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This is a pre-registration of a systematic review looking at the impact of waiting times on outcomes of IAPT-approved therapies

The purpose of this review is to assess the impact on parental mental health when caring for a child with ASD in the UK with an aim to informing those working in relevant services and policy makers about the needs of parents during the assessment process prior to diagnosis, and moreover about the potential need to provide suitable interventions.

In the present paper we introduce a Virtual Element Method (VEM) for the approximate solution of general linear second order elliptic problems in mixed form, allowing for variable coefficients. We derive a theoretical convergence analysis of the method and develop a set of numerical tests on a benchmark problem with known solution.

In a 1988 article, Dziuk introduced a nodal finite element method for the Laplace-Beltrami equation on 2-surfaces approximated by a piecewise-linear triangulation, initiating a line of research into surface finite element methods (SFEM). Demlow and Dziuk built on the original results, introducing an adaptive method for problems on 2-surfaces, and Demlow later extended the a priori theory to 3-surfaces and higher order elements. In a separate line of research, the Finite Element Exterior Calculus (FEEC) framework has been developed over the last decade by Arnold, Falk and Winther and others as a way to exploit the observation that mixed variational problems can be posed on a Hilbert complex, and Galerkin-type mixed methods can be obtained by solving finite dimensional subproblems. In 2011, Holst and Stern merged these two lines of research by developing a framework for variational crimes in abstract Hilbert complexes, allowing for application of the FEEC framework to problems that violate the subcomplex assumption of Arnold, Falk and Winther. When applied to Euclidean hypersurfaces, this new framework recovers the original a priori results and extends the theory to problems posed on surfaces of arbitrary dimensions. In yet another seemingly distinct line of research, Holst, Mihalik and Szypowski developed a convergence theory for a specific class of adaptive problems in the FEEC framework. Here, we bring these ideas together, showing convergence and optimality of an adaptive finite element method for the mixed formulation of the Hodge Laplacian on hypersurfaces.

This systematic review seeks to comprehensively examine how people with disabilities present themselves on social media platforms, what shapes these self-presentation practices, and how they impact users' psychosocial well-being. It is guided by the following three research questions: 1. How does existing research describe the ways in which people with disabilities present themselves and their identity construction strategies on social media? 2. How does existing research reveal the multiple pathways of influence and environmental conditions that shape the social media self-presentation of people with disabilities? 3. How does existing research assess the impact of social media self-presentation behaviors on the psychosocial well-being of people with disabilities? To address these questions, the review adopts a mixed-methods approach, integrating both narrative synthesis of qualitative studies and meta-analysis of quantitative findings. It focuses on peer-reviewed empirical research published between 2020 and 2025, reflecting recent shifts in digital content creation, online visibility, and disability advocacy. This review is expected to produce a comprehensive synthesis of how people with disabilities engage in self-presentation on social media, what factors influence these behaviors, and how they affect psychosocial wellbeing. By integrating qualitative and quantitative evidence, the study will contribute: A typology of self-presentation strategies used by disabled social media users. A conceptual framework of influencing factors (e.g., individual, technological, cultural). Evidence-based insights into how self-presentation impacts psychosocial outcomes such as self-esteem, identity, and social connection. The findings will fill a gap in the communication literature on digital identity and marginalized voices and offer guidance for inclusive platform design and policy.

Community colleges, known for their open access and inclusion, have seen consistent enrollment declines for several years. At Outward Flats Community College, the research setting in this study, student enrollment has consistently declined and a widening admission yield gap between students of color and white students occurred. The researcher utilized an explanatory sequential mixed methods design to first collect quantitative through a survey prior to collecting qualitative data through semi-structured interviews. The researcher sought to explain students' enrollment decisions and explore the extent to which these decisions vary by race. Quantitative results indicated that students' decisions to attend the research setting were influenced by cost, campus location, academic programs, availability of financial aid, and campus size. Using One-Way ANOVAs, the researcher found statistically significant differences between African American/Black and White students. Compared to White students, African American/Black students were more influenced by college reputation, social activities, faculty expertise, educational facilities, guidance counselors, college advertising, and college published materials. Implications for practice include diversifying institutional marketing and communication strategies and framing the institution's view of students as customers.

The purpose of this sequential explanatory mixed-methods case study was to investigate the effects of English language learning on creative thinking skills in the domains of fluency, flexibility, originality, and elaboration as measured with the Alternate Uses Test. Unlike the previous research studies that investigated the links between English language learning and cognitive skills and had large numbers of participants, this research study relied on small group of participants to provide detailed information about the effects of English language learning on their creative thinking skills in the domains of fluency, flexibility, originality, and elaboration as measured with the Alternate Uses Test. This study involved the collection of quantitative data at the pretest and posttest stages and the explanation of the quantitative data using qualitative data. The quantitative findings of this sequential explanatory mixed-method case study indicated that there were no statistically significant differences between the pretest and posttest results in the domains of fluency, flexibility, originality, and elaboration as measured with the Alternate Uses Test.

The present study delved into a language learning model in the domain of English as a foreign language (EFL), i.e., simulation. The term simulation is used to describe the activity of producing conditions which are similar to real ones. We hypothesized that simulation plays a role in middle school students' perceptions of classroom activities (i.e., interest, challenge, choice, and joy). It was also conjectured that simulation affects foreign language achievement. To do so, the study utilized an experimental design consisting of 51 female participants (25 learners in the control group and 26 students in the experimental group). The results demonstrated the positive role of simulation in students' perceptions of classroom activities and their language achievement. A semi-structured interview was also held at the end of the study with a number of students in experimental group to investigate student's attitudes and emotional reactions towards simulation.

Numerical methods based on unstructured grids, with irregular cells, usually require discrete shape functions to approximate the distribution of quantities across cells. For control-volume mixed finite-element methods, vector shape functions are used to approximate the distribution of velocities across cells and vector test functions are used to minimize the error associated with the numerical approximation scheme. For a logically cubic mesh, the lowest-order shape functions are chosen in a natural way to conserve intercell fluxes that vary linearly in logical space. Vector test functions, while somewhat restricted by the mapping into the logical reference cube, admit a wider class of possibilities. Ideally, an error minimization procedure to select the test function from an acceptable class of candidates would be the best procedure. Lacking such a procedure, we first investigate the effect of possible test functions on the pressure distribution over the control volume; specifically, we look for test functions that allow for the elimination of intermediate pressures on cell faces. From these results, we select three forms for the test function for use in a control-volume mixed method code and subject them to an error analysis for different forms of grid irregularity; errors are reported in terms of the discrete L2 norm of the velocity error. Of these three forms, one appears to produce optimal results for most forms of grid irregularity.

The purpose of this article is to analyze the issues and challenges faced by English Language Learners (ELLs) and the public schools that absorb them. Ample research has been conducted on the intrinsic validity of standardized assessments, and separately, on the factors affecting the assimilation and integration of ELLs. However, the reliability of these assessments as a universally applied tool to measure student learning, and as a basis for determining school performance needs to be more closely examined. Quantitative data for this research will be gathered from ten (10) high schools in the major urban independent school districts located in Texas. Qualitative data will be derived from an on-line questionnaire focusing on respondents' views and opinions about the varied ways in which standardized assessments impact English Language Learners.

Through the use of mixed qualitative and quantitative methods, the current study explored the impact of postsecondary study on the intimate relationships and school experiences of partnered mature students. Quantitative regression analyses indicated that parental status, family support, partner support, and sexual desire significantly predicted relationship satisfaction, while family support and partner support significantly predicted sexual satisfaction. Age and sexual desire predicted school satisfaction for women only. Through qualitative thematic analysis it was determined that not having enough time, feeling too tired, and being stressed negatively impacted sexual satisfaction, while experiencing personal growth was described as both beneficial and problematic. Some participants reported using sex to aid in their academic success by way of offering a distraction or reducing stress. We discuss possible ways that postsecondary institutions, through their campus programs, can better address the impact school may have on mature students' intimate relationships.

Background: A number of school systems worldwide have proposed and implemented later school start times as a means of avoiding the potentially negative impacts that early morning schedules can have on adolescent students. Even mild sleep deprivation has been associated with significant health and educational concerns: increased risk for accidents and injuries, impaired learning, aggression, memory loss, poor self-esteem, and changes in metabolism. Although researchers have begun to explore the effects of delayed school start time, no one has conducted a rigorous review of evidence to determine whether later school start times support adolescent health, education, and well-being. Objectives: We aimed to assess the effects of a later school start time for supporting health, education, and well-being in high school students. Secondary objectives were to explore possible differential effects of later school start times in student subgroups and in different types of schools; to identify implementation practices, contextual factors, and delivery modes associated with positive and negative effects of later start times; and to assess the effects of later school start times on the broader community (high school faculty and staff, neighborhood, and families). Search methods: We conducted the main search for this review on 28 October 2014 and updated it on 8 February 2016. We searched CENTRAL as well as 17 key electronic databases (including MEDLINE, Embase, ERIC, PsycINFO, and Sociological Abstracts), current editions of relevant journals and organizational websites, trial registries, and Google Scholar. Selection criteria: We included any randomized controlled trials, controlled before-and-after studies, and interrupted time series studies with sufficient data points that pertained to students aged 13 to 19 years and that compared different school start times. Studies that reported either primary outcomes of interest (academic outcomes, amount or quality of sleep, mental health indicators, attendance, or alertness) or secondary outcomes (health behaviors, health and safety indicators, social outcomes, family outcomes, school outcomes, or community outcomes) were eligible. Data collection and analysis: At least two review authors independently determined inclusion and exclusion decisions through screening titles, abstracts, and full-text reports. Two review authors independently extracted data for all eligible studies. We presented findings through a narrative synthesis across all studies. When two or more study samples provided sufficient information to permit effect size calculations, we conducted random-effects meta-analyses to synthesize effects across studies. Results: Our search located 17 eligible records reporting on 11 unique studies with 297,994 participants; the studies examined academic outcomes, amount and quality of sleep, mental health indicators, attendance, and student alertness. Overall, the quality of the body of evidence was very low, as we rated most studies as being at high or unclear risk of bias with respect to allocation, attrition, absence of randomization, and the collection of baseline data. Therefore, we cannot be confident about the effects of later school start times. Preliminary evidence from the included studies indicated a potential association between later school start times and academic and psychosocial outcomes, but quality and comparability of these data were low and often precluded quantitative synthesis. Four studies examined the association between later school start times and academic outcomes, reporting mixed results. Six studies examined effects on total amount of sleep and reported significant, positive relationships between later school start times and amount of sleep. One study provided information concerning mental health outcomes, reporting an association between decreased depressive symptoms and later school start times. There were mixed results for the association between later school start times and absenteeism. Three studies reported mixed results concerning the association between later school start times and student alertness. There was limited indication of potential adverse effects on logistics, as the qualitative portions of one study reported less interaction between parents and children, and another reported staffing and scheduling difficulties. Because of the insufficient evidence, we cannot draw firm conclusions concerning adverse effects at this time. It is important to note the limitations of this evidence, especially as randomized controlled trials and high-quality primary studies are difficult to conduct; school systems are often unwilling or unable to allow researchers the necessary control over scheduling and data collection. Moreover, this evidence does not speak to the process of implementing later school starts, as the included studies focused on reporting the effects rather than exploring the process. Authors' conclusions: This systematic review on later school start times suggests several potential benefits for this intervention and points to the need for higher quality primary studies. However, as a result of the limited evidence base, we could not determine the effects of later school start times with any confidence. [Additional funding was provided by: (1) Department of Public Health Sciences, Canada; and (2) Canadian Institutes of Health Research and the Population Health Intervention Research Network, Canada.]

While press coverage of MOOCs (massive open online courses) has been considerable and major MOOC providers are beginning to realize that employers may be a market for their courses, research on employers' receptivity to using MOOCs is scarce. To help fill this gap, the Finding and Developing Talent study surveyed 103 employers and interviewed a subset of 20 about their awareness of MOOCs and their receptivity to using MOOCs in recruiting, hiring, and professional development. Results showed that though awareness of MOOCs was relatively low (31% of the surveyed employers had heard of MOOCs), once they understood what they were, the employers perceived MOOCs positively in hiring decisions, viewing them mainly as indicating employees' personal attributes like motivation and a desire to learn. A majority of employers (59%) were also receptive to using MOOCs for recruiting purposes--especially for staff with technical skills in high demand. Yet an even higher percentage (83%) were using, considering using, or could see their organization using MOOCs for professional development. Interviews with employers suggested that obtaining evidence about the quality of MOOCs, including the long-term learning and work performance gains that employees accrue from taking them, would increase employers' use of MOOCs not just in professional development but also in recruiting and hiring.

Hypoactive sexual desire is one of the most common sexual problems in women. According to the International Statistical Classification of Diseases and Related Health Problems (ICD-11), Hypoactive Sexual Desire Dysfunction (HSDD) is diagnosed when low sexual desire persists for at least several months and is associated with clinically significant distress. Problems with low desire are widespread in clinical populations of women with other mental disorders, with depression being one of the most common comorbidities (Basson & Gilks, 2018). HSDD negatively impacts various aspects of life, including reduced well-being, lower life satisfaction, mental health problems, and issues within partnerships (Biddle et al., 2009; Herder et al., 2023; Velten & Margraf, 2017). There are effective treatment options for female sexual dysfunction, including hypoactive sexual desire. However, women often avoid seeking professional help, in part due to the stigma surrounding their concerns and structural barriers within the healthcare system. The purpose of this study is to explore the unique perspective of women who experience HSDD while also being diagnosed with a depressive disorder. To this end, the lived experiences and treatment preferences of women will be explored using an online survey and focus group methodology. Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s health, 14, 1745506518762664. Biddle, A. K., West, S. L., D’Aloisio, A. A., Wheeler, S. B., Borisov, N. N., & Thorp, J. (2009). Hypoactive sexual desire disorder in postmenopausal women: Quality of life and health burden. Value in Health, 12(5), 763–772. Herder, T., Spoelstra, S., Peters, A., & Knegtering, H. (2023). Sexual dysfunction related to psychiatric disorders: A systematic review. The Journal of Sexual Medicine. Velten, J., & Margraf, J. (2017). Satisfaction guaranteed? How individual, partner, and relationship factors impact sexual satisfaction within partnerships. PloS one, 12(2), e0172855.

This is a study about subjective health complaints in Women in a multiethnic community where this study managed to include hard to reach groups. Subjective health complaints/MUS/MUPS can lead to reduced functionality and reduced quality of life. In this qualitative part we will explore which perspectives women with subjective health complaints have in their lives and how they manage living with these complaints.

This study investigated the effect of writing process in Google Docs environment on Iranian EFL learners' writing performance. It also examined students' perceptions towards the effects of Google Docs and their perceived causes of success or failure in writing performance. In this regard, 48 EFL students were chosen based on their IELTs writing test scores. During the treatment, the students were taught how to write a formal five-paragraph essay in the class, but they were supposed to practice writing process and give feedback to their peers' essays through Google Docs. At the end of the treatment phase, the participants received another sample of IELTs writing test (posttest). Moreover, 20 participants were interviewed for their perceptions regarding the causes for their success and failure and the influence of Google Docs on their writing performance. The analysis of a Paired-Sample t-test revealed that Google Docs played an effective role in improving students' writing performance. In addition, the analysis of interview revealed that the students perceived both internal and external causes for their success and failure; but in case of failure, internal factors were cited more often than external ones. Also, it was revealed that students generally showed positive attitude towards the implication of Google Docs as a factor leading to success in their writing performance.

This study investigated the effect of writing process in Google Docs environment on Iranian EFL learners' writing performance. It also examined students' perceptions towards the effects of Google Docs and their perceived causes of success or failure in writing performance. In this regard, 48 EFL students were chosen based on their IELTs writing test scores. During the treatment, the students were taught how to write a formal five-paragraph essay in the class, but they were supposed to practice writing process and give feedback to their peers' essays through Google Docs. At the end of the treatment phase, the participants received another sample of IELTs writing test (posttest). Moreover, 20 participants were interviewed for their perceptions regarding the causes for their success and failure and the influence of Google Docs on their writing performance. The analysis of a Paired-Sample t-test revealed that Google Docs played an effective role in improving students' writing performance. In addition, the analysis of interview revealed that the students perceived both internal and external causes for their success and failure; but in case of failure, internal factors were cited more often than external ones. Also, it was revealed that students generally showed positive attitude towards the implication of Google Docs as a factor leading to success in their writing performance.

The shift to adolescence is a significant period in young people’s lives. Especially for early adolescents, significant changes occur in their lives as they move from elementary school to secondary school (Antheunis et al., 2016). During that phase, social interaction is a particularly crucial aspect of young people’s lives, as spending time with peers becomes a critical marker of increasing independence and developing relationships outside their families (Twenge et al., 2019). As a result, adolescents are required to handle a wide range of social situations (Spence, 2003). Consequently, when social situations become challenging or distressing for adolescents it can have a significant influence upon their psychological, academic, and adaptive functioning (Spence, 2003). More specifically, relationship difficulties with peers, family and teachers are associated with various mental health problems (Segrin, 2000). Moreover, avoidance of social situations that they find challenging tends to maintain their distress (Fisher et al., 2004). Therefore, to break the cycle of avoidance that maintains the tension they may experience, exposing themselves to social situations is crucial (Chorpita & Daleiden, 2009; Creswell, 2020). Research has shown that indeed exposing oneself to anxiety-provoking situations, also known as in vivo exposure (IVE), is an effective way to increase adolescents’ confidence in social situations (Guadiano, 2006). Nonetheless, adolescents tend to be hesitant to engage in IVE. Confronting themselves with real-life social situations might be too threatening for adolescents with social fear and social avoidance. In that regard, practicing with social situations in virtual reality (VRE) may be a more acceptable way to engage in exposure (Emmelkamp et al., 2020). There also appears to be a lack of up-to-date research on (1) the type of social situations adolescents tend to find challenging and (2) the type of negative expectations adolescents hold during these situations. This information could help in designing relevant exposure exercises for struggling adolescents, in a way that challenges their negative cognitions.

Many users of image-based social media platforms – such as Facebook and Instagram – engage in spontaneous online social comparisons with others (for a review see Verduyn et al., 2020). So-called relationship comparisons (RCs) are particularly likely to occur on these platforms, given that posts featuring photographs of people displaying interpersonal affection (e.g., hugging or kissing) or spending quality time together (e.g., partying or travelling) are common (cf. Baxter & Pittman, 2001; Utz & Beukeboom, 2011). Though increasing evidence suggests that such photographs are highly effective at triggering RCs (cf. Morry et al., 2018), little is understood about how frequent these photograph-based comparisons are or what type of thoughts they entail. Therefore, the current study investigates Instagram users’ RCs in response to other people’s relationship photographs.

Many users of image-based social media platforms – such as Facebook and Instagram – engage in spontaneous online social comparisons with others (for a review see Verduyn et al., 2020). So-called relationship comparisons (RCs) are particularly likely to occur on these platforms, given that posts featuring photographs of people displaying interpersonal affection (e.g., hugging or kissing) or spending quality time together (e.g., partying or travelling) are common (cf. Baxter & Pittman, 2001; Utz & Beukeboom, 2011). Though increasing evidence suggests that such photographs are highly effective at triggering RCs (cf. Morry et al., 2018), little is understood about how frequent these photograph-based comparisons are or what type of thoughts they entail. Therefore, the current study investigates Instagram users’ RCs in response to other people’s relationship photographs.

Improving health and healthcare are dynamic processes in which stakeholders from research and practice are interdependent. Therefore, there is an increasing demand in approaches that facilitate collaboration and knowledge exchange between academic research and daily practice of patients, healthcare professionals and healthcare policy (1-5). As an answer to this call, a myriad of collaborative networks and approaches are initiated, including communities of practice, academic collaboratives (AC) and research partnerships (6-9). However, collaboration networks often face challenges, such as lack of interaction between knowledge users and knowledge producers, inadequate match between the supply of and demand for knowledge products, suboptimal use of novel scientific knowledge and expensive innovations resulting in limited effects on practice (10-14). For sustainable development, an AC or any other type of collaboration network needs to create a way of working together that is able to address these challenges (15). In the Netherlands, AC’s are a common form to facilitate research practice collaboration and knowledge exchange (1). The AC ‘Stronger on your own feet’ (SOO) is such a collaboration between the Radboudumc and seven care organizations for people with intellectual disabilities (ID). The aim of this AC is to improve the health and healthcare for people with ID. Like in other AC’s, SOO encounters challenges in the collaboration and knowledge exchange between research and practice such as differences in timelines, knowledge needs and priorities (1). To date, there is little insight in the functioning of academic collaboratives and how collaboration and knowledge exchange within an AC is being shaped. This study provides more insight about the functioning of AC’s and into how collaboration and knowledge exchange within an AC in the ID care sector can be improved. In this way, the health of and healthcare for people with ID can benefit. The aims of this study are to explore 1) the network positions of organizations within AC SOO concerning collaboration and knowledge exchange within the AC, 2) on which themes organizations within AC SOO collaborate and exchange knowledge, and 3) what the perspectives are on the current and future network position of organizations within AC SOO concerning collaboration and knowledge exchange. An explanatory sequential mixed methods design will be used involving quantitative data and explaining the quantitative findings with in-depth qualitative data. The overall research question of this study is the following: How do organizations within an Academic Collaborative in care for people with ID collaborate and exchange knowledge? Sub research questions: 1. What network position do organizations have within AC SOO concerning collaboration, knowledge sharing and knowledge searching? 2. On which themes do organizations within AC SOO collaborate, share and search knowledge? 3. What are perspectives for the current (and future?) network position of organizations within AC SOO concerning collaboration, knowledge sharing and knowledge searching?

The main purpose of the study is to study the impact of a short (21 days) empathy training on changes in Chinese adolescents and their parents’ parent-child relationship quality, parents’ couple relationship quality, life satisfaction level, and empathy skills.

This article is from Journal of Medical Internet Research , volume 13 . Abstract Background: Ongoing initiatives to filter online health searches exclude consumer-generated content from search returns, though its inferiority compared with professionally controlled content is not demonstrated. The antidepressant escitalopram and the antipsychotic quetiapine have ranked over the last 5 years as top-selling agents in their respective drug classes. Both drugs have various off-label mental health and non–mental health uses, ranging from the relief of insomnia and migraines to the treatment of severe developmental disorders. Objective: Our objective was to describe the most frequently reported effects of escitalopram and quetiapine in online consumer reviews, to compare them with effects described in professionally controlled commercial health websites, and to gauge the usability of online consumer medication reviews. Methods: A stratified simple random sample of 960 consumer reviews was selected from all 6998 consumer reviews of the two drugs in 2 consumer-generated (www.askapatient.com and www.crazymeds.us) and 2 professionally controlled (www.webmd.com and www.revolutionhealth.com) health websites. Professional medication descriptions included all standard information on the medications from the latter 2 websites. All textual data were inductively coded for medication effects, and intercoder agreement was assessed. Chi-square was used to test for associations between consumer-reported effects and website origination. Results: Consumers taking either escitalopram (n = 480) or quetiapine (n = 480) most frequently reported symptom improvement (30.4% or 146/480, 24.8% or 119/480) or symptom worsening (15.8% or 76/480, 10.2% or 49/480), changes in sleep (36% or 173/480, 60.6% or 291/480) and changes in weight and appetite (22.5% or 108/480, 30.8% or 148/480). More consumers posting reviews on consumer-generated rather than professionally controlled websites reported symptom worsening on quetiapine (17.3% or 38/220 versus 5% or 11/220, P < .001), while more consumers posting on professionally controlled websites reported symptom improvement (32.7% or 72/220 versus 21.4% or 47/220, P = .008). Professional descriptions more frequently listed physical adverse effects and warnings about suicidal ideation while consumer reviews emphasized effects disrupting daily routines and provided richer descriptions of effects in context. The most recent 20 consumer reviews on each drug from each website (n = 80) were comparable to the full sample of reviews in the frequency of commonly reported effects. Conclusion: Consumer reviews and professional medication descriptions generally reported similar effects of two psychotropic medications but differed in their descriptions and in frequency of reporting. Professional medication descriptions offer the advantage of a concise yet comprehensive listing of drug effects, while consumer reviews offer greater context and situational examples of how effects may manifest in various combinations and to varying degrees. The dispersion of consumer reviews across websites limits their integration, but a brief browsing strategy on the two target medications nonetheless retrieved representative consumer content. Current strategies for filtering online health searches to return only trusted or approved websites may inappropriately address the challenge to identify quality health sources on the Internet because such strategies unduly limit access to an entire complementary source for health information.

Tattooing for medical purposes of the areola-nipple complex has an important therapeutic value: it represents the final stage in the course of breast demolition surgery, reconstructing its appearance. The study aims to assess the feasibility of areola and nipple dermopigmentation surgery in women undergoing surgical treatment for breast cancer in the local healthcare setting, in terms of: organisational sustainability; cosmetic outcome; practitioner experience; and experience of the women treated.

No Abstract Available

To explore the training received and experiences of community healthcare workers conducting shifted tasks to meet ear and hearing needs in their community.

This is a study about subjective health complaints in Women in a multiethnic community where this study managed to include hard to reach groups. Subjective health complaints/MUS/MUPS can lead to reduced functionality and reduced quality of life. This project has first a quantitative part and then a qualitative part- mixed method. In the quantitative part we will study the distribution of subjective health complaints/MUS/MUPS among women in a multiethnic community and explore associated risks and protective factors. In the qualitative part we will explore which perspectives women with subjective health complaints have in their lives and how they manage living with these complaints. Part one is described here in this registration. Part two is described in the second registration

Statement of the problem: In December of 2020, and upon an FDA Emergency Use Authorization of two mRNA-Covid-19 vaccines, a vaccination campaign was launched in most hospitals across Canada. Vaccine products were tested for safety and efficacy in large, albeit short-term, RCTs, that included mostly young and healthy adults. Potential safety signals, many of them long term, would become apparent over time – through data from early adopters such as Israel and India, or reporting systems across the world, such as the United Kingdom (UK) Yellow Card, the World Health Organization VigiBase, or the United States (US) Centers for Disease Control (CDC) Vaccine Adverse Events Reporting System (VAERS). These signals were concerning. For instance, already in January 2021, VAERS would record a higher number of deaths post-Covid vaccination than any other vaccine since the system was established in 1990. By mid-2021, the number of recorded deaths post-Covid-19 vaccination would surpass the total number of deaths post all vaccines deployed in the preceding 30 years. Many healthcare workers with firsthand experience in their day-to-day practice of vaccine harms on patients or colleagues, and/or access to data from Israel, India, or systems such as VAERS, were cognizant of signals of harm not included in the hospital-provided vaccine information literature. Anecdotal evidence indicates that as a result, many chose not to get vaccinated despite job loss being the cost of such choice. Many others opted for early retirement or career change. Yet others became disabled or lost their lives, as indicated by government and actuarial data from the UK and the USA. The type and scope of the impact of the policy of vaccine mandates on the Canadian health workforce, however, remains unknown. Given the ongoing healthcare labor force shortage affecting Canadians, documenting, and explaining what one major contributor may be is critical. Our project assesses this potential contributor through a mixed-method study of the province of Ontario, Canada. Research question: Our main research question is: “What has been the impact of healthcare sector Covid-19 policies on access to care in Ontario, Canada?” Ancillary questions include: “What is known from publicly accessible governmental data (e.g., Ontario Health’s databases) and Freedom of Information Requests (FOIR) from government and hospitals, about the impact of the Covid-19 vaccine mandates on the healthcare labour force, specifically staff reductions? What is known about the implications of this impact for access to care in the province? What is the rationale informing the current policy of ongoing vaccine mandates for new and existing staff? What are the views and lived experience of Canadian health workers concerning the crisis in the health labour force? Aims: Our study aims to document and explain an under researched aspect of the drivers of the health crisis, specifically the impact of healthcare sector Covid-19 policies, on access to care in Ontario. Methods: To address our research questions and achieve our study aim, we will use Creswell (2015) mixed methods approach to inform our narrative literature review, policy analysis, FOIA investigation, survey of healthcare workers, and interview of a sample of workers from within survey respondents. Significance: The Covid-19 crisis has resulted in a severe understaffing of hospitals across Ontario, compounding the problems of lack of experienced health workers and staff burnout. To the best of our knowledge, there is no research into what led to the policy decision to terminate experienced, healthy unvaccinated health workers, a decision ongoing to this day. By summarizing extant evidence, identifying information gaps, surveying the health workforce, and gaining a deeper understanding of the lived experience within this workforce our research should contribute to more effective and equitable policies in the health sector moving forward, relevant not only to the province of Ontario but potentially throughout Canada.

This article is from SpringerPlus , volume 3 . Abstract Background: Poverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people’s economic status and food security translate into changes in HIV vulnerability. Methods: In this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants. Discussion: In addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.

We propose in this work a unified formulation of mixed and primal discretization methods on polyhedral meshes hinging on globally coupled degrees of freedom that are discontinuous polynomials on the mesh skeleton. To emphasize this feature, these methods are referred to here as discontinuous skeletal. As a starting point, we define two families of discretizations corresponding, respectively, to mixed and primal formulations of discontinuous skeletal methods. Each family is uniquely identified by prescribing three polynomial degrees defining the degrees of freedom and a stabilization bilinear form which has to satisfy two properties of simple verification: stability and polynomial consistency. Several examples of methods available in the recent literature are shown to belong to either one of those families. We then prove new equivalence results that build a bridge between the two families of methods. Precisely, we show that for any mixed method there exists a corresponding equivalent primal method, and the converse is true provided that the gradients are approximated in suitable spaces. A unified convergence analysis is also carried out delivering optimal error estimates in both energy- and $L^2$-norms.

There is overwhelming evidence to show that early adversity impacts health, educational and economic outcomes across the lifespan so it is not surprising to find that educational and health outcomes are comparatively worse for children at-risk. The benefits of the outdoor environment for children’s social and emotional development have long been understood. However, most of the evidence accumulated to date relates to mainstream educational settings, with fewer studies exploring the use of natural learning environments for children at-risk. The systematic review sought to address the question: "What is the impact of outdoor environments on at-risk children and young people?" This review examined how different outdoor interventions affect the socio-emotional, academic, and psychophysical well-being of children and young people identified as at-risk.

The qualitative and quantitative objective of this scoping review is to identify medical students’ perspectives on the use of digital problem-based learning in medical education, and by a qualitative analysis of the perspectives improve the design options for future medical educational DPBL interventions.

This article is from International Breastfeeding Journal , volume 7 . Abstract Background: Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children’s Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling. Methods: Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling. Results: Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is “good”. Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits. Conclusions: In a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted.

This article is from Substance Abuse Treatment, Prevention, and Policy , volume 9 . Abstract Background: Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions from OST patients and stakeholders about the potential impact of dispensing fees on compliance and OST program retention. Current and past experiences and the potential impact of OST dispensing fees were evaluated. Methods: Mixed methodology was used to obtain data from OST patients and stakeholders. This involved 1) interviews with OST stakeholders, 2) a focus group of OST patients and 3) surveys of OST patients in Perth, Australia, between June and August 2013. Results: The majority of the eight stakeholders declared cost as the factor mostly impacting on OST compliance. Almost all of the stakeholders commented that there was a positive correlation between time on the OST program and success in terms of relapse. Most stakeholders advocated for OST fees to contribute towards the Pharmaceutical Benefits Scheme Safety Net, and for fee subsidy. Focus group themes supported stakeholder interview findings. A total of 138 surveys were completed. Survey analysis illustrated a strong correlation between patient debt and impacted lifestyle: 82.4% (p 

This project is a mixed-methods systematic review examining how HIV-related stigma affects the mental health of international migrants living with HIV. It aims to synthesize quantitative and qualitative evidence on the relationship between different forms of stigma (e.g., internalized, anticipated, enacted, intersectional) and mental health outcomes such as depression, anxiety, PTSD, psychological distress, and resilience. The review addresses three core questions: What is the relationship between HIV-related stigma and mental health outcomes in this population? How do migrants describe the impact of stigma on their mental health? What factors (e.g., demographics, migration status, stigma type) influence these relationships? It also explores subgroup differences based on migrant status (e.g., refugee vs. skilled worker), region of origin, host country context, and intersectional identities (e.g., gender, sexual orientation). Quantitative data will be meta-analyzed using Jamovi, and qualitative findings will be synthesized thematically. This project contributes to the first author’s PhD, supported by a Higher Degree by Research (HDR) scholarship at La Trobe University. Expected outcomes include evidence-based insights to inform HIV care, mental health services, and policy responses tailored to migrant populations.

This article is from PLoS ONE , volume 9 . Abstract Objective: Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures. Study Design: A national online survey of American Congress of Obstetricians and Gynecologists (ACOG) fellows and 3 focus groups of obstetricians. Results: We received 2,514 eligible survey responses, for a response rate of 14%. The majority (78%) of obstetricians agreed that they can reduce patient exposures to environmental health hazards by counseling patients; but 50% reported that they rarely take an environmental health history; less than 20% reported routinely asking about environmental exposures commonly found in pregnant women in the U.S.; and only 1 in 15 reported any training on the topic. Barriers to counseling included: a lack of knowledge of and uncertainty about the evidence; concerns that patients lack the capacity to reduce harmful exposures; and fear of causing anxiety among patients. Conclusion: U.S. obstetricians in our study recognized the potential impact of the environment on reproductive health, and the role that physicians could play in prevention, but reported numerous barriers to counseling patients. Medical education and training, evidence-based guidelines, and tools for communicating risks to patients are needed to support the clinical role in preventing environmental exposures that threaten patient health.

This project aims to evaluate the effect of a workplace active pauses intervention on the reduction of cardiovascular risk factors in call center workers using a mixed methods design. The study includes a qualitative phase to identify workers’ preferences and expectations, and a intervention supported by a mobile app. Funded by La Marató 3CAT (2023).

This scoping review protocol will map the existing scientific production on the promotion, protection and support of breastfeeding developed using mixed methods. The protocol will be registered and prepared according to the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR. The review stages will be: defining the descriptors and eligibility criteria, searching for studies in databases and repositories, selecting and extracting data from the studies and, finally, how the results will be presented.

The prevalence of substance use (alcohol, illicit drugs) in the United States (US) is widespread. In a multisite validation study of a substance use screening instrument conducted in a large sample of people aged 18 or older, 62% regularly used alcohol and 28% used illicit drugs in the last twelve months. This study aligns with data from the US Department of Health and Human Services (DHHS) 2020 National Survey on Drug Use. In that study, which spans a broad age range of 12 or older, 50% used alcohol and 14% used illicit drugs. In addition, the DHSS showed that substance use increased during the COVID-19 pandemic, particularly among adolescents.2 People who use substances have serious health problems that can result in, or result from, substance use. For example, an estimated 10% of chronic pain patients become addicted to opioids, while heavy alcohol consumption can cause illnesses ranging from oral cancers to cardiovascular disease to depression. Yet, despite the large numbers of people who use substances and the extensive range of co-morbidities experienced by these people, clinical trials may unduly exclude them from participation in clinical trials across a spectrum of health areas. In a study of eligibility criteria of study protocols posted on clinicaltrials.gov, 62% of protocols across four health areas (i.e., dementia, depression, diabetes, and lung cancer) excluded people who use substances from trial participation. Addiction to alcohol or illegal substances is considered a disability under the Americans with Disabilities Act which requires that people with disabilities have the same rights and opportunities as all other people. The goal of this study is to assess whether substance use is an exclusion criterion in a broader sample of clinical trial protocols, across all health areas with studies in Clinical Trials.gov, and if so, to better understand the justification for such exclusion. We will include not only interventional studies, but also observational studies, with the expectation that observational studies do not have safety (e.g., drug-drug interaction) reasons for exclusion.

The prevalence of substance use (alcohol, illicit drugs) in the United States (US) is widespread. In a multisite validation study of a substance use screening instrument conducted in a large sample of people aged 18 or older, 62% regularly used alcohol and 28% used illicit drugs in the last twelve months. This study aligns with data from the US Department of Health and Human Services (DHHS) 2020 National Survey on Drug Use. In that study, which spans a broad age range of 12 or older, 50% used alcohol and 14% used illicit drugs. In addition, the DHSS showed that substance use increased during the COVID-19 pandemic, particularly among adolescents.2 People who use substances have serious health problems that can result in, or result from, substance use. For example, an estimated 10% of chronic pain patients become addicted to opioids, while heavy alcohol consumption can cause illnesses ranging from oral cancers to cardiovascular disease to depression. Yet, despite the large numbers of people who use substances and the extensive range of co-morbidities experienced by these people, clinical trials may unduly exclude them from participation in clinical trials across a spectrum of health areas. In a study of eligibility criteria of study protocols posted on clinicaltrials.gov, 62% of protocols across four health areas (i.e., dementia, depression, diabetes, and lung cancer) excluded people who use substances from trial participation. Addiction to alcohol or illegal substances is considered a disability under the Americans with Disabilities Act which requires that people with disabilities have the same rights and opportunities as all other people. The goal of this study is to assess whether substance use is an exclusion criterion in a broader sample of clinical trial protocols, across all health areas with studies in Clinical Trials.gov, and if so, to better understand the justification for such exclusion. We will include not only interventional studies, but also observational studies, with the expectation that observational studies do not have safety (e.g., drug-drug interaction) reasons for exclusion.

Science teachers' job satisfaction is identified as a major factor that affects the quality of a science program. This research investigated to what extent a science program supports science teachers in terms of curriculum materials or extracurricular activities. It also examined the relationships among schools' curriculum support, the number of science teachers, and the levels of their job satisfaction. Qualitative data consisted of 50 interviews with principals from 50 high schools in Texas. Quantitative data related to 385 surveys collected from science teachers working at these schools. Analysis of the data revealed that the large schools offered more curriculum support materials to science teachers than the small ones. Teachers' job satisfaction was not related to the number of science teachers and school size. New teachers indicated their needs for emotional support from mentors, administrators and parents related to their concerns and challenges in reducing their job dissatisfaction. Further implications for future research and practitioners were discussed.

Globally, parents and children in same-gender parent families are impacted by a multitude of laws related to parental sexual orientation. These sexual orientation laws vary considerably from one country to another, ranging from full legal recognition of the family structure in some countries to its criminalization in others. The psychological consequences of this legal vulnerability for family members warrant consideration in clinical practice, as they likely interfere with parental mental health, family functioning, and healthy child development. However, a systematic evidence synthesis of the pertinent literature and its placement within a broader psychological model are currently lacking. Accordingly, the aims of this review are (1) to systematically review qualitative and quantitative evidence on the impact of sexual orientation laws and the resulting legal vulnerability of same-gender parent families in key domains (individual health, family functioning and parenting, child educational and cognitive outcomes) and (2) to place these findings within a broader model integrating theories related to sexual minority health as well as family functioning and parenting. We will retrieve published and unpublished records of quantitative and qualitative studies via a systematic database search (PubMed, Scopus, Web of Science) as well as forward and backward searches of eligible studies and key literature. Mixed method data synthesis will follow a data-based convergent synthesis design. Specifically, we will use thematic synthesis to generate descriptive and analytical codes, which we will place within an integrative model informed by sexual minority health, family functioning, and parenting models. Implications for clinical and therapeutic practice will be discussed.

Note this registration has been withdrawn: This protocol outlines the methodological approach for a mixed-methods systematic review aimed at exploring how the right to health is conceptualised, operationalised, and contested within the context of human migrations through a decolonial lens. The review seeks to identify, synthesise, and critically appraise empirical studies that engage with the intersections of health, migration, and (de)coloniality. It integrates qualitative and quantitative evidence to examine how colonial legacies shape health systems, health access, and health outcomes for migrants and refugees, and to explore transformative practices that advance epistemic, structural, and relational justice in health. All procedures are comprehensively presented in the attached document – Review protocol.

Authentic leadership is a promising leadership style for creating meaningful organizational contexts that promote well-being. Research on authentic leadership currently pays little attention to the processes that explain such positive effects. This study draws on self-determination theory to test the relation between authentic leadership, motivation, and exhaustion as well as the potentially mediating process of psychological need fulfillment. In addition, this study addresses current methodological shortcomings by employing a mixed methods approach that incorporates multiple study designs, which offers advantages in terms of generalizability and depth of analysis.

Despite an increasing number of studies on pre-service teachers' digital literacy, there are few studies on pre-service English as a second/foreign language teachers. In the existing studies, there are issues especially regarding sample size, methodology, and analyzing different variables. Hence, this study recruits more participants from different institutions and investigates the effects of five variables, which are gender, grade, daily amount of time spent on digital platforms, the most used device, and year of digital platform use. The participants were 186 pre-service teachers from Türkiye. The quantitative data were collected via the Digital Literacy Scale and analyzed by Statistical Package for the Social Sciences (SPSS) 25.0 via independent samples t-test and one-way variance analysis. The qualitative data were collected via semi-structured interviews and analyzed by Descriptive Analysis. The findings showed that the participants had a medium to high level of digital literacy, while they reported higher levels in the interviews. The analysis of the survey indicated that the most used device and year of digital platform use had a significant effect on the participants' digital literacy levels. The interview results combined with the survey implied that the vital point in digital literacy training is to ensure "learning how to exploit digital skills" rather than gaining knowledge on all the available tools, applications, and resources.

Reading Recovery is a short-term early intervention designed to help the lowest-achieving readers in first grade reach average levels of classroom performance in literacy. Students identified to receive Reading Recovery meet individually with a specially trained Reading Recovery teacher every school day for 30-minute lessons over a period of 12 to 20 weeks. The purpose of these lessons is to support rapid acceleration of each child's literacy learning. In 2010, The Ohio State University received a Scaling Up What Works grant from the U.S. Department of Education Investing in Innovation (i3) Fund to expand the use of Reading Recovery across the country. The award was intended to fund the training of 3,675 new Reading Recovery teachers in U.S. schools, thereby expanding service to an additional 88,200 students. The Consortium for Policy Research in Education (CPRE) was contracted to conduct an independent evaluation of the i3 scale-up of Reading Recovery over the course of five years. The evaluation includes parallel rigorous experimental and quasi-experimental designs for estimating program impacts, coupled with a large-scale mixed-methods study of program implementation. This report presents the findings of the second year of the evaluation. The primary goals of this evaluation are: (1) to provide experimental evidence of the impacts of Reading Recovery on student learning under this scale-up effort; (2) to assess the success of the scale-up in meeting the i3 grant's expansion goals; and (3) to document the implementation of the scale-up and fidelity to program standards. This document is the second in a series of three reports based on the external evaluation of the Reading Recovery i3 Scale-Up. The report represents results from the impact and implementation studies conducted over the 2012-2013 school year--the third year of the scale-up effort and the second full year of the evaluation. [This document is a reissue of the December 2014 CPRE Research Report RR-79 under the same title. For the Year One Report, see ED547669.]

Adolescence represents a critical stage of life during which health-related behaviors are established and tend to persist into adulthood. During this particular phase, inappropriate behaviors, such as insufficient physical activity and excessive screen time, negatively impact health-related quality of life. In addition, in social networks of friends, mechanisms such as social support, can modify individual health-related behaviors positively. The overarching aim of the present study is to determine the effects of a social network intervention based on Physical Education, providing social support through the cooperative learning pedagogical model. The study seeks to investigate its impact on the physical activity behaviors of adolescents, exploring their perceptions of participation and changes resulting from the intervention implementation process. Secondary outcome variables include exploring the intervention's effectiveness in reducing sedentary behaviors, measured by recreational screen time, as well as assessing adolescents' health-related quality of life and social support for physical activity and screen time. A mixed methods approach will be employed with a nested or intervention design. The quantitative desing will be a cluster-randomized controlled trial, while the qualitative desing will be community-based participatory research. The integration will be carried out by triangulation methods, reference matrix, and thread tracking. The study will be conducted in four methodological phases, each one oriented with its respective research subquestions and specific aims. Phase I focuses on understanding the evidence related to the topic, phase II focuses on understanding the system, in phase III the intervention is deployed, and in phase IV the evaluation process and results will be developed. This study adheres to the framework of complex and participatory interventions, operating within a pragmatic paradigm sensitive to the context. Participants will include seventh-, eighth-, and ninth-grade adolescents from four official schools in the municipality of Montería, specifically from the southern communes. The study aims to contribute findings that strengthen social network-based interventions utilizing social support mechanisms to address the phenomenon of physical activity and sedentary behaviors among adolescents within the realm of Physical Education. Intervention A 10-week school-based intervention will be conducted during Physical Education classes, focusing on improving physical activity behaviors and reducing excessive screen time. The intervention will be guided by the constructs of Self-Determination Theory (Ryan & Deci, 2000). In-class activities will be implemented under the principles of the Cooperative Learning pedagogical model (Dyson & Casey, 2016), which operationalizes social support (Berkman, 2014) among students, aligning with the theory's constructs. Groups will be formed using social network data to segment them, maximizing the utilization of friendship networks to deploy the intervention (Valente, 2012). Additionally, educational materials (infographics) focusing on developing knowledge about physical activity, following World Health Organization recommendations (Bull, 2020), screen time, and types of social support will be provided in each class. Weekly, students will have to answer a question related to the topic, and they will be encouraged to take on a weekly challenge at school and during their leisure time. The intervention will be delivered by Physical Education teachers who will undergo prior training. In addition to the school-based intervention, a family intervention component will be implemented through WhatsApp, focusing on social support for these behaviors and co-created by the adolescents themselves. This family intervention will be incorporated from week 6 to week 10, meaning it will span 5 weeks as an addition to the school-based component. Each student group will be responsible for creating content related to family social support for physical activity and screen time. This content will be sent by WhatsApp to parents to support adolescents at home in improving these behaviors. Follow-up will be conducted to measure the effect of the school-only intervention and the effect of including the family intervention along with the school intervention in behavior changes. Both the school and family interventions will be informed by co-created elements with adolescents in a group model building workshop (Hovmand, 2014) held in each intervention school. The workshop will produce causal loop diagrams to identify other elements that can enhance and guide some aspects of implementation. Therefore, some details may change, or additional elements may be added, and this will be duly reported. The control group will undergo a 10-week intervention with class activities based on the pedagogical model of sports education (Siedentop, 2011), including a weekly challenge related to exercising in their leisure time based on the specific sport being addressed. This group will not work with the constructs of Self-Determination Theory, social network data will not be used to segment groups, and social support will not be specifically developed, even though the model involves team activities where this type of social function is implicit. The family component will not be developed in this group as well. The study has the approval of the ethics committee of the University of Antioquia through approval certificate ACEI 44-2023. The study will adhere to the guidelines for enhanced communication of intervention studies to improve their reproducibility and comparability, following the items outlined in the Template for Intervention Description and Replication (TIDieR) framework (Hoffmann et al., 2014). A detailed description of the TIDieR elements will enhance the external validity of the study, which will also be evaluated according to the parameters of the RE-AIM (Glasgow et al., 1999) and PRECIS-2 (Loudon et al., 2015) frameworks.

The purpose of this mixed methods study was to determine if there are differences in pre-service teachers' depth of reflection when using a written self-reflection form, a written self-reflection form and a think-aloud protocol, and collaborative reflection. Twenty-six pre-service teachers were randomly assigned to fourteen teaching teams. The teams taught a lesson that was videotaped and completed a written self-reflection form while viewing their lesson. The participants were randomly assigned to a control group or experimental group. The control group reflected individually using a written self-reflection form. Experimental Group #1 reflected collaboratively using a written self-reflection form, and Experimental Group #2 reflected individually using a think-aloud process while completing the written self-reflection form. The reflection forms were analyzed for depth of reflection, and a one-way ANOVA revealed significant differences in depth of reflection between the three groups. Participants also engaged in focus group interviews to describe their experiences. Two significant themes emerged: reflection on the teaching experience and reflection on the process used. We recommend that reflection should be used to help pre-service teachers learn from experience. In addition, the use of collaborative reflection and reflection using think-aloud protocols should be considered to promote deeper reflection and understanding.

This article is from BMC Public Health , volume 11 . Abstract Background: Mongolia is undergoing rapid epidemiological transition with increasing urbanisation and economic development. The lifestyle and health of Mongolians are changing as a result, shown by the 2005 and 2009 STEPS surveys (World Health Organization's STEPwise Approach to Chronic Disease Risk Factor Surveillance) that described a growing burden of Non-Communicable Diseases and injuries (NCDs).This study aimed to assess, describe and explore the knowledge, attitudes and practices of the Mongolian adult population around NCDs in order to better understand the drivers and therefore develop more appropriate solutions to this growing disease burden. In addition, it aimed to provide data for the evaluation of current public health programs and to assist in building effective, evidence-based health policy. Methods/design: This national survey consisted of both quantitative and qualitative methods. A quantitative household-based questionnaire was conducted using a nationally representative sample of 3854 rural and urban households. Participants were selected using a multi-stage cluster sampling technique in 42 regions across Mongolia, including rural and urban sites. Permanent residents of sampled households were eligible for recruitment, if aged between 15-64 years. This quantitative arm was then complemented and triangulated with a qualitative component: twelve focus group discussions focusing on diet, exercise and alcohol consumption. Discussions took place in six sites across the country, facilitated by local, trained health workers. These six sites were chosen to reflect major Mongolian cultural and social groups. Discussion: KAP surveys are well represented in the literature, but studies that aim to explore the knowledge, attitudes and practices of a population around NCDs remain scarce. This is despite the growing number of national epidemiological surveys, such as STEPS, which aim to quantify the burden of these diseases but do not explore the level of population-based awareness, understanding, risk-perception and possible motivation for change. Therefore this paper will contribute to building a knowledge base of NCD KAP survey methodology for future use in epidemiology and research worldwide.

Three versions of the assumed stress hybrid model in finite element methods and the corresponding variational principles for the formulation are presented. Examples of rank deficiency for stiffness matrices by the hybrid stress model are given and their corresponding kinematic deformation modes are identified. A discussion of the derivation of general semi-Loof elements for plates and shells by the hybrid stress method is given. It is shown that the equilibrium model by Fraeijs de Veubeke can be derived by the approach of the hybrid stress model as a special case of semi-Loof elements.