The Positivism Paradigm of Research

Exploring the complexities of slum vulnerability in Haryana, India: a qualitative research journey into economic, social, physical, and health dimensions

PURPOSE

The study explores the conditions contributing to slum dweller's vulnerability to poor health and examines interplay between economic, physical/infrastructural, and social factors affecting health status to inform policy and programme.

METHODS

The methodology deployed for data analysis was mixed deductive-inductive. A deductive framework was adapted for categorizing the data into four broad themes: Economic, Physical/Infrastructure, Social, and Health. Using Braun and Clarke's principle, we also mapped sub themes based on researchers' insights with the experiences shared by the slum populations. The study was conducted across 13 districts in slum areas to gather information from vulnerable groups based on the 40 focus group discussions.

FINDINGS

Poverty serves as a primary driver of domestic/internal migration from rural to urban areas, aggravating issues such as illiteracy, unemployment, and inadequate living conditions, which predispose slum dwellers to various health problems. Limited access to food, poor water quality, and improper waste disposal further compound health risks. People living in slums face economic, social, and physical vulnerabilities leading to health vulnerability and outcome.

CONCLUSIONS

Enhancing the health and well-being of slum dwellers requires adopting an integrated and comprehensive approach of policy intervention, community mobilization, and multisectoral intervention.

Gamified Exercise in Virtual Reality: A Novel Intervention for Enhancing Mental Health and Reducing Suicidal Ideation in Older Adults

Background: Suicide is a major issue among individuals aged 60 and above, often linked to reduced life motivation and life expectancy. Innovative interventions are needed, and this study explores the impact of gamified Virtual Reality (VR) exercise on improving life expectancy in older adults with suicidal ideation. Methods: A quasi-experimental design with pre-test and post-test evaluations was conducted on 72 older men recruited through convenience sampling. A standardized life expectancy questionnaire was used. Due to heterogeneous variances, ANCOVA was deemed inappropriate, and a Shapiro-Wilk test was performed to assess normality. A parametric Student's t-test was used to analyze group differences. Results: The experimental group showed significantly higher life expectancy compared to the control group (t (58.219) = -26.693, p < 0.001), confirming the intervention's effectiveness. Conclusions: Gamified VR exercise improves motivation and adherence to physical activity, significantly enhancing life expectancy among older adults with suicidal ideation. This non-pharmacological approach also holds promise for managing other psychological disorders and expanding research in this field.

Genetic Counselors' attitudes & perceptions regarding suicide risk assessment and identification in practice

While the heritability of suicidal tendencies is debated, receipt of various genetic diagnoses has shown an increased risk of suicidal ideation and behavior while simultaneously conferring risk to mental health concerns that may further increase this risk. However, the role of genetic counselors (GCs) in assessing and addressing suicide risk remains underutilized. A 15-item recruitment survey was distributed via the National Society of Genetic Counselors Student Research Survey Listserv, and interested individuals could opt to be contacted for an interview after completion. The data analysis included 107 survey responses and 15 semi-structured interviews, which were conducted to explore whether GCs feel that formal suicide risk assessment (SRA) falls within their scope of practice and the frequency with which it is employed during counseling sessions. Additionally, the study examined GCs' experiences, comfort levels, and training in assessing for suicide risk. All interviews were transcribed verbatim and independently coded by two researchers. The coding scheme was systematically constructed, integrating both deductive and inductive coding methods to inform the authors' interpretive description of SRA in the clinic, with four major themes identified by content analysis. Most respondents reported that they had worried about a patient harming themselves or having suicidal thoughts. Most respondents agreed or strongly agreed that SRA is within a GC's scope of practice. Lack of training emerged as the primary barrier to assessing suicide risk and conducting risk assessments. Other barriers included low self-efficacy, societal stigma, and personal discomfort, while access to social workers, natural inclination, and standardized screening tools served as facilitators. Despite encountering patients at risk of self-harm and suicide, most GCs do not utilize SRA tools. Furthermore, GCs expressed a strong desire for additional training to enhance their skills in identifying and managing at-risk patients. A multifocal approach to suicide risk reduction and education is required.

A review of trends in health professions education research at the turn of three decades (2000, 2010, and 2020)

INTRODUCTION

Health professions education research has evolved as a discipline, yet chronological trends in topics and methodologies together have not been comprehensively explored previously. This study aimed to identify the trends in research topics and methodologies used in primary empirical studies published in reputable health professions education research journals at the turn of three decades (2000, 2010, and 2020).

METHODS

Underpinned by relativism and subjectivism, this review of trends included primary empirical studies published in five quartile 1 health professions education research journals, defined by Clarivate (Academic Medicine, Advances in Health Sciences Education, Medical Education, Medical Teacher, and Nurse Education Today) from three sample years at the start of three decades (2000, 2010, and 2020). Each study was coded for demographics (e.g., country of origin), topic area, and methodological approach, including philosophical positioning, study design, and methods. Data were analysed descriptively.

RESULTS

A total of 1126 empirical studies were published across the three time-points, with the majority from North American and European countries. More papers were published in recent years, with publications doubling in 2020 (n = 488) compared with 2000 (n = 223). Effective teaching methods were the most researched topic, whereas teaching and learning of Indigenous health received the least priority consistently across the three time-periods. Over half of the methodologies were quantitative, followed by qualitative, and mixed methods. The use of qualitative methodologies and the reporting of philosophical positioning (mostly in qualitative studies) have gradually increased over the three time-points. Many studies, however, still fail to report key markers of methodological quality.

DISCUSSION

Despite positive trends in health professions education research (more studies, multi-institutional research, and balanced methodological approaches), our review of trends identified notable issues (e.g., limited country diversity, missing criteria for methodological quality, and less-diverse research topics). We therefore encourage greater consideration of the role of journals in shaping the future, quality of output reporting, and gaps in the literature; thereby diversifying what and how we research health professions education.

Why participatory plant research now?

In the current polycrisis era, plant science, particularly when applied to agronomy, becomes instrumental: because our main substantial and renewable resource is plant biomass, many future solutions will depend on our ability to grow and transform plant material in a sustainable way. This also questions the way we conduct plant research and thus quantitative plant biology. In response to the increasing polarization between science and society, participatory plant research offers a pertinent framework. Far from moving away from quantitative approaches, participatory plant research builds on complexity associated with biology and situated knowledge. When researchers and citizens work together on societal issues, such friction becomes more fertile, quantitative questions become more complex, societal issues are addressed at their roots and outcomes often exceed that of top-down strategies. This article serves as an introduction to this ongoing bifurcation in plant science, using plant breeding as a key example.

A multicenter cross-sectional survey of the role of community pharmacists, attitudes, and perceptions in preventing and controlling cardiovascular diseases

BACKGROUND

Cardiovascular diseases are a leading cause of mortality globally and impose suffering and economic difficulties, particularly in low- and middle-income countries. Community pharmacists present an opportunity for effective prevention and control of cardiovascular diseases. The overarching aim of the study was to evaluate factors associated with the extent of involvement, barriers and facilitators, and perceptions of Lesotho community pharmacists in preventing and controlling cardiovascular diseases.

METHODS

The study utilised a quantitative cross-sectional survey. A semi-structured questionnaire was distributed to licensed community pharmacists across four districts between March and July 2023. Parametric and non-parametric tests were performed for data analysis using a Statistical Package for Social Sciences version 26.

RESULTS

Apart from medicine dispensing, community pharmacists were mostly involved in hypertension (mean = 4.38±.73) and diabetes (mean = 4.17±.91) screening, weight management advice (mean = 3.81±.87), disease education (mean = 3.93±.83), medication management therapy (mean = 3.74±.99, 3.81±.88), referral of and follow up on patients (mean = 3.70±.98 and 3.87±.92). There was a significant association between the extent of involvement and pharmacy location, experience of community pharmacists, availability of tools, number of patients seen daily, and presence of other healthcare professionals at a community pharmacy (p<0.05). The most common barriers were related to patient factors (>75% agree to strongly agree), such as lack of awareness of community pharmacists' services. Community pharmacists possessed positive (mean >3) attitudes and perceptions regarding their role in cardiovascular disease management.

CONCLUSIONS

Besides dispensing medicine, community pharmacists had varying extent of involvement in health promotion activities. The provision of these services differed between socio-demographic groups. Community pharmacists possessed good knowledge, positive attitudes towards their cardiovascular disease management role. Thus, they can improve cardiovascular disease outcomes. However, the barriers potentially limit their scope of practice and encourage inconsistent community pharmacy services. The findings present pertinent information to policy-makers, regulators, and pharmacists that can inform the development of frameworks to improve clinical and pharmacy practice in Lesotho and low- and middle-income countries.

"You're not taught to think about the words you use and then it just perpetuates"- a qualitative examination of medical students' perspectives of stigmatising language in healthcare

BACKGROUND

Stigmatising language is used commonly in healthcare, affecting healthcare providers' perceptions of patients and care delivery. Using person-first language is best practice, however, it does not reflect reality.

METHOD

This study examined medical students' perspectives on stigmatising language in healthcare. Twenty-one medical students at the RCSI University of Medicine and Health Sciences participated in four focus group interviews; a thematic analysis of the data was conducted.

RESULTS

Seven themes were identified: prevalence of stigmatising language, its impact on students and patients, being sensitive versus medically accurate, evolving nature of recommendations for language use, barriers to changing practice, power dynamics and cultural context influencing language use, stigmatising language being a societal issue. Participants provided recommendations for improving language use in healthcare: open discussions and student feedback on language in the learning environment, lecturers signposting person-first language, training workshops on person-first language for clinicians and lecturers, and social intelligence skills training.

CONCLUSION

Study findings highlight the impact of stigmatising language in healthcare. To address this issue and inform guidance for future generations of professionals, medical students recommended more open dialogue and improved social intelligence.

Quality appraisal of household recycling influences research found evidence was mostly insufficient for drawing conclusions

Research on recycling behaviour and its influences is critical to supporting public policy efforts to mitigate the negative effects of waste. However, recent reviews have raised concerns about the quality of recycling research. Despite this, no previous reviews have conducted quality appraisals. This is partly because validated appraisal tools have typically been developed for intervention reviews in the health/medicine fields, creating difficulties applying to behaviour influence reviews in environmental fields. This update of a previous systematic review aims to fill this gap. We developed and piloted a novel quality appraisal framework tailored to interdisciplinary reviews of influences on recycling behaviours. Application of the novel framework to 118 recycling papers highlighted a lack of strongly-rated evidence, particularly for causal claims and operationalisation of behaviour. Specifically, over 80% of papers contained insufficient causal evidence, while 90% contained insufficient or cautious evidence of influence on actual behaviour. Only four papers (1%) produced strong evidence across both measures, allowing compelling confidence in their conclusions. Lack of quality evidence undermines the ability of remaining papers (and the body of literature as a whole) to draw strong conclusions about what factors have causal influence on actual recycling behaviour. This has implications for how well the field can guide interventions to improve recycling outcomes. To strengthen future research, this review identifies feasible instances of better practice to increase quality of evidence. Implementing such recommendations could increase the field's confidence in what influences household recycling. The quality appraisal framework may also be of interest for other pro-environmental behaviours.

Public and participant involvement as a pathway to inclusive dementia research

The field of Alzheimer's disease and related dementias (ADRD) urgently requires inclusive research to ensure the priorities and outcomes of research apply to those most impacted. We postulate public and participant involvement (PPI) as a pathway to achieving the best science, both in research that informs health and social policy as well as in therapeutic studies to treat and prevent ADRD. This position paper aims to provide dementia researchers with evidence to understand how to apply PPI. We begin by highlighting the disparities experienced by people with dementia, including ageism, stigma of cognitive impairment, and health disparities for minoritized communities. We then provide examples of PPI in ADRD across the research lifecycle, from defining research topics of priority to those impacted by ADRD, through the design, analysis, dissemination, and translation to policy and practice. We also provide recommendations to create and maintain collaboration between researchers and communities through PPI. HIGHLIGHTS: A central premise of public and participant involvement (PPI) is collaborative relationships between researchers and community members. To build equitable partnerships, researchers must acknowledge and understand the context of research. This includes ageism, the stigma of dementia, and ongoing discrimination for many minoritized communities. Meaningful partnerships include choice, respect, shared decision making, access, inclusion, and representation. Notably, we recommend that researchers begin partnerships early in the research process and share the impact of PPI on research.

How the interplay of monitoring-enabled digital technologies and human factors facilitates or hinders metro systems' resilient response to operational disruptions

The metro is susceptible to disruption risks and requires a system response capability to build resilience to manage disruptions. Achieving such resilient response state requires readiness in both the technology side, e.g., utilizing digital technologies (DTs) to monitor system components, and the human factors side, e.g., fostering positive human coping capabilities; however, these two sides are usually considered independently, without sufficient integration. This paper aims to develop and empirically test a model in which monitoring-enabled DTs, employees' reactions, and their positive capabilities are simultaneously considered in terms of their interplay and impact on system response capability. The results showed that while DTs for monitoring physical components enhanced perceived management commitment and fostered collective efficacy, DTs for monitoring human components increased psychological strain and inhibited improvisation capability, creating a "double-edged sword" effect on system response capability. Additionally, explicit management commitment buffered the adverse effect of DTs-induced psychological strain on individual improvisation.

Shaping minds and hearts in medical education: Embedding and implementing a personal and professional development curriculum

This paper explores personal and professional development (PPD) as a key learning domain for the future of medical education and person-centered care. Guided by existing curriculum development models and lessons learned in practice, scenarios from academic and clinical learning environments will guide a theory-driven discussion of concepts and competencies that humanize the practice of medicine, such as emotional intelligence, professional identity formation, lifelong learning and inclusive practice. Factors contributing to contemporary curriculum implementation will be informed by a case study of a PPD program delivered to post-graduate medical students in Australia and propose an action-focused series of next steps to connect past, current and future directions for medical schools and graduates. Through reflections on iterative stages of program development and the incorporation of emerging concepts in PPD, this paper advocates for the true valuing of personal growth and professional development in medical education. If future doctors are to graduate as compassionate, socially informed, and critically reflective practitioners, they need dedicated PPD learning, opportunities to practice and active encouragement to remain curious towards and beyond their own experience.

The Challenges of Implementing Good Health and Well-Being During a Pandemic: A Case Study of the Behavior of Using Telemedicine Services in the Younger Generation

Objectives: Telemedicine has emerged as a crucial tool in addressing public health requirements, particularly during a pandemic. This aligns with the third Sustainable Development Goals (SDGs) objective of ensuring healthy lives and promoting well-being for all ages. The current generation demonstrates a greater proficiency in modern technology, prompting researchers to investigate their views and behavior trends in telemedicine. Methods: This research is aimed at examining the telemedicine adoption patterns of Generation Y and Generation Z by dividing them into two groups. Study Group 1 is comprised of those who have known modern technology but have yet to gain experience in using telemedicine. Meanwhile, Study Group 2 is comprised of those who had used telemedicine services. Utilizing structural equation model (SEM) analysis, this research investigates the magnitude of influence exerted by various determinants on an individual's tendency to utilize telemedicine. Results: Findings from both study groups indicate that younger generations have positive attitudes towards telemedicine, significantly influencing their willingness to use telemedicine. Furthermore, the level of readiness for change emerges as a crucial factor in determining the degree of affective commitment to change, continuance commitment to change, and normative commitment to change. In addition, the participants' affective experience state significantly influences all three dimensions of commitment to change. Conclusion: The results suggest the importance of fostering a positive and pragmatic understanding of telemedicine among young people. This can be achieved by encouraging the use of telemedicine services and fully adopting the shift to telemedicine. Therefore, it is crucial to prioritize the development of a positive view towards telemedicine, provide excellent service experiences, and promote social flexibility to attract a large user base, especially among the younger population.

Transforming research systems for meaningful engagement: a reflexive thematic analysis of spinal cord injury researchers' barriers and facilitators to using the integrated knowledge translation guiding principles

PURPOSE

To develop an in-depth understanding of spinal cord injury (SCI) researchers' barriers and facilitators to deciding to use 1) a partnered approach to research and, 2) systematically developed principles for guiding Integrated Knowledge Translation (IKT) in spinal cord injury research (IKT Guiding Principles).

METHODS

Qualitative interview study with North American SCI researchers who were interested in using a partnered research approach. The research was conducted using an IKT approach, and interview data were analyzed using reflexive thematic analysis.

RESULTS

Thirteen SCI researchers whose research focused on prevention, clinical, rehabilitation, and/or community SCI research were interviewed. Three themes were co-constructed with partners: 1) the principles are necessary but not sufficient for the implementation of a partnered approach to research; 2) relational capacity building is needed; and 3) institutional transformation is needed to value, resource, and support meaningful engagement.

CONCLUSIONS

Supporting change that enables SCI researchers to adopt and implement the IKT Guiding Principles will require transformation at the individual (theme 1), relational (theme 2), and institutional levels (theme 3). Findings provide clear, practical, and tangible actions to promote change that can support meaningful engagement in the SCI Research System.

Appraising eHealth Investment for Africa: Scoping Review and Development of a Framework

BACKGROUND

As opportunities grow for resource-constrained countries to use eHealth (digital health) to strengthen health systems, a dilemma arises. Wise eHealth investments require adequate appraisal to address opportunity costs. Economic appraisal techniques conventionally utilised for this purpose require sufficient economic expertise and adequate data that are frequently in short supply in low- and middle-income countries. This paper aims to identify, and, if required, develop, a suitable framework for performing eHealth investment appraisals in settings of limited economic expertise and data.

METHODS

Four progressive steps were followed: (1) identify required framework attributes from published checklists; (2) select, review, and chart relevant frameworks using a scoping review; (3) analyse the frameworks using deductive and inductive iterations; and, if necessary, (4) develop a new framework using findings from the first three steps.

RESULTS

Twenty-four candidate investment appraisal attributes were identified and seven relevant frameworks were selected for review. Analysis of these frameworks led to the refinement of the candidate attributes to 23 final attributes, and each framework was compared against them. No individual framework adequately addressed sufficient attributes. A new framework was developed that addressed all 23 final attributes.

CONCLUSIONS

A new evidence-based investment appraisal framework has been developed that provides a practical, business case focus for use in resource-constrained African settings.

Preventing Sexual Harassment in Higher Education: A Framework for Prevention Science Program Development

Sexual harassment is an intractable problem that harms the students, community, culture, and success of institutes of higher education (IHEs). The alarming prevalence of sexual harassment at IHEs highlights the urgent need for effective prevention programs. However, there are few empirically supported preventive interventions that effectively target the factors that most impact the determinants, trajectory, and short- and intermediate-term effects of sexual harassment. In this paper, we overview the problem of sexual harassment and propose an organizing framework to help IHEs develop effective interventions to prevent sexual harassment. Guided by prevention science, we propose a framework-modified from SAMHSA's (2019) guidelines for prevention practitioners-that underscores the criticality of trauma- and equity-informed characteristics in prevention programs. We offer a discussion on how IHEs must consider and evaluate the empirical evidence of effectiveness, flexibility, cultural competency, and sustainability when developing and adapting prevention programs to reduce and-ultimately-ameliorate sexual harassment. We conclude with recommendations that can provide a roadmap for higher education stakeholders and researchers to prevent this urgent public health concern.

A realist evaluation protocol: assessing the effectiveness of a rapid response team model for mental state deterioration in acute hospitals

Background

Mental state deterioration poses significant challenges in healthcare, impacting patients and providers. Symptoms like confusion and agitation can lead to prolonged hospital stays, increased costs, and the use of restrictive interventions. Despite its prevalence, there's a lack of consensus on effective practices for managing mental state deterioration in acute hospital settings. To address this gap, a rapid response team model has been proposed as a potential intervention, aiming to provide early identification and targeted interventions.

Methods

Based on realist evaluation steps, first, initial program theories are formulated to understand the logic behind the intervention. Second, literature synthesis identifies empirical evidence on contexts, mechanisms, and outcomes elements, refining initial theories. During the third step, data will be collected using qualitative methods such as field observations and interviews, as well as quantitative methods such as surveys of the staff, audits of electronic medical records, and analysis of incident records of mental state deterioration. Analysing this data informs configurations of contexts, mechanisms, and outcomes. In the fifth step, the configurations are synthesised, presenting refined, evidence-informed program theories.

Conclusion

This study addresses the knowledge gap by evaluating the rapid response model's effectiveness in managing mental state deterioration in acute hospital settings. Realist principles guide the exploration of causal mechanisms and their interaction with specific implementation contexts. The objective is to identify what works, for whom, and under what circumstances, aiming to manage deterioration, reduce restrictive interventions, and enhance the experience for patients and staff by implementing a proactive model of care. The findings contribute to evidence-based approaches for managing mental state deterioration in hospital settings, informing policy and practice in this crucial area of healthcare.

International short-term placements in health professions education-A meta-narrative review

INTRODUCTION

In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies. The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short-term placements in health professions education.

METHODS

A systematic review was conducted using a meta-narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio-economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions.

RESULTS

This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process.

CONCLUSION

The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.

Ethical considerations in the regulation and use of herbal medicines in the European Union

The regulation and use of herbal medicines is a topic of debate due to concerns about their quality, safety, and efficacy. EU Directive 2004/24/EC on Herbal Medicinal Products was a significant step towards establishing a regulatory framework for herbal medicinal products in the EU, and bridging the gap between conventional and herbal medicines. This Directive allows herbal medicinal products to be marketed in the EU through full marketing authorisation, well-established use, and traditional use of herbal medicinal products. The framework relies on the correlation between the therapeutic claims of herbal medicine and the scientific evidence backing them up: the greater the claims made regarding medicinal benefits, the more evidence is required to substantiate its efficacy and safety. This regulatory framework acknowledges and incorporates traditional knowledge when evaluating herbal medicines, showcasing a balanced approach that values cultural traditions while mandating monographs for traditional herbal medicinal products. Excluding herbal medicines completely limits access to affordable treatment, particularly when they serve as the only alternative for some, and protects consumer autonomy. This EU framework could therefore serve as a practical guidance for the use and regulation of herbal medicines, even outside the EU. In conclusion, it is argued that the same moral imagination and courage shown by regulators in the case of herbal medicines could perhaps be used in the regulatory frameworks of other healthcare products.

AI Through Ethical Lenses: A Discourse Analysis of Guidelines for AI in Healthcare

While the technologies that enable Artificial Intelligence (AI) continue to advance rapidly, there are increasing promises regarding AI's beneficial outputs and concerns about the challenges of human-computer interaction in healthcare. To address these concerns, institutions have increasingly resorted to publishing AI guidelines for healthcare, aiming to align AI with ethical practices. However, guidelines as a form of written language can be analyzed to recognize the reciprocal links between its textual communication and underlying societal ideas. From this perspective, we conducted a discourse analysis to understand how these guidelines construct, articulate, and frame ethics for AI in healthcare. We included eight guidelines and identified three prevalent and interwoven discourses: (1) AI is unavoidable and desirable; (2) AI needs to be guided with (some forms of) principles (3) trust in AI is instrumental and primary. These discourses signal an over-spillage of technical ideals to AI ethics, such as over-optimism and resulting hyper-criticism. This research provides insights into the underlying ideas present in AI guidelines and how guidelines influence the practice and alignment of AI with ethical, legal, and societal values expected to shape AI in healthcare.

Death anxiety and religiosity in a multicultural sample: a pilot study examining curvilinearity, age and gender in Singapore

This study investigated the association between multidimensional death anxiety and religiosity in multicultural Singapore by examining potential variations by age and gender. We also explored the possibility of a curvilinear effect, where highly religious or non-religious individuals report lower death anxiety than moderately religious people, forming an inverted U-curve pattern. Data were collected from 110 participants using questionnaires that assessed death anxiety and religiosity. Parametric and non-parametric tests were then conducted. The findings showed that women had significantly higher death anxiety and religiosity than men, and highly and moderately religious people had significantly higher death anxiety than non-religious people. People of all age groups had similar levels of death anxiety. These findings highlight the importance of developing targeted death anxiety interventions that integrate spiritual aspects in Singapore so that clinicians can provide culturally competent care.

The impact of a mixed reality technology-driven health enhancing physical activity program among community-dwelling older adults: a study protocol

Background

Physical inactivity and a sedentary lifestyle among community-dwelling older adults poses a greater risk for progressive physical and cognitive decline. Mixed reality technology-driven health enhancing physical activities such as the use of virtual coaches provide an emerging and promising solution to support healthy lifestyle, but the impact has not been clearly understood.

Methods and analysis

An observational explanatory sequential mixed-method research design was conceptualized to examine the potential impact of a user-preferred mixed reality technology-driven health enhancing physical activity program directed toward purposively selected community-dwelling older adults in two senior centers in the Philippines. Quantitative components of the study will be done through a discreet choice experiment and a quasi-experimental study. A total of 128, or 64 older adults in each center, will be recruited via posters at community senior centers who will undergo additional screening or health records review by a certified gerontologist to ensure safety and proper fit. Treatments (live coaching with video-based exercise and mixed reality technology-driven exercise) will be assigned to each of the two senior center sites for the quasi-experiment. The participants from the experimental group shall be involved in the discreet choice experiment, modeling, and usability evaluations. Finally, a qualitative sample of participants (n = 6) as key informants shall be obtained from the experimental group using purposive selection.

Discussion

This study protocol will examine the health impact of a promising mixed reality program in health promotion among older adults. The study utilizes a human-centered mixed method research design in technology development and evaluation in the context of developing nations.Clinical trial registration: ClinicalTrials.gov, identifier NCT06136468.

Practical Guide to Experimental and Quasi-Experimental Research in Surgical Education

This Guide to Statistics and Methods describes the methods and pitfalls of experimental and quasi-experimental study designs in surgical education.

Experiences of support received by carers of people who are involuntarily admitted to hospital under the Mental Health Act: qualitative study of carers' perspectives

BACKGROUND

Carers of people who are involuntarily admitted to hospital report feeling isolated and unsupported by services. The Independent Review of the Mental Health Act (MHA) recommended that carers be supported. However, no research has directly explored what type of support carers would find most helpful when a relative/friend is involuntary admitted.

AIMS

To explore carers' experiences and views around the support they want to receive when their relative/friend is involuntarily admitted under the MHA.

METHOD

A total of 22 one-to-one interviews with carers were conducted online at three sites across England. Audio recordings of the interviews were transcribed, and data were analysed with thematic analysis.

RESULTS

Four main themes were identified: (a) heterogeneity in the current support for carers, (b) information about mental health and mental health services, (c) continuous support, and (d) peer support and guidance. Carers reported receiving support from professionals, peers and relatives, but this was unstructured, and the extent of support varied across carers. Carers reported wanting more information about mental health services, and for this information to be consistent. Carers also reported wanting emotional support from a single, continuous person, helping them establish a more personal and sincere connection. Peers were also identified as important in the provision of carer support, allowing carers to feel reassured and understood in their experience.

CONCLUSIONS

The support received by carers is currently unstructured. To meet the MHA review recommendations, carers of patients who are involuntarily admitted should be allocated a named contact person, ideally with lived experience, to offer information and personal continuity of support.

Qualitative research in cardiac arrest research: A narrative review

Qualitative research is defined as "the study of the nature of phenomena", including "their quality, different manifestations, the context in which they appear or the perspectives from which they can be perceived". It is a methodology which is becoming extremely valuable in resuscitation science, especially in terms of improving our understanding of the true impact of sudden cardiac arrest on survivors, family members, lay responders and health care providers. This narrative review provides a high-level overview of qualitative methods as well as the current state of the qualitative evidence and key knowledge gaps in resuscitation science. It finishes with discussion of the bright future of qualitative research in our field.

Prevalence and correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda

Intimate partner sexual violence (IPSV) during pregnancy is of key reproductive health concern as it is associated with various risks linked to severe intrapartum complications. This study assessed the prevalence and the correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda. This was an analytical cross-sectional study conducted among 284 pregnant women who were obtained by systematic sampling in Napak district between November and December 2020. A structured questionnaire was used to collect the data, and this was analyzed using STATA version 15. The correlates of IPSV were determined at a multivariable level using a Poisson regression model with robust variance at the individual, relationship, and societal levels of the socio-ecological model. The study enrolled 284 pregnant women of whom, 65.5% were aged between 18 and 28 years and 62.0% were not formally educated. Also, 56% of the pregnant women had experienced IPSV during their current pregnancies, the most prevalent form (35.6%) being unwanted sexual advances. Factors of women being in their third or subsequent pregnancies, primiparity, women who rated their communication with their partners as low, being in a relationship for less than five years, lower age of the spouse, and a lower level of education (primary) among women showed a statistical association with IPSV. This study reports a high prevalence of IPSV during pregnancy, and it was associated with individual, relationship, and societal factors. Based on this, concerted efforts through sensitization on the dangers of IPSV are required to avert the practice.

Practical, Privacy and Ethical, and Philosophical Considerations for Using Big Data in Medical Education

ABSTRACT

In this issue of Academic Medicine , Thelen and colleagues present a thoughtful perspective on the emerging opportunity to use longitudinal educational data to improve graduate medical education and optimize the education of individual residents, and call for the accelerated development of large interinstitutional data sets for this purpose. Such applications of big data to medical education hold great promise in terms of informing the teaching of individuals, enhancing transitions between phases of training and between institutions, and permitting better longitudinal education research. At the same time, there is a tension between whose data they are and consequently how they ought to be used. This commentary proposes some practical, privacy and ethical, and philosophical considerations that need to be explored as early efforts to aggregate data across the medical education continuum mature and new efforts are undertaken.

Unsettling Settler Colonialism in Research: Strategies Centering Native American Experience and Expertise in Responding to Substance Misuse and Co-occurring Sexual Risk-Taking, Alcohol-Exposed Pregnancy, and Suicide Prevention Among Young People

Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people.

Ethical questioning in arts and health-based research: propositions and reflections

Ethical questioning is a framework for considering the ethical implications and practices in research and is used as a tool for thinking about the connections between art and health. It enables researchers and practitioners to gain a deeper understanding of the emotional dimensions in the field of art and health. In this paper, we propose that ethical questioning, grounded in the principles of ethics of care, can foster a more reflexive and holistic approach to understanding the concept of well-being. We also propose that adopting ethical questioning as a methodology, which requires intentional self-reflection and recognition of positionality, can expose and challenge conventional knowledge hierarchies, resulting in more ethical research outcomes and relationships between researchers and participants. Ultimately, our hypothesis proposes that ethical questioning holds the potential to offer an actionable practice that demonstrates ethics of care.

Systematic Development of Standards for Mixed Methods Reporting in Rehabilitation Health Sciences Research

OBJECTIVE

Mixed methods research (MMR) integrates quantitative and qualitative methods throughout the research process to answer complex research questions. MMR designs align with the guiding frameworks of patient-centered care and social determinants of health by effectively examining the role of contextual factors and human experiences in influencing health and rehabilitation outcomes. Reporting standards and critical appraisal tools ensure the quality and transparency of the research process. MMR standards exist; yet, there is a need for reporting guidelines and an appraisal tool that meets field standards, is applicable across rehabilitation fields of study, and can accommodate the range of possibilities for combining research approaches and methods.

METHODS

Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) was developed using a systematic consensus-building process in accordance with published guidance and was preregistered with the Enhancing the Quality and Transparency of Health Research Network. MMR-RHS evolved through a sequence of steps, including extensive literature review, expert consultation, stakeholder feedback, pilot testing, and tool refinement.

RESULTS

MMR-RHS consists of 20 criteria that align with field standards for rigor and transparency, with an emphasis on integration throughout the research process, a key component of MMR.

CONCLUSIONS

A systematic process was utilized to develop the reporting standards and an appraisal tool for MMR in rehabilitation and health science. The tool is comprehensive, includes a set of criteria grounded in MMR literature, and is flexible for application to a range of MMR designs commonly seen in rehabilitation research.

IMPACT

The MMR-RHS may improve the quality and transparency of MMR by supporting investigators, authors, reviewers, and editors during project development, manuscript preparation, and critical review. The tool may assist readers in critical appraisal, knowledge translation, and application of published MMR findings. Ultimately, the MMR-RHS may help legitimize mixed methods in rehabilitation and health research, an important step toward understanding the complexities of health care, patient outcomes, and evolving societal health needs.

Positive youth development as a guiding framework in sport research: Is it time to plan for a transition?

Positive youth development is a popular guiding framework for studying the psychosocial development of youth. In sport research, for more than two decades, this framework has enhanced our understanding of the mechanisms involved in successful shifts from youth to adulthood. Nonetheless, scholars have recently taken a more critical stance on the positive youth development framework by elucidating some of its shortcomings. To help determine whether it may be warranted to plan for a transition from the positive youth development framework in sport research, a critical commentary is offered. The purpose of this commentary lies in situating three ontologically distinct arguments that depict the shortcomings of the positive youth development framework, namely the operationalization argument, the social justice argument, and the posthumanist argument. This paper is offered as an open invitation to instigate dialogue on what may come next for youth development in sport research and whether planning for a transition is warranted.

Effect of Self-Hypnosis on Test Anxiety among Secondary School Students in Malaysia

Test anxiety comprises cognitive, physiological, and behavioral reactions due to anxiety about failure or a lower academic performance score on an exam or evaluation. This study examined the effect of self-hypnosis on reducing test anxiety among upper secondary school students using a quantitative methodology with a pre-experimental design. The prevalence of test anxiety was measured using the Friedben Test Anxiety Scale (FTAS) and students' demographic data were collected. Twenty-two 16-year-old students with moderate to high test anxiety were selected for a self-hypnosis intervention over a period of 5 weeks. The FTAS questionnaire was administered 4 times: at baseline, 3rd week, 5th week, and at follow-up (3 weeks after the intervention). Students' test anxiety differences were statistically significant across 4 time points. Self-hypnosis intervention decreased students' overall test anxiety scores and in the 3 constructs: social, cognitive, and tenseness. The outcomes indicate that self-hypnosis training can help students cope with test anxiety and should be further explored for managing test anxiety in school settings.

What's the low back pain problem represented to be? An analysis of discourse of the Australian policy directives

PURPOSE

Low back pain (LBP) directives provide information about how LBP should be managed, communicated and navigated in complex health systems, making them an important form of policy. This study aimed to examine how LBP is problematised (represented) in Australian directives.

MATERIALS AND METHODS

We employed an analysis of discourse of LBP directives drawing on Bacchi's "What's the problem represented to be?" policy problematisation approach.

RESULTS

Our analysis suggests that LBP is problematised as a symptom that tends to improve when individuals take responsibility for themselves, but may require care at times. The way in which LBP is represented in the directives excludes important aspects, such as the uncertainties of scientific knowledge, paradigms other than (post)positivist, multimorbidity, social and structural determinants of health.

CONCLUSION

LBP directives may benefit from problematisations of LBP that consider the ongoing nature of LBP and broader contextual factors that impact on both LBP outcomes and care, beyond individual responsibility. Consideration of a wider range of paradigms and expanded evidence base may also be beneficial, as these are likely to enable individuals, clinicians and the Australian healthcare system to address LBP while dealing with its complexities, enabling real-world changes to lessen the LBP burden.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who work with people who experience low back pain (LBP) may benefit from critically reflecting about discourses embedded in policy directives.Healthcare professionals may consider engaging in policy changes processes to expand the discourses on which LBP policy directives rely.Healthcare professionals' ability to enact policy recommendations may be enhanced by consideration of the fluctuating nature of LBP, uncertainties, multimorbidity and determinants of health.

Factors affecting student readiness towards OBE implementation in engineering education: Evidence from a developing country

Engineering universities in the South Asian region have been investigating the efficacy of Outcome-Based Education (OBE) in preparing their students to meet the demands of the Fourth Industrial Revolution (4IR). Evaluating students' motivations towards OBE is crucial for its successful implementation into engineering degree programs. This research aims to explore students' readiness towards OBE implementation at one of the prominent engineering universities in Bangladesh. To achieve this aim, an instrument was developed to comprehensively measure students' readiness towards the implementation of OBE. The survey instrument with a 7-point scale, measuring six constructs of the proposed model, such as (a) Students' awareness, (b) Teachers' commitment, (c) Institutional support, (d) Perceived easiness, (e) Students' motivation, and (f) Self-efficacy, was developed and administered to a pilot sample of sixty-eight participants (N = 68) from two engineering domains: Civil and Environmental Engineering (CEE), and Computer Science and Engineering (CSE). The final data was collected from a cohort of Three Hundred and Seventy participants (N = 370), distributed across four engineering domains. A structural equation modeling (SEM) with the help of the Smart-PLS software was conducted to determine the construct validity of the measurement model and to evaluate the model fit. Results from the analysis indicate no significant positive effect of teachers' commitment (TC) on students' readiness (SR). However, the results reveal a significant positive effect of students' awareness (SA) and perceived easiness (PE) on students' readiness (SR). Results also reveal no significant moderating role of institutional support (IS) on the relation between the exogenous variables (IS, SA, PE) and the endogenous variable (SR). The research recommends Institutional Support as essential for instructors and students to implement outcome-based education (OBE) in engineering education.

Making sense of competency-based medical education (CBME) literary conversations: A BEME scoping review: BEME Guide No. 78

BACKGROUND

Competency-based medical education (CBME) received increased attention in the early 2000s by educators, clinicians, and policy makers as a way to address concerns about physician preparedness and patient safety in a rapidly changing healthcare environment. Opinions and perspectives around this shift in medical education vary and, to date, a systematic search and synthesis of the literature has yet to be undertaken. The aim of this scoping review is to present a comprehensive map of the literary conversations surrounding CBME.

METHODS

Twelve different databases were searched from database inception up until 29 April 2020. Literary conversations were extracted into the following categories: perceived advantages, perceived disadvantages, challenges/uncertainties/skepticism, and recommendations related to CBME.

RESULTS

Of the 5757 identified records, 387 were included in this review. Through thematic analysis, eight themes were identified in the literary conversations about CBME: credibility, application, community influence, learner impact, assessment, educational developments, organizational structures, and societal impacts of CBME. Content analysis supported the development of a heat map that provides a visual illustration of the frequency of these literary conversations over time.

CONCLUSIONS

This review serves two purposes for the medical education research community. First, this review acts as a comprehensive historical record of the shifting perceptions of CBME as the construct was introduced and adopted by many groups in the medical education global community over time. Second, this review consolidates the many literary conversations about CBME that followed the initial proposal for this approach. These findings can facilitate understanding of CBME for multiple audiences both within and outside of the medical education research community.

Approaching physically active learning as a multi, inter, and transdisciplinary research field

In broad terms, physically active learning is a phenomenon that combines health and educational disciplines to integrate physical activity and core educational goals. Despite a growing research interest within the physically active learning field, conceptual clarity on combining and synthesising research disciplines appears to be needed. This article thus explores knowledge production within the physically active learning research field. First, it outlines the origin of the research field. Secondly, the terms multi-, inter-, and transdisciplinary are applied to confront how knowledge is produced. Finally, the three approaches' theoretical and ethical implications are discussed. The article contributes to conceptual clarity within the field by proposing that physically active learning is inherently inter- and transdisciplinary because it embraces the complexity of integrating and synthesising knowledge from health and educational disciplines to address real-world problems. To conclude, awareness of physically active learning's practical and theoretical dimensions through the three approaches is central to evolving the field.

Clinical decision-making and adaptive expertise in residency: a think-aloud study

Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians.This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework.We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise.Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know.For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.

Gastronomic Experience and Consumer Behavior: Analyzing the Influence on Destination Image

Gastronomy experiences are becoming a fundamental factor that influences the making of a decision regarding choosing a travel destination, as well as being a crucial factor in shaping tourists' satisfaction regarding their overall travel experience. The aim of the study is to identify and explain the simultaneous impact of the key factors that influence a gastronomic experience and their impact on tourists' satisfaction with a trip and the destination's brand. These issues were addressed within the context of Ukraine, as this is an overlooked area of academic research, and an online survey was conducted, targeting domestic and international tourists. Structural equation modeling was used to assess and reveal the proposed hypotheses in the model. The study contributed to the theoretical understanding of the key factors that increases the occurrence of a memorable gastronomic experience and the relationship between the experience of food and its role in the satisfaction of and the perceived brand of a destination. Moreover, the finding showed that past experience and prior knowledge have a positive influence on the gastronomy experience, while tourists' prior knowledge effects the perceived quality of a destination's cuisine, as well as the food activities in the destination. Linkages in the model were empirically supported by statistical analyses. Nonetheless, the various level of the tourists' involvement with gastronomy might be used as an input to examine and improve the memorable gastronomic experience on-site. The research simultaneously highlighted the importance of gastronomy to tourist destinations for positioning on international and domestic markets. The paper not only provides theoretical but also practical implications. The hospitality and tourism businesses benefit from acknowledging the importance of local food and the local food market. The findings of this study are also deemed to assist destination marketers who observe that tourists have become more demanding in search of unique experiences offered by destinations.

Quality and constructed knowledge: Truth, paradigms, and the state of the science

CONTEXT AND TRUTH

Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this.

QUALITY AND IMPROVEMENT

Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies.

IMPLICATIONS FOR FUTURE WORK

The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.

How argumentation theory can inform assessment validity: A critical review

INTRODUCTION

Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways.

METHODS

The authors followed a five-step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE.

RESULTS

We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real-world settings, with a variety of normative standards used to evaluate argument validity.

DISCUSSION

Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation.

A Fork in the Road for Emergency Medicine and Critical Care Blogs and Podcasts: Cross-sectional Study

BACKGROUND

Free open-access meducation (FOAM) refers to open-access, web-based learning resources in medicine. It includes all formats of digital products, including blogs and podcasts. The number of FOAM blog and podcast sites in emergency medicine and critical care increased dramatically from 2002 to 2013, and physicians began to rely on the availability of these resources. The current landscape of these FOAM sites is unknown.

OBJECTIVE

This study aims to (1) estimate the current number of active, open-access blogs and podcasts in emergency medicine and critical care and (2) describe observed and anticipated trends in the FOAM movement using the Theory of Disruptive Innovation by Christensen as a theoretical framework.

METHODS

The authors used multiple resources and sampling strategies to identify active, open-access blogs and podcasts between April 25, 2022, and May 8, 2022, and classified these websites as blogs, podcasts, or blogs+podcasts. For each category, they reported the following outcome measures using descriptive statistics: age, funding, affiliations, and team composition. Based on these findings, the authors projected trends in the number of active sites using a positivist paradigm and the Theory of Disruptive Innovation as a theoretical framework.

RESULTS

The authors identified 109 emergency medicine and critical care websites, which comprised 45.9% (n=50) blogs, 22.9% (n=25) podcasts, and 31.2% (n=34) blogs+podcasts. Ages ranged from 0 to 18 years; 27.5% (n=30) sold products, 18.3% (n=20) used advertisements, 44.0% (n=48) had institutional funding, and 27.5% (n=30) had no affiliation or external funding sources. Team sizes ranged from 1 (n=26, 23.9%) to ≥5 (n=60, 55%) individuals.

CONCLUSIONS

There was a sharp decline in the number of emergency medicine and critical care blogs and podcasts in the last decade, dropping 40.4% since 2013. The initial growth of FOAM and its subsequent downturn align with principles in the Theory of Disruptive Innovation by Christensen. These findings have important implications for the field of medical education.

Identifying conceptual incongruences within global leadership competency models

Despite decades of research on global leadership competencies, there is a continued unresolved debate among scholars around an integrative Global Leadership Competency model (GLC model), as none of the models proposed has been widely used in literature. Attempts to replicate and operationalize existing models are scarce, and scholars tend to recreate GLC models instead of building on existing ones. Instead of proposing yet another GLC model, this paper aims to identify factors that explain the unresolved debate around an integrative Global Leadership Competency model to be used in academic and managerial settings. To do so, we conducted a conceptual analysis based on an integrative literature review, where a sample of exemplar GLC models was surveyed and assessed. This analysis resulted in the identification of three conceptual incongruences, namely 1) varying assumptions regarding the meaning of competency; 2) divergent model structuring; and 3) varying delimitation, resulting in varied sets of competencies. These incongruences relate to diverse assumptions, perspectives and interpretations that are inherent to the development of GLC models, but often not explicitly acknowledged and addressed by studies. We argue that these incongruences hinder scholars’ and practitioners’ capacity to evaluate, compare and contrast different models, and may therefore explain the unresolved debate around an integrative GLC model. While grounded in global leadership theory, this article also contributes to cross-cultural leadership and management scholarship by providing a critical discussion about the competencies required by leaders to operate effectively in a global environment, where they are required to manage across different cultures and socio-economic contexts.

Do Digital Finance and the Technology Acceptance Model Strengthen Financial Inclusion and SME Performance?

Digital inclusive finance, as a vital engine for the country’s high-quality growth, provides new impetus and prospects for encouraging economic development during the looming economic downturn. SMEs play a significant role in economic growth and development, particularly in developing countries. However, value promoting financial inclusion for SMEs through digitalization is still understudied. The objectives aimed at by this investigation were: to study the impact of financial inclusion on SME performances, to observe the influence of digital financing on financial inclusion and SME performance association as a mediator and to examine how the Technology Acceptance Model (TAM) supports financial inclusion and SME performance. A well-structured questionnaire using a quantitative research approach was utilized to gather data from 366 owner-managers among Sri Lankan SMEs. The study’s findings are presented: financial inclusion, digital financing and TAM play influential roles in SME performance. More precisely, digital financing and TAM mediate positively the relationship between financial inclusion and performance in SMEs. The findings of this research endeavor to shed light on developing and popularizing digital financing by providing services which are cheap, secure and low risk from a supply-side perspective, as well as adopting and adjusting digital financing by enhancing financial literacy, which would be necessary from the demand-side perspective.

Applying educational theory to medical education research

Applying educational theory to medical education research is no different to the way theory drives research and practice in other domains. However, the practical application of theory to research in medical education can often be challenging for many different reasons. This article seeks to help researchers by exploring some important questions about educational theory, including what theory is, why it is important, and how it can be used in medical education research.

Intellectual Capital: A System Thinking Analysis in Revamping the Exchanging Information in University-Industry Research Collaboration

University-industry research collaboration (UIRC) is a major source for research, innovations and sustainable economic growth. Despite the extensive evidence on the importance of such collaboration in developed and developing countries, literature related to the strengthening of this collaboration, along with its innovation performance, is still scarce. Scholars believe that the impact of exchanging information has a vigorous influence on researcher’s innovative activities as well as research and innovations. Moreover, to flatten the flow of exchanging information between researchers, it is mandatory to refurbish human capital in conjunction with intellectual capital, along with their reinforcing factors i.e., communication and networking, respectively. In this paper, we evaluate the influence of human capital and intellectual capital along with their corresponding reinforcing factors on exchanging information using the system thinking method. Evidence from UIRC in Malaysia provides empirical corroboration that intellectual capital along with its reinforcing factors has a significant influence on exchanging information. Thus, the findings of this research suggest that intensifying the capabilities of intellectual capital with a reinforcing effect can sustain the circulation of exchanging information.

The best paradigm for nursing research

Reflects on the best approach of the paradigms in nursing research, which allows human phenomena to emerge and through them generate knowledge for this discipline. The systematic review was carried out of 25 documents, analyzing the hermeneutical positivist and interpretive approach to nursing research. According to the analyzed documents and in knowledge of the multiplicity and multidimensionality of phenomena related to the care of the human health experience, which is the object of study of nursing, one of these two paradigms could not be qualified as the best, since it would be foolish accepting one of them or thinking that one is better than another, even more so at the time science is currently going through. Paradigms will quantitative or positivist and qualitative or interpretive hermeneutic prevail to the extent that nursing science requires it.

Enhancing the Prospect of Corporate Sustainability via Brand Equity: A Stakeholder Model

Given that brand equity is increasingly recognized as a measure of corporate sustainability, in the present study, we examine the relationships among stakeholder benefits, stakeholder trust and brand equity. Derived from a sample of 433 stakeholders from 115 companies in Thailand, the findings indicate that functional benefits improve brand equity indirectly and directly via stakeholder trust and psychological benefits. On the other hand, psychological benefits improve brand equity indirectly and directly via stakeholder trust. Psychological benefits create more direct, positive effects on brand equity than functional benefits. The effects of functional benefits on brand equity are enhanced through psychological benefits. Directions for future studies and practical implications are also discussed.