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Many technology designers strive to involve end users in the design process, aiming to produce better outcomes. However, designers may struggle to engage autistic users effectively due to a lack of understanding of autistic characteristics and preferences. This systematic literature review aimed to identify how autistic adolescents and adults can best be engaged in effective participatory design activities. Seven databases were searched for articles reporting technology design involving autistic people, returning 276 results. Using the PRISMA approach, 258 were excluded due to not meeting the inclusion criteria. The remaining 18 articles were then quality assessed. A thematic analysis revealed five core themes: (1) Engagement: the importance of investment in, and ownership of, the design process to create engagement; (2) Relationships: building relationships through collaboration and careful facilitation; (3) Skills development: the development of personal skills such as teamwork, design and self-advocacy in order to grow confidence; (4) Structure: providing context and structure to make the design experience feel safe and predictable; and (5) Support: the importance of support and consideration of individual needs as well as discouraging negative behaviours. Valuing participants as equal partners in design emerged as an, arguably, universal principle. The specific needs and preferences of autistic people must be understood and respected by designers. This goes beyond obvious accommodations such as providing a quiet and safe environment, and requires a deeper, more personal engagement with the individuals and their interests. We provide tangible recommendations for increasing engagement and aiding the design process.

Coffee, a significant plantation product, holds vast opportunities in both domestic and global markets. Bandung Regency is renowned for its distinctive fruit-flavored coffee, particularly from Ciwidey and Puntang, where coffee is marketed in cherry and green bean forms without branding. A value chain analysis is essential to enhance the coffee industry's added value and sustainability. This study aims to identify the coffee value chain in Bandung Regency, analyze the cost of production, total revenue, and profit of the coffee processing industry in Ciwidey and Puntang, and determine the added value of coffee products in these areas. Using descriptive analysis, results indicate that Ciwidey (MS Coffee) has a lower cost of goods produced than Puntang (Acs Siliwangi) due to higher production volumes in Puntang leading to higher costs. However, Puntang’s larger production volume also generates higher monthly revenue and profit due to a higher selling price per kilogram. Value-added analysis reveals that Puntang’s value-added per kilogram (Rp. 55,025.00/kg) surpasses that of Ciwidey (Rp. 44,647.00/kg), attributed to higher selling prices, superior product quality, and greater market presence in Puntang. Conversely, higher input prices in Ciwidey result in lower value-added.

Setiap tahun, semakin banyak kasus anak yang mengalami masalah sosial. Anak dengan disabilitas adalah salah satu anak yang memiliki masalah sosial. Ketika mereka terpapar kekerasan, kekerasan seksual, penghinaan, pelecehan, narkoba, dan bentuk-bentuk pelecehan lainnya, anak-anak penyandang disabilitas tidak memiliki kemampuan untuk melarikan diri atau memberontak. Anak-anak dengan masalah sosial membutuhkan tempat rehabilitasi yang mendorong proses terapi atau penyembuhan korban. Sentra Handayani adalah salah satu fasilitas rehabilitasi di Jakarta. Tujuan dari penelitian arsitektur yang menggunakan pendekatan desain inklusif ini adalah agar setiap anak dapat beraktivitas secara bebas dan produktif, terlepas dari kondisi fisik mereka. Penelitian ini juga melihat tempat, fasilitas, dan aksesibilitas yang dapat digunakan oleh semua anak, terlepas dari kondisi kesehatan fisik maupun mental mereka. Metode penelitian ini menggunakan metode kualitatif deskriptif dan juga metode kuantitatif dengan perhitungan skala Likert. Analisis informasi yang dikumpulkan dari dokumentasi, wawancara informan, dan observasi lapangan. Temuan dari penelitian ini antara lain rekomendasi desain inklusif, seperti desain universal dan ruang tuli, yang dapat diimplementasikan secara efektif agar semua anak bermasalah sosial, termasuk anak dengan disabilitas, dapat secara mandiri dan efektif mengunjungi gedung Panti Handayani. Adanya pedoman PUPR Nomor 14/PRT/M/2017 dapat meningkatkan kesadaran akan isu aksesibilitas di kalangan masyarakat umum, terutama di antara pihak-pihak terkait seperti pemerintah, pengelola bangunan, desainer, atau calon desainer arsitektur.

IntroductionAntimicrobial resistance is closely linked with the health and stability of environmental systems and therefore a challenge for the health of the planet. General Practitioners, owing to their trusted positions and close patient relationships, can play a crucial role in addressing antimicrobial resistance within the framework of Planetary Health. The goal of our study was to examine General Practitioners’ knowledge, attitude, and practice regarding the linkage of antimicrobial resistance with Planetary Health to understand their potential as agents of change in this domain.Materials and methodsWe conducted 19 guided interviews with General Practitioners from four different German federal states (August–September 2022). Participants were selected from the intervention group of the RedAres randomized controlled trial, a study designed to optimize therapy and prescribing practices for uncomplicated urinary tract infections in general practice. Data were analyzed using Mayring’s structured qualitative content analysis and the typology approach by Kelle and Kluge.ResultsGeneral Practitioners generally demonstrated the ability to identify the interlinkages between antimicrobial resistance and Planetary Health. However, they exhibited varying levels of knowledge, problem awareness, and accountability for the associated challenges and partially outsourced the responsibility for Planetary Health. Some General Practitioners were capable of integrating Planetary Health arguments into patient counseling. They recognized rational prescribing practice, self-reflection on antimicrobial resistance and Planetary Health, interprofessional exchange, and raising awareness among patients as potential avenues for engagement in promoting Planetary Health.DiscussionAs antimicrobial resistance is increasingly recognized as a Planetary Health challenge, empowering General Practitioners as change agents requires tailored measures based on their level of previous knowledge and their attitude toward Planetary Health. General Practitioners express a need for concrete advice on how to integrate antimicrobial resistance as a Planetary Health topic into their daily activities. Developing and evaluating adaptable training materials is essential. Additionally, the integration of Planetary Health outcomes into clinical guidelines could accelerate the adoption of this dimension in antibiotic prescribing practices within primary care settings.

Objectives Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) are common in multimorbid patients. This study aims to describe PIMs and PPOs in an open-access outpatient setting and to investigate any association between continuity of care (CoC) and PIMs and PPOs in multimorbid older patients.Design Cross-sectional study using patient-confirmed outpatient medication plans to describe PIMs and PPOs using the ‘Screening Tool of Older Person’s Prescription/Screening Tool to Alert to Right Treatment’ version 2. Four Poisson regressions modelled the number of PIMs and PPOs using context-adapted versions of the Usual Provider of Care (UPC) and the Modified Modified Continuity Index (MMCI) as measures for CoC.Setting Southern Germany, outpatient setting.Participants 321 participants of the LoChro-trial at 12-month follow-up (both arms). The LoChro-trial compared healthcare involving an additional care manager with usual care. Inclusion criteria were age over 64, local residence and scoring over one in the Identification of Older patients at Risk Screening Tool.Primary outcomes Numbers of PIMs and PPOs.Results The mean number of PIMs was 1.5 (SD 1.5), lower than the average number of PPOs at 2.9 (SD 1.7). CoC showed similar results for both indices with a mean of 0.548 (SD 0.279) for MMCI and 0.514 (SD 0.262) for UPC. Both models predicting PPOs indicated more PPOs with higher CoC; statistical significance was only demonstrated for MMCI (MMCI~PPO: Exp(B)=1.42, 95% CI (1.11; 1.81), p=0.004; UPC~PPO: Exp(B)=1.29, 95% CI (0.99; 1.67), p=0.056). No significant association between PIMs and CoC was found (MMCI~PIM: Exp(B)=0.72, 95% CI (0.50; 1.03), p=0.072; UPC~PIM: Exp(B)=0.83, 95% CI (0.57; 1.21), p=0.337).Conclusion The results did not show a significant association between higher CoC and lesser PIMs. Remarkably, an association between increased CoC, represented through MMCI, and more PPOs was found. Consultation of different care providers in open-access healthcare systems could possibly ameliorate under-prescribing in multimorbid older patients.Trial registration German Clinical Trials Register (DRKS): DRKS00013904

Anti-melanoma differentiation-associated gene 5 (MDA-5) dermatomyositis (DM) is noteworthy for its association with rapidly progressive interstitial lung disease (RP-ILD), vasculopathy, and distinctive cutaneous features. First identified in a Japanese cohort in 2005, MDA-5 DM carries a significant mortality risk, emphasizing the crucial need for early diagnosis. This review explores the pathogenesis, clinical presentation, diagnosis, management, and prognosis of MDA-5 DM and ILD and includes new research and recommendations regarding disease management.

Human resources that are of high quality create a competitive advantage for companies, thus Human Resource Management (HRM) and High-Performance Work Systems (HPWS) that are good become key success factors that need to be considered by every company. This study aims to investigate the influence of Human Resource Management (HRM) and High-Performance Work Systems (HPWS) on Information Technology (IT) Performance and Competitive Advantage of a company. The method used in this study is a quantitative approach with a questionnaire as the data collection method. The research sample consisted of 191 supervisors, managers, and executives of manufacturing companies located in Medan, Indonesia. Data analysis was conducted using SmartPLS 4.0 software. The results showed that Human Resource Management significantly affects IT Performance but does not directly affect Competitive Advantage. Meanwhile, HPWS Capability does not affect IT Performance but significantly affects Competitive Advantage. IT Performance significantly affects Competitive Advantage. IT Performance also mediates the relationship between Human Resource Management and Competitive Advantage. However, it is not significant in mediating the relationship between HPWS Capability and Competitive Advantage. These findings underscore that Human Resource Management (HRM) and High-Performance Work Systems (HPWS) play pivotal roles in shaping Information Technology (IT) performance and competitive advantage within companies, thus impacting the overall success and sustainability of companies.

This paper undertakes a comprehensive analysis of the cutting-edge maneuvers in Electronic Customer Relationship Management e-CRM in an e-commerce context, encompassing four significant categories: e-CRM, cost, technology acceptance, and customer satisfaction. It also evaluates the construct developments in these four categories. To assess the effectiveness and accuracy of the measurement model, the method of Structural Equation Modeling was utilized. Gathered data from 167 e-commerce sellers in Bandung, the results showed that e-CRM performance relied heavily on the ability of infrastructure, ease of use, and e-learning systems. The development and integration of these factors led to a positive effect on the effectiveness of the e-CRM. In addition, the findings underscored that customer expenses had a favorable influence on customer relationship performance. Consequently, this relationship performance led to an enhancement in the overall effectiveness of the e-CRM in e-commerce. A managerial implication for each category is also provided, along with suggestions for future research and directions.

Non-cognitive outcomes like Academic Self-efficacy (ASE) and Intrinsic Goal Orientation (IGO) have a bearing on students' academic and life outcomes. Yet, the way teacher practices influence these outcomes has remained underexplored. We examined the influence of Teacher Innovative Behaviour (TIB) on students' IGO and ASE within a span of one academic year (2015-16) in Indian government primary schools. Using structural equation modelling, we studied change in IGO and ASE among school students (N = 6421, grades 6-8) taught by 346 teachers with varying levels of TIB. The findings revealed that higher levels of TIB predicted higher levels of IGO but were unrelated to ASE after controlling for student demographics and prior outcomes. The independent variables collectively explained 20% and 15% of the variation in IGO and ASE. The implications of this study for teacher educators, education administrators, and policymakers are discussed.

Purpose: The role of Teacher Innovative Behavior (TIB), in responding to systemic problems in educational systems and promoting "intrapreneurial" behavior has been recognized in recent times. A robust instrument that can help administrators and teacher educators gauge the levels of TIB among their teachers will facilitate the promotion of innovative behavior. Design/methodology/approach: This study tested a multidimensional innovative behavior inventory (IBI), innovation support inventory (ISI) and innovation output (IO) in a developing nation (India) context with public school teachers (n = 34,754), for reliability, validity, measurement invariance and structural invariance across caste, gender and subject groups. Findings: The IBI, ISI and IO showed good reliability and validity along with full measurement invariance at configural, metric and scalar levels. With respect to the structural parameters, the inventories exhibited invariance of factor variance and covariance, but not of factor means. Practical implications: Teacher innovative behavior (TIB) is seen by developing country education administrators as a tool to address difficult problems. With better measurement, it will be possible to identify teachers who need training in creativity and entrepreneurial behavior, teachers who might have developed innovative practices that could be used for teacher development, and ways of promoting competition among teachers. Originality/value: The study validates inventories, which were earlier tested in non-educational domains, for use with public school teachers of a developing country across gender, caste and subject groups.

Abstract Background To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. Methods Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. Participants Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. Primary outcome measures In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. Results Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. Conclusions Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.

Abstract Background In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness. Methods A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants’ evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling. Results We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p

Energy efficiency is one of the critical aspects, because the hotel sector has significant energy consumption and has an impact on environmental information. Energy efficiency helps reduce operational costs. By reducing excessive energy consumption, hotels can set a good example of responsible and sustainable business practices. It is important to understand the factors that affect energy efficiency. Some of the relevant factors are knowledge sharing, risk perception, and environmental information. This study aims to analyze the effect of knowledge sharing, risk perception, and environmental information factors on energy efficiency in the hospitality industry. The research method used in this study is a quantitative method with a survey approach. The number of samples used in this study were 176 hotel managers in Indonesia. Questionnaires were distributed to respondents using a Likert scale of 1 to 7. Data were analyzed using the Partial Least Square (PLS) method using SmartPLS software. The research results conclude that knowledge sharing, perceived risk, and environmental information have a significant influence on energy efficiency in the hospitality industry. Well-informed consumers tend to be more aware of the impact of their decisions and actions on environmental information, so they are more likely to choose hotels that adopt sustainable and energy efficient practices. In addition, the perception of risk also affects energy efficiency in the hospitality industry. Consumers who perceive risks associated with low sustainability or negative environmental information impacts are less likely to choose the hotel. Environmental information factors also play an important role in energy efficiency. Hotels that have an environment that supports and facilitates sustainable practices have the potential to achieve higher energy efficiency.

Objectives Multimorbidity challenges healthcare systems. In Germany, coordination of healthcare for older multimorbid patients remains unstructured.This study aims to identify key themes in the healthcare of these patients and the inter-relationships between them.Design Framework analysis of six cases based on 1-year data of primary and secondary care, patient-answered questionnaires and video material.Setting Southern Germany.Participants Six multimorbid older patients participating in a randomised controlled trial that compared usual care with a local, collaborative, stepped and personalised care management approach for older people with chronic diseases (LoChro-trial). The LoChro care intervention involved a care manager who assisted participants in self-management. The primary outcome was a composite of functional health and depressive symptoms at 12 and 18 months. The LoChro-intervention had no effect on the primary outcome.Primary outcome measure Key themes in the healthcare of older patients with multimorbidity and the inter-relationships between them.Methods One-year data included diagnoses, treatment plans, examinations, assessments and discharge reports. Patient perspectives were assessed using the Patient Assessment of Chronic Illness Care. In three cases, videos of the LoChro intervention showed patients describing their health needs. These data were evaluated by three doctors and public health researchers. Using framework analysis, recurring themes influencing the healthcare situation of multimorbid older patients and their inter-relationships were identified.Results Participants had an average age of 77, with 13 diagnoses, taking eight medications regularly. The five key themes describing the healthcare situation of these multimorbid patients were as follows: insufficient coordination, overuse and underuse of medical care, doctor and patient roles. Each theme covered three to four subcategories. The most significant inter-relationships between these themes were a lack of coordination leading to overuse and underuse of medical care. These were characterised by redundant inpatient stays, potential prescribing omissions and missed examinations. Deficiencies in vaccinations and secondary prevention were also demonstrated.Conclusion Coordination of care for multimorbid older patients in Germany is still deficient. Future healthcare arrangements should be explored with the participation of physicians and patients.Trial registration number LoChro trial: DRKS00013904.

Severe asthma patients with low type 2 inflammation derive less clinical benefit from therapies targeting type 2 cytokines and represent an unmet need. We show that mast cell tryptase is elevated in severe asthma patients independent of type 2 biomarker status. Active β-tryptase allele count correlates with blood tryptase levels, and asthma patients carrying more active alleles benefit less from anti-IgE treatment. We generated a noncompetitive inhibitory antibody against human β-tryptase, which dissociates active tetramers into inactive monomers. A 2.15 Å crystal structure of a β-tryptase/antibody complex coupled with biochemical studies reveal the molecular basis for allosteric destabilization of small and large interfaces required for tetramerization. This anti-tryptase antibody potently blocks tryptase enzymatic activity in a humanized mouse model, reducing IgE-mediated systemic anaphylaxis, and inhibits airway tryptase in Ascaris-sensitized cynomolgus monkeys with favorable pharmacokinetics. These data provide a foundation for developing anti-tryptase as a clinical therapy for severe asthma.

Abstract Background Older patients are at an increased risk of hospitalization, negatively affecting their health and quality of life. Such patients also experience a lack of physical activity during their inpatient stay, as well as being at increased risk of delirium and inappropriate prescribing. These risk factors can accumulate, promoting a degree of morbidity and the development of cognitive impairment. Methods Through the ReduRisk-program, patients at risk of functional impairment, immobility, falls, delirium or re-hospitalization shortly after hospital discharge, will be identified via risk-screening. These patients will receive an individually tailored, multicomponent and risk-adjusted prevention program. The trial will compare the effectiveness of the ReduRisk-program against usual care in a stepped-wedge-design, with quarterly cluster randomization of six university hospital departments into intervention and control groups. 612 older adults aged 70 years or more are being recruited. Patients in the intervention cluster (n = 357) will receive the ReduRisk-program, comprising risk-adjusted delirium management, structured mobility training and digitally supported planning of post-inpatient care, including polypharmacy management. This study will evaluate the impact of the ReduRisk-program on the primary outcomes of activities of daily living and mobility, and the secondary outcomes of delirium, cognition, falls, grip strength, health-related quality of life, potentially inappropriate prescribing, health care costs and re-hospitalizations. Assessments will be conducted at inpatient admission (t0), at discharge (t1) and at six months post-discharge (t2). In the six-month period following discharge, a health-economic evaluation will be carried out based on routine health insurance data (t3). Discussion Despite the importance of multicomponent, risk-specific approaches to managing older patients, guidelines on their effectiveness are lacking. This trial will seek to provide evidence for the effectiveness of a multicomponent, risk-adjusted prevention program for older patients at risk of functional impairment, immobility, falls, delirium and re-hospitalization. Positive study results would support efforts to improve multicomponent prevention and the management of older patients. Trial registration German Clinical Trials Register, DRKS00025594, date of registration: 09/08/2021.

Abstract Background Due to budget restrictions in mental health care, non-professional caregivers are increasingly burdened with the emotional and practical care for their depressed relatives. However, informal family caregiving is mostly a stressful role with negative consequences on the physical and mental health of the caretakers to the extent that they have an elevated risk of experiencing psychiatric disorders themselves. While psychoeducation for relatives of depressed individuals showed positive results both in terms of the caretakers’ strain and the depressive symptoms of the affected person, there are major barriers to participate in presence in those programs. Digital programs might be a viable alternative. We found no empirically evaluated digital program available for informal caregivers of depressed patients. Methods An online program for relatives of depressed individuals has been developed including four interactive modules on 1) psychoeducation, 2) how to strengthen the relationship with the depressed person, 3) how to deal with the depressive symptoms of the patient, and 4) find the right balance between caring for the depressed person and self-care. We investigate if this self-help program is more effective when used with individualized versus automated e-mail support, and if both supported conditions are more effective than treatment-as-usual (TAU in form of written information material) in terms of the risk of mental diseases in caregivers. The primary outcome is the reduction of the caregiver’s nonspecific mental distress as measured by the change of the Kessler Psychological Distress Scale score from baseline to four weeks after randomization. Caregivers (n = 500:500:250) will be randomized to one of the three conditions. Discussion Psychological support for caregivers of individuals with mental disorders such as depression should be offered as part of integrated services. There is a huge potential to develop and implement interactive online approaches to support informal caregivers of patients with depression to function in their multiple roles and to help them to remain healthy. Trial registration DRKS, DRKS00025241 . Registered 5 Mai 2021.

Abstract Background Older patients at risk of functional decline are frequently affected by polypharmacy. This is associated with a further loss of independence. However, a relationship between functional disability and medications, such as ‘Potentially Inappropriate Medications’ (PIMs) and ‘Potential Prescribing Omissions’ (PPOs), as itemised for (de) prescribing in practice-orientated medication lists, has yet to be established. Methods As part of a randomised comparative effectiveness trial, LoChro, we conducted a cross-sectional analysis of the association between PIMs and PPOs measured using the ‘Screening Tool of Older Persons’ Prescription Criteria / Screening Tool To Alert to Right Treatment’ (STOPP/START) Version 2, with functional disability assessed using the ‘World Health Organization Disability Assessment Schedule 2.0’ (WHODAS). Individuals aged 65 and older at risk of loss of independence were recruited from the inpatient and outpatient departments of the local university hospital. Multiple linear regression analysis was used to model the potential prediction of functional disability using the numbers of PIMs and PPOs, adjusted for confounders including multimorbidity. Results Out of 461 patients, both the number of PIMs and the number of PPOs were significantly associated with an increase in WHODAS-score (Regression coefficients B 2.7 [95% confidence interval: 1.5-3.8] and 1.5 [95% confidence interval: 0.2-2.7], respectively). In WHODAS-score prediction modelling the contribution of the number of PIMs exceeded the one of multimorbidity (standardised coefficients beta: PIM 0.20; multimorbidity 0.13; PPO 0.10), whereas no significant association between the WHODAS-score and the number of medications was seen. 73.5 % (339) of the participants presented with at least one PIM, and 95.2% (439) with at least one PPO. The most common PIMs were proton pump inhibitors and analgesic medication, with frequent PPOs being pneumococcal and influenza vaccinations, as well as osteoporosis prophylaxis. Conclusions The results indicate a relationship between inappropriate prescribing, both PIMs and PPOs, and functional disability, in older patients at risk of further decline. Long-term analysis may help clarify whether these patients benefit from interventions to reduce PIMs and PPOs.

Introduction Cardiovascular diseases are the most common cause of death in Germany and among the most frequent reasons for encounters in primary care. Most patients with cardiovascular risks (CVRs) have difficulties implementing health-promoting behavioural changes. In this study, a complex intervention containing evidence-based patient materials and structured follow-up consultations are intended to strengthen patients’ self-management to improve health behaviour.Methods and analysis In this cluster randomised controlled trial, we investigate the effects of the intervention Decision aid, action planning and follow-up support for patients to reduce the 10-year risk of cardiovascular diseases (DECADE) using a 2×2 design. All patients, including the control group (CG), receive a CVR calculation. Three intervention groups (IGs) receive one or both of two different components of the DECADE intervention: IG1 (patient materials), IG2 (follow-up consultations) and IG3 (patient materials and follow-up consultations). The study was planned to be conducted with 77 general practitioners in 3 German regions and a target sample size of 924 patients. The observation period for each patient amounts to 12 months with three patient surveys: baseline (t0), after 6 and 12 months (t1 and t2). The primary outcome is patient activation (Patient Activation Measure 13 (PAM13-D)) at t1. Secondary outcomes include PAM13-D at t2 and further patient-reported and clinical outcomes at t1 and t2. We will also analyse the cost-effectiveness of the intervention, the degree of usage and satisfaction with the intervention.Ethics and dissemination The study was first approved by the lead ethics committee of the University of Freiburg on 15 April 2021 (vote number: 21-1078) and subsequently by the other ethics committees in the study regions (Ethics committee of medical association Baden-Württemberg (B-F-2021-078), Ethics Committee of the Technische Universität Dresden, Dresden (BO-EK-251052021), Ethics Committee of the State Chamber of Physicians of Saxony (EK-BR-92/21-1), Ethics Committee of the Hamburg Medical Association (2021-200013-BO-bet)). Informed consent is required for patients to participate in the study. The results of this study will be published in peer-reviewed journals and presented at congresses by the DECADE team. The DECADE lead management will communicate the results to the funder of this study.Trial registration number German Clinical Trials Register, DRKS00025401 (registration date: 21 June 2021); International Clinical Trials Registry Platform, DRKS00025401.

Urinary tract infections (UTIs) are among the most common reasons patients seeking health care and antibiotics to be prescribed in primary care. However, general practitioners’ (GPs) guideline adherence is low. The RedAres randomised controlled trial aims to increase guideline adherence by implementing a multimodal intervention consisting of four elements: information on current UTI guidelines (1) and regional resistance data (2); feedback regarding prescribing behaviour (3); and benchmarking compared to peers (4). The RedAres process evaluation assesses GPs’ perception of the multimodal intervention and the potential for implementation into routine care. We carried out 19 semi-structured interviews with GPs (intervention arm). All interviews were carried out online and audio recorded. For transcription and analysis, Mayring’s qualitative content analysis was used. Overall, GPs considered the interventions helpful for knowledge gain and confirmation when prescribing. Information material and resistance were used for patient communication and teaching purposes. Feedback was considered to enhance reflection by breaking routines of clinical workup. Implementation into routine practice could be enhanced by integrating feedback loops into patient management systems and conveying targeted information via trusted channels or institutions. The process evaluation of RedAres intervention was considered beneficial by GPs. It confirms the convenience of multimodal interventions to enhance guideline adherence.

Non-cognitive competencies play critical role in education. Interventions targeted at these competencies require access to valid measures. Within Indian context, no such validated measure exists at present, and teachers depend on their subjective evaluation of students' non-cognitive competencies represented via grade or comment on report card. This study examined convergent validity and measurement invariance of seven sub-scales of the Motivated Strategies for Learning Questionnaire (MSLQ), a widely used tool but not yet validated within Indian context. MSLQ, a measure of several non-cognitive competencies, was validated across four castes and two gender groups (N = 6423 elementary school students), the two categories highly relevant in the Indian context. For establishing convergent validity, multi-group confirmatory factor analysis was conducted where all the subfactors were allowed to correlate with each other. For measurement invariance, configural, metric, and scalar invariance were assessed by sequentially imposing more restrictive conditions. We found evidence for strong configural, metric, and scalar invariance across the gender and caste groups, and across all the seven sub-scales of MSLQ. Results also indicated good model fit for all caste and gender groups, thus establishing the convergent validity of all the sub-scales. The implications of the findings are discussed.

Samgyeopsal has become a widely popular cuisine in the Philippines since 2014. The rise of Samgyeopsal is evident worldwide as it is available in countries such as the United States, Northern, and Southern Asia. This study aimed to explore the intention to eat Samgyeopsal during the COVID-19 pandemic utilizing structural equation modeling and random forest classifier. With a total of 1014 responses collected online, the result showed that utilitarian and hedonic motivation, Korean influence, and attitude led to very high actual behavior in east Samgyeopsal in the Philippines. Moreover, subjective norm, perceived behavioral control, and intention led to significant results influencing intention to actual behavior. Lastly, the COVID-19 safety protocol showed the least significant result. This study is the first study that evaluated the intention of consumers to eat Samgyeopsal in the Philippines during the COVID-19 pandemic. The results of this study would be beneficial to Korean BBQ restaurateurs and the further development of their marketing strategies even in other countries. Finally, the model construct of this study can be extended and applied in evaluating the consumers' eating intention toward other varieties of food or cuisines worldwide.

BackgroundConfronting a patient’s breathing difficulties, clinical junior nurses often do not know how to respond, and fail to give proper evaluation and treatment. Sudden changes in the condition make the clinical nursing novices feel pressured, and even, frustrated.ObjectivesThis study aims at exploring the effectiveness of the high-realistic situational simulation of dyspnea teaching program for pre-clinical and clinical 1st year nurses after graduation.DesignThis study adopts a quasi-experimental repeated measure pre-post-test design study with nonequivalent control group pre- and post-test research design. A total of 135 subjects participated in the research: nurses, post graduate year (NPGY) (N = 69), have been employed in the adult ward of a medical center for less than 1 year; and pre-clinical nurses (N = 66), 3rd-year nursing students with nurse licenses from a university in the central part of Taiwan. Simulation-based education instructed and incorporated into the high-realistic situation simulation dyspnea teaching program. Questionnaires were used to measure the effectiveness of learning, data were analyzed with SPSS version 20.0, and the scores were repeatedly measured with the generalized estimating equation.ResultsFor “cognition, skills, attitude, self-efficacy, teamwork,” NPGY and pre-clinical nurses’ post-tests are better than pre-tests, with statistically significant results. NPGY nurses’ “skills,” “attitude” and “teamwork” learning effectiveness are better than those of the pre-clinical nurses.ConclusionThe high-realistic situational simulation of dyspnea teaching program can significantly improve the learning effectiveness of NPGY nurses and pre-clinical nurses in the clinical evaluation and treatment of dyspnea.

BackgroundAn ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. ObjectiveIn this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. MethodsThis qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. ResultsA total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. ConclusionsTala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. International Registered Report Identifier (IRRID)RR2-10.1186/s12875-019-0925-8

AbstractThis study aims to examine the effects of market orientation and SCM strategy on SME financial performance and operational performance by using market performance as the mediating variable. A simple random sampling technique was employed. A total of 150 SME managers and owners participated in this study. By using Structural Equation Model (SEM) with AMOS 20 software, the results found the positive effects of market orientation on market performance and on financial performance. A positive effect was also obtained in examining the relationship between SCM strategy on market and operational performances. Market performance is also empirically proven to have a significant influence on operational performance. However, the results found no significant influence of market orientation on market and financial performances. The mediating testing showed that market performance strengthens the effect of SCM strategy on operational and financial performances. The results practically highlight the need for SMEs to rely on aspects of supply chain sustainability and be oriented to existing consumer demand patterns to encourage increased and sustainable business performance. Theoretically, the findings reveal SMEs’ emphasis on the strength of SCM strategy as a marketing focus and underscore the need to satisfy end customers and supply chain management members.