Qualitative Phase Research Articles

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

BackgroundChildren at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years.MethodsThis was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID.ResultsOf the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1.ConclusionThe Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.

Building a narcissism-based framework of picnics: An eastern culture perspective

Through the lens of narcissism theory, this study investigates and analyzes the recent trend of picnics in China with the following primary research objectives: (1) What are the patterns, attitudes, and motivations for picnics in China? (2) How the picnic experience shapes picnickers' attitudes and behaviors based on narcissism theory. A mixed-methods approach was conducted for this study, with 17 respondents participating in in-depth semi-structured interviews and 383 questionnaire respondents invited to participate. A theoretical framework was developed based on the findings of the qualitative phase and related literature. Subsequent quantitative results further verified that self-expression, self-presentation, and conspicuousness are three key narcissism-based motives for the picnic experience. Additionally, curiosity plays a moderating role that influences how self-expression, self-presentation, and conspicuousness drive perceived flow during picnics. The major contribution of this study is the construction of a theoretical framework that understands picnicking motives and processes as an overlooked tourism domain. Management implicationsThis study explored the picnic phenomenon in China and examined its implications from a management perspective. It was identified that picnicking in the Chinese context differs significantly from the western perspective. In Eastern cultures, picnics are conspicuous activities and lifestyles where the presentation of decorations and delicacies takes precedence over the picnic food itself. Therefore, destinations and stakeholders catering to Chinese picnickers should emphasize how they can assist picnickers in showcasing their uniqueness and self-presentation. This distinction has crucial management implications, highlighting the need to focus on the aesthetic and social aspects of picnicking to cater effectively to Chinese picnickers.

The role of leisure activities in enhancing well-being in Saudi’s retired community: a mixed methods study

This mixed-methods study delves into the impact of leisure activities on the well-being of retirees in Saudi Arabia, focusing on health, emotional balance, social integration, and self-fulfillment. In the quantitative phase, 545 retirees were selected through a snowball sampling, providing a diverse sample of age, gender, socio-economic status, and educational background. Data were collected using a structured questionnaire and analyzed using SPSS. The qualitative phase involved randomly selecting 23 participants from the initial cohort for semi-structured interviews, with the data subjected to thematic analysis for deeper insights. Findings revealed a moderate overall enhancement in well-being attributed to leisure activities, with health benefits being most significantly improved. Emotional and social well-being showed moderate enhancements, while self-fulfillment benefits were less pronounced. Demographic variations were evident, with gender, socio-economic status, and education level influencing the perceived benefits. Qualitatively, the importance of cultural alignment in leisure activities was highlighted, underscoring their role in social connectivity and personal development. The study underscores the need for culturally sensitive and accessible leisure programs tailored to the varied needs of the retired population in Saudi Arabia. It provides crucial insights for policymakers and community planners, emphasizing the importance of demographic considerations in leisure interventions to improve retirees’ quality of life. This research contributes significantly to understanding leisure’s role in enhancing post-retirement well-being, offering a comprehensive perspective for future leisure-related initiatives and policies.

A mixed-method approach on the glass cliff phenomenon: a case of public sector service organizations in Iran

PurposeThis study aims to develop and test a model of the antecedents, mediators and consequences of the glass cliff phenomenon through public sector service organizations in Iran to explore more insights on gender inequality in managerial positions.Design/methodology/approachThe current research was conducted based on a mixed-method approach, using both qualitative and quantitative research designs. First, the qualitative method includes content analysis by conducting semi-structured interviews with 20 university professors and expert managers working in public sector service organizations in Iran. The outcomes of the qualitative phase lead to designing the conceptual framework and research hypothesis. Then, through a quantitative phase, 384 female managers working in public sector service organizations in Iran are selected using stratified random sampling and fill out the research questionnaire. The exploratory factor analysis was used to verify the model. Moreover, structural equation modeling, using AMOS 24, was used to test the research hypothesis.FindingsThe findings of the qualitative phase were represented in three categories including antecedents (e.g. the characteristics of women’s leadership, the selection of women based on meritocracy criteria, women’s preferences and organizational factors), mediation effect (e.g. succession planning, personal development planning and support networks) and consequences of the glass cliff phenomenon (e.g. positive and negative consequences). The results of the exploratory factor analysis show there are ten components, explaining 88.5% of variances. Moreover, the test of the structural model supports the direct effect of antecedents on the glass cliff phenomenon. The results also show the effect of the glass cliff phenomenon on consequences through mediation effects.Research limitations/implicationsThere are some limitations that can be addressed by other researchers. Accordingly, the limited number of female managers in Iran prevented larger quantitative research. Moreover, the current research only found casual and mediation consequences of the glass cliff phenomenon, and potential moderators were not considered in this study.Originality/valueThe present study’s innovations may include using a mixed-method approach to investigate the antecedents, mediators and consequences of the glass cliff phenomenon in this study and examining the model constructs in some public sector service organizations. This research may provide a deep understanding of the antecedents, mediators and consequences of the glass cliff phenomenon by finding new factors using a mixed-method approach.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. This study investigated how social connectedness is associated with patient outcomes in a HaH program. The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. The quantitative phase included 100 patients (18years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

A Concurrent Analysis of Drug Relapse Risk, Drug Avoidance Self-Efficacy, and Aftercare Experiences among Aftercare Program Clients

The cases of drug use and abuse have predominantly increased globally. This issue has become the most significant challenge among mental health professionals, the national government, and the general population. With the absence of substantial research about drug relapse and avoidance in the Philippines, this mixed-method research seeks to find out the relationship between drug relapse risk and drug avoidance self-efficacy among substance users who participated in the aftercare program. This study employed a concurrent mixed method design, combining both quantitative and qualitative approaches. In the quantitative phase, the Advance Warning of Relapse (AWARE) Questionnaire and Drug Avoidance Self-Efficacy Scale (DASES) were administered to 66 participants from the Aftercare Program (ACP) at the Department of Health Treatment and Rehabilitation Center in Eastern Visayas. The aim was to establish a correlation between the risk of drug relapse and drug avoidance self-efficacy. In the qualitative phase, interviews were conducted with five participants who met the study's inclusion criteria. Purposive sampling was used to select these participants. Quantitative findings revealed that ACP clients had low drug relapse risk and high drug avoidance self-efficacy. Moreover, Pearson product-moment correlation shows an inverse relationship between lower drug relapse risk and high drug avoidance self-efficacy, and vice-versa. However, the correlation between these variables is weak, indicating that drug avoidance self-efficacy is not a strong predictor of relapse risk in aftercare program clients. Similarly, qualitative results exposed the client’s experiences in the After Care Program. Six themes emerge from their experiences, such as their various reasons for taking the drugs, the effects of substance use, their effective coping mechanisms, the treatment of their communities, their accomplishment of recovery goals, and overcoming challenges in their recovery. The study suggests that individuals who participate in the aftercare programs are trying their best to recover and increase their self-efficacy to avoid using drugs. This strong self-efficacy, in combination with various factors such as family support, the acceptance of the community, and continued reminders of the consequences of substance abuse, decreased their vulnerability to use drugs in high-risk situations. The findings will increase the awareness of Filipinos in the prevention and treatment of substance use among their loved ones, relatives, and friends. Likewise, the findings recommend improving the aftercare program to increase its effectiveness and efficiency in preventing relapse among individuals in recovery.

Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis.

Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.

Superfluid transition of a ferromagnetic Bose gas

The strongly ferromagnetic spin-1 Bose-Einstein condensate has recently been realized with atomic Li7. It was predicted that a strong ferromagnetic interaction can drive the normal gas into a magnetized phase at a temperature above the superfluid transition, and Li7 likely satisfies the criterion. We reexamine this theoretical proposal employing the two-particle-irreducible effective potential, and conclude that there exists no stable normal magnetized phase for a dilute ferromagnetic Bose gas. For Li7, we predict that the normal gas undergoes a joint first-order transition and jumps directly into a state with finite condensate density and magnetization. We estimate the size of the first-order jump and examine how a partial spin polarization in the initial sample affects the first-order transition. We propose a qualitative phase diagram at fixed temperature for the trapped gas. Published by the American Physical Society 2024

Exploring the typology of reasoning influencing university teachers’ language teaching and learning strategies

Despite the critical role of reasoning in shaping language teaching and learning strategies in higher education, prior studies have either separately examined reasoning or focused on one specific type thereof and language teaching and learning strategies. To address this gap, this study took a comprehensive approach by examining various types of reasoning in language instruction and their alignment with language teaching strategies in higher education. It adopted a sequential mixed-methods design through two phases of data collection. The study instruments included a mixed-method questionnaire, interviews, classroom observations, and document analysis. The quantitative phase collected data from 357 university teachers of Arabic-language disciplines at the university level who completed a mixed-methods questionnaire using a 5-point Likert scale and brief written explanation. Exploratory factor analysis, descriptive and inferential analysis of variance and the Scheffé test were used to analyse the quantitative data. In the follow-up qualitative phase, 20 university teachers from the quantitative phase were observed in the classroom and interviewed, and their document tasks were analysed using thematic analysis. The results unveiled four distinct typologies of university teachers’ reasoning closely aligned with their language teaching and learning strategies: inductive, abductive, analogical, and deductive reasoning. Notably, these typologies were associated with cognitive, metacognitive, interactional, and Knowledge strategies. Furthermore, the findings highlighted the intricate interplay and mixture of these typologies, indicating that university teachers do not rely solely on one type or strategy. Finally, the conclusion section outlines critical areas for future research concerning reasoning and language teaching and learning strategies in higher education.

Abstract PO1-18-01: Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment

Abstract Objectives: Factors that influence treatment preferences of patients with hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) are being investigated using discrete choice experiment (DCE) methodology. Appropriate attributes for the ongoing quantitative online survey phase were identified by this initial qualitative pilot study. Methods: To generate hypotheses and inform variables of the quantitative survey, the pilot phase consisted in online telephone interviews with patients with a diagnosis of Stage IV HR+/HER2- breast cancer at various stages of treatment. Interviews focused on exploring patients' perspectives on their interaction with physicians, preferences, and treatment experiences. Transcripts were coded using NVivo software to identify key themes. The ongoing DCE online survey aims to recruit patients meeting the same selection criteria as in the qualitative phase, also at various stages of treatment. Results: Fifteen mBC patients (median age, 43 years [range, 29-64]), including nine chemotherapy-treated and six without chemotherapy exposure, were enrolled in the pilot qualitative study. Eight and four patients reported receiving little information about their treatment plan and their risk status beyond the risk of relapse, respectively. Most participants did not know what to expect from their therapy but expressed trust in their physician’s decision in terms of treatment goals. Few patients (n=3) looked for a second opinion before starting treatment. Four out of fifteen patients declared that they were actively involved in their treatment plan decision, although all relied on their physician’s knowledge and decision. Reduced symptoms and improved quality of life (QoL) were patients’ main treatment goals, and side-effects and efficacy of treatment were their main concerns. When asked about the degree of acceptability of certain side effects, some participants considered hair loss and vomiting as unacceptable side effects, regardless of severity, while others considered them to be the most acceptable. This discrepancy is to be interpreted in the light of participants’ own treatment journey. Severity and duration of side-effects were mentioned by three patients as acceptability factors. In a choice task, patients were asked to express preferences between two hypothetical treatments. Efficacy (n=9) and administration mode (n=6) were spontaneously deemed important for treatment selection. While assessing the difference in risk between the two hypothetical treatments, ten patients explained that the main choice feature was extended progression-free survival (PFS) rate. Risk of infection and neutropenia (n=12) were concerns expressed by most patients in the post-COVID-19 period. Considering their substantial impact on QoL, alopecia (n=9) and vomiting (n=9) were presented by patients as particularly important, regardless of their degree of severity; whereas almost all patients reported that only severe fatigue (n=12), diarrhea (n=13) or nausea (n=13) would be an issue. These results allowed selection of the following attributes for further quantification of their preference weights in a DCE: PFS, risk of neutropenia, risk of alopecia, risk of vomiting, risk of diarrhea, risk of grade 3/4 side effects and mode of administration. Conclusions: This qualitative pilot study allowed for identification of what matters most to patients when selecting a treatment for mBC, which will be further assessed in the DCE. It also highlighted the need of patients with HR+/HER2- mBC for information about their treatment, potential side-effects, and health management. This research suggests that there is a need for patients to be more involved in treatment plans, and that taking patient preferences into account may help improve the treatment selection experiences. Citation Format: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron. Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-01.

Optimizing sports development: Identifying and prioritizing key indicators for professional and competitive sports

This study aimed to analyze the impact of professional and competitive sports on overall sports development, with a specific focus on identifying and prioritizing key indicators influencing sports development in these domains. To achieve this objective, a mixed-methods approach was employed, combining qualitative interviews and quantitative surveys. During the qualitative phase, experts were interviewed to determine the critical indicators for each component, while the quantitative phase involved surveys of sports managers and professors to collect data on the identified indicators. The findings of the study revealed that talent identification emerged as the foremost priority for competitive sports, underscoring its crucial role in fostering success in this realm. On the other hand, organizational effectiveness was identified as a critical factor for professional sports development. The quantitative results obtained provided empirical evidence that supported and reinforced the qualitative insights derived from the study. In the context of competitive sports, the study identified the development of systematic talent identification and youth nurturing platforms as the most vital requirement. Conversely, in the professional sports sector, enhancing organizational capabilities, governance, and commercial strategies were recognized as the top priorities. These results serve to emphasize the necessity for tailored strategies, investments, and policies that are specifically designed to enhance organizational effectiveness in professional sports and maximize talent identification in competitive sports. The evidence-based understanding of sports development priorities gained from this study holds the potential to foster a vibrant sporting culture that encompasses both grassroots participation and elite achievements.

Abstract PO2-22-11: 'A sledgehammer to crack a nut' or 'the safer option'? Understanding decision making for and against oncoplastic breast conserving surgery as an alternative to mastectomy in women with early breast cancer: The UK ANTHEM study

Abstract Background: Oncoplastic breast conserving surgery (OPBCS) may allow women with breast cancer to avoid mastectomy, but many women continue to choose more extensive surgery even when breast conserving options are offered. Reasons for women’s procedure choices are unclear. The UK prospective multicentre ANTHEM study (ISRCTN18238549) aimed to explore the feasibility of undertaking a large-scale multicentre study comparing the clinical and patient-reported outcomes of OPBCS as an alternative to mastectomy in women offered both options. The qualitative phase of the study aimed to use semi-structured interviews to explore women’s perceptions of choice and to understand factors influencing decision making for and against OPBCS in early breast cancer. Methods: Women offered OPBCS as an alternative to mastectomy were eligible to participate in the ANTHEM study. Participants underwent their surgical procedure of choice and were followed up for 12 months. Semi-structured interviews were conducted with a purposive sample of women who elected to undergo either OPBCS or mastectomy with or without immediate breast reconstruction (IBR) at multiple UK centres to explore perceptions of choice, rationale for decision-making, and factors influencing procedure choice. Thematic analysis was used to explore the qualitative interview data. Sampling, data collection and analysis were undertaken concurrently and iteratively until data saturation was achieved. Results: Twenty-seven women from 12 UK breast units were interviewed. Of these, 12 elected to have OPBCS with volume displacement (n=7) or replacement procedures (n=5) and 15 chose mastectomy with (n=10) or without (n=5) IBR. Overwhelmingly, women’s decisions were guided by their surgical teams and their understanding and interpretation of the information they received from them. Indeed, although provision of choice was a pre-requisite for study entry, almost a third of women didn’t feel they had been offered meaningful choice as their surgeon recommended either OPBCS or mastectomy for them. Several women described how choice was unexpected as they had automatically assumed that they would need a mastectomy and expressed delight at being offered OPBCS as an alternative. Having choice and needing to make a decision about surgery, however, was a difficult experience for some women who reported finding the process challenging. Decision-making for and against OPBCS was underpinned by women’s perceptions of three key inter-related factors based on the information they received from their surgical teams: i) the effectiveness of OPBCS at removing all the cancer; ii) perceived longer term oncological safety and iii) practical issues. Almost all women described concerns about whether all the cancer would be removed by OPBCS, the need for further surgery for involved surgical margins and anxieties about cancer recurrence over time. Women who felt reassured that OPBCS was oncologically safe were happy to accept this option. Women who remained very anxious about incomplete excision and cancer recurrence were more likely to opt for mastectomy as a ‘safer’ option. Practical issues such as the perceived magnitude of the surgery and duration of the recovery were also important with many women choosing OPBCS as a less invasive or radical option than mastectomy. While many women described preferring to keep their breast and maintaining their femininity, only a minority of women referred to the cosmetic benefits of OPBCS as influencing their decision-making. Conclusions: Women’s decision-making for OPBCS vs mastectomy for breast cancer is complex and heavily influenced by the attitudes and beliefs of their surgical team. Adequate, high-quality, accurate information about surgical options including appropriate reassurance about the short- and long-term oncological safety of OPBCS is vital if women are to make fully informed decisions and feel confident avoiding mastectomy if this is an option for them. Citation Format: Charlotte Davies, Carmel Conefrey, Nicola Mills, Patricia Fairbrother, Chris Holcombe, Lisa Whisker, Joanna Skillman, Paul White, Douglas MacMillan, Charles Comins, William Hollingworth, Shelley Potter. 'A sledgehammer to crack a nut' or 'the safer option'? Understanding decision making for and against oncoplastic breast conserving surgery as an alternative to mastectomy in women with early breast cancer: The UK ANTHEM study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-11.

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 to 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.

Implementation and evaluation of the WHO maternity care model: a convergent parallel mixed-methods study protocol.

According to the World Health Organization (WHO), intrapartum care is considered a platform for providing respectful, personalized, and women-centered services to women. This study aims to investigate the intrapartum care model proposed by WHO. This convergent parallel mixed-methods study will be carried out in qualitative and quantitative phases. In the quantitative phase (a quasi-experimental study), 108 pregnant women admitted to the maternity ward will be randomized to intervention (receiving intrapartum care based on the WHO model) and control group (receiving routine hospital care) before the beginning of the active stage of labor (cervix dilatation equal to 5 cm) and Wijma's delivery fear scale (DFS) will be completed for them and again at 7-8 cm dilatation. The participants of both groups will be followed up for 6 weeks after labor and then they will be invited to a relatively quiet place to complete the Childbirth Experience Questionnaire (CEQ 2.0), the Edinburgh Postpartum Depression Scale (EPDS), the Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS-I), the Pregnancy and Childbirth Questionnaire (PCQ), exclusive breastfeeding and a checklist on willingness to give birth to another child. The qualitative phase will employ content analysis to explain mothers' views about the effects of this model especially subjective components of this model on their labor process after 4-6 weeks. The two phase's results will be discussed in combination. The implementation of such care models is expected to prevent mental disorders caused by negative experiences of childbirth, and also, prevent uncontrolled increases in cesarean sections. https://fa.irct.ir/user/trial/68313/view, identifier (IRCT20120718010324N69).

Evaluating the World Health Organization's SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study.

Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. RR2-10.2196/39393.

Multidecadal Phase Changes in the Thermodynamic State of the System: Ocean–Atmosphere–Continent

The present-day climate (the recent 100–150 years) obviously constitutes the structure of a global intra-system rhythmic process with an individual rhythm of about 60 years. In turn, each of the rhythms is presented by the two climate phases of about 25–35 years characterized by qualitative differences: one phase is relatively continental, while the other is humid. Globality and quasi-synchronism of environmental changes are accompanied by planetary structures: the Global Atmospheric Oscillation (GAO) in the atmosphere and the Multidecadal Oscillation of the Heat content in the Ocean (MOHO) discovered relatively recently. Unexpected and rapid qualitative phase changes in the climate, which first focused attention in the mid-1970s of the last century, were titled “climate shifts”. The revealed features of the present-day climate are of exceptional scientific and practical interest and deserve the development of methods for predicting the timing of the forthcoming climate shift. Arising unexpectedly and accompanied by rapid significant changes, these shifts identified the problem of understanding the nature and establishing the processes and mechanisms causing them. First of all, of interest are phase changes in the thermodynamic state of the climate system components: the ocean, atmosphere, and continents. As a result of the World Ocean (WO) thermohydrodynamics numerical modelling, it is shown that MOHO is localized in the layer of the main thermocline, where the most important elements of the WO circulation are located. The performed study based on observational data allows us to conclude that, during the phase of the WO thermal discharge (1975–1999), the two key systems of currents, the Kuroshio and the Gulf Stream, were under similar thermodynamic conditions.

From Specialised Classrooms to Mainstream Classrooms: A Study on the Inclusion of Students with Special Educational Needs from the Voices of Their Mainstream Peers

The modalities of schooling and the educational measures for students with special educational needs (SENs) are postulated as important aspects within the field of study of inclusive education. The general objective of this research is to analyse the processes, through the voice of their peers, for the inclusion of students with SENs enrolled in specialised classrooms (SCs) in mainstream centres in Spain when they attend mainstream classrooms (MCs). The design of the research is mixed (QUAN-Qual), non-experimental, and descriptive. The participants in the quantitative phase were 2649 peers from MCs that have students enrolled in the SCs, and the participants in the qualitative phase were 57 students from MCs. A questionnaire designed ad hoc was used for collecting the quantitative information and discussion groups for the qualitative information. This study shows the barriers and facilitators towards the inclusion of students in the SU within mainstream centres or classrooms. Among the facilitators which stand out is the wish of classmates from mainstream classrooms to share times, spaces, and activities with their classmates with SENs from the SU. Among the barriers highlighted by a large number of students in the MCs are the fact that they do not participate in group activities with their peers with SENs and that the latter do not usually participate in common activities developed at the centre (like celebrations or excursions).

Leveraging Data and Artificial Intelligence for Innovative Educational Management Practices

This study explores the impact and implementation of data and artificial intelligence (AI) in educational management through a mixed-methods approach, combining quantitative and qualitative analyses. The quantitative phase involved surveying teachers, administrators, and students from the Yappi Makassar School of Administrative Sciences to gauge the use and effectiveness of data and AI in educational management. The qualitative phase included in-depth interviews and focus group discussions with selected stakeholders to understand their experiences, perceptions, and challenges with integrating data and AI into educational management practices. Results indicate a general positivity towards the integration of data and AI, with 70% of educators and administrators reporting improved efficiency in curriculum development and administrative tasks. However, only 50% of students noted a significant enhancement in their learning experience. Key themes emerged from qualitative analysis, highlighting the acceptance and adaptation of technology, the barriers to full integration, such as infrastructure and resistance to change, and the critical balance between technology use and human interaction in learning. The study concludes that while data and AI hold substantial promise for revolutionizing educational management, significant challenges remain. Addressing these challenges requires investments in technology infrastructure, comprehensive training programs for staff, and pedagogical strategies that effectively integrate technology with human-centered teaching methods. The research underlines the need for further investigation into overcoming these barriers to maximize the benefits of data and AI in education.

Development and psychometric properties of appraisals of post traumatic spinal cord injury health scale in Iran.

Development and psychometrics study OBJECTIVE: To evaluate the reliability and validity of a new version of Appraisals of Post-Traumatic Spinal Cord Injury Health Scale (APTSCIHS) in the Persian language for persons with spinal cord injury (SCI). The persons were selected from National Spinal Cord Injury Registry of Iran (NSCIR-IR) and Brain and Spinal Cord Injury Research center (BASIR). This was a mixed sequential exploratory study that performed in two phases. In the qualitative phase, a systematic scoping review and 12 interviews with the participants were done. Finally, items were generated. In the quantitative phase, face, content, construct and convergent validity were assessed to evaluate validity. To evaluate construct validity, a cross-sectional study was conducted on 305 persons with TSCI along with internal consistency and stability assessments. All quantitative data analyses were conducted using SPSS 22 software. The content validity and reliability were indicated by Scale's Content Validity Ratio (S-CVR) = 0.73 and Scale's Content Validity Index (S-CVI) = 0.86, Cronbach's α = 0.9 and the Test re-test reliability using intra-class correlations were (ICC) = 0.97 to 0.98. Exploratory factor analysis determined eight factors which showed more than 52% of the variance. APTSCIHS had a significant and strong correlation with Appraisals of DisAbility Primary and Secondary Scale (ADAPSS) (r = 0.475, P < 0.001). Results showed the 36 items APTSCIHS tool had an acceptable validity and reliability in Iran, and it can help health care providers or even administrators improve the quality of the rehabilitation services and quality of life.

Contribution of the Pilot Study for Methodological Enrichment of the Main Study

Introduction: A Pilot Study (PS) is useful for the assessment of the practicability of the methods and processes as well as the management of challenges before the main final study. The PS was conducted for the preparation of the mixed-method study related to nurses’ and parents’ perspectives regarding preterm infants’ care practice in neonatal care units (NCUs) in Nepal. Methods: Mixed method PS was conducted among nurses and mothers of preterm infants (PTIs) admitted to a NCU of an academic tertiary hospital. For data collection among nurses, a self-administered questionnaire and focus group discussion (FGD) were used in the quantitative and qualitative phases respectively. Whereas in-person interviews and in-depth interviews (IDIs) were conducted among mothers in the quantitative and qualitative phases respectively. Data were analyzed using descriptive statistics and content analysis methods. Results: The major amendments based on PS findings were the study design from convergent parallel to exploratory sequential mixed-method design for contextual instrument development, the addition of the observation method of data collection for enhancing the validity of the findings related to care practice, and the inclusion of both parents of PTIs instead of only mothers. The PS was also useful for providing the experience of qualitative and mixed-method study for the researcher for the final study, especially for the qualitative part. Conclusion: This article reflects the contribution of the PS to the main mixed-method study. Therefore, it is worthy to conduct the PS to enhance the methodological rigor of the study. It is commendable to discuss and disseminate the PS findings.