The detection of counter-speech on social media is heavily dependent on the conversational context, particularly in low-resource and code-mixed languages. This article presents a dataset of 10,021 contextual comment pairs extracted from political discussions on Bangladeshi YouTube channels. The dataset captures native Bengali script, fully Romanized Bengali ("Banglish"), and hybrid code-mixed sentences. Each instance consists of a parent comment and a corresponding nested reply, annotated manually by native speakers to indicate the presence or absence of counter-speech. Replies that actively dispute, correct, or challenge the parent text with a logical counter-narrative are labeled as '1' (Counter-Speech), while replies indicating agreement, off-topic remarks, or non-argumentative insults are labeled as '0' (Non-Counter Speech). The dataset underwent rigorous preprocessing, including the removal of URLs, user tags, and emojis, alongside the normalization of English characters. This dataset provides a foundational resource for training and evaluating natural language processing (NLP) models in understanding contextual political discourse in South Asian code-mixed environments. By preserving the direct link between a baseline statement and its response, the data allows researchers to move beyond isolated sentence classification and study actual dialogic structures. It specifically targets the acute shortage of resources for analyzing informal, phonetically typed regional dialects. Consequently, machine learning practitioners and social scientists can utilize this collection to benchmark text classifiers, test large language models (LLMs) on South Asian discourse, and explore algorithmic moderation strategies in highly polarized online spaces.
Children are voracious explorers. While this tendency is well established by both empirical and everyday evidence, accounts differ on whether exploration is goal-directed or stimulus-driven. In the current study, children (3- to 6-year-olds, n = 72) played with a novel toy that operated according to one of two possible causal rules and were given a choice between exploring to reveal the correct rule or repeating a previously successful action. Critically, while all children were aware of the rule's ambiguity and opportunity for information gain, their choices were tailored to the potential contextual value of that information. This result suggests that children's exploratory behavior is sensitive to goals rather than purely stimulus-driven, resonating with recent proposals about active learning, and providing insight into the complex character of early exploration behavior.
Despite strong evidence supporting cardiovascular and kidney benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes, prescribing rates remain suboptimal. The aim of this study was to assess clinicians' knowledge and comfort prescribing SGLT2i and GLP-1 RA in clinical practice and factors influencing prescribing of these agents. This multi-methods study used questionnaires to assess self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, and semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR) to assess factors affecting prescribing decisions among 21 clinicians (12 primary care physicians, 4 pharmacists, 5 nurse practitioners) at a large community-based health system in Virginia. Questionnaire results were analyzed using descriptive statistics, and interviews used a two-phase analytic approach combining inductive and deductive coding. Clinicians self-reported high knowledge (7.9/10) and comfort (8.1 and 8.4/10) prescribing SGLT2i and GLP-1 RA but identified multiple implementation barriers. The most significant barriers were insurance coverage and out-of-pocket costs, with prior authorization requirements delaying therapy initiation. Medicare beneficiaries faced particularly challenging access due to coverage gaps and ineligibility for manufacturer assistance programs. Organizational factors, including high workload, limited appointment time, and the absence of automated patient identification systems, hindered consistent prescribing. Medication burden, side effects, and aversion to injectable medications emerged as patient-related barriers. Facilitators included strong clinical evidence supporting these agents, organizational culture supportive of innovation, and access to pharmacist support. Despite high self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, clinicians identified barriers to their use in clinical practice at the patient, clinician, organizational, and medication access levels. Future work should identify the best implementation strategies to address these barriers.
Social vulnerability is an inherently context-dependent concept that has recently gained increasing attention within the framework of the social determinants of health. This study aimed to define and conceptualize social vulnerability within the specific context of Iran. A sequential mixed-methods design was employed. An initial pool of indicators was systematically developed through a literature review. The Delphi consensus technique was used to conceptualize social vulnerability in Iranian society by identifying context-sensitive and culturally relevant indicators. Over six months, 23 national experts in health and social welfare participated in three rounds of discussions. To assess the relevance and importance of these indicators, statistical indices, including the mean, standard deviation, and coefficient of variation, were applied. A directed qualitative content analysis was conducted to systematically categorize the indicators into distinct dimensions. Experts identified 65 relevant indicators of social vulnerability. Indicators with the strongest consensus included families living below the poverty line, the unemployment rate, the ratio of marginalized populations, the number of malnourished individuals, people lacking social insurance, the share of housing costs, the number of out-of-school children, the proportion of food expenses in total household spending, education levels below a diploma, and the under-five mortality rate. The ten identified dimensions of social vulnerability in Iran were: Populations at Risk; Family and Gender; Economic; Health Infrastructure and Public Health; Education; Housing and Built Environment; Transportation and Mobility; Crime and Social Security; Emergency Response and Disaster Preparedness; and Social Capital and Institutional Support. In developing countries such as Iran, social vulnerability is strongly influenced by macroeconomic fragility, governance constraints, and cultural factors. Developing a robust, context-sensitive framework for conceptualizing social vulnerability provides a foundation for practical tools to assess and monitor vulnerability more effectively. Ultimately, this approach supports targeted interventions aimed at improving the social determinants of health and enhancing population well-being.
An interprofessional approach integrating the perspectives of teachers and school-based occupational therapists is crucial for identifying and addressing complex activity problems among students with developmental difficulties. Nonetheless, the process through which professionals jointly perceive and describe these problems remains underexplored in Indonesia. This study is aimed at describing the experiences of Indonesian teachers and occupational therapists in identifying activity problems among primary school students with developmental difficulties. This descriptive qualitative study included 15 participants (seven teachers, one assistant teacher, and seven occupational therapists) who were purposively sampled and invited to participate in four online focus group interviews. Data were analyzed using inductive content analysis supported by member checking, peer debriefing, and an audit trail to ensure trustworthiness. Two primary descriptive themes were identified as follows: (i) "holistic approaches to the management of student activity problems" and (ii) "students' functional participation challenges at school." The participants perceived those restrictions on students' participation in expected activities resulted from the dynamic interplay between student capacities and contextual environmental constraints. These findings underscore the value of integrating diverse professional perspectives to capture the complex, transactional nature of students' functional participation challenges in educational environments. School-based occupational therapy practices should adopt holistic, collaborative approaches that empower school personnel and align with each school's context. Further studies are necessary to develop contextually relevant assessments, protocols, and support programs addressing participation restrictions in Indonesian school settings.
To investigate factors associated with help-seeking for urinary symptoms among Chinese patients with bladder cancer. A qualitative descriptive research design was employed, involving semi-structured interviews with patients diagnosed with bladder cancer. Content analysis was used to analyze the data. A total of 19 patients were interviewed . Four key themes were identified: (1) Factors influencing initial symptom appraisal, with three subthemes: attribution of urinary symptoms to non-threatening causes, lack of awareness of hematuria as a cancer sign, andillusion of self-healing caused by painless and intermittent symptoms; (2) Factors sustaining inaction, with three subthemes: masculine endurance, prioritizing social roles, age-related fatalism; (3) Factors converting inaction into action, with three subthemes: symptom persistence or worsening, social support, authoritative advice; (4) Factors that serve as sociocultural and contextual moderators, with four subthemes: financial constraints, festival taboos, the digital divide in healthcare, the warning effect of others' illness experiences. Help-seeking behavior among Chinese patients with bladder cancer is influenced by gaps in symptom awareness and appraisal, cultural-psychological barriers, and contextual moderators. Targeted interventions could focus on enhancing risk awareness of hematuria, addressing endurance norms and age-related fatalism, strengthening family and social support, and bridging the digital divide, with the aim of supporting timely help-seeking.
Accurate preoperative coronary artery delineation in X-ray angiography is critical for stenosis quantification, cardiovascular diagnosis, and treatment planning, yet class imbalance, weak bifurcation contrast, and overlapping artefacts often cause broken or distorted vessel segmentation. We propose a decoupled hybrid architecture that separates multi-scale detail recovery from global context aggregation, combining an FPN neck for distal-vessel edge preservation with a UPerHead head for multi-level contextual prior modelling. On the ARCADE benchmark, the model achieves Dice, IoU, and Centreline Dice scores of 0.7633, 0.6290, and 0.7827, outperforming competitive baseline methods in terms of Dice, IoU, and Centreline Dice, with consistent but moderate improvements over the strongest competing model. Grad-CAM++ and feature-distribution analyses suggest improved contextual attention and enhanced interpretability of learnt representations. The framework enhances robust preoperative vessel segmentation, supporting assessment of distal continuity, bifurcation morphology, and lesion-adjacent boundaries for clinical decision-making.
Self-management support is central to long-term condition care, yet little is known about how healthcare professionals support self-management in everyday clinical practice in Arctic healthcare settings. This study explored how healthcare professionals in Greenland understand and enact support for self-management among individuals with chronic obstructive pulmonary disease (COPD) or type 2 diabetes and examined how these practices relate to principles of self-management support. An inductive qualitative study used Interpretive Description. Semi-structured, face-to-face interviews were conducted with 23 healthcare professionals across the Greenlandic healthcare system. Data were analysed iteratively to generate practice-relevant interpretations. An integrative conceptual overview was developed to synthesise the relationships between themes and contextual conditions that shape support for self-management. Four interrelated themes were identified. First, support for self-management was primarily informal, embedded in routine clinical encounters and focused on biomedical explanations rather than structured, action-oriented strategies. Second, relational and empathetic practices, including non-judgemental communication and trust-building, were described as essential for patient engagement but were enacted intuitively rather than systematically. Third, participants described support for self-management as requiring a broad and evolving set of skills; however, limited access to timely specialist support and fragmented organisational structures constrained practice in complex situations. Fourth, language and cultural factors shaped communication and understandings of illness, highlighting challenges related to multilingual clinical encounters and perceptions of health, responsibility, and agency. In Greenlandic healthcare, support for self-management was described as largely informal, with a focus on biomedical knowledge, and embedded in routine clinical encounters. Current practices appeared to place greater emphasis on biomedical education than on structured, action-oriented and everyday-life-oriented components of self-management support. Strengthening self-management support may therefore benefit from an organisational health literacy approach that supports healthcare professionals in complementing biomedical explanations with pedagogically informed, action-oriented and contextually responsive support.
Progressive waves of coronavirus disease 2019 (COVID-19) have been driven by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants carrying mutations in the spike glycoprotein, particularly in immunodominant regions such as the receptor-binding domain (RBD) and the N-terminal domain (NTD). These mutations can alter antigenic surfaces and are associated with changes in antibody recognition and vaccine-induced protection. Integrating experimental neutralisation data with computational analyses may contextualise variant-associated differences in antibody responses. Neutralisation responses were evaluated using a pseudovirus-based luciferase reporter assay including SARS-CoV-2 spike proteins from B.1 (Wuhan), B.1.617.2, AY.2 (Delta), and B.1.1.529 (Omicron). Plasma samples from three cohorts: naturally infected (I), vaccinated (V), and vaccinated-infected individuals (V+I), along with RBD-directed monoclonal antibody CR3022, were assessed to determine neutralizing titres (NT50). In parallel, spike sequences were analysed using epitope prediction, antigenicity profiling, and structural modelling. Docking simulations of CR3022 with variant RBDs were performed using HADDOCK, and binding parameters were estimated using PRODIGY. Neutralisation responses varied across cohorts and viral variants, reflecting differences in immune exposure history. Plasma from V group individuals showed comparatively higher neutralisation titre, whereas B.1.617.2 and B.1.1.529 exhibited reduced susceptibility to neutralisation by infection-elicited antibodies. Computational analyses indicated variant-associated differences in predicted antigenicity and epitope landscapes within the RBD and NTD. Structural modelling and docking suggested that spike mutations may influence the CR3022-RBD interaction interface, with corresponding changes in predicted binding affinity across variants. These computational observations provide structural context for experimentally observed trends in reduced neutralisation but do not establish a direct mechanistic relationship. This study provides a combined experimental and computational characterization of SARS-CoV-2 variant-specific neutralisation across infection, vaccination and hybrid immunity-driven cohorts. The integration of pseudovirus neutralisation data with structural and in silico analyses offers a hypothesis-generating framework to contextualize observed differences in antibody responses and epitope recognition across variants.
Accurate drug-target interaction (DTI) prediction remains difficult for underexplored drugs and targets, especially when available interaction evidence is sparse. Existing approaches often focus either on pairwise molecular representations or on heterogeneous biomedical graph topology, making it difficult to effectively integrate structure-derived representations with multi-relational contextual evidence. We propose ColdstartMHDTI, a two-stage framework for heterogeneous-graph-based DTI prediction that integrates sequence-derived structural representations with local and global relational information. Specifically, drug SMILES and target sequences are encoded by pretrained transformer models, while one-hop heterogeneous relations are captured through self-supervised DistMult embeddings. These representations are then fused through a meta-path-guided module that models ordered meta-path instances and aggregates them with cross-attention for interaction scoring. Across two benchmark datasets, ColdstartMHDTI shows consistent improvements under warm-start and entity-disjoint settings, with particularly strong performance for underexplored drugs and targets. It also remains robust under more imbalanced evaluation protocols with 1:5 and 1:10 positive-to-negative ratios. In addition to standard classification performance, ColdstartMHDTI supports candidate prioritization for downstream screening and evidence-guided hypothesis generation. Case studies on ESR1, EGFR, and Parkinson's disease further demonstrate its practical utility, with the Parkinson's disease analysis additionally highlighting strong per-drug target ranking performance.
The nursing profession across developed countries faces significant pressures, particularly due to nursing shortages, highlighting the need for effective organisational interventions of nursing care at hospital level, e.g. new nursing roles, experimenting with different types of nurses and differentiated practices of nursing, and the expansion of the nursing profession within the hospital. However, it is difficult to learn from those experiences, partly because of the absence of a standardised description of these interventions. We benefited from a window of opportunity that occurred after failed reorganisation attempts at national level in the Netherlands, leading to a wide range of local initiatives to experiment and organise nursing care differently. To develop a comprehensive descriptive system to systematically describe the diversity of interventions to reorganise nursing care in different hospital settings. A scoping review of Dutch grey literature on these initiatives was conducted to identify interventions to (re)organise nursing care in Dutch hospitals between 2015 and 2021. The results were analysed thematically and synthesised into a descriptive system, consisting of a checklist and a matrix, embedded in international literature to capture the diversity in the (re)organisation of hospital nursing care. We applied the descriptive system on two cases of interventions of (re)organising nursing care in Dutch hospitals. Initially, 1102 records were identified, of which 27 were included in the review. Three main themes were determined: the organisation of different types of nurses, the organisation of different types of nursing work, and the organisation based on terms of employment. The three themes formed the basis for the descriptive system, each outlined with three dimensions describing each theme in more detail. Nine dimensions were identified within these three themes: (1) educational degree, competences, and subjective professional requirements, (2) patient care, indirect operational patient tasks, and quality and research, and (3) positions and embedding, quantity and ratios, and valuation. Additionally, the context was added to the descriptive system in order to take into account contextual factors not captured by the dimensions. All themes and dimensions proved valuable when applying the descriptive system to the two existing interventions. We propose a system of interventions of (re)organising nursing care to enable a systematic and comprehensive description of such interventions as the basis for evaluation.
Entrustable Professional Activities (EPAs) translate competencies into observable workplace tasks and are central to competency-based pharmacy education. However, context-specific EPAs for undergraduate pharmacy training in low- and middle-income countries, including Namibia, remain limited. To develop and achieve stakeholder consensus on core EPAs required of University of Namibia Bachelor of Pharmacy (BPharm) graduates prior to internship. A two-round modified Delphi study was conducted with Namibian pharmacists from academia, public and private sectors, and regulatory bodies who had experience supervising intern pharmacists. Round 1 evaluated 40 draft EPAs derived from Namibia's 2010 National Pharmacist Competency Framework using a five-point Likert scale and open-text feedback. EPAs achieving ≥ 75% consensus progressed to Round 2, where they were assessed for essentiality, clarity, and observability using retention thresholds of ≥ 70% essential and ≥ 90% observable. Descriptive statistics and qualitative comment analysis informed refinement of the final framework. Of 33 invited pharmacists, 18 completed Round 1 and 10 completed Round 2, with participant attrition occurring between rounds. Eleven EPAs were excluded after Round 1, mainly those related to veterinary medicines, disaster response, and selected management functions. In Round 2, 17 of the 29 EPAs failed observability or essentiality thresholds and were considered overly specialized, unclear, or insufficiently observable. The final 12 EPAs covered compounding and manufacturing, patient care, clinical pharmacy, supply chain management, and pharmacovigilance. A contextually relevant EPA framework for Namibian BPharm graduates was developed and may support curriculum development, workplace-based assessment, and graduate preparedness.
To systematically evaluate the overall performance, subject-based differences, and question type adaptability of five mainstream large language models (ChatGPT, DeepSeek, Kimi, Qwen, and Doubao) in the Chinese National Pharmacist Licensing Examination (CNPLE), and to explore their feasibility as auxiliary tools for pharmaceutical examinations. A cross-sectional comparative study design was adopted. The practice questions of the 2024 CNPLE were used as the evaluation dataset, covering 480 standardized questions across four subjects: Pharmaceutical Professional Knowledge (I), Pharmaceutical Professional Knowledge (II), Comprehensive Knowledge and Skills of Pharmacy, and Pharmaceutical Administration and Regulation. The question types included Type A (single best choice), Type B (matching choice), Type C (comprehensive analysis), and Type X (multiple choice). Standardized prompts were used for independent tests using the official web versions of each model with default parameters. Each question was input separately in a new conversation session to avoid contextual interference. Taking the official standard answers as the gold standard, the subject accuracy rate, question type accuracy rate, and overall accuracy rate of each model were calculated. To compare the overall performance among the five models, Cochran's Q test was applied. Post-hoc pairwise comparisons were performed using McNemar's test with Bonferroni correction for multiple comparisons. All five models exceeded the 60% passing score threshold of the CNPLE. The overall accuracy ranking was: Kimi (89.58%) > Doubao (88.96%) > DeepSeek (87.29%) > Qwen (77.92%) > ChatGPT (72.50%). Cochran's Q test showed a statistically significant difference in the overall accuracy among the five models (Q = 111.39, df = 4, P < 0.001). Pairwise comparisons showed no significant differences among Kimi, Doubao and DeepSeek (P > 0.05), while all three performed significantly better than Qwen and ChatGPT (P < 0.001). At the subject level, all models achieved the best performance in Pharmaceutical Professional Knowledge (II) (average accuracy 89.50%) and relatively weak performance in Pharmaceutical Administration and Regulation (average accuracy 76.50%). At the question type level, Type C questions yielded the highest average accuracy (90.00%), whereas Type X questions had the lowest average accuracy (69.00%). In this single-run evaluation, the Chinese large language models tested achieved higher overall accuracy than ChatGPT under the same conditions. Among them, Kimi, Doubao and DeepSeek have reached an excellent performance level. Different models present differentiated advantages across subjects and question types. Regulatory subjects and Type X (multiple-answer) questions are common challenges for all models. The findings indicate that mainstream LLMs possess considerable potential as auxiliary tools for the CNPLE, and can provide intelligent support for pharmaceutical education and examination preparation.
E-cigarette (EC) use is increasing among young adults in Malaysia. However, evidence on how EC-related behaviours and perceived physical activity barriers are associated with physical activity participation remains limited. This study examined the associations between EC-related behaviours and perceived physical activity barriers with physical activity status among Malaysian university students who use EC. A cross-sectional online survey was conducted between December 2023 and July 2024 across six Malaysian universities. Of 660 respondents, 564 met the age and International Physical Activity Questionnaire (IPAQ) criteria and were included in the analysis. Physical activity was classified as active and inactive. Exposures included EC use frequency, dual use, nicotine content, nicotine dependence, EC knowledge, motivations and perceptions for EC use, EC-related side effects, and perceived physical activity barrier items across personal, social and physical domains. Associations were analysed using chi-square tests and binary logistic regression, with odds ratios (ORs) and 95% confidence intervals. Overall, 64.9% were classified as active. At the crude level, EC use frequency, nicotine content, and dual-use status were associated with physical activity. However, these variables were not retained in the multivariable model due to multicollinearity. Nicotine dependence emerged as one of the strongest behavioural correlates of physical inactivity, with higher dependence associated with greater odds of physical inactivity. Perceived barriers to physical activity, particularly personal and social barriers, demonstrated the strongest and most consistent associations, with substantially higher odds of inactivity across barrier levels. EC knowledge and perception variables were not independently associated after adjustment, although item-level patterns were observed. Reported EC related symptoms were mainly gastrointestinal, respiratory, and neurological but were not analysed in relation to physical activity. Physical activity among Malaysian university students who use EC is more consistently associated with nicotine dependence and perceived barriers, than with sociodemographic or knowledge variables. These findings suggest that interventions may benefit from addressing behavioural dependence and contextual constraints. Given the cross-sectional design, these results should be interpreted as hypothesis-generating. Physical activity among university students who use EC appears more closely associated with nicotine dependence and perceived barriers than with knowledge or sociodemographic factors. While some EC use patterns showed crude associations, nicotine dependence emerged as one of the strongest behavioural correlates of physical inactivity. Lower perceived barriers, particularly personal and social, were consistently linked to higher activity participation. These findings suggest that intervention strategies may benefit from addressing behavioural dependence alongside reducing personal and social barriers to physical activity, particularly factors related to motivation, self-confidence, and competing demands. Integrating accessible, context-specific physical activity opportunities within EC cessation or harm-reduction programmes may enhance engagement and promote healthier lifestyle behaviours among young adults.
Corporate social responsibility (CSR) and irresponsibility (CSIR) impact firm risk in complex, dynamic ways, rather than as mere opposites. In a meta-analysis of 197 empirical studies, we find asymmetric patterns in which CSIR's risk-generation effects outweigh CSR's risk-mitigation effects. These impacts vary across dimensions of social outcomes, risk types, and contextual moderators. Moreover, CSR's risk-mitigation effects are influenced by indirect paths related to CSIR, whereas CSIR's risk-generation effects are not associated with indirect paths. Our findings highlight the nuanced interplay among CSR, CSIR, and risk, offering new insights for future research on theoretical mechanisms, contexts, measurements, and methods.
Social anxiety is a common psychological challenge among college students and is closely associated with impaired interpersonal functioning and reduced wellbeing. Although physical activity has been linked to better mental health, limited research has examined whether the broader school sports atmosphere is associated with social anxiety and through which psychological pathways this association may operate. Drawing on Ecological Systems Theory and Social Cognitive Theory, this study investigated whether exercise self-efficacy mediates the relationship between school sports atmosphere and social anxiety, and whether gender moderates the constituent paths of this process. A cross-sectional survey was conducted among 576 Chinese college students selected through stratified cluster sampling. Participants completed measures of school sports atmosphere, exercise self-efficacy, and social anxiety. Descriptive statistics, correlational analyses, confirmatory factor analysis, and common method bias testing were performed. Mediation and moderated mediation analyses were conducted using PROCESS Model 4 and Model 59 with bootstrapping procedures, while controlling for relevant demographic covariates. School sports atmosphere was significantly and negatively associated with social anxiety. Exercise self-efficacy partially mediated this relationship, indicating that a more positive school sports atmosphere was associated with higher exercise self-efficacy, which in turn was associated with lower social anxiety. Gender significantly moderated two constituent paths of the indirect process. Specifically, the positive association between school sports atmosphere and exercise self-efficacy was stronger for males, whereas the negative association between exercise self-efficacy and social anxiety was stronger for females. However, the overall indirect effect did not significantly differ in magnitude across genders, suggesting a potential path-specific compensatory pattern rather than a universal mechanism. A supportive school sports atmosphere may serve as a protective contextual factor associated with lower social anxiety among college students, partly through enhanced exercise self-efficacy. The findings further suggest that the internal pathways linking sports atmosphere, self-efficacy, and social anxiety differ by gender in a compensatory manner. These results provide evidence for developing gender-sensitive campus sports and mental health interventions aimed at reducing social anxiety in higher education settings.
Early childhood education and care (ECEC) is widely recognized for supporting children's development and school readiness; however, evidence from Western Australia remains limited. To examine the association between ECEC attendance and developmental vulnerability at school entry. This population-based cohort study included children participating in Australian Early Development Census waves in Western Australia from 2009 to 2021. Analyses were conducted between November 2025 and January 2026. The primary exposure was participation in ECEC, defined as attendance at either preschool or daycare before starting full-time school. Preschool and daycare were also examined separately. Additional analyses examined overlapping ECEC exposure patterns, including children who attended both preschool and daycare. Developmental vulnerability on 1 or more domains (DV1) and on 2 or more domains (DV2) across 5 Australian Early Development Census domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Mixed-effects modified Poisson regression with robust SEs estimated adjusted relative risks (aRRs). Of 123 256 children, complete data were available for 117 691 children in the ECEC analysis (59 335 [50.4%] male; 87 216 [74.1%] aged 5 years 1 month to 5 years 10 months), 117 496 in the preschool analysis (59 234 [50.4%] male; 87 089 [74.1%] aged 5 years 1 month to 5 years 10 months), and 85 544 in the daycare analysis (43 289 [50.6%] male; 63 155 [73.8%] aged 5 years 1 month to 5 years 10 months). Preschool attendance was high (95.0%; 111 650 children), whereas daycare attendance increased from 23.1% (4362 children) in 2009 to 37.1% (6478 children) in 2021. ECEC attendance was associated with a reduced risk of developmental vulnerability (DV1, aRR, 0.78; 95% CI, 0.74-0.82; DV2, aRR, 0.67; 95% CI, 0.62-0.72). Similar associations were observed for preschool. In contrast, daycare attendance was associated with a higher risk of DV1 (aRR, 1.09; 95% CI, 1.06-1.13) and DV2 (aRR, 1.15; 95% CI, 1.10-1.21), with higher vulnerability in social competence and emotional maturity but lower vulnerability in language and cognitive skills (school-based) and communication skills and general knowledge. In this cohort study of 123 256 children, participation in ECEC, particularly preschool, was associated with lower developmental vulnerability at school entry. These findings support efforts to improve equitable access to early childhood education. The heterogeneous associations for daycare attendance suggest that differences in participation patterns, timing, and contextual factors may influence developmental outcomes and warrant further investigation.
To describe the development of Respir'air BPCO, a theory-driven self-management digital intervention to promote physical activity in people living with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation. Physical activity is a key component of COPD self-management, yet activity levels often decline after discharge from pulmonary rehabilitation. Digital interventions may extend support beyond face-to-face care, but existing interventions are heterogeneous and frequently lack explicit theoretical grounding. Involving patients and healthcare professionals in intervention development is essential to enhance acceptability and clinical relevance. Development was guided by the updated Medical Research Council framework for complex interventions and operationalized using pragmatic elements from Bleijenberg's approach. The process included evidence synthesis (umbrella review), theory selection (Middle-Range Theory of Self-Care of Chronic Illness and Self-Determination Theory), stakeholder needs assessment through focus groups with people living with COPD and healthcare professionals, contextual assessment in a Swiss pulmonary rehabilitation center, and modelling of processes and outcomes through a logic model. Content validity was assessed through a two-round modified e-Delphi with an expert panel. Respir'air BPCO is a mobile application-based intervention comprising: (1) eight structured educational modules targeting physical activity, (2) daily step monitoring and personalized goal setting, and (3) motivational features including reminders and feedback. The intervention components were designed mainly to strengthen knowledge, self-management competencies, and motivation. Respir'air BPCO is expected to be feasible and acceptable, and to promote physical activity, improve disease self-management and motivation, enhance health-related quality of life, reduce symptom severity, and decrease exacerbations and hospitalizations. Respir'air BPCO was developed through a structured, theory-based, and stakeholder-informed design process involving patients and health professionals. Feasibility and acceptability will be evaluated in future studies. The intervention may help extend self-management support after rehabilitation and promote physical activity maintenance in daily life of COPD patients.
Access to and use of mobile phones are increasingly a prerequisite for full participation in modern society. Yet, a significant digital gender gap persists in India, where women are less likely than men to own phones or access the internet. To measure and understand this gap, survey questions must be both comprehensible to the respondents and contextually appropriate. We conducted 101 cognitive interviews with men (n = 44) and women (n = 57) in rural Uttar Pradesh to test 118 draft survey questions developed for an upcoming survey on digital access and use. These draft questions were drawn primarily from validated global instruments, with some additional questions newly developed by our team, and were all translated into Hindi. Through team debriefs and systematic analysis of the interview transcripts, we identified seven categories of question problems: (1) inappropriate terminology, (2) overly complex wording, (3) low resonance of digital concepts (e.g., personal data, online tracking, privacy policies, hacking), (4) confusion when asking about permission and supervision of mobile phone use due to phone sharing and overlap with concept of help or support, (5) problematic question structures and response options (especially Likert scales), (6) self-practice bias, and (7) unclear time frames and recall expectations. Overall, we found that many draft survey questions were incomprehensible to respondents despite our research team's efforts to develop clear and simple translations. Revisions were required for almost all questions. Our findings highlight the critical role of cognitive interviewing in improving data quality, particularly when conducting surveys across languages and sociocultural contexts, and amid rapidly changing digital landscapes.
Clinical reasoning in nursing is described as complex, context-dependent, and difficult to articulate. Despite its recognised importance, it is often examined through narrative accounts or inferred from decision outcomes, offering limited insight into how reasoning is articulated and organised in practice. This has limited our understanding of the structure of reasoning, particularly in complex and dynamic settings, and underscores the need for approaches that make this structure explicit and open to systematic analysis. To explore and describe how registered nurses retrospectively explain and structure their clinical reasoning in relation to observed care situations in home-based care. A retrospective think-aloud design was used. Nineteen transcripts from registered nurses were analysed using a rule-based modified clinical protocol analysis, with AI-assisted procedures to identify clinical domains, operator configurations, and cross-case structures. Clinical reasoning was consistently organised around recurring patterns of observation and evaluation, often extended into planning in more complex or risk-oriented situations. Reasoning was characterised by non-linear structures combining diagnostic and procedural orientations. Different clinical domains were associated with distinct reasoning structures, including verification-based processes in procedural care and evaluation-planning processes in autonomy- and support-focused situations. Registered nurses' clinical reasoning in home-based care can be described as structured, multi-layered, and contextually adaptive, rather than strictly linear. The findings suggest that reasoning can be systematically described across cases, making reasoning structures visible and comparable. This study offers a basis for describing and discussing clinical reasoning more systematically in nursing education, supervision, and future research.