ABSTRACT Following the collapse of Islamic State (IS) in 2019, the fate of IS-affiliated foreign nationals detained in northeast Syria has been the subject of intense debate. While feminist scholarship has studied gendered representations of IS affiliates, the practical implications of these constructions have yet to be explored. This article presents a qualitative feminist analysis of empirical data from practitioners, and demonstrates how gender shapes both the routes toward and the obstacles in the way of repatriation. On the one hand, gendered differentiation strategies construct women and children as vulnerable victims, creating possible avenues for their return. However, in reifying gender stereotypes, men and older boys are securitized and invisibilized, making their repatriation even more difficult. On the other hand, the recent tendency to homogenize all IS affiliates as dangerous security risks closing down avenues for repatriation, and positions advocacy organizations in a feminized role vis-à-vis the “tough” masculinist state as they argue for devalued and subordinated human rights to be respected. We conclude by arguing for the repudiation of gendered differentiation and homogenization strategies through a critical intersectional people-centered model.

Pain is a critical symptom to assess in clinical care and trials. This study aimed to explore experiences of pain in adults with myositis. Patients were strategically identified to represent different myositis-diagnosis, duration and self-reported pain. Ten adults with polymyositis (n = 5), dermatomyositis (n = 3) or antisynthetase syndrome (n = 2), six women, age range 28-71 years, median VAS pain score 59 mm (range 30-84 mm), participated in an individual, semi-structured interview. Interviews were audiotaped, transcribed and analysed by inductive qualitative content analysis. Three overarching themes emerged. The first was: 'Myositis pain-a new experience'. Myositis-related pain is unique and heterogeneous as to character, localization and duration. It can be chronic and fluctuate depending on disease activity. Adapted exercise and medical treatment can reduce pain. Activity balance and various coping strategies are keys to manage daily activities and pain. The second theme was: 'Pain impacts my life and my significant others'. Myositis-related pain impact self-perception and roles in life with additional impact on family and friends. They expressed frustration and sadness about others' inability to understand their pain. The third theme was: 'Education and support are key'. Participants emphasized the importance of knowledgeable health care providers to reduce the misinformation that myositis is a painless disease. Pain is a key symptom of myositis, impacting many aspects of daily life and varies in character, location and duration. Although pain can be treated, it may persist as a chronic symptom, often worsening during flares. Health-care professionals should recognize and address myositis-related pain early and consistently throughout the disease course.

BackgroundSex is an important part of life for many adults, yet sexual function may be impacted by chronic respiratory diseases such as pulmonary fibrosis (PF). This multinational study sought to characterise the impact of PF on sex and sexual function, using mixed quantitative and qualitative methodology.MethodsWe analysed data from a patient registry, a clinical study, an online survey and patient interviews to accomplish our objective and develop a conceptual framework for describing the effects of PF on sex-related quality of life. These cohorts used three distinct questionnaires, University of California, San Diego Shortness of Breath Questionnaire (UCSD-SOBQ), Sheffield Profile for Assessment and Referral to Care (SPARC) questionnaire, and Changes in Sexual Function Questionnaire (CSFQ), to assess sexual dysfunction, respectively. Individual patient interviews were conducted and qualitatively evaluated using thematic analysis.ResultsDyspnoea with sexual activity affected 2054/2759 (74%) of registry patients, associated with male sex, lower forced vital capacity (FVC) % predicted, lower diffusing capacity of the lung for carbon monoxide (DLCO) % predicted and worse cough. Distress due to the effect of PF on their sex life was reported in 52/225 (23%) of the clinical cohort, associated with younger age, male sex, lower DLCO % predicted and worse cough. Sexual dysfunction was common, affecting 56/67 (83%) female and 63/73 (86%) male survey respondents. Qualitative analysis of patient interviews identified several themes, including sex life limitations, changes in interpersonal relationships and quality of life. All patients wanted to discuss sex with trusted healthcare providers.ConclusionsIn this multinational study, patients with PF reported engaging in sex and sexual activities but were adversely impacted by the effect of PF on their sex life, with both physical and psychological limitations. Sexual dysfunction was common, driven by multiple disease domains. Sexual health appears to be an important component of comprehensive patient care.

ABSTRACT This exploratory study investigated motivations for using fantasy, monster, and animal-shaped sex toys through qualitative analysis of public online forum discussions. Despite growing commercial availability of these products, research on non-human sex toys remains notably absent from scholarly literature. Using thematic analysis, we identified four primary motivational themes: Seeking Novelty (pursuit of novel tactile sensations), Valuing Aesthetics Over Verisimilitude (preference for artistic design over anatomical realism), Finding Pleasure in the Taboo (arousal from perceived socially forbidden elements), and Paraphilic Harm Reduction (ethical expression of zoophilic interests). These findings extend previous research on sex toy motivations beyond conventional ‘fun’ and ‘novelty’ factors to include aesthetic considerations and harm-reduction frameworks. The preference for non-anatomical designs aligns with emerging evidence that realistic features do not predict sex toy popularity. Notably, the harm reduction theme parallels recent findings on sex doll ownership that challenge assumptions about increased risk behaviours. This study provides initial insights into a previously unexamined aspect of sexual expression and suggests these products may serve beneficial purposes beyond mere novelty. These results have important harm reduction implications for clinicians, policy makers, and front line staff who deal with human sexuality topics.

Introduction: Limited resources have caused many challenges in health care. Health workers faced dilemmas that potentially cause burnout. Medical students must be strengthened with resilience when facing dilemmas. This study aimed to investigate Indonesian students’ strategies for strengthening resilience after participating in a bioethics workshop based on reflective and collaborative principles. Methods: A bioethics workshop based on reflective and collaborative principles without didactic elements was conducted with 30 medical students. We collected quantitative data from the Adapted Version of the Adult Personal Resilience Questionnaire and qualitative data from the students’ reflections on strategies to strengthen resilience. Descriptive statistics and thematic analysis were used to analyse the quantitative and qualitative data, respectively. Results: Thirty students participated in the study. The total score of the resilience questionnaire was 4.28 (SD 0.39), indicating that the students perceived themselves as having a moderate-to-high level of resilience for all items. The following four themes from the qualitative analysis were identified: faith, adaptation, self-management, and relationships. Conclusion: Indonesian students’ strategies for strengthening resilience are related to faith, adaptation, self-management, and relationships. Although without a didactic approach, the reflective and collaborative learning in this workshop can raise medical students’ awareness of strategies for building resilience and provided an opportunity for students to reflect on their resilience level. Keywords: Resilience, Reflective Learning, Collaborative Learning, Self-Management, Relationships, Faith, Mixed-Method Approach

The importance of training healthcare providers to care for sexual and gender minority (SGM) patients is highlighted in the medical education literature; however, best practices for inclusion of this content in medical education are not well defined. The authors aimed to identify best practices for inclusion of SGM content in physician assistant (PA) education through analysis of factors related to student preparedness and incorporation of educator perceptions about best practices. This study used a mixed-methods approach. National PA program data on LGBTQ+ curricular content was collected from November 2021 to January 2022 via a survey sent to all US PA programs (n = 284) at the time. Qualitative data from expert PA educators of SGM content were collected from March 2024 to May 2024 through semi-structured focus groups. Primary outcome measures were student preparedness to care for SGM patients and expert PA educator recommendations for best practices in the delivery of SGM content in PA school. The survey response rate was 71.8% (n = 204). PA programs with LGBTQ+-knowledgeable faculty members were more likely to report having adequately or well-prepared students than programs without knowledgeable faculty (adjusted odds ratio [AOR] = 6.16). Similarly, programs teaching >3h of any type of LGBTQ+ content were more likely to report having prepared students (AOR = 5.20). Content analysis of qualitative data showed recommendations for educational strategies, student competencies, evaluation of competencies, and facilitators and challenges to integration of SGM content. Implementing best practices in medical education and increasing preparedness of students to care for SGM patients will improve access to quality healthcare for SGM individuals. Strengths include the response rate of US PA programs, rigorous methods in the qualitative analysis, and use of a conceptual model for mixed-methods analysis. Limitations include possible survey bias and the inability to directly link quantitative and qualitative responses. This study provides insight into factors associated with reported student preparedness to care for LGBTQ+ patients and identifies best practices for delivery of SGM curricular content.

Excited states of systems composed of linked fragments or stacked molecules are important for understanding their optoelectronic properties. These states, when projected to individual fragments, are either local (LEs) or charge transfer excitons (CTEs). However, the canonical molecular orbitals (CMOs) obtained from a typical calculation tend to delocalize, which makes the subsequent analysis of excited states cumbersome. In this work, we report a simple approach to address this problem by employing localized molecular orbitals (LMOs) as linear combinations of the CMOs in the occupied and virtual subspaces separately after a self-consistent field calculation. This separated linear combination ensures that configuration interaction singles (CIS), random phase approximation (RPA), and their corresponding density functional theory (DFT) counterparts [Tamm-Dancoff approximation time-dependent DFT (TDA-TDDFT) and TDDFT] calculations with LMOs are mathematically equivalent to those performed with CMOs. We performed tests on simple symmetric and asymmetric dimer systems and found that the excited states are numerically identical in excitation energies and transition moments for both LMOs and CMOs, except for very few states that are only found in either LMO or CMO (in symmetric cases). The LMO basis makes both qualitative and quantitative analyses of the excited states much more accessible, as the extent of LE and CTE contributions can be easily defined. Consequently, this simple yet robust approach can be useful for characterizing excitons in multichromophoric systems and in condensed phases, which is useful when studying problems pertaining to electron/excitation energy transfer processes.

Public-Private Partnerships (PPPs) represent a hybrid project model characterized by complex processes, particularly during the implementation phase. The success of such partnerships is heavily dependent on effective management, which is directly influenced by the managerial competencies of managers overseeing PPP projects. While structural and policy aspects of PPPs are well-studied, fewer empirical works focus on managerial competencies that specifically examine the competency requirements for effective PPP management. Understanding these competencies is critical for enhancing project outcomes and ensuring the sustainability of PPP initiatives. The objective of this study, therefore, is to identify and synthesize the competencies that have been cited in empirical literature as essential for the effective management of PPPs. Guided by the PRISMA 2020 protocol, this systematic literature review (SLR) synthesizes empirical studies published between 2020 and 2024, sourced from Scopus and Web of Science. Using automation and qualitative analysis, 15 relevant studies were identified, leading to the emergence of ten key themes across the domains of knowledge and skills. The findings reveal the interdependent nature of these competencies, with several functioning as antecedents or enablers of others. This review offers a comprehensive understanding of the core competencies required by PPP managers and organizations, thereby contributing valuable insights for both scholars and practitioners aiming to strengthen the effectiveness of PPP implementation.

This study explores the politeness strategies employed by characters in the film Shortcomings (2023), using Geoffrey Leech’s Grand Strategy of Politeness (GSP) framework. While politeness plays a crucial role in maintaining interpersonal relationships, it is often overlooked in daily interactions, especially in intercultural contexts. The film’s main character, Ben Tagawa, frequently exhibits impoliteness, highlighting the socio-pragmatic challenges of communication in diverse social settings. This study aims to address a gap in existing literature where GSP has not been widely applied to film discourse, particularly within intercultural communication. A qualitative content analysis was conducted, focusing on selected dialogues that showcase either politeness or its absence. Dialogues were purposively sampled based on their relevance to interpersonal dynamics and key emotional or conflict-driven scenes. The analyses were carried out manually, with data coded using Leech’s ten maxims to identify dominant strategies and patterns. Findings were discussed descriptively, with attention to how cultural norms and character roles shape linguistic choices. This study offers insights into the application of politeness theory in media texts, serving as a reference for scholars in pragmatics, sociolinguistics, and language education. It also aims to promote greater awareness of how politeness can enhance communication effectiveness in intercultural and social interactions.

Purpose This paper aims to introduce and theorize the concept of “complex digital bureaucracy” to explain the paradox of Qatar’s digital transformation: the coexistence of advanced digital infrastructure with persistent bureaucratic inefficiencies and limited participatory governance. Design/methodology/approach This study draws on 38 semistructured interviews with government officials, private sector representatives, third sector actors and citizens. It uses qualitative thematic analysis to examine how institutional fragmentation, legal ambiguity and restricted civic engagement constrain Qatar’s shift from e-government to integrated digital governance. Findings The findings reveal that, rather than dismantling hierarchical structures, digital systems often reproduce them by centralizing control, entrenching siloed practices and excluding third sector actors from co-production. This paper demonstrates that digital governance requires more than technological adoption; it demands structural, legal and cultural reforms. Research limitations/implications This study is limited to qualitative interviews conducted in Qatar between February and March 2025, which may constrain generalizability. While findings offer rich insights into digital governance in rentier states, they may not fully capture experiences in more pluralistic or low-capacity contexts. Future research could use comparative case studies and quantitative measures to assess whether “complex digital bureaucracy” applies across diverse political economies. Despite these limitations, this paper provides a valuable conceptual tool and highlights the need for integrated approaches to digital governance that move beyond technology-centric explanations. Practical implications For policymakers, this study underscores the necessity of addressing institutional fragmentation, clarifying legal frameworks and promoting interagency interoperability to achieve effective digital governance. Recommendations include developing unified regulatory bodies, enhancing cross-sectoral collaboration and embedding participatory mechanisms for citizens and civil society. By reframing digital transformation as an institutional rather than purely technological project, the paper provides actionable strategies for governments seeking to maximize the benefits of digital tools while avoiding the reproduction of bureaucratic inefficiencies. These insights are particularly relevant for rentier states undergoing rapid modernization. Social implications This research highlights how digital governance models shape citizen–state relations in high-capacity contexts. In Qatar, restricted civic participation and limited inclusion of third sector actors reduce opportunities for public accountability and co-production, contributing to a perception of top-down modernization. The persistence of bureaucratic silos in digital form risks reinforcing social distance between state and society, particularly among youth and civil society groups. By emphasizing participatory reform, the study suggests pathways toward more inclusive digital governance that can strengthen trust, responsiveness and social cohesion in rapidly modernizing states. Originality/value In offering a new theoretical lens and empirical evidence from a high-capacity state, the study contributes to international debates on digital bureaucracy, platform governance and rentier state modernization. The analysis highlights how digital transformation can either reinforce or reform bureaucratic power, providing lessons for digitally ambitious states seeking participatory and accountable governance.

ABSTRACT Despite an increasing academic interest in post-growth planning, empirical examples of its practical implementation remain scarce. Still, there are real-world cases from which lessons can already be learned. One of these is Wales, which is working on establishing a wellbeing economy. Although not officially labelled ‘post-growth’, this wellbeing agenda undoubtedly shares many characteristics with such an approach. This study aims to explore how the Welsh wellbeing agenda can be understood from a post-growth perspective and to what extent it has led to institutional changes in new planning directions. The study applies a combination of a qualitative content analysis of relevant planning documents and semi-structured interviews with planning officials in Wales. As a result, the study identifies several signs of institutional change, primarily at a regulative level, but also tendencies in the normative and cultural-cognitive domains. Finally, the study concludes that the Welsh planning system has taken steps in a post-growth direction, but its full realization is hindered by a range of factors, namely: an insufficient toolkit of growth-independent planning strategies, an overall lack of resources in local government, and the fact that pro-growth and post-growth are two continuously competing institutional logics.

Purpose The purpose of this study is to identify how Ethereum transforms the concepts of power, resilience and ethics in decentralized digital systems using the theories of Michel Foucault and Nassim Taleb. Design/methodology/approach The research relies on a conceptual approach that includes a literature review and qualitative analysis of key cases, such as the decentralized autonomous organizations (DAO) hack and Ethereum’s transition to the Proof of Stake mechanism. Data synthesis is carried out through the theoretical frameworks proposed by Foucault and Taleb. Findings Ethereum alters the dynamics of power through the use of smart contracts and DAO. The platform demonstrates antifragility by successfully adapting to crises and embodies the “Skin in the Game” principle through the staking mechanism. However, ethical challenges related to privacy arise, highlighting the importance of finding a balance between transparency and privacy. Research limitations/implications The research focuses exclusively on Ethereum, which limits the generalizability of the findings. Future research should consider other blockchain platforms. Social implications The work emphasizes the need to resolve the conflict between blockchain transparency and the right to privacy in the digital environment. Originality/value This work offers a new conceptual framework for studying decentralized systems by combining Foucault’s ideas on power with Taleb’s theories on antifragility and ethical participation. Special attention is given to the ethical aspects of digital governance.

Patients' Values, Perspectives, and Priorities on Outcome Domains for Persistent Spinal Pain Syndrome Type 2: A Focus Group Study.

Purpose The purpose of this research was to elucidate the adoption of Industry 4.0 (I4.0) within the shipping industry in Vietnam, where this industry plays a central role in trade and economic development. Aligned with this focus, the opportunities and challenges of I4.0 uptake, together with how companies are capitalising on its adoption, and how they evolve within the I4.0 environment were examined. Design/methodology/approach The study was based on semi-structured, open-ended, face-to-face and online interviews with 15 shipping company managers/directors. To assess the interview data, the study employed qualitative content analysis and data structure. Findings Regarding opportunities, I4.0 was mainly perceived as a channel to transform into a global virtual and productive office, increasing automation and affording seamless transactions, while staff’s limited digital capabilities and cybersecurity risks were key challenges. Increased alignment with contemporary developments in the shipping industry represented a fundamental demonstration of maximising I4.0’s potential, and achieving readiness for companies’ human resources to aim for global competitiveness was a primary form of evolution. Overall, the qualitative analysis helped craft 11 conceptual dimensions and develop a conceptual model. Originality/value This study is original and valuable, primarily in revealing conceptual dimensions that helped elucidate how shipping industry stakeholders perceived I4.0 uptake, with profound practitioner and conceptual implications. Regarding the evolution of I4.0, the importance of diversification, being customer-centric or building talent internally can inform practitioners of avenues companies should consider in their evolutionary path. The proposed framework provides conceptual directions to guide future investigations and theoretical development.

Environmental performance through sustainable innovation: The roles of ambidextrous intellectual capital and green supply networks.

Views from chief veterinary officers about decision making during animal health emergencies: A qualitative analysis.

Opinions of trainers of Warmblood, Thoroughbred and Trotter horses in Germany on the pretraining management of yearlings and two-year-old horses - a qualitative analysis.

Contributing factors of pediatric medication errors involving high-alert medications: A qualitative content analysis of self-reported medication safety incidents.

Many patients, especially those with long-term conditions, face significant challenges in managing their health. Burden of treatment is the effort required for self-managing health. This burden is often intensified by social determinants of health, such as limited access to care and financial instability. Burden of treatment is understudied in socially and medically complex patients, particularly in the critical period of transitioning home after hospital discharge. To address this gap, this study analyzed data from telephone interviews with urban primary care patients who had been recently hospitalized and were identified by an algorithm as having complex medical and social needs, and received a nurse-led outreach call intervention to examine the following areas: (a) how patients with complex health and social needs experience burden of treatment following hospitalization; (b) the individual, interpersonal, and healthcare system factors that patients perceive as impacting burden of treatment; and (c) the impact of an outreach phone call on burden of treatment. The study team completed telephone interviews with 22 patients who received the outreach call intervention, using a semi-structured interview guide based on established treatment burden measurement tools. Interview data were analyzed using rapid qualitative data analysis techniques to identify key themes to answer the research questions. Findings indicated that most participants reported minimal treatment burden across key domains, such as understanding diagnoses, scheduling appointments, managing medications, and engaging in self-care. A minority experienced substantial difficulties, such as frustration with appointment scheduling and challenges with activities of daily living due to their conditions. Several factors were identified as influencing treatment burden, including health condition complexity, family support, and provider communication. Patients generally responded positively to the outreach calls, finding them reassuring and informative. Treatment burden is variable among medically and socially complex patients following hospitalization and is shaped by a number of individual, interpersonal, and healthcare system factors. Further research is needed to develop and evaluate interventions to build healthcare system capacity to serve this population, to minimize treatment burden.

The purpose of this study was to design and elaborate a model of “teaching grammatical concepts based on simultaneous thinking” for middle school students in Iraq. The study employed a mixed exploratory design. In the qualitative phase, grounded theory was applied using the systematic approach of Strauss and Corbin. The qualitative population consisted of experts in Arabic language teaching, curriculum design, and educational psychology. Through purposeful and snowball sampling, 18 experts were interviewed until theoretical saturation was achieved (from May to November 2023). To validate the identified components and indicators, the Delphi technique was implemented in two rounds with 30 experts. The consensus criteria were defined as a mean score above 4 and a standard deviation below 1. The Kendall’s coefficient of concordance was calculated as W = 0.85, indicating a high level of agreement among experts. In the qualitative analysis, 266 open codes were extracted and organized into axial categories. The core phenomenon, “teaching grammatical concepts based on simultaneous thinking,” was explained within a paradigmatic model consisting of four clusters: causal conditions, contextual conditions, intervening conditions, strategies, and consequences. The Delphi results confirmed the content and face validity of the model’s components. In conclusion, the proposed model provides an applicable and contextually grounded framework for redesigning Arabic grammar instruction at the middle school level and can contribute to enhancing linguistic skills and developing higher-order thinking among students.