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18 papers

Calibrated Emotional Engagement in Perioperative Care: A Middle-Range Theory for Sustainable Clinical Practice.

Eriksson J. · Jul 1, 2026

Emotional engagement in clinical practice has been theorised as a professional virtue, a form of emotional labour and a potential pathway to compassion fatigue and burnout. Although these traditions have shown that emotional practice is shaped by relational and organisational conditions, they have less clearly specified how clinicians regulate engagement in high-demand perioperative settings, or what organisational conditions make such regulation achievable. Drawing on emotion regulation theory, nursing scholarship on caring and emotional labour and Donabedian's structure-process-outcome framework, we introduce calibrated emotional engagement as a middle-range theoretical concept describing the dynamic, professionally regulated adjustment of emotional, attentional and relational involvement required to remain clinically responsive without becoming detached or overwhelmed. Calibrated emotional engagement is understood as a multilevel process: individually enacted, team-mediated and organisationally conditioned. A three-zone model, comprising under-engagement, over-engagement and a calibrated zone of functionally sustainable engagement, offers a way of conceptualising the range of emotional states in high-demand perioperative settings, including the cue-deprived character of the operating room where anaesthetised patients and sterile draping remove the relational feedback that ordinarily supports empathic practice. We further propose that organisational conditions, including staffing, team stability, autonomy and recovery structure, constitute an empathic infrastructure that shapes whether calibrated engagement is achievable in practice. The concept opens new directions for perioperative education, workforce policy and research that move beyond individual resilience towards systemic accountability for the emotional conditions of care.

Social Sciences

The Role of Family Functioning in the Relationship Between Job Burnout and Parental Burnout in Working Parents: A Moderation Model.

Marchetti D et al. · Jul 1, 2026

Research has underscored the interconnection between work and family domains, showing that an imbalance between demands and resources can lead to job and parental burnout. Our study examined the moderating role of family functioning in the association between job burnout and parental burnout among working parents in Italy. Drawing on Olson's Circumplex Model, balanced family functioning was conceptualized as optimal levels of cohesion and flexibility, reflecting a well-regulated family dynamic. Three-hundred-nine working parents of children aged 0-18 completed a survey assessing sociodemographic characteristics, job burnout, parental burnout, and family functioning. Results indicate that parental burnout was positively related to job burnout and negatively to family functioning. Simple slope analyses showed that the association between job and parental burnout progressively weakened as family functioning increased and became non-significant beyond a specific threshold. Our findings highlight the clinical value of balanced family functioning's buffering effect on work-family stress processes.

Social Sciences

Local responses to the threats of dramatic crises: do institutional leaders make a difference, and if so, how?

Capano G et al. · Jul 1, 2026

This study examines the complexity of disaster response management and the role of local institutional leadership. Drawing on a comparative analysis of the May 2023 floods in two Emilia-Romagna provinces in Italy, it explores how local leadership influences the outcomes of crisis management within a shared institutional and hazard context. Using local press reports, municipal ordinances, and interviews with key figures, the study reconstructs the decision-making processes involved and identifies critical leadership practices. The findings demonstrate that differences in preparedness, coordination, and post-event trajectories are significantly impacted by the experience and professional background of leaders, as well as their capacity to make decisions in circumstances characterised by uncertainty and time pressure. By isolating leadership practices under constant structural conditions, the study makes a valuable contribution to disaster research by specifying how local agency shapes responses and learning in multi-level disaster governance. It highlights, in particular, the importance of investing in local leadership development to strengthen municipal disaster management capacities.

Social Sciences

Health, Social and Recidivism Outcomes Among People Who Have Been Incarcerated in New South Wales, Australia: Study Protocol and Cohort Profile for the Prison Outcomes STudy (POST).

Degenhardt L et al. · Jul 1, 2026

Introduction We have been funded to examine post-incarceration health and social outcomes for all people incarcerated in New South Wales, Australia, 2000-2022; assess treatment and services for drug dependence and serious mental illness; and project the impact of expanding intervention coverage. We will use a linked cohort, the Prison Outcomes STudy (POST), which we also describe. Methods The POST cohort was established using linked administrative data for all adults (≥ 18 years) admitted to full-time custody in New South Wales, 2000-2022. Custody records were probabilistically linked to 18 health, justice and mortality datasets. We report baseline sociodemographic and custody characteristics and the frequency of key post-release events. Results 200,486 adults, 15% women (n = 30,698), were incarcerated, with 2,282,367 person-years of follow-up and 11% (257,545 person-years) of follow-up spent in custody. First Nations people comprised 27% of the cohort. Half (48%) of the cohort (n = 95,563) had at least one contact with community mental health services, and 27% (n = 54,100) had received alcohol and other drug treatment. POST will provide population-wide evidence on health and social outcomes after custody, including the effects of treatment for drug dependence and serious mental illness. We will compare across subgroups and the outcomes of post-release service engagement. Mathematical modelling will test the impact of expanding access to care in prison and post-release on outcomes in the community. Discussion and conclusions POST will inform policy and service responses across justice, health and community settings to reduce harms among people who experience incarceration.

Social Sciences

School Refusal and Parental Illness: A Narrative Review.

Villetorte S et al. · Jul 1, 2026

Introduction School refusal (SR) affects many young people and has short- and long-term consequences on their development. Early interventions improve SR prognosis. Among the risk factors studied, parental illness is often mentioned. This narrative review assesses the frequency and strength of the link between SR and parental illness and its specificities. Methods PsycInfo, PsycArticles, Google Scholar and PubMed were queried, resulting in the inclusion of 18 studies. Results This link exists, but the number of robust studies is limited. While often acknowledged, it is seldom considered the main topic and is more often found with parental mental illness than physical illness. Discussion This association, observed in both quantitative and qualitative studies, seems to correspond to clinical reality. This review highlights the lack of precise data on parental illnesses in the SR literature and the limited hypotheses put forward to explain this link. This relationship requires greater attention in order to better understand and improve support for these children and adolescents and their families.

Social Sciences

How Hazards Turn Into Disasters: Perspectives of Emergency Responders.

Bhattacharyya A et al. · Jul 1, 2026

Natural hazards like floods, storms, or earthquakes turn into disasters if they hit vulnerable communities and societies. In policy and academia, this understanding has led to a surge of models and risk reduction policies that aim to reduce vulnerability and strengthen resilience. However, it remains unclear which vulnerabilities are the most important, and what stakeholders in different contexts prioritize. To address this gap, this article identifies critical exposure, vulnerability, and coping capacity factors, elicits their priority among emergency responders from different contexts, and analyses their perceived interdependences to understand their cascading potentials. To do that, we conducted a stakeholder survey with experienced disaster and emergency management professionals around the world. The results are used to analyze the perceived relationships between the priority factors via a fuzzy cognitive map. The professionals identified the level of preparedness, exposure to hazard, risk and crisis communication, community engagement, and disaster risk financing as the most important factors. The results show that the most catastrophic disasters are perceived to be caused by a combination of multiple factors and their interdependences. It was also found that practitioners thought that active civil protection agencies and available disaster risk financing have the greatest potential to prevent disasters.

Social Sciences

'It's Primarily Around Their Viral Load': Public Health Decision-Making and HIV Risk Assemblages in Ontario, Canada.

Daroya E et al. · Jul 1, 2026

In Ontario, Canada, public health authorities can issue and enforce orders to people living with HIV (PLWH). However, how public health practitioners determine when someone's behaviours constitute 'significant' risk remains underexplored. We drew on assemblage theory to examine how HIV risk is co-constituted through the interplay among biomedical technologies, institutional practices, legal frameworks and social discourses. We conducted 18 semi-structured interviews with public health personnel and used reflexive thematic analysis. Five interrelated themes emerged. First, high viral load was considered a potential risk indicator when associated with high-risk activities. Second, discontinuity in HIV care may flag individuals for intervention. Third, co-infection with sexually transmissible and blood-borne infections (STBBI) triggered a viral load review to assess HIV exposure potential. Fourth, noncompliance with public health directives positioned PLWH as needing management. Fifth, Undetectable = Untransmittable (U = U) discourses have reconfigured and neutralised risk, functioning as a technology of reflexive governance. However, uptake of U = U was described as uneven across Ontario's public health units, leading to variable, and sometimes coercive, approaches. By conceptualising HIV risk as emergent, this study challenges individualised notions of responsibility and highlights the relational production of risk. Adoption of U = U and equity-based public health practices is needed to ensure nonpunitive HIV responses.

Social Sciences

Evaluating Source-Based Large Language Models for Preclinical Dermatology Education: Comparative Study.

Lin FJ et al. · Jun 25, 2026

Background Large language models (LLMs) have gained increasing popularity in medical education, with evidence supporting their educational value when framed through the lens of cognitive load theory. Source-based LLMs, which explicitly ground responses in user-uploaded material via retrieval-augmented generation algorithms, may offer additional educational value by using student-developed materials to conceptualize new areas of learning within a familiar framework. This has applications for areas like medical education in dermatology, which could benefit from inclusive sources and enhanced education to alleviate health care gaps. However, no prior studies have examined whether the inclusion of student-authored notes alters the response characteristics of a source-based LLM when responding to medical questions. Objective This study aims to conduct an observational, comparative performance evaluation study assessing the accuracy, response reproducibility, and intermodel response similarity of freely available LLMs on text-only step 1 dermatology questions, and to explore whether providing extensive student-generated notes to a source-based LLM alters these performance characteristics. Methods In December 2024, 4 LLMs were evaluated: NotebookLM (NLM) with uploaded preclerkship study guides (NLM w/ Notes), NLM with an uploaded blank sheet of paper (NLM w/o Notes), ChatGPT-4o Mini, and Google Gemini 1.5 Flash. Each model completed 3 trials of 121 text-based United States Medical Licensing Examination (USMLE) step 1 dermatology questions from the AMBOSS question bank. They were evaluated for overall majority-consensus accuracy, accuracy by question difficulty, intertrial reproducibility, and agreement in answer choice selection between models. Differences were analyzed through a Cochran Q omnibus test and subsequent pairwise McNemar tests with Benjamini-Hochberg correction. Response reproducibility and intermodel agreement were analyzed through Fleiss κ statistics with 95% CI. Results ChatGPT-4o Mini achieved the highest overall majority-consensus accuracy (102/121, 84.3%). NLM w/ Notes demonstrated the highest intertrial reproducibility (Fleiss κ=0.927, 95% CI 0.875-0.978) and strong performance on lower-difficulty questions but comparatively reduced accuracy on higher-difficulty items. NLM w/o Notes exhibited significantly higher omission rates (38/363, 10.5% vs ≤7/363, 1.92% for other models) than other tested LLMs. Sensitivity analysis excluding omissions increased NLM w/o Notes' accuracy from 66.9% (81/121) to 77.8% (77/99), matching NLM w/ Notes' accuracy of 74.4% (90/121). Intermodel agreement was significantly higher between NLM w/ Notes and ChatGPT-4o Mini compared to NLM w/o Notes and Gemini 1.5 Flash. Conclusions Provision of student-generated notes substantially increased response reproducibility in a source-based LLM, likely reflecting consistent retrieval of similar source excerpts across trials. However, note-grounding appeared to constrain performance on higher-difficulty questions, suggesting a retrieval-augmented generation algorithm retrieval error when question stems excluded characteristic "keywords" present in lower-difficulty items. The results highlight potential challenges of a student-level, cognitive load theory-grounded educational LLM that must deal with notes not curated by experts, balance source use and internal reasoning, and meaningfully appraise uploaded sources to assess a student's individual learning gaps.

Social Sciences