Interrelated Influences Research Articles

Decline of student engagement in online studies

This research in progress examines student engagement in online synchronous learning sessions, focusing on trends from extended lockdowns during the COVID-19 pandemic to the present day within a higher education pathways subject. While our longitudinal data provides insights into declining student engagement trends, the reliance on chat messages within online synchronous sessions as the primary measure of engagement may only partially capture the multifaceted nature of student engagement. By re-examining the student engagement model by Kahu, we identified a possible direct link with student structural factors as influences on student engagement. As a result, we propose a model representation that further emphasises the interrelated influences of multiple dimensions of student engagement. The next phase of this study is to develop a broader range of engagement metrics, including direct feedback from students, which is expected to provide a better understanding of student engagement trends.

Using the Complex Network Model to Associate Nutritional, Psychological, and Physical Parameters and Aspects of Sleep with Depression Symptoms.

Background/Objectives: Major depressive disorder is a significant public health concern linked to factors such as a low-quality diet, a sedentary lifestyle, and poor sleep quality, all of which contribute to its development; nevertheless, the existing literature lacks a comprehensive framework to effectively integrate these interrelated influences. Methods: To address this gap, we conducted a questionnaire-based study involving 411 individuals aged 18 to 74 and employed a weighted complex network model to clarify the associations among nutritional factors, physical activity levels, psychological parameters, and sleep profiles and depression. In addition to constructing networks that encompass distinct subgroups based on general context, sex differences (female vs. male), and four age categories, our network was designed with a clearly defined target: the score from the Beck Depression Inventory. Results: In all networks studied, psychological parameters (e.g., tension, depression, hostility, fatigue, confusion, and total mood disturbance) emerged as the most influential nodes in relation to the targeted node (Eigenvector centrality of approximately 0.30). Additionally, sleep quality was identified as the next most relevant parameter for the general network (Eigenvector = 0.25), while nutritional factors-particularly carbohydrates-demonstrated greater prestige within the male network (Eigenvector = 0.06). Nutritional parameters had a stronger influence on depressive symptoms among individuals aged 29-39 years (Eigenvectors = 0.09, 0.09, and 0.14 for energy, carbohydrates, and fat, respectively). Conclusions: This novel approach allowed for a clearer visualization of how the studied parameters impact depressive symptoms, revealing significant differences when certain aspects are examined independently across distinct groups.

Renewing Fundamental Understanding of Ionic Transport in Inorganic Crystalline Solid‐State Electrolytes from the Perspective of Lattice Dynamics

AbstractLattice dynamics has been widely employed to study various properties of crystalline materials, by revealing the atomic vibration rules with phonon dispersion curves. Modulating lattice‐dynamics‐related factors is an emerging trend in the design of inorganic crystalline solid‐state electrolytes (ICSSEs) with promoted ionic conductivity. Nevertheless, due to complicated interplay of these enormous factors, fundamental understanding of lattice‐dynamics‐influenced ionic transport is still limited. In this review, all related factors are classified into lattice static and dynamic ones based on their variability in ionic transport process, facilitating a methodological evaluation of their individual and interrelated influences. The previous efforts are affirmed to design ICSSEs by constructing potential energy surfaces for ionic transport based on lattice static factors (e.g., ionic arrangement, time‐scale dependent ionic concentration, and lattice softening). As for lattice dynamic factors, the possibility to quantify ionic transport activation energy and to screen the type of migration ions by phonon frequency and amplitude, respectively is validated. Specifically, it is highlighted that the optimization of specific phonon mode and the coupling of both lattice static and dynamic factors are essential to achieve superior ionic transport in ICSSEs. Finally, challenges and opportunities are pointed out in this field, which can potentially guide the future development of ICSSEs.

A bioecological systems review of ethical practice in educational and school psychology

ABSTRACT This narrative scoping review examines ethical practice in educational and school psychology from a bioecological systems’ perspective. A search of four databases yielded 34 articles in the final narrative synthesis. Informed by Bronfenbrenner and Morris’ bioecological systems theory, the ethical experiences of educational and school psychologists were analyzed using the concepts of Process, Person, Context and Time. The complexity, intensity and frequency of ethical dilemmas are reviewed in Process. The demand, resource, and force characteristics impacting on psychologists as Person are reviewed. Within Context, studies identified dilemmas that arose for psychologists across systems. In Time, issues including implications of the Fourth Industrial Revolution on psychologists’ ethical practice with the emergence of Artificial Intelligence are examined. This paper demonstrates the synergies and the interrelated influences on psychologists’ ethical practices arising from a systematic review of their experiences and their professional training needs.

Layered vulnerability and researchers’ responsibilities: learning from research involving Kenyan adolescents living with perinatal HIV infection

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/AIDS, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/AIDS (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/AIDS, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities.

Supporting Physical Activity Maintenance in Older Adults Following Supervised Group Exercise: A Mixed-Methods Study Among Culturally Diverse Older Adults.

Physical activity (PA) is important for prevention of falls and chronic disease in older adults. We aimed to examine the interrelated influences upon PA in culturally diverse older adults who completed a short-term exercise program, to inform maintenance strategies, using a mixed-methods design. Eighty-two past participants from the "Stepping On"© program were surveyed examining ongoing participation, social and cognitive determinants of PA, mental and physical functioning, and fear of falls. Semi-structured interviews were undertaken with 34 respondents regarding enablers and barriers, cultural factors, and preferences for PA. Data were collected in English, Chinese, Arabic, Punjabi, or Hindi. Cultural factors minimally affected PA participation. There was low perceived availability of PA opportunities. Health difficulties not only discouraged but also motivated participation. Social connection was a facilitator and could be used to support maintenance. Older adults may benefit from assistance in accessing PA opportunities and clinical guidance about the benefits of ongoing PA.

Urban residence as a driver of wealth differentials: New evidence from Norway

AbstractWe investigate theoretically and empirically how urban residence contributes to interpersonal differentials in wealth accumulation trajectories through its interrelated influences on labour and housing market outcomes. On the basis of Norwegian register data, we estimate models of one's position in various national wealth distributions over the 2010–2018 period, employing fixed‐effects to reduce geographic selection bias and obtain plausibly causal estimates of the impact of moving between levels of the rural–urban hierarchy. We find that residing in a more urbanized area for a longer duration is strongly related to one's rank in the net wealth, housing wealth and financial wealth distributions. Differentials in net wealth growth among levels of urbanization are most dramatic for younger and higher‐educated individuals, with further advantages for those who settle in Oslo. Structural equation modelling reveals that these plausibly causal effects arise primarily through gains in housing equity and (to a lesser degree) in earnings and capital incomes, confirming our conceptual model.

Understanding community level influences on the prevalence of SARS-CoV-2 infection in England: new insights from comparison over time and space.

Understanding and monitoring the major influences on SARS-CoV-2 prevalence is essential to inform policy making and devise appropriate packages of non-pharmaceutical interventions. Through evaluating community level influences on the prevalence of SARS-CoV-2 infection and their spatio-temporal variations in England, this study aims to provide some insights into the most important risk parameters. We used spatial clusters developed in Jahanshahi and Jin (2021 Transportation 48, 1329-1359 (doi:10.1007/s11116-020-10098-9)) as geographical areas with distinct land use and travel patterns. We also segmented our data by time periods to control for changes in policies or development of the disease over the course of the pandemic. We then used multivariate linear regression to identify influences driving infections within the clusters and to compare the variations of those between the clusters. Our findings demonstrate the key roles that workplace and commuting modes have had on some of the sections of the working population after accounting for several interrelated influences including mobility and vaccination. We found communities of workers in care homes and warehouses and to a lesser extent textile and ready meal industries and those who rely more on public transport for commuting tend to carry a higher risk of infection across all residential area types and time periods.

Forgetfulness in the First English Reformation? Tithes Forgotten

Bequests for tithes forgotten were a staple component of orthodox wills in the early sixteenth century. Interestingly, this element appeared considerably less frequently in these documents in the diocese of (Coventry and) Lichfield and the archdeaconry of Leicester in the 1530s and 1540s. Two probable and possibly inter-related influences were at work: a change of perception of tithes from spiritual redemption to benefice income; and some remembered legacy from Lollard criticism of the purpose of tithes. This examination confirms the idea of a variety of responses in different locations, illustrated by those small adjustments which were achievable by testators.

Experimental study of contacting surfaces microgeometry and gas gap impact on thermal contact conductance of metallic joints

Thermal contact resistance is an important phenomenon in heat transfer and impacts many fields of technology. The interrelated influences of many factors—such as geometry and microgeometry of contacting surfaces, their mechanical and thermal properties, apparent contact pressure, type and properties of interstitial fluid—make prediction of this resistance problematic and necessitate both theoretical and experimental research. The paper reports an experimental study of thermal contact conductance (the reciprocal of thermal contact resistance) of joints created by flat, conforming metallic surfaces in static contact. The measurements were performed for samples made of mild steel and stainless steel with relatively low roughness (σ = 0.5 - 2.14 µm) and large slope of asperities (m = 0.4 – 1.3), resulting in values of σef/mef = 1.25 - 1.96 µm that are distinctly lower than reported in the majority of experimental research on thermal contact conductance. The apparent contact pressure was changed from 1.5 to 11 MPa and for some cases up to 19 MPa. Analysis of the results obtained showed that the correlations available in the literature, for greater values of roughness and smaller asperity slope, mostly overestimated the predicted thermal contact conductance. The elasticity indices values for samples used in this study indicated plastic deformation of asperities, but it was concluded that the smoothest surfaces of both kinds of steel underwent elastic deformation. A new experimental correlation for contact of mild steel surfaces (σ = 0.5 - 2.14 µm, σef/mef = 1.25 - 1.96) was proposed. The results of this study indicate the need for further investigation of thermal contact conductance, especially for this range of surface microgeometry parameters, which is not dealt with in the correlations available in the literature. There is also a need to study the impact of asperity curvature on contact conductance. The results of this study proved the important role that air gaps play in the transfer of heat across a joint. The gap conductance values were predicted correctly for low mechanical loads and rough surfaces.

Where we work determines what we eat: A qualitative exploration of the multi-dimensional influences on meat consumption when home and office working during the Covid 19 lockdown in London, UK

Food choices, including the decision to consume meat, are complex and determined by many inter-related influences. This study examined the choice of working professionals to consume meat in the context of forced changes in working conditions during lockdowns in London during the Covid 19 outbreak in 2020–21. Guided by an adapted Ecological Framework depicting influences on food choice in this context, semi-structured interviews were conducted with 33 employees of a financial services consultancy who normally work from offices in central London but were homeworking at the time of research. Food choices associated with all meals (but especially lunches) when working in each setting were explored. Four key themes emerged from the research. Firstly, when office-working the influence of colleagues (social environment factor) on the choice to consume meat was variable and individual-level factors, particularly personality traits, impacted the extent of social influence. Secondly, limited availability of non-meat options and preferences for buying meat-based meals outside the home (physical environment factor), contributed to more meat consumption when office-working. Thirdly, alignment of food choices between household members (social environment factor), largely for convenience reasons, resulted in a greater likelihood of non-meat meals being eaten when homeworking. Finally, not having to commute (physical environment factor) meant participants had more time available, resulting in changes to routines and priorities (individual-level factors), with some reduced meat consumption. Overall, research findings contribute to building understanding of how both home and office-working influence the choice to consume meat. Findings may be used to inform strategies to reduce meat consumption, which will in turn play a role in supporting global climate change targets and reducing harm to the natural environment associated with food choices.

Excommunicating the Faithful: Jewish Christianity in the Early Church

Excommunicating the Faithful traces the development of Jewish Christianity from among the earliest Jesus followers through its apparent disappearance in the fourth or fifth century. The author’s thesis is that among Jewish Christians in the early Church, there existed at least one Jewish Christian sect whose theology stood within the acceptable boundaries of orthodoxy at that time and existed through at least the fifth century, at which point it was declared heretical by the Church Fathers and eventually died out despite the fact that it considered itself part of the greater Church. The author’s thesis also suggests that the increasing antipathy of the Church toward Jewish Christianity was the result of a variety of interrelated influences operating over several centuries. Some of these influences included the changing demographics of the Church and the accompanying clash of cultures; the increasing isolation of Jewish Christianity from the predominantly Gentile Church; power struggles between competing Christian communities in Palestine, as well as Rome’s interest in asserting its primacy; and theological and pastoral concerns, which were well-intentioned but resulted in increasingly narrow views of orthodoxy and orthopraxis; and lasting anti-Jewish sentiments throughout the Empire, some of which still exist today.

NEW MATERIALISM: PROJECTIONS INTO LITERARY THEORY AND CRITICISM

The article considers the recent (re)turn to materiality in philosophy and theory, in particular, such schools as speculative realism and object-oriented philosophy. They offer rethinking of objects and criticism of anthropocentric worldview. The attention to materiality privileges matter, body, and nature. Theorists of New materialism reject the binary oppositions (nature/culture, human/nonhuman, etc.) and insist on intra-action as a new materialist orientation. The author argues that the new materialist critique of conventional critique will be useful for literary theory and criticism. According to Latour, critique should be productive and collaborative. As far as critical judgments rely on thelogic of representation that in its turn is based on similarity, analogy and opposition they restrict the analytic enterprise. Moreover, it is necessary to rethink conventional practices of interpretation and explanation. In this context, K. Barad proposes to substitute these strategies with the practice of ‘diffraction’. In the second part of the article, the author analyzes Graham Harman’s article The Well-Wrought Broken Hammer:Object-Oriented Literary Criticism. We pay attention to Harman’s critique of New Criticism, New Historicism, and Deconstruction in their contrast to object-oriented philosophy. In his analysis of New Criticism, Harman figures out the taxonomic fallacy within this theory. He argues against the idea that only poetry has all the non-prose sense while other disciplines have the literal sense. His second argument against New Criticism problematizes the unity of all the elementsin a literary work. Harman outlines the assumptions of New Historicism and points out that it turns everything into interrelated influences. Instead, he argues that contextuality is not universal. In his criticism of Deconstruction Harman underlines that Derrida wrongly believes that ontological realism automatically entails an epistemological realism. In his turn, Harman insists that the thing is deeper than its interactions are.

Sexually Transmitted Infections in the U.S. Military: A Sexual Health Paradigm to Address Risk Behaviors, Unintended Pregnancy, Alcohol Use, and Sexual Trauma.

To address the ongoing epidemic of sexually transmitted infections (STIs) in the United States, the National Academies of Sciences, Engineering, and Medicine (National Academies) conducted a consensus study on STI control and prevention in the United States to provide recommendations to the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. The culminating report identified military personnel as one of the priority groups that require special consideration given the high prevalence of STIs and their associated behaviors (e.g., concurrent sexual partners and infrequent condom use) that occur during active duty service. Universal health care access, the relative ease and frequency of STI screening, and the educational opportunities within the military are all assets in STI control and prevention. The report offers a comprehensive framework on multiple and interrelated influences on STI risk, prevention, health care access, delivery, and treatment. It also provides an overview of the multilevel risk and protective factors associated with STIs that could be applied using a sexual health paradigm. The military context must integrate the multilevel domains of influences to guide the effort to fill current gaps and research needs. The Department of Defense, with its large clinical and preventive medicine workforce and its well-established universal health care system, is well positioned to enact changes to shift its current approach to STI prevention, treatment, and control. STI control based on highlighting behavioral, social, cultural, and environmental influences on service members' sexual health and wellness may well drive better STI care and prevention outcomes.

Associations between occupational therapy students\u2019 academic performance and their study approaches and perceptions of the learning environment

BackgroundRelationships between students’ academic performance and their employed study approaches have been studied extensively. However, research using study approaches and learning environment factors as concurrent predictors of academic performance is sparse. There is a need to disentangle the potentially interrelated influences of individual and contextual factors on students’ academic performance.ObjectiveThis study aimed to increase the understanding of the associations between occupational therapy students’ academic performance, and their approaches to studying, perceptions of the learning environment, and sociodemographic characteristics.MethodA cross-sectional study was designed, and 174 first-year students completed the Approaches and Study Skills Inventory for Students and the Course Experience Questionnaire, in addition to background information. Data on grades were collected from the data registries of each education institution, and associations were analyzed by multiple linear regression.ResultsNone of the learning environment scales were associated with grades. Adjusting for all variables, better exam results were associated with being female (β = 0.22, p < 0.01) and having higher scores on strategic approach (β = 0.31, p < 0.001) and lower scores on surface approach (β = -0.20, p < 0.01).ConclusionThe study suggests that students with a desire for obtaining good grades ought to use strategic study behaviors and avoid using surface approach behaviors. While it is important to ensure good quality of the learning environment for a variety of reasons, the learning environment did not contribute significantly to explain the students’ academic performance.

Modest sleep restriction does not influence steps, physical activity intensity or glucose tolerance in obese adults.

Sleep restriction (SR) (<6h) and physical activity (PA) are risk factors for obesity, but little work has examined the inter-related influences of both risk factors. In a free-living environment, 13 overweight/obese adults were sleep restricted for five nights to 6h time-in-bed each night, with and without regular exercise (45min/65% VO2 max; counterbalanced design). Two days of recovery sleep followed SR. Subjects were measured during a mixed meal tolerance test (MMT), resting metabolic rate, cognitive testing and fat biopsy (n=8). SR increased peak glucose response (+7.3mg/dl, p=.04), elevated fasting non-esterified fatty acid (NEFA) concentrations (+0.1mmol/L, p=.001) and enhanced fat oxidation (p<.001) without modifying step counts or PA intensity. Inclusion of daily exercise increased step count (+4,700 steps/day, p<.001) and decreased the insulin response to a meal (p=.01) but did not prevent the increased peak glucose response or elevated NEFA levels. The weekend recovery period improved fasting glucose (p=.02), insulin (p=.02), NEFA concentrations (p=.001) and HOMA-IR (p<.01) despite reduced steps (p<.01) and increased sedentary time (p<.01). Abdominal adipose tissue (AT) samples, obtained after baseline, SR and exercise, did not differ in lipolytic capacity following SR. Fatty acid synthase protein content tended to increase following SR (p=.07), but not following exercise. In a free-living setting, SR adversely affected circulating NEFAs, fuel oxidation and peak glucose response but did not directly affect glucose tolerance or AT lipolysis. SR-associated metabolic impairments were not mitigated by exercise, yet recovery sleep completely rescued its adverse effects on glucose metabolism.

What are the key features of orthorexia nervosa and influences on its development? A qualitative investigation

Orthorexia nervosa (ON) – a pathological obsession with healthy eating - is an emerging eating disorder. The precise nature of ON and its causes remain unclear, yet few published research studies speak directly to those with ON tendencies or professionals working with them. Our study redresses this gap in the literature by uncovering the defining ON features and the factors influencing its development. The exploratory qualitative research design included semi-structured interviews with those self-identifying as orthorexic or obsessively preoccupied with healthy eating (n = 9), and professionals working with ON and eating disorders - psychologists, dieticians and a family therapist (n = 7). Data were analysed thematically. ON emerged as multifactorial, with a variety of interrelated influences needing to coalesce for ‘healthy eating’ to become pathological. Key features included rigidity and control (around food choices, routines and preparation) and moral judgements around food, along with a range of negative psychosocial and physical impacts. Influences on the development of ON were organised according to their occurrence at the individual (micro) level, external/relational (meso) level and societal (macro) level. Influences on the individual included health concerns, belief in food as medicine, past trauma, personality (e.g. obsessive, perfectionist), exposure to extreme views and behaviours while growing up and moral concerns. External influences included parents, partners and relational groups (e.g. fitness or clean eating groups). Societal influences included aestheticism, moral citizenship and social media. We conclude that ON is more than an individual pathology, it is symptomatic of our ‘orthorexic society’: where hyper-reflexivity around food choices, conflicting information regarding the correct diet, preoccupation with appearance, and emphasis on individual (not collective) responsibility for health combine with individual susceptibilities and ecological/moral concerns, to predispose toward pathological ‘healthy’ eating.

The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context.

People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals’ decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The ‘Whole-of-Person Retention Improvement Framework’ (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.

Changes in Coagulation following Brain Injury.

Traumatic brain injury (TBI) is a worldwide public health concern due to increasing mortality, affecting around 10 million patients per year. A wide variety of clinical presentations are a function of the magnitude of injury and the anatomical perturbation of the brain parenchyma, supporting structures, and cerebral vasculature, with subsequent alteration of the blood-brain barrier. These disturbances correspond with the evolution of intracerebral hemorrhage and clinical outcomes. The associated hemostatic alterations associated with TBI are caused by the disruption of the delicate balance between bleeding and thrombosis formation, which can exacerbate initial injury. TBI-associated coagulopathy is a function of a cross-talk between coagulation and inflammation, with varying influences on the immunomodulation and regulation of coagulation that occur on platelets and the endothelium of injured TBI patients. In addition to the severity of initial injury, the following factors modulate the hemocoagulative response to TBI: time from the onset of injury to treatment, age, gender, catecholamine secretion, platelet dysfunction, endotheliopathy, premorbid anticoagulation, fibrinolysis, tissue factor, and activated protein C contribution. All these entities are intertwined and influence the pathologic evolution of TBI. These factors have implications for therapeutic options such as the choice of blood components for transfusion and hemostatic agents such as tranexamic acid. Monitoring hemostatic changes of TBI patients requires an understanding of these interactions between immunology and coagulation, which can be discerned by point-of-care viscoelastic testing with specific limitations. This review considers the implications of these interrelated influences on the evaluation of coagulopathy in TBI.

Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project

BackgroundAcute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy.MethodsProspective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams’ ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project.ResultsChole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others’ experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway.ConclusionCollaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.