One in six hospital beds across England is occupied by someone with diabetes. While guidance on inpatient diabetes care is available, national audit data demonstrate that people still experience significant and avoidable diabetes-related harms. This study is unique in exploring how people with diabetes admitted to hospital for any medical reason experienced diabetes care from admission to discharge. It is part of a bigger project aiming to develop and test a Patient Reported Experience Measure for inpatients with diabetes. A qualitative approach was used to explore experiences of inpatient diabetes care. Twenty-seven participants with type 1 or type 2 diabetes, hospitalised for any reason, were recruited using purposive sampling across four acute NHS Trusts in the South of England. Data collected in semi-structured interviews were analysed with reflexive thematic analysis. In diabetes care, the emphasis is on supporting people with self management of their diabetes. The inpatient care setting compromises this by limiting self management behaviours. These restrictions may apply to those who want to and can be actively involved in their diabetes care and may contribute to less effective diabetes management and poorer outcomes. For some participants in this study, diabetes self management was discouraged in three ways. First, their knowledge of their diabetes and willingness to self-manage were not taken into account on admission or in planning their inpatient diabetes care. Second, their involvement in decisions about their ongoing diabetes care was limited. Third, their needs related to diabetes management were not met because of the lack of flexibility in hospital practices and schedules. Inpatient care is not always conducive to diabetes self management. Understanding the patient experience in the inpatient setting related to self management is important in reducing harm to patients while they are in hospital. Our findings emphasise the importance of involving people with diabetes in planning and managing their care while hospitalised. Further work needs to be done to ensure that the knowledge, involvement and flexibility of care of people with diabetes are incorporated into an inpatient setting.

In an increasingly complex business environment, earnings quality is influenced not only by operational performance but also by various internal and external factors of a company. This study aims to analyze the effect of accrual earnings management, firm size, and audit quality on earnings quality in manufacturing companies listed on the Indonesia Stock Exchange (IDX) during the period of 2021 to 2023. Earnings quality is an important indicator in evaluating a company's financial performance and serves as a basis for investors' decision-making. This research employs a quantitative approach using multiple linear regression analysis. The sample was selected using purposive sampling, with secondary data derived from companies’ annual financial reports. Based on agency theory, there is a conflict of interest between managers and owners, which encourages managers to maximize earnings quality by utilizing various internal and external factors. Accrual earnings management, audit quality, profitability and firm size serve as external monitoring mechanisms to mitigate conflicts between managers and owners. The results indicate that accrual earnings management has a positive and significant effect on earnings quality. However, firm size and audit quality do not have a significant effect on earnings quality. Nevertheless, simultaneously, all three independent variables are proven to have a significant effect on earnings quality. These findings suggest that accrual management practices play a crucial role in enhancing the quality of earnings information, while firm size and audit quality have not yet made a meaningful contribution in this context. This study has implications for companies to adopt greater transparency in financial reporting practices, and for investors to consider internal factors affecting earnings quality. The results are also expected to serve as an academic reference for future research in the field of financial accounting.

Gender perspectives on experiences of kangaroo mother care for preterm infants in neonatal intensive care unit in China: A qualitative study.

A Qualitative Exploration of How the Pregnancy and Postpartum Journey Was Shaped by the COVID-19 Pandemic: Lessons Learned.

Good communication is crucial in creative production teams. This study examines the communication patterns of the edutech team FitAcademy, which faced internal communication challenges. This study aims to identify communication patterns vertical/horizontal and the mediating role of technology in the workflow. A qualitative case study method was used. Primary data were obtained through participant observation researcher as Video Editor and in-depth interviews with informants CEO, Teacher, Editor selected via purposive sampling. Data analysis utilized the Miles and Huberman model, reduction, display, conclusion. Results show vertical patterns CEO to Team operate via directives and weekly reviews. Horizontal patterns Teacher and Editor are intensive, using face-to-face contact and Google Docs collaboration. The workflow is highly mediated by technology CapCut, AI, Canva.

Financial distress represents a critical condition that threatens a company’s sustainability due to difficulties in fulfilling its financial obligations. In Indonesia, the property sector has been particularly vulnerable, especially in the post-COVID-19 period marked by declining markets and reduced consumer purchasing power. This study aims to provide empirical evidence on the effects of liquidity (CR), debt policy (DER), and leverage ratio (ICR) on financial distress, measured by the Altman Z-Score. Using a quantitative approach, multiple linear regression analysis was conducted on secondary data obtained from the annual financial statements of property companies listed on the Indonesia Stock Exchange (IDX) for the 2021–2024 period. The sampling method applied was purposive sampling. The results reveal that liquidity (CR) has a significant positive effect on financial distress, while debt policy (DER) and leverage ratio (ICR) show significant negative effects. These findings are in line with Signaling Theory, which suggests that financial information serves as an important signal for external stakeholders in assessing corporate conditions and prospects. The study’s limitations include the restricted sample size and short observation period. Therefore, further research is recommended to expand the sectoral coverage, extend the observation period, and include additional variables such as profitability and sales growth. These variables are expected to strengthen the financial distress prediction model by representing a company’s ability to generate profits and sustain revenue growth.

Self-management support for pre-hospital patients is urgently needed to bridge the gap between hospital and home. An example of a self-management supporting intervention is PREDOCS (PREvention of Decline in Older Cardiac Surgery patients). However, patients' experiences with this nursing consultation remain unclear. Therefore this study aims to explore experiences of older cardiac surgery patients with a pre-surgery nursing consultation and the influence on their self-management prior to cardiac surgery. A generic qualitative study was conducted using fifteen semi-structured interviews with older cardiac surgery patients selected through purposive sampling. Interviews were thematically analysed. Patients' experiences and the influence on their self-management were divided into two main themes: (1) Taking a role in preparation for open cardiac surgery. Through the entire process of preparation for surgery, patients showed an active or a more avoiding style of preparation. (2) Emotional management. After the PREDOCS consultation, patients mentioned different effects of the consultation in managing their emotions. On the one hand, too detailed information negatively affected their fear, on the other hand, the nurse increased patients' trust. Findings suggest that PREDOCS is not aligned with individual patients' style of preparation. Therefore, PREDOCS needs a more tailored approach taking into account patients' coping styles, anxiety level, need for information and current level and readiness for self-management, to support all patients' self-management. Moreover, the importance of tailored interventions to support self-management should be considered when developing similar interventions for larger scale deployment, as well as the consideration that nurses should be key-figures in supporting patients' self-management.

This study aims to analyze the marketing communication strategy implemented by Lido Lake Resort by MNC Hotel in maintaining brand existence after its acquisition by MNC Land. A qualitative descriptive approach was applied, utilizing observation, in-depth interviews, and documentation. Informants including marketing managers, and communication staff were selected through purposive sampling. Data were analyzed using thematic analysis involving coding, categorization, and theme development, validated through source triangulation and member checking. The results reveal three main findings: (1) 85–90% of the marketing budget was allocated to digital channels emphasizing social media optimization, (2) influencer collaboration became the core strategy to expand market reach and engagement, and (3) synergy within the MNC ecosystem and the Special Economic Zone (KEK) Lido City strengthened hotel visibility and brand perception. Effectiveness was reflected through digital interaction growth, audience reach expansion, and improved brand image among guests. The findings highlight the importance of consistent cross-channel messaging and brand identity reinforcement during post-acquisition integration.

The transition to motherhood among first-time mothers in China during the first six months postpartum: A qualitative study based on the transition shock model.

This study aimed to explore the prevalence and regional distribution of acute and chronic musculoskeletal pain related to joint hypermobility (JHM) among students at the Health Science Centre (HSC), Kuwait University. Using a cross-sectional study design, we enrolled 256 students (78.5% young adults; 74.7% female participants) between March 2023 and March 2024 through a non-probability convenience sampling technique. Students with a self-reported history of inflammatory musculoskeletal disorders or current musculoskeletal injuries, neurological deficits, and/or genetic disorders were excluded. JHM was assessed using the 9-point Beighton Score test, and musculoskeletal pain was screened using the Nordic Musculoskeletal Questionnaire. JHM had a prevalence of 42.3%, with females showing significantly higher Beighton scores (P < 0.001). Chronic and acute musculoskeletal pain followed a descending anatomical pattern, starting from the highest proportion at the neck and ending with the lowest proportion at the knees. Among students with JHM, 95 reported chronic musculoskeletal pain, whereas 40 reported acute musculoskeletal pain. Only chronic musculoskeletal pain was found to be significantly higher in students with mild JHM (BS cut-off 4-6/9; n = 77; P < 0.009). Chronic and acute musculoskeletal pain is common among HSC students and may be related to the presence of JHM. Female students appear to be at a higher risk of developing musculoskeletal pain related to JHM than male students. However, the indicated correlation between JHM and musculoskeletal chronic/acute pain needs to be affirmed in further studies with validated quantitative outcome measures and longitudinal designs. Key Points • Chronic and acute musculoskeletal pain is common among Health Science Centre students in Kuwait. • Chronic and acute musculoskeletal pain has the potential to be related to Joint Hypermobility. • Female students with joint hypermobility are at greater risk of pain. • The presence of chronic and acute musculoskeletal pain is inversely proportional to the severity of Joint Hypermobility.

Unveiling the unpredictable: A comprehensive inquiry into sudden and unexpected deaths undergoing medico-legal investigation at Tygerberg Forensic Pathology Services Mortuary.

Exploring the drivers of substance use in Zambia: A qualitative study of stakeholder perspectives.

Accessible tourism has emerged as a national priority within Saudi Arabia's Vision 2030 agenda, yet empirical evidence on the psychological mechanisms linking accessibility to tourist behavior remains limited. This study examines how accessibility barriers and service quality predict satisfaction and revisit intention among persons with disabilities, drawing on Expectancy-Disconfirmation Theory. Data were collected through an online questionnaire using purposive and snowball sampling, yielding responses from 173 participants across 11 regions. Descriptive statistics, Pearson correlations, multiple regression, and bootstrapped mediation analyses were conducted. Accessibility barriers were negatively associated with perceived service comprehensiveness and satisfaction, whereas inclusive service practices were positively linked to emotional evaluations and behavioral intentions. Satisfaction emerged as the strongest predictor of revisit intention and significantly mediated the effects of accessibility and service quality on loyalty outcomes. These findings highlight the central role of satisfaction in shaping tourism behavior and offer theoretical and practical insights that support ongoing national efforts to advance inclusive and accessible tourism within the framework of Vision 2030.

Constructing a theoretical model based on grounded theory to evaluate the downstream effects of home caregiver burden in hemodialysis patients.

Identity transformation after breast cancer: A qualitative study informed by attention reorientation.

Design and evaluation of an oral health booklet during pregnancy

The background of this research is based on the condition of capital expenditure allocation management in the provinces of Sumatra Island, which has not yet reached an optimal level. The objective is to analyze the influence of the Regional Financial Ratio on capital expenditure allocation. Effective PAD management is important to reduce dependence on debt and ensure the sustainability of infrastructure financing. Excessive dependence on short-term debt has the potential to create fiscal risks, so efficient financial management is needed to maintain liquidity stability and long-term investment. The type of data used is secondary data in the form of financial reports. The analysis was conducted using a purposive sampling approach and panel data regression using Eviews 12 software. The results of the adjusted R2 analysis with a value of 0.540432 indicate that 54% of the variation in Capital Expenditure Allocation can be explained through the contribution of the Degree of Decentralization Ratio, Regional Financial Efficiency Ratio, and Liquidity Ratio. For future research, it is recommended to include additional independent variables and increase the number of research samples to expand the scope of the empirical analysis.

Understanding student preceptorship across healthcare disciplines: The experience of preceptors.

The globalization of trade and the rapid development of the digital economy have promoted the explosion of e-commerce through livestreaming, which stands out as the megalive phenomenon, extremely large-scale broadcasts with outstanding sales. In this context, keeping consumers in suspense (KCIS) has emerged as an essential strategy that shapes perceptions and promotes consumer behavior. However, this topic has not been fully explored. Therefore, this study aims to explore the impact of KCIS strategies, including preview fuzziness (PF), suspense setting (SS), and delight creation (DC), on impulsive buying behavior (IBB) through perceived scarcity (PS), curiosity (CU), emotional arousal (EA), and price perception (PP). A purposive sampling method was employed to collect data from 508 Vietnamese consumers. Structural equation modeling (SEM) using SmartPLS was applied for data analysis. The findings reveal that PF, SS, and DC positively influence PS, CU, and EA. In turn, PS, CU, and EA mediate the relationships between PF, SS, DC, and IBB. Furthermore, PP significantly moderates the links between CU and IBB, EA and IBB, and PS and IBB. Based on these results, the study proposes managerial implications for retailers and brands conducting business through livestreaming on e-commerce platforms to enhance the IBB of consumers in megalive sessions. It also provides theoretical insights while highlighting limitations and suggesting directions for future research.

Introduction: Nursing competence is a cornerstone of highquality patient care, yet there is limited empirical evidence from rural regions of Northeast India, particularly Meghalaya. These areas face unique systemic challenges, including workforce shortages, high patient loads and limited resources, which may further impede the delivery of effective healthcare services. Aim: To assess the level of nursing competence among nurses employed in secondary healthcare centres in the Garo Hills region of Meghalaya and to examine whether selected workplace factors predict variations in competence. Materials and Methods: A cross-sectional study was carried out in 16 Secondary Healthcare Centres (District Hospitals and Community Health Centres) across the Garo Hills region of Meghalaya, from 11th July 2023 to 19th August 2023. Using purposive sampling facilitated by Institutional gatekeepers, 226 nurses were approached, with 222 responding to the questionnaire. Data were collected using the validated Nurse Professional Competence Scale – Short Form (NPC-SF), which assesses multiple domains of nursing competence. Prior to data collection, ethical approval was obtained, and written informed consent was secured from all the participants. Descriptive statistics summarised demographic, workplace characteristics and competence data, while multiple linear regression analysis was applied to identify predictors of competence. Results: The mean overall competence score was 5.34±1.28, indicating a moderate level of nursing competence. Among the competence domains, documentation and administration of nursing care scored highest (5.51±1.27), while nursing care scored lowest (5.03±1.16). The majority of nurses (96.85%) reported working more than 50 hours a week, with 82.88% frequently involved in overtime duties. Regression analysis revealed that workplace factors such as overtime involvement and departmental distribution did not significantly predict competence {(R²=0.018, F (4,217)=0.99, p-value=0.413)}. Conclusion: Nurses in the Garo Hills, Meghalaya, demonstrated a moderate level of competence across all assessed domains. The findings suggested that nursing competence may be influenced by broader organisational, educational, and psychosocial factors not captured in the present study.