High Turnover Research Articles

Mental health interventions in low- and middle-income countries (LMICs) face significant sustainability challenges, often leading to 'programme drift' (protocol deviation ) and 'voltage drop' (reduced effectiveness). While implementation science frameworks emphasise fidelity, they often fail to explain how frontline providers in resource-constrained settings maintain services. Here, we investigate how adaptive mechanisms function as legitimate sustainability strategies within Lagos, Nigeria's Mental Health in Primary Care programme, which contends with chronic underfunding, high staff turnover, and community stigma. We conducted a convergent mixed-methods study in six Lagos local government areas. Data were collected from 130 stakeholders (policymakers, managers, health workers, care recipients) through quantitative surveys and from a nested subsample of 70 participants through in-depth interviews and institutional ethnography. We analysed quantitative data using multiple regression and qualitative data using thematic analysis, systematically integrating the findings through triangulation to produce meta-inferences about sustainability dynamics. Systemic constraints, particularly underfunding (<2% of health budget) and high staff turnover (30% annually), drove programme drift and community stigma, deterring 40% of patients and contributing to voltage drop. However, this drift often manifested through constructive adaptive mechanisms, including informal peer mentoring networks and role flexibility, which maintained service continuity. Multiple regression (R2 = 0.45) identified leadership (β = 0.42), infrastructure (β = -0.35), and stigma (β = -0.30) as significant predictors of sustainability. Mixed-methods integration revealed these adaptations were the primary mechanism through which effective leadership operated - a dynamic invisible to quantitative measures alone. Adaptive mechanisms represent legitimate and necessary sustainability strategies in resource-constrained settings, not implementation failures. We propose 'functional fidelity' (maintaining core outcomes through flexible processes) and 'adaptive capacity' as crucial theoretical extensions for implementation science in LMICs. Sustainable mental health integration requires frameworks that recognise and support frontline innovation while ensuring quality safeguards are maintained, offering a more realistic pathway to closing the global mental health treatment gap.

Abstract Introduction The 2021 ‘National Overprescribing Review’ outlined the detrimental impact of polypharmacy and overprescribing at patient, system and environmental levels [1]. The National Director for Prescribing has outlined several strategies to address this problem, which includes structured medication reviews (SMRs) [2]. Our Health Board has many prescribing challenges, including overspend in the primary care medicines budget and poor performance on several high-risk national prescribing indicators e.g. opioids, gabapentinoids. While excellent primary care teams tackle this, it’s an overwhelming problem at scale. The skills of advanced secondary care pharmacists could be utilised for medication reviews to help with this dilemma, but high turnover and pressure in a hospital setting doesn’t provide consistent opportunity. The collaborative ‘Repeat Prescribing Toolkit’ also recommends improvements within prescribing systems [3]. However, for hospital teams that have not undergone newer multisector training, understanding of these system challenges will vary. Could supported primary care medication review/deprescribing clinics with secondary care pharmacists help address these issues? Scepticism around this idea was widespread, so a small proof of concept pilot was conducted. Aim Evaluate the impact of sessional medication review clinics delivered by advanced secondary care pharmacists within the general practice setting. Methodology Activity, adverse-event and cost-saving data between 4th November 2024 and 31st March 2025 was collected prospectively by the pharmacists using FDB CoordinateRx® prescribing software. Outcome data summaries were obtained on 26th May 2025. Intervention data was also analysed using Microsoft Excel 360®. Ethical approval was not required for this service evaluation. Results 46 sessions were completed by 3 different pharmacists. For this pilot, a session equated to 3 hours. A total of 117 reviews were carried out, with 167 medication interventions recorded. 33% (n = 34) of patients reviewed were in the age category of 75 to 84 years old, and 21% (n = 22) aged 85 to 94. 12-month drug savings were estimated to be £10,295. 52% of these medicines savings related to reviews of central nervous system drugs e.g. melatonin, opioids. Of the interventions documented on FDB coordinateRx®, 18% (n = 30) also generated adverse event data, with 12 month adverse-event cost savings estimated to be £6867. Interventions included stopping hypnotics, proton pump inhibitors, and reducing anticholinergic burden. The secondary care pharmacists, general practice host-site staff and tutor feedback acknowledges the wider benefits, such as an appreciation of interface and primary care prescribing challenges, improved communication and the opportunity to manage complex prescribing over longer-time periods. The pharmacists also recognise these clinics provide useful evidence for advanced practice portfolios. Discussion This evaluation has resulted in the project continuing, with extra sessions being arranged. While estimated cost-avoidance savings were not as high as those achieved by primary care medicines optimisation teams, they were still double the cost of the pharmacist time invested. Crucially, wider benefits around improved understanding of system challenges, cross-sector working and multidisciplinary networks are enough to continue. Also, majority of reviews were carried out in the older, most vulnerable age groups. Lack of patient experience data and small numbers are recognised limitations.

In low- and middle-income countries, maternal, newborn, and child health face significant challenges due to infrastructure limitations, access disparities, and service delivery inefficiencies. The Sehatmandi mobile health (mHealth) app was deployed in 2018 to address these issues across 189 health facilities in Afghanistan's Bamyan and Badakhshan provinces. This app aims to enhance service provision through real-time data monitoring, improved accountability, and performance-based health system strengthening. This study aims to explore the enablers, challenges, and lessons learned for the sustainability of the Sehatmandi mHealth intervention from the perspective of key stakeholders to inform the future scaling of digital health tools in fragile and resource-constrained settings. A qualitative study was conducted between June and July 2024 involving 24 in-depth interviews with stakeholders, including health facility managers, administrators, and high-level decision-makers. Participants were selected using stratified purposive sampling to ensure diverse facility representation. Interviews were conducted in person or virtually by using a semistructured guide, recorded, transcribed and translated into English. Thematic content analysis was performed using NVivo version 11 software. Ethics approval was obtained, and informed consent was secured from all the participants. Stakeholders reported that Sehatmandi improved health system responsiveness by enhancing performance monitoring, accountability, timely reporting, and data-driven decision-making. Offline data entry was identified as a critical feature, enabling data collection in remote areas without internet access and ensuring synchronization when connectivity was resumed. However, several barriers affected the long-term sustainability: poor internet connectivity, electricity shortages,inadequate technical support, and high staff turnover, which disrupted functionality and data quality. Training gaps and insufficient supervision further hampered consistent and effective use. Participants emphasized the need for structured capacity building, regular follow-up, and sustainable funding to maintain the intervention. Integration with national health information systems and alignment with broader digital health strategies were also seen as prerequisites for scaling and institutionalization. The Sehatmandi mHealth intervention demonstrated enhanced performance monitoring and accountability across health care facilities in Afghanistan's conflict-affected settings. However, for digital health interventions to be sustainable and scalable in low- and middle-income countries, foundational investments in digital infrastructure, continuous training and monitoring, system-level integration, and long-term funding are essential. These findings provide actionable insights for governments, implementers, and donors aiming to strengthen health systems through digital innovation in fragile settings.

Long lasting complement neutralisation by RAY121, an engineered anti-C1s antibody with C1q displacement function.

Abstract The prevalence of both osteoporosis and sarcopenia increases with age, and 60% of elderly sarcopenia patients also develop osteoporosis. However, the co-occurrence of osteoporosis and sarcopenia remains unclear. We performed single-cell 5’RNA-seq on human skeletal muscle tissues and investigated the enrichment of heritability for musculoskeletal traits in cell type specific cis-regulatory regions. We found the fibroblast-specific cis-regulatory regions are highly enriched in the heritability of bone mineral density (BMD). Using GWAS, we identified estrogen receptor α (ESR1) as a common transcription factor that correlated with both BMD and lean mass. We hypothesized that deficiency of estrogen signaling in fibroblast may attenuate musculoskeletal homeostasis. Therefore, we generated mice lacking Esr1 in PDGFRα (a fibroblast marker) + cells (Esr1ΔPα). Although muscle mass and grip strength were not different between groups, distal femoral BMD and cortical thickness were significantly lower in Esr1ΔPα compared to control. Bone histomorphometry showed that cortical bone in Esr1ΔPα exhibited a high turnover bone phenotype. Bulk RNA-seq using PDGFRα+ cells revealed that Igfbp5 expression was significantly higher in Esr1ΔPα compared to control. Furthermore, serum IGFBP5 level was significantly higher in Esr1ΔPα. IGFBP5 treatment in vitro significantly suppressed osteoblast differentiation and facilitated osteoclast differentiation. These results suggest that estrogen signaling in PDGFRα+ cells suppresses Igfbp5 expression, then maintains bone mass, indicating that estrogen signaling in PDGFRα+ cells plays a significant role in bone metabolism.

Each company has different implementation of motivation and compensation according to the company's capabilities, one of which is implemented by Bank Syariah Indonesia KC. Kotamobagu. Motivation and compensation should be given to employees so that they have the spirit to work and welfare so that the company's goals and objectives are achieved. In the past year, employee performance has decreased resulting in a high employee turnover rate. This type of research is field research, while the research method and approach use qualitative methods with a descriptive approach. This study uses data collection techniques through observation, interviews and documentation. This study found several things. First, the application of motivation to employee performance, including direct motivation: providing direct encouragement, namely greeting, shaking hands, giving praise, giving a smile when meeting and parting, holding routine events to read the Qur'an to strengthen the mentality of employees, holding outbound activities, providing career paths, and holding training. While indirect motivation: upholding a sense of family, and providing office facilities. Second, the application of compensation to employee performance, including providing basic salary, office facilities, awards (rewards), and allowances. While the provision of bonuses is not appropriate. Third, the implications of implementing motivation and compensation for employees, namely employees feel happy, increasingly satisfied with their work, have a positive attitude. However, employee loyalty begins to decline because their performance also declines because their achievements are not properly appreciated, they should get 20% of the results of their achievements but only get 15%, so that the level of employee welfare is less guaranteed, employee discipline increases. Therefore, the implementation of motivation is appropriate but the provision of compensation such as bonuses is less appropriate. From these findings, this study concludes that the implementation of motivation is in accordance with the theory and needs of employees, but the compensation received by employees does not match the achievements that employees have achieved while meeting the targets seen from the evidence of the 2022 management system recap preview in the moderation management system criteria column shows that there are some that need to be fixed. Therefore, the implementation of compensation is not in accordance with the expectations and desires of employees, so that it affects employee performance to be unproductive in the past year, thereby increasing the employee turnover rate.

Microevolution and macroevolution describe evolutionary change at different scales: short-term genetic and phenotypic variation within populations, and long-term patterns of diversification and extinction. Despite their interconnected nature, they have often been studied separately, and the reciprocal causal links between them remain poorly understood due to their operation on different timescales and the complexity of the processes involved, making mechanistic approaches particularly challenging. To bridge this operational gap, we introduce a novel bottom-up, process-based computational framework that integrates genotype-to-phenotype mapping, fitness evaluation under environmental constraints, and biotic interactions shaping ecological niches and adaptive pressures, while incorporating lower-level mechanisms such as mutation, gene flow, and gene-pool expansion through stochastic duplication of genes. Its modular design accommodates diverse microevolutionary mechanisms to study the emergence of large-scale eco-evolutionary patterns from explicit individual-level processes. The framework allows addressing research questions ranging from the formation of spatiotemporal biodiversity patterns to the role of eco-evolutionary feedbacks in macroevolution. It provides an open-ended platform that serves both as a theoretical tool for testing evolutionary hypotheses and as a flexible environment for exploratory simulations. To illustrate its heuristic potential, we present proof-of-concept simulations under biologically plausible conditions that reproduce multiple well-documented macroevolutionary patterns-such as biphasic diversification, saturating and exponential-like biodiversity trends, speciation-extinction correlations, species duration distributions, and niche structuring-as emergent phenomena. Beyond reproducing patterns, the simulations reveal underlying mechanisms, including trial-and-error dynamics in long-term adaptation, high species turnover maintaining biodiversity equilibrium, and self-organized niche occupancy. These findings establish the framework as a versatile tool for investigating the complex interplay of ecological and evolutionary forces shaping biodiversity. By capturing emergent dynamics from mechanistic microevolutionary processes without imposing predefined constraints, the model provides a unique perspective on long-term evolutionary change, contributing to a broader theoretical toolkit for studying macroevolutionary patterns under controlled conditions. Future extensions could assess how variations in environmental dynamics, genomic architecture, or species interactions influence evolutionary trajectories, refining our understanding of biodiversity evolution.

Orientation: The high turnover rate of essential core skills in South African state-owned enterprises (SOEs) is a significant issue, raising serious concerns about employee retention. Failure to retain talented employees threatens the performance and survival of SOEs. Research purpose: The main purpose of the study was to develop and validate an employee retention model that could be applied by South African SOEs. Motivation for the study: Employee retention in South African SOEs is under-researched, and there is no empirical evidence supporting the effectiveness of their current retention models. This necessitates a new, validated employee retention model for these SOEs. Research approach/design and method: The study used a quantitative, cross-sectional survey design, and data were collected from a sample of 685 SOE employees using a self-report questionnaire. After a new theoretical model of employee retention for South African SOEs was developed, it was validated by subjecting the data to structural equation modelling (SEM). Main findings: The SEM process revealed three key factors that significantly impact employee retention in South African SOEs. These factors, which are essential for retaining employees in SOEs, include organisational culture (OC), compensation and benefits (CB) and training and development (TD). Practical/managerial implications: The findings of the study provides the management of South African SOEs with valuable insights into the critical factors that should be considered in retaining talented and valuable employees. Contribution/value-add: The study provides a validated model of employee retention for SOEs in South Africa. No such validated model existed previously.

A plethora of biologically active compounds contain an imidazolones system as a central skeleton. Therefore, developing efficient methods for constructing such a skeleton holds significant research value. Here we show an efficient green procedure for synthesizing imidazolones via dehydrogenative condensation of urea with 1,2-diols. The reaction proceeded efficiently under mild conditions in the presence of a PhPNP-Mn catalyst and a weak base (Na2CO3). The applicability of the proposed catalytic reaction was highlighted by synthesizing more than 30 imidazolone derivatives, bearing different functional groups, in good to excellent isolated yields. Our study reports on the dehydrogenative condensation of ureas with 1,2-diols to synthesize imidazolones using a homogeneous non-noble metal catalyst. The proposed catalytic reaction proceeded even at a low catalyst loading of 0.05 mol%, with a high turnover number of 1660, resulting in yields up to 99%.

This study evaluated the influence of substrate diversity on the distribution of cave floor invertebrates within the largest limestone cave in the Amazon, using substrate variation as a proxy for microhabitat heterogeneity. Sampling was conducted at two spatial scales: larger sectors (10x3 m) and smaller quadrats (1x1 m) to assess faunal responses across different scales. We tested the hypothesis that floor substrate variation, measured as total substrate diversity, shelter and organic debris diversity, microclimatic conditions (temperature and humidity), and distance from the cave entrance, affects cave invertebrates’ composition, richness, and taxonomic distinctness. A total of 101 species were recorded, with 101 species observed in the sectors and 67 in the quadrats. The richest taxonomic groups included Araneae (11 species), Diplopoda (11), Acari (9), Coleoptera (8), Diptera (8), Hymenoptera (8), and Isopoda (7). Ten species were classified as troglobites. Faunal similarity was low (less than 20%), indicating a high turnover across the cave’s microhabitats. Substrate diversity and distance from the entrance were the main factors driving faunal dissimilarity. The number of non-troglobitic species decreased with increasing distance from the cave entrance, reflecting the reduced availability of organic debris and shelters in deeper zones. Non-troglobitic taxonomic distinctness was positively associated with substrate diversity within quadrats. In contrast, variations in troglobitic species composition were primarily determined by distance from the entrance. Entrance zones, characterized by greater habitat heterogeneity and higher organic matter input, supported a larger number of species. Non-troglobite taxonomic distinctness responded positively to substrate diversity within the quadrats. Distance from the entrance determines variations in the troglobite species composition. Areas near the entrance had a greater variety of habitats and a higher supply of organic matter, which enables them to support a greater number of species. This study underscores the importance of conserving and managing cave ecosystems with particular attention to substrate and microhabitat diversity at multiple spatial scales. Understanding these ecological dynamics is critical for identifying biodiversity patterns and developing effective conservation strategies.

Employees are the fundamental source of a sustainable competitive advantage. Without the high quality of human capital, organisations cannot attain a competitive advantage that can be sustained over time. Employer branding is a strategy that focuses on engaging and attracting the best talent from the job market, which is crucial for sectors known for high employee turnover rates. In recent years, digital platforms and information technology systems have revolutionised employer branding by helping organisations connect with talent in more personal and innovative ways. In this study, we sought to explore and understand the role of LinkedIn in employer branding efforts and evaluate the benefits of using LinkedIn to brand an employer as the first choice for prospective employees. Additionally, the research proposes a LinkedIn-Integrated Employer Branding Model (LIEBM) that incorporates LinkedIn strategies. Qualitative data were collated from the recruiting heads of the leading four- and five-star hotels in Al Ain, United Arab Emirates. The findings indicate that LinkedIn is widely used to improve an organisation’s employer brand image through various strategies. The results also demonstrate that employing LinkedIn strategies enhances the benefits of employer branding, contributing to actionable insights in the hotel industry to make excellent decisions at pre-recruitment, recruitment and selection stages.

In the media environment where mobile internet has deeply penetrated and fragmented content consumption by the audience has become the mainstream, short dramas have achieved explosive growth thanks to their characteristic of "micro-sized content" (single episode duration ranging from 1 to 10 minutes, highly condensed narrative, and production cycle compressed to within several months). In 2024, the total online viewership exceeded 10 billion times. Their "short, simple, and fast" content production logic and multi-channel dissemination form are in stark contrast to the traditional film and long drama-based media and entertainment industry. For a long time, traditional film and television capital operations have followed a slow-paced model of "large-scale capital investment, long production and polishing period, and single copyright/box office channel recovery". This model not only has limitations such as high capital threshold and low turnover efficiency, but also faces the industry pain point of weak risk resistance. Meanwhile, the rapid development of short dramas not only strongly impacts this traditional model but also forces traditional film and television capital to actively adapt - by adjusting the investment layout of "light and heavy assets combination", optimizing the fast-paced content production process, innovating the profit mechanism of platform sharing and e-commerce linkage, and introducing data-driven precise decision-making methods to adapt to the new trend. This transformation not only injects new vitality into traditional film and television capital but also promotes the capital logic of the film and television industry to shift from "scale priority" to "efficiency priority", opening up efficient and diverse high-quality development paths for the industry in the media transformation.

This study aims to analyze the factors that cause high employee turnover rates and their impact on improving human resource (HR) performance in the culinary industry. The research methods used include field observation, documentation analysis, and in-depth interviews with owners and employees of several culinary businesses. The results indicate that high turnover is caused by the absence of standard operating procedures (SOPs), a lack of training and competency development programs, and low work motivation due to a lack of recognition and welfare. High employee turnover has various negative impacts, including reduced team stability, increased recruitment and training costs, decreased customer service quality, and weakened productivity and operational effectiveness. Furthermore, the repeated adaptation process that new employees must undergo hinders the achievement of long-term performance targets. Therefore, a more comprehensive HR management strategy is needed, including the implementation of clear SOPs, improved employee welfare and motivation, and the implementation of ongoing training and retention programs to support the growth and competitiveness of culinary businesses amidst the dynamics of a competitive industry.

Orientation: The hospitality industry is known for its high employee turnover rates, which pose challenges to organisational stability and service quality. Human resource management practices play a crucial role in shaping employees’ job satisfaction, engagement and retention. Research purpose: Using empirical data from formally employed hospitality employees, this study examined how selected human resource management practices, notably training and development, teamwork, work-life balance and compensation, impact turnover intentions with psychological capital as a mediating variable. Motivation for the study: As a result of the labour-intensive and customer-oriented focus of the hospitality industry, high employee turnover rates are a continuous concern. Research approach/design and method: A structured questionnaire was administered using QuestionPro. Participants were identified using snowball sampling. One hundred and fifty respondents who are formally employed in the hospitality industry completed the questionnaire. Main findings: The findings of this study suggest that human resource management practices significantly enhance psychological capital, leading to lower turnover intentions. Organisations that invest in employee well-being and development should foster resilience, hope, optimism and self-efficacy, reducing the likelihood of voluntary turnover. Practical/managerial implications: The value of sound human resource management practices for hospitality establishments is a main implication, and management needs to develop strategies to retain talent in an increasingly competitive labour market. Contribution/value-add: The findings support the importance of strengthening compensation and benefit structures, fostering work-life balance, and leveraging teamwork as a retention strategy for hospitality establishments.

Introduction: While advancements in neurodiversity initiatives in the workplace are notable, a persistent gap remains in effectively addressing the high unemployment and turnover rates among individuals with autism. Objective: This literature review focuses on the main challenges faced by autistic employees in the workplace and solutions either proposed or enacted. Methods: Multiple databases were searched within the date range of January 1st, 2010 and May 1st, 2025 using the keywords listed. This initial search yielded 886 publications. Following a screening process, 187 publications met the inclusion criteria for further analysis. Results: Communication issues were the most common barrier to workplace success cited by the autistic employee, coworkers, and management. Educating coworkers and management about autism was associated with reducing this barrier and others associated with it. A strong support circle consisting of HRM, job coaches, and a direct manager with autistic employee experience were able to decrease turnover and increase morale. The direct manager is especially important in ensuring a harmonious workplace and preventing burnout in the autistic employee. The work environment, consisting of both workflow and physical factors, could also be improved to ensure success. Bullying was best handled with a zero-tolerance policy which many organizations already have but nothing specific to autistic or neurodivergent employees who are more prone to such behavior. Masking was the most common technique autistic employees used to fit in but was found to be both exhausting and a contributor to burnout if used at high levels. Disclosure of autistic status, especially in hopes of obtaining accommodations, was found to have mixed results. Conclusion: An organization that prepares a work environment for an autistic employee before their employment has a far better chance of success. This included education of the staff, ensuring the direct manager has additional education and skills regarding autism, and altering the workflow and physical environment of the workplace to better suit the autistic employee. Evaluating current leadership and their devotion to diversity and inclusion deserves evaluation, as those in charge ultimately determine the success or failure of these policies.

BackgroundAs the global population ages, the demand for palliative care is expected to increase. However, studies show that older patients often receive inadequate palliative care, partly due to healthcare professionals lacking sufficient training and tools to identify and address palliative care needs effectively. This study aims to explore healthcare professionals’ experiences regarding facilitators and barriers to integrating a palliative care approach in a geriatric setting by implementing the Swedish Palliative Care Guide.MethodsThis qualitative study employed a design consisting of four small-group interviews (with three participants each) and one individual interview, involving a total of 13 healthcare professionals working in a geriatric setting. The aim was to explore their experiences with integrating the Swedish Palliative Care Guide. Data were analyzed using the rapid identification of themes method and inductive content analysis.ResultsThe analysis revealed four interrelated themes—organizational prerequisites, knowledge of palliative care, teamwork, and communication—that acted as both facilitators and barriers to integrating the Swedish Palliative Care Guide in a geriatric setting. While structured tools and shared goals supported implementation, challenges such as unclear responsibilities, knowledge gaps, and discomfort discussing end-of-life issues hindered consistent application. Participants emphasized that continuity in care and a shared understanding among team members enhanced the use of the guide. In contrast, short-term admissions and a lack of systemic integration of the Swedish Palliative Care Guide into routine practice pose significant challenges to its long-term sustainability.ConclusionsSuccessful implementation of the Swedish Palliative Care Guide in geriatric settings requires clear professional responsibilities, integration into existing digital documentation systems, and targeted training to support staff in initiating end-of-life conversations. Tailoring implementation strategies for local conditions, such as short-term admissions and high staff turnover, can enhance sustainability. These findings provide practical guidance for improving the integration of palliative care approaches into everyday geriatric practice.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06516-1.

Introduction: Our busy children’s emergency department sees a high turnover of Resident Doctors from a range of training pathways, many of whom have had limited exposure to paediatrics in their careers to date. In addition, there has been a growing nursing team over recent years and the department hosts a number of student nurses from local universities. Simulation has an ever-growing presence in many aspects of medical education, providing a safe environment for learners to build confidence and competence, particularly in high-stakes emergency scenarios [1]. Short, low fidelity simulation sessions were already regularly used in our department and we therefore elected to build on this premise to create a bespoke simulation-based study day aimed at junior colleagues to further enhance clinical practice. Methods: With support from our simulation and education nurses, we created a simulation study day aimed primarily at junior medical and nursing staff. We aimed to cover a range of paediatric emergencies with medical and trauma presentations across a range of ages. Scenarios were either written specifically for the course or adapted from other locally used resources. The sessions were delivered in the hospital’s dedicated simulation suite using high fidelity child and infant simulators (Gaumard: Paediatric HAL and Super TORY). The scenarios can also be easily adapted to use lower fidelity mannequins in other centres. We ran the study day twice per six-month medical rotation from March 2024–March 2025 in order to maximise attendance opportunities. The course was adapted in response to feedback after each iteration. Results: We have had approximately 25 candidates attend the course thus far with questionnaires completed by 22 learners. The responses reflect the mix of attendees: 8 were from doctors working at ‘Senior House Officer’ level; 8 nurses (Band 5 and above); 3 healthcare assistants/associate practitioners (Band 4 and below); and 3 student nurses. Feedback was overwhelmingly positive: 20/22 (90.9%) reported their confidence improved following the course. Qualitative feedback identified key themes including a supportive learning environment, effective debriefs and a good range of scenarios covered. Discussion: We have been pleased with the reception of our new course and have taken steps to ensure the project’s longevity by ensuring permanent senior staff members in the department are involved in its ongoing organisation and delivery. We also plan to make our resources available as a free package for use in other emergency departments in the region or further afield. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Background: The burden of documentation has led to the adoption of Medical Scribes to ease Clinician workloads. However, Scribe duties have evolved beyond note taking; Pre-charting, care-coordination, and other administrative tasks are increasingly completed by Scribes. Moreover, training is time-intensive, and high turnover limits Scribe efficiency and efficacy. The development of Agentic AI, individual AI units capable of processing data and communicating with each other autonomously, presents opportunities to optimize workflows while reducing costs and maintaining proficiency. Methods: Our AI ScribeBot was developed from a modular system of AI agents, each designed with a complex prompt to perform a task, such as extracting clinical information or interpreting visit transcriptions, with outputs passed to subsequent agents in the chain. All data is run through a secure instance of google cloud with a BAA connected to a private instance of Open AI. We compared an Experienced Scribe, a New Scribe, and our AI ScribeBot during 12 outpatient cardiology visits. Scribes, contracted at $27/hr, were timed while Pre-charting and writing notes. Visits were transcribed from ambient audio recording. AI performance was then measured in cost per execution and completion time. A Scribe spent 1 hour reviewing the AI notes and made any necessary corrections. Results: AI documentation demonstrated similar speed and lower cost compared to Scribes. The average time spent per patient was 00:12:34 for the AI, compared to 00:14:30 for a well-trained scribe and 00:24:00 for a newly trained scribe. Additionally, while the Experienced Scribe cost $78.30 per 12-patient day and New Scribe cost $129.60, the AI processing cost was $3.87. Even with the reviewer's hourly rate, the total cost was $30.87. Discussion: Our findings demonstrate that Agentic AI offers a scalable, cost-effective alternative to traditional Scribes. Even with limited human oversight, AI generated notes were completed at lower cost, a 60–76% reduction compared to Human Scribes. Given AI operates concurrently, total completion time was not an accurate measurement of AI performance. However, this asynchronous processing had the added benefit of reducing delays associated with sequential note-writing allowing for improved clinic flexibility and speed. While larger-scale studies are needed to evaluate long-term accuracy and impact, our pilot demonstrates that Agentic AI can reduce documentation costs and enhance efficiency.

The textile and apparel sector is a cornerstone of India’s industrial growth, employing millions and contributing significantly to exports and GDP. However, it is also resource-intensive and polluting, largely due to linear “take-make-dispose” supply chains. As environmental concerns grow, circular supply chains (CSC) have emerged to reduce waste, optimise resources, and close material loops especially crucial in textiles, given high material turnover, waste, and chemical use. Despite global momentum, research on how Indian SMEs engage with CSCs remains limited. This study explores barriers to CSC implementation in Indian textile SMEs using an exploratory qualitative approach. Semi-structured interviews with supply chain and operations managers across 23 SMEs revealed multiple interrelated barriers: low awareness of circular principles, limited access to green technologies and financing, inadequate infrastructure, weak regulatory enforcement, and internal resistance due to perceived risks and uncertain returns. Findings highlight the need for integrated support through policy innovation, ecosystem partnerships, and capacity-building initiatives tailored to SMEs. This study contributes empirical evidence on CSC adoption in Indian SMEs and provides a foundation for policy and comparative research across manufacturing sectors.

The United States (US) federal Title X program provides funding for affordable and accessible family planning and sexual health services through competitive grant funding across US jurisdictions. In 2022, non-profit clinic network Converge: Partners in Access became the sole Title X grantee in the state of Mississippi. Converge developed a strategic evaluation plan to ensure efficient utilization and high-quality provision of care by eligible state residents. The study purpose is to determine the implementation climate of the Title X clinic network, including service utilization, quality improvement opportunities and challenges, and potential patients' awareness of and experience with receiving Title X-funded services. The study utilized in-depth, semi-structured phone and in-person interviews conducted between January 2023 and May 2023 with clinic staff, administrators, providers, and potential patients to assess implementation climate, challenges in healthcare provision, and opportunities to improve Title X utilization by eligible state residents. Researchers conducted 22 interviews with clinic staff and health care providers and 16 with potential patients. Clinic-based participants indicated the use of evidence-based practices in their respective settings-a key component of the Title X program. However, challenges to implementation were identified including understaffing, high staff turnover, difficulties with reporting and documentation, competing priorities for patients, and differences in capacity based on clinic characteristics. Potential patients identified the need for person-centered approaches to care and increased awareness and availability of Title X services in their communities. Results from this study can inform strategies to improve service utilization by potential patients and the quality of care for Title X funded networked clinics in Mississippi. Improving the delivery of care and service utilization can ultimately better meet the reproductive and sexual health needs of patients served through the Title X funded system.