Research Design Research Articles

Impact of pediatric continuous renal replacement therapy parameters on Meropenem, Piperacillin and tazobactam pharmacokinetics: an in vitro Model

ABSTRACT Background Limited data exist on how continuous renal replacement therapy (CRRT) affects antimicrobial dosing in pediatric patients. This study examined the impact of pediatric CRRT parameters on the pharmacokinetics (PK) of meropenem, piperacillin, and tazobactam using an in vitro CRRT model. Research design and methods An in vitro CRRT model with a pediatric ST60 circuit was used to assess antimicrobial clearance during continuous veno-venous hemodialysis (CVVHD) or hemofiltration (CVVH). Antimicrobials were administered intermittently or continuously, with samples taken pre- and post-filter, and from the effluent. The model tested two conditions: 1) off treatment (0 mL/kg/h), and 2) an elimination phase with CRRT flow rates ranging from 40 to 400 mL/kg/h. Results Clearance of meropenem, piperacillin, and tazobactam increased significantly with higher dialyzate/ultrafiltration flow rates (p < 0.001). Median clearance rates differed significantly by CRRT flow rates and modality (p < 0.001). Under CVVHD, the saturation coefficient (Sa) decreased with increasing dialyzate flow rates, while under CVVH, the sieving coefficient (Sc) remained stable regardless of ultrafiltration rates. Conclusions The clearance of low protein-binding, low molecular weight antimicrobials increases with higher CRRT effluent flow rates, with modality-specific differences in clearance dynamics.

Assessment of distributions and gender difference in adverse events related to faricimab: a real-world study based on FDA adverse event reporting system

ABSTRACT Background Faricimab is a novel bispecific antibody drug for treating retinal disease. We aim to study the adverse events of faricimab based on the FDA Adverse Event Reporting System (FAERS) database. Research design and methods The FAERS data from 2020 to 2024 was extracted to conduct disproportionality analysis. The risk signals were mined by using reporting odds ratio (ROR) and proportional reporting ratio (PRR). Results A total of 1401 cases with adverse events were reported. Eye disorders were the most frequent AEs. New ocular AEs were identified, such as diplopia, metamorphopsia, blindness transient, visual field defect, subretinal fibrosis. New non-ocular AEs were also found such as cellulitis, acute respiratory failure, end stage renal disease, proteinuria, nephropathy, VIth nerve paralysis, and deafness. It was found that there is a difference between men and women on the ocular adverse events. Adverse events happened in the initial month of the treatment, but mostly happened between the 91 to180 days. Conclusions Faricimab have ocular and non-ocular adverse events, in which some ocular adverse events differ across genders. Important potential adverse events should be considered in the clinical practice to provide better individualized treatment.

Up for Debate: Does Regular Physical Activity Really Improve Mental Health?

Physical activity is frequently touted as beneficial for mental health. This paper, based on a 2023 ACSM colloquium, highlights key strengths and limitations of the evidence regarding physical activity and mental health from three perspectives: epidemiological studies, randomized controlled trial experiments, and investigations that explicitly consider the potential role that contextual factors, such as the social climate in which physical activity is completed, can play in physical activity-mental health interactions. A large body of epidemiological evidence supports that regular leisure time physical activity is associated with less depression and anxiety. Higher amounts of physical activity are often associated with fewer depressive symptoms, but there may be a dose-response point where for some people more is not better but can plateau or even worsen. Epidemiological evidence is emerging but currently inadequate to support associations between mental health and occupational, transportation/active commuting or domestic/household physical activity types. A large body of randomized controlled trials, typically small, short duration and conducted with samples biased toward middle-to-higher socioeconomic status Whites, supports that the adoption of regular exercise improves aspects of mental health; however, the mechanisms are unclear and for those without mental disorders the mean effects are small. Mental health benefits of exercise may be partially a placebo response or result from contextual factors surrounding exercise. A small body of evidence supports that contextual elements, such as the program implementation quality and social environment, can influence the mental health outcomes associated with physical activity programs, but the evidence is currently inadequate to identify which contextual variables have consistent moderate or larger effects. Greater progress will be made in this area when research designs are expanded to include consideration of the potential influence of contextual factors on relationships between physical activity and mental health.

Embracing the complexity of lived experiences in psychiatry research: Reflexivity, cultural sensitivity, and emergent design

This article examines the critical integration of reflexivity, cultural sensitivity, and emergent design in qualitative psychiatry research focused on lived experiences. While quantitative methods offer essential clinical insights, qualitative approaches provide a deeper understanding of the emotional, psychological, and social dimensions of mental health. Reflexivity enables researchers to remain aware of how their personal biases and professional backgrounds shape data interpretation. Cultural sensitivity ensures that mental health conditions are understood within their broader cultural contexts, helping avoid misrepresentation and promoting authentic participant expression. Emergent design offers flexibility in adapting the research process to evolving themes, particularly in the dynamic and multifaceted realm of psychiatric conditions. Together, these principles promote ethically sound, participant-centered research that captures the full complexity of lived experiences. The article also highlighted the practical implications of these principles for enhancing both academic knowledge and clinical practice in psychiatry.

Use of videoconferencing in audit committee–auditor communication during the COVID-19 pandemic: evidence from Korea

Purpose The purpose of this study is to examine whether the use of videoconferencing for communication between the audit committee (AC) and auditors affects the quality of client firms’ audits. Design/methodology/approach This paper analyzes the mandatory disclosure information on AC–auditors communication using 1,065 Korean listed firm-years for the fiscal years 2020 and 2021. The details of AC–auditor communication (i.e. the extent of firms’ use of videoconferencing) are manually collected from audit reports. Findings This study finds that videoconferencing has a negative impact on audit quality, suggesting that it is not an effective communication medium between AC and auditors. The results are robust to alternative research designs (e.g. entropy-balanced sample, propensity score matching analysis and change analysis) that address endogeneity concerns. This study also finds that while the negative effect of videoconferencing is mitigated by holding more frequent AC meetings, neither AC independence nor expertise mitigates this effect. Research limitations/implications This paper suggests that videoconferencing may affect audit quality by hurting the discussion between the AC and auditors. Practical implications The findings that videoconferencing impairs the effectiveness of ACs and thus lowers audit quality have practical implications as the COVID-19 pandemic has significantly changed how AC members and auditors interact. This study offers timely and valuable insights into the potential implications of these pandemic-induced changes on audit environments. Originality/value This study provides large-sample empirical evidence that directly examines the effect of videoconferencing on audit quality, enhancing the understanding of the communication dynamics between the AC and auditors. This study also contributes to the literature on the role of ACs in emerging markets by highlighting the information processing role of the AC.

The power of subjectivity in CLIL assessment: evidence of cognitive/emotional dissonance

ABSTRACT Since CLIL assessment is not immune to subjectivity, this exploratory study seeks to understand and make sense of the emerging cognitive/emotional dissonance episodes (confluence of contradictory thoughts and conflicting emotions) resulting from current CLIL assessment practices from content teachers’ perspective. Based on a narrative qualitative research design, a thematic content analysis was employed for the qualitative data collected through open-ended questions. Findings indeed provided empirical evidence of cognitive/emotional dissonance episodes faced by CLIL teachers when assessing and grading their learners’ academic achievement. Among the main reasons behind such cognitive/emotional dissonance expressions are the complexity of content and language integration and the mediating role of the target language in content acquisition, which may constrain students’ ability to demonstrate or express their actual content subject knowledge, as evidenced by the concerns, fears, self-doubts, dilemmas, uncertainties, contradictions, insecurities, pressures and emotional vulnerability faced by CLIL teachers in assessing and grading bilingual learners’ academic achievement. Findings also suggest the need to consider such dissonance episodes in their complex and dynamic interactions with the surrounding environment. The main implication that emerges from the study is that CLIL teacher education must mediate and encourage reflective practice, helping pre- and in-service teachers manage such cognitive/emotional challenges appropriately.

Dimensions and Subcategories of Digital Maturity in General Practice: Qualitative Study.

The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework. The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice. An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH). In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice. The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed.

Analysis of sustainable development goals in university foundational documents

Purpose Higher education institutions play a pivotal role in addressing global challenges and cultivating responsible, sustainable practices among future leaders and professionals. However, some institutions emphasize actions without fully integrating the United Nations Sustainable Development Goals (SDGs) into their foundational documents. This study aims to actively examine the extent to which universities in both developed and developing countries incorporate SDGs into their foundational documents. The investigation assesses the presence and articulation of SDGs, representing a crucial step toward fostering a culture of sustainability within universities. This is essential for promoting environmentally responsible behavior, ethical leadership and social awareness among students and young scientists, benefiting both society and the planet. Design/methodology/approach The authors employed a descriptive-comparative research design, conducting content analysis to ascertain the integration of SDGs within foundational documents of universities in both developed and developing countries. The authors selected academic documents from 12 countries and established keywords for each SDG to identify references. Statistical analyses, which included frequency tables, along with qualitative analysis, highlighted the similarities and differences among the documents. Findings The analysis of universities’ foundational documents revealed significant insights into the integration of the SDGs. Notably, SDG 4 (Quality Education) emerged as the most frequently mentioned goal, appearing in a substantial 66.7% of the documents, while SDG 16 (Peace, Justice and Strong Institutions) followed closely at 50.8%. In contrast, SDG 14 (Life Below Water) and SDG 2 (Zero Hunger) received minimal attention and were notably missing in the documents. Furthermore, the research highlighted varying degrees of SDG integration in different types of documents, with strategic plans exhibiting a presence rate of 28%, while codes of ethics lagged behind at 11.3%. Qualitative analysis further revealed an intriguing dichotomy: universities in developed countries provided detailed insights into their SDG initiatives, while those in developing countries mentioned the goals without delving into specific actions. Originality/value These findings underscore the imperative for a more consistent and robust commitment to sustainability and ethical leadership within higher education institutions. This is particularly crucial for universities in developing nations, as it fosters environmentally responsible behavior and social awareness among students, faculty, staff and university leaders, benefiting both society and the planet.

Occupational therapy embedded in early childhood education (OTEEC): Developing a population-focused, place-based approach to early intervention through occupational therapy and early childhood education center partnerships

ABSTRACT Occupational therapy practices supporting population health are emphasized in the American Occupational Therapy Association’s Vision 2025 statement, yet limited examples of how practitioner’s design, construct, and evaluate health promotion practices exist in the literature. This manuscript describes how occupational therapy providers collaborated with early childhood education administrators, teachers, and parents to create a novel approach to supporting young children’s development and learning called the Occupational Therapy Embedded in Early Childhood Education (OTEEC) Partnership Model. Educational design research informed how the OTEEC Partnership Model was developed and refined via the integration of scientific inquiry within the context of program development. We completed literature reviews, conducted in-depth interviews with key decision-makers, hosted stakeholder focus groups, and engaged in critical reflection as an occupational therapy provider team to arrive at the foundational principles and unique practices of the OTEEC Partnership Model. Early childhood education center administrators, teachers, and parents believed the strengths of the OTEEC Partnership Model included universal access to an occupational therapy provider, collaborative partnerships with teachers and parents, and integrating occupational therapy practices within an early childhood classroom context. Occupational therapy providers can use the procedures described in this manuscript to develop innovative practices focused on population health and may consider if elevating their own classroom involvement, interprofessional collaboration, and partnerships with parents can enhance their current practices. Occupational therapists may also consider how to create new access pathways for children who might benefit from occupational therapy yet do not qualify for services within current practice guidelines.

An Integrative Review of Specialised Nursing Career Frameworks to Develop a Nursing Career Framework for Registered Nurses Working in Aged Care.

The aim of this study is to synthesise literature on specialised nursing career frameworks to inform the development of an aged care nursing career framework. An integrative review was conducted. The review followed Whittemore and Knafl's five-step integrative review method. To appraise the quality of the studies, the Quality Appraisal for Diverse Studies tool for peer-reviewed articles and the ACCODS (Authority, Accuracy, Coverage, Objectivity, Date, and Significance) checklist for grey literature were used. Data were extracted and synthesised using the constant comparison method. The electronic databases of CINAHL, Medline, PsycINFO and Google Scholar were searched to identify peer-reviewed articles and grey literature reporting on specialised nursing career frameworks for registered nurses. Eight studies were reviewed, and the findings were presented corresponding to each of the three research questions of the review. First, the research methods adopted to develop specialised nursing career frameworks were described based on the research design, stakeholder involvement and data collection methods. Second, the key elements of specialised nursing career frameworks were identified as career pathways, nursing competencies and roles and progression between the career levels. Third, the findings suggested that the key purposes for developing specialised nursing career frameworks are to improve professional development, recruitment and retention and to promote consistency and quality in nursing practice. The study highlights a significant gap in the evidence base of career frameworks for registered nurses in aged care, emphasising the need for future research. This review answered three research questions: methods for developing specialised nursing career frameworks, their key components and main purposes, providing insights to guide healthcare organisations and researchers. The findings indicate that career frameworks are primarily intended to promote knowledge and skills development and may also to bolster recruitment and retention rates, and support nurses' career advancement, but there is limited evidence on implementation, evaluation and sustainability. The findings will guide healthcare organisations and future researchers with methods and techniques to develop specialised nursing career frameworks. Implementing a specialised nursing career framework in aged care could enhance continuous professional development, recruitment, retention and career progression among nurses. Nursing career frameworks have been widely applied to address professional development and retention objectives. However, there is limited evidence available to formulate a career framework for registered nurses working in aged care. The review identified the research methods adopted to develop specialised nursing career frameworks along with the key elements of specialised nursing career frameworks. These findings will guide employers and future researchers in developing evidence-based aged-care nursing career frameworks. Additionally, the findings will guide registered nurses in using career frameworks as a tool to facilitate career advancement and competency development. Furthermore, the review recognised the key purposes for developing specialised nursing career frameworks, suggesting that the meaningful adoption of career frameworks could be utilised as a strategic approach for enhancing retention and workforce development of the aged care workforce. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used for reporting. No patient or public contribution. The integrative review protocol was registered in the PROSPERO international prospective register of systematic reviews database (registration no: CRD42022354728).

Considerations When Measuring Exclusive Breastfeeding.

Exclusive breastfeeding, as recommended by the World Health Organization (WHO) for the first 6 months of life, is a critical metric for evaluating maternal and infant feeding practices and health outcomes. Despite its importance, inconsistencies in defining and measuring breastfeeding exclusivity present challenges for research comparability and interpretation. Equally, research design, outcomes of interest, and study resources are necessary considerations when collecting and analyzing exclusive breastfeeding data, and may require the adaption of standardized questions and techniques to individual situations. This paper explores key considerations for researchers when operationalizing and measuring exclusive breastfeeding. We address the nuances of point prevalence and since-birth measures, highlighting their influence on study outcomes and data interpretation. Statistical approaches for analyzing exclusivity data, including logistic regression, survival analysis, and Kaplan-Meier methods, are also discussed. By outlining best practices for precise definitions, tailored data collection, and transparent reporting, this paper aims to provide an overview for precise definition, effective data collection, and clear interpretation.

Cost-effectiveness of bivalent respiratory syncytial virus prefusion F vaccine for prevention of respiratory syncytial virus among older adults in Germany

ABSTRACT Introduction Among older adults, lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is common. We evaluated the cost-effectiveness of bivalent RSV prefusion F protein-based vaccine (RSVpreF) for prevention of RSV-LRTI among older adults in Germany. Research design and methods A static cohort model was developed to estimate lifetime health and economic outcomes of RSV-LRTI among adults aged 60–99 years in Germany, with (vs. without) use of RSVpreF. Vaccine uptake ranged from 27% to 54%. Vaccine effectiveness was derived from trial data and was assumed to last over 3 years, with some waning, following vaccination. Base case analyses were conducted from the societal perspective (costs/benefits discounted 3% annually); sensitivity analyses also were conducted. Results Among adults aged 60–99 years (N = 25.3 M), RSVpreF prevented 117,360 cases of hospitalized RSV-LRTI, 100,433 cases of ambulatory RSV-LRTI, and 9,298 RSV-LRTI-related deaths over a lifetime horizon. With total overall costs higher by 1.8 € billion and 49,576 quality-adjusted life-years (QALYs) gained, cost-effectiveness of RSVpreF was 36,064 €/QALY. In probabilistic sensitivity analyses, the mean cost-effectiveness ratio was 36,518 €/QALY; 925 of 1,000 replications yielded ratios <50,000 €/QALY. Conclusions RSVpreF has the potential to greatly reduce the public health and economic burden of RSV among older adults in Germany.

A real‑world pharmacovigilance study of raloxifene based on the FDA adverse event reporting system (FAERS)

ABSTRACT Background Raloxifene was approved for the treatment of postmenopausal osteoporosis; however, its safety profile remains inadequately understood. This study aimed to evaluate the safety signals associated with raloxifene. Research design and methods Adverse events (AEs) related to raloxifene, spanning from the first quarter of 2004 to the fourth quarter of 2023, were extracted from the FDA Adverse Event Reporting System (FAERS) database. A disproportionality analysis was conducted using several methods, including the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayes Geometric Mean (EBGM). Results The analysis yielded 7 229 reports related to raloxifene across 19 277 AEs. A total of 217 significantly disproportionate signals were identified, including muscle spasms and hot flashes. Notably, the study also uncovered novel AEs, including eye conditions like cataracts and macular degeneration, as well as gynecological issues like uterine polyps and hemorrhage. Additionally, the analysis confirmed that pulmonary embolism and deep vein thrombosis were the two most prevalent thromboembolic AEs. Conclusion Our study reaffirmed some existing safety information regarding raloxifene while also unveiling novel risk signals. The findings provided crucial insights to enhance the rational use of the drug and inform safety regulatory strategies.

A qualitative study exploring stakeholders’ perceptions of registry-based randomised controlled trials capacity and capability in Australia

BackgroundTraditional randomised controlled trials (RCTs) are the gold standard for evaluating the effectiveness of interventions in clinical research. Traditional RCTs however are complex, expensive and have low external validity. Registry-based randomised controlled trials (RRCTs) are an emerging alternative approach that integrates the internal validity of a traditional RCT with the external validity of a clinical registry by recruiting more real-world patients and leveraging an existing registry platform for data collection. As RRCTs are a novel research design, there is limited understanding of the RRCT landscape in Australia. This qualitative study aims to explore the RRCT landscape in Australia including current capacity and capabilities, and to identify challenges and opportunities for conducting RRCTs.MethodsWe conducted 30 semi-structured interviews with 18 clinician researchers, 6 research program managers and 6 research governance officers. Interviews were audio-recorded and transcribed verbatim. We analysed the data using thematic analysis.ResultsWe identified four overarching themes: (1) understanding of the RRCT methodology concept and knowledge of Australian clinical registries and RRCT landscape; (2) enablers and barriers in the uptake and conduct of RRCTs; (3) ethics and governance requirements impacting the conduct of RRCTs and (4) recommendations for the promotion, support and implementation of RRCTs. Understanding of and ability to define an RRCT varied considerably amongst participants, as did their appreciation of the role the registry should play in supporting these trials. Lack of ongoing funding to support both registries and RRCTs, along with low awareness and minimal education around this methodology, were identified as the predominant barriers to the uptake of RRCTs in Australia. The simplicity of RRCTs, specifically their pragmatic nature and lower costs, was identified as one of their best attributes. There was consensus that inadequate funding, onerous research governance requirements and poor awareness of this methodology were currently prohibitive in enticing clinicians and researchers to conduct RRCTs. Recommendations to improve the uptake of RRCTs included establishing a sustainable funding model for both registries and RRCTs, harmonising governance requirements across jurisdictions and increasing awareness of RRCTs through education initiatives.ConclusionsRRCTs in Australia are an evolving methodology with slow but steady uptake across a number of clinical disciplines. Whilst RRCTs are increasingly identified as a beneficial alternative methodology to evaluate and improve current standards of care, several barriers to effective RRCT implementation were identified. Creating greater awareness of the benefits of RRCTs across a number of stakeholders to help secure ongoing funding and addressing both registry and RRCT governance challenges are two essential steps in enhancing the uptake of RRCTs in Australia and internationally.

Economic evaluation of childhood pneumococcal conjugate vaccination programs in Qinghai and Hainan provinces, China

ABSTRACT Background The burden of pneumococcal disease varies regionally in China, particularly affecting children in Qinghai and Hainan. Nevertheless, absence of pneumococcal conjugate vaccine (PCV) in the National Immunization Program (NIP) or local programs presents limited coverage. This study evaluated the health and economic impact of including PCV in immunization programs in Qinghai and Hainan. Research design and methods A decision tree Markov model was constructed to simulate health outcomes and lifetime costs among children under different 13-valent PCV (PCV13) vaccination strategies compared to current practices, from societal and healthcare perspectives. Data on epidemiology, vaccine efficacy, cost, and utility were obtained from literature or open databases. Sensitivity analyses were conducted to explore parameter uncertainty. Results Including three-dose PCV13 in provincial programs at NIP coverage (98.91%) could avert 7100 episodes and 118 deaths in Qinghai, and 6200 episodes and 66 deaths in Hainan. It was cost-effective at the $68.2/dose in private market and cost-saving at the United Nations Children’s Fund (UNICEF) recommended $25/dose for both provinces. Increasing coverage to 50% or 75% was also cost-effective. Sensitivity analyses confirmed results robustness despite parameter uncertainty. Conclusions Prioritizing PCV13 in immunization programs in Qinghai and Hainan could effectively reduce disease burden, improve population health, and promote health equity.

Commitment and Quiet Quitting: A Qualitative Longitudinal Study

ABSTRACTRecently scholars across a range of fields have noted the importance of the issue of quiet quitting in term of both pervasiveness and profundity of impact. Our study views quiet quitting as employees intentionally opting actively to manage their work/working lives to adhere to contracted duties/hours while avoiding voluntarily taking on additional responsibilities, tasks, or roles. To date, almost universally, existing studies assume that quiet quitting is a single, monolithic, homogenous phenomenon which relentlessly generates ‘bad’ outcomes for firms and ‘good’ outcomes for perpetrators. This current study addresses these important assumptions with a key aim of our research is to supply grounded evidence of the nature of quiet quitting and to examine the outcomes of such actions for perpetrators' longitudinally. To facilitate this, we adopt the concept of commitment as our conceptual lens for explicating how employees' quiet quitting is manifested and utilize a longitudinal, qualitative research design to gauge outcomes. After outlining existing research in the area, we detail our research design and methodology, before presenting the insights gained during data collection and analysis. Our paper concludes with a discussion of a series of contributions to both theory and practice.

Re-examining cognitive load measures in real-worldlearning: Evidence from both subjective and neurophysiological data.

Cognitive load theory is widely used in educational research and instructional design, which relies heavily on conceptual constructs and measurement instruments of cognitive load. Due to its implicit nature, cognitive load is usually measured by other related instruments, such as commonly-used self-report scales of mental effort or task difficulty. However, these concepts are different in nature, as they emphasize distinct perspectives on cognitive processing. In addition, real-world learning is more complex than simplified experimental conditions. Simply assuming that these variables will change in a monotonic way with workload may be misleading. This study aims to examine whether these measures are consistent with each other, and to discover the neurophysiological basis underlying the potential discrepancy. The study collected data in both a real-world (Study 1, 22 high school students in 13 math classes) and a laboratory setting (Study 2, 30 students in 6 lab-based math tasks). In addition to self-report measures, the study also collected multimodal neurophysiological data, such as electroencephalography (EEG), electrodermal activity (EDA), and photoplethysmography (PPG). The results show that although the difficulty level can be perceived with difficulty ratings, it does not lead to the corresponding level of mental effort. Only within an appropriate level of load, can we observe a positive correlation between self-report difficulty and mental effort. Neurophysiological evidence also supports the conceptual discrepancies and group differences, indicating distinct neurophysiological mechanisms underlying these 'similar' constructs. These findings also emphasize the need for combining these concepts to better evaluate students' cognitive load.

Healthcare Providers' Experiences With and Perspective on Delivering the Enhanced Recovery After Elective Caesarean Birth Pathway With Next-Day Discharge: Qualitative Analysis.

To understand the perspectives and experiences of healthcare providers who have experience working with an enhanced recovery care after elective caesarean birth pathway with next-day discharge and home midwifery. This study applies a qualitative study design with a pragmatic realist approach. The realist framework was used while also taking a post-positivist philosophy. The work was conducted in South Australia, Australia between May and October 2019. Twenty-three semi-structured interviews were completed with 5 doctors and 18 midwives who had occupational experience working with the pathway. Interviews were analysed using following the six-phase qualitative thematic analysis process outlined by Braun and Clarke. COREQ guidelines were followed. Four main themes and 11 sub-themes were identified. Main themes identified were as follows: The pathway is more than just early discharge; experiences with the process; staff engagement with the pathway; and the impact of the pathway within the health system. Healthcare providers generally accepted the pathway and found enhanced recovery care to be a positive and beneficial model of care. Staff identified five main challenges with implementing the pathway: early discharge; eligible women's automatic inclusion on the pathway; engaging women; change for staff and organisational constraints and procedures. Elements that support integration include the following: education for women; reassurance and communication with women and families; prepared care and supports including home midwifery; staff education and communication of the evidence; clear guidelines and protocols; defined staff roles; enough clinical time and clinical flexibility. Knowledge from staff in this study would be useful for other health services to consider when looking to deliver similar models of care. The health service and health providers were involved with the initiation and development of the research aims and design.

Engagement in research: doctoral students’ reasons for not engaging in research activities in universities in Cameroon

ABSTRACT Due to the fact that doctoral education is a research-based learning and socialization experience, all doctoral students are expected to engage in research activities. This study focused on determining factors doctoral students perceived to be hindering their engagement in research activities to propose appropriate recommendations for improvement. An exploratory case study research design was used based on a qualitative methodology. A semi-structured interview guide was used to collect data. The data collected was analyzed thematically. The study offers several contributions to theory and practice. The study extends the understanding and applicability of Maslow’s hierarchy of needs theory by using it to identify the factors hindering doctoral students from engaging in research activities in Cameroonian universities. This study found that factors doctoral students perceive to be hindering their engagement in research activities include inadequate financial assistance, lack of extrinsic motivation to engage in research, inadequate research facilities, lack of support from research supervisors and inadequate research method expertise. Implications are given to enhance doctoral students’ engagement in research.

Prevalence and correlates of post-traumatic stress disorder and depression among welfare- and justice-involved adolescents in Nigeria

ABSTRACT Background: Childhood maltreatment (CM) is higher among welfare- and justice-involved youth than in those not involved in these systems, which increases the risk of depression and post-traumatic stress disorder (PTSD). However, the mechanisms underlying the link between CM and these two psychiatric conditions are less well understood among at-risk populations in low- and middle-income countries. Objective: This study attempts to fill this gap by examining the prevalence of and risk factors for depression and PTSD among at-risk groups in Nigeria. Method: A cross-sectional research design using multistage sampling was adopted. The sample comprised 205 adolescents: justice-involved [102 (49.8%)] and welfare-involved [103 (50.2%)]. In total, 151 (73.7%) were males, while 54 (26.3%) were females. Multivariate logistic regression analysis and multivariate analysis of variance were applied. Results: The results showed that 66.1% of welfare-involved adolescents and 69.6% of justice-involved adolescents reported PTSD, while 68.9% of welfare-involved adolescents and 75.5% of justice-detained adolescents reported depression. Neglect (OR = 0.253; 95% CI 0.146–0.571; p < .001) and witnessing violence (OR = 0.230; 95% CI 0.114–0.597; p < .004) predicted depression. Emotional abuse (OR = 0.186; 95% CI 0.090–0.80; p < .015), witnessing violence (OR = 0.147; 95% CI 0.014–0.876; p < .043), neglect (OR = 0.187; 95% CI 0.14–0.90; p < .008), and physical abuse (OR = 0.27; 95% CI 0.254–0.937; p < .001) predicted PTSD. Also, PTSD significantly differed based on type of placement (F = 6.08, p < .014, η 2 = .029), but depression did not differ based on type of placement (F = 2.46, p > .118, η 2 = .012). Conclusions: CM profiles are risk factors in PTSD and depression among at-risk groups. CM screening should be included in mental health services of out-of-home placements to prevent the cycle of mental health problems and reoffending. Trauma-focused and cognitive–behavioural therapies have the potential to alleviate the suffering of traumatized adolescents.