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The gamification of learning has increased in popularity in recent years as a tool for enhancing student engagement and attainment. In undergraduate chemistry courses, hybridization is a fundamental concept that students need to master in order to understand introductory organic and inorganic topics. This study focused on the development of a card game for use as a revision tool (i.e., a learning resource that can be used by students to engage with a topic they have previously encountered and develop their understanding of the topic in advance of an assessment) based on the topic of hybridization for students taking introductory chemistry courses. The game was designed to both engage students and support their learning. Covering the core concepts of hybridization, including molecular geometry, orbital character, and hybridization states, the speed-based game requires students to answer "question cards" before their opponents by placing down the correct "hybridization card". The game was implemented with chemistry cohorts at the University of Birmingham, United Kingdom, and Xi'an Jiatong-Liverpool University, China. The impact of the game on student learning was evaluated through pre- and postintervention quizzes, as well as a survey based on student impressions of the game play experience. Students responded positively about the game play experiences, and a comparison of quiz scores suggests a positive impact on student understanding of the topic.

The study covers the development and testing of the alternative mechanics survey (AMS), a modified force concept inventory (FCI), which used automatically marked free-response questions. Data were collected over a period of three academic years from 611 participants who were taking physics classes at high school and university level. A total of 8,091 question responses were gathered to develop and test the AMS. The AMS questions were tested for reliability using classical test theory (CTT). The AMS computer marking rules were tested for reliability using inter-rater reliability (IRR). Findings from the CTT and IRR studies demonstrated that the AMS questions and marking rules were overall reliable. Therefore, the AMS was established as a physics concept inventory which uses automatically-marked, free-response questions. The approach used to develop and test the AMS could be used in further attempts to develop concept inventories which make use of automatically-marked, free-response questions.

Abstract Background Staff in health systems everywhere have exhibited flexibility and a capacity for improvisations during, and in response to, the COVID-19 pandemic. Looking to other examples of such resilient behaviours outside of those induced by the pandemic is instructive for those involved with researching or understanding change, or making health systems improvements. Methods Here, we synthesise and then assess the value of eight case studies of in situ resilient performance from Canada, Sweden, Japan, Belgium, the United Kingdom, Norway, the United States and Brazil. The cases are divided into four categories: responsiveness to a crisis; adaptiveness over time; local adoption in accommodating to a top down, national policy change; and the consequential outcomes of an intervention. Results The cases illuminate the resourcefulness of translational and social researchers in examining such behaviours and practices. More than that, they also foreground the ingenuity and adaptive capacity of staff on-the-ground who continually anticipate, respond and adapt to make systems work and provide continuous care in the face of many challenges, including resource deficiencies, policy misalignments, and new technologies, policies and procedures that need to be integrated into local workflows. Front line clinicians make care systems work, pre-empting issues and sorting out problems before they occur or as they arise. Conclusions A key lesson amongst a range of findings is that, rather than focusing on shiny new tools of change (checklists, frameworks, policy mandates), it is much more insightful and satisfying to deeply apprehend care at the sharp end, where clinicians deliver care to patients, understanding how everyday work is executed. This, rather than the Health Ministry, the Boardroom, or the Management Consultant’s office, is where and how change is being enabled, and where street level actors solve problems, thwart issues in advance, and constantly avoid pitfalls.

Abstract Background Healthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution. Methods A retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains. Results Within the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited. Conclusions Physiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools.

Abstract Background and aim The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. Methods A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. Results Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. Conclusion Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.

Abstract Background While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012–2023) change towards VBHC in a pioneering Dutch university hospital. Method Through retrospective, complexity-informed process research, we study how a Dutch university hospital’s strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital’s internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). Results The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a “hybrid” strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients’ responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians’ use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. Conclusions VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.

Deaf-sighted, deaf-blind, and hearing-sighted people have been interacting within a small community in the Bay Islands of Honduras for over a century (Ali 2023; Ali and Braithwaite 2020). In this article, we sketch the history of the community and the ways in which signers make use of their own and their interlocutor's bodies to co-construct meaning. Based on a short conversation between two deaf-blind signers, we identify mechanisms used to regulate turn-taking, including some which are familiar from other visual and tactile sign languages, and some which are rather novel in the literature. We show that signers make use of visual and tactile-proprioceptive channels, bearing in mind, but not entirely determined by, the sensorial orientations of their interlocutors. We conclude that this way of languaging is not a visual sign language and not yet fully adapted to the tactile modality, nor is it undeveloped or disordered in any other sense. Rather, we believe that this case demonstrates the ways in which human languaging makes use of multiple modalities and adapts to the needs of each interactional context. While linguists have sometimes been inclined to classify languages into neat modality boxes (auditory-vocal, visual-gestural, tactile-gestural), this analysis supports Henner and Robinson's (2023) calls for what they term a "crip linguistics," which embraces disabled ways of languaging, rejects ideas of disordered language, and recognizes languaging as multimodal.

Context: Sudden cardiac arrest is the leading cause of sport-related deaths in young athletes. Athletic training students must understand cardiovascular anatomy and physiology in addition to pathophysiology to appropriately care for patients with cardiovascular conditions. Objective: Describe a teaching technique to actively engage students in lecture about cardiovascular anatomy, physiology, pathophysiology, and electrocardiograms. Background: Drawing for retention is an educational technique used in medical education to help students recognize patterns, reinforce knowledge, and retain information. Using drawing for abstract concepts that cannot always be visualized or applied enhances comprehension. Description: An educational technique using drawing for retention to teach cardiovascular concepts, conditions, and basic electrocardiogram interpretation was implemented in an emergency care in athletic training course. The instructor drew and lectured on concepts of anatomy, physiology, pathophysiology, electrocardiograms, and interventions while the students drew and took notes on the concepts. Educational Advantage(s): Students describe this activity as a beneficial way to learn and apply cardiovascular anatomy and physiology to cardiovascular conditions and treatment. Conclusions: Faculty may consider implementing drawing for retention as an active learning technique to engage students with complex or abstract topics.

The motivation of linguistically diverse young adults to learn Korean as a Foreign Language (KFL) was studied at a university on the US-Mexico border. This diglossic setting permitted a complex investigation of multiple elements, including L2-motivation theoretical attributes, exposure to Korean contemporary pop culture, and the linguistic and cultural diversity of the local community. 152 KFL university students completed an online survey. Participants were sorted into four language groups according to the degree to which English/Spanish predominated in their daily life: Spanish-dominant, balanced, and English-dominant bilinguals, in addition to English monolinguals. Maximum Likelihood Exploratory Factor Analysis found two underlying KFL motivation factors, which were conceptualised as a social-cultural factor (F1) and an educational factor (F2). This underlying motivation structure was then further explored to find associations between the factor-based motivational attributes and the four language groups. Repeated MANOVA measures found statistically significant interactional effects and between-group differences between the balanced and non-balanced bilingual groups and the English monolinguals. Further discussion highlights the diglossic environment, the cultural interests of bilingual young adults in L3 learning, and the role of English as a power language.