Multi-method Study Research Articles

Don’t be a hamster! Social appeals to curb panic buying at the point-of-sale

The COVID-19 pandemic confronted retailers with an unprecedented challenge: convincing customers to buy less. Given the ineffectiveness of real-life strategies against panic buying, we explore the power of social appeals to convince consumers of buying less voluntarily. In three multi-method studies based on field and lab data, we demonstrate that the use of social appeals not only comes with favorable marketing outcomes for retailers (i.e., loyalty and attitudes), but that adequately designed social appeals are also a promising instrument to curb undesirable consumer behaviors such as panic buying in a health crisis.

Effects of natural treatments on the varroa mite infestation levels and overall health of honey bee (Apis mellifera) colonies.

The survival of the honey bee (Apis mellifera), which has a crucial role in pollination and ecosystem maintenance, is threatened by many pathogens, including parasites, bacteria, fungi and viruses. The ectoparasite Varroa destructor is considered the major cause of the worldwide decline in honey bee colony health. Although several synthetic acaricides are available to control Varroa infestations, resistant mites and side effects on bees have been documented. The development of natural alternatives for mite control is therefore encouraged. The study aims at exploring the effects of cinnamon and oregano essential oils (EOs) and of a mixed fruit cocktail juice on mite infestation levels and bee colony health. A multi-method study including hive inspection, mite count, molecular detection of fungal, bacterial and viral pathogens, analysis of defensin-1, hymenoptaecin and vitellogenin immune gene expression, colony density and honey production data, was conducted in a 20-hive experimental apiary. The colonies were divided into five groups: four treatment groups and one control group. The treatment groups were fed on a sugar syrup supplemented with cinnamon EO, oregano EO, a 1:1 mixture of both EOs, or a juice cocktail. An unsupplemented syrup was, instead, used to feed the control group. While V. destructor affected all the colonies throughout the study, no differences in mite infestation levels, population density and honey yield were observed between treatment and control groups. An overexpression of vitellogenin was instead found in all EO-treated groups, even though a significant difference was only found in the group treated with the 1:1 EO mixture. Viral (DWV, CBPV and BQCV), fungal (Nosema ceranae) and bacterial (Melissococcus plutonius) pathogens from both symptomatic and asymptomatic colonies were detected.

A framework for higher education institutions sustainability: A multi-method study

A framework for higher education institutions sustainability: A multi-method study

The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018–2023

BackgroundEffective governance arrangements are central to the successful functioning of health systems. While the significance of governance as a concept is acknowledged within health systems research, its interplay with health system reform initiatives remains underexplored in the literature. This study focuses on the development of new regional health structures in Ireland in the period 2018–2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation.MethodsThis qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis.ResultsThe analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. The findings highlight how these challenges can be addressed through strengthening governance arrangements and processes. Importantly, the research reveals the interwoven nature of the five TAPIC dimensions of governance and the need to engage with the complexity and relationality of health system reform processes.ConclusionsLarge scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed.

Exploring Medical Student Experiences With Direct Observation During the Pediatric Clerkship.

Direct observation (DO) enables assessment of vital competencies, such as clinical skills. Despite national requirement that medical students experience DOs during each clerkship, the frequency, length, quality, and context of these DOs are not well established. This study examines the quality, quantity, and characteristics of DOs obtained during pediatrics clerkships across multiple institutions. This multimethod study was performed at 6 U.S.-based institutions from March through October 2022. In the qualitative phase, focus groups and/or semistructured interviews were conducted with third-year medical students at the conclusion of pediatrics clerkships. In the quantitative phase, the authors administered an internally developed instrument after focus group discussions or interviews. Qualitative data were analyzed using thematic analysis, and quantitative data were analyzed using anonymous survey responses. Seventy-three medical students participated in 20 focus groups, and 71 (97.3%) completed the survey. The authors identified 7 themes that were organized into key principles: before, during, and after DO. Most students reported their DOs were conducted primarily by residents (62 [87.3%]) rather than attendings (6 [8.4%]) in inpatient settings. Participants reported daily attending observation of clinical reasoning (38 [53.5%]), communication (39 [54.9%]), and presentation skills (58 [81.7%]). One-third reported they were never observed taking a history by an inpatient attending (23 [32.4%]), and one-quarter reported they were never observed performing a physical exam (18 [25.4%]). This study revealed that students are not being assessed for performing vital clinical skills in the inpatient setting by attendings as frequently as previously believed. When observers set expectations, create a safe learning environment, and follow up with actionable feedback, medical students perceive the experience as valuable; however, the DO experience is currently suboptimal. Therefore, a high-quality, competency-based clinical education for medical students is necessary to directly drive future patient care by way of a competent physician workforce.

Metabolic Syndrome in people treated with Antipsychotics (RISKMet): A multimethod study protocol investigating genetic, behavioural, and environmental risk factors.

The RISKMet project aims to: (1) identify risk factors for metabolic syndrome (MetS) by comparing patients with and without MetS; (2) characterise patients treated with second-generation antipsychotics (SGAs) about MetS diagnosis; (3) study behavioural patterns, including physical activity (PA) and dietary habits, in patients and healthy individuals using a prospective cohort design. The RISKMet project investigates MetS in individuals treated with SGAs, focusing on both adult and paediatric populations. The study utilizes a case-control design to examine potential risk factors for MetS, categorizing participants as MetS+ considered as "Cases" and MetS- considered as "Controls" matched by sex and age. The evaluation of factors such as MetS, lifestyle habits, and environmental influences is conducted at two time points, T0 and T3, after 3 months. Subsequently, the project aims to assess body parameters, including physical examinations, and blood, and stool sample collection, to evaluate metabolic markers and the impact of SGAs. The analysis includes pharmacological treatment data and genetic variability. Behavioural markers related to lifestyle, eating behaviour, PA, and mood are assessed at both T0 and T3 using interviews, accelerometers, and a mobile app. The study aims to improve mental and physical well-being in SGA-treated individuals, establish a biobank for MetS research, build an evidence base for physical health programs, and develop preventive strategies for SGA-related comorbidities. This project innovates MetS monitoring in psychiatry by using intensive digital phenotyping, identifying biochemical markers, assessing familial risks, and including genetically similar healthy controls. ISRCTN18419418 at www.isrctn.com.

Improving linkage to HIV care following a reactive HIV self-testing result among men in KwaZulu-Natal, South Africa

BackgroundDespite the many interventions that have been implemented in sub-Saharan Africa to improve the uptake of HIV testing and antiretroviral (ART) initiation services, the rates at which men are tested for HIV and initiated on ART have remained consistently lower compared to those for women. We aim to investigate barriers and facilitators for linkage to care following HIVST positive results among men aged between 18 and 49 years, and use these findings to design an intervention to improve linkage to care among men in a high-HIV prevalent district in KwaZulu-Natal province, South Africa.MethodsThis multi-method study will be conducted over 24 months in eight purposively selected HIV testing and treatment facilities from December 2023 to November 2025. For the quantitative component, a sample of 197 HIV positive men aged 18–49 years old who link to care after HIV self-test (HIVST) will be recruited into the study. HIVST kits will be distributed to a minimum of 3000 men attending community services through mobile clinics that are supported by the Health Systems Trust, at different service delivery points, including schools, taxi ranks and other hotspots. The qualitative component will consist of in-depth interviews (IDIs) with 15 HIVST users and IDIs with 15 key informants. To design and develop acceptable, feasible, effective, and sustainable models for improving linkage to care, three groups of HIVST users (2*positive (N = 12) and 1*negative (N = 12)) will be purposively select to participate in a design workshop. Chi square tests will be used to identify social and demographic factors associated with linkage, while logistic regression will be used to identify independent factors. Kaplan Meier curves and cox proportional hazard models will be used to identify factors associated with time to event. Content and thematic approaches will be used to analyze the qualitative data.DiscussionThere remains an urgent need for designing and implementing innovative intervention strategies that are convenient and tailored for addressing the needs of men for improving HIV testing and linkage to care at early stages in resource-limited settings, to improve individual health outcomes, reduce transmission from HIV and minimize HIV-related mortality rates. Our proposed study offers several important innovations aimed at improving linkage to care among men. Our study targets men, as they lag the HIV continuum but are also under-researched in public health studies.

Digital human calls you dear: How do customers respond to virtual streamers’ social-oriented language in e-commerce livestreaming? A stereotyping perspective

Social-oriented language as a linguistic style can improve customer experiences in various service contexts, involving both human employees and AI-enabled service agents. The emergence of digital human characters in e-commerce livestreaming, also known as virtual streamers, raises the question: Can social-oriented language used by virtual streamers increase the customers' purchase intention? However, the theoretical understanding of whether, how, and when the interaction effect between virtual streamers' social-oriented language and product type influences purchase intention remains far from conclusive. Based on the stereotype content model (SCM), we developed a theoretical model to explain the mechanism between virtual streamers' linguistic style and customers’ purchase intention. A multi-method study combining two online experiments, one lab experiment, and one focus group was conducted to explore the effectiveness of social-oriented language (Study 1: N = 321; Study 2: N = 292; Study 3: N = 120; Study 4: N = 9). Participants in both Study 1 and Study 2 were recruited online and were randomly assigned to a condition in 2 (linguistic style: social-oriented vs. task-oriented) × 2 (product type: experience vs. search) between-subjects experimental design. Participants were recruited in the university by three blind-to-hypothesis experimenters in Study 3 and were randomly assigned to a condition in 2 (linguistic style: social-oriented vs. task-oriented) × 2 (product type: experience vs. search) × 2 (virtual streamer type: human-like vs. animated) between-subjects experimental design in the behavioral lab. Participants in Study 4 were recruited from a large WeChat group specifically interested in online shopping discounts. The results of Study 1 indicate the effect of social-oriented language on purchase intention solely in the experience product condition. Study 2 demonstrates the mediating role of perceived warmth and perceived competence, and confirms a compensatory effect and a positive relationship between perceived warmth and competence. Study 3 verifies the moderating role of the virtual streamer type while a focus group Study 4 supports the findings from Studies 1–3. Our findings extend the livestreaming commerce literature by exploring the implications of social-oriented language and task-oriented language when the live streamer is a digital human rather than a human. Also, we provide fresh insights into the literature on human-AI interactions by unraveling both the cognitive mechanism and the boundary condition, deepening our understanding of a novel but under-investigated phenomenon. Furthermore, our findings provide practical implications for livestreaming commerce practitioners.

Weight management personas of breast cancer patients undergoing chemotherapy in China: a multi-method study

BackgroundMobile health (mHealth) may be an ideal solution for breast cancer (BC) patients in China to access weight management interventions. User retention and engagement are the main challenges faced by mHealth applications. A user persona, which is a user-centered design process, can lead to the development of mHealth that is more acceptable to the needs of target users. This study aimed to investigate the variety of experiences in weight management and the behavioral preferences of BC patients receiving chemotherapy to develop users’ personal information and persona development for the design and implementation of mHealth interventions.MethodsSixteen individual semi-structured in-depth interviews were conducted with BC patients receiving chemotherapy. We employed the thematic analysis method to analyze the interview transcripts in NVivo 11 software. The themes obtained from the analysis were used as the subdomains of personas. A proforma was designed to extract each participant’s experience in each subdomain. Patients who exhibited similar experience in subdomains were grouped into a persona using affinity diagrams. The personas were named according to their prominent features. A questionnaire survey was conducted to validate the personas and to test whether the personas that were generated from the qualitative interview data were applicable to the Chinese population with BC.ResultsFour themes were identified as subdomains of weight management personas: the perception of weight management while undergoing chemotherapy, symptoms and emotional disturbance, changes in diet and exercise, and health literacy and information seeking. Five personas were ultimately obtained: (1) positive weight controllers, (2) patients who were inactive due to fatigue, (3) young patients who avoided communication, (4) overweight patients with treatment priority, and (5) patients who engaged in irregular exercise. Finally, the quantitative study showed that 51.58% of patients chose one of these five personas to represent themselves in weight management. None of the patient reported selecting options that were not explicitly outlined in the questionnaire and provided personalized descriptions of their weight management characteristics.ConclusionsThe selected personas were developed from in-depth interviews on biopsychosocial areas. They highlight different weight management patterns in Chinese BC patients and provide implications for both the design of mHealth systems and traditional interventions.

Parents' Trigger Tool for Children with Medical Complexity - PAT-CMC: Development of a recognition tool for clinical deterioration at home.

To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content. This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach. A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study. The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system. Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions. The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge. Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.

Instruments for Measuring Youth Digital Media Use

In the context of adolescents’ increasing engagement with digital media, accurately assessing their media usage becomes challenging. This complexity arises from factors such as heightened multitasking, shorter attention spans, and peer influence. The Mobile Experience Sampling (MES) method has emerged as an alternative in digital media research with the strong advantage of measuring media use in situ several times a day over an extensive period. However, there is a lack of research investigating how MES studies among teenagers should be set up and which specific MES tools should be used to ensure high response rates. To answer this question, we conducted a multi-method study (N = 34) comparing data quality indicators (i.e., response rate and response delay) and perceived usability of a web-based and an app-based MES tool among Austrian middle and high school students, consisting of a one-week experimental MES study followed by qualitative interviews. In the MES part, participants were notified by three beeps on three days (NMES = 306) to complete a short survey measuring their time use in the last 60 minutes. The qualitative interviews revealed that adolescents perceived both MES tools as positive regarding usability (except for installation). The MES data, however, show great differences in data quality, highlighting that the web mode generated higher response rates and fewer errors (e.g., for response delays due to technical problems) than the app mode. This study provides a deeper understanding of technological considerations that should be made when planning an MES study and offers methodological guidance for future research.

P184 Geographical variations in delivery of intravenous treatments for ANCA-associated vasculitis

Abstract Background/Aims Timely access to intravenous immunosuppressant therapy is essential to effectively manage systemic vasculitis; however, significant variations in care and outcomes exists across centres. We systematically evaluated access to treatment for ANCA-associated vasculitis across the UK and Ireland. Methods This multi-method study included: a survey of 87 UK and Ireland Vasculitis Society sites and 11 Scottish Health Boards between Nov 2020 and June 2021; interviews with staff and patients with systemic vasculitis. Survey data was analysed descriptively. Interviews were audio or video recorded and analysed thematically. Results 59 responses from 51 Trusts/Health Boards across Scotland (n = 11), England (n = 33), Wales (n = 2), and Ireland (n = 5) included equal numbers of rheumatology and nephrology vasculitis services across diverse healthcare settings. 67 healthcare professionals across six case studies in Scotland (n = 3) and England (n = 3) and 32 patients with systemic vasculitis were interviewed. Services faced significant challenges in prescribing and delivering high-cost drugs to manage systemic vasculitis: balancing accountability versus bureaucracy, and tensions between different specialties looking after vasculitis patients when implementing access to high-cost drugs via multi-disciplinary networks. There was significant variation in how services delivered intravenous treatments: 10%(5/51) used inpatient beds; 35% (18/51) accessed another specialty unit or shared a daycase facility; 65% (33/51) used their own specialty daycase unit. Average wait time for urgent IV treatment was 2.67 days (range 1-10 days). 18% of services had waiting times >7 days, and of those 67% accessed intravenous treatments via another daycase facility. Specific challenges in accessing daycase facilities included availability of slots and staff, particularly in shared units, due to competition with other services and limited awareness of the importance of timely treatment for systemic vasculitis. This could impact on timing and treatment decisions e.g., prolonged steroid prescriptions. Staff training, competencies and governance to deliver cytotoxic drugs was problematic, particularly for smaller services, and 70% of services said national training modules would be helpful. Oncology units could provide workarounds but daycase nurses with vasculitis knowledge were a valuable source of advice and support for patients attending for treatments, identifying medical issues and arranging assessment if required. Conclusion There is significant variation in access to intravenous treatment for systemic vasculitis. Healthcare organisations should ensure timely access to urgent intravenous treatment for systemic vasculitis within 7 days and appropriately trained staff. National training modules for non-cancer chemotherapy could facilitate equitable access to training. Where treatment is delivered via other units, greater awareness of systemic vasculitis would help provision of information and support for patients. Disclosure W. James: None. A. Nicoll: None. L. Locock: None. L. Harper: None. M. Little: None. N. Basu: None. R.J. Hollick: None.

Mixed Methods EvAluation of the high-volume low-complexity Surgical hUb pRogrammE (MEASURE): a mixed methods study protocol

IntroductionThe waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs...

Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study.

Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. Primary care multi-method qualitative study. Adults with experience of persistent pain and taking opioids participated in semi-structured interviews (n=15, 73% female) and an online discussion forum (n=31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within-domains to generate subthemes, and subtheme comparison to form across-domain overarching themes. The behaviour change technique taxonomy v.1 and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. 32 facilitator and barrier subthemes for patients reducing opioids were identified across 13 TDF domains. These combined into six overarching themes: learning to live with pain, opioid reduction expectations, assuming a medical model, pharmacist-delivered reviews, pharmacist-patient relationship and patient engagement. Subthemes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. This study generated theoretically-informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training.

Competitive Video Game Exposure Increases Aggression Through Impulsivity in Chinese Adolescents: Evidence From a Multi-Method Study.

It is widely known controversies about the results of violent video game increase aggression. However, the role of competitive video games, has received less research attention, and the underlying mechanisms of their influence are unknown. This study aimed to expand the existing literature by systematically exploring the effects of competitive video game exposure on adolescent aggression and the mediating role of impulsivity. In so doing, three types of studies (collectively N = 2919, mean age varied from 13.75 to 15.44 years, with a balanced gender) combining cross-sectional, experimental, and longitudinal approaches, were conducted. The findings consistently show that competitive video game exposure increased adolescents' aggression and impulsivity. Also, impulsivity mediated the correlation and long-term effect of competitive video game exposure on aggression. However, the experimental study did not confirm the short-term mediating effect of impulsivity, which may be related to the type of aggression measured in the study. The results indicate that competitive video game exposure is an important antecedent factor for adolescent aggression, and impulsivity is the key underlying mechanism.

Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study.

Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.

Real-life clinical management patterns in extensive-stage small cell lung cancer across France: a multi-method study

BackgroundWe designed this study based on both a physician practice survey and real-world patient data to: (1) evaluate clinical management practices in extensive-stage small cell lung cancer (ES-SCLC) among medical centers located across France; and (2) describe first-line treatment patterns among patients with ES-SCLC following the introduction of immunotherapy into clinical practice.MethodsA 50-item questionnaire was completed by physicians from 45 medical centers specialized in SCLC management. Responses were collected from June 2022 to January 2023. The survey questions addressed diagnostic workup of ES-SCLC, chemoimmunotherapy in first-line and second-line settings, and use of prophylactic cranial irradiation (PCI) and radiotherapy. In parallel, using a chart review approach, we retrospectively analyzed aggregated information from 548 adults with confirmed ES-SCLC receiving first-line treatment in the same centers.ResultsIn ES-SCLC, treatment planning is based on chest computed tomography (CT) (as declared by 100% of surveyed centers). Mean time between diagnosis and treatment initiation was 2–7 days, as declared by 82% of centers. For detection of brain metastases, the most common imaging test was brain CT (84%). The main exclusion criteria for first-line immunotherapy in the centers were autoimmune disease (87%), corticosteroid therapy (69%), interstitial lung disease (69%), and performance status ≥ 2 (69%). Overall, 53% and 36% of centers considered that patients are chemotherapy-sensitive if they relapse within ≥ 3 months or ≥ 6 months after first-line chemoimmunotherapy, respectively. Among the 548 analyzed patients, 409 (75%) received chemoimmunotherapy as a first-line treatment, 374 (91%) of whom received carboplatin plus etoposide and 35 (9%) cisplatin plus etoposide. Overall, 340/548 patients (62%) received maintenance immunotherapy. Most patients (68%) did not receive radiotherapy or PCI.ConclusionsThere is an overall alignment of practices reflecting recent clinical guidelines among medical centers managing ES-SCLC across France, and a high prescription rate of immunotherapy in the first-line setting.

Teacher modelling as a way to foster Bildung in vocational education: a multi-method curriculum study

ABSTRACT This study presents an inquiry into the relevance of Bildung for students in (pre-) vocational education. While Bildung has seen a remarkable revival in international educational theory, its relevance for educational practice(s) remains under-investigated, particularly in vocational education. This paper presents the insights offered by a multi-method curriculum study, conducted as part of a larger project in which (pre)vocational teachers in the Netherlands experimented with their own role as a model of and for their students’ Bildung. Building on a thematic analysis of teacher observations, teacher interviews and student focus groups, we explore how six teachers enacted and perceived their modelling role, and how their students experienced it. While all teachers modelled elements of what they found important for their students’ Bildung, the teachers actually perceived as models of Bildung by their students were those who shared their own experiences and stories with students, and who related to them on a personal level by offering them support, trust and inspiration to pave their own paths in life. Based on our findings, we suggest implications for broadening common understandings of Bildung and modelling, as well as practical implications for teachers, teacher education and policy to foster vocational students’ Bildung.

Effect of clinical engagement on value, standardisation, decision-making and savings in NHS product procurement.

UK healthcare expenditure is now £193.8 billion a year. The procurement function is seen as central to driving efficiencies within the NHS. This comes with an increasing onus on clinicians, including nurses and allied health professionals, to accept procurement outcomes to realise efficiency savings, with or without prior engagement. This empirical study seeks to examine whether clinical engagement in the procurement of healthcare products in the NHS is necessary to achieve value, savings and standardisation; it will thereby address a gap in the research. A multi-method qualitative case study design was used, which included a survey and eight semi-structured interviews. Results identified three factors that influence the achievement of value, savings and standardisation around clinical engagement: micro-level processes for clinical engagement; clinical stakeholders and clinical procurement professionals as experts at the centre of procurement activity; and clinical value in standardisation. A shift away from standardisation to resilience was identified, resulting from current market supply pressures. This research brings empirically derived findings to address gaps in research, supports the benefit of clinical engagement through specific forums for collaboration at a trust level and provides a clinical/expert impact/preference matrix as a resource for procurement professionals to facilitate clinical engagement.

Approaching the Complete Basis Set Limit for Spin-State Energetics of Mononuclear First-Row Transition Metal Complexes.

Convergence to the complete basis set (CBS) limit is analyzed for the problem of spin-state energetics in mononuclear first-row transition metal (TM) complexes by taking under scrutiny a benchmark set of 18 energy differences between spin states for 13 chemically diverse TM complexes. The performance of conventional CCSD(T) and explicitly correlated CCSD(T)-F12a/b calculations in approaching the CCSD(T)/CBS limits is systematically studied. An economic computational protocol is developed based on the CCSD-F12a approximation and (here proposed) modified scaling of the perturbative triples term (T#). This computational protocol recovers the relative spin-state energetics of the benchmark set in excellent agreement with the reference CCSD(T)/CBS limits (mean absolute deviation of 0.4, mean signed deviation of 0.2, and maximum deviation of 0.8 kcal/mol) and enables performing canonical CCSD(T) calculations for mononuclear TM complexes sized up to ca. 50 atoms, which is illustrated by application to heme-related metalloporphyrins. Furthermore, a good transferability of the basis set incompleteness error (BSIE) is demonstrated for spin-state energetics computed using CCSD(T) and other wave function methods (MP2, CASPT2, CASPT2/CC, NEVPT2, and MRCI + Q), which justifies efficient focal-point approximations and simplifies the construction of multimethod benchmark studies.