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The rapid increase in chronic non-communicable diseases (NCDs) poses a major challenge to already strained health systems in sub-Saharan Africa. This study investigates the factors associated with seeking and receiving NCD services in Tanzania, using a household survey and client exit interview data from Kilombero and Same districts. Both districts are predominantly rural, with one semi-urban area called Ifakara town and Same town. Of the 784 household survey respondents, 317 (40.4%), 37 (4.7%), and 20 (2.5%) were diagnosed with hypertension, diabetes mellitus, and other NCDs, respectively, of whom 69% had sought care in the past six months. After controlling for covariates, those enrolled in the National Health Insurance Fund (NHIF) and those who received a user fees waiver were more likely to use health services. However, even when NCD patients managed to access the care they needed, they were likely to receive incomplete services. The main reason for not receiving all services at the health facility visited on the day of the survey was drug stock-outs. Among health care users, those registered with the improved Community Health Funds (iCHF) were less likely to receive all prescribed services at the health facility visited than uninsured patients. The findings of this study highlight the need to strengthen both primary care and social health protection systems to improve access to needed care for NCD patients. [ABSTRACT FROM AUTHOR]

AbstractBackgroundPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONPersisting Symptoms after Concussion (PSaC) are common and difficult to treat. Mindfulness-based interventions can support recovery but are rarely included in rehabilitative care. We developed OWNMindfulness, an eight-week live-video mindfulness-based group for PSaC.To assess feasibility and preliminary clinical effects of OWNMindfulness.Fourteen individuals with PSaC enrolled in this mixed-methods single-arm feasibility study. We assessed enrollment/retention, adherence, fidelity, instrument completion, safety, and satisfaction. We evaluated preliminary trends in the impact of the intervention on mindfulness (CAMS-R), concussion symptoms (PCSS), and QOL (WHOQOL-BREF). Qualitative analysis of exit interviews explored participants’ perceptions of the effects of the intervention, and framework analysis assessed adequacy of the quantitative measures to capture perceived effects.Feasibility results met a priori benchmarks. Mindfulness, concussion symptoms, and QOL scores improved (CAMS-R: adjusted p = 0.01, large effect size; PCSS: adjusted p = 0.03, moderate effect size; WHOQOL-BREF: not significant, small effect size). Qualitative analysis of interview data found benefits including validation, compassion, self-awareness, self-efficacy, concussion symptoms, resilience, life participation, social relationships, and QOL. Framework analysis demonstrated that quantitative tools captured change in concussion symptoms but did not comprehensively assess the other benefits identified through qualitative methods.OWNMindfulness shows preliminary feasibility and promise for improving clinical outcomes. Results suggest the need for additional quantitative tools for comprehensive measurement of the effects and may point to potential mechanisms of action.Integration of mindfulness-based interventions in standard rehabilitation care for persistent concussion symptoms has potential to boost recovery for this difficult to treat population.OWNMindfulness, a live-video mindfulness-based group intervention, can be delivered in a clinical education setting.People with persistent concussion symptoms may benefit from validation from providers and peers, self-compassion, self-awareness, and self-efficacy to support resilience and recovery.Integration of mindfulness-based interventions in standard rehabilitation care for persistent concussion symptoms has potential to boost recovery for this difficult to treat population.OWNMindfulness, a live-video mindfulness-based group intervention, can be delivered in a clinical education setting.People with persistent concussion symptoms may benefit from validation from providers and peers, self-compassion, self-awareness, and self-efficacy to support resilience and recovery. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index‐Daily Diary (ANMS GCSI‐DD) is a patient‐reported outcome (PRO) instrument for gastroparesis. This study evaluated the psychometric properties of the ANMS GCSI‐DD and determined a meaningful change threshold using the data from a phase 2b trial in adults with moderate‐to‐severe idiopathic or diabetic gastroparesis (DG).The psychometric properties of ANMS GCSI‐DD were analyzed using other clinician‐ and patient‐reported outcomes from 242 patients during the 12‐week trial. Trial exit interviews were conducted in a cohort of 32 patients to capture their perspectives on meaningful change from the trial.ANMS GCSI‐DD demonstrated good performance: unidimensionality scores exhibited good fit; internal consistency reliability was >0.70; test–retest reliability was above 0.90, and convergent validity showed strong correlations (0.70–0.90) with overall severity rating and moderate correlations (0.30–0.70) with other outcomes. ANMS GCSI‐DD scores discriminated among groups with varying severity of gastroparesis symptoms in known‐groups validity (p < 0.001) and were responsive to symptom improvement. Triangulation of the quantitative anchor‐based estimates of 0.9–1.4 category points as a meaningful change in the ANMS GCSI‐DD composite score, and the qualitative exit interview findings of 0.5–1.5 as meaningful change, supports a one‐point change on a five‐point scale (0–4) as the meaningful change threshold.The ANMS GCSI‐DD is a reliable and valid PRO instrument to employ in clinical development for patients with moderate‐to‐severe idiopathic or DG, and a one‐point score change in the ANMS GCSI‐DD composite score is recommended as a meaningful change threshold of symptom change. [ABSTRACT FROM AUTHOR]

Introduction: Fear of cancer recurrence (FCR) is prevalent and distressing among survivors of cancer. Evidence‐based mind‐body and cognitive‐behavioral skills lack integration and testing in scalable formats. Objective: This pilot randomized controlled trial (NCT04876599) tested a synchronous, virtual mind‐body group resiliency intervention for FCR (IN FOCUS). Method: Adults with elevated FCR (FCR Inventory severity ≥ 16; 16–21 = elevated, 22–36 = clinically elevated) after completing primary treatment for non‐metastatic cancer were randomly assigned (1:1) to eight weekly sessions of IN FOCUS or usual care (UC; synchronous, virtual community group support referral). Feasibility metrics included ≥ 70% retention per arm (primary outcome), ≥ 75% attendance in ≥ 6 sessions, ≥ 75% adherence to relaxation skills practice ≥ 3 days per week and by delivery fidelity (% content covered in video‐recorded sessions). Acceptability was assessed quantitatively via ratings of enjoyableness, convenience, helpfulness, odds of future use, and satisfaction (benchmark ≥ 80% of ratings ≥ 4 on 1–5 Likert scale) and qualitatively via individual exit interviews. Linear mixed models explicated slopes in FCR (secondary) and resiliency (exploratory; Current Experiences Scale) from baseline to 2 months (primary endpoint) and 5 months using intention‐to‐treat. Results: From July 2021 to March 2022, 64 survivors enrolled (25–73 years old, M = 7 years since diagnosis). IN FOCUS was feasible and acceptable (91% retention; attendance median = 7 sessions, 97% relaxation practice adherence, 95% content fully covered; 82% of acceptability ratings ≥ 4). Interviews (n = 59) revealed benefits in both arms. By 2 months, compared to UC, IN FOCUS reduced FCR to a medium‐to‐large effect (Mdiff = −2.4; 95% CI = −4.2, −0.7; d = 0.66). By 5 months, FCR effects had attenuated (Mdiff = −0.16, 95% CI −1.97, 1.65; d = −0.04), although levels of resiliency had increased with a medium‐to‐large effect (Mdiff = 10.0; 95% CI = 4.9, 15.1; d = 0.78). Conclusions: For survivors of non‐metastatic cancer, a synchronous, virtual mind‐body resiliency program for FCR is feasible, acceptable, and seemingly beneficial compared to a community group referral. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nSHORT CONDENSATIONTo evaluate the feasibility and acceptability of outpatient medical induction at 13-18 weeks’ gestation to limit overnight hospital stays.In this prospective cohort study, participants with 13-18-week pregnancies seeking abortions at two government hospitals swallowed mifepristone 200 mg and self-administered misoprostol 400 mcg buccally 24-48 h later, 1-2 h before returning to the outpatient clinic (OPD). Repeat misoprostol was dosed every 3 h until expulsion. Participants requiring care beyond OPD hours were admitted as inpatients. Acceptability was evaluated by exit interview before discharge. Participants were contacted two weeks later to assess any subsequent issues.Ninety-eight (82%) of 120 participants had successful outpatient abortions using a median two (IQR 2, 3) misoprostol doses. The median induction-to-abortion time was five hours (IQR 4, 7.5). Eleven (9%) participants expelled before clinic arrival. Twenty-two (18%) participants were transferred as inpatients at OPD closing. Transferred participants remained inpatient for a median 18 h (IQR 18, 21.25). There were no serious adverse events and satisfaction with the abortion process was high.Although the outpatient model did not meet statistical expectations, it is clinically feasible, acceptable, and improves efficiency, expands access, and reduces burdens for women and providers. Operational adjustments may facilitate higher outpatient success.Outpatient medical induction at 13-18 weeks’ gestation is feasible, improves efficiency, expands access, reduces staff and patient burdens, and aligns guidelines and practice with evidence. [ABSTRACT FROM AUTHOR]

Objective: People commonly cope with chronic low back pain (cLBP) by ignoring and distraction. Can mindful interoceptive exposure to the pain sensation itself and its phenomenological components be an alternative approach? Methods: Single-arm feasibility study in patients with cLBP using a 2-minute attention exercise guided by a smartphone app several times per day over 8 weeks. We assessed feasibility, pre/post pain, function, and psychological parameters using mixed methods: standard questionnaires, ecological momentary assessment, and exit interviews that included micro-phenomenology technique and subsequent reflexive thematic qualitative analysis. Results: We enrolled 31 participants, mostly female, mean age 48, the majority had pain for >5 years; 29 completed. Mean pain intensity [0–10] improved from 4.8 ±1.7 to 3.1 ±1.9 (p <.0001); mean PEG scores (intensity and interference with daily life; range 0–30) improved from 13.7 ±6.2 to 8.4 ±6.6 (p <.0001); pain impact (9 items incl physical function) 22.3 ±8.7 to 19.7 ±8.1 (p =.0010). Twenty-one of 29 improved PEG score ≥30%. There were significant improvements in PCS Rumination and MAIA Not-Worrying. Participants became aware of their usual habit of avoidance and the challenge of and resistance to focusing on pain. They were surprised how pain sensations varied over time, and that pain intensity and the threat value of pain could diminish by focusing on it. They described a variety of 3D pain shapes (e.g., football, pool ball, rod, nail, brick, stars) with a range of colors, transparency, temperature, and density that for some changed with mindful attention. Most struggled to find appropriate words for sensory awareness and attention regulation and found that the threat value of their pain diminished. Conclusions: Mindful interoceptive exposure to the sensations of their cLBP using a 2-minute attention exercise with a phone app—rather than ignoring and distracting from it—may be a beneficial intervention for cLBP. Trial registration: ClinicalTrials.gov #NCT06186193. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsTo describe the adaptation and feasibility of the Swedish version of the Promoting Resilience in Stress Management (PRISM) intervention among adolescents and young adults (AYAs) newly diagnosed with cancer.PRISM is a 5-session, manualized program designed to strengthen AYAs individual resources for managing stress by promoting resilience skills: stress-management, goal-setting, cognitive reframing and meaning-making. It is delivered 1:1 by an interventionist via video-visits. PRISM was developed in the US and adapted for a Swedish population. A feasibility study was conducted looking at recruitment, retention, acceptability of the intervention (evaluation survey and exit interviews) and pre- and post- exploratory psychosocial outcome measures (resilience, global health, emotional functioning and rehabilitation needs). Participants were recruited from a comprehensive cancer center in Sweden.Of the 31 eligible individuals (16–30 years), 20 (65%) agreed to participate and 11 (55%) completed PRISM. Eighty-six percent (6/7) of the participants who completed the evaluation survey thought that the order of the modules and the content were “very good or good”. The AYAs that participated in the exit interviews expressed that the programme contributed new knowledge and for some confirmed previous knowledge, which was valuable both during and after participation. The role of the interventionist was stressed as important to support participants through the programme. Suggestions for the future included making PRISM more personalized. Exploratory quantitative analyses suggested improved mean scores regarding resilience, global health and emotional functioning from pre- to post-intervention.This study suggests that participating in PRISM has the potential to guide AYAs during the initial period after a cancer diagnosis. Further work to make PRISM more personalized might increase AYAs’ interest in, and completion of, PRISM. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to examine current procedures that are used to evaluate competency development in clinical neuropsychology at the postdoctoral level and to investigate policies and procedures for the management of performance that is below expectations during the postdoctoral fellowship. Method: Clinical neuropsychology fellowship program directors were invited via email with multiple reminders to participate in an online survey between 1/26/2023 and 3/31/2023. Results: Most programs administer a competency-based written evaluation of fellow performance (92%) and have a written policy for managing performance that is below expectations (86%). However, greater variability was reported regarding the use of other evaluation tools, including fellow self-assessments (46% of programs), program evaluations (57% of programs), supervisor evaluations (73% of programs), and exit interviews (82% of programs). Moreover, there was variability between programs with regard to the specific competencies that were measured and how performance that is below expectations is managed. Conclusions: Competency-based evaluations and clear, written policies and procedures for management of performance that is below expectations are recommended. Such tools and policies provide clear expectations for fellowship outcomes, promote regular communication between fellows and supervisors, foster early identification of gaps in training, facilitate program quality improvement, and increase opportunities to support and intervene during the course of fellowship training. [ABSTRACT FROM AUTHOR]

Background: Health-care practitioners have opportunities to talk with clients about unhealthy behaviors. How practitioners approach these conversations involves skill to be effective. Thus, teaching health-care students to communicate empathetically with clients should promote effective client-practitioner conversations about health behavior change. The primary objective of this pilot trial was to assess the feasibility, acceptability, and appropriateness of a theoretically informed intervention designed to improve perspective-taking. Methods: For inclusion in this randomized mixed-methods parallel two-arm trial, participants needed to be a student at the investigators' Canadian university and have completed course content on behavior change communication. Using a 1:1 allocation ratio, participants in Respiratory, Physical, and Occupational Therapy; Nurse Practitioner; and Kinesiology programs were randomly assigned to full or partial intervention conditions. Full intervention participants completed a perspective-taking workshop and practiced perspective-taking prior to an in-lab dialogue with a client-actor (masked to condition) about physical activity. Partial intervention participants received the workshop after the dialogue. We assessed feasibility and appropriateness by comparing recruitment rates, protocol, and psychometric outcomes to criteria. We assessed acceptability (secondary outcome) by analyzing exit interviews. Results: We screened and randomized 163 participants (82 = full intervention; 81 = partial intervention). We fell slightly short of our recruitment success criteria (10–15 participants per program) when 2/50 Occupational Therapy students participated. We met some but not all of our protocol criteria: Some full intervention participants did not practice perspective-taking before the dialogue, because they did not see anyone during the practice period or did not have a practice opportunity. Psychometric outcomes met the criteria, except for one measure that demonstrated ceiling effects and low reliability (Cronbach's alpha <.70). There were no adverse events related to participation. Conclusions: The intervention should be largely feasible, appropriate, and acceptable to deliver. We suggest changes that are large enough to warrant conducting another pilot study. We outline recommended improvements that are applicable to researchers and educators interested in recruitment, adherence to home practice, and online uptake of the intervention. Trial registration: This trial was registered retrospectively on November 8, 2023, at https://clinicaltrials.gov/study/NCT06123507. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionThis study assessed the readiness of The Individualized Positive Psychosocial Interaction (IPPI) program in the nursing home (NH) setting from the perspective of NH providers implementing the IPPI. The evidence-based IPPI program is designed to help remediate distress and improve mood for residents living with dementia. NH staff are trained to engage residents in brief (i.e. 10-min) one-to-one, preference-based activities to alleviate emotional distress and enhance quality of life.NH providers (n = 15) who championed the IPPI implementation completed an exit interview based on the nine domains of the Readiness Assessment for Pragmatic Trials (RAPT). Interviews were audio-recorded, transcribed, and coded by RAPT domains, then scored by the research team to reflect an average for each domain.Providers rated the IPPI program’s readiness high on the domains of alignment, impact, risk, implementation protocol, evidence, cost, and acceptability. The domains of measurement and feasibility scored lower, likely due to broader contextual issues and require particular attention.Results illustrate that the IPPI program successfully aligns with stakeholder priorities, is a safe intervention with minimal risk, and has beneficial outcomes. The IPPI’s low cost, design, and alignment with organizational goals also facilitated implementation while measuring outcomes and staffing considerations impacted organizational capacity for implementation. [ABSTRACT FROM AUTHOR]

Digital health interventions (DHIs) can facilitate positive health outcomes. User engagement (UE) plays an important role in DHI efficacy. Yet, DHIs vary in functionality, design and intended outcomes, underscoring the importance of incremental, user-centred design to understand engagement in specific settings. This study explores the relationship between user engagement and DHI implementation in three design iterations, or rounds, of a unique, multi-week asynchronous intervention that leverages online discussion and problem-solving therapy (PST). The intervention seeks to engage older adults to improve problem solving skills relating to the intervention focus, health aging (two rounds) and Lewy Body Dementias (LBD) caregiving (one round). The PST component drew upon personas, a common user-centered design method, in a novel way. Exit interviews were conducted at the end of each round to understand participants' experiences. Using thematic analysis, we identified factors that contributed to social engagement ('engaging with others') and learning engagement ('engaging with content') with the DHI. The findings demonstrate how iterative changes in the design and delivery of a DHI can contribute to user engagement, increasing the likelihood of knowledge acquisition and developing problem-solving skills as part of health self-management. [ABSTRACT FROM AUTHOR]

Introduction: Qualitative research methods can be used to obtain a deeper understanding of patient experience by collecting information in the patients’ own words about their encounters, perspectives, and feelings. In this study, patients with schizophrenia were interviewed to capture their voice and to complement the quantitative data typically obtained in clinical trials. Methods: Semi-structured exit interviews were conducted with 41 patients who completed or prematurely discontinued from a phase 3, open-label trial (NCT02873208). The interview guide included open-ended questions on current and prior disease burden, symptoms, quality of life, and treatment experiences. Steps taken to reduce interview stress and secure the validity of data included interviewer sensitivity training specific to mental health conditions and schizophrenia, use of in-person interviews whenever possible and use of videoconferencing for remote interviews to promote trust and comfort, and working closely with clinical site staff to identify patient eligibility and willingness to participate. Transcripts based on audio recordings were content coded and analyzed using thematic analysis; a post-hoc quantitative content analysis was conducted. Results: Patients reported that the symptoms of schizophrenia negatively impacted their work, relationships, self-esteem, emotional health, and daily activities. Most patients had positive experiences with medications that alleviated hallucinations, depression, and anxiety. However, side effects of medications were associated with negative impacts on physical, emotional, behavioral, and cognitive health. Lack of energy/drowsiness, weight gain, mood changes, and involuntary movements were the most common side effects reported with the use of antipsychotic medications. Patients reported unmet treatment needs related to better symptom control and to improved social and physical functioning. Conclusion: Collection of qualitative information within a schizophrenia clinical development process provides value and insights into patients’ views on burden of illness, experiences with previous medications, and experiences following participation in a clinical trial and can inform design for future studies. [ABSTRACT FROM AUTHOR]

Background: Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage. Methods: Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates. Results: We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation. Conclusion: Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs. [ABSTRACT FROM AUTHOR]

Background: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia. Method: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria. Results: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services. Conclusions: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines. [ABSTRACT FROM AUTHOR]

This paper examines the study space preferences of college students in their respective university colleges. The study utilized principles of visual ethnography to collect participatory photographic data. Student participants completed three tasks, a demographic survey, participant-supplied photographs, and an exit interview. We recruited from the Colleges of Architecture and Education and Human Development 60 participants who captured their preferred study spaces in their colleges and adjacent areas through photographic evidence. Grounded theory and qualitative coding were applied to analyze and create preliminary code themes from the visual and textual data to further evaluate student study preferences. The authors discovered that there were differences, and sometimes similarities, of space availability between the colleges, patterns of semesterly inhabiting behavior and transient movement, and organic ability for collaboration. [ABSTRACT FROM AUTHOR]

In an attempt to discover a more suitable and culturally relevant form of therapy for children and adolescents, the principal investigator of this study proposed a framework for therapy by adapting child-centered play therapy and key concepts of Terry Kottman’s approach to Adlerian play therapy within a skateboarding context. Five children whom the principal investigator had not previously known participated in this six-week-long case study. Each child attended five one-hour-long play therapy-informed skateboarding sessions and an exit interview. Before the therapeutically informed skateboarding sessions, parents were provided with questionnaires adapted from Terry Kottman’s questionnaires for Adlerian play therapy, inquiring about each child’s sense of connection, capability, courage, and feelings that they count. Parents received a similar follow-up questionnaire after their child attended five therapeutically informed skateboarding sessions. On the final questionnaires, parents reported an increase in their child’s confidence, capability within relationships, connection, and task initiation. [ABSTRACT FROM AUTHOR]

• Only half of Early Intervention providers who expressed interest in Project ImPACT training ultimately enrolled. • Providers delivered Project ImPACT to families and children who were representative of state-level demographic information. • Providers reported adapting Project ImPAC frequently but felt that the program was still effective. • At 6-month follow-up, many providers reported that they continued to use Project ImPACT. A growing number of research studies are attempting to increase access to naturalistic developmental behavioral interventions (NDBIs) for autistic toddlers and their families by translating these approaches into Part C Early Intervention systems. As efforts to increase the use of NDBIs across EI systems grow, it is important to expand the scope of research to evaluate the implementation impact of this work. In order to address this gap, the current study was grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) to evaluate a broader range of implementation outcomes when a parent-mediated NDBI, Project ImPACT, was implemented within an Early Intervention system. Specific aims included examining: 1) the reach of Project ImPACT to children across the system; 2) the perceived effectiveness of Project ImPACT; 3) rates of provider participation in Project ImPACT training and consultation; 4) the delivery and adaptation of Project ImPACT by Early Intervention providers; and 5) providers' intent to sustain their use of Project ImPACT. Forty-eight Early Intervention providers enrolled in Project ImPACT training, with a subsample participating in ongoing group consultation followed by an exit interview and a 6-month follow-up survey. Although there was a high level of interest in Project ImPACT training and good retention once enrolled, only half of EI providers who expressed interest in Project ImPACT training ultimately enrolled. Participating providers delivered Project ImPACT to families and children who were representative of state-level demographic information and perceived that Project ImPACT was effective for families and children on their caseload irrespective of whether children were autistic. Consistent with other research studies, providers' fidelity to Project ImPACT was inconsistent, and providers reported a moderate level of adaptation to the program. At 6-month follow-up, providers reported high maintenance of Project ImPACT. The findings from this study have implications for how the RE-AIM framework could be used to more concisely characterize the impact of implementation efforts within public systems serving autistic toddlers and their families. [ABSTRACT FROM AUTHOR]

Human resources (HR) are important assets for an organization. HR includes the abilities, skills, knowledge, and capabilities that individuals or groups possess to achieve organizational goals. In management, human resources (HR) includes everyone who contributes to an organization's operations, from top management to operational employees. It is very important to understand HR as an asset that can improve a company's performance and competitiveness. According to research, inadequate career development, poor work-life balance, and unsupportive boss behavior are the main reasons employees leave the company. Exit Interviews are an important way to find out the feedback of outgoing employees and provide important insights into company policies and working conditions. This study investigates the exit interview process of PT Semen Indonesia Logistik to find out the methods used, the problems faced, and the advantages. The results of the analysis show that data from outbound interviews can help companies understand the reasons why employees leave the company and provide constructive suggestions for improvements that can be made to improve employee retention and company performance. Based on these findings, there are suggestions to improve the exit interview process and maximize its benefits for the company. [ABSTRACT FROM AUTHOR]

Supervisors' dispositions have not received enough attention as potential antecedents to employees' knowledge - hiding behaviors. Based on this, the current study investigates the impact of abusive supervision on knowledge-hiding behaviors, considering the mediating role of work disengagement in this relationship, as well as investigating the moderating role of perceived organizational support in the study model. Data was obtained from frontline service employees of five-star hotels in Sharm El-Sheikh and tourism companies in Cairo, Egypt, by a questionnaire that surveyed 298 employees. The collected data was scrutinized using the Smart PLS-structural equation modeling technique. The PLS-SEM statistics proved the highly positive and significant effect of abusive supervision on knowledge-hiding behavior and employees' work disengagement, supported the mediating effect of work disengagement, and the moderating effect of perceived organizational support. The study highlights some practical implications for hotels, such as implementing integrated knowledge offering a digital library, continuous management and administrative skills training, and behavioral training to facilitate the gaining of knowledge and enhance staff skills, self-confidence, loyalty, and job security. It also strongly suggests adopting a strategy to monitor abusive supervisors through open communication channels, regularly conducting exit interviews to reduce turnover, and enhancing engagement, thereby preventing abusive practices. [ABSTRACT FROM AUTHOR]

Ice management is essential for maintaining the safety of offshore operations in Arctic regions. We present the combined results of three experiments conducted in a full-mission bridge simulator specially designed for ice management. From a quantitative analysis of the results, we infer the effect of three variables on performance: (1) experience, (2) training, and (3) Decision Support System (DSS). The results confirm that experience and training improve performance for untrained and inexperienced simulator participants. The DSS also improves performance, but with a smaller effect. Qualitative observations using vessel position heat-map diagrams and exit interviews suggested that novice participants using the DSS adopted expert strategies but carried out their tasks more slowly and with less precision. This has important consequences for the design of a future DSS used in training simulators or onboard ships. Potential improvements to the DSS design might include real-time feedback to the user, a redesign of the human-machine interface (HMI), and increasing user input and customization with a human factors focus. [ABSTRACT FROM AUTHOR]

Introduction: Pre-hospital ambulance service is the most important part of healthcare service. Client satisfaction with the service indicates the degree of adaptation to the appropriate quality and quantity of services. Patients' dissatisfaction with the service can affect their expectations of the overall services that they will receive later in the definitive care facility. However, it is not a well-addressed area in developing countries, including Ethiopia. Objective: This study aimed to identify the ambulance service satisfaction level and associated factors among service users in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted in five governmental hospitals in Addis Ababa city. A face-to-face exit interview technique was employed on a total of 410 consecutively selected participants using a pretested tool developed from similar sources. The cleaned data was entered into the Epi-Data Manager 4.6 version and then exported to SPSS version 26 for analysis. The dependent variable was dichotomized into satisfied and unsatisfied to compute bivariate logistic regression. In the multivariate logistic regression model, predictors with a p-value < 0.05 at the 95% CI were considered to have a significant association. Result: A total of 410 respondents were included in the study. The mean of participants' responses regarding ambulance personnel, call operator, treatment on the scene, and ambulance subscale was 3.64, 3.48, 3.40, and 3.43, respectively. The study found that only 21.5% of participants were satisfied by the ambulance service they received. There was a statistically significant association between ambulance service satisfaction and age (AOR = 3.52, 95% CI: 1.01–12.36), monthly income (AOR = 3.13, 95% CI: 1.41–6.94), ambulance response time (AOR = 10.33, 95% CI: 2.09–51.06), type of ambulance used (AOR = 4.55, 95% CI: 2.19–9.43), and previous ambulance usage (AOR = 2.33, 95% CI: 1.34–4.05). Conclusion: The study found a low level of satisfaction among ambulance users. The findings suggest that ambulance personnel performance is a key determinant of user satisfaction, while treatment at the scene and in the ambulances, and call operator areas require improvement. Age, monthly income, ambulance response time, type of ambulance, and previous ambulance use also influenced satisfaction. Improving the quality of services, reducing response time, and ensuring call operators are trained are vital steps to enhance satisfaction. [ABSTRACT FROM AUTHOR]

Background: Pain and dysfunction persist for most patients following hip-related pain treatment. Additionally, individuals with hip-related pain are typically less physically active than individuals without hip pain, despite evidence that regular physical activity reduces chronic musculoskeletal pain. Poor psychological health is common in patients with hip-related pain and further reinforces low physical activity. Mind–body interventions can improve psychological health and activity levels but have yet to be integrated to provide comprehensive, psychologically informed care for patients with hip-related pain. Thus, we are using the NCCIH intervention development framework to develop Helping Improve PSychological Health (HIPS), a novel, multimodal mind–body intervention to improve physical activity for individuals with hip-related pain and poor psychological health. Methods: We will recruit physical therapists (N = 20) and patients with hip-related pain (N = 20) to participate in 60 min qualitative interviews (focus groups with therapists; one-on-one interviews with patients). Using these data, we will develop the initial HIPS intervention and provider training materials. One physical therapist will be trained to deliver the HIPS intervention to five participants in an open pilot trial. Participants will attend six 30 min HIPS intervention sessions. We will collect quantitative data on satisfaction, improvement, and physical activity, alongside qualitative exit interviews with participants and the physical therapist in order to refine the HIPS intervention and provider training materials. Results: This study has been approved by the MGB IRB. We aim to develop and test the initial feasibility of the HIPS intervention in an open pilot trial. The findings from this project will inform a subsequent feasibility RCT. [ABSTRACT FROM AUTHOR]

Success for 4-year universities is often measured by graduation and retention rates; however, gaps exist in understanding nonreturning students at private institutions. Recent research is helping to build the lexicon of drop-outs, stop-outs, opt-outs, and transfer-outs to inform strategic retention initiatives. Using an action research method, we characterized 1,091 students into designated subclasses and utilized exit interviews, advising notes, and university surveys to theme their departure intentions. Findings reveal transfer-outs to be the largest subclass, with departure reasons being summarized within themes of university experience and fit, health, academic, and financial. Recommendations are made for university administrators and retention offices related to exit survey questions, broadening success metrics, and to focus on specific student characteristic groups. [ABSTRACT FROM AUTHOR]

Background: Malaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based combinations. This affects access to effective treatment increasing risk of malaria parasite resistance development and adverse drug events. This study investigated access to quality-assured artemisinin-based combination therapy (QAACT) medicines among clients of selected private drug-outlets in Uganda. Methods: This was a cross sectional study where exit interviews were conducted among clients of private drug outlets in low and high malaria transmission settings in Uganda. This study adapted the World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance. Results: A total of 1114 exit interviews were conducted among systematically sampled drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an artemisinin-based combination anti-malarial. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained anti-malarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a QAACT. Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing a QAACT anti-malarial among drug outlet clients include type of drug outlet visited (aPR = 0.74; 95%CI 0.6, 0.91), not obtaining full dose (3-day treatment) of ACT (aPR = 0.49; 95%CI 0.33, 0.73), not finding the ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49), post-primary education (aPR = 1.29; 95%CI 1.07,1.56), business occupation (aPR = 1.24; 95%CI 1.02,1.50) and not having a prescription (aPR = 0.76; 95%CI 0.63, 0.92). Conclusion: Less than a third of the private drug outlet clients obtained a QAACT for management of malaria symptoms. Individuals who did not find artemisinin-based combinations to be expensive were more likely to obtain a QAACT anti-malarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of QAACT anti-malarial agents under the current private sector copayment mechanism. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) and muscle weakness can cause impaired physical function, significantly impacting patients' health-related quality of life (HRQoL). Loss of muscle strength is usually assessed through clinical and performance outcome (PerfO) assessments, which consists of tasks performed in a standardized manner, providing evidence of a patient's functional ability. However, evidence documenting the patient experience of COPD and muscle weakness is limited. Methods: This two-stage qualitative study used semi-structured interviews in patients aged 45–80 years with COPD (post-bronchodilator forced expiratory volume in 1s [FEV1]/forced vital capacity ratio < 0.70, and FEV1% predicted of 30–80%) and muscle weakness. In Stage 1, 30-minute concept elicitation interviews were conducted with participants recruited across three US sites to explore impacts on physical functioning and activities of daily living. In Stage 2, interviews were performed with participants exiting a Phase IIa trial investigating the efficacy of a selective androgen receptor modulator (GSK2881078) on leg strength, whereby PerfOs were used to evaluate strength and physical functioning endpoints. These participants completed either 60-minute in-depth (n = 32) or 15-minute confirmatory (n = 35) interviews exploring trial experience, completion of outcome measures, disease experience and treatment satisfaction. Results: In Stage 1 (n = 20), most participants described their muscles as weak (83.3%). Difficulties with walking (100%) and lifting heavy objects (90%) were reported. In Stage 2, 60-minute interviews, all participants (n = 32) reported a positive trial experience. Most participants reported that the home exercise program was easy to fit into daily life (77.8%), the PROactive daily diary was easy to complete (100%) and wearable sensors were easy to use (65.6%). However, technical issues were reported (71%), and few participants (19.4%) found physical assessments easy to complete. Improvements in muscle strength and functional limitations were reported by most participants. The shorter 15-minute confirmatory interviews (n = 35) supported the in-depth interview results. Conclusion: The qualitative interviews generated in-depth evidence of key concepts relevant to patients with COPD and muscle weakness and support the assessments of patient strength and physical function as outcome measures in this population in future studies. Trial number: GSK Stage 1: 206869; Stage 2: 200182, NCT03359473; Registered December 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03359473. [ABSTRACT FROM AUTHOR]

Introduction: Patient satisfaction with clinical services can have an effect on retention in HIV care and adherence to antiretroviral therapy. This study assessed patient satisfaction and its association with retention and viral suppression in Zambézia Province, Mozambique. Methods: Monthly exit interviews with persons living with HIV were completed from August 2017-January 2019 in 20 health facilities; clinical data were extracted from medical records. Regression analyses assessed the effect of satisfaction scores on retention and viral suppression, adjusting for age, sex, education, civil status, time on treatment, and site. Satisfaction scores were correlated with time spent at health facilities using generalized linear regression models. Results: Data from 4388 patients were analyzed. Overall median satisfaction score was 75% (IQR 53%-84%); median time spent at facilities (from arrival until completion of clinical services) was 2h54min (IQR 1h48min-4h). Overall satisfaction score was not associated with higher odds of retention or viral suppression, but association was seen between satisfaction regarding attention given to patient and respect and higher odds of viral suppression. Patient satisfaction was negatively associated with time spent in facility (Spearman's correlation -0.63). Increased time spent at facility (from 1 to 3 hours) was not associated with lower retention in care (OR 0.72 [95%CI:0.52–1.01] and 0.83 [95%CI: 0.63–1.09] at 6- and 12-months, respectively), nor with a lower odds of viral suppression (OR 0.96 [95%CI: 0.71–1.32]). Conclusions: Strategies to reduce patient wait times at the health facility warrant continued prioritization. Differentiated models of care have helped considerably, but novel approaches are still needed to further decongest crowded health facilities. In addition, a good client-provider communication and positive attitude can improve patient satisfaction with health services, with an overall improved retention. [ABSTRACT FROM AUTHOR]

Background: The present study explored the acceptability of psilocybin‐assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention. Methods: Guided by the conceptual framework of acceptability, the authors conducted semi‐structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses. Results: Participants' (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants' sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants' experience, ultimately opening a dimension of self‐transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions. Conclusions: This study enhances understanding of what promotes acceptability of the psilocybin‐assisted therapy group model for the treatment of MDD in cancer patients. Plain Language Summary: We conducted exit interviews with participants of a phase 2 trial of psilocybin‐assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions.Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants' perceived safety and efficacy compared to uniquely individual or group delivery models of PAT.Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care. Psilocybin‐assisted group therapy to treat depression in patients with cancer is acceptable and might enhance safety and efficacy. The findings of this study highlight critical factors conditioning acceptability of the group model and suggest new ways psilocybin‐assisted therapy may be scaled and integrated into cancer care. [ABSTRACT FROM AUTHOR]

Understanding how individuals utilize and perceive digital mental health interventions may improve engagement and effectiveness. To support intervention improvement, participant feedback was obtained and app use patterns were examined for a randomized clinical trial evaluating a smartphone-based intervention for individuals with bipolar disorder. App use and coaching engagement were examined (n = 124). Feedback was obtained via exit questionnaires (week 16, n = 81) and exit interviews (week 48, n = 17). On average, over 48 weeks, participants used the app for 4.4 h and engaged with the coach for 3.9 h. Participants spent the most time monitoring target behaviors and receiving adaptive feedback and the least time viewing self-assessments and skills. Participants reported that the daily check in helped increase awareness of target behaviors but expressed frustration with repetitiveness of monitoring and feedback content. Participants liked personalizing their wellness plan, but its use did not facilitate skills practice. App use declined over time which participants attributed to clinical stability, content mastery, and time commitment. Participants found the coaching supportive and motivating for app use. App engagement based on viewing time may overestimate engagement. The delay between intervention delivery and the exit interviews and low exit interview participation may introduce bias. Utilization patterns and feedback suggest that digital mental health engagement and efficacy may benefit from adaptive personalization of targets monitored combined with adaptive monitoring and feedback to support skills practice and development. Increasing engagement with supports may also be beneficial. • App use predominantly involved monitoring using the daily and weekly check-ins. • Check-ins encouraged awareness around sleep, routine, early warning signs and symptoms. • App use declined due to clinical stability, content mastery, and time constraints. • Time spent with coaches was substantial and comparable to app use. • Suicidality and functional evaluation calls highlight the need for provider involvement. [ABSTRACT FROM AUTHOR]

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A retrospective facility-based costing study was undertaken to estimate the comparative cost per visit of five integrated sexual and reproductive health and HIV (human immuno-deficiency virus) services (provider perspective) within five clinic sites. These five clinics were part of four service delivery models: Non-governmental-organisation (NGO) directly managed model (Chitungwiza and New Africa House sites), NGO partner managed site (Mutare site), private-public-partnership (PPP) model (Chitungwiza Profam Clinic), and NGO directly managed outreach (operating from New Africa House site. In addition client cost exit interviews (client perspective) were conducted among 856 female clients exiting integrated services at three of the sites. Our costing approach involved first a facility bottom-up costing exercise (February to April 2015), conducted to quantify and value each resource input required to provide individual SRH and HIV services. Secondly overhead financial expenditures were allocated top-down from central office to sites and then respective integrated service based on pre-defined allocation factors derived from both the site facility observations and programme data for the prior 12 months. Costs were assessed in 2015 United States dollars (USD). Costs were assessed for HIV testing and counselling, screening and treatment of sexually transmitted infections, tuberculosis screening with smear microscopy, family planning, and cervical cancer screening and treatment employing visual inspection with acetic acid and cervicography and cryotherapy. Variability in costs per visit was evident across the models being highest for cervical cancer screening and cryotherapy (range: US$6.98—US$49.66). HIV testing and counselling showed least variability (range; US$10.96—US$16.28). In general the PPP model offered integrated services at the lowest unit costs whereas the partner managed site was highest. Significant client costs remain despite availability of integrated sexual and reproductive health and HIV services free of charge in our Zimbabwe study setting. Situating services closer to communities, incentives, transport reimbursements, reducing waiting times and co-location of sexual and reproductive health and HIV services may help minimise impact of client costs. [ABSTRACT FROM AUTHOR]

This paper explores research with children through repeated online video interviews during the COVID-19 pandemic. It provides insight into the geographical and relational affordances provided by online interviewing, including repeated online interviewing, and discusses some of the kinds of unpredictability that can uniquely arise during online interviews. We draw on a qualitative research study conducted with children in Ontario, Canada, that explored their early pandemic experiences. With attention to children's participation, knowledge production and relationality, we reflect on the challenges, advantages and unexpected ethical moments that arose through using online video interviews. We provide a comprehensive reflection on our longitudinal, online research with children during a global crisis by focusing on three areas: building relationships in online interviews; entering and exiting children's worlds; and unexpected ethical challenges of online interviewing. Within these three areas we provide insight into relational dynamics shaped by the online space, how online video interviews with children can provide opportunities for them to share their feelings, the importance of careful planning when exiting research projects, and how online engagements provided relational spaces for understanding, building rapport, finding comfort, listening, and sharing during the early days of COVID-19. [ABSTRACT FROM AUTHOR]

This paper extends a similar study by Kim and Emeliyanova (2021) by comparing the effects of self-revision (R) and peer-discussion (D) on linguistic accuracy following semi-focused direct written corrective feedback WCF. The study involved three groups of low-intermediate English as a second language (ESL) learners in a Sri Lankan university. The two experimental groups (R and D) received semi-focused WCF on ten problem-solution writing tasks. The R group (n = 30) revised each task and the D Group B (n = 31) discussed corrections for each task in pairs. A Control group (n = 31) just completed the tasks without WCF. Grammatical accuracy in all ten tasks was measured using obligatory occasion analysis. Both experimental groups (but not the Control group) improved in accuracy over the ten tasks. The R group was consistently more accurate than the D with medium effect sizes but the difference was not statistically significant. Overall, the findings echo those reported by Kim and Emeliyanova. The results are discussed in terms of the writers' cognitive, behavioural and attitudinal engagement with WCF, drawing on findings from an exit questionnaire and interviews. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze secondary resiliency and user experience outcomes from a novel, 8-week website-based mind-body intervention (NF-Web) for adults (18+) with neurofibromatosis (NF1, NF2, and schwannomatosis), a genetic, neurocutaneous disorder characterized by nerve sheath tumors of the central and peripheral nervous system. The study design was a secondary data analysis of a single-arm, early feasibility pilot study (September 2020-May 2021) for adults with NF (N = 28). Across participants, the mean age was 46 (SD = 13.67) and included 22 females and 6 males. Participants completed baseline and posttest assessments (t-tests), as well as exit interviews (exploratory rapid data analysis). Results demonstrated that participation was associated with pre-to-post improvements in gratitude, coping, and mindfulness (p <.05). Exit interviews indicated participant enjoyment and that many would recommend NF-Web to a friend. Participants found the website easy to navigate and enjoyed NF-Web's video format. Many found transcripts useful if they had hearing differences or if English was their second language. NF-Web demonstrated initial signals of improvement in resiliency outcomes and positive user experience. Future pilot RCTs will explore these changes by NF type. [ABSTRACT FROM AUTHOR]

Purpose: This research intends to develop a model for predicting employees at a high-risk attrition and identify the most important factors affecting them. Design/methodology/approach: In this study, using the triangulation technique of a mixed research method, the employee attrition problem is investigated by identifying its affecting factors. For that matter, data related to the human resources department of a pharmaceutical company in Iran are used. And to achieve the intended goal, advanced data mining algorithms and interviews with human resource managers are applied. Findings: A model for predicting employees at a high-risk attrition is presented based on the gradient boosting machine algorithm with 89% accuracy. The use of the mixed research approach shows that qualitative and quantitative methods can be more effective in identifying the factors affecting employee churn or loss of staff. The results also contain a new situation arising out of the COVID-19 pandemic and remote working scenarios having impact on employee attrition. Finally, human resource policies are presented based on variables related to each of the identified factors. Originality/value: The novel contributions of this study include real data related to a leading pharmaceutical company as well as a combination of two quantitative and qualitative methods. The hybrid approach can identify the reasons for attrition and, consequently, retention policies to benefit from the advantage of both approaches. Data mining can be useful to identify the factors, which are usually not mentioned in termination interviews, such as direct managers. On the other hand, the results obtained from termination interviews can also include features that the authors cannot identify through data mining, which are specifically related to the characteristics of the pharmaceutical industry such as building a more professional career path. From a practical perspective, since this company specializes in pharmaceutical marketing in a new way and is primarily comprised graduates, it is important to note that the churn of specialized people disperses organizational and technological know-how. On the other hand, the pharmacist community in Iran is small, and their attrition might adversely affect not only the reputation of an organization but the employer's brand as well. So, this research would help other similar firms in retaining their valuable human capital. [ABSTRACT FROM AUTHOR]

Background: The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress. Methods: To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20–35 weeks pregnant—20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health. Results: Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing. Conclusions: The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials. Trial registration: Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022. ClinicalTrials.gov ID: NCT05219552 Protocol ID: K23MH116807. [ABSTRACT FROM AUTHOR]

Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies. [ABSTRACT FROM AUTHOR]

Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was utilised. A quantitative questionnaire was completed after every sampling timepoint to report levels of discomfort and pain, as well as time taken to collect samples. Participants were also invited to discuss their experiences in a qualitative structured exit interview. We received questionnaires from 36 families. Most adults and children >5y experienced no pain (94% and 70%) and little discomfort (73% and 47% no discomfort) regardless of sample type, whereas children ≤5y experienced variable levels of pain and discomfort (48% no pain but 14% hurts even more, whole lot or worst; 38% no discomfort but 33% moderate, severe, or extreme discomfort). The time taken for saliva and hand sampling decreased over the study. We conducted interviews with 24 families. Families found the sampling method straightforward, and adults and children >5y preferred nasal sampling using a synthetic absorptive matrix over nasopharyngeal swabs. It remained challenging for families to fit sampling into their busy schedules. Adequate fridge/freezer space and regular sample pick-ups were found to be important factors for feasibility. Messaging apps proved extremely effective for engaging with participants. Our findings provide key information to inform the design of future studies, specifically that self-sampling at home using minimally invasive procedures is feasible in a family context. [ABSTRACT FROM AUTHOR]

Background: Missed Tuberculosis (TB) screening opportunities are key drivers of continued tuberculosis transmission. Objective: To determine the proportion of and factors associated with missing TB screening amongst patients who attended two health centres in the Manafwa district to inform future TB prevention and control efforts in Uganda. Methods: A facility-based, cross-sectional study was conducted at two public health centres offering comprehensive TB services in Manafwa district, Uganda, among patients (≥ 18 years) who presented with at least one symptom suggestive of TB. Using exit interviews, data on demographics and TB symptoms were collected using an electronic structured questionnaire. A logistic regression model was performed to determine the factors associated with missed opportunities for TB symptom screening. Results: Of the 125 patients enrolled in the study, the majority 76.0%, (n=70) of patients presented with cough for 2 weeks or more (cough of any duration for HIV positive patients) and a big proportion, 68% (n=85) of patients missed the opportunity to be screened for TB. Having a; post-primary education level (Adjusted Odds Ratio [AOR] =5.9; 95% Confidence Interval [95% CI] = 1.3, 27.1) and attending Bubulo HCIV (AOR= 0.01; 95% CI: 0.01, 0.2) were significantly associated with having a missed opportunity for TB screening. Conclusion: Slightly more than two-thirds of the patients who presented to the study health facilities with symptoms suggestive of TB missed the opportunity to be screened for TB. We suggest a need for a multifaceted intervention to improve TB screening, particularly among better-educated TB patients. [ABSTRACT FROM AUTHOR]

Context: Assessment plays a key role in competence development and the shaping of future professionals. Despite its presumed positive impacts on learning, unintended consequences of assessment have drawn increasing attention in the literature. Considering professional identities and how these can be dynamically constructed through social interactions, as in assessment contexts, our study sought to understand how assessment influences the construction of professional identities in medical trainees. Methods: Within social constructionism, we adopted a discursive, narrative approach to investigate the different positions trainees narrate for themselves and their assessors in clinical assessment contexts and the impact of these positions on their constructed identities. We purposively recruited 28 medical trainees (23 students and five postgraduate trainees), who took part in entry, follow‐up and exit interviews of this study and submitted longitudinal audio/written diaries across nine‐months of their training programs. Thematic framework and positioning analyses (focusing on how characters are linguistically positioned in narratives) were applied using an interdisciplinary teamwork approach. Results: We identified two key narrative plotlines, striving to thrive and striving to survive, across trainees' assessment narratives from 60 interviews and 133 diaries. Elements of growth, development, and improvement were identified as trainees narrated striving to thrive in assessment. Neglect, oppression and perfunctory narratives were elaborated as trainees narrated striving to survive from assessment. Nine main character tropes adopted by trainees with six key assessor character tropes were identified. Bringing these together we present our analysis of two exemplary narratives with elaboration of their wider social implications. Conclusion: Adopting a discursive approach enabled us to better understand not only what identities are constructed by trainees in assessment contexts but also how they are constructed in relation to broader medical education discourses. The findings are informative for educators to reflect on, rectify and reconstruct assessment practices for better facilitating trainee identity construction. This study explores two plotlines describing how assessment impacts trainees' identity: "striving to thrive" and "striving to survive". Narratives reveal growth or oppression; character tropes play a role, shedding light on broader medical education discourses along with valuable insights for educators. [ABSTRACT FROM AUTHOR]

Background: Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn't well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients' perceived affordability of essential medicines, and accommodation and acceptability of the public facility. Methods: A cross-sectional study was carried out at 30 primary healthcare facilities' drug dispensaries across three districts in Khartoum state. Within each Centre's dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan's national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. Results: Participants' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. Conclusion: Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan. [ABSTRACT FROM AUTHOR]

This qualitative study investigates conditions for online reflective sessions, the challenges faced and the perceptions of young children when classes moved online. 18 children ages 10–11 participated in the study; they attended 9 online reflection sessions over Zoom and an exit interview. The study concluded that challenges faced when conducting online reflection sessions were the common technical problems – the instability of the network connections and limitations of an online platform. The conditions necessary for reflective sessions include creating appropriate and effective questions to facilitate the process, provision of pictures to prompt discussions and ensuring that the contexts for discussions should be relatable to young children's experiences. The children had overall positive experiences and considered online reflections as enjoyable learning opportunities. This study provides ideas for supportive and effective conditions for online reflection sessions to promote and motivate meaningful reflections amongst young children. [ABSTRACT FROM AUTHOR]

Background: Cancer clinicians and systems aim to provide patient‐centered care, but not all patients have the self‐advocacy skills necessary to ensure their care reflects their needs and priorities. This study examines the feasibility, acceptability, and preliminary efficacy of a self‐advocacy serious game (an educational video game) intervention in women with advanced breast or gynecologic cancer. Methods: Women with recently diagnosed (<3 months) metastatic breast or advanced gynecologic cancer were randomized 2:1 to receive a tablet‐based serious game (Strong Together) (n = 52) or enhanced care as usual (n = 26). Feasibility was based on recruitment, retention, data completion, and intervention engagement. Acceptability was assessed via a postintervention questionnaire and exit interview. Preliminary efficacy was assessed on the basis of change scores from baseline to 3 and 6 months in self‐advocacy (Female Self‐Advocacy in Cancer Survivorship Scale) using intention‐to‐treat analysis. Results: Seventy‐eight women (55.1% with breast cancer; 44.9% with gynecologic cancer) were enrolled. Feasibility was demonstrated by satisfactory recruitment (69% approach‐to‐consent rate; 93% enroll‐to‐randomize rate), retention (90% and 86% at 3 and 6 months, respectively; 85% data completion), and intervention engagement (84% completed ≥75% of the game). Participants endorsed the intervention's (75%) and trial's (87%) acceptability. Participants in the intervention group experienced significant improvements in self‐advocacy at 3 and 6 months compared to participants in the control group. Conclusions: Strong Together is feasible and acceptable among women with advanced breast or gynecologic cancer. This intervention demonstrates promising evidence of clinical efficacy. A future confirmatory trial is warranted to test the efficacy of the intervention for patient and health system outcomes. Evidence‐based interventions to enhance patients' self‐advocacy skills in advanced cancer are lacking. This pilot study supports the feasibility, acceptability, and preliminary efficacy of a self‐advocacy serious game intervention to teach women with advanced breast and gynecologic cancer self‐advocacy skills. [ABSTRACT FROM AUTHOR]

Background The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective. Questions/purposes (1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition? Methods In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating inMedicare. Atotal of 18,107 orthopaedic surgeonswere identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied ("condition one" AND "condition two" AND "condition three"). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77%(13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95%confidence intervals was constructed to investigate characteristics associated with early-career attrition. Results Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01). Conclusion A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization. Clinical Relevance Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which earlycareer surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession. [ABSTRACT FROM AUTHOR]

Employees' roles as organizational members often do not end immediately after they have made the decision to leave or it has been made for them. Instead, this decision serves as a turning point initiating an exit transition process. The purpose of this article is to consolidate prior scholarship in order to gain an understanding of the state of the science, as it pertains to exit transitions. Our literature review yielded almost 200 articles that have directly or indirectly studied the exit transition process. In organizing the insights from these studies, four categories of exit transition scholarship emerged—exit transitions in the context of voluntary turnover, involuntary turnover, temporary transitions, and top management exits. Moreover, our review indicated that exit transitions are shaped by three critical forces—the permanence of the transition, the magnitude of the identity change associated with the exit, and the organizational impact of the exit. We review research on each of the four categories and show how each type of transition is shaped by these forces. Finally, we turn our focus to the future of work and discuss how changes in the way that work is structured may alter the study of employee exit transitions in the future. [ABSTRACT FROM AUTHOR]

Institutions are required to conduct exit interviews and surveys (EIS) with departing athletes, however, these instruments are currently an untapped data source for further understanding the college athlete experience. Through the lens of Comeaux and Harrison's conceptual model for student-athlete academic success, this study examined 17 FBS institutions' exit interviews and surveys with 528 athletes, focusing on athletes' academic experiences. Analyses revealed that EIS questions pertaining to educational experiences focused on the following areas surrounding athletic/institutional environment and academic outputs: academic services, overall academic experiences, time demands, coach support of academics, and faculty support. Athletes in this sample expressed overall positive academic experiences and gratitude for the academic services provided. Additionally, the majority of athletes noted few issues with time demands, strong coach support, and positive faculty interactions. These findings challenge some of the current literature noting negative educational experiences and opportunities for college athletes. Implications and recommendations are discussed. [ABSTRACT FROM AUTHOR]

With high survival rates of 91% and 85% at 5 and 10 years, breast cancer survivors face a myriad of physical and psychological challenges, and urgent measures are needed to improve their survivorship. Breathing regulation is an easily accessible practice to address the altered physical and psychological demands of cancer survivors. A yogic breathing (YB) involving cyclic inhalation, breath-retention, and exhalation appears promising in managing symptoms and improving survivors' quality of life. Based on the anxiolytic properties of YB, we tested if YB could be delivered through an app and used in cancer survivorship. This clinical trial was conducted in an academic hospital in the USA between December 2021 and June 2023. Post-radiation therapy adult female breast cancer survivors (N = 40) referred by their radiation oncologists who completed radiation therapy within the past six months were recruited and randomized 1:1 to YB and MI groups. Participants received initial in-person training for YB, a nostril-specific timed inhalation, retention, and exhalation exercise, or MI, watching the thoughts without any cues to breathing regulation. A web app provided video guidance and group or solo practice options and captured practice times for 12 weeks. Behavioral Risk Factors Surveillance System Questionnaire was collected at the baseline. The primary outcomes were feasibility and acceptability of the intervention measured by app use (adherence), system usability scale (SUS), and qualitative exit interviews. Secondary outcomes included Patient-Reported Outcomes Measurement Information Systems (PROMIS), (PROMIS) scales of Sleep Disturbance (Short Form 4a), Emotional Distress – Anxiety (Short Form 8a), Emotional Distress – Depression (Short Form 8a), MD Anderson Symptom Inventory (MDASI), and perceived stress (PSS). Patient-reported assessments were performed on weeks 1 and 12. Participants had a median age of 56 (range = 34-79) years. Adherence and acceptability proportions of the app-delivered intervention were 0.2 (95% CI = -0.09, 0.36) and 0.6 (95% CI = -0.41, 0.77) respectively. There was a significant improvement in mean anxiety (-6.01 ± 1.58) and depression (-3.55 ± 2.81) in YB when compared to MI (-1.72 ± 1.56 for anxiety and -0.29 ± 2.57 for depression) post-intervention. Other outcomes showed moderate improvements in MI and YB. Qualitative exit interviews informed the intervention was beneficial and offered suggestions for program improvements. The accessible YB practice may help to manage key symptoms during cancer survivorship. The YB exercise may be a valuable tool for symptom management in breast cancer survivors and can be delivered through an app. Limitations include the fact that this study involves a small group of patients, and more extensive, fully powered studies are required to validate the findings further. ClinicalTrials.gov Identifier NCT05161260. [ABSTRACT FROM AUTHOR]

It is important that children obtain not only academic knowledge but also skills to express emotion and sustain relationships. Fostering school communities that embody and teach compassion is increasingly recognized as an important component of many social and emotional learning (SEL) approaches. To generate SEL programs that are inclusive of diverse perspectives, it is critical to center community expertise. We engaged the framework of community-based participatory research (CBPR) to elicit Latina mothers' perspectives on compassion in their lives and in their children's school community. We used Photovoice, an art-based participatory action approach, in which participants were invited to create photographs that expressed their understanding of compassion. A subset of participants also participated in semi-structured exit interviews. The photographs, captions, and interviews were analyzed qualitatively. The results were conceptualized in terms of the themes of "definitions and conceptualization of compassion," "family and community," "communication," and "nature." Findings from this study inform an understanding of compassion focused SEL programs and implications for practice in schools through the cultural wealth of Latina mothers. [ABSTRACT FROM AUTHOR]