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Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

This study aims to reveal residents’ individual perceptions of nature-based destination development and preferences for infrastructure and tourism superstructure development among communities that rely heavily on wildlife tourism.

A discrete choice experiment (DCE) was used among the Maasai community based in the villages and towns near the Maasai Mara National Reserve in Kenya. The attributes included type of tourism accommodation, location of tourism accommodations, types of access roads (tarmac or marram), tourist numbers and desired land-use options (between tourism development, livestock grazing and agriculture). A DCE analysis with hierarchical Bayes estimation was performed.

It revealed that the introduction to land-use restrictions and the location of tourism accommodations were the most important attributes for the respondents, with average importance values of 30.36% and 24.02%, respectively. A significant less important attribute was the types of access roads with an average importance of just 8.38%. Cluster analysis revealed widespread heterogeneity in preferences.

The survey-based DCE was conducted in the Maasai Mara National Reserve, Kenya, and therefore may not be relevant in other contexts. The focus was also only on the residents’ preferences. The findings broaden the knowledge on tourism developments and residents’ support for development and management of protected areas.

For policymakers, conservation practitioners and tourism businesses, this study provides a source of reference for understanding the development preferences of the Maasai community. In general, the study contributes to a better understanding of local communities in relations to tourism development and residents’ support for developments and management of protected areas (PAs).

This study fills the gap in the literature on tourism development and residents’ support for developments in PAs by presenting some limits of acceptable and desirable use of PAs among a community that has a complex coexistence with a wildlife tourism destination. It provides an alternative perspective for future research by examining residents’ choice towards destination development and preferences for infrastructure and tourism superstructure development using an experimental approach.

Informed by social representation theory, the study aims to explore how marketing workers represent their activities on social media.

A naturalistic data set of 17,553 messages posted on Twitter by advertising workers was collected. A sample of over 1,000 unique messages from this data set, incorporating all external links and images, was analysed inductively using structured thematic analysis.

Advertising workers represent marketing work as a series of fun yet constrained activities involving relationships with clients and colleagues. They engage in cognitive polyphasia by evaluating these productive differences in both a positive and negative light.

The study marks a novel use of social representation theory and innovative social media analysis. Further research should explore these relations in greater depth by considering the networks that marketing workers create on social media and establish how, when and why marketing workers turn to social media in their everyday activities.

Marketing workers choose to represent aspects of their work to one another, using social media. Marketing managers should support such activities and consider social media as a way to understand the lives and experiences of marketing workers.

Marketing researchers have embraced digital media as a route to understanding consumers. This study demonstrates the value of analysing digital media to develop an understanding of marketing work. It sheds new light on the ways marketing workers create social relationships and enables marketing managers to understand and observe the social aspects of effective marketing.

How does the human brain absorb information and turn it into skills of its own in psychotherapy? In an attempt to answer this question, the authors will review the intricacies of processing channels in psychotherapy and propose the term transprocessing (as in transduction and processing combined) for the underlying mechanisms. Through transprocessing the brain processes multimodal memories and creates reparative solutions in the course of psychotherapy. Transprocessing is proposed as a stage-sequenced mechanism of deconstruction of engrained patterns of response. Through psychotherapy, emotional-cognitive reintegration and its consolidation is accomplished. This process is mediated by cellular and neural plasticity changes.

Studies suggest deep brain stimulation (DBS) as a treatment modality for the refractory obsessive-compulsive disorder (OCD). It is unclear where to place the DBS. Various sites are proposed for placement with the ventral capsule/ventral striatum (VC/VS) among the most studied. Herein, we aim to summarize both quantitative Yale-Brown Obsessive-Compulsive Scale (YBOCS) data and qualitative descriptions of the participants' symptoms when given. A literature search conducted via PubMed yielded 32 articles. We sought to apply a standard based on the utilization of YBOCS. This yielded 153 distinct patients. The outcome measure we focused on in this review is the latest YBOCS score reported for each patient/cohort in comparison to the location of the DBS. A total of 32 articles were found in the search results. In total, 153 distinct patients' results were reported in these studies. Across this collection of papers, a total of 9 anatomic structures were targeted. The majority of studies showed a better response at the last time point as compared to the first time point. Most patients had DBS at nucleus accumbens followed by VC/VS and the least patients had DBS at the bilateral superolateral branch of the median forebrain bundle and the bilateral basolateral amygdala. The average YBOCS improvement did not seem to directly correlate with the percentile of patients responding to the intervention.

Well-controlled, randomized studies with larger sample sizes with close follow up are needed to provide a more accurate determination for placement of DBS for OCD.

In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

The purpose of this quantitative study was to assess the relationship between volunteer leadership competencies and stewardship action-taking experiences among Master Gardener (MG) and Master Watershed (MW) volunteers during the COVID-19 pandemic. We collected data from 1196 Penn State Extension MG and MW respondents. The mean summative score for the volunteer stewardship action-taking experience was 2.32 (SD = .79), and volunteer leadership competencies was 3.45 (SD = .60). The results of this study showed a significant moderate association between volunteer stewardship action-taking experiences and volunteer leader competencies (r = .34, p ≤ .001). Volunteer leadership competencies can explain approximately 11 % of the variation in volunteer stewardship action-taking experiences during the COVID-19 pandemic. The new knowledge that our research brings can significantly contribute to the practice in leadership teaching and learning of Extension organizations’ volunteers. Future leadership trainings on the enhancement of the MG and MW volunteer leaders’ stewardship action-taking capacity can help contribute to the greater good in their communities in a more confident and efficient manner. Further research should focus on identifying other factors that can affect MG and MW stewardship action-taking experiences, including the impact of the demographics and motivation.

The interconnections between climate change and health are well studied. However, there is a perceived need for studies that examine how responses to health hazards (e.g. cardiovascular diseases, ozone layer effects, allergens, mental health and vector-borne diseases) may assist in reducing their impacts. The purpose of this paper is to review the evidence on health responses to climate hazards and list some measures to address them.

A mixed literature review, bibliometric analysis and an original online survey were undertaken on 140 participants from 55 countries spread across all geographical regions.

The bibliometric analysis identified that most climate-related health hazards are associated with extreme weather events. However, only one-third of the investigated papers specifically analysed the connections between climate change and health hazards, revealing a thematic gap. Also, although Africa is highly affected by climate change, only 5% of the assessed studies focused on this continent. Many respondents to the survey indicated “heat distress” as a significant vulnerability. The survey also identified social determinants relevant to climate-induced health vulnerabilities, such as socioeconomic and environmental factors, infrastructure and pre-existing health conditions. Most respondents agree that policies and regulations are the most effective adaptation tools to address the public health hazards triggered by climate change. This paper presents some suggestions for optimising public health responses to health hazards associated with climate change, such as the inclusion of climate-related components in public health policies, setting up monitoring systems to assess the extent to which specific climate events may pose a health threat, establishing plans to cope with the health implications of heatwaves, increased measures to protect vulnerable groups and education and awareness-raising initiatives to reduce the overall vulnerability of the population to climate-related health hazards. These measures may assist the ongoing global efforts to understand better – and cope with – the impacts of climate change on health.

The combination of a literature review, bibliometric analysis and an original world survey identified and presented a wide range of responses.

This study aims to investigate how attributes associated with local food (intrinsic product quality; local support) motivate purchase behaviour. Previous research assumes heterogeneity in consumer motivation, but this has never been formally assessed. As such, the influence of local food attributes in motivating product use is integrated into a model in which consumer values and personal characteristics/situational variables are specified as moderators.

Eight hypotheses are tested using data collected from a quota sample of respondents recruited via an online panel of 1,223 shoppers. A three-stage analysis is used using structural equation modelling. Moderation effects are tested using both latent interactions and multiple-group analysis.

Shoppers purchase local food more frequently as a consequence of local support rather than intrinsic product quality. Unpicking these relationships reveal that local support has an amplified effect when local identity is higher, and when the shopper is either female or of an older age (55 years plus). Surprisingly, the influence of intrinsic product quality is equivalent by gender, age and location (rural/urban).

Marketers promoting locally produced foods should focus on both the intrinsic attributes of local food as well as the role it plays within the local community. The latter is more likely to be successful with communications aimed at women and older consumers.

With previous studies focusing on how local food attributes influence favourable consumer behaviours, the current study unpicks these relationships by examining heterogeneity in responses. This is the first study to concurrently use attributes, values and personal characteristics/situational variables in explaining shopping behaviour for local food.