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This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

Drug cryptomarkets increase information available to market actors, which should reduce information asymmetry and increase market efficiency. This study aims to determine whether cryptomarket listings accurately represent the advertised substance, weight or number and purity, and whether there are differences in products purchased from the same listing multiple times.

Law enforcement drug purchases – predominantly cocaine, methamphetamine, MDMA and heroin – from Australian cryptomarket vendors (n = 38 in 2016/2017) were chemically analysed and matched with cryptomarket listings (n = 23). Descriptive and comparative analyses were conducted.

Almost all samples contained the advertised substance. In most of these cases, drugs were either supplied as-advertised-weight or number, or overweight or number. All listings that quantified purity overestimated the actual purity. There was no consistent relationship between advertised purity terms and actual purity. Across the six listings purchased from multiple times, repeat purchases from the same listing varied in purity, sometimes drastically, with wide variation detected on listings purchased from only one month apart.

In this data set, cryptomarket listings were mostly accurate, but the system was far from perfect, with purity overestimated. A newer, larger, globally representative sample should be obtained to test the applicability of these findings to currently operating cryptomarkets.

This paper reports on the largest data set of forensic analysis of drug samples obtained from cryptomarkets, where data about advertised drug strength/dose were obtained.

This study aims to provide a comprehensive bibliometric analysis of social exclusion research, examining its evolution and identifying emerging trends and influential contributions in the field.

Using bibliometric and thematic analysis of 3,041 Scopus database documents, the study uses tools like VOSviewer for network analysis and Biblioshiny for trend analysis, focusing on publication patterns, author contributions and thematic clusters.

The findings reveal significant growth in social exclusion research since 1979, highlighting key contributions from diverse academic fields. Notable trends include the rise of digital exclusion and environmental justice themes. The study identifies leading authors, institutions and countries contributing to this field, along with highly cited documents that have shaped the discourse on social exclusion.

The study acknowledges its reliance on Scopus data and suggests incorporating other databases for future research. It highlights the need to explore emerging topics and address literature gaps.

This paper presents a unique bibliometric perspective on social exclusion research, underscoring its interdisciplinary nature and evolving focus. The study’s comprehensive approach offers valuable insights into the field’s trajectory, contributing to a deeper understanding of social exclusion phenomena.

In recent decades, researchers have increasingly begun to study the effects of transformational leadership on various teachers’ attitudes in K-12 settings. However, studies on the effect of transformational leadership on the job satisfaction of vocational high school teachers are not sufficient. Therefore, in this study, the nature of the relationship between transformational leadership and job satisfaction in Turkish vocational high schools was examined.

The study data came from 847 teachers working at 82 state vocational high schools located in 12 regions in Türkiye. To test the research model, we conducted multilevel structural equation modeling to explore the structural relationships between transformational leadership, teacher professional learning, teacher’ self-efficacy and job satisfaction.

The analysis confirms that teacher professional learning and self-efficacy are prominent mediators in the relationship between transformational leadership and job satisfaction in Turkish vocational high schools.

The present study is expected to contribute to the body of research focusing on the effects of transformational leadership on job satisfaction in vocational high schools. Implications for theory, practice and policy are discussed.

This study aims to stimulate scholarly attention and practical application pertaining to individuals recognized as “Docs.” Through conducting a comprehensive analysis and acquiring a profound understanding of its many connotations, the objective is to shift attitudes and approaches concerning those who are seen to possess knowledge and value within society.

For this study, culturally relevant pedagogies were used as theoretical frameworks in addition to Sankofa and concept explication being used as methodologies.

The authors identified three themes: (1) honorary cultural practice-community nomination of “professahs” and “docs,” (2) (Black) robinhoods – cultural signifiers of distinction and relatability and (3) docs as catalysts – elevating community via consciousness, trust and mentorship as significant understandings of this distinction.

The study emphasizes the importance of “Docs” in both academic and social contexts. The role of “Docs” serves to alleviate potential conflicts of being a Black intellectual. This study further reveals the ways in which Docs align with, promote or possibly undermine established frameworks of thought. Finally, this study provides institutions with opportunities to consider strategies for the utilization, recognition and integration of individuals who are frequently overlooked or undervalued.

The purpose of this study is to investigate the effect of transformational leadership (TL) of school leaders on tacit and explicit knowledge sharing (KS) of teachers via the mediating roles of knowledge self-efficacy. This study also attempts to bring a deeper insight on the correlation between TL and KS by exploring the moderating effect of knowledge-oriented school culture (KSC).

The paper used the quantitative approach and structural equation modeling to test the relationship among the latent factors in the proposed research model using data collected from 335 teachers in Vietnamese universities.

The findings revealed that TL might be an important precursor to create significant influences on tacit and explicit KS behaviors of teachers directly or indirectly through its positive effect on knowledge self-efficacy. In addition, the paper highlights the moderating role of KSC in strengthening the impact of TL on tacit and explicit KS behaviors of teachers.

This paper offers principals and managers in higher education a novel approach and valuable understanding of the effective pathways to foster KS behaviors of teachers.

This study is unique in its attempts to bridge research gaps in the literature and advance the insights of how school leadership fosters knowledge self-efficacy and KS willingness of teachers through practicing TL style and building a knowledge-oriented climate in higher education.

The study aims to have adults discuss experiences, practices needs and feelings related to health management, diet and food security.

A total of 22 immigrants were recruited from the Open School of Immigrants in Piraeus, Attica, Greece, to participate in focus group discussions. The discussions were audio recorded and thematically analyzed. Three major themes were developed: pathways to health care, nutrition management and experiences related to food shortages.

Most of the participants identified internet as the most commonly used way to obtain health advice; they also stated that unexpected ill-health is usually accompanied by feelings of fear, anxiety and loneliness. Immigrants, who had visited a public hospital in Greece, identified the language barrier as the most challenging issue, followed by the long waiting lists. Fear and anxiety of hospital visits was an important factor in their decision to vaccinate against COVID-19. Lack of time, high cost of healthy food and lack of knowledge were the most common obstacles to a healthy diet. One in two immigrants reported that they have faced food insecurity issues in the past. Stress, psychological distress and irritation were reported, due to food shortages, especially during the first few years of arriving in Greece. The exclusion of some foods, reduced portion sizes and buying cheaper foods were among the coping strategies to address food shortages.

The study offers an insight into immigrant’s experiences, practices and feelings about managing health issues and could be useful for health-care practitioners, researchers and policymakers.

In the state of Hawaii, it has been shown that certain ethnic minority groups, such as Filipinos and Pacific Islanders, suffer disproportionally high rates of cardiovascular disease, evidence that local health-care systems and governing bodies fail to equally extend the human right to health to all. This study aims to examine whether these ethnic health disparities in cardiovascular disease persist even within an already globally disadvantaged group, the houseless population of Hawaii.

A retrospective chart review of records from Hawaii Houseless Outreach and Medical Education Project clinic sites from 2016 to 2020 was performed to gather patient demographics and reported histories of type II diabetes, obesity, hyperlipidemia, hypertension and other cardiovascular disease diagnoses. Reported disease prevalence rates were compared between larger ethnic categories as well as ethnic subgroups.

Unexpectedly, the data revealed lower reported prevalence rates of most cardiometabolic diseases among the houseless compared to the general population. However, multiple ethnic health disparities were identified, including higher rates of diabetes and obesity among Native Hawaiians and other Pacific Islanders and higher rates of hypertension among Filipinos and Asians overall. The findings suggest that even within a generally disadvantaged houseless population, disparities in health outcomes persist between ethnic groups and that ethnocultural considerations are just as important in caring for this vulnerable population.

To the best of the authors’ knowledge, this is the first comprehensive study focusing on ethnic health disparities in cardiovascular disease and the structural processes that contribute to them, among a houseless population in the ethnically diverse state of Hawaii.

Construction projects require a range of documents (e.g. drawings and specifications) prepared by built environment professionals. In recent years, there has been a perception amongst professionals that quality of documentation has declined. “Low” professional fees were cited as one of the reasons for poor quality documentation. However, most studies on the topic contained inappropriate methodologies. Therefore, the purpose of this paper was to develop a conceptual methodology to comprehensively examine the relationship between fees and professional service output quality.

A systematic literature review (SLR) was conducted to evaluate the limitations of previous methodologies and identify variables in the relationship between fees and quality of professional service outputs. Findings from the SLR were used to develop a conceptual methodology to investigate the relationship between fees and quality of professional service outputs.

Based on a frequency analysis of factors in the construction literature, the three main variables influencing professional service output quality were fees, coordination and amount of time available for project tasks. The SLR and shortcomings in previous studies informed the development of a conceptual methodology to examine the relationship between fees and professional service output quality.

The conceptual methodology will assist in comprehensively investigating the effect of fees on the quality of professional service outputs. This is particularly relevant in countries where clients procure built environment professional services based on the lowest fee tendered but are concerned about quality. The methodology can establish how and to what extent “low” fees impact on professional service output quality. Industry professionals can also use variables identified in this paper to mitigate quality-related risks when producing professional service outputs.

This paper adds to the body of knowledge by identifying variables in the relationship between fees and professional service output quality. The identified variables can be monitored and controlled by researchers during future investigations. Additionally, a conceptual methodology was proposed to assist researchers to determine the effect of fees on professional service output quality. The flexibility of the conceptual methodology enables it to comprehensively investigate other key variables (apart from fees) impacting on professional service output quality.

Given the complex nature of integrated care systems (ICSs), the geographical spread and the large number of organisations involved in partnership delivery, the importance of leadership cannot be overstated. This paper aims to present novel findings from a rapid realist review of ICS leadership in England. The overall review question was: how does leadership in ICSs work, for whom and in what circumstances?

Development of initial programme theories and associated context–mechanism–outcome configurations (CMOCs) were supported by the theory-gleaning activities of a review of ICS strategies and guidance documents, a scoping review of the literature and interviews with key informants. A refined programme theory was then developed by testing these CMOCs against empirical data published in academic literature. Following screening and testing, six CMOCs were extracted from 18 documents. The study design, conduct and reporting were informed by the Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) training materials (Wong et al., 2013).

The review informed four programme theories explaining that leadership in ICSs works when ICS leaders hold themselves and others to account for improving population health, a sense of purpose is fostered through a clear vision, partners across the system are engaged in problem ownership and relationships are built at all levels of the system.

Despite being a rigorous and comprehensive investigation, stakeholder input was limited to one ICS, potentially restricting insights from varied geographical contexts. In addition, the recent establishment of ICSs meant limited literature availability, with few empirical studies conducted. Although this emphasises the importance and originality of the research, this scarcity posed challenges in extracting and applying certain programme theory elements, particularly context.

This review will be of relevance to academics and health-care leaders within ICSs in England, offering critical insights into ICS leadership, integrating diverse evidence to develop new evidence-based recommendations, filling a gap in the current literature and informing leadership practice and health-care systems.