of learner-centered medical education.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08145-z.

Flexible working is a priority highlighted by the NHS Long Term Workforce Plan. However, flexible working options can be limited when it comes to wards that operate shift patterns designed to cover a 24-hour-period, with staff expected to work a variety of shifts, including night shifts, which can be detrimental to their health and well-being. The service evaluation detailed in this article trialled the use of electronic team rostering (ETR) across two hospital departments providing 24-hour care. The evaluation surveyed 130 nurses to compare their experience of the baseline rostering system (a mixed paper and electronic system) and ETR. The survey sought to measure nurses' rostering satisfaction, the fairness of each system and the effect on nurses' work-life balance and well-being. The findings indicated that while some nurses identified system issues with the ETR, there were overall improvements in job satisfaction and perceptions of fairness, work-life balance and well-being.

BackgroundDue to an aging population, the incidence of musculoskeletal disorders and serious pathologies like spinal fractures and cancer is rising. Physiotherapists are ideally positioned to screen for signs and symptoms of serious pathologies (red flags) early; however, training in recognizing these signs and symptoms is limited. Additionally, evidence on the effectiveness of digital educational tools for this purpose is sparse. This study aimed to assess the feasibility of a digital educational training designed to improve physiotherapists’ ability to identify serious pathologies.MethodsA randomised mixed-methods feasibility study ran from March to May 2024, involving Austrian physiotherapists recruited via email. After providing informed consent and demographic data, participants completed a structured digital educational training. This training comprised three asynchronous chapters, with Chap. 2 featuring modules in orthopaedics, oncology, and internal medicine. Various digital formats (video podcast, presentations, animations) of different durations were included to gauge user preferences. Feedback was gathered using the Feasibility of Intervention Measure (FIM) and a mixed-methods survey. Quantitative data were analysed descriptively using SPSS, and qualitative data inductively using MAXQDA.ResultsThirty-nine physiotherapists registered, and 30 completed the digital educational training. The median FIM score was 5, indicating high feasibility. Participants favoured digital materials lasting 6 to 15 min. Qualitative feedback highlighted the need for platform improvements (e.g., flexible module access) and enhancements to the digital educational training (e.g., detailed background information, more complex vignettes, varied formats). Participants appreciated the asynchronous learning possibility, progression tracking, and varied short digital formats but noted the limitations of online learning compared to in-person interactions.ConclusionsOur findings suggest that a digital educational training aimed at improving physiotherapists’ ability to detect serious pathologies is feasible. Participants emphasized the importance of adaptable platforms and a variation in digital materials to enhance the training. Limitations included the need for additional complex vignettes and limited participation in face-to-face discussions. Future research should explore flexible learning options, complex scenarios, and direct feedback mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08101-x.

Image-Based Meta- and Mega-Analysis (IBMMA): A Unified Framework for Large-Scale, Multi-Site, Neuroimaging Data Analysis.

Perovskite solar cells (PSCs) have emerged as a leading technology for indoor photovoltaics due to their high-power conversion efficiency, tunable bandgaps, and cost-effective fabrication. While significant efforts are made in optimizing perovskite absorbers and charge extraction layers, the role of back contacts (BCs), particularly non-metallic alternatives, remains largely underexplored in indoor PSCs. BCs critically influence charge collection, device stability, and overall performance under low-intensity indoor illumination, yet most studies have historically prioritized metallic electrodes, overlooking cost-effective, stable, and flexible non-metallic options. This review provides a comprehensive analysis of BC materials in indoor PSCs, with a particular focus on non-metallic electrodes, including carbon-based electrodes and transparent conductive electrodes. It begins with an overview of indoor PSCs, covering indoor light sources, perovskite materials and bandgaps, and fundamental roles of BCs, followed by recent developments in non-metallic BCs. Key challenges related to performance and energy output density, processability and scalability, mechanical flexibility and durability, as well as different types of BC materials, are discussed along with promising strategies for interface engineering, low-temperature processing, and material innovation. By highlighting this critical research gap, the review offers actionable insights into advancing efficient, stable, and scalable indoor PSCs for self-powered electronics and IoT applications.

Disclosure: H. Hodis: None. C. Dominguez-Bali: None. E.S. Johnson: None. H.A. Goraya: None. M.A. Syed: None. W.K. Massah: None. K. McCoy: None. M.A. Bencomo: None. E.S. Tsehaye: None. R. Polam: None. A. Dominguez-Bali: None.In our 2 medical centers, more than 50% of postmenopausal (PMP) women seeking care for their symptoms exceed the typical 10 year window protocol for the initiation of Hormonal Replacement Therapy (HRT) under current guidelines. To address this gap, we develop the protocol to treat a significant subset of these affected women with HRT beyond the 10 years window protocol. The purpose of this study is the evaluation of the utilization and safety of late HRT in symptomatic or asymptomatic PMP women using coronary calcium score (CCS). This retrospective analysis examines clinical outcomes for more than 100 patients (108) over the past 8 years. Women with a CCS of zero were eligible for full systemic HRT. With close follow up, considering individual comorbidities, preferences and responses, women with CCS above 50 were given local treatments, vaginal estradiol and testosterone without systemic HRT (vaginal estradiol and levonorgestrel transdermal patch) and patient outcomes were assessed using standardized questionnaires documenting symptom relief, hormone response, personal satisfaction and quality of life. Preliminary findings suggests that woman with a CCS of 0 experience symptom relief and therapeutic responses comparable to those initiating HRT within the recommended 10 year window protocol. Up to now, we have confirmed that CCS provides flexible treatment options. This study indicates that a significant number of late PMP women that go under the 10 year window protocol or are more than 60 years of age with a CCS of 0 can benefit from the delayed HRT achieving outcomes similar to early initiators of HRT. More studies need to be done that confirm that offering HRT in late menopause could be as secured and beneficial as those initiated in early menopause.Presentation: Monday, July 14, 2025

Stainless-steel preformed crowns (SSCs) are effective but esthetically unappealing, while zirconia preformed crowns require extensive tooth reduction. Bioflx preformed crowns combine esthetics and minimal preparation. To evaluate the clinical effectiveness of Bioflx preformed crowns in restoring primary molars in children aged 4-8 years at Ho Chi Minh City Odonto-Maxillofacial Hospital in Vietnam. A single-arm pilot observational study (October 2023-June 2024) at Ho Chi Minh City Odonto-Maxillofacial Hospital involved primary molars treated with Bioflx crowns. Variables included clinical features and treatment outcomes, using descriptive statistics and an unpaired t-test. Forty primary molars from 17 children were treated (mean 2.35 ± 1.62 crowns/child). Most were first molars (55%), lower right quadrant (30%), with caries (65%). At the 3-month follow-up, 90% were rated as "excellent" masticatory ability, with 100% of "excellent" esthetics and restoration integrity, while 95% of crowns had "excellent" marginal adaptation, along with 92.5% healthy surrounding gums. Short-term evaluation suggests Bioflx preformed crowns may be a promising new, flexible, and durable treatment option for primary molar restoration considering both esthetic and masticatory function. Yet, longer follow-up studies with control groups remain necessary for the long-term clinical evaluation to ensure a comprehensive approach for pediatric patients. The study received permission for implementation from the Board of Directors of Ho Chi Minh City Odonto-Maxillofacial Hospital and Can Tho University of Medicine and Pharmacy, which has also been confirmed in the document issued by the Ethics Council for Biomedical Research (23.341.HV/PCT-HĐĐĐ) signed on April 12, 2023.

IntroductionBuruli ulcer (BU) is a skin-related neglected tropical disease (skin NTD) considered to be a disease of the poor. This study explored BU wound management in a traditional therapeutic setting in the Atwima Mponua District of Ghana and described the social interactions observed.MethodEthnographic data about the practices of a herbalist renowned for his experience in treating BU wounds were obtained using direct observations, photography, and informal conversations.ResultsAt this therapeutic setting, we observed wounds cleaned and dressed using gloves, gauze, antiseptic solutions, non-sterile scissors, and a petrol and bark preparation supported with prayers. Most clients of the traditional healer indicated that they experienced their BU as a stubborn wound that needed powerful medicine to cure it, and believed the wounds might have supernatural origins. Key reasons clients provided for seeking care at the traditional therapeutic setting included trust in the traditional healer, his practices, respectful care, a friendly and non-stigmatising environment, low-cost and flexible payment options, and people’s opinions about the potency of traditional plant medicines.DiscussionOur findings suggest that the traditional healer enjoyed substantial public legitimacy from his clients due to his perceived interest in helping affected individuals achieve cures using culturally and financially appropriate ways to manage wounds. However, we also observed the use of non-sterile procedures and unregulated preparations, which may be potentially deleterious. The willingness of the traditional healer to collaborate with the formal healthcare system to meet the health needs of people with wounds could form the basis for future collaborative approaches between the two healthcare systems to address inequities regarding clients’ access to care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12939-025-02640-x.

The COVID-19 pandemic introduced profound and rapid disruptions to family life, particularly affecting parents through altered routines, economic instability, and reduced access to childcare and social support. This study investigates the cascading effects of these stressors on parent-child relationships and their influence on children's mental and physical well-being. Drawing on a U.S. based national sample, findings reveal that parental daily routine disruptions were significantly associated with adverse child outcomes. The quality of the parent-child relationship emerged as a central mediating factor, fully mediating mental health outcomes and partially mediating physical health impacts. While parental anxiety was a factor, its mediating impact was less pronounced. After peaking in 2020, modest improvements were observed by the end of 2022, yet residual stress and incomplete recovery highlight the enduring psychological impact of the pandemic. These results underscore the importance of strengthening parent-child relationships and alleviating parental burdens during public health crises. Effective policy responses should integrate mental health resources, flexible employment options, and parenting-focused programs that reinforce family stability and developmental outcomes.

This study was conducted at Madrasah Ibtidaiyah (MI) Blagung, Boyolali using a qualitative approach, involving the principal, teachers, and curriculum administration staff as research subjects. The aim of the study is to analyze the curriculum management and administration processes in supporting effective learning at the madrasah. Data were collected through interviews, observations, and documentation, and analyzed descriptively. The findings show that curriculum management is carried out through four main stages: planning, implementation, supervision, and evaluation. The planning stage involves designing learning programs based on students’ needs; the implementation stage focuses on the application of the curriculum in teaching and learning processes; the supervision stage ensures alignment between curriculum design and classroom practices; while the evaluation stage assesses the effectiveness of curriculum implementation and informs continuous improvement. Curriculum administration plays a strategic role in optimizing resource utilization, offering flexible learning options for students, and ensuring the efficiency and effectiveness of learning processes through systematic oversight. The study concludes that structured curriculum management, supported by sound administrative practices, is essential for achieving optimal educational outcomes in madrasahs.

ABSTRACT The local authority private-rented housing sector regulatory workforce, often part of wider environmental health and housing service teams in England and Wales, has faced multiple challenges in recent years due to declining numbers entering and remaining in the profession, a rise in the number and complexity of the private-rented housing sector itself and austerity measures. Combined, this has led to a depleted workforce needing authentic, tailored, and appropriate training options. There has been very little research in this area. Therefore, an online Qualtrics survey focusing on the local authority private-rented housing regulatory workforce and training needs was developed and shared. Eighty-three completed responses were analyzed. Interrelated challenges were raised around workforce challenges. Results demonstrated challenges in recruitment and retention largely due to a shift in the profession from long term, accredited professional degrees with practice experience, leading to fewer Environmental Health Officers and Practitioners, to a range of “other staff” working in this space with some solutions suggested. Local authorities need to take these complex and interrelated issues forward with strategic plans around training, recruiting and retaining the workforce. Equally, education institutions need to work with the sector to design and deliver relevant flexible, accessible, and affordable training options.

When a pet owner cannot afford care, is it the responsibility of the veterinary practice to offer flexible payment options? Many practices hesitate to do so based on past negative experiences with in-house, staff-managed plans; however, partnerships with third-party-managed pay-over-time plans, digital wallet payments, and crowdfunding platforms can alleviate distress for clients and veterinary teams while increasing acceptance of recommended diagnostics and treatment plans.

Various oral methylphenidate formulations are available to treat attention-deficit/hyperactivity disorder, but unmet needs still exist, particularly for individuals with swallowing difficulties or those requiring more flexible dosing options. Two phase 1 studies evaluated the comparative bioavailability and safety/tolerability of two prolonged-release (PR) methylphenidate formulations, an oral suspension and a chewable tablet, compared with an established immediate-release (IR) oral tablet formulation. Healthy volunteers were randomised to receive a single dose of methylphenidate PR oral suspension (total dose 60 mg; study 1) or chewable tablet (total dose 40 mg; study 2) and methylphenidate IR tablets (total dose 60 mg in study 1 and 40 mg in study 2) in a crossover manner, with a 7-day washout between treatment periods. Blood samples were collected over the 24-h post-administration period. Comparative bioavailability was defined as the 90% confidence interval (CI) of the relative mean plasma D-methylphenidate area under the plasma concentration-time curve from zero to last measurable concentration (AUClast) of methylphenidate PR formulation to methylphenidate IR being between 80 and 125%. Adverse events (AEs) were documented. In total, 24 individuals (mean age 39-42 years, approximately 50% male) were randomised in each study, of whom 23 received methylphenidate PR oral suspension in study 1 and 23 received methylphenidate PR chewable tablets in study 2; 24 received methylphenidate IR tablets in each study. The relative mean plasma D-methylphenidate AUClast ratios for methylphenidate PR formulation to methylphenidate IR tablets had 90% CIs of 82.30-87.18% in study 1 and 90.01-97.52% in study 2. Treatment-emergent AEs were reported in 26% and 22% of participants receiving the oral suspension and chewable tablets, respectively (versus 50% and 33% of those receiving the IR tablets in the respective studies). These AEs were typical of orally administered methylphenidate, mild in severity and, in general, resolved prior to study end. The methylphenidate PR oral suspension and chewable tablet formulations are bioequivalent in terms of the total extent of exposure (AUClast) to methylphenidate IR tablets and are tolerable in healthy adults.

Rural communities face persistent transport disadvantages due to low population density, limited-service availability, and high operational costs, restricting access to essential services and exacerbating social inequality. Autonomous public transport systems offer a transformative solution by enabling flexible, cost-effective, and inclusive mobility options. This study investigates the operational determinants for autonomous road-based transit systems in rural and peri-urban South-East Queensland (SEQ), employing a structured survey of 273 residents and analytical approaches, including General Additive Model (GAM) and Extreme Gradient Boosting (XGBoost). The findings indicate that small shuttles suit flexible, non-routine trips, with leisure travelers showing the highest importance (Gain = 0.473) and university precincts demonstrating substantial influence (Gain = 0.253), both confirmed as significant predictors by GAM (EDF = 0.964 and EDF = 0.909, respectively). Minibus shuttles enhance first-mile and last-mile connectivity, driven primarily by leisure travelers (Gain = 0.275) and tourists (Gain = 0.199), with shopping trips identified as a significant non-linear predictor by GAM (EDF = 1.819). Standard-sized buses are optimal for high-capacity transport, particularly for school children (Gain = 0.427) and school trips (Gain = 0.148), with GAM confirming their significance (EDF = 1.963 and EDF = 0.834, respectively), demonstrating strong predictive accuracy. Hybrid models integrating autonomous and conventional buses are preferred over complete replacement, with autonomous taxis raising equity concerns for low-income individuals (Gain = 0.047, indicating limited positive influence). Integration with Mobility-as-a-Service platforms demonstrates strong, particularly for special events (Gain = 0.290) and leisure travelers (Gain = 0.252). These insights guide policymakers in designing autonomous road-based transit systems to improve rural connectivity and quality of life.