Subject Formation Research Articles

Public trust in national electronic health record systems: A scoping review of qualitative studies

Abstract Background Having public trust in national electronic health record systems (EHRs) is essential for the successful implementation of electronic health records within a country’s healthcare system. Without trust, people are less likely to consent to sharing their health data through an EHR and government stakeholders will have difficulties promoting uptake and facilitation of EHRs. Research investigating public trust in EHRs is limited, however. In response, we conducted a scoping review in order to gain clarity on the influences and themes behind public trust in EHRs, which can support the implementation of EHRs. Methods We reviewed 27 qualitative studies focusing on public trust in EHRs. Studies were identified between January 2022 and June 2022 and were ascertained using an inclusive search method and guided by the PRISMA-ScR checklist. In an iterative process, conceptual themes were derived, and detail the promoters and outcomes of public trust in EHRs. Results Three major themes that describe the promoters of public trust in EHRs and two major themes that detail the outcomes once public trust in EHRs exists were ascertained from the literature. Additional findings bring forth the consequential role of healthcare actors in the public trust building process. Conclusions Results show comprehension, autonomy, and data protection are key concepts that help build and consolidate public trust in EHRs, while the public and the healthcare system benefit from public trust in EHRs. Furthermore, health system actors can be supportive or detrimental to the implementation of EHRs. Their effect is dependent on their activities within the health care system and how the public perceives those activities. Based on: Papadopoulos K, von Wyl V, Gille F. What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021. DIGITAL HEALTH. 2024;10. doi:10.1177/20552076241228024 Key messages • This research clarifies the conceptualizations that make up the trust relationship between the public and EHRs. • The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in EHRs.

Capgras Syndrome in Dementia: A Systematic Review of Case Studies.

In an ageing population, dementia has become an imminent healthcare emergency. Capgras syndrome, the most common delusion of misidentification (DMS), is frequently found alongside dementia. Previous research showed that Capgras syndrome has significant negative effects on people living with dementia and their carers due to its complex presentation and impact on their lives. This qualitative systematic review explores the evidence base of the effective management and treatment of Capgras syndrome in dementia. As per our knowledge, this is the first systematic review exploring the symptomatology of Capgras syndrome across different types of dementia. Additionally, it aims to identify the treatments used and their efficacy. Four databases (EMBASE, MEDLINE, PsycINFO, and CINHAL) were screened in March, 2023. Twenty-six studies met the inclusion criteria and were included in the review. Thematic analysis was performed to explore and synthesise the qualitative findings of the studies. Three conceptual themes were identified: diagnostic tools, Capgras syndrome symptomatology, and Capgras syndrome treatment. Results showed that Capgras syndrome in dementia is not diagnosed and treated in a standardised manner. Following the pharmacological intervention, 28% of cases showed resolution of symptoms, and another 28% experienced improvement. However, 7% of cases reported worsening symptoms, and 10.7% experienced no change. While some patients had positive outcomes with specific medications, others either did not respond or experienced a deterioration of their condition. The results highlight that there is no single treatment approach for Capgras syndrome in people living with dementia. This underscores the need for person-centred care, where treatment is tailored to individual needs. The review also reveals a heavy reliance on antipsychotic medications and a noticeable lack of psychosocial interventions. Given the limited benefits and significant risks associated with antipsychotics, future research should prioritise developing and testing psychosocial approaches. Additionally, establishing standardised diagnostic criteria and consistent outcome measures for Capgras syndrome in dementia is crucial for evaluating treatment effectiveness and improving care.

Dialectic of the Event

This article aims to compare Gert Biesta’s, Hartmut Rosa’s and Thomas Kuhn’s perspectives on how transformative “events” emerge and become possible, and to relate their viewpoints to an educational context. The article shows how Biesta’s concept of subjectification, and Rosa’s idea of resonance, depend on viewing contemporary education as a state of status quo that is disrupted by a transformative event. Although their diagnoses of the contemporary and views on individual agency differ to some extent, Biesta and Rosa respectively place emphasis on the relationship between the subject and the world as the “space” where these events emerge. Subsequently, the article turns to Kuhn to propose another approach to understanding the dialectic of status quo and events. Through Kuhn, it is possible to introduce a more affirmative way of looking at how a state of status quo can underpin events, and how these events take place on a collective level, rather than in encounters between individual subjects and the world.

On the Subject, Purpose and Method of Religious Education as a Practical Metaphysics

The aim of this study is to discuss the possibilities of designing the current science of religious education as a practical metaphysics without excluding its objectives. The current science of religious education is a religious pedagogy in terms of the conditions that brought it into existence and its characteristics. Accordingly, religious education activities are carried out after transforming religious knowledge within the limitations of pedagogy. Pedagogy, on the other hand, depends on the paradigm of being, human being and behavior that finds its meaning in natural sciences such as physics and biology, human sciences, especially psychology, and educational sciences, which are established depending on the natural state in which modernity is formed. Religious education activities are therefore bound to a conception of the human being whose capabilities are determined. But, as a newly established discipline, religious education as religious pedagogy naturally does not possess a fully developed theoretical framework (naẓarīyat), and thus, its principles, goals, methods, and the outcomes of religious education activities have not been subjected to a critical analysis. However, education is the process of becoming human, and by taking various differences in meaning into account, it means becoming a social reality, historicizing, and becoming a subject. Religious education as a practical metaphysics which is proposed to replace religous pedagogy, maintains its critical perspective and since it deals with subjectivity and the historicization of subjectivity, pedagogy can be articulated to discourses and institutions taking into account the criteria of verification. The pedagogical approach to religion is inherently anthropological due to the requirements of its discursive characteristics. While it necessarily considers a specific religion and its tradition, it derives its principles from a spectrum of sciences, ranging from natural sciences to educational sciences. Religious education as practical metaphysics isn’t obliged to derive its principles from any specific science, as it’s founded on existence itself. Instead, it calls for the reevaluation of sciences based on potential forms of subjectivity and promotes the establishment of new scientific disciplines. The general framework and concepts adopted in this study are derived from Platonic philosophy and Foucault’s analyses. The current educational paradigm is part of the line extending from Aristotle to modern science. Traditional religious thought, represented by the sciences of the explication (bayān) has established strong links with Aristotelian thought via kalām. Plato's philosophy, on the other hand, provides a third theoretical possibility alongside Aristotelian philosophy and the discipline of kalām. Foucault's analyses on subjectivation, which refers to the socialization of individuals and consequently their historicization, theorize the allegory of the cave in Politeia, which coincides with the verse that the worldly life is play and amusement. The analysis of subjectivity enables us to perceive the human being in a holistic manner, which is reduced in the Aristotelian thought system and fragmented in the discipline of kalām, as it reveals the human existence in its most general characteristics. Religiosity in terms of identity is the primary characteristic of subjectivity. As the science of subjectivity, practical metaphysics will be able to analyze religiosity without dividing it and thus create a new basis for interpreting traditional religious sciences. The study consists of three parts in which the subject, aims and methods of religious education as a practical metaphysics are expounded. The subject of religious education as a practical metaphysics is the most general form of human existence in the world, which is subjectivity. Its purpose is to scrutinize the conditions for the formation of subjectivity and to articulate a process of subjectification integrated with pedagogy. Thus, pedagogy can be conducted in harmony with the general principles of subjectification. Practical metaphysics can use the dialectical method in terms of human relation to truth, archaeology and genealogy for the analysis of subjectivity and forms of subjectivation, and any justified method for its pedagogical dimension.

Stylistic codification of traditional forms of poetic text (based on the material of the ancient Chinese theoretical study of poetry “Shi-Ping” (诗品, “Categories of Poems”)

Abstract The study of the main works that codified the classical forms of the Chinese text is important for analysing the ways of development of poetic works and determining the formation of their stylistic norms, mechanisms, and thematic concepts. The research aims to analyse the peculiarities of the stylistic codification of ancient Chinese traditional verse forms based on the theoretical material of Zhong Rong’s “Shi-Ping” (诗品). The following methods were used: deductive, content analysis, and comparative. The research results determined that ancient Chinese poetry is known for its unique depth, sophistication, and richness of images. Zhong Rong’s treatise “Shi-Ping” influenced the formation of stylistic features of classical Chinese five-line poetry. The analysis of its textual data has shown that this anthology emphasises the importance of the poetic form, especially rhythm and melody, and provides specific recommendations for the use of iambic pentameter, which contributed to its popularisation and development. The practical significance lies in the use of the information by scholars in the fields of philology, linguistics, cultural studies, linguistics, as well as specialists who study the traditional forms of Chinese poetic text.

Understanding health-related quality of life after hypospadias repair: A qualitative study with pre-adolescent males and parents

Hypospadias is a common disease that affects approximately 1 in every 200 live male births in the United States, and long-term studies of individuals who have undergone repair demonstrate complication rates of 15%-70%. The Hypospadias-Specific Health-related Quality of Life (HRQOL) Conceptual Framework for youth and adults suggests that additional morbidity may be incurred from poor psychological, social, and sexual health. The current study sought to clarify hypospadias-specific HRQOL and care priorities in a pre-pubertal population. This IRB-approved, semi-structured interview study used rigorous qualitative research methods. Eligible patients were English-speaking 8-12-year-old males with hypospadias and their parents. Families completed a demographic questionnaire and separate youth and parent 30-min telephone interviews. We used hybrid thematic analysis to develop an operational codebook, analyze participant responses, and generate conceptual themes. Mixed methods analysis was used to explore patterns of experiences across groups defined by socioeconomic level. We interviewed 10 parents and 8 children (Median age 9 years, Range 8-11). We generated three overarching themes: Penile Factors, Psychosocial Concerns, and Expectations of Surgery and the Healthcare Team. These highest-order themes were generated for youth, parent-proxy, and parent self-reported experiences, and there were different sub-themes for each participant type (Figure). Youth were focused on avoidance of disclosure and the psychological impact of self-comparisons and embarrassment, while the parental perspective centered on worries about future fertility, complications, psychological health, and normality. Some youth and parents from disadvantaged neighborhoods or those with public insurance indicated a need for more education on normal penile functions and provision of strategies for long-term self-monitoring and facilitation of long-term follow-up on mixed methods analysis. These findings add insight into the multifaceted experiences of pre-pubertal youth and families dealing with hypospadias, and underscore the consistent, wide-ranging interplay between medical, psychological, and social concerns. Patterns in themes across socioeconomic status and insurance coverage suggest that access to information and quality care may vary significantly and could contribute to health disparities. Urologists should employ an individualized approach to counseling and care delivery. Future studies will seek to characterize care priorities in pubertal and post-pubertal age groups to design developmentally adjusted support tools for youth and adults with hypospadias and their families.

Investigating Ecocinema through the Video Essay

How can the video essay be deployed as a critical tool to analyse ecocinema and its relevance to the current environmental crisis? The Video Essay for Ecocinema course, held in the 2023 spring semester at the Academy of Architecture in Mendrisio, introduced videographic techniques to investigate the topic of ecocinema and critically analyse ecological imaginaries. A heterogeneous bibliography of texts, films and video essays related to ecocinema presented key thematic concepts, including: visualizations of ecological scale(s); the role of affect in producing environmental consciousness; materialising intangible infrastructures and hidden “grey energies”; and the digital footprint of film and media industries. These concepts in turn served as the basis for a distinct series of videographic exercises that prepared students for their final videographic project. The results demonstrate the profound value of the video essay as a pedagogical practice that can provide students with the tools to address such a challenging and multifaceted topic as the global environmental crisis.

A Comprehensive Bibliometric Analysis Content Mapping of English Language Teaching as the Second Language in Arab Countries

This bibliometric analysis maps patterns in the literature on English language teaching (ELT) in Arab countries from 2000 to 2024. and provides a quantitative mapping of the research status, trends, and developmental trajectories in this domain. A total of 512 journal articles were analyzed using scientometric techniques. Data across social science, arts, and humanities publications were retrieved from Scopus. The results establish the genesis and growth patterns, collaborative networks, influential contributors, conceptual themes, and knowledge gaps that characterize ELT research in the Arab region. Key findings show: (1) Publications grew by 24% annually, accelerating across three stages: the initial, developmental, and rapid expansion. Research has concentrated on the education and linguistics fields. (2) Saudi Arabia led to productivity, while Lebanon, Yemen, and Morocco achieved the highest citation impact. Cross-country collaboration remains limited, although it has increased in China. The most prolific authors were ELYAS and AL-AHDAL. Core journals included System and Language Learning; (3) Foundational keywords like “English language teaching” persisted prominently, while terms like “Saudi EFL learners” and “EFL writing” gained prominence, signaling rising localization. However, the integration of sociocultural dimensions is limited. This study provides empirical guidance for future research policies and strategies. This study aims to advance impactful ELT scholarship tailored to the Arab context.

Artificial Intelligence in Education: A Bibliometric Study on Its Role in Transforming Teaching and Learning

This study aimed to present a comprehensive bibliometric analysis of 1,726 academic studies from among those indexed by the Web of Science database platform between 2013 and 2023, to provide a general framework for the concept of artificial intelligence in education (AIEd). Trends in publications and citations across countries, institutions, academic journals, and authors were identified, as well as collaborations among these elements. Several bibliometric analysis techniques were applied, and for each analysis, the motivations behind the execution and method of producing findings were documented. Our findings showed that the number of studies on the concept of AIEd has increased significantly over time, with the U.S. and China being the most common countries of origin. Institutions in the U.S. stand out from those around the world. Pioneering journals in education have also emerged as prominent in the field of AIEd. On the other hand, collaboration between authors has been limited. The study was supplemented with keyword analysis to reveal thematic AIEd concepts and to reflect changing trends. For those exploring artificial intelligence in education, our insights on popular topics offer valuable guidance toward greater understanding of the latest advancements and key research areas.

Personalized Language Model Selection Through Gamified Elicitation of Contrastive Concept Preferences.

Language models are widely used for different Natural Language Processing tasks while suffering from a lack of personalization. Personalization can be achieved by, e.g., fine-tuning the model on training data that is created by the user (e.g., social media posts). Previous work shows that the acquisition of such data can be challenging. Instead of adapting the model's parameters, we thus suggest selecting a model that matches the user's mental model of different thematic concepts in language. In this article, we attempt to capture such individual language understanding of users. In this process, two challenges have to be considered. First, we need to counteract disengagement since the task of communicating one's language understanding typically encompasses repetitive and time-consuming actions. Second, we need to enable users to externalize their mental models in different contexts, considering that language use changes depending on the environment. In this article, we integrate methods of gamification into a visual analytics (VA) workflow to engage users in sharing their knowledge within various contexts. In particular, we contribute the design of a gameful VA playground called Concept Universe. During the four-phased game, the users build personalized concept descriptions by explaining given concept names through representative keywords. Based on their performance, the system reacts with constant visual, verbal, and auditory feedback. We evaluate the system in a user study with six participants, showing that users are engaged and provide more specific input when facing a virtual opponent. We use the generated concepts to make personalized language model suggestions.

Novel Framework of Financial Hardship in Childhood Cancer: Incorporating Stakeholder Perspectives.

Although financial hardship in childhood cancer contributes to poor outcomes, no standardized tool to assess its impact exists. Existing methods are heterogeneous and designed using high-income country (HIC), adult perspectives. This project aimed to construct a stakeholder-informed conceptual framework of financial hardship in childhood cancer with global relevancy. Group concept mapping, a participatory mixed-methods approach, was used. Participants were parents or caregivers of a child with cancer, childhood cancer survivors, and clinical or nonclinical support personnel, fluent in English, Spanish, or Portuguese. A representative panel established a comprehensive list of relevant items. Participants individually sorted these items into concepts and then rated each item for impact using a four-point Likert scale. Multidimensional scaling and hierarchical cluster analysis identified concepts. Descriptive statistics were calculated for impact ratings. One fourth (21/80) of participants were parents/caregivers or childhood cancer survivors. Participants worked in clinical (44/80), charity/volunteer (27/80), and other nonclinical (13/80) roles. Of the 41 represented countries, 78.0% (32) were low- and middle-income countries (LMICs). Conceptual themes spanned six distinct clusters: medical, nonmedical, assistance and support, treatment impact, family impact, and caregiver impact. These were distinct in composition compared with an existing framework for adult oncology. Caregiver impact (mean, 3.39) and treatment impact (mean, 3.29) were the highest rated clusters, and impact ratings were higher in LMICs compared with HICs. We developed a framework for financial hardship in childhood cancer that reflects the voices of stakeholders, including parents and caregivers, from diverse global contexts. The findings lay a foundation for the development and validation of tools to systematically assess financial hardship in families of children with cancer and inform effective policies and interventions.

Identifying Decisional Needs for Adult Tracheostomy and Prolonged Mechanical Ventilation Decision Making to Inform Shared Decision-Making Interventions.

Decision making for adult tracheostomy and prolonged mechanical ventilation is emotionally complex. Expectations of surrogate decision makers and physicians rarely align. Little is known about what surrogates need to make goal-concordant decisions. Currently, little is known about the decisional needs of surrogates and providers, impeding efforts to improve the decision-making process. Using a thematic analysis approach, we performed a qualitative study with semistructured interviews with surrogates of adult patients receiving mechanical ventilation (MV) being considered for tracheostomy and physicians routinely caring for patients receiving MV. Recruitment was stopped when thematic saturation was reached. We describe the decision-making process, identify core decisional needs, and map the process and needs for possible elements of a future shared decision-making tool. Forty-three participants (23 surrogates and 20 physicians) completed interviews. Hope, Lack of Knowledge Data, and Uncertainty emerged as the 3 main themes that described the decision-making process and were interconnected with one another and, at times, opposed each other. Core decisional needs included information about patient wishes, past activity/medical history, short- and long-term outcomes, and meaningful recovery. The themes were the lens through which the decisional needs were weighed. Decision making existed as a balance between surrogate emotions and understanding and physician recommendations. Tracheostomy and prolonged MV decision making is complex. Hope and Uncertainty were conceptual themes that often battled with one another. Lack of Knowledge & Data plagued both surrogates and physicians. Multiple tangible factors were identified that affected surrogate decision making and physician recommendations. Understanding this complex decision-making process has the potential to improve the information provided to surrogates and, potentially, increase the goal-concordant care and alignment of surrogate and physician expectations. Decision making for tracheostomy and prolonged mechanical ventilation is a complex interactive process between surrogate decision makers and providers.Qualitative themes of Hope, Uncertainty, and Lack of Knowledge & Data shared by both providers and surrogates were identified and described the decision-making process.Concrete decisional needs of patient wishes, past activity/medical history, short- and long-term outcomes, and meaningful recovery affected each of the larger themes and represented key information from which surrogates and providers based decisions and recommendations.The qualitative themes and decisional needs identified provide a roadmap to design a shared decision-making intervention to improve adult tracheostomy and prolonged mechanical ventilation decision making.

Variations in definitions used for describing restrictive care practices (seclusion and restraint) in adult mental health inpatient units: a systematic review and content analysis.

The main purpose of this review was to (1) identify thematic elements within definitions used by recently published literature to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inpatient units. We conducted a comprehensive literature search of six databases (Scopus, MEDLINE, PsycINFO, Web of Science, Embase, and CINAHL-Plus). In this review, we conducted content analysis to synthesize evidence to understand and compare the commonalities and discrepancies in conceptual elements that were incorporated within the definitions of different forms of restrictive care practices. A total of 95 studies that provided definitions for different forms of restrictive care practices [physical/mechanical restraint (n = 72), seclusion (n = 65) and chemical restraint (n = 19)] were included in this review. Significant variations existed in the conceptual domains presented within the applied definitions of physical/mechanical restraint, seclusion, and chemical restraint. Conceptual themes identified in this review were methods of restrictive care practice, reasons and desired outcomes, the extent of patient restriction during restrictive care practice episodes, timing (duration, frequency, and time of the day), the level of patient autonomy, and the personnel implementing these practices. Inconsistencies in the terminologies and conceptual boundaries used to describe the constructs of different forms of restrictive care practices underscore the need to move forward in endorsing consensus definitions that reflect the diverse perspectives, ensuring clarity and consistency in practice and research. This will assist in validly measuring and comparing the actual trends of restrictive care practice use across different healthcare institutions and jurisdictions.

Exploring birth experience of mothers, based on comfort theory.

To analyse the phenomenon of "giving birth" on the basis of the lived experiences of women and midwives. The qualitative study was conducted in the delivery room of a mother-friendly hospital in western Turkey from March 1 to December 30, 2019, and comprised primiparous women aged 18-35 years having a spontaneous vaginal birth, and midwives who delivered the babies. Data was collected through indepth interviews that were audiorecorded. Additionally, women's written birth stories and researcher's observation regarding the participants were used. Data was subjected to content analysis using NVIVO 12 Pro software. Of the 28 subjects 15(53.6%) were lay women with mean age 24.2±3.87 years (range: 18-30 years), and 13(46.4%) were midwives with mean age 42.61±4.50 years (range: 37-50 years). The most referred conceptual themes in Kolcaba's Theory of Comfort were "enhanced comfort", "mother-friendly hospital policy", and "midwives' comforting interventions." Under the theme of "Increasing Comfort", women cared about psychological and environmental comfort. Women had the most psychospiritual comfort and environmental comfort as well as physical and sociocultural comfort. Women cared about psychological and environmental comfort that facilitated birth. The mother-friendly hospital policy increased and contributed to the support and comfort provided to women. Kolcaba's Comfort Theory was an appropriate and working theory for birth and midwifery care, indicating that women's comfort should be ensured in the psychospiritual, environmental, physical and sociocultural contexts.

Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology.

Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.

Electronic commerce for development: a conceptual analysis and future research agenda for Africa

ABSTRACT Despite the e-commerce boom worldwide, Africa ranks last on all indicators of e-commerce readiness, indicating that it is not sufficiently benefiting from this practice's economic, social, and human development potential. This paper explores the role of research in promoting knowledge on how e-commerce can contribute to Africa’s development. It uses Jakubik’s knowledge creation theory and the scientometric perspective of knowledge diffusion to identify six main conceptual themes that characterize knowledge creation and diffusion through research on e-commerce in Africa using four different science mapping methods. Results show that knowledge created and disseminated through academic research on e-commerce in Africa is not adapted to what practitioners and policymakers need to better understand how e-commerce can promote development in Africa. We discuss six main points regarding this issue and propose recommendations for addressing them in future research.

Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students’ Learning

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners’ epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

The impact of perinatal maternal stress on the maternal and infantgut and human milk microbiomes: A scoping review protocol.

The objective of this scoping review is to review the research evidence regarding the impact of perinatal maternal stress on the maternal and infant gut and human milk microbiomes. Perinatal stress which refers to psychological stress experienced by individuals during pregnancy and the postpartum period is emerging as a public health concern. Early exposure of infants to perinatal maternal stress can potentially lead to metabolic, immune, and neurobehavioral disorders that extend into adulthood. The role of the gut and human milk microbiome in the microbiome-gut-brain axis as a mechanism of stress transfer has been previously reported. A transfer of colonised aberrant microbiota from mother to infant is proposed to predispose the infant to a pro- inflammatory microbiome with dysregulated metabolic process thereby initiating early risk of chronic diseases. The interplay of perinatal maternal stress and its relationship to the maternal and infant gut and human milk microbiome requires further systematic examination in the literature. This scoping review is an exploratory mapping review which will focus on the population of mothers and infants with the exploration of the key concepts of maternal stress and its impact on the maternal and infant gut and human milk microbiome in the context of the perinatal period. It will focus on the pregnancy and the post-natal period up to 6 months with infants who are exclusively breastfed. This study will be guided by the Joanna Briggs Institute's (JBI) methodology for scoping reviews along with use of the Prisma Scr reporting guideline. A comprehensive search will be conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO, Web of Science and Scopus. A search strategy with pre-defined inclusion and exclusion criteria will be used to retrieve peer reviewed data published in English from 2014 to present. Screening will involve a three-step process with screening tool checklists. Results will be presented in tabular and narrative summaries, covering thematic concepts and their relationships. This protocol is registered with Open Science Framework DOI 10.17605/OSF.IO/5SRMV.

Critical Adoptee Standpoint: Transnational, Transracial Adoptees as Knowledge Producers

Drawing on Asian adoptee-authored research, this article conceptualizes a critical adoptee standpoint. It underscores the significance of adoptees as knowledge producers and offers new insights into family dynamics, racialization processes, and adoptee personhood. Through three conceptual themes derived from adoptee-authored research, it illuminates the intersectional power dynamics shaping adoptees’ lived experiences and challenges traditional adoption narratives. This approach repositions adoptees as agentic subjects who have cultivated a group consciousness that transcends traditional boundaries of belonging. While focused on Asian adoptees, the essay ultimately calls for broader recognition of adoptees’ contributions to adoption discourse and a more comprehensive understanding of a critical adoptee standpoint in both academic and advocacy settings and among the broader adoptee population.

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI). This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.